Alzheimer’s disease, a neurodegenerative brain disease, is the most common cause of dementia. It currently afflicts about 4 million Americans and is the fourth leading cause of death in the United States. Furthermore, Alzheimer’s disease is the leading cause of mental impairment in elderly people and accounts for a large percentage of admissions to assisted living homes, nursing homes, and other long-term care facilities. Psychotic symptoms, such as delusions and hallucinations, have been reported in a large proportion of patients with this disease. In fact, it is the presence of these psychotic symptoms can lead to early institutionalization (Bassiony, et all, 2000).
Learning about Alzheimer’s disease and realizing that it is much more that just a loss of memory can benefit the families of those with the disorder as well as society as a whole. The purpose of this paper is to look at the disorder, as well as to discuss the history, symptoms, diagnosis and hopes of a cure for Alzheimer’s disease.
Around the turn of the century, two kinds of dementia were defined by Emil Kraepin: senile and presenile. The presenile form was described more in detail by Alois Alzheimer as a progressive deterioration of intellect, memory and orientation. As a neuropathologist, Alzheimer studied the case a 51 year-old woman. When she died, Alzheimer performed an autopsy and found that she had “cerebral atrophy” (deterioration of the brain), “senile plaques” (protein deposits) and “neurofibrillary tangles” (abnormal filaments in nerve cells) in her brain — three common pathological features of those who have Alzheimer’s Disease (Ramanathan, 1997).
Today, as research on Alzheimer’s disease progresses, scientists are describing other abnormal anatomical and chemical changes associated with the disease. These include nerve cell degeneration in the brain’s nucleus and reduced levels of the neurotransmitter acetylcholine in the brains of Alzheimer’s disease victims (Alzheimer’s Disease). However, from a practical standpoint, conducting an autopsy of an individual to make a definitive diagnosis is rather ineffective. Newer diagnostic techniques will be discussed in a later section of this paper.
The progression of Alzheimer’s disease is classified into three phases: forgetfulness, confusional, and dementia. The forgetfulness phase is the first stage and is characterized by a loss of short-term memory. Patients in this phase will often have trouble remembering names of well-known people and will misplace items on a regular basis. This stage also may include behavioral changes. Additionally, a loss of spontaneity and social withdrawal often occurs as the individual begins to become aware that there is something inherently wrong. Speech problems and difficulty with comprehension may also appear. Cleary, it is sometimes difficult to distinguish an Alzheimer’s patient from normal everyday people or people with other disorders.
In the confusional stage, the cognitive deterioration is more noticeable and memory loss is much more pronounced. Individuals in this stage will often have trouble recognizing where they are or remembering the date and day of the week. Poor judgment is also a noticeable trait at this state and the individual’s personality will likely change to some degree as well.
In the final stage of dementia, there are profound losses of memory and mental abilities. Patients will often not recognize their spouse or children or be able to read with comprehension. Eventually, individuals will become bedridden as brain functions disintegrate (Ramanathan 1997).
As of yet, there are no known causes that can be concretely linked to Alzheimer’s disease. To further complicate matters, there are a number of diseases that have symptoms in common with the dementia associated with Alzheimer’s. Understanding the different types of dementia-related illnesses is important when trying to diagnose a patient with these kinds of symptoms. Doctors separate the dementia illnesses into three groups: primary undifferentiated dementia, primary differentiated dementia and secondary dementia.
Primary undifferentiated dementia diseases produce the dementia by direct effects on the brain, such as those seen in Alzheimer’s. They resemble each other quite closely and often cannot be distinguished from one another through ordinary diagnostic means. The primary differentiated dementia diseases often include losses of muscular control and thus they can be separated from the previous group. Most of these diseases are rare. The secondary dementia diseases are not due to a permanent impairment of the brain and can often be cured, so accurate diagnosis is critical. Therefore, one can see how the three types can cause diagnosis problems for people in the medical field (Heston and White 1983).
For example, Pick’s disease is so similar Alzheimer’s that distinguishing the two in living patients is almost impossible. Like Alzheimer’s patients, those with Pick’s disease show signs of neurofilament masses and disarray in the neurotubules. However, there is a syndrome that is seen more in Pick’s patients than any other patient, which can aid in the diagnosis of the illness. This is a disease of the brain center and the individual often shows signs of severe overeating, hypersexuality and euphoric disposition. Pick’s patients often show signs in their early fifties and nearly all die within eight years of the onset of the illness (Ibid).
Low-pressure-hydrocephalus or ‘water on the brain’ is one illness of the primary differentiable type. If this disease can be properly diagnosed, it can be treated and, in most cases, the symptoms are relieved or greatly improved. It is caused by an overabundance of cerebral fluid on the brain, which must be relieved surgically. Huntington’s disease is another differentiable type, but it, as of yet, has no cure. Patients who have this disease exhibit involuntary writhing movements that are distinctive to this disorder. Finally, viral diseases, Parkinson’s disease and Wilson’s disease, among others, can also be causes of primary dementia similar to that seen in Alzheimer’s patients (Ibid).
Accordingly, how are doctors able to diagnosis Alzheimer’s disease in the face of all these difficulties? One answer is to look at the article written by Douglas Gelb for the Statistics in Medicine Journal. Dr. Gelb puts forth four areas that could be useful in the diagnosis of Alzheimer’s. These are: cognitive testing, global assessment, functional assessment, and behavioral rating scales.
Cognitive testing, while not directly related to everyday tasks, can be helpful in rating the change in a patient over time. Dr. Gelb discusses at length how copying geometric puzzles and counting backwards by seven doesn’t reflect everyday skills. His main point about this kind of testing is the rate of change seen between tests. This rate of change can help doctors diagnose the dementia and classify it into it proper category, one of those being dementia of the Alzheimer’s type.
A single test or series of tests can be used to test an individual’s dementia on a global scale, i.e. specific symptoms are not focused on, but the effect of all the symptoms together are studied. Dr. Gelb puts form that there are at least two ways in which global measures could conceivably be useful in diagnosis of dementia. First, global testing can help identify which treatment strategies are working for specific groups of dementias. Second, the global testing of a wide patient pool could offer evidence of a scale with which to rate the progress of the disease.
Functional testing is perhaps the most practical of all the testing as it studies the motor and brain skills required to function on a day to day basis. Self-care tasks are studied to asses whether a patient is able to care for themselves. Repeated tests can also show if a patient is responding in a positive way to a treatment regime. Like the global testing, this kind of testing could also be used to create a rating scale.
Finally, Dr. Gelb states the need for more behavioral testing. In the past, this area has been ignored since most of the tests come at the request of the caregiver. These tests, too, could be studied across a vast group of patient in order to create a rating scale. Likewise, response to treatment can be assessed (Gelb, 2000).
Research is also being conducted in an attempt to correlate the deterioration of the individual’s cognitive functions and psychiatric phenomena. According to one group of researchers, patients with dementia and major depression also showed a low level of a particular enzyme in the brain. Furthermore, there was a higher neuron count in a portion of the brain. Thus, they conclude, this enzyme may be related to neuron function, which is, in turn, related to the depression (Harwood et all, 2000). This correlation may lead to research that can help alleviate the depression symptoms in patients with dementia.
Studying the effects of different symptoms and their relationship with the patient’s dementia are also being conducted. These kinds of studies are useful in diagnosing the particular dementia, as there seem to be slight differences in the amount of dysfunction and its progress in different dementias.
For example, gait and balance dysfunctions were studied in a group of patients consisting of individuals with Alzheimer’s, Parkinson’s and Vascular dementia. It was seen in this study, as one might expect, that those patients with Parkinson’s disease showed the greatest dysfunction in this area (Wait et al, 2000). This is probably due to the fact the Parkinson’s disease also severely affects the patient’s motor control.
Also, research is being conducted in the area of Alzheimer’s itself and the disease’s progression. One set of researchers has found that Alzheimer’s patients, while being aware of their deficits in memory and other function in the beginning of the illness, lose some of this self-awareness as the disease progresses. This self-awareness is most likely, logically, connected to the fact that an Alzheimer’s memory deteriorates as the disease progresses — a patient cannot be aware of things they do not remember (Derouesne et all, 2000).
In addition, many more areas are being researched in regards to dementia and Alzheimer’s disease. In fact, there are so many that it is beyond the scope of this paper to discuss them all. However, some of these are worth mentioning. For example, significant findings from studies have improved doctors’ understanding of the plaques and tangles seen in the brains of individuals with Alzheimer’s disease. This understanding eventually may lead to the development of treatments to slow the effects of the disease process. Ultimately, the prevention of the plaque deposits and tangles is the goal of this research.
Moreover, the recent discovery of a previously unknown lesion characteristic of Alzheimer’s disease may lead researchers to further understand the disease process and how intervention therapies may be designed. This lesion, called AMY plaque, may play a role in the onset and progression of Alzheimer’s. Moreover, studies of the inflammatory processes of the brain and the role of oxidative stress in Alzheimer’s disease have been conducted. This has led to preliminary indications of the beneficial use of anti-inflammatories, such as ibuprofen, and antioxidants, such as vitamin E, in treating or slowing progression of the disease.
As of yet, there are no known cures for Alzheimer’s disease. In fact, many of the dementias similar to Alzheimer’s also lack a cure. However, research is continually being conducted. This research covers a wide range of areas, from better diagnostic tools to genetic testing.
One such diagnostic tool recently received a patent. According to the inventor of the tPST, H. Paul Voorheis, M.D., Ph.D., Professor of Biochemistry at Trinity College, his new blood test can make a diagnosis of Alzheimer’s disease simply, and without risk or discomfort to the patient. The tPST detects tau- peptide fragments, which are released into the blood by degenerating neurons in Alzheimer’s disease sufferers. Dr. Voorheis has been able to detect tau-peptide in early Alzheimer’s disease and believes that the tPST is as sensitive to the early stages of Alzheimer’s disease as to later stages. In addition, Dr. Voorheis noted that because very little tau-peptide is found in normal blood, he believes that the tPST will prove to be both a sensitive and highly specific test for Alzheimer’s disease and that, when the tPST is fully developed and routinely available, it will provide a safe and cost-effective diagnosis of the disorder . This test would go a long way toward the accurate diagnosis of Alzheimer’s disease and provide a concrete way of pinpointing who has this disease.
Obviously, knowledge regarding Alzheimer’s disease has progressed far from thinking that it is just a loss of memory. This disease produces a full-blown dementia in its patients and affects millions of people and their families. These people and their families have special needs. Consequently, programs, environments, and care approaches must reflect this uniqueness. Developing an effective care/service plan for a person with dementia requires careful assessment of that person, a detailed plan, and attention to the individualized needs of persons with dementia. All individuals (including the person with Alzheimer’s disease, family, and staff) should be involved in the development, implementation, and evaluation of the assessment and care/service plan process.
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