Update on Glen Campbell

In a new Rolling Stone article, Glen Campbell‘s wife Kim revealed that the singer’s Alzheimer’s Disease has progressed and he is now back at home.

Although the 79-year-old “Rhinestone Cowboy” was first diagnosed with the disease in 2011, he continued to perform in a “farewell tour” as a way to de-stigmatize the disease. That tour became basis for the 2014 documentary film Glen Campbell: I’ll Be Me.  Campbell and co-writer Julian Raymond were nominated for an Academy Award for Best Song for “I’m Not Gonna Miss You.”

Campbell left a skilled-care facility at the end of July, and Kim, his wife of 33 years, is acting as his primary caretaker. It’s a difficult task, as Kim says Glen has progressed to the sixth of the disease’s seven stages.  He can’t communicate verbally, and occasionally can become combative. Kim told the Chattanooga Times Free Press:

“But he can become extremely combative if you try to redirect him to something that he doesn’t want to do. I have a black eye right now. I know that’s not him, that’s not who he is; it’s just the Alzheimer’s.”

 She went on to give this advice to other caregivers of those with Alzheimer’s Disease:

“I guess my message to caregivers is to look on the bright side of things. Make the best of a bad situation. Cherish every moment you have with each other. I want to tell them ways they can educate themselves and different options that are available to them… There is not a right or wrong answer — you can’t do it by yourself, you have to have help.”

Some Alzheimer’s Disease Basics

Alzheimer’s disease (AD) is the most common form of dementia among older people. Dementia is a brain disorder that seriously affects a person’s ability to carry out daily activities.

brain_slicesAD begins slowly. It first involves the parts of the brain that control thought, memory and language. People with AD may have trouble remembering things that happened recently or names of people they know. A related problem, mild cognitive impairment(MCI), causes more memory problems than normal for people of the same age. Many, but not all, people with MCI will develop AD.

In AD, over time, symptoms get worse. People may not recognize family members or have trouble speaking, reading or writing. They may forget how to brush their teeth or comb their hair. Later on, they may become anxious or aggressive, or wander away from home. Eventually, they need total care.

AlzheimerThere are three major hallmarks in the brain that are associated with the disease processes of AD.

  1. Amyloid plaques, which are made up of fragments of a protein called beta-amyloid peptide mixed with a collection of additional proteins, remnants of neurons, and bits and pieces of other nerve cells.
  2. Neurofibrillary tangles (NFTs), found inside neurons, are abnormal collections of a protein called tau. Normal tau is required for healthy neurons. However, in AD, tau clumps together. As a result, neurons fail to function normally and eventually die.
  3. Loss of connections between neurons responsible for memory and learning. Neurons can’t survive when they lose their connections to other neurons. As neurons die throughout the brain, the affected regions begin to atrophy, or shrink. By the final stage of AD, damage is widespread and brain tissue has shrunk significantly.

What are the Seven Stages of Alzheimer’s Disease?

Many healthcare workers describe the severity of Alzheimer’s disease as a 3 stage disease, progressing from Mild/Early to Moderate/Middle and Severe/Late.

In 1982, psychiatrist Dr. Barry Reisberg developed the seven stage Global Deterioration Scale (GDS) as an overview for caregivers dealing with patients with progressive primary degenerative dementia, such as Alzheimers. Stages 1 to 3 are considered pre-dementia, stages 4-7 dementia. Patients with Stage 5 dementia and above would be unable to care for themselves and will need assistance.

The seven stages are:

  • Stage 1 – No impairment. Memory and cognitive abilities appear normal.
  • Stage 2 – Minimal Impairment/Normal Forgetfulness. Memory lapses and changes in thinking are rarely detected by friends, family, or medical personnel, especially as about half of all people over 65 begin noticing problems in concentration and word recall.
  • Stage 3Early Confusional/Mild Cognitive Impairment. While subtle difficulties begin to impact function, the person may consciously or subconsciously try to cover up his or her problems. Difficulty with retrieving words, planning, organization, misplacing objects, and forgetting recent learning, which can affect life at home and work. Depression and other changes in mood can also occur. Duration: 2 to 7 years.
  • Stage 4 – Late Confusional/Mild Alzheimer’s. Problems handling finances result from mathematical challenges. Recent events and conversations are increasingly forgotten, although most people in this stage still know themselves and their family. Problems carrying out sequential tasks, including cooking, driving, ordering food at restaurants, and shopping. Often withdraw from social situations, become defensive, and deny problems. Accurate diagnosis of Alzheimer’s disease is possible at this stage. Lasts roughly 2 years.
  • Stage 5 – Early Dementia/Moderate Alzheimer’s disease. Decline is more severe and requires assistance. No longer able to manage independently or recall personal history details and contact information. Frequently disoriented regarding place and or time. People in this stage experience a severe decline in numerical abilities and judgment skills, which can leave them vulnerable to scams and at risk from safety issues. Basic daily living tasks like eating and dressing require increased supervision. Duration: an average of 1.5 years.
  • Stage 6 – Middle Dementia/Moderately Severe Alzheimer’s disease. Total lack of awareness of present events and inability to accurately remember the past. People in this stage progressively lose the ability to take care of daily living activities like dressing, toileting, and eating but are still able to respond to nonverbal stimuli, and communicate pleasure and pain via behavior. Agitation and hallucinations often show up in the late afternoon or evening. Dramatic personality changes such as wandering or suspicion of family members are common. Many can’t remember close family members, but know they are familiar. Lasts approximately 2.5 years.
  • Stage 7 – Late or Severe Dementia and Failure to Thrive. In this final stage, speech becomes severely limited, as well as the ability to walk or sit. Total support around the clock is needed for all functions of daily living and care. Duration is impacted by quality of care and average length is 1 to 2.5 years.

Source: HelpGuide.org

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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