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Alzheimer¶s Disease

Diana Vizoso Samantha Concepcion Melissa Sirolli Sean Faria William Lopez Jr. BSC2085 M & W 7:05pm

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Alzheimer¶s disease

Diana Vizoso Samantha Concepcion Melissa Sirolli Sean Faria William Lopez Jr.

BSC2085 M & W 7:05pm Professor Bidot December 07, 2009

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Reason The reason my group choose this topic for our research paper is for three reasons. One reason was the availability of information; it is easy to find information on the topic. Secondly was the topic seemed very interesting because from the research we have collected at least two people from this group will have Alzheimer¶s disease as we age. Lastly was at least three of us from the group have relatives with this disease and would like to know what at least is going on so we may be some use to them. From this research paper we have learned a lot and this information we have learnt is irreplaceable. Concept

Alzheimer¶s disease is a brain disorder named for German physician Alois Alzheimer, who first described it in 1906. Alzheimer's destroys brain cells, causing memory loss and problems with thinking and behavior severe enough to affect work, lifelong hobbies or social life. Alzheimer¶s disease accounts for 50 to 70 percent of dementia cases. Other types of dementia include vascular dementia, mixed dementia, dementia with Lewy bodies and front temporal dementia. The brain has 100 billion nerve cells (neurons). Nerve cell networks have special jobs. In Alzheimer¶s disease, as in other types of dementia, increasing numbers of brain cells deteriorate and die. Plaques build up between nerve cells. Tangles form inside dying cells. Scientists are not absolutely sure what role plaques and tangles play in Alzheimer¶s disease.

Causes

Scientists are still trying to fully understand the cause or causes of Alzheimer¶s disease. In the meantime, it¶s said to be helpful that we understand the hallmarks of Alzheimer¶s plaques

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and tangles and the risk factors that affect a person¶s likelihood of developing the disease. Alzheimer's disease is characterized by a build-up of proteins in the brain. Though this cannot be measured in a living person, extensive autopsy studies have revealed this circumstance. The build-up manifests in two ways. Plaques which are deposits of the protein beta-amyloid that accumulates in the spaces between nerve cells. Another way this build up can occur is through tangles, which are deposits of the protein tau that accumulate inside of nerve cells. Scientists are still studying how plaques and tangles are related to Alzheimer¶s disease.

One theory is that they block nerve cells¶ ability to communicate with each other, making it difficult for the cells to survive. It is likely that the causes include genetic, environmental, and lifestyle factors, because people differ in their genetic make-up and lifestyle, the importance of these factors for preventing or delaying AD differs from person to person. Autopsies have shown that most people develop some plaques and tangles as they age, but people with Alzheimer¶s develop far more than those who do not develop the disease. Scientists still don¶t know why some people develop so many compared to others. However, several risk factors for Alzheimer¶s disease have been uncovered. Genetics play a role in some people with AD. A rare type of AD, called early-onset AD, affects people ages 30 to 60. Some cases of early-onset AD, called familial AD, are inherited. Familial AD is caused by mutations (permanent changes) in three genes. Offspring in the same generation have a 50-50 chance of developing familial AD if one of their parents had it. Advancing age is the number one risk factor for developing Alzheimer¶s disease. One out of eight people over the age of 65 have Alzheimer¶s disease, and almost one out of every two people over the age of 85 has Alzheimer¶s. Facts and studies show that the probability of being diagnosed with Alzheimer¶s nearly doubles every five years after age 65. People who have a

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parent or sibling that developed Alzheimer¶s disease are two to three times more likely to develop the disease than those with no family history of Alzheimer¶s. If more than one close relative has been affected, the risk increases even more. Scientists have identified two kinds of genes that are associated with this familial risk factor. The first is thought to be a ³risk gene,´ ApoE 4, that increases the likelihood of developing Alzheimer¶s, but does not guarantee it. In addition to ApoE 4, scientists think there could be up to a dozen more risk genes yet to be discovered. The second kind of gene is a ³deterministic gene´ and is much rarer than risk genes. Deterministic genes are only found in a few hundred extended families around the world. If a deterministic gene is inherited, the person will undoubtedly develop Alzheimer¶s, but probably at a much earlier age. Although age and family history are out of our control, scientists have also identified several lifestyle factors that can influence a person¶s risk of developing Alzheimer¶s disease. A connection has been found between serious head injury and future development of Alzheimer¶s, so those who practice safety measures such as wearing seat belts and not engaging in activities where there is a high risk of falling are at an advantage. Evidence states that there should be a greater promotion of exercise and a healthy diet, to help reduce Alzheimer¶s risk. Avoiding tobacco, limiting alcohol consumption, staying socially active, and engaging in intellectually stimulating activities, have also been shown to have a protective effect against Alzheimer¶s disease. Finally, there is a strong link between heart health and brain health. Those who are free of heart disease or related conditions are at a lower risk of developing Alzheimer¶s or another kind of disease than those who have cardiovascular problems.

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Signs and Symptoms of Alzheimer¶s disease Alzheimer¶s disease is the most common forms of Dementia. Alzheimer¶s disease is a serious brain disorder that impacts daily living through memory loss and cognitive changes. Some common signs of Alzheimer¶s disease can be mixed up with normal everyday normality of forgetfulness. Early stages of Alzheimer¶s can be detected mainly by memory loss regarding recent conversations and events. It can start off as routinely placing important items in odd places, forgetting names of family members and common objects. It also is a result of, repeated questions, forgetting the way to get to a frequent visited place and even the inability to following simple directions for a recipe. This stage can usually last from 2-4 years.

Moderate to middle stage Alzheimer¶s disease is usually discovered when they can no longer cover up problems, have rambling speech, unusual reasoning, and have problems with places and times. Constant reminders are needed; assistance is needed with daily living activities, mood and behavioral changes start to occur and about 80% of patients show evidence of emotional and behavioral problems which are aggravated by stress and change that they are not used to. This Stage can last from 2-10 years.

Severe to Late stage Alzheimer¶s is the result of confusion of the past and present. Another sign is severe to total loss of verbal skills, they forget to speak or how to speak or write. The person becomes completely incapable to care for self. They become very high risk to falling due to gait dysfunction, and become bedridden. Patients begin to hallucinate, have severe mood swings and behavioral issues. They tend moan and cry when unable to express what they are feeling at the moment. They become totally dependent on others and need total support and care.

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They can end up with issues such as the inability to swallow, incontinence, and illness. Illness is the result of the body systems shutting down usually resulting in death. To sum up the basic important information about Alzheimer¶s disease one should the top ten basic signs to detect Alzheimer¶s.

First Sign is memory loss. We all experience it one way or another; it is just a matter of knowing the difference between a slip-up and long-term forgetfulness. It is natural to forget an appointment and/or a person¶s name but to later remember it. Second basic sign of Alzheimer¶s is challenges arising when planning or solving problems. We can easily make a mistake while balancing our check book every once in awhile but forgetting to pay monthly bills can be a sign to a serious condition. Third sign of possible Alzheimer¶s disease is difficulty in completing familiar tasks at home. Of course we forget what button to press when wanting to TiVo something but forgetting the rules to your all time favorite board game, there¶s obviously a problem.

The fourth simple sign to detect Alzheimer¶s disease is confusion time and place. Obviously we can occasionally forget what day of the week it is but we always remember in the end, whereas forgetting where we are and having no clue how we got there. These situations can be very stressful. The fifth sign of Alzheimer¶s is trouble understanding. Alzheimer¶s prospect begins having visual problems creating difficulty with reading. Over the years, with age, it is common to be diagnosed with cataracts, which at this time would be natural to have difficulty reading or seeing.

The sixth sign of Alzheimer¶s is having trouble with speech i.e. speaking and writing. It creates difficulty in joining in on conversations happening around them and or even while

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they¶re speaking they stop because they do not recall the subject of the conversation. We can be in the middle of a conversation and be distracted by something but as long as we are reminded by just a simple word. The seventh sign of Alzheimer¶s is misplacing things and the inability to retrace ones steps to remember. It¶s normal for us to misplace the remote or even our car keys time to time but to place our common everyday items in awkward places is a little sign of Alzheimer¶s.

The eighth sign of Alzheimer¶s disease is decreased or poor judgment. It is normal for us to every once in a while make bad decisions and Alzheimer¶s prospects pay less attention to their personal hygiene or can even pay people such as telemarketers large sum of money due to poor judgment with money. The ninth sign of Alzheimer¶s disease is withdrawal from work or social activities. We are always at fault for feeling weary from work and wanting to be alone not having to go social gatherings or family gatherings from time to time. It is perfectly normal. An Alzheimer¶s prospect will begin to withdraw from their favorite hobbies and forget how their favorite teams play. They can begin to feel that they don¶t want to participate in anything anymore and become lonely.

The final sign of Alzheimer¶s is the change in mood and/or personality. The prospect can become depressed, confused and even suspicious. We can usually create a routine of how we do things and when they get interrupted we can become irritated and frustrated and it is perfectly normal on occasion.

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Diagnosis

Alzheimer¶s disease causes physical change in a person¶s brain that cannot be properly diagnosed until being closely examined. Physicians are able to diagnose Alzheimer¶s with 90% accuracy due to thorough examination. Several of these medical examinations include the patient¶s history, a mini-mental state exam, specific laboratory testing, and certain neuro-imaging examinations (Beers and Berkow). By gathering certain information from these exams, a doctor can identify if a patient suffers from Alzheimer¶s and what stage of Alzheimer¶s the patient is currently in. For further explanation, a doctor will ask a series of questions to compose a medical evaluation of the patient. The questions asked as part of the patients history includes information of the problem occurring, a history of current illnesses, and any family history in regards to the occurring problem. Physicians perform mini-mental exams that focus on the patient¶s attention span, memory and other types of mental moods. For instances, the doctor performing the exam will try to interpret the different mood swings the patients undergoes. Another example would be the attitude, behavior and appearance towards other people. Specialists evaluate patients on the following statuses: Cognition, Insight judgment, Speech and language, Thought content, and Thought processes. After the physician has performed several mental tests, they usually send the patient to a laboratory to have blood work done. Even though there is not a specific lab test that can identify Alzheimer¶s, the physician tries to rule out the possibility of other diseases by checking the levels of certain chemicals in the body. Specialist analyze the levels of Vitamin B12, TSH (for

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the thyroids), CBC (for anemia), and HIV. Furthermore, depending on the conditions of the patient, the next step to evaluate if the patient has Alzheimer is to perform several neuro-imaging exams. One of the main exams that a patient undergoes is a CT scan. A CT scan takes multiple X-ray pictures of a certain body part to analyze any major changes. Patients with possible Alzheimer¶s carry out a CT scan of the brain, where specialist can observe changes in the size of the brain. A size reduction of the brain may be a result of Alzheimer¶s. Another imaging exam will be an MRI, which shows the functional changes of the brain. MRI¶s also rule out the possibility of Alzheimer¶s by observing if any tumors are present (Kasper, Braunwald and Fauci). As stated previously, a patient cannot be properly diagnosed with Alzheimer¶s until further studies are done after the patient¶s death. These are some of the methods to determine the possibility of a patient suffering Alzheimer¶s. There is only one method that has been recently discovered to diagnose Alzheimer¶s at 100% accuracy which is an autopsy on the brain. Treatments Although no cure for Alzheimer¶s disease is yet available, medical and behavioral treatments for the disease may ease symptoms for the individual with Alzheimer's. The symptoms that can be treated are the cognitive and behavioral symptoms. There is only three ways for treating symptoms of Alzheimer¶s. They are the Standard Treatments, Sleep Treatments and lastly Alternative Therapy. Standard Treatments consist of two types of medications that have been approved by the U.S. Food and Drug Administration (FDA). The two types of drugs are cholinesterase inhibitors and Memanatine. Cholinesterase inhibitors are prescribed to treat symptoms related to memory, thinking, language, judgment and other thought processes. Three different cholinesterase

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inhibitors are commonly prescribed. Donepezil also called Aricept, which is used to treat all stages of Alzheimer¶s disease. Galantamine also called Razadyne, used to treat mild to moderate stages of Alzheimer¶s. Rivastigmine also called Exelon, usually used to treat mild to moderate Alzheimer¶s. Tacrine also called Cognex, the first cholinesterase inhibitor, was approved in 1993 but is rarely prescribed today because of associated side effects, including possible liver damage. Cholinesterase inhibitors work by increasing the levels of a chemical messenger involved with memory, judgment and other thought processes called acetylcholine. There are certain cells in the brain that produce or release this chemical messenger acetylcholine, which in fact actually help communicate between other cells. Upon this messenger reaching the receiving cell various other chemicals as well as an enzyme called acetyl cholinesterase appear. This enzyme acetyl cholinesterase breaks down acetylcholine so it can be recycled. However Alzheimer¶s disease damages or worst yet destroys the cells that produce or use acetylcholine. As a result of this process reduces the amount of acetylcholine to carry messages. Cholinesterase inhibitor is actually an enzyme created to slow down the process of breaking down the acetylcholine. Cholinesterase inhibitor accomplishes this by blocking the activity acetyl cholinesterase. This process saves some acetylcholine from being destroyed by the Alzheimer¶s disease. These medications help the brain work better but it doesn¶t stop or reverse the destruction of the brain cells. Cholinesterase inhibitors do not prevent Alzheimer¶s from getting worst this is just a method to slow the progression down. Cholinesterase inhibitors seem to offer other benefits, as well. For example, Galantamine appears to stimulate the release of acetylcholine and to strengthen the way certain message-receiving nerve cells respond to it. Rivastigmine may block the activity of another enzyme involved in breaking down acetylcholine. In contrast if side effects occur, they

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commonly include nausea, vomiting, loss of appetite and increased frequency of bowel movements. It is strongly recommended that a physician who is experienced in using these medications monitor patients who are taking them, and that the recommended guidelines be strictly observed. Memantine also called Namenda is prescribed to improve memory, attention, reason, language and the ability to perform simple tasks. This was the first Alzheimer drug of the NMDA receptor antagonist type. Memanatine is used to treat moderate to severe Alzheimer¶s only. Memantine works by regulating the activity of a chemical involved in information processing, storage and retrieval called glutamate. Perceptibly Glutamate triggers NMDA receptors to let a controlled amount of calcium into a nerve cell as a result of this process it significantly helps with learning and memory. The calcium helps creates the chemical environment required for information storage. In the same way Glutamate can be helpful it can be damaging. If there is excess Glutamate it over stimulates NMDA receptors so that they allow too much calcium into nerve cells. In a nut shell excess glutamate causes disruption and death of cells. However Memantine may protect cells by partially blocking NMDA receptors. Adverse side effects include headache, constipation, confusion and dizziness. Scientists have made remarkable progress in understanding how Alzheimer¶s affects the brain. Their insights point toward promising new treatments to slow or stop the disease. Ultimately, the path to effective therapies is through clinical studies. The second treatment to help Alzheimer¶s is sleep treatment. This is a significant factor of Alzheimer¶s because doctors have not found the exact reason why this happens. Many people

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with Alzheimer¶s experience changes in their sleep patterns. Similarly how Alzheimer¶s affect memory and behavior, sleep changes also occur to Alzheimer¶s patients. There have been cases of this in older adults without dementia who notice this as well. These conflicts occur more frequently and tend to be more brutal in Alzheimer¶s patients. This is common in later stages of Alzheimer¶s yet there have been reports and studies show to be found in the early stages as well. This seems hard to believe that such a thing as difficulty sleeping can be caused by Alzheimer¶s. There are several patients with Alzheimer¶s that wake up more often and stay awake longer during the night. Brain wave studies have shown to have a decrease in both dreaming and non-dreaming sleep stages. Sometimes those who can¶t sleep may be unable to lie still, or yell or call out, disturbing the sleep of their caregivers. Alzheimer¶s patients have tendency for daytime napping and other shifts in the sleepwake cycle. Individuals may feel very drowsy during the day and then be unable to sleep at night. Experts estimate that in late stages of Alzheimer¶s, individuals spend about 40 percent of their time in bed at night awake and a significant part of their daytime sleeping. Patients should have a thorough medical examination to identify any treatable illnesses that may be contributing to the sleeplessness. Some conditions are Depression, Restless legs syndrome, Sleep apnea. Most doctors mostly try the non-drug treatment first due to the amount of medications patients usually are taking. This treatment aspires to build a sleep routine, to decrease daytime napping and to create the sleep environment necessary. The structure of this treatment consists of Maintaining a schedule for regular times for meals and for going to bed and getting up, Encourage regular daily exercise includes seeking morning sunlight exposure, Treat any pain, Avoid alcohol, caffeine and nicotine, If the person is taking a cholinesterase inhibitor avoid

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giving the medicine before bed, Make sure the bedroom temperature is comfortable, If the person awakens, discourage staying in bed while awake; use the bed only for sleep, Discourage watching television during periods of wakefulness. The second Sleep treatment is obliviously medications. This is for the cases that nondrug fails help the sleeplessness. There is one rule for delivering sleep medications all experts agree on begin low and go slow. This rule came about because of the risk of sleep inducing medication on older adults who are cognitively impaired are significant. The risks are increased risk for falls and fractures, confusion, and a decline in the ability to care for oneself. However once a sleep pattern has been established patients are too slowly discontinue them.

The most common used sleep medications are Tricyclic antidepressants, such as nortriptyline and trazodone. Another is Benzodiazepines which common names are lorazepam, oxazepam and temazepam. Sleeping pills also called zolpidem, zaleplon and chloral hydrate. Lastly are antipsychotics such as haloperidol, risperidone, onlanzapine and quetiapine.

The final treatment is alternative therapy which consists of several herbal remedies, vitamins and other dietary supplements. The safety and capability of these products are based fundamentally on testimonials, tradition, and a rather small body of scientific research. The reason this is called alternative therapy is due to the unknown. The effectiveness, safety, purity are all unknown. The claims do not present enough evidence of effectiveness for FDA, as well as FDA has no authority over supplement production. The safety of this therapy is also not regulated. The safety precautions are actually given by healthcare professionals to the manufacturers. Not to mention the risk of these products can have serious or serve interactions with prescribed medications.

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Vitamin E is used to treat Alzheimer¶s because it is an antioxidant, a substance that may protect nerve cells from certain kinds of chemical wear and tear. There is one large federally funded study that shows that vitamin E can slightly slow down the loss of ability to carry out daily life. Patients should not take vitamin E to treat Alzheimer¶s unless supervised by physician. The Vitamin E doses in these cases are relatively high. This high dose is why vitamin E should never been taken without proper supervision. Vitamin E can interact with other medications, including those prescribed to keep blood from clotting.

Coenzyme Q10 or ubiquinone is another antioxidant that is used in Alzheimer¶s patients. This usually naturally produced in the body and is necessary for ordinary cell reactions. There was a synthetic version of this compound called idebenone, which was studied with Alzheimer¶s but produced complimentary results. There is also no information on an adequate dose to be taken and considered safe. Consequently there can be harmful effects due to the lack of study.

Coral Calcium which is advertised as a cure for Alzheimer¶s, cancer and other illnesses. This is a form of calcium carbonate that is derived from shells of formerly living organisms that made up coral reef. In June 2003, the Federal Trade Commission (FTC) and the Food and Drug Administration (FDA) filed a formal complaint against the promoters and distributors of coral calcium. Coral calcium differs from ordinary calcium supplements only in that it contains traces of some additional minerals incorporated into the shells by the metabolic processes of the animals that formed them. It contains no amazing health benefits.

Ginkgo biloba is a plant extract containing several compounds. Ginkgo biloba is thought to have antioxidant and anti-inflammatory benefits that may have positive effects on cells within the brain and the body. However, multicenter Phase III study published in the Journal of the

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American Medical Association (November 19, 2008) proved that gingko was acting as a placebo in delaying changes in memory, thinking and personality and had no impact on the development of Alzheimer¶s.

Huperzine-A is a moss extract usually used in traditional Chinese medicine. The properties of Huperzine-A is very similar to those of cholinesterase inhibitors. As a result, it is promoted as a treatment for Alzheimer's disease also may be comparable to approved drugs for Alzheimer¶s. There was a study for this drug launched in spring 2004 by no results has been mentioned. This is also another drug that has been regulated as a dietary supplement with no uniform standards. It is recommended not to be taken with prescribed medication due its similarity to cholinesterase inhibitors and increase side effects of prescribed drug.

Last form of alternative therapy is Omega-3 fatty acids. Omega-3 is a type of polyunsaturated fatty acid it has been more linked to heart disease and stroke than Alzheimer¶s. There are only two types of Omega-3¶s qualified for use. Docosahexaenoic acid (DHA) and Eicosapentaenoic acid (EPA) recently added to 75% of prenatal vitamins for develop of brain in babies. This fatty acid cannot be made in the body this is fatty acid primarily use from fish oil or flax oil. The reason why this was linked to the reduction of brain decline was that DHA is the chief omega-3 in the brain. There are theories that Omega-3¶s are might influence dementia risk include their benefit for the heart and blood vessels, anti-inflammatory properties, and support while protecting the nerve cell membranes. These findings are still under study and are in the preliminary stage.

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Index 1. Alzheimer¶s disease - a common form of dementia of unknown cause, usually beginning in late middle age, characterized by memory lapses, confusion, emotional instability, and progressive loss of mental ability. Named after Alois Alzheimer (1864±1915), German neurologist, who described it in 1907. 2. Anti-inflammatory- acting to reduce certain signs of inflammation, as swelling, tenderness, fever, and pain. 3. Antidepressants- of or pertaining to a substance that is used in the treatment of mood disorders, as characterized by various manic or depressive affects. 4. Autopsy- inspection and dissection of a body after death, as for determination of the cause of death; postmortem examination. 5. Cholinesterase inhibitors- is an enzyme that increases the levels of a chemical messenger involved with memory, judgment and other thought processes called acetylcholine. 6. Coenzyme Q10- a naturally occurring, fat-soluble, vitamin like enzyme found in a variety of foods and synthesized in the body: sold as a dietary supplement for its antioxidant properties. 7. Confusion- lack of clearness or distinctness: a confusion in his mind between right and wrong. 8. Coral Calcium- This is a form of calcium carbonate that is derived from shells of formerly living organisms that made up coral reef. 9. Dementia- severe impairment or loss of intellectual capacity and personality integration, due to the loss of or damage to neurons in the brain.

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10. Depression- condition of general emotional dejection and withdrawal; sadness greater and more prolonged than that warranted by any objective reason. 11. Diagnose- to determine the identity of (a disease, illness, etc.) by a medical examination: The doctor diagnosed the illness as influenza. 12. Dietary supplement- product taken orally that contains one or more ingredients that are intended to supplement one's diet and are not considered food. 13. Docosahexaenoic acid (DHA)- an omega-3 fatty acid found especially in cold-water fish. 14. Eicosapentaenoic acid (EPA)-An omega-3 fatty acid found in fish oils. 15. Federal Trade Commission (FTC)- A federal agency responsible for maintaining the competitive markets, thereby discouraging restraint of trade and monopoly. The clout and aggressiveness of the FTC vary greatly depending on its membership and the incumbent Presidential administration. 16. Food and Drug Administration (FDA) - The FDA is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our nation¶s food supply, cosmetics, and products that emit radiation. 17. Fatty acid- any of a class of aliphatic acids, esp. palmitic, stearic, or oleic acid, consisting of a long hydrocarbon chain ending in a carboxyl group that bonds to glycerol to form a fat. 18. Ginkgo biloba- is a plant extract containing several compounds. 19. herbal remedies- a plant or plant part or an extract or mixture of these used to prevent, alleviate, or cure disease called also herbal, herbal medicine.

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20. Huperzine-A - is a moss extract usually used in traditional Chinese medicine. The properties of Huperzine-A is very similar to those of cholinesterase inhibitors. 21. medical examinations- thorough physical examination; includes a variety of tests depending on the age and sex and health of the person. 22. Memory- the mental capacity or faculty of retaining and reviving facts, events, impressions, etc., or of recalling or recognizing previous experiences. 23. mild stages of Alzheimer¶s- progress from mild forgetfulness to widespread neurological impairment and ultimately death. 24. moderate stages of Alzheimer¶s- progress from moderate forgetfulness to widespread neurological impairment and ultimately death. 25. Omega-3 - a polyunsaturated fatty acid, essential for normal retinal function, that influences various metabolic pathways, resulting in lowered cholesterol and triglyceride levels, inhibited platelet clotting, and reduced inflammatory and immune reactions. 26. Polyunsaturated fatty acid - an unsaturated fatty acid whose carbon chain has more than one double or triple valence bond per molecule; found chiefly in fish and corn and soybean oil and safflower oil. 27. Restless legs syndrome- a nervous disorder of uncertain patho-physiology that is characterized by restlessness of the legs usually as evidenced by aching, crawling, or creeping sensations in them especially at night or when lying down and that is often accompanied by insomnia and by involuntary twitching of the legs during sleep called also restless legs.

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28. Serve stages of Alzheimer¶s- is the result of confusion of the past and present. Another sign is severe to total loss of verbal skills, they forget to speak or how to speak or write. The person becomes completely incapable to care for self. 29. Sleep apnea- a temporary suspension of breathing, occurring in some newborns (infant apnea) and in some adults during sleep 30. Supplements- something added to complete a thing, supply a deficiency, or reinforce or extend a whole. 31. Vitamin- any of a group of organic substances essential in small quantities to normal metabolism, found in minute amounts in natural foodstuffs or sometimes produced synthetically: deficiencies of vitamins produce specific disorders. 32. Vitamin E- a pale-yellow viscous fluid, abundant in vegetable oils, whole-grain cereals, butter, and eggs, and important as an antioxidant in the deactivation of free radicals and in maintenance of the body's cell membranes: deficiency is rare. Bibliography Alzheimer¶s Association. Early Onset Dementia: A National Challenge, A Future Crisis. (Washington, D.C.: Alzheimer¶s Association, June 2006) Accessible at www.alz.org y Alzheimer¶s Association. Professionals & Researchers, Alzheimer's disease, Treating Alzheimer¶s: Cognitive Symptoms. Accessible at www.alz.org y Beers, Mark H. and Robert Berkow. "The Merck Manual of Diagnosis and Therapy, 17th Edition." Delirium and Dementia. Whitehouse Station, New Jersey: Merck Research Laboratories, 1999. Chapter 40.

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Lon S. Schneider MD, (University of Southern California) reflects in the Journal of the American Medical Association (JAMA. 2008;300[19] ³Ginkgo Biloba and Alzheimer's Disease´ Online article accessible http://www.audiology.org/news/Pages/20081119a.aspx Kasper, Dennis L., et al. "Harrison's Principles of Internal Medicine, 16th Edition." Bird, Thomas D. and Bruce L. Miller. Dementia. New York: McGraw-Hill Professional, 2004. Chapter 365.

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