Cerebral Amyloid Angiopathy and Alzheimer's Disease: Dad's Double Burden

     Five years after Dad first had memory problems, we're starting to understand what caused his dementia.  Seven months after he died, we know what caused his hemorrhagic stroke.  I'm both relieved and sad to have a diagnosis.

     Last week I got a report from the Neuropathology Lab at Massachusetts General Hospital, where we sent some of Dad's brain tissue.  The report says he had severe cerebral amyloid angiopathy, or CAA.  In people with CAA, a destructive protein is deposited on the walls of the blood vessels in the brain. The protein causes the vessel walls to crack, allowing blood to leak out.  Every hemorrhage, large or small, damages brain cells and can cause dementia, difficulty speaking, or even paralysis.  Some CAA patients, like Dad, die of these hemorrhagic strokes.

     In a way, it's a relief to know that researchers don't yet understand what causes CAA, or how to treat it.  As Dad's memory problems slid into full-blown dementia, I felt like there was an answer, but we just couldn't find it.  This diagnosis means no one - not me, not my family, not his doctors - could have done anything to help him, no matter how hard we tried.

     My father also had a "moderate number" of the plaques and tangles characteristic of Alzheimer's disease in some areas of his brain.  According to the neuropathology report, these "contributed to his neurologic difficulties."  It's sad to think about him entangled by both Alzheimer's and CAA.

     On my birthday last year, Dad stayed on the phone with me longer than usual.  It was hard for him to find words, but he wanted to talk.

        Dad, Beau and Mom

     "Things are different here now," he said.  "But when I nap, Beau [their dog] stays with me.  He climbs up on me so I feel better. And Mom and I still push on each other [give each other backrubs], so that's good."

     "You've got a lot of good things, Dad."

     "Yes.  Hi from me to you...happy birthday," he said.  "I'm still older than you are!"

     Struggling under the double burden of CAA and Alzheimer's, Dad kept both his gratitude and his sense of humor.

Comments

[Paula Martinac]

Hi Mona,

It's cruel that your father had a double whammy of CAA and AD - as if one or the other wasn't enough - but, like my dad, he was still "there" somewhere underneath the fog. I found "Things are different here now" such a moving and apt statement - simple on the surface, yet a perfect summary. And what a great photo!

Thanks for commenting at my site - I am a bit of a slacker when it comes to comments, but am trying to catch up with all the helpful blogs I'm discovering on AD and dementia.

[Lara]

Hi Mona,

I wanted to thank you for your blog. In March of 2008 my mom had a massive hemorrhagic stroke at the age of 66 which took her life. It came as a shock to us all ... and 7 months later we finally had the autopsy report - that she had CAA. I've done some searching over the past few months for info and support groups for CAA ... and am always directed back to your blog.

We too wondered if we could have been better diagnosticians in the weeks leading up to her death. She was unusually confused over how to work her new apple computer - very strange for a woman who taught apple based skills to children as a teacher. And, memory loss was, looking back on it more evident than any of us (and she) wanted to see. The night she had the stroke I spoke to her on the phone about 2 hours before ... and she commented how wonderful it was I couldn't recall some detail.

Thank you again for your continued search for answers ... there are others that are too.

Best,

Lara