Treatment of Alzheimers Disease - Essay Example

? Paper Dementia/Alzheimer’s Disease A problem or opportunity in my field is identified by conducting a literature review to find out the impact of Alzheimer's disease on the lives of people. Alzheimer's disease is the most common type of dementia associated with problems in memory, behavior and thinking. It solely accounts for 50% of all dementias and 90% when combined with other diseases (Alzheimer’s Association, 2013; Geldmacher, 2012). It affects 5 million of the people in the US and could rise up to 13 million by 2050 and costs about $170 billion annually to care for the patients. There is a wide body of knowledge that addresses various aspects of the issue including causation, prevalence, effects and treatment. Thus, there would be no need for primary research. Alzheimer's disease has for long been associated with old age, particularly age 65 and above. However, it has also been reported to affect teenagers. It affects those with family histories of the disease and those people with diabetes mellitus, elevated levels of plasma homocysteine, cardiovascular diseases, depression, low educational achievement, lack of social interaction, lack of intellectual activity, lack of leisure activities and excessive response to stress. The ethical consideration of care dictates the standards of care that should be given to the people with whom the caregiver has concrete relationships. Alzheimer's disease affects people closely related to the caregiver and should therefore be accorded the deserved care. The following is the definition of Alzheimer's disease using cause-effect organizational pattern: Causes of Alzheimer's disease Biological factors Environmental factors Psychological factors Effects of Alzheimer's disease Negative behavioral changes Negative health effects Death Use of medicinal therapy and psychotherapy for treatment As noted by Geldmacher (2012), if Alzheimer's disease is not treated or treated in time, the plaques and tangles spread in the brain leading to death. Therefore, Alzheimer's disease is a dementia that causes problems in memory, behavior and thinking. Paper 2: Alzheimer’s Disease 1. What is Alzheimer’s Disease? Dementia is a terminology used in describing various kinds of brain disorders which progressively result in the loss of brain function. People affected by dementia particularly suffer from the problem of short-memory. Thus, such people consistently forget what they have just done but clearly recall what happened several years back. They typically lose the sense of place and time. Furthermore, they face challenges finding words and find it increasingly difficult to do new things or learn new information. With the passage of time, these people would need to be assisted in doing their daily activities such as eating, dressing and washing. Ultimately, they could become incontinent and uncommunicative. Dementias would often last for many years, even 20, and would usually not be the actual cause of death. There are more than 100 varied types of dementia (Alzheimer’s Association, 2013). The most commonly occurring type of dementia is Alzheimer’s disease. According to Alzheimer’s Association (2013), Alzheimer’s disease accounts for about 50% of all dementia cases, while Geldmacher (2012) further indicates that if this is combined with the clinical diagnosis of its occurrence with other diseases, it would account for 90%. Hence, it is common to find people referring to the disease as dementia. More than 5 million people in the US suffer from the disease, causing a financial burden of about $ 170 billion every year caring for these patients. By the year 2050, the number of those affected in the US could rise up to 13 million, the growth largely attributed to the growth in the number of the aging population. Alzheimer’s disease is therefore a type of dementia known to cause problems in memory, behavior and thinking. It got its name after a German neurologist, Dr. Alois Alzheimer (1864 – 1915), who observed the changes that occurred in the brain tissue of one woman thought to have died of an unusual mental illness in 1906 (Lu & Bludau, 2011). From research, it was appreciated that the woman had strange brain cells knots and clumps which later came to be known as tangles and plaques respectively. Plaques comprise of a protein that grows between neurons located in the brain. On the other hand, tangles comprise of a protein known as tau which changes throughout the course of the disease, causing the twisting and tangling of material thread which damages neurons. With immune cells fighting to get rid of the dying and dead cells, inflammation of the brain could occur. Figure 1 shows the spread of tangles and plaques from onset until the late stage of Alzheimer’s disease. Normal Brain Onset of AD Full-blown AD Figure 1: The progression of Alzheimer’s disease in the brain (Source: Alzheimer’s Association, 2013) Just as noted of dementia in general, AD has memory deficits and other forms of cognition deficits as its defining features. It reduces the ability of one to perform daily activities. These deficits come about as a result of neuronal loss and synaptic dysfunction following predictable distribution observed in the brain. Therefore, dysfunction observed in the polymodal association cortex, limbic cortex and hippocampus characterize the clinical pattern of the disease and assists in clinically differentiating AD from other dementias. Age, apolipoprotein E genotype and family history have been closely linked to the disease. Other risk factors documented by Geldmacher (2012) include diabetes mellitus, elevated levels of plasma homocysteine, cardiovascular diseases, depression, low educational achievement, lack of social interaction, lack of intellectual activity, lack of leisure activities and excessive response to stress. 2. Signs of Alzheimer’s Disease Cognitive signs The maiden symptom to be recognized in people with AD is memory dysfunction. This would be detected through clinical neuropsychological tests. According to Geldmacher, memory dysfunction would typically involve “difficulties with learning new information but relative preservation of remote factual information” (2012, 129). This is referred to as short-term memory loss. The impairment of recent memory results from the fact that new information do not get adequately stored for future recall. The short-term span increases with time. Furthermore, the impairment of declarative memory causes individuals to only store and later recall specific experiences and information. This memory loss trait changes with time, with moderate and mild stages exhibiting preserved recall of materials that were learnt before the onset of the dysfunction in memory. The late stage would be characterized by complete recall failure of information previously well remembered, including names of spouse, children and parents. Individuals with AD tend to be vulnerable to orientation to time and place. They have distorted relative time concepts such as the inability to recount the time passed since the most recent holiday. With progression of the illness, place orientation gets distorted such that these persons get lost in familiar settings. There could also be loss to self orientation, particularly in case of profound AD, with response or language disturbances preventing those mildly affected with AD from identifying themselves when questioned (Geldmacher, 2012). Language impairments begin with difficulty in finding a word in spontaneous speech, later becoming severe such that it interferes with the flow of speech, mimicking dysfluent aphasia. Additionally, Geldmacher (2012) observes that circumlocution becomes common. Progressively, language in persons with AD becomes vague due to substitution of generic words with more explicit nouns. They also use pronouns in place of proper nouns. It has also been noted that verbal comprehension and reading skills worsen with progression of the disease. In late stages, muteness, referred to as aphemia, become common (Lu & Bludau, 2011). As observed by Geldmacher (2012), about all AD patients develop apraxia in severe stages. The most common is ideometer apraxia, where the individual find it difficult to translate an idea into a properly directed action. This causes difficulties in managing eating utensils or clothing fasteners. Being unable to place parts of the body in position in space could cause problems in dressing and even positioning appropriately in the car. Individuals with AD also experience higher visual function disorder and executive dysfunction. According to Geldmacher (2012), a higher visual function disorder impairs basic visual processing including contrast and sensitivity to movement. The patient also suffers from deficit in depth perception. Thus, AD patients face the problem of using their vision for voluntary gazing at an item or guiding arm movements. Executive dysfunction results in problems with judgment, planning and solving and begins at the early stages of the disease. It could also cause an emergence of socially inappropriate behavior, poor task persistence and disinhibition. Executive dysfunction could cause positive symptoms due to abnormally triggered behaviors or negative symptoms resulting from inability to respond to normal motivating situation. Non-cognitive and behavioral signs Personality changes entailing apathy would be commonly observed in the early stages of Alzheimer’s disease involving loss of motivation. It involves reduced emotional expression, decreased expression of affection and diminished initiative. Geldmacher (2012) observes mood changes, depression and withdrawal in individuals with Alzheimer’s disease. Secondly, these people would be unaware of deficits, including illnesses. Later in the disease, these people exhibit psychosis making them prone to selection biasness, delusions and hallucinations. Depression has been noted by Geldmacher (2012) to increase with the severity of AD. Those who had depression prior to the disease experience more severe forms of depression. Also experienced in later stages of the disease is anxiety, which could cause catastrophic reactions involving intense short lived emotional outbursts according to Lu and Bludau (2011). Aggressive behaviors exhibited due to AD could be associated with delusions and misidentification of these delusions. Additionally, AD could cause pacing and wandering. Finally, AD could be exhibited by sundowning, referring to predictable increase in behavioral symptoms and confusion in the afternoon and evening. It is not considered as a unitary symptom as it indicates diurnal variation in symptoms other than a particular pathophysiology. The onset of Alzheimer’s disease would often be overlooked and incorrectly labeled by relatives, friends and professionals as normal ageing process. Being a gradual disease, Alzheimer’s Association (2013) appreciates that it could be difficult to point out exactly when it sets on. Moreover, the unawareness of illness in persons with AD could impede early diagnosis and hamper early effective management. According to Lu and Bludau (2011), the early signs of AD include showing difficulties with language, disorientation in time, getting lost in familiar places, significant memory loss, lack of motivation and initiative, difficulties in decision-making, loss of interest in activities and hobbies and aggression and depression. The disease follows different courses in different people at varied rates and symptoms. 3. How Alzheimer’s Disease Affect’s One’s Life Whereas most illnesses are known to attack the body, Alzheimer’s disease destroys the mind, thus annihilating the very self. It makes it troublesome for one to count money, balance a checkbook or carry out an activity requiring abstract thinking. They constantly find it difficult or impossible to search for the right word, in the end leading to difficulties in writing and reading (Geldmacher, 2012). AD patients lack the sense of time or where they are, causing them to wander around aimlessly. They become unable to solve simple challenges like what to do when water in a sink rises too high, and additionally finds it hard to do things that need planning. Furthermore, it results in mood swings and a change in personality, probably due to memory loss or frustration. Eventually, AD could cause depression (Lu & Bludau, 2011). These impacts of AD are gradual. Alzheimer’s disease affects not just the patient but even the people around him. Even before diagnosis of AD, the family of the patient would have witnessed the decline in memory of their loved one. Just as the patient, the lives of the family members get affected inexorably. One of the major ways in which the family gets affected as cited by Lu and Bludau (2011) is in the change of roles. A child used to playing could change into a caregiver, a reversal of roles which could be overwhelming. This could be taxing both psychologically and emotionally. This also applies to spouses, grandchildren and other members of a family. The caregiver involved in day-to-day care of Alzheimer’s disease patient witnesses as the health of a loved one progressively deteriorates. This caregiver could be affected physically, mentally, emotionally and even financially (Geldmacher, 2012). The responsibilities of the caregiver could extend for a long period of time depending on the course of the Alzheimer’s disease. 4. How Caregiver Could Deal and Cope with Alzheimer Disease Patients With the progression in Alzheimer’s disease, the needs of an individual also increase, causing an increased demand on the caregiver. Whether living with the affected person or not, a caregiver plays a critical role in the life of such a person. The burden of care giving could over time result in medical problems, including anxiety and depression (Lu & Bludau, 2011). With the physical, mental, emotional and financial burden pegged on the caregiver, it would be critical to have an effective approach to dealing and coping with the situation. To cope with the Alzheimer’s disease patient, the caregiver should set attainable goals on how the patient should be, including cleanliness, feeding and comfort. The caregiver should anticipate misrepresentation from the patient as the patient does not have the capability to interpret non-verbal and verbal cues accurately (Alzheimer’s Association, 2013). It would be important for the caregiver to thus be concise in communication, repeating the same communication using different words. Because AD barely affects the physical fitness of an individual, the caregiver should keep socializing with the patient as this could encourage them. Above all, flexibility would be an important virtue because the disease progresses and thus changes over time (Geldmacher, 2012). Changing a strategy that seems not to work for another that could work would lead to better results. To deal with the severity of cognitive impairment and behavioral symptoms associated with the Alzheimer’s disease, pharmacological treatment could be helpful following the physician’s prescriptions. Independence prompting approaches using incentives, physical and verbal prompting and physical guidance could help AD patients retain their physical and mental abilities and thus help them in their daily activities including grooming, dressing and eating. Mobility or strength enhancement techniques leverage on the benefits of exercise and include scheduled walking, simple stretches and peddling a stationary cycle among others. Finally, the caregiver could encourage art therapy that involves drawing, coloring, dance, sculpture and listening to music among others (Lu & Bludau, 2011). When the behavioral and medical issues make the disease complex to handle, referral to a geriatrician would be useful. Conclusion Alzheimer’s disease is the most common form of dementia that results in problems in memory, behavior and thinking. Though for long it was associated with old age, it has become common even among the young exhibited through a combination of cognitive and behavioral characteristics. It commonly causes memory loss in an individual which results in a myriad of other problems that affects even the family and the caregiver. Therefore, caregivers should adopt effective approaches to deal and cope with AD patients, appreciating that the disease progresses over time. However, complex behavioral and medical indications should be referred to a geriatrician for proper guidance. References Alzheimer’s Association. (2013). What is Alzheimer’s? Retrieved 1 December 2013 from http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp Geldmacher, D. S. (2012). Alzheimer disease. In M. F. Weiner & A. M. Lipton (Eds.), Clinical manual of Alzheimer disease and other dementias (pp. 127 - 158). Arlington, VA: American Psychiatric Association. Lu, Linda C. & Bludau, Juergen H. (2011). Alzheimer’s disease. Santa Barbara, California: ABC-CLIO. Read More