Analysis of Alzheimer's Disease - Essay Example

Running head: Alzheimer’s disease Alzheimer’s disease The Human Experience of Disability My meeting with Jane was quite distressing as I observed this 65-year old woman sitting silent, with not much of reaction towards what was happening in her surroundings. At first she looked at me, stared for a few seconds, and continued to look out of the window by her bedside. She did not respond to my greeting, nor did she ask me who I was or what I wanted, and looked extremely dull. At first, anyone would have thought that Jane was mentally ill or probably deaf. However, her condition was something different. I also observed her mumbling something to herself, which I could not comprehend. I was told that she was suffering with Alzheimer’s disease, a condition very often found in people above 60. This is a neurological disorder leading to dementia, and most commonly described as loss of mental abilities such as memory and reasoning. With its progressive nature, it manifests as slight memory and language problems in the beginning and further leading to confusion, personality and behavioral changes. Thus, this disease manifests in the form of cognitive and behavioral symptoms. Physiological The most common clinical findings in this disease include loss of recent memory, problems in calculation and execution of activities. These difficulties eventually progress to dementia in a span of eight to nine years. Motor functions may get impaired in the terminal stages of the disease causing inability to walk or move. The pathological precursors of this disease begin several decades before the clinical symptoms are manifested. The most important characteristic features of this disease, as described by Alois Alzheimer in 1907, are neuronal loss, profuse extracellular deposition of amyloid B peptide (AB), and widespread formation of intraneuronal neurofibrillary tangles, usually found in the higher order cortical regions including frontal, parietal, and temporal cortex and the limbic system, and are relatively rare in primary motor or sensory areas except for olfaction. For this reason, Alzheimers disease is looked at more like a cognitive disorder than motor one (Rogers, J.; 2001). However, the reasons for neurodegeneration are still unknown. Incidence Alzheimers disease, like most other chronic diseases, is likely to be caused by a complex interaction of genetic and environmental risk factors. A few definite risk factors associated with Alzheimer’s disease, identified by Kuhn and Bennett (2003), are advanced age, family history in firs-degree blood relation, genetics, Down’s syndrome, history of head trauma, and low educational and occupational status. This disease commonly affects people aged above 65 years; the chance of getting affected is about one in 20, and after the age of 80, chances further increase to one in five. When the disease occurs in people who are over 65, it is considered a sporadic or late-onset; when it occurs in younger people, i.e. between 40-60 years, it is considered as early-onset or familial Alzheimer’s disease (FAD) with a definitive genetic link (Silverstein, Flaherty & Tobin, 2006). Researches carried out in the US populations have projected a three-fold increase in incidence of Alzheimer’s disease over the next 5 decades if no proper interventions or new discoveries in this field are undertaken in the present situation (Herbert et al, 2003). Signs and Symptoms Alzheimer’s disease manifestations can be seen in the brain with disruption of three key processes, i.e., nerve cell communication, metabolism, and repair. This disruption ultimately causes nerve cells to stop functioning, lose connections with other nerve cells, and die. The disease progresses in stages; firstly, in the form of early mild forgetfulness, and then to severe loss of mental function, referred to as dementia. Jane’s current state could be a transitional state between these two stages because of her behavior. As I eventually frequented my visits, she occasionally recognized me and greeted me with my name, but at other times she either did not recall my name or sometimes even did not respond to my greetings. The cognitive symptoms include problems with thought processes like memory, language, and judgment. Behavioral symptoms include agitation, suspicion, and depression (Alzheimer’s disease, n.d). Symptoms of depression include irritability, crying spells, apathy, difficulties with concentrating or remembering, sleep disturbance, fatigue, problems with eating (weight gain or loss), diminished interest in pleasurable activities, feelings of worthlessness and hopelessness, and a gradual loss of intellectual abilities. A growing dependency on others because of limitations imposed by the disease may diminish their self-esteem. I found most of these symptoms in Jane with varied intensities. For instance, I found her very depressed and fatigued at times, which she related to inability to sleep properly. At times she also exhibited indifference towards the activities she was supposed to perform, with my assistance. She wished to be left alone with the pretext of feeling sleepy. With the frontal lobes getting affected, the patient may become disorganized or exhibit inappropriate behavior. When the parietal lobes are affected, the patient may lose his/her orientation skills, which I found in Jane’s inability to wear her clothes properly. Eventually, when all lobes get affected, the patient may lose the ability to perform routine and daily tasks (Fotuhi, 2004). Current Health Based on Jane’s age, and the symptoms and signs, I feel her Alzheimer’s has either progressed faster or had begun slightly earlier. At 65, she exhibited lack of orientation skills, at times behaved violently and indifferently. Although she was able to perform her daily routine tasks like eating, taking a shower, dressing up etc, she did not seem to be doing these activities as one would expect from a normal person. Snowdon et al (1996) and Reiman et al (1996) have noticed that the disease process may begin well before the symptoms appear, almost 20 years before clinical diagnosis (qtd.in Silverstein, Flaherty & Tobin, 2006). Diagnostics People having difficulties with memory and other mental functions are examined by a healthcare provider to diagnose Alzheimer’s disease. This examination includes person’s history, complete physical exam, laboratory tests, brain scans, and a series of other tests to measure cognitive skills such as memory, language skills and other abilities related to brain functioning. Here, it is important to rule dementia caused due to other illnesses and medications. Consequent to the pathological processes associated with this disease, biological changes in the brain can be observed at a microscopic level. These changes include neurotransmittal loss, dendritic pruning of neurons, and neuronal cell death. Complex imaging techniques are used to assess these changes. Various functional imaging techniques used include single photon emission computerized tomography (SPECT), positron emission tomography (PET), proton magnetic resonance spectroscopy (MRS), diffusion tensor imaging, and functional magnetic resonance imaging (fMRI). Structural imaging of the brain is studied through magnetic resonance imaging (MRI) and computerized tomography (CT) (Barnes, Archer & Fox, 2007). Scope of Ability/ Limitations Although Jane lived on her own for more than 5 decades and gained enough experience of work and life, her present health condition does not permit her the same independence and dignity. It is extremely difficult for her to live alone and perform her daily chores properly. Issues related to safety and security is also a concern, although she is not in a position to realize the same. She needs support and assistance from other people to live a normal life, which she can get adequately with the help of Creative Support Alternatives (CSA) group. It has been proved that Alzheimer’s has no cure, and progresses towards greater severity with age; it progressively impairs all functions of human body and mind including cognitive and behavioral impairment. Hence, external support becomes mandatory as the disease progresses. Although the disease cannot be cured, support is required to help the patient carry out his/her daily chores, maintain reasonably good health as far as possible and live a dignified life till the end. Environmental factors Restoration and Adaptation: Caregiving to Alzheimer’s patients is a complex and sensitive task especially if they live alone. In the initial stages, caregivers focus on helping the patient get adapted to new situations, which is a challenge because forgetting habitual behaviors takes longer time. For example, Jane is used to making her own breakfast in the morning; this activity poses potential risk of accident or harm to her in different ways such as improper cooking, forgetting to turn fire off, inability to recognize leakage, spillage etc. In this condition, Jane needs to be monitored and assisted to perform her routine tasks. Other alterations such as safety locks, fire alarms, labeling household items, making checklist of items etc will help reducing risk to an extent and also assist her in carrying out her routine activities without much problem. Jane needs to be constantly made to follow new routine or new methods of performing her routine tasks till she gets used to the new ways of doing things. Another challenge in caretaking of Alzheimer’s patients is the progress of the disease itself. Caregivers have to be consciously looking for changes in symptoms, behaviors, and cognitive abilities of the patient, and modify their methods accordingly. Exacerbation and Remission: Alzheimer’s disease being progressive in nature, symptoms only become more and more severe, eventually disabling the patient completely making him/her bed-ridden, losing drinking and eating abilities, incontinence of stool and bladder, and inability to recognize others. Jane’s behavior is indicative of progress, however has not yet reached the severe stage. In case of severity of any of the symptoms, she will be observed and tested for infections and appropriate treatment will be provided (Patterson, Albala & McCahill, 2006). Management of Alzheimers disease is done separately for cognitive and behavioral symptoms. According to the American Psychiatric Association (2006), a comprehensive care plan for this disease should include appropriate treatment options and a continuous monitoring of the options for their effectiveness; changing of treatment course and exploring alternatives as necessary; consider individual and family goals for treatment and tolerance for risk; appropriate counseling for caretakers of the patients. Race, Class, Gender & Culture: People diagnosed with Alzheimer’s disease inevitably become disoriented, forgetful, behave inappropriately, and show drastic changes in their personality. With progress of the disease, they tend to lose the ability to identify themselves with specific group, family, or even society. Although they seem to recognize their place of living or the way they worship, they will not be able to logically relate these aspects to their own origin or existence. With this disease affective the life time of a person, Andersen and Taylor (2005) explain that life expectancy is also determined by factors such as gender, race, social class etc; hence, quite possible that incidence of this disease also depends on these factors. Strategies for Success Management of this condition is a sensitive issue and requires different approaches including medication and non-medication treatments. Specifically, behavioral symptoms treatment is classified as non-drug treatments and prescription medications. The non-drug treatment includes identifying the symptom and cause followed by changing the environment to remove challenges or obstacles; often change in patient’s environment causes the symptom. Observable behavioral symptoms in Jane include depression, mood swings, anxiety, and irritability; pharmacological treatments approved in these conditions include anti-anxiety medications, anti-depressants, and anti-psychotic drugs. Two interrelated causes of depression have been identified, psychological disturbances and biological changes. It is important to ensure Jane is not exposed to too much noise, light, heat or cold. It was also seen that Jane behaved better during and after a short evening walk. Professional Implications Strengths and weaknesses in a care-giving role are measured based on their attitude, patience, skills, awareness, knowledge, true concern, their ability to deal with problems, etc. This requires creation of an emotional or a psychological environment to facilitate the adjustment for the patient to cope with the changes happening biologically and psychologically. The caregivers have to establish trusted and supportive relations with the patient and his/her family to enable them to deal with the situation (Eisenberg, Glueckauf & Zaretsky, 2005). Conclusions: In conclusion, Alzheimers disease is a disorder identified with many etiologies and is connected with brain and its functions. The dementia associated with this disease is more serious as it progresses. It is associated with deterioration of cognitive functions followed by behavioral functions. No specific cause can be attributed to this distressing disease which affects elderly persons mentally and physically. From an incurable stage, it has reached a stage where most of the symptoms can now be addressed with appropriate care and frequent monitoring. A myriad of treatment methodologies are being developed to manage this disease through prevention, slowing and treating its symptoms. As this disease requires wide-ranging, rigorous, and serious management, its treatment can prove very expensive. The family members and community play a vital role in bringing about improvement in the patient’s condition. References Andersen, M.L. and Taylor, H.F. (2005). Sociology: understanding a diverse society. (4th ed.) U.S.A: Cengage Learning. http://books.google.co.in/books?id=LP9bIrZ9xacC&pg=PA365&lpg=PA365&dq=race+class+gender+culture+alzheimers+disease&source=bl&ots=Qd7LFdirBA&sig=1Bu1z19er3fSDoSliVD1lba2etA&hl=en&ei=OC42S6fxIY-gkQWskdCCBA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CCUQ6AEwBg#v=onepage&q=&f=false Barnes, J, Archer, H, and Fox, N.C. (2007) Imaging cerebral atrophy in Alzheimers disease. In Sun, M.K’s (Ed) Research progress in Alzheimers disease and dementia. New York: Nova Publishers Inc. pp. 403-435. http://books.google.co.in/books?id=o2kw6t8oRFAC&pg=PA403&dq=alzheimer%27s+disease+above+65+years+and+above+80+years Eisenberg, M.G, Glueckauf, R.L. and Zaretsky, H.H. (2005). Medical aspects of disability, a handbook for rehabilitation professional. New York: Springer Press http://books.google.co.in/books?id=YTYRSGY6il4C&pg=PA613&dq=strengths+of+a+rehab+worker&lr=&as_brr=3&ei=yzmsSvfSDJ2sNYz0ueIN#v=onepage&q=&f=false Fotuhi, M. (2004) The Memory Cure: How to Protect Your Brain Against Memory Loss and Alzheimers Disease. Published by McGraw-Hill Professional. http://books.google.co.in/books?id=eFruMLHTupoC&printsec=frontcover&dq=The+Memory+Cure+By+Majid+Fotuhi&cd=1#v=onepage&q=&f=false Patterson, J, Albala, A.A and McCahill, M.E. (2006). The therapists guide to psychopharmacology: working with patients, families, and physicians to optimize care. New York: Guilford Press. http://books.google.co.in/books?id=EC-SyITUPMoC&pg=PT146&dq=exacerbation+of+alzheimers+disease&cd=5#v=onepage&q=exacerbation%20of%20alzheimers%20disease&f=false Rogers, J. (2001) Neuroinflammatory mechanisms in Alzheimers disease: basic and clinical research. U.S.A: Birkhäuser. http://books.google.co.in/books?id=x5y3wRrRquAC&pg=PA3&dq=alzhemier%27s+disease&lr=#PPA3,M1 Silverstein, N.M, Flaherty, G and Tobin, T.S. (2006). Dementia and Wandering Behavior: Concern for the Lost Elder. U.S.A: Springer Publishing Company. http://books.google.co.in/books?id=vPK6lijpje8C&pg=PA10&dq=progressive+stages+of+behavior+in+Alzheimers&ei=2uM1S7jfBpuOkQT5ucnJAQ&cd=5#v=onepage&q=&f=false American Psychiatric Association (2006). American Psychiatric Association practice guidelines for the treatment of psychiatric disorders. U.S.A: American Psychiatric Pub. http://books.google.co.in/books?id=zql0AqtRSrYC&pg=PA169&dq=American+Psychiatric+Association+(2006).++American+Psychiatric+Association+practice+guidelines+for+the+treatment+of+psychiatric+disorders.+Published+by+American+Psychiatric+Pub#PPA102,M1 Journal: Herbert et al. (2003). Alzheimer Disease in the US Population: Prevalence Estimates Using the 2000 Census. Arch Neurol. U.S.A. Vol.60 No. 8. pp: 1119-1122. Accessed on December 26, 2009 from, http://archneur.ama-assn.org/cgi/content/full/60/8/1119 Website: Alzheimer’s Disease. (n.d.). Retrieved from Wikipedia: The Free Encyclopedia. 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