Causes, Diagnosis, Treatment of Neurological Disorders - Essay Example

Dementia of the Alzheimer’s Type Student’s name Course name and number Instructor’s name Date submitted Neurological disorders are disorders that affect the body’s nervous system. These disorders are directly traceable to structural destruction of the brain tissues or nerves, biochemical imbalances or electrical abnormalities that have a major effect on the cognitive processes like memory. Dementia is an example of the neurological disorders that is characterized by a general deterioration of emotional, intellectual and motor functioning due to progressive pathological changes in the brain. Dementia of Alzheimer’s type has no cure and is the most common form of dementia that worsens with recognizable stages. This paper discusses the physiological basis of dementia of Alzheimer’s type, its prognosis, treatment considerations and impact it has on self and family unit. According to WHO (2006), dementia arise when there is disturbance of multiple higher cortical functions that include thinking, memory, orientation, calculation, comprehension, learning capacity, language and judgment. This condition which mainly affects the older people can be caused by various medical conditions and abuse of drugs or alcohol that cause negative changes in the cognitive functioning of an individual. Some of these causes include infectious diseases of HIV and syphilis, variety of traumas to the brain that destroy blood vessels such as stroke, severe head damage, introduction of poisonous or toxic substances to the body, and diseases such as Huntington’s and Parkinson’s. Based on their etiology, Durand (2006) identifies five classes of dementia: dementia of Alzheimer’s type; Vascular dementia; dementia due to other general medical conditions; substance induced persisting dementia; and dementia due to multiple etiologies. Dementia of the Alzheimer’s type This is the most common form of dementia and is characterized by both cortical senile plaques (microscopic lesions in the neurons) and neurofibrillary tangles (twisted and distorted nerve fibers). The primary symptoms of Alzheimer’s disease include cognitive deficits that develop gradually and steadily- particularly, impairment in memory, judgment, orientation and reasoning (Durand, 2006). Individuals with Alzheimer’s disease are unable to integrate new information and thus fail to learn new associations. They forget important things and are prone to lose objects. According to Scarmeas et al (2007), the early signs of the disorder include failure of memory and concentration, irritability, and mild difficulties in recalling words and names. As the disorder develops, the patients tend to lose interest in others thus becoming socially isolated, they become confused, agitated, depressed, anxious or even combative. Further, patients may display other cognitive disturbances such as apraxia (impaired motor functioning), aphasia (difficulty with language), agnosia (failure to recognize objects) and difficulty in such activities like planning, sequencing, organizing or abstracting information. These cognitive impairments represent a significant decline from previous abilities since they have a serious negative impact on the occupational and social functioning. Prognosis The prognosis for individuals with dementia of the Alzheimer’s type does not seem to be good. These patients expect to live for about 8 years after the diagnosis. However, other factors such as the individual’s overall health may make the life expectancy to vary from one patient to another and some may live for 20- 25 years after the diagnosis (Gordeau & Hillier, 2005). Generally, the life expectancy for these patients is shortened, but it is not easy to predict the exact time for each individual patient. Qizilbash (2002) argues that the time varies because there is no definitive biological marker of the disease onset. Therefore, the duration and long term prognosis depend on the methodology used to mark the onset time of dementia. Besides, a delay is likely to occur between the onset of mild symptoms and clearly diagnosed dementia. Sadik & Wilcock (2003) say that the Functional Assessment Staging System (FAST) can be used to follow the progression of Alzheimer’s disease and thus helping to decide how far the problem has progressed. This system consists of 7 stages. The first stage comprises of no symptoms while the seventh stage describes the advanced end stage of dementia. In the early stages, the patients are mildly impaired and Sarbadhikari (2005) refers this condition as mild cognitive impairment (MCI). Qizilbash (2002) say that it is not clear if the MCI patient should be given treatment since there are no randomized controlled trials of therapies for MCI. In spite of these uncertainties on the outcomes of mild dementia, broad statements are made on what to expect, and how to manage the patients with these syndromes. Research indicates that lower survival rates of dementia cases are associated with male gender, older age, lower education, greater number of co-morbidities and greater functional disability. In stage six, the individual need supervision in bathing, dressing, toileting and eating. Caregivers play an important role in ensuring the patients carry out these activities effectively (Shaji, 2002). Also, late deficits such as incontinence and inability to flush the toilet may develop and patients normally die or are institutionalized after three years. Besides, they may stop eating spontaneously but they need encouragement. The difficulty of eating displayed mark the terminal phase of Alzheimer’s dementia and patients die after a year. Prognosis information is so crucial in considering the dementia treatment that should be offered and the anticipated quality of life as well as presenting the likelihood of accrued risks. The prognosis is not aimed at offering treatment since there is no long term efficacy of the treatments for dementia but rather, it helps to determine decisions in a more qualitative process while projecting family expectations. Another prognostic question answered through the information is whether there is a likelihood of having additional care such as going to long term care facility or a nursing home. This, however, depends on the country in which the patient resides. Some countries like in the USA have their patients reside in the nursing homes (Qizilbash, 2002). Treatment Considerations According to WHO (2006), an early diagnosis helps the caregiver to deal with the disease effectively as well as know what to expect. The diagnosis of Alzheimer’s disease takes into consideration the individual’s problems from close people, together with an examination of the individual’s mental and physical state. Other illnesses and conditions that cause memory loss, such as alcohol problems, depression and other organic brain effects should be excluded. At present, there are no treatments of dementia due to the nature of damage that the disorder causes. Damage of some of the brain neurons is compensated by the development of new neurons due to plasticity. Besides, there is no known treatment that can restore the lost abilities. The only available treatment is aimed at preventing its spread and further damage and to help the individuals and the caregivers to cope with the advancing deterioration. Thus, the biological treatments aim to stop the cerebral deterioration while the psychosocial treatments help the patients and the caregivers to cope with the condition. Biological treatment Alloy, Jacobson & Acocella (2000) argue that Alzheimer’s disease cause a disruption in the production of neurotransmitter acetylcholine, and presumably, its symptoms may be relieved by raising the acetylcholine levels. Various drugs such as tacrine hydrochloride (Cognex), donepezil (Aricept) galantamine (Reminyl), and rivastigmine (Exelon) have been developed to decelerate the progressive decline of the cognitive abilities by preventing the breakdown of neurotransmitter acetylcholine. Most researchers, however, indicate that the gain is not permanent. The patients respond positively at first but continue to experience a cognitive decline later on. Cognex gives modest benefits but the side effects are serious i.e. liver problems. Aricept seem promising since it has no adverse effects on the patient’s liver functions, and thus, replacing Cognex. Another promising treatment is 2000 IU per day of vitamin E per day. It slows the progression of Alzheimer’s disease among patients with moderately severe impairment as compared to placebo. Other drug regimens such as estrogen replacement therapy for older women, anti-inflammatory drugs as well as other drugs that inhibit the immune system decrease the risk for Alzheimer’s (Gordeau & Hillier 2005). In addition, Ginko biloba (maiden hair) helps inn improving the memory of individuals with Alzheimer’s disease. All mentioned drugs do not act on the disease, but rather on the symptoms by making a small contribution in maintaining the cognitive functions (WHO, 2006). Therefore, there are no drugs available that can directly treat or completely stop the progression of the conditions that cause the cerebral damage in Alzheimer’s disease. Anti depressants such as the SSRI are recommended by doctors since they alleviate the anxiety and depression which, more often, accompany the cognitive decline. Antipsychotic is also helpful for those who are agitated (Alloy, Jacobson & Acocella, 2000). Psychosocial treatment The non-drug interventions focus on enhancing the lives of the individuals with dementia and their families. According to (WHO, 2006), the psychosocial interventions such as the provision of information and support to the caregivers help in reducing severe psychological distress. Alloy, Jacobson & Acocella (2000) adds that the patients should be taught skills that help them compensate for the lost abilities. They are encouraged to use memory aids to help them carry out conversations. Such aids can also be used to help the individual to orient themselves in places and time. This helps in reducing the frustration that they may have when it comes to the awareness of their own decline. Psychosocial treatment is an alternative to physical and medical restraints since it provides cues to help the individuals to safely navigate in their homes as well as other places. They also relieve the caregivers the necessity of monitoring the patients. The caregivers are given assertive awareness to help them deal with hostile behaviors such as verbal abuse or physical aggressiveness that are common in individuals with dementia. The caregivers are educated on how to handle stressful situations. Generally, supportive counseling can help the caregivers and other family members to cope with the depression, frustration, guilt and loss that may be a great emotional toll for them (Shaji et al, 2002). They also need information on dementia as well as the implications it has on the family. This will help the caregivers in understanding how the disorder progresses so that they may be able to manage behavioral difficulties and develop effective ways of communicating with the patients. Generally, there is no imminent indication that the cognitive decline characteristics of dementia can be stopped. The available medication gives some recovery of function but do not stop the progressive deterioration of cognitive abilities. Psychological treatment helps individuals to cope effectively with the loss of cognitive abilities during the early stages of dementia. Unconditional support for the caregivers and understanding is also necessary, and therefore, there needs should be identified and attended to. Impact on self and family unit Dementia affect patients in different ways and its impact on these patients depend on their personality, physical health, lifestyle, and significant relationships they had before the disease. During the early stages, which is often overlooked as a normal aging process, the patient get language problems like difficulties in talking, experience significant memory loss especially for thing that just happen, show loss of interests in activities and hobbies, react aggressively or angrily in some occasions, show mood changes, anxiety or depression, become unmotivated or inactive, become lost in familiar places and may have difficulties in making decisions as well as knowing the time of the day or the day of the week (WHO, 2006). As the disorder progresses the individual experiences difficulties in their daily lives and may become very forgetful especially on people’s names and recent activities, become extremely dependent on caregivers and family members because they cannot be able to live alone without problems in cleaning, cooking and shopping, become lost outside and even within home, may have hallucinations, have behavioral problems such as repeated questioning, disturbed sleeping, calling out and may have increased difficulty with speech, washing and dressing and therefore, they need help (Sarbadhikari, 2005). The late stage is marked by inactivity or nearly total dependency from the caregivers or the family. The individuals have serious problems with the memory. They may be unable to communicate, eat and may have difficulties in recognizing friends, relatives and familiar objects. They may also not be able to understand what is going on around them and have difficulties in finding their way home, walking and swallowing. In addition they may display bladder and bowel incontinence as well as display inappropriate behavior in the public. Generally, dementia causes disability in later life of the patients. According to Sadik & Wilcock (2003), the family unit suffers from enormous costs associated with “formal care” of the patients with dementia that include their health care, social and community care, long term residential or nursing home care, respite care and “informal care” that include unpaid care by the family members as well as the lost opportunity of earning income by the individual. As the disease progress, the need for medical staff involvement increases resulting into increased formal care costs with institutionalization raising the overall costs. It is also a burden for the delivery of care due to the frustrations and stressful situations they have. Conclusion Alzheimer’s disease is a disorder with no effective treatment and its seriousness progresses over time. The disorder is common with the elderly peoples and it makes an individual’s intellectual and emotional abilities to deteriorate. The cognitive impairment hinders the person’s occupational and social functioning, and thus, depending heavily on the family and caregivers. Patients with Alzheimer’s type of dementia have a shorter life expectancy. Treatments given to these patients include biological and psychosocial treatments and are only aimed at reducing the symptoms rather than curing the disease, and making the individual and the caregivers to cope with the disorder. References Alloy, L., Jacobson, N. & Acocella, J. (2000). Abnormal Psychology: Current Perspectives (8th ed). New York, NY: Mc Graw-Hill. Durand, B. (2006). Abnormal Psychology: Integrative Approach (4th ed). Mason, OH: Thomson Wadsworth. Gordeau, B. & Hillier, G. (2005). Alzheimer's Essentials: Practical Skills for Caregivers. California: Carma Publishing LLC. Qizilbash, N. (2002).Evidence-Based Dementia Practice. Malden, MA: Wiley-Blackwell Sadik, K. & Wilcock, G. (2003).The Increasing Burden of Alzheimer disease. Alzheimer Disease and Associated Disorders. 17(3): S75–S79. Sarbadhikari, S. (2005). Depression and Dementia: Progress in Brain Research, Clinical applications, and Future Trends. London: Nova Publishers. Scarmeas, N., et al. (2007). Disruptive Behavior as a Predictor in Alzheimer Disease. Archives of Neurology. 64(12): 1755-1761. Shaji, K. et al. (2002). Caregivers of Patients with Alzheimer’s disease: A Qualitative Study from the Indian 10/66 Dementia Research Network. International Journal of Geriatric Psychiatry. 18:1–6. WHO (2006). Neurological Disorders: Public Health Challenges. Switzerland: World Health Organization Read More