ALZHEIMER’S DISEASE
Alzheimer’s disease is relentlessly destroying the brains and lives of our
nation’s older adults, robbing them of memory, the ability to reason, and
affecting their emotions and behavior. Alzheimer’s disease is a degenerative
disorder of the brain. The longer we live the greater the risk: one out of
every two Americans aged 85 and older and one out of every 10 aged 65 and older
are afflicted with the disease. It affects two groups of people: those with the
disease and the loved ones who care for them. By the year 2050, an estimated 14
million Americans will be in its grip. (Medina xi, 2)
Alzheimer’s disease (AD) is a progressive disease of the brain, which is
characterized by a gradual loss of memory and other mental functions.
Alzheimer’s is the most common form of dementia -- a general term referring to
loss of memory and the ability to think, reason, function, and behave appropriately.
(Medina 4) The word dementia is derived from two Latin words, which mean away
and mind, respectively. (Goldmann 2) It’s different from the mild forgetfulness
normally observed in older people. Over the course of the disease, people with
AD no longer recognize themselves or much about the world around them. (Medina
4)
Alzheimer’s is marked by abnormal clumps, called senile plaques, and irregular
knots, called neurofibrillary tangles, of brain cells. The plaque is an
accumulation of an abnormal protein, amyloid. One theory regarding the cause of
Alzheimer’s disease suggests that this plaque forms because the processes that
normally operate to clear away this protein have become defective.
Neurofibillary tangles are skeins of another abnormal protein, but the tangle
is found inside the nerve cells. The reason why the tangles develop is not
known, but the normal processing of protein by the cell seems to be disrupted.
These tangles choke the nerve cells and prevent them for working properly. For
reasons not well understood, these plaques and tangles take over healthy brain
tissue, which devastates the areas of the brain associated with intellectual
function. (Goldmann 6)
There are a number of behaviors which may signal that a person might be in the
beginning stages of Alzheimer’s disease. Here is a list of warning signs: (1)
difficulty with familiar tasks, (2) slipping job performance, (3) language
difficulties, (4) confusion of place and time, (5) lack of judgment, (6)
problems in abstract thinking, (7) misplacing objects, (8) mood fluctuations,
(9) changes in personality, and (10) lack of initiative. (Cutler and Sramek 14)
The first signs of Alzheimer’s disease include difficulty in remembering recent
events and performing familiar everyday tasks. As the disease progresses, the
affected person may experience confusion, personality and behavior changes,
impaired judgment, and difficulty finding words, finishing thoughts, or
following directions. (Cutler and Sramek 16) In the early and middle stages of AD,
people with the illness may be painfully aware of their intellectual failings
and what is yet to come. These changes occur at widely varying speeds in
different people, and not all changes occur in everyone, but the outcome is
always the same. Eventually, people with Alzheimer’s disease completely lose
the ability to care for themselves and must be confined to bed with constant
care. In the latest stages of disease the brain can no longer regulate body
functions, and victims die of malnutrition, dehydration, infection, heart
failure, or other complications. Alzheimer’s disease progresses slowly, taking
between three to eighteen years to advance from the earliest symptoms to death;
the average duration of the disease is eight years. (Goldmann 1) Unfortunately,
science has not yet found a cure.
Dr. Alois Alzheimer, who discovered Alzheimer’s disease, was a gifted German
scientist who was born in the mid-nineteenth century. Though he will be forever
linked to the disease that bears his name, Dr. Alzheimer actually did his
landmark work in other areas of research. The sole reason his name became a
household word for Alzheimer’s disease was because of a brief talk he gave in
1906 to a small group of researchers. (Medina 12)
Research indicates that there may be certain factors that seem to be more
common in people with Alzheimer’s disease than in the general population. There
is major research into the origin of Alzheimer’s disease, and explanations
include genetic and environmental causes. (Goldmann 66) There are two types of
Alzheimer’s disease - familial AD, which is found in families and follows
certain inheritance patterns, and sporadic AD, where no obvious pattern of
inheritance exists. Family history is a consistent risk factor. People who have
a relative with Alzheimer’s disease are more likely to develop the disease
themselves. (Doraswamy 50)
Over four million people in the United States are living with Alzheimer’s
disease. Experts predict that as baby boomers age, Alzheimer’s may affect as
many as 14 million people nationwide. Alzheimer’s is widespread, affecting 10%
or more of those over age 65 and nearly half of those over age 85. Slightly
more women that men have Alzheimer’s disease. Its increasing prevalence has led
epidemiologists to call Alzheimer’s “the disease of the century”. (Doraswamy
22)
The risk of Alzheimer’s disease increases with age. While Alzheimer’s usually
affects those over age 65, a rare and aggressive form of Alzheimer’s can happen
in some people in their 40s and 50s. Family history or traumatic head injuries
suffered earlier in life may increase the likelihood of developing Alzheimer’s
disease.
Since normal aging may also cause a decline in the ability to remember names,
places, and objects, as can strokes and heart disease, it is important to be
examined by a doctor for a proper diagnosis. Even though Alzheimer’s disease is
responsible for more dementia than all other causes combined, more than 60
other diseases are capable of causing Alzheimer’s-like dementias, that is why
AD can be so hard to detect. There is no well-accepted specific test to
identify AD during a patient’s lifetime. Therefore, doctors can diagnose
Alzheimer’s disease only after they have ruled out all other possible causes of
dementia. No one test can determine whether Alzheimer’s actually exists, which
is also the reason why a physician must administer an exhausting battery of
tests before making an Alzheimer’s diagnosis. A detailed patient and family
history will be taken; a physical exam will be conducted; mental status test
will be administered; neurological exam will be completed; laboratory tests
will be performed; and an extensive psychiatric exam conducted before a
diagnosis can be made. Some doctors may order brain scans to rule out strokes
or tumors that could be causing symptoms of dementia. Memory and task-related
tests used to diagnose AD measure the level of impairment or stage of the
disease. Alzheimer’s disease is usually characterized as mild, moderate, or
severe, depending upon the severity of symptoms. (Medina 50)
It is difficult to place a patient with Alzheimer’s disease in a specific
stage. However, symptoms seem to progress in a recognizable pattern and these
stages provide a framework for understanding the disease. It is important to
remember that they are not uniform in every patient and the stages often
overlap. (Cutler and Sramek 75)
The First Stage, or mild dementia, lasts approximately 2 to 4 years, leading up
to and including diagnosis. Symptoms of mild dementia including: recent memory loss
which affects job performance, confusion about places (gets lost on way to
work), loses spontaneity (the spark or zest for life), loses initiative (can
not start anything), mood/personality changes (anxious about symptoms, avoids
people), poor judgment, makes bad decisions, takes longer with routine chores,
and trouble handling money. (Cutler and Sramek 75)
The Second Stage, or moderate dementia, lasts approximately 2 to 10 years after
diagnosis. The second stage is usually the longest stage of the disease
process. Symptoms of moderate dementia include: increasing memory loss with
confusion, shorter attention span, problems recognizing close friends and
family, repetitive statements and movements, restless (especially in late
afternoon and at night), occasional muscle twitches/jerking, perceptual motor
problems, difficulty organizing thoughts, cannot think logically, can not find
right words (makes up words to fill in blanks), problems with
reading/writing/numbers, may be suspicious/irritable/fidgety/teary/silly, loss
of impulse control, trouble dressing, will not bathe or is afraid to bathe,
and/or may see or hear things that are not there. A patient in the second
stage, moderate dementia, often requires full-time supervision. (Cutler and
Sramek 76)
Terminal Stage, severe dementia, lasts approximately 1 to 3 years. Usually the
patient can no longer recognize family or own self image, loses weight even
with a good diet, cannot care for self, cannot communicate with words, cannot
control bowels or bladder, may have seizures, experience difficulty with
swallowing and/or skin infections. (Cutler and Sramek 77)
Alzheimer’s disease exacts a terrible price, both in human and monetary terms.
Alzheimer’s costs the United States between $80 billion and $100 billion a
year. In 1996, the federal government spent $325 million on research. Which
means, Alzheimer’s cost society $308.00 for every federal dollar spent for
research. Alzheimer’s disease creates a financial burden not just on a nation
but also on a family. Nineteen million people have a relative wi325 million on
research. Which means, Alzheimer’scost society $308.00 for every federal dollar
spent for research. Alzheimer’s disease creates a financial burden not just on
a nation but also on a family. Nineteen million people have a relative wi325
million on research. Which means, Alzheimer’sost society $308.00 for every
federal dollar spent for research. Alzheimer’s disease creates a financial
burden not just on a nation but also on a family. Nineteen million people have
a relative wi325 million on research. Which means, Alzheimer’sected by AD. One
in particular, the Alzheimer’s Association, has created local chapters in every
state of the country.
There is nothing yet available that can stop the deterioration associated with
the disease. Several research breakthroughs have helped to slow the progression
of the disease process.
A series of experiments reported in 1997 has shown that Vitamin E can modestly
change the course of AD. Vitamin E was able to delay the admission into nursing
homes by almost seven months. While no one understands exactly why this
positive result occurred, the logic for testing Vitamin E has a sound
scientific basis. Vitamin E is in a class of molecules called antioxidants,
such molecules have the ability to fight free radicals. Some symptoms of
Alzheimer’s disease may be caused by an overabundance of free radicals. If so,
then taking some kind of antioxidant may perhaps slow the age of onset of AD.
(Medina 150)
Another result that shows promise as an effective treatment for Alzheimer’s
disease in postmenopausal women is the use of estrogen. This hormone has been
shown to have many different effects on brain neurons. Estrogen may even be
able to improve higher mental functions such as memory and learning. There are
health risks associated with taking estrogen (for example, an increased risk
for breast cancer). Nonetheless, the data with estrogen, as with Vitamin E,
represents a milestone in Alzheimer’s research. They provide the first hope the
disease may be significantly slowed. (Medina 151)
Some researchers believe Alzheimer’s is intimately associated with the immune
system. Symptoms may appear because of an ongoing inflammatory response. If
true, then antiflammatory medications might slow the effects of AD. Ibuprofen
(Advil) is an example of a nonsteroidal anti-inflammatory drug (NSAID) that
seems to provide protective effects in some cases. (Medina 151)
The Food and Drug Administration has given approval for certain medications for
the treatment of Alzheimer’s. One medicine is called tacrine (Cognex), another
is called donepezil (Aricept). Unlike Vitamin E or estrogen, these medications
work by inhibiting a molecule which normally breaks down the neurotransmitter
acetylcholine. There can be some improvement of symptoms with these medications
though the underlying deterioration of the brain continues. (McGuffey 5)
A new medication, Exelon is available for treatment of mild to moderate
Alzheimer’s disease. It has been tested in thousands of patients and has been
proven to have a positive effect on the three main areas of overall functioning
which includes: behavior, cognition, and activities of daily living (dressing,
bathing, toileting, eating). Exelon may help patients maintain function longer
than they would without therapy. (Doraswamy 82)
Currently, there is no known cure for Alzheimer’s disease. The goal of
physician and caregivers is to help maintain patient’s abilities for as long as
possible, and keep them safe and comfortable. (Coogle 1)
Alzheimer’s disease, or any other form of dementia, is a personal tragedy for
the patient and for those who love them and bear the burden of caring for them.
It is a slow, progressive disease with no known cure. As our population ages,
Alzheimer’s is a tragedy that is affecting more and more people.
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