Jackie Parra

The Progressiveness of Alzheimer’s Disease/ Dementia

About 5.5 million Americans of all ages have Alzheimer’s disease. Alzheimer’s is a brain

disorder that slowly destroys memory and thinking skills, eventually the inability to be able to do

the simplest of tasks. The earliest people get Alzheimer’s occurs between the person’s 30’s and

mid 60’s. Dementia is not a specific disease like Alzheimer’s, it is an overall term that describes

a wide range of symptoms that are caused by disorders affecting the brain. Symptoms would be

memory loss, difficulties with thinking, and problem solving or language. This would reduce a

person’s ability to do everyday activities. Because of the severity of this topic I decided to

research more about it to see if scientists are any closer to finding a cure. I want to see the

progress they’ve made researching Alzheimer’s. I’ve gathered good information on three

research articles on this topic. My topic is important for people to know and be aware of because

anyone can get it as they age and for those who know loved ones that have this disease. People

who have friends or family members with this disorder will want to know what is being done to

improve this disease and or what has been done. This topic is important to me not only because I

want to become a RN and always care for people’s health but also because my grandmother has

been showing signs of dementia and I want to know and learn more about it as well.

Dementia is an overall term that describes a wide range of symptoms that are caused by

disorders affecting the brain. Also in the article Susan, L.M., it states that, “Dementia is a leading

cause of death in the United States but is under recognized as a terminal illness. The clinical
course of nursing home residents with advanced dementia has not been well described,” (Susan

L. M., 2009, Pg. 1529). A healthy brain contains tens of billions of neurons, they send

messages between different parts of the brain. Alzheimer’s disease disrupts this communication

among neurons which results in loss of function and cell death. Because Alzheimer’s destroys

neurons and their connections in part of the brain involved in memory, ​it later affects areas in the

cerebral cortex responsible for language and social behavior. Over time, a person with

alzheimer’s loses their ability to live and function independently. When someone is being

diagnosed with dementia, they are being diagnosed with a set of symptoms. Dementia is a term

that alzheimer’s can fall under. People can have more than one type of dementia. It is a group of

symptoms that affects tasks such as memory and reasoning. There are a lot of signs and

symptoms of dementia and alzheimer’s. A list of them are memory loss that disrupts daily life,

challenges in planning and problem solving, confusion with time and place, misplacing things

and losing the ability retrace steps, trouble understanding visual images and spatial relationships,

changes in mood and personality, plus many more. Currently, there is no cure for Alzheimer’s

but drug and nondrug treatments have helped with both cognitive and behavioral symptoms.

Higher average glucose levels were related to an increased risk of dementia. Scientist

thought that people who had diabetes were automatically increasing their chances of getting

dementia but it’s not just that it’s the person’s glucose levels that increases the person’s chances

in getting dementia. Even among persons without diabetes. But diabetes is a risk factor for

dementia. It is unknown whether higher glucose level increases the risk of dementia in people

without diabetes. That was mentioned in my “Glucose Levels and Risk of Dementia” Research

article. In “The Clinical Course of Advanced Dementia” it says how scientist “Followed 323
nursing home residents with advanced dementia and their health care proxies for 18 months in 22

nursing homes. Data were collected to characterize the residents’ survival, clinical

complications, symptoms, and treatments and to determine the proxies’ understanding of the

residents’ prognosis and the clinical complications expected in patients with advanced

dementia”(Susan L. M., 2009, Pg. 1529). Over eighteen months passed and 54.8 % of the

residents died. Pneumonia, Febrile episodes, and eating disorders, are common complications in

people with advanced dementia. “Distressing symptoms and burdensome interventions are also

common among such patients. Patients with health care proxies who have an understanding of

the prognosis and clinical course are likely to receive less aggressive care near the end of the

life.” (Susan L. M., 2009, Pg. 1529).

In “The clinical course of Advanced Dementia” it adds that, “The probability of pneumonia

was 41.1%; a febrile episode, 52.6%; and an eating problem, 85.8%. After adjustment for age,

sex, and disease duration, the 6-month mortality rate for residents who had pneumonia was

46.7%; a febrile episode, 44.5%; and an eating problem, 38.6%. Distressing symptoms, including

dyspnea (46.0%) and pain (39.1%), were common. In the last 3 months of life, 40.7% of

residents underwent at least one burden- some intervention (hospitalization, emergency room

visit, parenteral therapy, or tube feeding)”(Mitchell, S. L., 2009, p. 1529). In the article “A Phase

3 Trial of Semagacestat for Treatment of Alzheimer’s Disease” The observations were talked

about in their trial and also what was being done to the patients being used in the research, “As

compared with placebo, semagacestat did not improve cognitive status, and patients receiving the

higher dose had significant worsening of functional ability. Semagacestat was associated with

more adverse events, including skin cancers and infections”(Doody, S. R., 2013, p. 341).
 On the article, “Glucose levels and risk of dementia” it states how diabetes has been known

to be a lead risk factor for getting dementia. Although it makes it seem as it is pointing that

diabetes is one of the risk factors of dementia, it is still unknown. It has become a bigger problem

to figuring out the cause. The reasons for figuring out the cause is that every 66 seconds,

someone in the United States develops the disease. With that being said other factors were put

into consideration for the cause. The three causes they researched were: Diabetes,

Apolipoprotein E Genotype, and other risk factors. How they analyzed diabetes was that

they,”classified participants as having treated diabetes on the basis of diabetes-related medication

data from Group Health pharmacy records (Table S2 in the Supplementary Appendix)”(Crane,

K. P., 2013, pg. 542).Onto that the article with the methods they implied being thoroughly

looked over they found out that,”Among participants with diabetes, higher average glucose

levels were also related to an increased risk of dementia (P=0.002); with a glucose level of 190

mg per deciliter (10.5 mmol per liter) as compared with 160 mg per deciliter (8.9 mmol per liter),

the adjusted hazard ratio was 1.40 (95% CI, 1.12 to 1.76),”(Crane, K. P., 2013, pg. 540).

Although each research article did have a well done idea of what they wanted to analyze

and prove, the overall experiment had some turnouts of death, and did not prove their analogy.

Each experiment was well done and provided the details of what happened. The only article that

had a success, in a way would be, “The clinical course of advanced dementia”. The reason I

believe that it is, is because it states the data of each individual patient and how they all acted

with having Dementia. It supports their information by adding how they collected it stating that

the,“Data on nursing home residents were collected from chart reviews, interviews with nurses,

and brief physical examinations at baseline and once per quarter for up to 18 months; for
residents who died during the study period, data was also collected within 14 days after the

death”(Mitchell, S.L., 2009, pg. 1503). On the other hand with the other two articles, they were

not successful with what they stated. The reason being is that each article talked about a different

thing, but it led them both to understand why their method didn’t work. The article, “A Phase 3

Trial of Semagacestat for Treatment of Alzheimer’s Disease” had to stop and be terminated due

to the results gathered and to the safety of their monitoring board. That’s one of the example of

why this particular article was not successful in their research. With all data supported and their

analysis, I do agree with what they’ve developed as their conclusion. The reason why, is due to

the fact that Dementia and Alzheimer's are misunderstood diseases and very complicated to

narrow down. For each experiment done on each article I could add multiple things but one

being that it needed more support on what more was being researched. What I refer to that is

that, even though the article had great data to support what they came to the conclusion, maybe a

bit more background information to what they could change or add would have been helpful.

Another thing to end this part is that the article of, “A Phase 3 Trial of Semagacestat for

Treatment of Alzheimer’s Disease” could have done differently in their experiment is having a

smaller group for their experiment. I say that because it could have helped maybe not lead that

experiment to be terminated, as maybe having too many people in this particular research was

too much to handle at once.

Throughout the research, the articles I used were very resourceful and helped me gain more

information on Alzheimer’s and Dementia. The use of the results collected in each individual

research article supported their results. With each article having its own source of information, I

can use that to investigate more and see if it can lead to a future treatment. This helps me gather
information, to better inform myself about this issue and how to analyze it in my future career.

Not only that but also how to be able to help my loved ones like my grandma. This will help me

either want to collaborate in this research or investigate a new method for a treatment.

Reference page
Crane, K. P.,​ Walker, R., Hubbard, R. A., Li, G., Nathan, D. M., Zheng, H., ... & McCormick,
W. (2013). Glucose levels and risk of dementia. ​The New England Journal of Medicine​,
2013​(369), 540-548, doi: 10.1056/NEJMoa1215740.
Doody, R. S., Raman, R., Farlow, M., Iwatsubo, T., Vellas, B., Joffe, S., ... & Aisen, P. S.
(2013). A phase 3 trial of semagacestat for treatment of Alzheimer's disease. ​New
England Journal of Medicine​, ​369​(4),341-350,doi:10.1056/NEJMoa1210951
Mitchell, S. L., Teno, J. M., Kiely, D. K., Shaffer, M. L., Jones, R. N., Prigerson, H. G., ... &
Hamel, M. B. (2009). The clinical course of advanced dementia. ​New England Journal of
Medicine​, ​361​(16), 1529-1538.