Awareness in Alzheimer’s Disease

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Alzheimer’s disease (AD) is the leading cause of progressive dementia in the United States accounting for 95% of all dementias. It is believed that approximately 5 million Americans suffer AD and that this number will nearly triple in the next 40 years. AD is also on the increase worldwide.

AD is a progressive dementia that affects functions of memory, language, spatial skill, personality and functional ability. The disease continues to erode these functions rendering the patient completely dependent. It is generally believed that patients with more advanced AD are not aware of their condition and do not have an awareness of the people or places around them.

New research on awareness in those with vegetative state suggests this may not be true. Communication may also be possible for those in vegetative state. One case of a 29 year-old patient in a vegetative state was able to answer yes no questions by visualizing specific scenes the doctors asked him to imagine. The brain yielded different activity when different scenes were viewed. This particular patient was in a vegetative state for five years.

This new study published in the online version of the New England Journal of Medicine supports previous cases of awareness in those with vegetative state and raises significant issues concerning understanding of brain function and ethical matters dealing with end of life decisions.

Another suspicion this raises for me is whether a patient with advanced Alzheimer’s disease maintains some awareness of his surroundings. Perhaps the patient’s smile or blink to a family member has more meaning than we previously believed. It is not unreasonable to believe that the complexity of the human brain will not permit complete disconnect from those persons or things that are most important to that brain. We may simply not yet have the ability to measure such activity.

The new study reported in the online New England Journal of Medicine will help to spur research into this and other questions. We are on the frontier of an entirely new understanding of the human brain and we will be very surprised by how we have underestimated its ability and power. I refer to this new exploration of human brain potential as “neural energies.”


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8 thoughts on “Awareness in Alzheimer’s Disease

  1. Ron Fanyak

    I was in a 2 month coma. While i was not aware where I was,
    i heard voices…….but they sounded like they were far away [like in the hall outside my room or in another room].
    I remember hearing Christmas carols. My daughter told me that on Christmas she sat beside me and sang carols.I was not aware it was my daughter singing, but I was aware it was Christmas.
    i also remember hearing people opening presents and commenting on them. My family said they brought their presents into my room to have a bit of the holiday while they stayed with me. I was not awaere that the voices were my family.

  2. Mary

    I found your post on Alzheimers intriguing. My mother didn’t seem aware in the later stages, but always was calmer in my father’s presence.
    I find your site very interesting,especially the brain games focus. Thanks

  3. Sarah Hayes

    Hello Dr. Nussbaum,

    My husband has had Diabetes Type 2 since 1986 and has recently been put on insulin (34 Units per day before meals, 14 before breakfast, 12 before lunch and 8 before supper). Before he was on a drug called Glyburide and was prescribed too much because his sugar went down into the 40′s and 50′s and he had stroke like symptoms, sweating, confusion, weakness.
    The EMS was called and they said he had low sugar and gave him sugar and he was OK. He has had several of these episodes and now he acts like he has some degree of Alsheimers but his endocrinologist, Dr. Miranda says the low sugar episodes kill brain cells and this will cause him to lose part of his brain function. In your studies have you found this to be true with diabetic patients? Should we take him to a neurologist for tests and can his memory and brain function be improved? Our primary care doctor did not recognize one low sugar episode when we were in his office my husband was sweating profusely and he told us to take him to the emergency room and the ER attendant said it was low sugar.

  4. Joan Tunick

    3rd. time written. Email address entered each time. It’s me, honest; has been before you were born. Don’t know your age, but looked you up on computer and learned lots. Trust your knowledge more than mine.
    Have had intractable tle for over 50 years. Been on plethora of medications. Neuro. just put me on zonasamide; no seizures, except under very unusual circumstances. Memory returned somewhat, anger subsided.
    Will tell her about your site and the NEA if that’s o.k. with you.
    One problem tho’. Having problems getting on your site. Keeps asking me to register again. What am I doing wrong? Please let me know if possible. Thanks

  5. Joan Tunick

    Alzheimer’s or dementia are something that really scare me. But I figure that, by keeping a positive attitude and exercising a lot – walking over 5 miles every morning except when my house waits patiently for me (never says a word, just waits patiently) I should be o.k. If not, I guess I can live with that too. I only hope that my family who don’t understand my past history of memory loss due to tle don’t suffer unduly and neither do I! Now to try to figure out how to play some games!

  6. Iona

    This is very interesting, and alos reading the comments. My granny didn’t seem aware of anything towards the end, but who knows. I certainly know it was a very trying and desperate time for the family, and we were lucky we found a a free bonus book all about alzheimers which helped guide us through the stages, hopefully it might help some readers too.
    Free bonus book about dealing with Alzheimer’s

What are your thoughts?