The May B Memory: Case study of patient May B. that raises questions on Alzheimer's and Memory Loss

Firstly, I must declare that I am neither a scientist nor a trained medical professional. This article is written based on the close day to day observation and care for an elderly family member. As a trained analyst in the field of business systems, I am not qualified, nor will I attempt to prescribe for a medical condition. However, my accumulation and analysis of information during the care of May B. has inspired thoughts that may be of value to those who are qualified to find answers and prescribe remedies.

May B.'s memory loss has been progressing over a period of about eight years. At the time of this writing, she has not been diagnosed with Alzheimer's disease, and is currently not on any Alzheimer's medication. However she does experience periods of confusion, anxiety, disorientation and sometimes displays compulsive behaviors.

Short term memory and Food
Several factors in the care of May B. have raised the question in my mind about the relationship between food processing and her inability to recall recent occurrences. As we try to be responsive to her needs, a key issue in the management of her condition has been to keep a careful eye on her meal times. Here are some of the occurrences that led us to this:

Hypoglycemia?
On many days in her home especially in the late afternoon, May B. experienced extreme restlessness and an urge to "go home". It was often a time of anxiety for her and in those days, that was about the only time she would not recognize close members of her immediate family. We discovered that after having a cup of tea and cookies or eating a little Hershey's kiss, she would soon become calm.

On one occasion during one of these episodes, on impulse I took a glucometer, tested May B. and got a reading of 70. Discussing this with her doctor at our next visit, he suggested that that was a sign of hypoglycemia. The question is, could it be simply, or not so simply, that some or all this talk of dementia be in any way related to the ability of brain tissue to process sugars?

Sun Down or Sugar Down?
I am aware that these afternoon episodes have been referred to as 'Sun Down Syndrome'. It is useful to have a name for the collection of symptoms, and with May B. they actually do occur mostly late in the day. However, as a lay person it has helped my analysis to avoid this label, especially since the symptoms I have seen have occurred at times other that sundown. Because I am unsure that we can presume a causal relationship between sundown and these symptoms I will leave those conclusions to the professionals.

What does the clock have to do with brain function?
In caring for May B., I can see how easy it is to support the hypothesis that time of day has something to do with the symptoms. The symptoms do fluctuate throughout the day.

However on closer examination it can be noted that May B. tends not to snack between meals, and the late afternoon represents the longest stretch she has without something to eat. I observed a consistent inverse relationship between the time she has eaten and the time May B. is least disoriented. That is to say, after she has eaten May B. immediately becomes relaxed and may sit quietly by herself and be very co-operative with tasks. As time wears on, that changes as we get closer to the time for the next meal. In her household it was learned that meals need to be ready so as not to 'miss the beat'. The resulting hypothesis is that the behavior displayed is somehow related to eating habits and food processing and not to the sun or time of day.

Acids in the brain?
May B. suffers with acid reflux problems and any anxiety attack she may have is frequently followed by significant spitting and expressions suggesting distaste. In observing this in association with the inverse relationship with her meal times, one nagging concern has been the role of hydrochloric acid in her body. Could some malfunction or aging process cause hydrochloric acid in the stomach to somehow be absorbed and to trigger some negative reaction in brain tissue? Although I am speaking from the layman's view of the body system, this question of the relationship between the acid reflux and the memory problems seems consistent with the hypothesis about food.

Red Letter Day?
As a lay person, I think of the blood stream like a mail system delivering the right nutrients in a flowing red stream wherever required. Could this 'b-mail' get confused and deliver the acid to the brain? In this hyupothesis, the acid is the bad news that creates confusion symptomatic of a red letter day. From this perspective it seems reasonable to allude to a connection between the two complaints. It should be noted here that there has been no analysis or testing of the content of May B.'s saliva or her stomach to support this.

A Glass of Water
Ensuring that May B. has enough to drink has enabled her to have calmer days. Her forehead is usually warm to the touch whenever she begins to get anxious. It is not clear why? However, a glass of water has on occasion dissipated the onset of anxiety. Although I have no idea why this happens, nor the significance of the 'hot flash', it seems consistent with the hypothesis that the digestive system is somehow implicated.

Multivitamins
Over the last two years, May B. has been taking the Centrum silver daily multivitamin with her breakfast. There is a distinct difference in her behavior on any day that she does not take her multivitamin. On those days she is more restless and uncooperative. It seems hopeful that if only we could isolate the particular item in that multivitamin that contributes to that change, then perhaps taking more and more of that item could lead to a cure.

Medications
I cannot conclude this discussion without referring to May B's awareness of her memory loss. Before we noticed any sign of memory loss, May B. herself repeatedly expressed concern to her doctor that her hypertension medication (Cardizem CD) was causing her to lose her memory. It saddens me when I recall how anxious she became as she frequently raised her concerns about the effect the mediation was having on her memory. She agreed with her doctor that the life saving benefits of controlling her high blood pressure were nothing compared with "a little" memory loss. None of us had any idea whatsoever of how important memory was to our basic everyday existence or how much could be lost¹. Before she retired, May B. had been a trained nurse with approximately thirty years experience. Sadly today, not only is she unaware of her condition, but she also has intermittent recollection of who she is.

Currently May B. has been prescribed Nexium which is taken as needed for her acid reflux. She also has nitroglycerin on hand to be taken for any chest pain, but she has hardly ever had to use it. She also has Ambien prescribed for sleep based on a bad nights experience we had with her, but she has never taken it.

May B. was once also prescribed Aricept. However, she became so incoherent that we discontinued its use.

Over the past few years she has taken courses of the following medications as prescribed for various complaints: Prevacid, Axid, Procardia.

Socializing
May B's temperament is generally good natured. That is consistent with her temperament before losing her memory. Conversing with her, even though she will immediately forget it all, nevertheless has a positive impact on her disposition.

Music
Singing sometimes helps to sooth and calm May B. It is also a generally accepted fact that we remember things more easily when they are set to music. Added to this I saw a television program recently where they referred to the positive response of alzheimer's patients to music therapy. Is music what the medical profession refer to as the 'electrical impulse?' Once we can eradicate the source of the problem, I am encouraged that somewhere in this is hope for repair and reversal.

Further study
The cumulative influence of my observations make me think that maybe the understanding and hence the solution could be really so simple that we keep missing it. Further study could determine if any of these factors are the culprits. I recognize that even if they are implicated, more information is needed. There are still other issues. For example, if my hunches are correct how would one go about the process of re-hydration? Or of neutralizing the acids in the stomach? Is there a solution in a simple glass of water? Is there a pill to regulate hypoglycemia? What is it in that multivitamin that reduces anxiety? Can it be isolated and taken in larger doses?

Conclusions
No doubt different people may have different sources and manifestations of memory problems. Not to mention severity, diagnoses, prognoses and other co-existing conditions. This case study is based only on a single exposure to someone with severe memory loss. Some observations may not be typical, and it is possible that there is no causative or other relationship between the symptoms and behaviors and her memory loss. Concerns about chronic or progressive dehydration may be irrelevant and issues like hydrochloric acid, hypoglycemia, digestion, water and food may be neither part of the problem nor the solution. However, I am hoping that somewhere in this puzzle is a picture that could contribute to the search for a cure for memory loss, alzheimer's and dementia.

UNANSWERED QUESTIONS AND THEORIES

Is there a relationship between cell dehydration and memory loss? After viewing a television documentary some time ago, I was struck that the information included on the manifestations of dehydration in people in the desert resembled what I observed in May B.'s care at home. Confusion and disorientation are common, and I am tempted to use the term hallucination to describe the fact that she sometimes sees and can describe things and people that I cannot see. Could it be that the aged brain cells become dry or unable to absorb moisture and nutrients? Is she manifesting symptoms of some form of chronic dehydration? Can brain cells become hardened? I have no idea whether tissue dryness could also lead to hardening. I am encouraged in this thought by the fact that other tissues such as the arteries are known to become hardened in some conditions. Could this happen to brain cells, and may hardening render the formerly delicate cells incapable of absorbing nutrients to maintain themselves? An answer to this question may provide some direction to attempts to reverse the condition. Do memories get lost, or do people develop an inability to store data or an inability to retrieve it once stored? I read in a recent family health publication2 that the difference between long term and short term memory is that early memories are stored chemically, while short term memory may be first stored electrically and then converted. If this is so, could it be that the chemical required for the conversion becomes depleted with age? Or maybe that affects the body's ability to transport some chemicals to the cells where they are needed? On the other hand, I do not know too if the electronic triggers could become weakened so that the memory data does not get stored in the first place. What is the source of the chemical or the electrical trigger needed to convert memory? From anther angle, could it be that perhaps the hardening (or some other change) renders the cells incapable of secreting or producing the required chemical or triggering the electronic impulses considered typical of the healthy cells. Where do the electrical impulses come from, what stimulates them? Perhaps if the cause of the chemical or electrical impulse referred to in this article can be determined, we would ultimately be better able to prescribe effective treatment or even prevent the complaints.

© Karen Sinclair, July 2002.

Karen Sinclair is a business analyst consultant who specializes in analyzing business problems and finding appropriate solutions to make business plans come true. She wrote this article based on a personal relationship with the patient May B.

Contact her at:
KarenSinclair@compuserve.com
973.325.9178
PO Box 206, South Orange, NJ 07079