Recently, a friend who retired from farming in 2016 passed away at age 77. He and his wife, whom he cared for because she suffers from Alzheimer’s disease, moved to town three years ago so he could be with her at all times, unless his daughter or other competent people were available for backup.

“Joe” kept a vow he made to “Blanche” that he would never place her in a nursing facility as long as he was alive. Joe and Blanche made their plans seven years ago when her thinking was still mostly clear, even though she was already having trouble remembering names and events that she could have recited easily just a few months earlier.

Correct diagnosis is important. Joe became concerned that Blanche might be experiencing Alzheimer’s-type dementia when her memory for usual matters began to fail, and even more concerned after she became lost when she drove to the city for a shopping excursion in 2012 and had to call him to come pick her up. That was the last time Blanche drove a vehicle.

When Joe contacted me shortly afterwards, I suggested Blanche have a complete gerontology evaluation. The neuropsychology portion of the evaluation confirmed our suspicions. I advised the couple to update their Advance Health Care Directives for each other and their Power of Attorney forms to make health care and business decisions.

Joe and Blanche consulted their three children; they agreed together that their daughter who lived near their town would manage Blanche’s affairs if Joe died first. One morning in March this year, Joe didn’t answer their daughter’s routine telephone call around breakfast time.

When she went to check on her parents, the daughter discovered that her father had died during the night. An autopsy indicated he suffered a brain hemorrhage.

Alzheimer’s disease affects people differently. For instance, Blanche couldn’t use a public restroom without her husband or daughter present to assist her. If Blanche “had an accident” in the restroom or before getting to a restroom, Joe or other family members assisted Blanche and then they returned home.

Eventually Joe, Blanche, and the entire family realized that Blanche was best able to care for herself independently when she was in places that were familiar to her and when routines were followed. Blanche’s cognitive functioning gradually deteriorated to the point that she could not be alone without someone nearby at all times.

Unlike some people with Alzheimer’s disease, Blanche was placid and not cantankerous. She was prone to wandering aimlessly or could sit quietly for hours.

Blanche recognized that her husband had died when she attended his funeral. She was nicely dressed and answered everyone’s greetings and sympathy with, “Thank you” while remaining with her children and their families. Her respectfulness was reciprocated by everyone.

Alzheimer’s disease is a complex syndrome, and not a disease in the sense of having a bacterial or viral cause. Factors that contribute to Alzheimer’s disorder are not fully understood.

Alzheimer’s is a progressive brain disorder that slowly destroys brain functions, with complications first in the outer cortex of the brain before gradually eroding into the inner cortex, and eventually affecting even the brain stem, which is essential for such life functions as breathing.

Biological changes in the brain were first detected in 1906 by a German physician, Dr. Alois Alzheimer, when he examined the brain of a deceased patient who exhibited progressive dementia. He observed plaques (clumps of brain tissue), tangles (abnormal bundles of nerves), and shrunken brain tissue in his deceased patient. Later researchers observed changes in brain chemistry, resulting in the loss of connections among brain cells.

As the brain slowly deteriorates, thinking capacity and basic life regulations governed by the brain gradually diminish until a peaceful death usually occurs. Some medications that replace essential nervous system transmitters that are decreasing 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, a 2018 systematic review of relevant scientific studies concluded the following: “Evidence suggests that lifelong cumulative exposure to pesticides may generate lasting toxic effects on the central nervous system and contribute to the development of Alzheimer’s disease (www.ncbi.nlm.nih.gov/pmc/articles/PMC5007474).”

Access to health care and socioeconomic well-being, as well as exposure to unknown substances, could be contributing factors in agricultural areas and other rural communities. Insufficient research in the United States has been conducted to adequately sort out the culprits, but an earlier body of international research findings, in the International Journal of Epidemiology in 2012, reached similar conclusions.

Alzheimer’s disease affects some 5 million Americans and causes about 4 percent of all deaths in the U.S. Blanche is fortunate to have understanding and caring people around her; she now lives with her daughter’s family.

Dr. Mike Rosmann is a psychologist and farmer in western Iowa. The views and opinions expressed in this column are those of the author and not necessarily those of Farm World. Readers may contact him at mike@agbehavioralhealth.com