It seems a few people have been surprised at our analytical approach to mum and dad's Alzheimer's. I am surprised at their surprise - I don't see how else we might have handled it. Well, maybe that's not quite true. I've seen so many examples of groups behaving bizarrely in the face of problems that I ought not to minimise our achievements, no matter how modest. For example, here's a few common approaches to how not to solve problems:
  1. Pretend the problem is not there
  2. Run away
  3. Rearrange a few deckchairs
  4. Blame someone else
  5. Give up
There are multitudinous variations on each of these. No 1 for example, has a variant which says 'all problems are opportunities'. Sounds good, helps little.

Here's a more effective strategy, which first looks at what feasibly can be done before looking into how to do it:
  1. Prevention
  2. Cure
  3. Treating symptoms
  4. Adapting to symptoms
When we apply this to Alzheimer's, particularly in mum and dad's case, we get the following:

Prevention
We missed the boat on this one. Whatever measures can be taken to prevent Alzheimer's disease, we are far too late.

In any event, no-one claims that there is any way to prevent the disease. The best that can be suggested at this stage is to minimise the probability of getting it. The suggestions amount to maintaining a healthy life, both physical and mental: consume vegetables, not nicotine; watch your weight, not your television. But, again, too late for mum and dad.

Cure
Depending on whether your definition of 'cure' means a return to how things were before the disease struck or stopping it in its tracks, there are two different observations to be made. Reversing Alzheimer's is a notion that has been given some credence recently by science, However, this is at the stage of 'We've got some promising results with white mice, let's issue a media release and see if we can improve our grant-attracting powers' rather than the 'We've just rolled the government into subsidising the huge prices we are charging for a medicine we started developing ten years ago' stage. Mum and dad's Alzheimer's will therefore not be reversed unless they manage to hang around for at least another decade.

Equally, there are no treatments for actually halting the development of the disease, as opposed to merely resisting the worsening of its symptoms.

Treating the symptoms
The symptoms of Alzheimer's, including loss of memory, anxiety, aggression, are amenable to treatment, but all the treatments are symptom-reducing rather than disease-abating. In the long run, only lowering the gradient of decline is possible, and the results are still disputed: in some cases there is nothing to say the medicines are effective in any positive way. However, as far as memory is concerned, our family may be getting a small benefit. In mum's case the Aricept may be responsible for helping her to be a little less confused. Since her dosage went to 10 mg she has been able to lay the table properly once more. Before, she would get, say, a knife and three forks out of the cutlery drawer and simply stand there dithering about what to do with them. In dad's case he sounds much more articulate since starting on Aricept though, from the examples of his speech that I have reported verbatim, it is clear that he would not cut the mustard at Toastmasters. We have not sought to treat anxiety or aggression. My main concern here is that treatments for these symptoms often worsen the patient's confusion.

Adapting to symptoms
This is where we are operating with mum and dad. We acknowledge that they are increasingly forgetful, confused, anxious, and in mum's case, aggressive. We respond by adjusting their surroundings so that there is, correspondingly, less to remember, less complication, less to worry about, and less aggravation. Where this is not enough, as in the areas of nutrition and hygiene, we have stepped in and sought outside help. Some of these interventions have worked, others haven't. Experimentation and variation is necessarily continuous. However, being specific about which aspect of their life we are trying to fix has been essential. Simply trying to maintain respectable middle-class habits and appearances, which is what we may have tried to do at first, just doesn't make any crucial difference. Building a pyramid of support for mum and dad's happiness is the only important goal. This means keeping the cats (though they are a source of problems), staying at home (though this is also a source of problems), giving dad a day out (though this either causes mum anxiety or aggression, depending on whether she has company during this time), giving them cash (though they appear to lose it frequently), and compromising between foods they like and what's good for them, and cleanliness on the one hand and not bullying them into cleaning on the other. There are simply so many small elements to these imperfect aspects of their lives that not to keep a table of them would leave the rest of us equally confused and anxious.