Memory and Alzheimer's Disease

 Can multivitamin supplements help prevent memory loss and mental decline in older adults? We share research that shows encouraging results, and why you should start taking a supplement now.  

Learn also all about Alzheimer's disease symptoms, causes, treatments and self-care in our S1E48 rebroadcast. More than 6 million people currently live with Alzheimer's disease, the most common form of dementia. 

Get show notes, resource links and more: https://bit.ly/4gzZbc0 

In This Episode:

• 00:00 - Intro; Why You Should Start Taking a Multivitamin Now
• 00:30 - How Multivitamin Supplements May Help Prevent Memory Loss and Mental Decline
• 03:01 - What Multivitamin to Choose?
• 04:03 - Intro to S1E48 Episode on Alzheimer's (First Episode in Series on Dementia)
• 05:15 - Recipe: Pineapple Casserole
• 10:41 -  Dementia causes, and Alzheimer's disease symptoms, causes, treatments and self-care 
• 46:17 - Five Films about Dementia You Need to See
• 45:52 - A Scene from the Film "Still Alice"
• 54:17 - Outro

Chapters

• 0:00 Intro; Why You Should Start Taking a Multivitamin Now
• 0:30 How Multivitamin Supplements May Help Prevent Memory Loss and Mental Decline
• 3:01 What Multivitamin to Choose?
• 4:03 Intro to S1E48 Episode on Alzheimer's (First Episode in Series on Dementia)
• 5:15 Recipe: Pineapple Casserole
• 10:41 Dementia causes, and Alzheimer's disease symptoms, causes, treatments and self-care
• 45:52 A Scene from the Film "Still Alice"
• 46:17 Five Films about Dementia You Need to See
• 54:17 Outro

Transcript

Memory-and-Alzheimers-Disease

Hello and welcome to Everyone Dies, the podcast where we talk about serious illness, dying, death, and bereavement. I'm Mary Ann Matzo, a nurse practitioner, and I use my experience from working as a nurse for 46 years to help answer your questions about what happens at the end of life. The staff at Everyone Dies are taking a much-needed holiday break.

Today we are republishing our podcast about Alzheimer's disease with new information about what may help you maintain your memory while you're still healthy. The American Journal of Clinical Nutrition have published two research articles about how multivitamin supplements may help prevent memory loss and mental decline in older adults. The first study by Jung and colleagues evaluated the effects of multivitamin supplements on mental function.

They followed 3,562 elder men and women for three years who received either a multivitamin supplement or placebo. Placebo is like a sugar pill. Cognitive tests were given on enrollment in yearly each year of the study.

At one year, and on the average during the three-year follow-up, participants who received the multivitamins had better immediate recall compared with the placebo group. The researchers estimated that the effect of the multivitamin intervention improved memory performance above placebo by the equivalent of 3.1 years. Their findings indicate that compared to a placebo, taking a daily multivitamin mineral supplement was associated with better scores for thinking and decision-making and less decline in those areas.

A study by Vails and colleagues published in 2024 that used similar methods but conducting more detailed neuropsychological assessments. Their findings suggest clear evidence that the multivitamin benefits on global cognition. Global cognition describes different mental abilities required to perform both intellectual tasks and daily activities such as memory and the spoken word.

So what they looked at was global cognition, which you could describe as different mental abilities required to perform both intellectual tasks and daily activities such as memory and the spoken word. And they looked at episodic memory, which is a form of long-term memory that captures the details of past events personally experienced. It includes information about times, locations, emotions, and other background details.

Their findings suggest clear evidence of multivitamin benefits on global cognition, attention, and episodic memory. The authors concluded that multivitamins affected global cognition equivalent to reducing cognitive aging by two years. So what vitamins to choose? First, talk with your health care practitioner to see if there's any reason you shouldn't take a multivitamin.

When I was seeing clinic patients, I would recommend that they take a prenatal vitamin. Yes, even the men. I had a lot of veterans taking prenatal vitamins.

So why? Prenatal vitamins have what is needed in a good multivitamin, are less expensive than other brands because they want pregnant women to be taking a multivitamin, and for the same reason, can be reimbursed under pre-tax reimbursement accounts. Now CVS has a prenatal multivitamin gummy that are very tasty. CVS does not give us any money.

Also, these taste so good that you don't want to leave them around for kids or grandkids to get a hold of. Almost as good as the Flintstone vitamins of my youth. And now please listen to our season 1 episode 48 rebroadcast where we talk about Alzheimer's disease symptoms, causes, treatments, and self-care.

This podcast does not provide medical advice. Please listen to the complete disclosure at the end of the recording. Hello everyone and welcome to Everyone Dies, the podcast.

I'm Marianne Matzo and I'm Charlie Navarette. So please grab your beverage of choice, something, I mean a snack on, and thank you for spending the next half hour, 45 minutes, maybe a whole hour, with us as we talk about a film called Still Alice. In the second half I'm going to talk about Alzheimer's disease and we're going to actually be starting a series on different types of dementias.

And so this first one will be, this first podcast will be about Alzheimer's disease. And in our third half we're going to have another episode of Funeral Theater with a scene from Still Alice. So Charlie, while I was reading my new book, which is called Being Dead is No Excuse, you know you think that when you die that you'd at least have an excuse not to do stuff, but according to these authors Metcalf and Hayes, being dead is no excuse not to have, you know, like the perfect funeral and good food served and to behave yourself.

So go figure that. Go figure. But, well, I don't know.

So while I was reading this book I found a recipe for something called pineapple casserole. Pineapple casserole? Which I, have you ever had that? I've had a pina colada, is that similar? Not at all. So I thought I would let you try to explain to our listeners what the heck this is.

I mean, yes, I look forward to that. Well, when someone dies we instinctively possess the urge to find that person's loved ones and fill their refrigerators with an absurd amount of food. For some unknown reason we usually do this with casseroles.

Really, really weird casseroles. The result is a very specific type of cuisine that has earned the blunt name funeral food. It takes on different forms in different regional cultures, but in the American South in particular, refrigerators tend to fill up with jello salads and mayonnaise-based casseroles.

Casserole is typically made of canned pineapple chunks coated in sugar and flour and then baked with a topping made of crumbled Ritz crackers, melted butter, and often grated cheddar cheese. Mixed together and baked. Mm-mm-mm.

Now, does that sound good to you? Um, I like cheddar cheese. I like Ritz crackers and butter. I like Ritz crackers and peanut butter.

Wait a minute, butter? Just butter? You put butter on Ritz crackers? Ooh, it's like butter and butter, yeah. Now, just like cold butter or do you then melt it? No, just like regular butter. You know the other thing I really like in the summer when my tomatoes come in? Yeah.

Is a tube of Ritz crackers and then you put a squirt of Miracle Whip on top of that, a piece of American cheese, and a slice of tomato from the garden. Does that sound like a northern girl or what? Or what? I'm, I'm, I'm, I'm, wow. Okay, I don't know why that doesn't, I am a big fan of mayonnaise.

Especially salad dressing, you know, Miracle Whip. I love Miracle Whip. Oh yeah, it's like, that tanginess to it.

I didn't know that there was real mayonnaise until I was like in my 20s. I always thought Miracle Whip was mayonnaise, period. I did too.

I don't know, I don't, I don't remember when I discovered it's not mayonnaise, mayonnaise per se. Yeah, I don't know, but yeah, I've always, I've always preferred Miracle Whip. But man, with a fresh tomato, and especially if you get the tomato where it's still warm from the garden.

Uh-huh. It's heaven. Heaven.

But I'm thinking the more I read this recipe, I thought to myself, you know, it might be worth making just once to see if, like it could be incredibly good. It could be. And, and with that, to, to find out for Marianne, for you and for our listeners, please go to everyonedies.org for the recipe.

That's every, the number one dies.org for the recipe and additional resources for this program. We appreciate your questions and anything else you want to tell us. You can email us at mail at everyonedies.org. Again, that's with the number one.

Please join our Facebook group, Everyone Dies. That's the name of the Facebook group, and this time you have to spell out everyone. So, Everyone Dies.

And please remember to rate and review this podcast. Molly, our Twitter correspondent, the most magnificent of the Magnificent Seven, is hoping you will follow us on Twitter and repost her tweets so that we stop making up names for her. Nah.

I can't imagine how many Twitter retweets or whatever it is that there would have to be for us to leave Molly alone. Um, something with lots of zeros in it. Lots of zeros.

Let's say a minimum of five zeros. Minimum of five zeros. Yeah.

Yeah. Yeah. Yeah.

Yeah. Okay. So, that's everyone's homework.

If you want us to stop making up names for Molly and look after our dear Molly, we need zeros. So, Marianne, what's next? Oh, well, you know what? I thought that I would kind of start doing a series about dementia because the dementias are a series of diseases that there's no cure for. People are not going to recover and kind of go back to where they were.

Uh-huh. So, and there's, you know, often you'll hear them talked about as, you know, the slow death and that the effect on the family is it's greater on the family than it is on the person who's going through it themselves. So, I thought we could start, you know, a series of that.

Would you be interested in that, Charles? I would. You know, my mother died actually just last year at age 91. But her body was, you know, it gave out.

But, you know, toward the end, it wasn't extreme dementia. But there was, yeah, there were several episodes of that. And I was just glad that, you know, she went peacefully.

There wasn't anything extreme. It wasn't like, you know, an extreme case of dementia. Yes.

So, yeah, I can see that. So, our brains are just phenomenal things. And some of the data are that there can be physiological changes, meaning actual changes in our brains 20 years before symptoms are even seen.

So, we can lose a huge portion of our brain function before anybody even notices. That's how complex and incredible our brains are. So, things like what? Oh, sorry.

What? Well, things like, you know, like being able to, like if one part of our brain is supposed to do something, let's say make out the Christmas cards, and that part that's supposed to do it says, oh, crap, I can't remember how to do this. Another part will say, hey, I'll figure it out. And so, one part will take over for the other part until the damage within the brain is so bad that neither part can do it and the Christmas cards can't be made out.

That's a very simplistic example. But often, when you talk with people, family members, in terms of Alzheimer's disease, it'll be something simple, like they couldn't figure out how to make out a Christmas card. They couldn't figure out how to write a check anymore.

It's those little things that suddenly the brain says, you know what, I don't know how to do this anymore. And there isn't a backup part of their brain that's able to step in and do it. So, what's the? Oh, I'm sorry.

Oh, no, I was going to ask. And so, what's the difference between, you know, I forgot where I leave my car keys. And what you're describing that, you know, you forget where, you know, it just become more forgetful in general.

Well, let me tell you more about that. Okay. About 50% of people with dementia are not diagnosed.

Now, some of that has to do with, like, let's say they're in a relationship. And I've seen this particularly where women compensate for the men. It's like, oh, here's your keys, you know, don't forget to put your shirt on, you know, do all these things.

And the woman is, and you know, not to say that the men don't do this too, but I've seen it in particular with women, will compensate and will kind of be another part of the person's brain so that you don't ever see that he is having these kinds of cognitive deficits. And it's not until the woman's not in the room or perhaps she dies that people say, holy smoke, how did he ever get along? Well, he got along because somebody else was doing it for him. So, dementia is a symptom.

And it can be a part of any disease that results in debilitative cognitive decline, decreased independence in activities of daily living, things like being able to take a shower, shampoo, get dressed, make a meal, feed yourself. And you also can see behavioral changes. Now, of the dementias, Alzheimer's is the most common, but many other diseases include dementia, which we're going to talk about over the next few weeks because they're different.

They have parts that are the same, but they're different diseases. The current statistic is that 5 million people live with Alzheimer's disease, and it's projected to reach 7 million people by 2025. And those numbers, in terms of going up to 7 million, is because the boomers are getting old.

And as always, whenever the boomers come along, we affect everything. And, you know, we've had pretty healthy lifestyles. And so, way back, people didn't get Alzheimer's disease, we didn't think, because we didn't know why, but they didn't, oh, it's just, you know, it's a new disease.

It's not a new disease. What is new is longevity. So, in my father's family, he was the youngest of, like, oh, I don't know, six relatives, six brothers and sisters.

They were all morbidly obese. They all died in their early 50s. Nobody lived long enough to get Alzheimer's disease, except one uncle, Uncle Nick.

Uncle Nick survived into his 70s, and Uncle Nick developed Alzheimer's disease. So, it's not a matter of, oh, look at this new disease that we found. It was actually found by Alzheimer in, like, 1906 or something.

It's not a new disease. It's a new problem for us because of longevity. So, it's a brain disorder that causes problems with memory, thinking, and behavior.

Now, they can do some lab tests. They can do some imaging, looking at how the brain works. And, you know, if you look at older people's brains, there's going to be brain changes without problems with memory, thinking, or behavior, just because our brains physiologically change as we get older.

But what they have found, and the only really definitive way to diagnose Alzheimer's, is through a brain biopsy. And we don't do brain biopsies on people who are alive. So, you only would know for sure that it's Alzheimer's, or Lewy Body Dementia, or some other kind of dementia is with a brain biopsy.

So, what you see in that brain biopsy, though, are this tangle of, I don't know how to describe it to you, it's like the neurons get all tangled up. And so, instead of the pathways being clear to move the information, and to keep those memory pathways open, excuse me, I have to clear my throat, they're tangled. And I'll talk a little bit more about that in a minute.

Treatments can help manage the condition, okay? But there is no cure. We don't have a cure for this disease. So, if you're diagnosed with this, what you're facing is that there will be a gradual decline in your ability to take care of yourself, to remember, that kind of thing.

How long that happens, how long that takes to happen, a lot depends on the age at which you are when you're actually diagnosed. So, that change in your memory and your thinking and your behavior, those changes can last over several years, or it could be over a lifetime. I mean, you can be like, oh, this isn't moving very fast, this isn't changing very fast, because it's different in different people.

So, Alzheimer's is associated with genetic, lifestyle, and environmental factors that affect the brain cells over time. At the initial stage of the disease, forgetfulness and mild confusion is seen. Now, you know, we forget things, Charlie, we do.

And generally, we're not confused, but a lot of times I'm confused as to, like, what day it is. Like, since I've retired, I have to really think about, what day is this? It's not that I'm confused, it's just that I don't have the usual touchstones in terms of what's going on on what day. But what happens over time is that recent memories also start erasing.

So, think about, like, if you have a computer, and it's a, this isn't a real good example, but it's the best I got. So, like, when the computer was really new, and you saved information, there was lots of room to save that information on the computer, those segments were there, they didn't have to, the computer didn't have to put, oh, a little bit of the information here, and a little bit of the information there, could all be together, and you could find it when you needed it. And that's true for our brains.

You know, ask, you know, you and I, we're great about what happened when we were 20, but, you know, like, well, what exactly happened yesterday? Let me think about it. The difference is, is that when we were 20, we stored that information very efficiently. We took it, we put it on the node, we had a way in our heads to be able to go back there and find it.

You know, we, give us any tune or commercial, man, we can pull that up and sing that out for you. Please don't ask me what I ate yesterday, because I didn't save it in a way where I could find it again. It wasn't that important to me.

And so I didn't save it efficiently. Do you want to say something? So is there, and I'm sorry, maybe you already said it, and I didn't pick up on it, to save things efficiently? Or maybe you already forgot it. That's possible.

Is that, so is there a way to improve the efficiency, to improve memory, you know, for things that are happening now? Well, there are ways to improve efficiency and memory if you don't have a disease. So like if, let's say you don't, let's say you don't have Alzheimer's, and you say, I want to make sure that I remember things. Well, there's, you know, ways that you can get an appointment book and actually write in it and make lists and actually check them off.

There's a lot of ways to improve your memory. But it's like saying, could I learn how to run? Well, sure, Charlie, you can learn how to run. But if your leg is broken, you're not going to be able to.

And that's how it is with Alzheimer's. You know, it's like, could you? Well, yeah, but something's broken here. And so it's not going to be able to work.

With advanced stage symptoms of Alzheimer's, those can vary from person to person. There's no cure for Alzheimer's disease, and medication can temporarily reduce some symptoms or slow down the progression of the condition in some people. So what are the symptoms? Alzheimer's causes a gradual decline in memory, thinking, and reasoning skills.

So memory is, you know, where did I put my keys? So how could you fix that? Always put your keys on the little hangy thing, or always put them in the bowl. That's your habit, that's where it is. And that way, when you need them.

So if you're like walking around carrying them around and you put them down when you go to the bathroom, you're not going to find them again. I don't care if you have Alzheimer's or not, you're not going to find them again. You have to develop, as we get older and as our memories changes, we have to develop better habits about if we're ever going to find anything ever again.

So thinking. Thinking in terms of being able to solve a problem. Reasoning skills.

One way we test that in patients is we'll say things like, if you found a stamped, addressed envelope on the ground, what would you do with it? So Charlie, what would you do with it? I would probably mail it. So that would be good reasoning, right? It's stamped, it's addressed, somebody dropped it, I'll throw it in the next mailbox, I see it. Ask that of somebody with Alzheimer's disease, and you'll get a whole long story that doesn't end up with that envelope being in the mailbox.

So that's when we're talking about reasoning. So the symptoms that you see depend on the stages of the disease. So early symptoms include memory loss, misplacing items, forgetting the names of places and objects.

Now, you know, I recently had surgery, and my surgery took five hours. Ever since then, I have trouble coming up with the names of things. So I ask them out.

I describe what they do. And, you know, part of me says, oh, this is sudden onset Alzheimer's disease. And the other part of me, the part that went to school and is a nurse, says, this is from a long surgery time, and it'll get better.

In fact, it is getting better. But in the meantime, I forget the names of things. And sometimes you'll even hear me, when we're talking on the podcast, be like, oh, damn, darn.

You know, that's there somewhere. Give me enough time, I'll come up with it. People repeat themselves regularly, such as asking the same question several times.

Now, I'll do that, too. I'll say to David, hey, did I already ask you about such and such? And he might say, yes, and here's the answer. Or he might say, no, you didn't.

Because sometimes I'm thinking about it, and he's not around for me to have asked him. So in my head, I really don't remember. Did I actually ask him or did I just think about it? But that's kind of part of how we think.

And sometimes then you might need to write down the questions so that you can say, next time he comes through, I need to ask him this. Also, becoming less flexible and more hesitant to try new things. That's early stage Alzheimer's.

Because, you know, Charlie, for us, it's like we can manage the world. We've been all over the world. We can go into new situations and figure them out.

But if you have a dementing illness, like Alzheimer's disease, you go into this situation and you're like, I've never been to this restaurant before. I don't know how they do things here. I can't manage this.

And this makes me really anxious. Another thing that is, I think, really, really telling is loss of sense of humor. If somebody's not able to pick up what's funny, because that's a very subtle kind of thing, it takes abstract thinking and abstract reasoning to be able to say, oh, I get that joke.

But if you tell somebody a joke and they look at you like, unless they're one of those people who never get a joke, well, they're not suddenly going to an old age and say, I get it now. So kind of a laundry list of other things. Can't recall recent new learning.

Can't create new memories. Have trouble recognizing familiar faces or objects. Repeat the same questions.

Forget dates. Misplace items. Finding the right word.

Impaired judgment and decision-making. And I started facilitating Alzheimer's support groups back in, shoot, I was in my early 20s. I was not that long out of nursing school.

And all the way through, you hear family members say, well, but shouldn't I do this and shouldn't I do that? It's like, sister, they don't know. If you decide you're going to do something, you're doing it because it's what you want to do. You know, like when they look at you and they say, oh, are you my sister? And your heart breaks because you're their daughter and they don't remember anymore.

It's not about them. They love you and if their brain could pull that out as to who you are, they would pull it out. But you can be anybody with people with Alzheimer's.

I always had nursing students on the Alzheimer's unit when I was teaching. And I would work with students. I had this one lady who was a nun in the nursing home on the Alzheimer's unit and she'd come up to me and she'd lean really close and she'd say, don't tell the others, but you're my favorite.

And I'd lean close to her and I'd say, sister, you're my favorite too. And she would do that to all the nurses. It's like, it doesn't matter.

I can be her favorite and somebody else can be her favorite. And if she thinks that you're her sister, then be her sister. In these cases, it's not about you.

Yes, we'll talk about missing your mom or missing your dad and the losses that you go through, but you see so many people put a lot of energy into saying, well, how do I get her to remember me? You can't. You can't. And I'm sorry, but you can't.

And so love her the way that she can let you love her and let her love you the way that she can. And if that's because you're her sister or you're her mom, that's okay. It's about the love.

It's not about, does she know this or does she know that? So when you talk about middle stage symptoms, these include increasing confusion and disorientation. Obsessive, repetitive, or impulsive behavior. I had a patient in one of my support groups, she said, my husband goes outside with a fly swatter and hits flies.

So if you think about repetitive, obsessive behavior, killing flies outside would probably count. But it kept him busy. He was safe.

He had an activity he enjoyed. Does it make sense? No. Did it need to? No.

It just really didn't. Delusions, believing things that aren't true. Big issues in support group.

Go over to see mom. Someone took my coffee again. Somebody broke into the house and took my coffee again.

And you're like, good Lord, mom. It's right up here in the cupboard. No, it's not.

And you open it up. Okay, it's not there. So what happened is that mom moved the coffee either to be safe or to make herself a cup of coffee and put it back God knows where.

Now, I don't know if you've done this. I've done this a billion times where I've like, okay, I'm putting this somewhere where I can remember it. And a year go by and I'll say, now what the heck is that doing there? Because I've been looking for it for a year.

I put it someplace safe. My mother used to do that with like candy. Be like, mom, you know, like she'd hide the candy from us kids and be like, can we have this? She's like, I gotta figure out where I hid it.

So don't fight about it. It's coffee for God's sake. Buy her some more or, you know, get her pods for your Keurig or figure something else out.

Another thing is like mirrors, because people with Alzheimer's will look in the mirror and they'll say, who is that old person? And they're going to hurt me and get them out of my house. And you might need to take down mirrors, cover them up because it's them. They just don't recognize themselves.

And you're not going to be able to make them recognize themselves. Show them a picture with when they got married, they'll recognize themselves, but not now. So just remove the things that are a source of difficulty.

If you're, you know, like one of those kind of people who feel like I got to control the situation, you're kind of in trouble because you can't control the situation. Got to kind of roll with it. Be creative and, you know, find other ways.

I remember a patient on the Alzheimer's unit who would like desperately want to get off the unit, wanted to get through the door. And I'd stand there and I'd say, where are you going? Not, oh my God, you can't go through that door. It's like, where are you going? Well, she said, I have to go make lunch for my husband.

I said, ooh, that sounds good. And I put my arm around her and she put her arm through mine and I started direct, you know, we started walking the other way. I said, tell me what you're going to make for lunch.

And we'd have this long conversation about what she was going to make from lunch. By the time she got back to her room, she'd forgotten that she was leaving to go make lunch. Now, that's not going to mean that in 20 minutes she's not going to go do it again.

And that, as a caregiver, is one of the things that wears you out because it's like, oh boy, here we go again. Because it doesn't change. And in fact, it'll only get worse.

And that's part of that heartbreak of that disease. Problems with speech or language aphasia, not being able to get out at the very end stages of Alzheimer's disease. People don't talk at all.

Disturbed sleep. This is one of the things that really, really makes it difficult for caregivers. What happens is the sleep-wake cycle changes so that they're awake at night and sleep during the day.

Well, that's marvelous if you don't work and you can adjust your schedule to theirs. But if you're working during the day and you come home and you need to be able to sleep at night and they're up trying to cook or do whatever, that ain't gonna work. And so there are certain things that kind of result in people going into a memory unit or an Alzheimer's unit.

Those are wandering. These issues with sleep. The caretaker is not able to get any sleep.

An incontinence being urinating bowel or bladder in their pants. Those are the things that caregivers say, I just can't do this anymore. And you know what? I gotta tell you that I've been with family members as they've made those decisions and their heart is breaking over the decision to put their loved one, their mom or their dad or their husband in a memory care unit.

And once the decision's done and the person's there and they go and visit, they go, holy crap, I really should have done this a long time ago. Because for the person, they're perfectly happy. People are paying attention to them.

There's people to talk to. Somebody's doing their nails. Their care is distributed over 10 people instead of it all resting on you.

Honest to God, you put it off. And it is at no benefit to you and at no benefit to your loved one. So other things, middle stages, behavioral changes, wandering, irritability, agitation, aggression.

Sometimes people will hit you, punch you, do all kinds of things. And you say to yourself, oh my God, this is the most mild-mannered person ever to have lived in the world and now all of a sudden they're punching me. It's not, we'd always talk in the support group, it's not them, it's the disease.

So when they say ugly things, they're not saying ugly things. Alzheimer's is saying ugly things. It could be paranoid delusions and depression.

You can see changes in mood, frequent mood swings. Anxiety, frustration. Difficulty performing spatial tasks.

They have trouble judging distances, how close is something. Then there's later stages. So we say there's three stages of Alzheimer's.

Later stages is difficulty in changing position or moving around without assistance. Literally in the end stages of Alzheimer's disease, people would kind of curl up in a fetal position in the bed and there's not a lot of movement that goes on. Considerable weight loss, although some people might eat too much and put on weight.

Gradual loss of speech and significant problems with short and long-term memory. Current treatment approaches focus on maintaining mental function to the amount that you can, managing behavioral symptoms to slow or delay the disease. There are a few drugs.

They're called ACE inhibitors or cholinesterase inhibitors that compensate for the death of the cholinergic neurons. And what they do is they offer kind of a, to treat the symptoms, so symptomatic relief by interfering with the breakdown of the ACH turnover and leaving more of the ACH in the system to help increase the brain circulatory supply and make the areas at the synapses, which is where those nerves cross each other, make them kind of work more efficiently. Those are only used in mild to moderate Alzheimer's disease.

There's really nothing for end stages. So, self-care. Create a self-safe and supportive environment.

Adapt the living situation to the needs of the person with Alzheimer's which is an important part of any treatment plan. Always keep keys, wallets, mobile phones and other valuables in the same place at home. Tell ya, with or without Alzheimer's, I'd suggest you do that.

Develop the habit of carrying a mobile phone with location capability. Now, David is a runner. He's been running since he was in high school.

And he still goes out and he runs. And he has, up until recently, refused to take his mobile phone with him because, you know, when he was working as a general, he didn't want people disturbing him. It was his time.

And he does these hills here and he goes off beat and tracks. And I said, you know what? Honestly, I just really need you to take your phone with a GPS tracker because if you fell, I mean, we're out here in the wilderness, I said, if you fell, I'd never be able to find you. If something happened to you, I'd never be able to find you.

I just felt really uncomfortable with the fact that there was just no way to know where he was. So he got himself a little fanny pack and he carries his phone now not because he wants to but because it just really made me nervous that, you know, the buzzers or whoever was going to be eating his body. That's a pleasant image.

I'm from Detroit. We go right down to the basic stuff. Use a calendar or whiteboard to track schedules.

Check things off when things are completed. Remove excess furniture and clutter. You don't want to give people things to fall over or anything.

Exercising regularly. Eating healthy. So I was talking a little bit earlier about what causes Alzheimer's.

There's these amyloid plaques which are abnormal deposits of protein that damage and destroy the brain cells. So that's one cause that affects the brain tissues and causes Alzheimer's. The other is what's called neurofibrillary tangles.

My mouse is not working well. The brain cells require the normal structure and functioning of a protein called tau. In Alzheimer's, threads of the tau protein twist into abnormal tangles inside the brain cells leading to the death of the brain cells and that's why they don't work.

So if you kind of understand that then you can say to yourself, I can't untangle those and so they're not gonna work and so I need to adjust my expectations. So factors known to increase the risk of developing Alzheimer's are age, older you are, greater chance, family history and genetics and we're gonna talk about some that the younger you are when you get Alzheimer's or dementia, those are more likely to be genetic related. Down syndrome.

Now when we were kids, Charlie, if you had Down syndrome, you didn't make it past 20. Now people with Down syndrome live into older age, 40s, 50s but 100% of them will get Alzheimer's disease. So Down syndrome, another factor is head injuries, past head trauma and people who've had mild cognitive impairment could be a risk factor for Alzheimer's itself.

Do you have any questions about Alzheimer's that I can answer for you? Can someone die from Alzheimer's? But how? How does one die from Alzheimer's? So you think about so you get to stage 3 and you can't swallow anymore, you're not up and moving anymore so how would you die? And then when you say you can't swallow anymore, how is it possible to lose the ability to swallow? I mean related to Alzheimer's. Because it's a neurological function and you lose your neurological abilities. So you would get pneumonia, that would be one way that you would die.

You know all the things that we've talked about, artificial food and fluids, well if a person's not able to eat or drink on their own and they're allowed to die a natural death with artificial food and fluids then that would be a way that they would die. But nutritional issues, pneumonia, are the, I would say the primary ways that people die. And with that, I mean we often talk about advanced care directives it's something like that, if it turns out eventually someone with Alzheimer's can only like you said, can't swallow or can't take food on their own can something like that be addressed in a healthcare proxy that if I reach this point and I can't feed myself or I can't you know that somebody doesn't want to be... That's true for anybody.

You could have that in your healthcare proxy right now. You don't know if Alzheimer's is coming your way. So you can put that in your healthcare proxy.

That's sort of the whole point right? Is that if you don't want artificial food and fluids from and you have a disease that there's no hope of meaningful recovery well you can write that right now. Yeah. So in our resources page we gave you a list of five unforgettable films about dementia that you should think about watching.

They are Glen Campbell, I'll Be Me a film called Still Alice a film called Robot and Frank. Have you seen that? I did. Langella Frank Langella is great.

Frank Langella is great too. Is it good? Yes. Another one called Alive Inside and one called Memories of Tomorrow.

So Funeral Theatre where we put the fun and funeral is going to do a scene from the 2014 film Still Alice and it's a film that was adapted from a book called Still Alice and it's a story about a woman named Alice Howland who's married, has three grown children. She's a renowned linguistic professor who starts to forget words. She receives a diagnosis of early onset type of dementia and the family and it's a there's a genetic link and she's got three adult children and two of her children decide to be tested genetically to see if they haven't.

One of her daughters says I don't even want to know. So that's part of the storyline and in this scene we're going to do some gender equality and Charlie's going to play Alice but in this scene she has started down pretty heavily down the road in terms of getting lost, difficulty with words and that kind of thing but still well enough to communicate and there's an Alzheimer's conference and her physician has asked her to do a speech about Alzheimer's disease and so here we have from Still Alice Charlie as Alice I love the wig Charlie looks good. Thank you very much.

Thank you. And this is actually a monologue because she's doing a talk at this conference. Charles? Good morning.

It's an honor to be here. The poet Elizabeth Bishop once wrote the art of losing isn't hard to master. So many things seem filled with the intent to be lost that their loss is no disaster.

I'm not a poet. I am a person living with early onset Alzheimer's and as that person I find myself learning the art of losing every day. Losing my bearings, losing objects, losing sleep but mostly losing memories.

All my life I've accumulated memories. They've become in a way my most precious possessions. The night I first met my husband the first time I held my textbook in my hands.

Having children, making friends, traveling the world. Everything I accumulated in my life. Everything I've worked so hard for.

Now all that is being ripped away. As you can imagine or as you know, this is hell. But it gets worse.

Who can take us seriously when we are so far from who we once were? Our strange behavior and fumbled sentences change others perception of us and our perception of ourselves. We become ridiculous, incapable comic. But this is not us.

This is our disease. And like any disease it has a cause. It has a progression and it could have a cure.

My greatest wish is that my children, our children, the next generation do not have to face what I am facing. For the time being I'm still alive. I know I'm alive.

I still have people I love dearly. I still have things I want to do with my life. I rail against myself for not being able to remember things.

But I still have small moments in the day of pure happiness and joy. So live in the moment I tell myself. It's really all I can do.

Live in the moment. And not beat myself up too much for mastering the art of losing. One thing I will try to hold on to though is the memory of speaking here today.

It will go. I know it will. It may be gone tomorrow.

But it means so much to be talking here. Like my old ambitious self who was so fascinated by communication. Thank you for this opportunity.

It means the world to me. What do you take from that having thought about this monologue? Just to see You know if you pick up a handful of sand there are always grains that fall out. And even if you have your hand your fingers all smashed together still pieces are going to fall out.

And you can't control those pieces falling out. And if you move a little well more grains fall out. And you can't just sit there.

At some point you have to get up and walk to the bathroom. So in that movement more pieces fall out. More grains fall out.

Until eventually just living your life you will still have pieces of grains of that sand in your hand but it will diminish so much that it's just not well it's not what it was. You've lost so much and there's no way to get those grains back. That.

And I guess there's then that value to use your analogy and put those grains of sand in a picture book or in some way that you can even though some have dropped is that if you can in some way go back and look at them and Right, right. In a picture book. Refill that memory.

Yeah and when I think even if I then okay put what grains remain in my hand into a jar say or I can look at it whenever I want it's not in my hand anymore. I can't touch it. It doesn't affect me.

I can't manipulate it. I can't feel it. I don't have the texture of that in my hand.

It's in a jar now. So it's it continues to be removed. It's a tough disease.

So everyone thank you for listening. Please stay tuned for future episodes of Everyone Dies. Our thanks to our executive producer Major General Retired David Gillette, our producer Sandy, John our technical advisor, Tom Hartman our administrative advisor, Molly our Twitter correspondent and our friends family and our loyal listeners who are supporting our work at Everyone Dies.

This is Charlie Naborette. And I'm Arianne Matzo and we look forward to talking with you soon. Remember, every day is a gift.

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