Impacts of Alzheimer Disease on Family and Society - Research Paper Example

?ALZHEIMER’S DISEASE AND ITS IMPACTS ON FAMILY AND SOCIETY Alzheimer’s disease has a major impact on societies and families. It is estimated that 5.4million people have Alzheimer’s disease in the USA (Hebert et al., 2003). There are fifteen million of unpaid caregivers, mostly family members, taking care of these patients. Costs of the disease total 183 billion dollars annually (Alzheimer's Association, 2011). Deaths from this disease continue to rise even when deaths due to other causes are declining. Alzheimer’s disease is the most common type of dementia, accounting for more than 60% of cases of dementia. It is characterized by loss of memory, apathy, depression, impaired judgment, confusion, difficulty in controlling behavior, and in walking, speaking and swallowing. The Alzheimer’s Association, a non-profit organization based in Chicago, lists ten warning signs that could point to an early onset of Alzheimer’s. The most typical sign of the disease is loss of memory that is not distinct from age-related forgetfulness. Alzheimer’s memory loss is characterized by forgetting important dates or events and not remembering these later. Another significant sign of early onset Alzheimer’s is losing the ability to do routine tasks involving numbers such as balancing a checkbook or paying monthly bills. Daily tasks are difficult to complete, whether at home or at work. Problems with vision and in speaking or writing, having sudden mood swings, and being suddenly anti-social are also associated with early signs of Alzheimer’s. Once these symptoms are observed, a visit to the doctor becomes very necessary. Although it has been more than 100 years since Alzheimer’s disease was identified, studies on its causes, treatment and symptoms started only thirty years ago. In persons with the disease, protein deposits called beta-amyloid accumulate outside of the neurons in the brain, while tau, another protein accumulates inside the neurons. The neurons comprise the nerve cells which are responsible for communicating information or signals to the brain. The nerve cells are connected to each other by synapses, where the information flows in tiny pulses. The brain has trillions of these synapses for creation of memories, movements, emotions, sensations and thoughts. In Alzheimer’s disease, the synapses have accumulation of beta-amyloid proteins that lead to interference in the transfer of information and the death of the neurons. Tau proteins inside the nerve cells also block nutrient and cellular flow, which also result in cell death. Imbalance between the removal of the beta amyloid proteins and the accumulation result in the formation of the neurofibrillary tangles. The brains of people with Alzheimer’s disease are littered with dead and dying neurons. Risk factors The chance of getting Alzheimer’s is increased when heritable mutations are present in the genetic make-up of certain individuals. People with this type are said to have “familial” Alzheimer’s disease; symptoms of the disease can be observed starting at age 30. However, this genetic and heritable type occurs in only 1% of the cases. Risk factors for the disease have been identified (Alzheimer's Association, 2011). The primary risk factor is advancing age. Other risk factors are family history of Alzheimer’s, a specific form of apolipoprotein E-?4, having mild cognitive impairment, head trauma, and the presence of cardiovascular disease factors like high cholesterol levels. A medical history of Alzheimer’s also improves the chances of getting the disease, especially when a direct family member (parent or sibling) is afflicted with the disease. The correlation with apolipoprotein E-?4, and cardiovascular disease factors with the disease imply that lifestyle and diet can also contribute to disease development. Biochemical, genetic and medical history tests have been formulated that can actually predict the risk of having Alzheimer’s later in life. Family members of patients with Alzheimer’s feel the perceived risk of getting the same disease. This feeling of risk influences the genetic counseling process; most family members who can afford it opt for genetic counseling, which is also a means to cope with the disease. This perceived risk is an outcome of the known association between family history and increased risk of other members getting the disease. A randomized trial was conducted to assess if knowing the levels of apolipoprotein E-?4 from genetic studies would have an impact on the family members who took the test. Two hundred ninety-three participants were shown to think that they have higher risks of getting the disease (Hiraki et al., 2009). Most of the patients believed that having increased levels of apolipoprotein E-?4, also believed that genetics is an important factor in getting Alzheimer’s. Moreover, the same participants in the study believed that being a female Caucasian increased the chances of getting the condition. This study was the first to show an association between risk perception and family history (Hiraki et al., 2009). Results imply that family members should be given counseling, since fear of getting Alzheimer’s will also affect their present day lives. Outcomes of knowing results of genetic testing could result in depression. Treatment of Alzheimer’s disease Although no treatment is available that can reverse the deterioration of brain cells in Alzheimer’s disease, there are a few drugs that can slow the progression of the adverse symptoms for about a year. These drugs are not effective for all the patients who take them. Antioxidant damage has been partly blamed to cause Alzheimer’s (Smith, Perry, & Richey, 1996). Evidence shows that drugs that increase the amount of catecholamine in the brain and antioxidants can also reduce symptoms similar to those observed in Parkinson’s disease (The Parkinson Study Group, 1993; Alzheimer's Disease Cooperative Study, 1997). Common symptoms of early stage Alzheimer’s can be reduced with some drugs that have been approved by the US Food and Drug Administration. These drugs are designed to improve memory and are effective only during early stages (Family Caregiver Alliance). Tacrine (brand name Cognex) was approved first in 1993. However, it has many adverse side effects that lead to liver damage. Tacrine also does not really improve the memory of some patients, which was quite disappointing considering that many people had high expectations. As a consequence, Tacrine is seldom prescribed by doctors. The other drugs are donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl). These medications were found to improve memory significantly with lesser side effects observed. However, these drugs do not work effectively for all the patients using them. The drugs also work only during the early onset and middle stages of Alzheimer’s effectiveness, and are ineffective during severe Alzheimer’s. Memantine HCl (Namenda) is a newer drug that has been designed for late stages of the disease but is not also very effective. The disease is irreversible and its progress can only be slowed. More studies are being conducted and several drugs are still undergoing clinical trials. The information of these trials can be accessed in several databases and organizations that are dedicated to Alzheimer’s disease. As for emotional issues and behavioral problems that are associated with the disease, some medications are available and are prescribed. Examples of such medications are tranquilizers and sleeping pills that can reduce the anxiety, unpredictable behavior and sleeping disorders in the patients. Depression can also be reduced with prescription drugs. Another supplement given is tocopherol or vitamin E which has proven effective for some patients in reducing memory loss and behavior problems (Family Caregiver Alliance). Taking care of the patient with Alzheimer’s Seeing the progressive nature of the disease, individuals with Alzheimer’s are incapacitated to fend for themselves during the late stages of the disease. Sometimes, even during early stage, they already require care because the memory loss impairs their abilities to perform routine tasks. Hence these patients will need continuous care and attention so that they can continue with their lives and do not endanger themselves in doing so. Usually, the family members are caregivers of people with Alzheimer’s. Family members usually choose to take care of their own, more so if they cannot afford the high cost of having the patient in the care homes. These caregivers are usually unpaid; if paid, their services will be valued at over US$ 202 billion (Alzheimer's Association, 2011). To care for a person with dementia or Alzheimer’s is very difficult. Mood swings, physical incapability and not being able to identify or recognize your own caregiver who could happen to be a spouse, or loved child, can be very difficult emotional challenges for the caregiver. Some patients even show aggression and anger at their caregivers. The familial link makes these changes difficult to accept. As a result, the caregivers usually become emotionally stressed and depression becomes very common among them. Because of the unpaid nature of the job, the income and financial security of the caregivers are compromised. Moreover, there is no health insurance for the caregivers, which also affect their healths, having no means to have medical check-ups and money to pay for medical care. Another factor which is affected is the employment history of the caregivers will not have any records, which is a negative factor when the time comes for them to apply for jobs once their patients die or are moved to care homes. Most caregivers are women, married and are 55 years old or older. Since most of the patients are cared for at home, children are also living in the same household. If the patient is a parent or spouse of the caregiver, then the caregiver has to provide care for both patient and the children staying in the house, which adds more to the stress of the caregiver (Alzheimer's Association, 2010). If the caregiver is employed, normally she has to work part-time or has to give up her work depending on the degree of severity of the Alzheimer’s disease. Other changes that the caregiver endures are taking on a leave of absence from work, losing job benefits, turning down promotions, and choosing early retirement. All these result in a loss of income for the whole family and untold misery and frustration to the caregiver. Interventions to help caregivers cope with the symptoms and outcomes of the disease and to their caregiving job have also been studied (Sorensen, Pinquart, & Duberstein, 2002). Training and information dissemination on how to effectively care for the patient is provided, including how to respond to symptoms of cognitive impairment and other behavioral changes. Support is also given to caregivers in the forms of groups or forums where they can share stories, ideas and strategies that will help them to be more effective in coping with the disease. Psychotherapy also helps imparting skills on developing problem solving capacity, emotion management and engagement in positive experiences. Alzheimer’s disease has also increased the demand for paid caregivers. The health sector will need an additional 3.5 workers in the next 20 years just for the patients of Alzheimer’s disease. Therefore it is foreseen that there is a need to train health care workers for the geriatrics sector. Without a doubt, Alzheimer’s disease is a social and public health problem that is predicted to affect millions of aging citizens in many nations. Aside from the effects on the patient itself, it can also affect the emotional and financial health of families and societies. Being able to cope with these effects is a major challenge to the health care sector of any nation. REFERENCES 1. Alzheimer's Association. (2011). Alzheimer’s & Dementia. Chicago: Alzheimer's Association. 2. Alzheimer's Association. (2010). Women and Alzheimer's Poll. Chicago: Alzheimer's Association. 3. Alzheimer's Disease Cooperative Study. (1997). A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer’s disease. New England Journal of Medicine, 336:1216-1222. 4. Family Caregiver Alliance. (n.d.). Alzheimer's Disease. Retrieved 2011 March, from Family Caregiver Alliance National Center on Caregiving: http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=567 5. Hebert, L., Scherr, P., Bienias, J., Bennett, D., & Evans, D. (2003). Alzheimer’s disease in the U.S. population: Prevalence estimates using the 2000 Census. Archives of Neurology , 60(8):1119–1122. 6. Hiraki, S., Chen, C., Roberts, J., Cupples, L., & Green, R. (2009). Perceptions of familial risk in those seeking a genetic risk assessment for Alzheimer's disease . Journal of Genetic Counseling , 18(2):130-136 . 7. Smith, M., Perry, G., & Richey, P. (1996). Oxidative damage in Alzheimer’s. Nature, 382:121-122. 8. Sorensen, S., Pinquart, M., & Duberstein, P. (2002). How effective are interventions with caregivers? An updated meta-analysis. Gerontologist, 42(3):356-372. 9. The Parkinson Study Group. (1993). Effects of tocopherol and deprenyl on the progression of disability in early Parkinson’s disease. New England Journal of Medicine , 328:176-83. Read More