Understanding Alzheimer's
Book review: Sourcebook an aid to caregivers, professionals

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Five million Americans today have Alzheimer's disease (AD). By 2040, that number is expected to triple. Alzheimer's is an irreversible, progressive brain disease that destroys brain functions over the course of three to 15 years. At age 65, one in 10 individuals has AD, and at age 85 the rate is almost one in two. Most of these people are cared for by family members.

Without support and guidance, families confronted with AD shoulder an overwhelming burden. A book by Howard Greutzner, "Alzheimer's: A Caregivers Guide and Sourcebook, Third Edition" supports caregivers through the realities of caring for loved ones struggling with the disease.

The author draws on more than 25 years of specialized work with elderly who suffer from Alzheimer's, depression, and other psychiatric disorders. In the book, he gives both families and professionals a better understanding of the behavior of the person with the disease, and ways to cope effectively with the demands of caring for Alzheimer's patients.

The book details advances in treatment and care options, the stages of Alzheimer's and the importance of early diagnosis, Greutzner informs the reader about causes and risk factors for the disease and provides overviews of current research findings.

The author further explains both what is happening in the brain as Alzheimer's progresses and the symptoms manifested at each stage. An understanding of the phases of AD can help caregivers to assess the condition; identify symptoms and follow their progression as the illness develops; determine the rate at which the illness is developing; and have realistic expectations of the patient's capabilities.

According to Greutzner, the focus of treatment has moved from finding a cure to developing drugs that slow or prevent the disease. There have been a number of advances in recent years, and the book outlines them. Overviews of current drug-treatment research, as well as other research findings that may contribute to treatment, are included.

The bulk of the book is dedicated to helping caregivers cope with the day-to-day issues. Chapter 6, "Coping: a step-by-step guide to the caregiver's experience", covers the gamut Ð from noticing early symptoms, seeking information and taking action to planning care and easing caregiver stress. The author emphasizes the value of early diagnosis, noting that treatment is more effective the sooner it is initiated. Later chapters are dedicated to the later stages of the disease, helping families make the transition from home to institutional care and understanding behavioral changes. Greutzner thoughtfully explains the stages of family adjustment, from acceptance, denial and over-involvement to anger, guilt and ultimately, acceptance. He offers practical advice for readers on managing caregiver stress.

The latest edition of Greutzner's book features several new chapters dealing with depression. The depression is sometimes a response to disease-related losses; other times it is associated with brain damage and changes in neurotransmitters. According to Greutzner, depression is responsible for suffering and a greater loss of function than can be explained solely by AD.

Depression in caregivers is also a common problem. Greutzner notes that the majority of caregivers who develop depression have never before experienced depressive episodes. He attributes chronic stress as the major cause of caregiver depression.

Particularly valuable to those who care for AD patients are appendices at the back of the book. A series of worksheets, modeled on assessment tools used by health-care professionals, allow caregivers to easily evaluate patient behavior, personal and social support, in-home care and care-management stress. Another appendeix identifies national self help groups including the Alzheimer's Association (www.alz.org); the American Health Assistance Foundation (http://ahaf.org); and Area Agencies on Aging (in Santa Clara County www.sccgov.org/site/0.4760,sid=11595,00.html). Internet contact information for international resources is also included.

"Alzheimers: A Caregivers Guide and Sourcebook, Third Edition" is available for check out, without charge, from the Stanford Health Library's E-Book collection. E-Books are found on the Health Library Web site at http://healthlibrary.stanford.edu.

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