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Published September 06, 2013, 09:25 AM

Alzheimer’s disease may have a ‘rural’ connection

One of my friends in North Dakota told me several months ago, “You know what real love is when you take care of someone who has Alzheimer’s.” He and his wife cared for his father, who suffered from this form of dementia, for seven years.

By: Mike Rosmann, INFORUM

One of my friends in North Dakota told me several months ago, “You know what real love is when you take care of someone who has Alzheimer’s.” He and his wife cared for his father, who suffered from this form of dementia, for seven years.

My friend first became suspicious that his widower father might be experiencing Alzheimer’s disease when, at 76 years old, his dad began to have trouble remembering names and events that were retrievable just a few months earlier. Within two years, his father could not be trusted to live alone because he periodically left his stove turned on after heating food and began to receive bills for unnecessary items he had purchased unwittingly from telephone solicitors and scammers.

My friend and his wife moved “Joe” into their home and took over the management of his business and health care affairs, as Joe had specified previously in his advance health care directives and power of attorney forms. They promised they would take care of Joe, who insisted he never wanted to go to an “old folks’ home.”

There were embarrassing times, such as when Joe blurted out inappropriate proposals to women who visited their house or entered the living room unclothed while visitors were present. Joe couldn’t be permitted to leave the house unescorted because he would be unable to find his way back.

My North Dakota friends opted to accept North Dakota Medicaid Waiver funds, which partially reimbursed them for providing care for Joe. This arrangement, along with occasional respite care paid through the Medicaid waiver program, enabled them to keep their promise to Joe.

Joe had few financial resources because he farmed rented ground all his life and spent most of what he and his wife had saved paying for his wife’s cancer treatments until she died at age 63. Joe died last December.

Alzheimer’s disease is more a symptom complex than a disease with a causal agent, like a bacterium or virus. Contributing factors are not fully understood.

Alzheimer’s disease is a progressive brain disorder that slowly destroys memory and cognitive thinking skills. In President Ronald Reagan’s case, the first signs of dementia were apparent to him and his close associates in 1984 while he participated in a campaign debate that fall.

President Reagan uncharacteristically fumbled his words and notes; he seemed tired and bewildered. This was 10 years before President Reagan gave his dignified acknowledgement of having Alzheimer’s disease in a “farewell” address to Americans in 1994, and another 10 years before he died in 2004.

Biological changes in the brain were first detected in 1906 by a German physician, Dr. Alois Alzheimer. He examined the brain of a patient who exhibited progressive dementia, after her death.

Alzheimer observed plaques (clumps of brain tissue), tangles (abnormal bundles of nerves) and shrunken brain tissue in his deceased patient. Later, changes in brain chemistry, resulting in loss of connections among brain cells, were observed as well.

As the brain slowly deteriorates, thinking capacity and basic life regulations governed by the brain gradually diminish until a usually peaceful death occurs. Some medications that replace brain signal transmitters that are being lost can slow down the disease process for a while, but there is no known cure or prevention.

There might be a connection to farming and rural livelihoods. Although the causes of Alzheimer’s have not been fully determined, there is scientific evidence that growing up in a rural area may double the risk of developing Alzheimer’s disease.

A meta-analysis of how growing up in rural and urban areas affects the development of Alzheimer’s, published by University of Edinburgh and London researchers in the International Journal of Epidemiology in 2012, indicated nonurban people had twice the chance of incurring Alzheimer’s later in life. The researchers theorized that access to health care, socioeconomic well-being and exposure to unknown substances could be contributing factors.

A review of 2.6 million death certificates by Dr. Robert Park of the National Institute of Occupational Safety and Health, and published in 2005 in the American Journal of Occupational Safety and Health, indicated a greater risk for degenerative brain diseases, especially Parkinson’s and Alzheimer’s, among farmers and people in several other occupations where chemical exposures were likely to occur.

Other studies of farmers in particular have suggested exposures to commonly used agricultural insecticides in the organophosphate and chlorinated pesticide families and certain fumigants are well known to contribute to onset of Parkinson’s disease, and may be precipitants to Alzheimer’s disease. Not enough research in the U.S. has been conducted to adequately sort out the relationships, but a body of confirmatory research findings is developing that includes both foreign and domestic investigations.

Alzheimer’s disease affects 5.1 million Americans, and is the cause of nearly 4 percent of all deaths in the U.S. We need to understand the disorder better and what we can do to prevent it.

Farm people should stay tuned.


Mike Rosmann is a Harlan, Iowa, psychologist and farmer.

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