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Alzheimer's Disease

As the population of today's aging increases, we will see a higher incidence of Alzheimer's disease cases and deaths. Learning about Alzheimer's disease helps to aid an individual suffering from the disease which robs people of their mind, body and self. Until a way can be found to arrest the disease, friends and families are able to make the remaining time as meaningful, active, and comfortable as possible.

According to the National Institute on Aging, Alzheimer's disease (AD) is an incurable neurodegenerative disease which affects nearly 4 million individuals in America per year. It usually affects people starting after age 65 and more often women than men. The disease slowly progresses until it ends in death (Matteson, McConnel, and Linton, Gerontological nursing: Concepts and Practice, 1997).

Complete diagnosis of the disease can only be achieved during autopsy; however, new medical advances have allowed through the use of diagnostic tools, such as PET and SPECT scans and genetic testing, detection many years before the age of onset. While the patient is still alive, laboratory testing, a case history, and evaluations help to rule out other disorders including dementia, diseases, infections, and trauma. Evaluations by a diagnostic team of primary care physician, neurologist, and psychiatrist are all used in the diagnostic process.

AD includes the gradual loss of intellectual thinking and memory as well as a person's motor abilities. Individuals suffering from AD have problems remembering recent events and people; problems in abstract thinking; learning new tasks; forgetfulness; difficulty finding words, finishing thoughts and following directions. As the disease progresses, sufferers will experience impaired judgment and impulse control, delusions, confusion, disorientation, changes in mood and personality. Once familiar activities such as personal hygiene and simple household chores become difficult to impossible to achieve.

Stage I: Early Confusional Phase

Forgetfulness becomes a problem. The individual denies there is a problem. At times the person can successfully compensate and conceal the problem, however at other times they cannot. Demonstrations of confusion and slower responses. For example, an individual can continue to drive a vehicle on familiar routes but may become lost and confused on less familiar routes. Personality changes appear. The individual becomes easily upset, anxious and angry. He/she tries to avoid unfamiliar situations.

Stage II: Late Confusional Phase

• Memory problems are more evident. The retention of current events declines.
• Decision making becomes increasingly difficult.
• Orientation with time and place is affected. Memories of the distant past may be clear, however difficulties in concentration make it difficult to recall what was done just an hour earlier.
• Depression becomes evident as he/she becomes aware that capabilities are slipping away.

Stage III: Early Dementia

• More dependency on the caregiver. The caregiver is now responsible for helping to meet the person's needs and keeping him/her safe from harm.
• Defensive behavior and a heightened sense of insecurity developing into paranoia and agitated behavior and anger.
• Logical, sequential reasoning and actions diminish. An individual may complete only part of a task, such as dressing.

Stage IV: Middle Dementia

• Reacts more severely to loss of abilities. Withdrawal may be replaced by agitation, paranoia, and delusions. The need for security is no longer satisfied by the patient's mind but can be met through structure, routine, and caring.
• Sleep disturbances. The patient may be wandering at night. Difficulty walking may develop.
• Demonstrates repetitive behavior and inability to comprehend what appropriate behavior is. May respond inappropriately.

Stage V: Late Dementia

• Motor abilities deteriorate leaving the person bedridden.
• Loss of bowel and bladder functions.
• Loss of ability to chew and swallow food.
• Susceptible to seizure, aspiration, pneumonia and other infections.

The biggest myth of AD is the thought that nothing can be done to help the patient. However, there is much that can be done to make the patient's remaining months and years more meaningful, pleasant, and comfortable.

Planning: Good planning for future care can ease the burdens on patient and family. While still possible, the patient needs to be involved in the decision-making process on what type of care will be given as the disease progresses. While in the early stages of AD, patients are still able to participate in the decision of:

• Care preferences
• Preparing living wills
• Financial considerations

Stress: Families caring for loved ones with AD often become very stressed. Support groups and other local community programs are available to help family members care for loved ones. Sharing ideas with other individuals who also have family members suffering from AD helps families with information, support, assistance and stress.

According to Christine Kovach, author of Alzheimer's Disease: Long Term Care Issues (Law & Medicine, 1996), community based long term care has become increasingly available. Some of the services available include:

Homemaker services	Nursing care	Respite care
Personal attendant	Case Management	Meals-on-Wheels

Group homes	Assisted living residences
Nursing homes	Hospice care

Adult day care	Respite services	Protective services
Recreational services	Legal services	Information services
Referral services	Telephone answering service	Transportation

"The time often comes, at different points for different families, when there is a need to turn over the care of the patient to a long term care institution" according to Kovach (1996, Law & Medicine). More than 75% of AD patients eventually live in long-term care facilities. Many nursing homes include a family living area and recreational areas which create a home-like environment. Skilled care nursing facilities offer the environmental modifications to assist in the different stages. Crafts, games, music, field trips, all help with enriching the quality of care and is frequently provided by nursing centers where patients reside.

What causes Alzheimer's disease?

Theories to the cause of AD by Katzman, 1983:

• Vascular Theroy- Hardening of the arteries or cereborarteriosclarosis.
• Slow virus or unconventional transmissible age theory- getting old
• Autoimmune theroy- antibrain antibodies in the brain
• Chemical theory- chemical deficiencies
  • acetylcholine
  • and neurotransmitters
• Chemical theory-chemical excesses
  • aluminum
• Genetic theory- familial not genetic
• The largely dismissed theory- having marked cognitive deterioration juxtaposed to excellent physical status

Are there any treatments?

Two critical junctures cross in the approach to the treatment of AD were:

• Recognition of AD as a disorder demanding treatment as opposed to an inevitable concomitant of normal aging.
• Realization that in developing interventions for a major illness or disability the concept of care can be as important as that of a cure.

What are the medications used?

Medications disigned to enhance memory or slow progression of the disease

• Physostigmine
• Tetrahydroaminoacridine
• Tacrine hydrochloride

Can cognitive functioning be improved?

Aids to assist cognitive function include:

• Display of clocks and calenders
• Night-lights
• Daily schedules
• Written directions
• Labels on commonly used items

Useful activites include:

• Listening to music
• Watching TV
• Reading the newspaper

What is some other helpful advice?

• Using B-complex vitamins
• Most important is to keep the mind active!
• Low cholesterol allows the blood to flow freely, reducing the risk of stroke and the symptoms of Alzheimers.

How long can a person remain in a community?

Behavioral problems that may influence remaining at home:

• Cognitive dysfunction
• Problems behavior
• Psychological symptoms
• Psychosocial stress

More than 60 other disorders have symptoms similar to AD, so one must not assume that someone has AD just from the signs mentioned earlier. Alzheimer's disease is not a part of aging, it has been found in people as young as 40 years old. The disease claims more than 100,000 lives a year in the United States. Alzheimer's not only affects it's victims, but also family and firends.

To locate an Alzheimer's Association near you, call toll-free 1-800-272-3900. The Woldwide Web address is http://www.alz.org.