Alzheimers Disease - Research Paper Example

Alzheimer’s Disease The most common form of dementia is the Alzheimer’s disease, AD. It is an irreversible and progressive disease of the brain which slowly destroys thinking skills and memory, deterring even the ability to undertake normal day-to-day activities. Acknowledging its extensive prevalence, this paper evaluates how the disease affects the brain yielding the associated signs and symptoms which help in diagnosis. Furthermore, the causes of AD would be evaluated, presenting the adopted treatments and prevention and care strategies to manage the symptoms. Introduction Alzheimer’s disease is considered as the most common form of dementia. The US National Institute of Aging, NIA defines dementia as a collective name that describes progressive degenerative brain syndromes affecting emotion, memory, thinking and behavior which affects the daily life of the victim. Similarly, Alzheimer’s disease, AD refers to a progressive and irreversible brain disease which slowly destroys thinking and memory cells, eventually interfering with the ability of the affected person to undertake the simplest tasks (Grossberg and Kamat 2). It is the leading cause of dementia among older people, its symptoms known to first appear after age 60. The Effect of Alzheimer’s on the Brain Normally, the 100 billion nerve cells, referred to as neurons, in the brain connect to each other so as to establish communication networks. According to the Alzheimer’s Association, these nerve cells play a critical role in learning, remembering and thinking, with others facilitating smell, vision and hearing. These brain cells generate energy, construct equipment, receive supplies and eliminate waste in the process of storing information and communicating with other cells. Execution of these processes requires oxygen and fuel. It is believed that the Alzheimer’s disease deters the cells from operating well. With the spread of this damage, more cells lose the ability to function, eventually dying and thus the irreversible changes that occur in the brain. Two abnormal structures, plaques and tangles, have been widely linked to the damaging and killing of brain cells. Plaques refer to the deposits of beta-amyloid, a protein fragment that builds up in spaces occurring between nerve cells. On the other hand, tangles refer to the twisted fibers of yet another protein known as tau which builds up in cells (Lu and Bludau 9). Even though as people age they develop plaques and tau, those people with AD develop exceptionally more of these. Furthermore, this development occurs in a predictable pattern according to the Alzheimer’s Association, beginning in those areas critical for memory and then spreading to other regions. Although scientists still have hazy idea on the role of plaques and tangles in Alzheimer’s disease, a majority hold the opinion that these abnormal structures block communication among brain cells, gradually weakening the brain cells, thus disrupting their survival processes. With time, these brain cells completely lose functioning ability, failing to communicate with each other, thus their deaths. Shortly after, the damage would spread to the nearby hippocampus, critical in forming memory. As more brain cells die, more of the affected brain regions shrink according to NIA. It is this destruction and death of the brain cells that causes the symptoms associated with Alzheimer’s disease. Signs and Symptoms Just as the rest of the body, the brain changes with age, leading to slowed thinking and occasional challenges in remembering things. Nonetheless, confusion and severe memory loss, among other major changes in the functioning of the brain, could be an indication of the brain cells failing according to the Alzheimer’s Association. Alzheimer’s disease is progressive, meaning that it develops gradually over the course of its existence. In fact, healthcare professionals do not even know when it starts as noted by NIA, postulating that brain damage starts much earlier than a decade before early signs evidence. During this preclinical stage, people with AD would be free of any symptoms even though toxic changes occur in their brains. Among the first warning signs is memory problem. This could cause amnestic mild cognitive impairment, MCI, a condition that causes people to have severe memory problems than their ages dictate. MCI has also been associated with movement difficulties and interference with sense of smell. People with MCI significantly lack abilities to undertake tasks. However, a majority of the older people with MCI would develop AD as compared to those without MCI (Bredesen 708). Other signals of early stages of AD as documented by NIA include a decline in cognition aspects such as spatial issues, word-finding and impaired judgment or reasoning. Currently, studies are ongoing to determine whether biomarker studies and brain imaging could help detect early brain changes. As AD progresses to the mild stage, memory loss would worsen as the changes affecting other cognitive abilities become more evident. According to Grossberg and Kamat, problems at this stage include getting lost, repeating questions, using poor judgment, having some mood, personality changes and trouble handling money (3). Other people could fail to notice these symptoms in the person suffering from mild AD at first. According to Lu and Bludau, this stage could last for years (30). Diagnosis normally occurs at this stage. As such, it should be considered as an appropriate time to make decisions on care as the disease progresses. At the moderate stage, AD would damage the brain in areas responsible for controlling reasoning, language, continuous thought and sensory processing. According to Grossberg and Kamat, confusion and memory loss worsen and the problem of recognizing friends and family sets in (1). Also observed would be the inability to learn new things, cope up with new situations or carry out tasks having multiple steps. People with moderate stage AD have delusions, hallucinations and paranoia and could behave impulsively. According to Lu and Bludau, this is the longest phase in Alzheimer’s disease, lasting many years (32). The symptoms at this stage differ from one person to another. In the final stage, severe AD causes tangles and plaques to spread throughout the brain. As a result, the brain tissue would have shrunk significantly as argued out by NIA. People suffering from severe AD suffer from inability to tell the body what it should do and to communicate, thus completely depend on others for care. Towards the end, the person with AD could be in bed most of the times as the body slowly shuts down. These stages present how Alzheimer’s evolves generally even though the disease could progress differently. The changes in abilities occur uniquely to different people. According to the Alzheimer’s Association, people averagely live for 8 years after being diagnosed with AD following their symptoms being noticeable to others. However, survival ranges between 4 and 20 years, age and health conditions being the critical determinants. According to the UK National Health Service, NHS, AD is usually not the actual cause of death. Rather, it is a contributing factor. Pneumonia is an example of a common factor that causes death among people with Alzheimer’s disease especially if untreated due to the difficulty among people with AD to recognize when they are ill. Prevalence The estimates on prevalence of Alzheimer’s disease vary. In America, NIA estimates the number of people suffering from the disease at 5.1 million. Of all the dementia cases, Alzheimer’s disease accounts for between 60% and 80% according to the Alzheimer’s Association. Those aged 60 and above are the ones at risk of contracting Alzheimer’s disease, though Grossberg and Kama document people getting affected as early as 30, referred to as early-onset Alzheimer’s disease (5). This is however noted to be rare, affecting just about one in every 1,000 people. On the other hand, it affects one in every 20 people aged between 40 and 65 and one in every six people aged 80 and above. AD is the sixth top cause of death, and the fifth among those aged 65 and above. The prevalence is lesser in the UK, NHS putting the estimates at about 500,000 people. Causes The exact cause of Alzheimer’s disease is largely unknown to scientists. However, NIA appreciates that the cause of AD is a complex series of events which occur in the brain over a significant period of time. As such, the causes could be a combination of genetic, lifestyle and environmental factors. Early-onset AD is rare, normally affecting just about 5% of people with AD. A majority of the cases are familial AD due to changes in one of the three genes inherited from either parent (Lu and Bludau 15). A majority of people develop AD after age 60, with NIA linking the alipoprotein E (APOE) gene to this. Among the many forms of this gene, APOE ε4 has been noted to increase the risk of getting AD. However, carrying gene APOE ε4 does not necessarily mean that one would contract AD; neither does not having it free one from developing the disease. Scientists are still searching for additional genes perceived to increase the likelihood of getting late-onset Alzheimer’s. Other than genetic factors, there are a host of other factors noted to increase the chances of one contracting Alzheimer’s disease. Bredesen observes the keen interest that seeks to link the disease to cognitive decline and metabolic and vascular conditions like stoke, diabetes, high blood pressure, obesity and heart disease (711). Clinical trials would help confirm whether a reduction in these risk factors could positively affect Alzheimer’s. Additionally, NIA observes that the lifestyle of people influences their risk of having this disease. For this reason, the organization advocates for nutritious diet, social engagement, mentally stimulating pursuits and physical activity to promote health even as people age. Diagnosis of Alzheimer’s Disease The definitive diagnosis of Alzheimer’s disease can only be undertaken after death through the linkage of clinical measures, examining pathology and brain tissues in an autopsy. However, NIA observes that doctors currently use several tools and methods that help them determine possible Alzheimer’s dementia fairly accurately. To do so, doctors probe the patient to find out information about their medical history, personality and behavioral changes, ability to undertake daily tasks and overall health. Conducting tests on attention, problem solving, memory, language and counting has also been proven as beneficial. Standard medical tests like urine and blood tests help in the identification of other possible causes. In some cases, brain scans like magnetic resonance imaging, MRI and computed tomography, CT could be undertaken for symptoms like tumor and stroke so as to make a distinction between Alzheimer’s and other possible causes. A repetition of these tests helps doctors observe the changes in the memory of the patient over time (Bredesen 708). Early and accurate diagnosis of the disease would tell whether the symptoms observed are due to Alzheimer’s or other causes such as Parkinson’s disease, tumor, medication side effects, sleep disturbances, stroke or other reversible or treatable conditions. This also helps with planning for the future and developing support networks. Treatment Alzheimer’s is a complex disease that poses a high unlikelihood of any intervention to delay, cure or prevent it. Early commencement of treatment could help in preserving function for a while, albeit the process of the underlying disease cannot be altered. This explains why the current treatment approaches and research seek for solutions from diverse aspects, including the management of symptoms, helping in the maintenance of mental function and slowing the symptoms. With regards to management of behavioral symptoms, the Alzheimer’s Association documents efforts by scientists to learn the occurrence of the symptoms associated with the disease like agitation, wandering, sleeplessness, depression, anger and anxiety and therefore developing drug and non-drug treatments to manage them. Treating these behavioral symptoms causes people with Alzheimer’s disease to be more comfortable, making it easier to also administer care to them. Moreover, psychological treatment has been suggested by NHS as helpful in improving language ability, problem-solving skills and memory. Cognitive stimulation is a common form of psychological treatment applied with this regard. Medication helps in memory, speaking skills and maintenance of thinking and could also be useful in the wake of some behavioral problems. There are four medications approved by the US Food and Drug Administration, FDA for the treatment of Alzheimer’s. As documented by NIA, these include galantamine (Razadyne®), rivastigmine (Exelon®) and donepezil (Aricept®) as the drugs for treating mild to moderate forms of AD. Even though donepezil could also be used to treat the severe Alzheimer’s disease, memantine (Namenda®) has been exclusively developed for this purpose, even though this could also be used to treat the moderate form. Nonetheless, it should be appreciated that these drugs do not alter the underlying processes of the disease and are thus effective for some people and only for a limited period of time. Research on Alzheimer’s disease has undergone tremendous development, with researchers now keen on addressing the underlying processes of the disease. The ongoing clinical trials seek to come up with interventions such as cognitive training, immunization therapy, antioxidants, effects of diabetes and cardiovascular treatments and physical activities (Bredesen 714). Thus, Alzheimer’s disease still offers immense gaps for research. Prevention and Care With the exact cause of Alzheimer’s disease being unclear, it also holds that its prevention is elusive. Nonetheless, NHS recommends ways that could be adopted to significantly reduce the risk of the dementia or delaying its onset. These include quitting smoking, cutting on alcohol, having regular health tests especially as one gets older and eating balanced diet. These measures have additional health benefits of improving overall mental health and lowering the risk of contracting cardiovascular disease. Caring for persons with Alzheimer’s disease comes with significant financial, emotional and physical costs. Critical decisions have to be made regarding changing family roles, placement in care facilities and day-to-day care demands. As such, numerous strategies have been fronted to help caregivers manage these situations well. Bredesen points out being well-informed on the disease as a beneficial and long-term strategy and this could be acquired through the numerous programs that seek to teach families about the disease (714). Moreover, there would be need to develop good coping skills, seek strong support network from friends and family to help in handling the accompanying stresses. Being physically active has proven to be emotionally and physically beneficial. NHS notes that the participation of caregivers in a support group is beneficial. In these support groups, caregivers share experiences, find respite, receive emotional comfort, get useful tips and express concerns. This could specifically be important when facing the decision of whether to place the patient in an assisted living facility or a nursing home. Conclusion Alzheimer’s is one of the types of dementia which negatively affects memory, behavior and thinking. Whereas there could be a few cases of people aged 30 being affected by the disease, AD is a disease associated with old age, normally from age 60. Plaques and tangles are the abnormal structures that destroy and kill brain cells thus leading to the symptoms of AD which vary in severity with the advancement of the disease and from one person to another. With no known causes other than postulates of a combination of genetic, environmental and lifestyle factors, there are also no known treatments for AD, save for medication and management of behavioral symptoms meant to ease the severity of the symptoms. In the same way, prevention measures intervene in the lifestyle of people to deter the lifestyle factors that could risk contracting the disease. The complexity of this disease makes care involving. As such, support from social networks and support groups would be beneficial to caregivers. Despite the vast knowledge available on Alzheimer’s disease, there remain gray areas which scientists extensively research on. Works Cited Alzheimer’s Association. What is Alzheimer’s? Alzheimer’s’ Association National Office, 2014. Web. 15 Nov. 2014. Bredesen, D. E. “Reversal of Cognitive Decline: A Novel Therapeutic Program.” Aging 6.9 (2014): 707 – 717. Grossberg, G. and S. Kamat. Alzheimer’s: The Latest Assessment and Treatment Strategies. Sudbury, MA: Jones and Bartlett, 2011. Print. Lu, L. C. and J. H. Bludau. Alzheimer’s Disease. Santa Barbra, CA: ABC-CLIO, 2011. Print. National Health Service. Alzheimer’s Disease. Author, 26 Mar. 2014. Web. 15 Nov. 2014. National Institute of Aging. Alzheimer’s Disease Fact Sheet. US Department of Health and Human Services, 27 Aug. 2014. Web. 15 Nov. 2014. Read More