Doctor John Kim says…

I met up with Ah Teck’s family today. After talking to them, I realized that although they do care a lot about him, they communicate very little with him. Alzheimer’s affects the whole family, so it is very important for everyone to talk to one another, share feelings and be supportive. They showed Ah Teck a lot of care and concern but because of his bad memory, they find it hard to communicate with him.

However, due to the problems Ah Teck’s family face when talking to him, I suggested to them to find help from healthcare professionals with special skills and training. These professionals’ job involves working with families affected by Alzheimer’s disease and helping the patient emotionally. Some examples are social workers, community nurses and counselors.

Better understanding of the disease is also very important for the patient as they would not feel as fearful of the illness. Many organizations operate telephone lines to provide information and support regarding any aspects of Alzheimer’s disease. These offer advice and assistance for the patient and practical and emotional help and information to families affected by the disease. They also put pressure on the government to spend more money on services to help look after people with Alzheimer’s disease.

Most Alzheimer’s support organisations have websites which offers the latest research news and information about the disease. Many also have a message board where people with Alzheimer’s disease can communicate with others around the world. Carers of such patients can also share their experiences with others. I urged Ah Teck’s family to go to these websites and learn more about Alzheimer’s disease and how, as a family, they can help Ah Teck. By getting to know the disease, Ah Teck’s family can help him cope with his symptoms and emotional stress. Also, Ah Teck can go to the website and talk to other patients or carers of the world. This way, he would not feel afraid and can understand that people with the same disease are faced with the same situation as him.

Ah Teck has always been a faithful Christian. I think it would be comforting if he talked to his priest about his feelings and thoughts. It is helpful and calming for him to attend religious services. If Ah Teck reached the stage of not even able to go for church, I suggest that his family invite the priest to their house to talk to him.

I hope, by interacting more, Ah Teck can get to know the disease and not be afraid to face it. Dr. Nori Graham, chairman of Alzheimer’s Disease International, said at the launch of Alzheimer’s World Health Day (annually, 21^st September) in April 2001,“Everyone whose life is affected by dementia will find it easier to be courageous when they know the people around them and their government recognize its appalling nature.” Also, I urged Ah Teck’s family to show love for him and to support and fight the disease alongside with him. As quoted from Jayne, Alaska, USA, who cared for her mother who had Alzheimer’s disease: “My mother’s need for love continued until the end. In her last days, as she lay there, she still responded to a gentle massage, soothing music or soft voices.”

- Wang Yue Wan (27) 4G

[Care and Support – People to talk to]

Doctor John Kim says...

Other than help and care from Ah Teck's family, another form of treatment is through drugs.

There are no drugs that can cure Alzheimer's disease, but there are some that can slow down the speed at which people's symptoms deteriorate. These drugs are cholinesterase inhibitors. They stop an important chemical called acetylcholine from being removed from the brain. Acetylcholine is a neurotransmitter that helps brain cells to pass messages to one another. Studies have shown that people with Alzheimer's disease do not have enough acetylcholine.

However, cholinesterase inhibitors are not suitable for everyone with Alzheimer's disease. They tend to be prescribed only for early to middle stages of the disease. Each and every individual reacts to the drugs differently.

Before prescribing drugs, we doctors have to think about the possible side effects as well. The side effects include dizziness, nausea, headaches, vomiting and diarrhoea. Many people will cope with these unwanted side effects, but for others they may be so upsetting that they cancel out any benefits of the drugs. Different people may have different side effects, and they do not last for the same period of time.

Alternative treatments include non-drug treatments, also called alternative therapies. These approaches cannot cure the illness, but they may relieve some of the symptoms or improve the quality of life for the person with Alzheimer's disease and their family.

Acupuncture, which is an ancient Chinese therapy, is one example of alternative therapies. In acupuncture, very fine needles are pushed in through the skin to bring about healing. It seems that acupuncture could have some benefit in Alzheimer's disease, but more studies are needed to prove this.


Aromatherapy, which is another alternative treatment, is the use of pleasant-smelling oils and plant extracts to help to relax a person, or encourage a feeling of wellbeing. In Alzheimer's disease, aromatherapy may also have more specific benefits. Research has shown that aromatherapy using the scent of the lemon balm plant may help prevent loss of the neurotransmitter acetylcholine - one of the key chemicals that allows brain cells to communicate with each other.


Also, a body massage helps to relax tense muscles and improve blood circulation. Studies have shown that a combination of aromatherapy and massage has helped people with Alzheimer's disease or other types of dementia to relax.


Hence, I have decided to discuss Ah Teck's alternative therapy sessions with his family and would recommend aromatherapy and massage for Ah Teck.

- Jocelyn Teo (23) 4G

[Treatment]

Doctor John Kim says...

Ah Teck has been my good friend since young. I really hope for his speedy recovery. Hence I've decided to give his family some tasks to help him.

First, I have instructed his family to spend more time with him. A good example will be to share some memories of the distant past by going through photo albums. This can help spark some memories from long ago.

Secondly, I find that care and support is very important, especially from their closed ones. They need to deal tactfully and respectfully with any situation where he refuses to take part in a particular activity, such as having a bath. They also need to help him reduce any risks to their personal safety and be more safety conscious. For example, they could check to make sure he did not forget to turn off the stove.

Thirdly, this diary can act as a memory jogger for Ah Teck. This is important as it will help his memory whenever he reads his diary entries in the future. Moreover, it is helpful to stick closely to a daily routine. This makes Ah Teck feel less anxious as it is easier for them to remember what usually happens. It also helps if everyday objects are always put back in the same place.

I hope his family would take extra care of him and take note of the above pointers. During this period of time, the patient would definitely need the care and support of his loved ones.

- Jocelyn Teo (23) 4G

[Treatment]

Doctor John Kim says...

I'm glad to see that Ah Teck has been blogging daily. Ever since he missed the appointment last month and kept insisting he did went for the appointment, i became suspicious of his medical condition. I started giving him simple memory tests every session. At first, he could answer my questions, but gradually, he began giving me wrong and inaccurate information, sometimes even saying "i don't know. was there such a thing?"

His daughter was concerned about his behaviour at home too. She called me to discuss about her father. He had been doing odd things at home such as putting the milk in the oven instead of the fridge.

My worse fear was confirmed when i did a brain scan for him. A brain scan can provide a picture of what changes are taking place in his brain.

There are two types of brain scans to use:
1) Computerized Tomography (CT scan):
can show pictures of 'slices through' the brain.






Image source: http://www.jnch.nic.in/


2) Magnetic Resonance Imaging (MRI scan)
produces a more detailed image of the brain using radio signals produced by the body in response to the effects of a very strong magnet inside the scanner.






Image source: http://www.sporttalk.com.au/

I used the CT scan on him. From the brain scan, i found out that the fine fibers of a protein called tau were twisted together, forming tangles inside the brain cells. These tangles actually builds up until they burst the cells, causing them to die. Another protein, beta amyloid, was building up in layers called plaques in between his brain cells. These plaques are toxic to the brain cells and was in fact killing the cells lying close to it. I believe that the part of his brain that is responsible for storing new memories was affected first. Now the part of the brain that is responsible for planning and carrying out tasks is damaged. Fortunately, Ah Teck has not reached the final stage of the disease, whereby the area of the brain that controls the muscles will be affected, making walking and other movements difficult.

I will definitely do my best to help my friend.

- Lim Jia Jia (12) 4G

[Diagnosis]

Chan Ah Teck says...

I can't believe it. I actually forgot to blog yesterday. How could i? I promised Dr. Kim to blog everyday! Why am i so forgetful?

Nothing much happened today.

*Update by Dr. Kim*
Ah Teck's condition is getting worse. He typed this post and didn't click publish post. I saw this post under drafts and helped him to publish it. :(

I understand that he has been easily upset and angry recently. This is a symptom of the disease. A common sign of this disease is short-term memory, which i have mentioned earlier. He has been getting more and more forgetful. He may also become restless and suffer insomnia. Some people get confused about where they are, or wander off and become lost. Damage to the part of the brain responsible for behaviour may cause him to behave inappropriately such as going outside for a walk in his pyjamas. Some people may even have hallucinations.

"My memory might not be as good as it was, but it doesn't stop me from being me."
This is quoted from the book Tangles and Starbursts by Sharon Bailey and Julia Darling.

- Lim Jia Jia (12) 4G

[Symptoms]

Chan Ah Teck says...

today..
my children brought me to see Dr. Kim..
they said something is wrong with me..

it was Alzhemier's disease..

Ah Kim said:
the causes of me getting it are:


1)Chemical Theories
A. Chemical Deficiencies.
One of the ways in which brain cells communicate with one another is through chemicals called neurotransmitters. Studies of Alzheimer's diseased brains have uncovered diminished levels of various neurotransmitters that are thought to influence intellectual functioning and behavior.
B. Toxic Chemical Excesses. Increased deposits of aluminum have been found in Alzheimer's disease brains.

2)Genetic Theory.
The inheritance of a gene that directs production of apolipoprotein (ApoE). In early-onset Alzheimer's, researchers identified a mutation on chromosome 14, which accounts for 10 percent of Alzheimer's cases. Additionally, a mutation was found on chromosomes 1 and 21. In 1997, researchers found another mutation on chromosome 12 that is linked to late-onset Alzheimer's.

3)Autoimmune Theory.
The body's immune system, which protects against potentially harmful invaders, may erroneously begin to attack its own tissues, producing antibodies to its own essential cells.

4)Slow Virus Theory.
A slow-acting virus has been identified as a cause of some brain disorders (resemblance of Alzhemier's)

5)Blood Vessel Theory.
Defects in blood vessels supplying blood to the brain (possible cause of Alzhemier's)

He said I was most likely to be affected cause im already 65 years old...
I am worried..

-Lineatte Tan (14) 4G

[Causes]

Chan Ah Teck says...

hmmm..
recently i found out i keep forgetting things..
my family members asked me about this..
"have you eaten??"
i took a long time to recall about it..
what is becoming of me??

is this the third month or the fourth month??
march or april??
not very sure..
maybe i have not been thinking about things for a long time..

also..
my children have been scolding me..
they said i have been sitting in front of the television for long hours..
what is wrong with that??

im suspecting that my family want to abandon me..
im suspecting that they hate me..
im suspecting they want me dead..
i don't know what is wrong with me...
getting older...


-Lineatte Tan (14) 4G

[Symptoms]

Chan Ah Teck says...

these days are wierd..
things from my home keep disappearing..
and appearing back again..

recently..
i remembered leaving my keys on the bed..
after a few hours..
it wasn't on my bed..

when i asked my grand-daughter..
she said i left it in the kitchen..
i scolded her for taking my keys and place it in the kitchen..

i also found my keys in the salt bowl..
my watch under the bed...
anyways..
im finding weird stuffs in weird places recently..
my grand-daughter simply has nothing to do..

my family members like to play pranks on me when i get older..
they think im too old to remember where things are..
but i know..
where they are.. exactly..

maybe my house is 'dirty' or something..
things can be in this place one moment..
and another place the next moment..
my grand-daughter always say i took it..
but i remember it wasnt there in the first place..
maybe the ghost put it there...

i think my family members are getting wierder..
i always remind them to have lunch..
but it seems like they are never hungry...
and i remember that the last time i ate was a long time ago!!
they keep telling me i have eaten..
but i know that they just want me to eat lesser...

or have i eaten?????


-Lineatte Tan (14) 4G

[Symptoms]

Chan Ah Teck says...

Hello! Testing Testing 1 2 3.

This is my first time trying to create a blog.

Ah Kim urged me to do so.
He wants me to jot down my thoughts and feelings every day.
Well... Ah Kim and i have been good pals ever since secondary school. I go to his private clinic "Kim Clinic" every 2 months for my medical checkup for ten years straight already!

But recently, i realised he has been extending my checkup hours by asking me many questions about myself. Maybe he thinks i'm getting senile? He asked me if what is my name. Obviously i'm Chan Ah Teck. I think he's the one who is getting senile.

- Lim Jia Jia (12) 4G