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Memories and Alzheimer's - WCCO-TV's "Good Question Series"

 Hippocampus

(The Hippocampus area of the Brain)

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WCCO-TV on their "Good Question" series (7 May 2013) attempted to answer a viewer’s “Good Question” of “Why do we remember some things and forget others” During the explanation by WCCO’s Jason DeRusha, he briefly touched on the subject of Alzheimer's and the victim’s memories…the information he gave was inappropriate and reflected an ignorance of the subject of Alzheimer’s and memory problems. The only reference he made to Alzheimer’s memories was what he termed “Procedural Memories” like driving a car that the Alzheimer’s victims remembered…I felt obligated to object and to offer a better and more complete explanation. I did this by going to the WCCO-TV Facebook page on "Good Questions" and posted my below comments…

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 “I am afraid I cannot give you a good grade for your “Good Question” tonight on “Memories”…When you mentioned Alzheimer’s and why they were able to remember certain things, it became obvious to me that you were on the wrong track…"

The Brain's Short and Long Term Memory

"In Alzheimer’s we have to distinguish between “short term memory” and “long term memory” or perhaps you might say “new” and “old” memories…the hallmark first symptom of Alzheimer’s is the loss of one’s “short term memory”…the reason for this is that the lower portion of the brain (Hippocampus) which would normally process and store all of one’s new incoming experiences or memories as “new” or “short term” memories has been damaged by the disease Alzheimer’s…the brain can no longer store these “new” memories or experiences and thus such new memories are all lost…that is also why the Alzheimer’s victims can no longer remember what they did 5 minutes ago or a day or two ago, a few weeks ago or a few months ago…

On the other hand, their “old” memories or their “long term” memories have already or previously been safely stored in the brain's frontal and temporal lobes and are still available and can still be accessed by the brain…it is common for Alzheimer’s victims to remember childhood and other old memories…eventually however, as the disease Alzheimer’s progresses into the late stages of the disease and as the brain is slowly dying, it loses that portion of the brain that contained all the old stored memories…at this point, they no longer remember anything, short term or long term…all memories have been lost. The loss of the long term memory takes place in the middle and later stages of this progressive disease."

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 Diagram of Brain

 (Brain Diagram - Memory areas are located in the frontal and temporal lobes)

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The average Alzheimer’s victim’s brain is only 2/3rds the normal size at the time of their death…this results because of the constant death of the Neurons or brain cells during the course of the disease… (See: the below illustration of the massive and dramatic brain destruction.)

I have found that most doctors are very ill informed when it comes to anything Alzheimer’s…considering that the average MD gets only 2 hours instructions on all dementia diseases in medical school, this is to be expected…most cannot even distinguish between the terms “dementia” and “Alzheimer’s”…most death certificates I have seen were improperly completed as to the cause of death…”

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Normal and Alzheimer's Brain

 (Normal Brain on left, Alzheimer's Brain on right)

Note: The brain as the body's control center, which governs and controls all functions of the body including such things as balance, coordination, muscle control and swallowing etc. etc....it is little wonder that in the advanced stages of the disease , the victims of Alzheimer's can no longer walk. The Hallmark first symptom of Alzheimer's is the loss of short term memory. The loss of the long term memory does not take place until in the dementia phase of the disease or in the middle and late stages.

It is believed that the length of Alzheimer's disease from start of symptoms to termination may vary from 2 to 20 years. The average life span from diagnosis to termination is 8 years. the length of life from diagnosis to termination is dependent on the individuals general health, physical condition and genetic factors. Because of these considerations, the length of the stages are not uniform and cannot simply be divided into three equal portions...the rate of progress of the Alzheimer's disease is dependent on the individual factors listed above and these will govern the length of the individual stages. June's early stage was around 7 years in length. June's remaining life from first symptoms to termination was approx. 12 years. President Reagan went for 10 years. Charlton Heston only lived slightly longer then 5 years. My mother Ellen who was in her 90's went for 6 years. My good friend's wife Gloria went for 15 years. Prime Minister Margaret Thatcher went for 17 years...

The wrinkled outer layer of the brain is the cortex...this is the thinking, planing and remembering part of the brain. This is the area of the brain's most visible damage and shrinkage from Alzheimer's...

It is thought that the disease actually starts working in the brain from 10-20 years before the first symptoms appear...this period of time is designated as the pre-clinical phase...The Alzheimer's Association advises that the early or mild stage (MCI)  (mild cognitive Impairment) to the middle stage may be from 2 - 10 years. The dementia phase of the disease starts at the middle or the moderate stage of progression...They estimate that the late or severe stage may be from 1-5 years.

The spread of the brain damage and shrinkage is not uniform from bottom, to frontal, temporal and rear of the brain's cortex. The shrinkage is especially severe in the hippocampus, the area that plays the critical role in the formation of new memories. In the late stages of the disease the entire cortex of the brain is severely damaged and the shrinkage is dramatic. The brain at this point is only 2/3rds the normal size.

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 June’s Memory Problems

June had noted short term memory problems and brought her memory concerns up at her annual physical examination in late 1997. - (Photo below right is June in December 1997 when she first noted short term memory problems.)

This resulted in June being tested by the University of Minnesota’s Neuro-psychology Laboratory by Deborah D. Roman, a doctor of Psychology. Dr. Roman’s report of 26 January 1998 described June’s medical complaint as: “she has noticed that she is more forgetfulshe often forgets conversations and then becomes upset about her memory lapses

June December 1997

After subjecting June to a series of tests, Dr. Roman concluded in her examination that “evaluation reveals grossly intact intellectual and executive abilities…and a recent fairly severe memory impairmentpattern of deficits is most consistent with early stage Alzheimer’s diseases…she remains fairly functional and to some extent is able to compensate for the memory problems.”

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For the first few years following diagnosis, June was able to function quite well…we both simply made accommodations for June’s loss of her short term memory. June’s long term memory was fine and was certainly as good as mine…We traveled much, and did many of the things we had put off doing at an earlier time…Bus trip to Branson, a visit to Hawaii, a farewell trip to London and our friends at Bexley, Kent…sort of emptied our bucket list…we also attended every scheduled forensic science conference nationally and internationally…some of our forensic friends made a point of looking after June so that she would always be safe. It was in the 7th year and later that Alzheimer’s started slowly taking control of June…It was in the 8th and 9th years that we noted June’s long term memory starting to also slip away…

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June continued her initial care through her regular doctor (Daniel Stein), Doctor of Geriatrics and Internal Medicine. Dr. Stein referred June to Mayo Clinic at the end of the year 2000 (June’s third year following diagnosis but 4th year since first symptoms) for further evaluation. June’s first visit to Mayo was on January 30th2001 for a half day of a series of examinations, that were very intense and very difficult for June to handle…I noticed June’s hands trembling during the examinations and the many questions…I requested the Mayo staff to “take it easy”…this resulted in a break period…I tried to reassure June that the many questions were needed for a proper evaluation. June confided in me that “I am sorry I came down here”…”I would rather be dead”…I communicated this to the Mayo Staff and as a result they changed their demeanor and things went much better for the balance of the day.

Follow up visits were done on March 5th and 6th 2001 that also included an MRI. June was at that time also enrolled in the Mayo Clinic’s Alzheimer’s research program…During her visits at Mayo, June was seen by a team of doctors. (Dr. Dotson, Dr. De La ‘Vega, Dr. Trenerry and Dr. David Knopman.)…Their report of March 6th 2001 concluded: “Probable Alzheimer’s Disease…"

Mayo’s report read: “The patient’s clinical profile, neuro-psychological testing results and MRI of the head with PJ protocol are consistent with a neuro-degenerative disorder, probable Alzheimer’s disease…The predominant networks involved are the memory network and the language network. On casual conversation, it appears that she has reasonable comprehension and expression.” A plan of future treatment was agreed upon at that time.

Dr. Knopman, who supervised the examinations, discussed the findings with June and I jointly. Dr. Knopman placed the MRI up onto a screen where we could all observe it…He then pointed out to June and I, the missing portions of the brain that represented the short term memory processing area. (Hippocampus) Initially I was horrified that he would display June’s MRI in front of her, showing a missing portion of her brain…much to my surprise, June did not react adversely and in fact asked some questions about the MRI…her last question was: “What can you do about it.” Dr. Knopman replied that there was nothing they could do about it. (The brain cells unlike other body cells do not regenerate.) In subsequent visits in later years, new MRI 's were done and they were then compared side by side with the previous years MRI. It was startling to me to be able to actually see a black hole that represented a missing portion of the brain that controlled memories...

We continued our annual visitations to Mayo Clinic’s Alzheimer’s Research Center at Rochester until the 19th of June 2003. (June’s 6th year after diagnosis but 7th year since first symptoms.) The visits were exceedingly stressful for June and there appeared to be no good reason for continuing them…June was exhibiting great fear at the time of the visits…it appeared to me that she feared I would leave her there…(June was in that phase of her disease where “fear” is a part of their daily life.) Mayo appeared at that point to be just cataloging June’s progress for their research purposes…They agreed with me that further visits to Rochester would not be necessary. Dr. Knopman’s very complimentary (unexpected but much appreciated) last report to Dr. Stein on June’s condition and care stated:

Alzheimer’s Disease moderately severe…Mrs. Berg has unfortunately continued to progress compared to a year ago…Mr. Berg is a fantastic caregiver…He takes excellent care of Mrs. Berg and she is being very well cared for…We are not going to see Mrs. Berg in follow up in the Research Center because of the severity of her dementia at this time, but we will try to keep in touch by telephone.” (The suggested phone contacts did not take place.)

It was on March 16th, 2005, as June was going into her 9th year of Alzheimer's that it became necessary to place her in the care of an Alzheimer's facility. June still had much of her long term memory and could remember me most of the time...I scheduled my three local children for visitations to June one day every week...the days that they were not there, I would be there...It was my goal to have a family member at the nursing home for a period of time every day of the week. I have a short note from my son David in which he commented on his visit one Saturday, (16 April 2005) just a month after June came under the care of the facility..."Very pleasant visit with Mom today...Mom asked about you. "Where is Stan", or "When will Stan be back" just as if you had left the room for a moment..." My later logs for the year 2007 show that when I would arrive and talk with June and take her hand there would be no response...at that time her long term memory was gone... 

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Reader’s Comments

Christine Ann Williams  - Kingston upon Hull, United Kingdom – (8 May 2013): “Loving your post Stan - accurate as always ...Not a lot understood yet how it takes hold and why the AD sufferer reacts as they do ...Doctors and medical nurses have admitted to me they do not understand AD I find I spend half my time fighting in the sufferer’s corner. I can meet someone with AD and I know what they are having difficulty with why they are upset - what will make them feel more confident - so much more awareness needed ... Even end of life is difficult. AD is not understood, no doubt about it more - training in this field is needed …Great post Stan with good points.”… It certainly does Susan (below comment)...Twice last year…I was with my team…all highly experienced in AD…both passed away in their own homes with loved ones by their side…if possible how it should be...Cause of death certainly not listed as AD…but it was...I worked on these two cases for six years...

Susan Day  - Willmar, Minnesota – (8 May 2013): “This is really good information. There should be people such as yourself who talk to medical students, because you're so correct…that so many in medicine aren't adequately informed about the condition. Most death certificates list a secondary condition as the cause of death when AD is part of the situation.”

Bryn Sineath  - Hot Springs, Arkansas – (8 May 2013): “Great post, Stan. Mom's death certificate didn't mention her AD nor Dementia. Just stroke even though she clearly suffered from AD for years. More Doctors and nurses need to dedicate themselves to AD.”

Lora Rushing Robinson  - Benton, Louisiana – (8 May 2013): “Very interesting to read....and (spot on), thank you for sharing...enjoyed the comments also…”

Bridie Breen  - Manchester, United Kingdom – (8 May 2013): “Stan, a heart-breaking truth in your article. Makes me wonder - will we ever beat it as a disease.”

Lin Schmidt  - Anoka, Minnesota – (8 May 2013): “Very good post for WCCO to read and get! Maybe they'll do another feature on it - this time making it right!”

Linda Casey-Overholt  - Coshocton, Ohio - (10 May 2013):"So bittersweet !!  Agree with the one comment – that you should speak to the medical students to make them more aware!... and love that you took such tender loving care of her... Bless your heart  for keeping her memory alive… And for educating us all so well in this awful disease!! "

Denise Roberts  - Southend-on-Sea, United Kingdom - (10 May 2013): "I see Stanton has been posting some very interesting topics...thank you ..."

Kristin Marie Carmen  - Cardiff, New Jersey - (10 May 2013): "Thank you... I needed to read that (funny how you remember the feelings even if you dont remember what it was...Ahhh...love lasts thru all and that is such a huge comfort."

Alzheimer  Society of Newfoundland and Labrador  - Mount Pearl, Canada - (11 March 2014): "Thank you so much for sharing! -Amelia White, Events Coordinator."

John Stevens  - Twin Falls, Idaho - (12 March 2014): "Excellent piece.  Should be required reading for the dummies who talk about that which they know not."

Jackie Irving - Liverpool, United Kingdom - (28 July 2015): "Thank you Stan I've just read your link an found it very absorbing from beginning to June's passing...I thought it was sad that she was afraid by her visits to the cinic ....I'm truly humbled by your knowledge and the way you cared for June right up until the end ...although I knew our prime minister Margaret Thatcher had Alzheimer's I was shocked to read that she had it for so long...and whatever people thought of her she had a brilliant mind which sadly this disease stole from her...as I said earlier I don't know much about this horrible disease....and I don't think I'll ever be at the point were you are Stan but I've enjoyed reading all you've written about it...thank you my friend."

 

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June's Passing

June 1994

After an almost 12 year journey into the shadows of Alzheimer's, early one morning in late October 2008, an exhausted June felt God's gentle touch on her shoulder and heard the words: "Come Home June!" As June lay like a wounded soldier on a battlefield, it was God's Angels that ushered June into a Heavenly Kingdom to the sound of a chorus of Angels...and into June's new home, a "Mansion on the Hilltop", where there is no pain, nor illness nor tears...June's funeral notice as published in the Minneapolis Star in October 2008 can be seen on this website in the drop down menu under the "In Memoriam" label - just Click on:

 

"June K. (Rolstad) Berg - In Memoriam"