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The basics of Alzheimer’s Disease
Mississippi College 3/12/2009
Alzheimer’s (AHLZ-high-merz) is a disease of the brain that causes problems with memory, thinking and behavior. The first problem many people notice is forgetfulness that is severe enough to affect their ability to function at home or at work, or to enjoy lifelong hobbies. With the baby boomers aging thousands of Americans are expected to suffer from Alzheimer’s. Reports suggest that 10 million baby boomers will be affected. Although the cure and the cause of the disease are still unknown, researchers are trying to solve the mystery with the help of modern technology. With more advancement in science and medicine the longevity has become another issue, and hence it is necessary that the Alzheimer’s population get proper care and attention.
The main purpose of this paper is to try to explain the disease and its causes. Alzheimer’s is a gradual disease and is sometimes mistaken with common aging process. It is also necessary to know the signs and red flags for the disease. Hence, it is necessary to understand the phenomenon. This paper tries to explain the causes and the management of the disease. Family support and understanding are very important issues related to the Alzheimer’s. With proper care and attention Alzheimer’s can be slowed if not cured.
More than 5 million Americans now have Alzheimer’s disease (Alzheimer’s Association, 2008). Alzheimer’s disease (AD) currently afflicts over 5.2 million Americans, including an estimated 200,000 patients under the age of 65. The number is increasing annually as the population continues to age. Following the aging of the baby boomers, prevalence is expected to double by 2020. Studies show that one of every eight baby boomers is expected to suffer from this disease. Alzheimer’s disease is the most common cause of dementia. More women than men have Alzheimer’s and other dementias, mainly because women live longer, on average, than men, and their longer life expectancy increases the time during which they could develop Alzheimer’s or other dementias. The prevalence of Alzheimer’s and other dementias also differs for people with fewer versus more years of education and for African-Americans compared to Caucasians.
An estimated 5.2 million Americans of all ages have Alzheimer’s disease in 2008. This number includes 5 million people age 65 and over and 200,000 individuals under age 65 who have younger-onset Alzheimer’s. The Alzheimer’s Association estimates that there are approximately 500,000 Americans under age 65 who have Alzheimer’s or another dementia, and about 40 percent of them have Alzheimer’s disease. Every 71 seconds, someone in America develops Alzheimer’s disease. By mid-century, someone will develop Alzheimer’s every 33 seconds. According to some studies having fewer years of education is also related with the greater risk of Alzheimer’s. Researchers believe that years of education may provide “cognitive reserve” that either protects a person from Alzheimer’s or allows the person to compensate for a longer time before the symptoms of Alzheimer’s can be seen. The quality of education and the socio – economic background also play an important factor for the risk of Alzheimer’s disease (AD). African – Americans are more at risk of AD than whites when these conditions are taken into consideration. Also, if we look at the future the scenario looks pretty grim, as the number of
Americans surviving into their 80s and 90s is expected to grow because of advances in medicine, medical technology and social and environmental conditions. Since the incidence and prevalence of Alzheimer’s disease and dementia increase with age, the number of people with these conditions will also grow rapidly. In 2000, there were an estimated 411,000 new cases of Alzheimer’s disease. That number is expected to increase to 454,000 new cases a year by 2010, 615,000 new cases a year by 2030, and 959,000 new cases a year by 2050. The number of people age 65 and over with Alzheimer’s disease is estimated to reach 7.7 million in 2030, more than 50 percent increase from the 5 million age 65 and over who are affected. By 2050, the number of individuals age 65 and over with Alzheimer’s could range from 11 million to 16 million.
What is Alzheimer’s disease??
Alzheimer’s disease is an illness of the brain. It causes large numbers of nerve cells in the brain to die. This affects your ability to remember things and think clearly. Doctors don’t know what causes the disease. They do know that it usually begins after age 60 and nearly half of people age 85 and older may have Alzheimer’s. However, it is not a normal part of aging. Alzheimer’s is the most common cause of dementia. Dementia is the loss or decline of memory and cognitive abilities. It is caused by conditions that lead to brain cell damage. Alzheimer’s disease accounts for 60 to 80 percent of dementia cases. Classic AD symptoms include: Difficulty remembering names and recent events is often an early clinical symptom; later symptoms include impaired judgment, disorientation, confusion, behavior changes and trouble speaking, swallowing and walking.
Hallmark abnormalities are deposits of the protein fragment beta-amyloid (plaques) and twisted strands of the protein tau (tangles). The brains of individuals with Alzheimer’s have an abundance of plaques and tangles. Plaques are deposits of a protein fragment called betaamyloid that builds up in the spaces between nerve cells. Tangles are twisted fibers of another protein called tau that builds up inside cells. Though autopsy studies show that most people develop some plaques and tangles with increasing age, those with Alzheimer’s tend to develop far more. These deposits tend to develop them in a predictable pattern in Alzheimer’s, beginning in the areas important for memory before spreading to other regions. In Alzheimer’s increasing numbers of nerve cells deteriorate and die. A healthy brain has 100 billion nerve cells, or neurons with connections. All these connections are called as synapses, information flows in tiny chemical pulses released by one neuron and taken up by the receiving cells. Different signals move constantly through the brain creating the cellular basis of memories, thoughts and skills. In Alzheimer’s disease, information transfer at the synapses begins to fail, the number of synapses declines and eventually cells die. A brain with advanced Alzheimer’s there is shrinkage from cell loss and widespread debris from dead and dying neurons. Scientists have not yet fully understood the processes. But, according to a leading theory the main suspect is a tiny protein fragment called beta-amyloid. When there is overproduction of protein or brain is unable to dispose of it. The excess jams signaling at the synapse, blocking the information flow and leading to a series of events that leads to cell death. Beta-amyloid fragments gradually accumulate into the microscopic strands inside dead and dying neurons. Other abnormalities seen in Alzheimer brain tissue include inflammation and oxidative damage due to highly reactive oxygen-containing products of cellular metabolism.
The disease starts slowly. People blame their forgetfulness on old age. However, overtime the problem gets worse. People with Alzheimer’s lose the ability to drive a car, cook a meal, or even read a newspaper. They find simple confusing. Some patients have emotional extremes like anger, violence. At a certain point people with Alzheimer’s need someone to take care of all their needs (bathing, eating etc,) at home or in a nursing home. Many conditions can disrupt mental functions. Possible causes of memory problems include: Depression, Medication side effect, poor diet, vitamin deficiency, infections. It is important to see a doctor. Early diagnosis and intervention methods and support can improve the quality of life. The major difference Alzheimer’s and other age related memory loss is that the person rarely remembers the experiences later. Alzheimer’s not only robs individuals of cognition, memory, and language, but it exposes family and friends who serve as caregivers to considerable emotional, physical, or financial stress.
Signs and Symptoms
Alzheimer’s disease can affect different people in different ways, but the most common symptom pattern begins with gradually worsening difficulty in remembering new information because of disruption of brain cells usually begins in regions involved in forming new memories. As damage increases, individuals also experience confusion, disorganized thinking, impaired judgment, trouble expressing themselves and disorientation to time, space and location, which
may lead to unsafe and socially inappropriate behavior. In advanced Alzheimer’s, people need help with bathing, dressing, using the bathroom, eating and other daily activities. Those in the final stages of the disease lose their ability to communicate, fail to recognize loved ones and become bed-bound and reliant on 24/7 care. Alzheimer’s disease is ultimately fatal. Although families generally prefer to keep the person with Alzheimer’s at home as long as possible, most people with the disease eventually need more assistance than families can provide and move into a nursing home or other residential care facility. There are 10 warning signs for Alzheimer’s disease: 1) Memory Loss: A person usually forgets more often and is unable to recall information. 2) Difficulty in performing familiar tasks : Individuals may lose track of the steps involved in simple daily tasks like cooking and cleaning
3) Problems with language: People with Alzheimer’s often forget simple words and use
unusual words making their speech and writing difficult to understand. 4) Poor judgment: people with Alzheimer’s have decreased judgment; they can make bad decisions for example giving away money.
5) Disorientation to time and place: people with Alzheimer’s sometimes forget their
neighborhood or the time. They do not know how they got there or how to get back home? 6) Misplacing things: a person with Alzheimer’s may put things and forget about them. 7) Changes in mood or behavior: rapid swings in mood for no apparent reason
8) Changes in personality: the personality changes in dementia extremely confused,
suspicious, fearful or dependent. 9) Problem with abstract thinking: Alzheimer’s can make the complex thinking difficult for the person. Like forgetting numbers or how they should be used.
10) Loss of initiative: a person may become passive. Sleeping more than usual or not wanting to do the usual activities. The symptoms can be broadly divided into two categories. The early signs are difficulty in remembering names, places, and events. Patient has difficulty in solving a simple puzzle or, a simple math problem. In his later stages a person may forget common daily things like how to comb hair. In its late stages a person needs constant care and attention. There are other illnesses or problems that cause Alzheimer’s like symptoms and may look like Alzheimer’s. These include; bad reaction to certain medicines, depression, not eating enough healthy food, too few vitamins in the diet, brain tumor, thyroid problems etc. The greatest risk factor for Alzheimer’s is advancing age. Most people with Alzheimer’s are over 65 years of age. Although individuals younger than 65 can develop the disease, these condition is referred as “younger onset” Alzheimer’s or “early- onset” dementia. A small percentage is caused by rare genetic variations found in a small number of families worldwide. In the inherited form of the disease, Alzheimer’s tends to develop before the age of 65, sometimes in individuals as young as 30. Another genetic form of Alzheimer’s that develops after the age of 65 is Apolipoprotein E – e4 (APOE-e4). This is one of three common forms of the APOE gene, which provides the blueprint for a protein that carries cholesterol in the blood. APOE is inherited from each of the parent. Those who inherit APOE-e4 gene have increased risk of developing the disease. Some of the strongest evidence links brain health to heart disease. The risk of developing Alzheimer’s or vascular dementia is increased by many conditions that risk/ damage the heart and blood vessels. These include heart disease, diabetes, stroke and high blood pressure.
There is no doctor that specializes in diagnosing and treating the symptoms of Alzheimer’s disease. People tend to contact their regular physician. Primary care doctors often oversee the diagnostic process themselves. There is not a single test to prove Alzheimer’s. The workup is designed to evaluate a general health and identify any condition that could affect the heart and mind. Steps to diagnose include:
1) Understanding the problem: check the type of symptoms, the frequency and the duration
of the symptoms.
2) Check the medical history: it is better to gather the information from the person and the
family about current and past mental and physical illnesses. It is helpful to bring a list of all the medications. An accurate family history helps to diagnose Alzheimer’s disease or related disorder.
3) Evaluating mood and mental status: this gives a general idea of how well the mind is
working. This testing gives an overall sense of person’s awareness and mental status.
There are medicines that can treat the symptoms of Alzheimer’s. However, there is no cure. Some medicines keep your memory loss and other symptoms from getting worse for a time. These medicines work best if Alzheimer’s disease is found early. Other medicines work to help
you sleep better or feel less worried and depressed. These medicines don’t directly treat the disease. They do help you feel more comfortable. There are main area in which people need more care with treatment. Those are (1) apprppriate treatment plan, (2) moniter effectivenss of the disease progress. And (3) Respect individual family goals for treatment for risk.
Cholinesterase Inhibitors A large number of clinical trials have been conducted to evaluate the effect of ChEIs on the symptoms and course of Alzheimer’s Disease. Several meta-analyses of both individual agents and the class as a whole have provided insight into the clinical effect of these agents. A review of donepezil studies (Birks & Harvey, 2006) indicated that both 5 mg and 10 mg doses of donepezil, given for up to 52 weeks, produced small but statistically significant benefits in cognition. But we know Alzheimer does not have any proper treatment so we need more family care to the patient and in terminal condition we need better hospice care for the patient. Family must be co operative in nature they should not talk with them in louder voice because they will easily get fatigue and lost their mind.
Conclusion and future developments
Many other new approaches to treatment are also under investigation worldwide. With the advent of science and technology the number of death due to heart, cancer and stroke is
decreasing. As a result, the remaining lifetime risk of Alzheimer’s and dementia is expected to increase substantially in the future. That is because the decreasing number of deaths from heart disease, cancer and stroke means that more people live long enough to develop the disease. The most promising treatment on the horizon is targeting beta- amyloid protein. This protein fragment builds up into the plaques considered as hallmark of the disease. Researchers have developed several ways to clear the protein or prevent it from forming. This drug is under trial. Some of the most exciting research in this area suggests that people can reduce the risk by eating low fat diet rich in fruits and vegetables, exercising regularly, and staying mentally and socially active can help protect brain. Some evidence also, links the brain health to heart health. The brain has one of body’s richest networks of blood vessels. Hence, it is important for the people to maintain blood pressure, weight, blood sugar and cholesterol. This helps prevent stroke, heart diseases and diabetes. And hence, reduce the chances of Alzheimer’s aswel. Providing for safety is an important job for caregivers. A safe environment can help prevent Injuries and it can help the person with dementia feel relaxed and less overwhelmed. To enhance safety, assess the environment for hazards. Try to see the world through the eyes of a person who has Alzheimer’s and adapt the environment to his or her needs.
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