Can Alzheimer’s turn adults into children?

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We pediatricians all get trained with the mantra: “children are not just small adults!”  But can dementia, more specifically Alzheimer’s, turn adults into children?

The pediatric mantra means that children are vastly different than adults, with a different spectrum of disease, displaying different symptoms, along with handling drugs and surgery differently. The pediatrician’s approach in clinical encounters is necessarily different than an internist’s, instantly focused on a child’s developmental abilities. 

I used to tell students that kids have three secrets factors in successfully fighting disease:  they are tougher than they look, their organs have a better capacity to recover, and they have parents after all.  Parents are usually fastidious in making them take awful tasting medicine on schedule or bringing ’em kicking and screaming for shots or IV’s (older teens and adults?  well, you know!)

In this blog’s menu page about ADL, I cite Dr. B. Reisberg’s work on the Functional Assessment Staging Tool (FAST).  As I mentioned, the details have been helpful to me.  Sometimes it’s published with a timeline, and sometimes with comments like “functions at a 2-4 year of age.”  Now NO pediatrician can let that go without a comment!

(graphic from Ian Kremer’s recent Tweet)

Dr. Reisberg and his group have also written about the concept of “retrogenesis”,  how an Alzheimer patient’s functional and behavioral abilities might seem to reverse the pattern of a child’s increasing abilities, during infancy and childhood. Remember Shakespeare’s own seven stages of man, from “infant, mewling” to “Last scene…second childishness and mere oblivion…”?

Three quick comments:  1) as a caregiver, I think the FAST observations are very useful, and I think the age comparisons provide a common frame of reference.  Of course, from my  pediatric POV I cringe (I am an old guy who started before the FAST was published, but realize it’s all shorthand);  2) Sometimes, folks  speak to people with dementia as if they were children, which I detest.  They don’t usually make that mistake around my wife, especially if they know of her professional accomplishments, but I guess that’s an opening for a teaching point.; and 3) there are many times that my wife’s verbal abilities, understanding and emotional intelligence shine through, despite her apparent stage. 

It goes without saying that everyone is an individual, and my feeling is that it’s essential to honor the person, and not shortchange him or her, no matter what apparent stage might be appropriate at the time.