Alzheimers Disease: Experiencing the Myths - Essay Example

?Alzheimer’s Disease: Experiencing the Myths Alzheimer’s disease (AD) is a progressive and irreversible brain disease affecting the person’s perception, memory, language, emotion, and other executive functioning. It is the most common type of dementia, and accounts for about 60- 80% of all cases (Alzheimer’s Association, 2011). A clinical pattern of symptoms usually begins from frequent forgetfulness to difficulty of performing tasks, cognitive compromise and behavioral outbursts. Significant formation of protein fragment beta-amyloid (plaques) and twisted strands of the protein tau (tangles) that eventually interferes with the normal physiology of the brain cells distinguishes it from the normal process of aging (National Institute of Aging, 2003). Although medical research still could not provide a single and reliable cure, improvement is now realized in the management of clients with AD (Sorensen, 2009). In this paper, a case of AD is examined in details including a background information, symptoms, assessment, and prognosis. Background information Catherine, 76, started showing signs of Alzheimer’s disease at age 60 when she retired from her work as a clerk in small sales office. Her family reports that “she was rather a sickly child…” In fact, her medical records say that she had frequent bouts of pneumonia especially during winter. Although she did not have a good physical health, she was a chronic smoker. When she was younger, clinic visits had been a part of her monthly routine. Aside from this, she was hospitalized after having a heart attack, and was diagnosed of having Coronary Artery Disease with incomplete blockage in the anterior heart portion. At 57, she sustained a serious head injury after she fell down the office staircase. After she recovered from the injury, she was advised with activity limitations. She is an African- American, and her uncle on the maternal side was also diagnosed of AD at age 77. Symptoms The main presenting symptom for AD is frequent forgetfulness that resulted to gross negligence associated with unacceptable reasons (Alzheimer’s Association, 2011). The client noticed her being forgetfulness three years before she retired from her work. However, she attributed this decline in memory into aging and did not tell her doctor about it. Since she was advised with activity limitations, her social activities with her friends and associates were gradually reduced. Not until she forgot that she was cooking one night and left the stove open for hours, she was brought by her daughter to the hospital for a check- up. Memory. Having a fragile memory affected her work as a clerk. Although it is normal to occasionally forget an assignment, deadline, or colleague’s name, her frequent forgetfulness or unexplainable confusion at home or in the workplace signaled that something was wrong. There were also times that she was disoriented to time and place. One afternoon, she could not remember how she got into a park. Although it seemed familiar, the rapid transition of people in the park made her confused until she could not remember how to get home. Furthermore, she frequently forgot where she placed important household things like keys, knife, iron, and her favorite wristwatch. Until she found these things in unusual places at home like in the tool box, oven, or broom stand. Perception. People with AD eventually lose the ability to respond to their environment (Alzheimer’s Association, 2011). In this case, the client experienced trouble understanding visual images and spatial relationships. While she has intact sensory function, she has difficulty recognizing or identifying objects. In the late stage of AD, the client was having visual hallucinations and delusions, meaning she was seeing things which are not there, and perceiving false ideas of reality. Language. Along with her difficulties of perception and memory, the client was observed to have inappropriate use of words and vocabulary, compromising her communication with other people. Her sentences were difficult to understand despite the efforts of her caregiver. She lacked the words to say, and she could not understand other people’s words. Everything seemed meaningless to her. Everything was mere mumbling, and nonsense. Emotion. The compounded problems with memory, perception and language made her feel isolated, angry, suspicious, and fearful. It was a shapeless fear, directed to everyone, and she did not know the reason why. She could not understand her emotions. There was a dramatic change in her personality over a period of time. Because of this, she had emotional and behavioral outbursts. Executive functioning. The most difficult social consequence of AD is the progressive degradation of executive functions (Alzheimer’s Association, 2011). The client experienced difficulty performing familiar tasks. At first, she had a problem performing basic calculation which is the basic nature of her work. Numbers seemed meaningless to her. Later, she could not read any printed words. Newspapers, magazines, and other reading materials did not interest her. Then she began to lose interest in her work and social activities. She could not decide what to do and preferred to stay at home. There was one instance that she requested to go on swimming at a beach during winter. Indeed, she has lost her reasoning and logic. Assessment and Other Data The complex interplay of cognitive and behavioral discrepancies affected the client and her concerned family. Subsequent neuropsychological tests were performed to determine her overall functioning. To assess her daily functioning, a comprehensive interview from the patient and her surrogates was performed using the Barthel Index that include feeding, bathing, dressing, mobility, toileting, and instrumental activities like shopping, cooking, and managing finances and medications. The initial assessment of functional abilities is important to determine a baseline to which future functional deficits may be compared. Assessment of a patient’s living environment can identify environmental supports that may be needed to maximize function, ensure safety, and minimize caregiver stress (California Workgroup, 2008). On the other hand, neuropsychological testing using Mini Mental Status Examination (MMSE) was performed to differentiate cognitive deficits of AD from other dementias as well as deficits associated with other neurological and psychological disorders. Since AD is associated with co-morbid medical conditions (American Psychiatric Association, 2007), the involvement of family members and other caregivers in gathering a history and completing an evaluation to identify co-morbid medical conditions is essential. Although biopsy of brain tissue once the patient has died is still the definitive diagnostic procedure to confirm AD, several imaging studies have been utilized in the actual clinical setting to help doctors rule- out other possible causes of cognitive deficits. In this case, a Computed Tomography (CT) scan of the client’s brain showed cerebral atrophy and ventricular enlargement, wide sulci and shrunken gyri. These are indicative of a significant neuronal loss in the cerebrum causing problems in logic and thinking, memory, perception, emotions and language. In addition, the Positron Emission Tomography (PET) scan in the brain showed a significant decrease in its metabolic activity. In fact, the results of electroencephalogram (EEG) showed slow-wave delta activity. Actually, the slow-wave delta activity and decreased metabolic activity together suggest a compromise in the normal brain processes causing cognitive and behavioral changes. Prognosis Currently, the medical literature still could not provide a precise medication that could reverse the progress of AD. The drugs available are prescribed to slow down its progress and help the patients to cope and adapt to the cognitive deficits. Based on the severity of the client’s symptoms, she is now in the late stage of AD. The ability to understand treatments and participate in medical decision-making declined with the progression of the disease. Her care shifts to focus on the relief of discomfort. Normative Background The involvement of specific areas of the brain is the key in understanding the cognitive deficits experienced by the client. The brain is composed of billions of brain cells (neurons), performing as a group vital function comparable to a well- specialized industry. These neurons communicate with each other through synapses at its ends. With the rapid exchange of electrical impulses, oxygen and nutrients are used up. This rapid metabolism happens in a healthy brain. Speech, memory, logical and emotional response, as well as consciousness, interpretation of sensation, and voluntary movement, are all functions of neurons of the cerebral cortex (Marieb, 2006). These groups of neurons are located at specific areas of the cerebrum. In AD, there is an increased formation of neurofibrillary tracts and tangles. Scientists do not know exactly what role plaques and tangles play in Alzheimer’s disease. Most experts believe that they somehow play a critical role in blocking communication among nerve cells and disrupting processes the cells need to survive. It is the destruction and death of nerve cells that causes memory failure, personality changes, problems in carrying out daily activities and other symptoms of Alzheimer’s disease (Alzheimer’s Association, 2010). References Alzheimer’s Association. (2010). Basics of Alzheimer’s disease: What it is and what you can do. Chicago, IL: Alzheimer’s Association. Alzheimer’s Association. (2011). Alzheimer’s Disease Facts and Figures, Alzheimer’s & Dementia, 7 (2). Chicago, IL: Alzheimer’s Association. American Psychiatric Association. (2007). Practice Guideline for the treatment of patients with Alzheimer’s Disease and other dementias. Second edition. (2007). American Journal of Psychiatry, 164, 4-56. California Workgroup on Guidelines for Alzheimer’s Disease Management. (2008). Los Angeles, CA: Alzheimer’s Disease and Related Disorders Association, Inc., Los Angeles Chapter. Marieb, E. (2006). Essentials of human anatomy and physiology. Singapore: Pearson Education, Inc. National Institute of Aging. (2003). Alzheimer’s disease: Unraveling the mystery. Silver Spring, MD: Alzheimer’s Disease Education and Referral (ADEAR) Center. Sorensen, A. (2009). Alzheimer’s Disease Research: Scientific Productivity and Impact of the Top 100 Investigators in the Field. Journal of Alzheimer’s Disease. Switzerland: IOS Press Read More