Alzheimer's Disease

By

Pastor  Barb Maynard 
i_walkbyfaith@msn.com
 

·      People used to call dementia 'senility'. There are many causes of dementia, and the most common one is Alzheimer Disease.

             Alzheimer Disease causes gradual breakdown in the nerve cells of the brain. The brain changes and no longer works as it used to. As a result, people with Alzheimer Disease become less and less able to make sense of information from the outside world and to send messages to their bodies. People with Alzheimer Disease become unable to think, remember, understand, and make decisions as before. They will have trouble with everyday activities such as getting dressed, cooking a meal, or washing the car. Eventually, they become unable to look after themselves and will develop other illnesses such as pneumonia, which will cause death.

           The disease was first described in 1907 by a German physician, Dr. Alois Alzheimer. The family and friends may notice Momma or dad is forgetting more and more and blame it on “old age”.  Alzheimer's disease is a disorder marked by a gradual decline in brain function that gets worse with time. It used to be assumed that this change was a normal part of aging that we called "senility." Some persons develop this condition when they are as young as 40 years of age. However, the disease is most common in persons over the age of 65. It is estimated that approximately 10 percent of persons over 65 years of age may have Alzheimer's disease and that in persons over the age of 85, up to 50 percent may be affected.   Alzheimer's disease is not a normal part of the aging process. It is not "hardening of the arteries." It is not contagious, and it is not known how it can be prevented. While the physical changes in the brain are very similar among different people, the behavioral and psychological symptoms that result are complex and may differ from person to person. These symptoms lead to a form of "dementia" which is the loss of mental skills and abilities, including self-care capabilities. As Alzheimer's disease progresses, these losses will result in total dependency for even the simplest activities. In the earlier stages, the victim often express frustration at their difficulty in grasping and expressing their thoughts.  Other early symptoms include: memory loss that affects job skills; difficulty in performing familiar tasks (such as handling the checkbook or preparing meals); difficulty learning new tasks; loss of a sense of time; and problems with language.  As the disease progresses, a person with Alzheimer's disease or a related disorder may experience disorientation of place, poor or decreased judgment, problems with abstract thinking, misplacing things, changes in mood or behavior, changes in personality, and loss of initiative.  These changes will be severe enough to interfere with routine work or social activities.  The second tier victims of Alzheimer's – the family members helping them – may experience emotional distress, guilt, anger, fatigue, isolation, family conflict, anxiety, and depression.

There are a few “common” facts about Alzheimers:

1.      Alzheimer Disease is not a normal part of aging.

2.      The majority of people with Alzheimer Disease are over the age of 65, though individuals have been diagnosed as young as 30.

3.       Alzheimer Disease knows no boundaries, it affects men and women of all races, religions and socio-economic backgrounds.

4.      To date, the cause of Alzheimer Disease is not know.

5.      To date, there is no treatment to slow or stop the progression of the disease 

           While the cause of Alzheimer's disease is not known at this time, it is the subject of intense scientific investigation.  There are many organizations to help the family and friends cope with this horrible disease.  The Alzheimer’s Assoc. in each city has a vary of programs both for the victims, the caregivers, and the medical staff working with Alzheimer’s.  The Caregivers Army (caregiversarmy.com) is a fantastic organization that does many things to make the public awareness of this disease greater and to have petitions and fund raisers to promote and aid the research of Alzheimer’s.   Although genes have been identified for the rare Familial Alzheimer's disease, for most people the genetic involvement is less clear.  There is an increased risk for individuals with one or two copies of the apolipoprotein E (APOE) type 4 gene.  However, there is no predictive value of the presence of this gene, so asymptomatic genetic testing is not recommended at this time.  Although discoveries are occurring daily, this is a very complex disease and scientists have much more to learn before cause(s) are identified.

           Although there is no cure for Alzheimer's disease at the present time, good planning and medical and social management can ease the burdens for the diagnosed person and family.  It is very important to involve the person with the disease in this planning, and to talk openly about the disease, if at all possible.  They are almost always the first to be aware of their problems, and the diagnosis should, therefore, be shared with them.  Openly acknowledge their feelings and frustrations, and reassure them that you and others will be there for them as the disease progresses.
 

             Appropriate medication can lessen agitation, anxiety, unpredictable behavior, disruptive sleeping patterns, and depression.  Physical exercise and social activity are important, as are proper nutrition and health maintenance.  A calm, well structured environment and routine lifestyle may help the diagnosed person to maintain as much independence and dignity as possible.  The drug, Aricept has been approved by the FDA for treatment of Alzheimer’s; talk with your physician to determine if this is appropriate for your situation.  Research into additional medications and other treatments holds promise for the future.

            The course of Alzheimer's disease usually spans several years, and during some of that time the diagnosed person may require total care.  It is estimated that more than $100 billion is spent annually on the costs of Alzheimer care, both in nursing homes and private homes.  It is estimated that the total cost to care for a person with Alzheimer's is $174,000.  Families should seek financial planning and legal advice to prepare themselves for the expenses ahead.

            There are some obvious differences for family to watch for.

   Normal Forgetfulness

1. Forgets details not events
2. Will remember later
3. Can use notes/cues
4. Can recognize people/places
5. Can follow directions
6. Knows day and time

   Alzheimer's Disease

1. Forgets recent events
2. Does not remember he has forgotten
3. Cannot when the disease has advanced
4. Gradually there is no recognition
5. Eventually cannot follow directions
6. Gradually becomes unaware of day or time
*   Unable to learn new things
*   Difficulty making decisions
*   Difficulty understanding what is being said, and in turn expressing him/herself
*   Problems with doing simple tasks that he/she has been doing Any or all of these
    difficulties may result in the individual being confused or disoriented.

Although there is no set pattern for “stages” the victim will go through, there are some general “rules of thumb”.  Included here just a few of the early symptoms of Alzheimer's disease in the general population:

 *Language problems. The person cannot find the right word or name for a familiar person, place or object. This is not the same as taking longer to recall a word. It is far more than the "occasional" slip of a name that everyone experiences.

*Loss of recent memory. The person may forget that he or she just had breakfast or has left something cooking on the stove, or may check and recheck that the bed has been made. However, recall of events from the distant past is often unaffected.

*Loss of a sense of time and place. The person may become more and more confused about what day it is, or forget the route to well-known places.

*Decline in activities of daily living. The person may exhibit an unexplained loss of activities of daily living (ADL) skills. What once was an easy task for the person may now be difficult.

*Personality changes. These may be so slight that, at first, they are difficult to notice. Some people become more quiet and withdrawn. In other cases, they may become more and more restless. Some persons may start to get angry over little things or have sudden changes of mood for no apparent reason.

            Despite the fact that Dr. Riesberg wrote the stages of Alzheimer's disease into seven that is now used by the medical field; there are three basics or concepts.   These consist of:

First (or onset stage):
           The initial symptoms often appear very gradually. There may be some minimum memory loss, particularly of recent events. The individual may experience difficulty in finding the right words to use during casual conversations. Work performance may begin to deteriorate and changes in behavior may start to become obvious. These changes may last for a period of up to five years.

Second (or progressive stage):
           The symptoms noted during the onset stage now become more obvious. There may be distinct problems with language abilities--this is typically the most obvious sign of movement to this stage. Persons affected may have difficulty naming objects or with maintaining a logical conversation. They may also have difficulty understanding directions or instructions. They often become easily disoriented with regard to what day it is (time), where they are (place), and who they are with (person). Confusion and the resulting frustration are often evident. Memory losses become even more pronounced. They may also begin to experience loss of self-care skills, including the ability to use the toilet (incontinence). Severe changes in personality may begin to become obvious, and their social behavior may be marked by suspiciousness (paranoia) and delusions. These changes may last for up to about twelve years.

Third (or terminal stage):
           Persons affected now experience substantial dysfunction. Basic skills such as eating or drinking are forgotten. Because of eating problems, many persons may experience a substantial loss of body weight (up to 20- 30 percent). They may eventually lose their ability to maintain balance and walk. Their ability to recognize other persons and their environment is gone. Both long- and short-term memories are lost. At this stage, persons affected require complete 24-hour care and often become bedridden and inactive. Because of this, they are at increased risk for any infection, especially pneumonia, and consequently are far more likely to die. These changes, leading to death, may last for three or more years.

            There are numerous other disorders or conditions that result in symptoms similar to those of Alzheimer's disease. Many of these conditions are treatable. It is therefore crucial to determine the cause of the symptoms and not assume they are always due to Alzheimer's disease. It must not be assumed that someone has Alzheimer's disease because he or she exhibits some symptoms of the disease. Other common causes of these symptoms include: stroke, depression, medication reactions, thyroid disease, nutritional deficiencies, brain tumors, head trauma, subdural hematoma, and normal pressure hydrocephalus.

   If a diagnosis of Alzheimer's disease is assumed without adequate evaluation, the adult with a treatable condition may be deprived of remedies that could help return him or her to normal function. A variety of psychosocial and medical procedures must be used to rule out associated disorders as the cause of personality or behavior changes that otherwise could be mistakenly attributed to Alzheimer's disease.

             Although Alzheimer's disease is the most common cause of dementia, it is only one of many causes. There are also "related disorders" that cause various forms of dementia. These include multi-infarct dementia (a cortical dementia) and conditions like Huntington's disease, Parkinson's disease, and Creutzfeldt-Jakob disease (which are sub-cortical dementias).

            There are also "associated disorders," such as thyroid abnormalities, arthritis, hearing loss, temperature sensitivity and sleep pattern changes, that may occur at the same time as Alzheimer's disease but which are not caused by Alzheimer's disease. These conditions may be reversible or treatable. They result in dementia-like symptoms but do not actually cause the permanent brain changes that result in dementia.

            A person with Alzheimer Disease has less expression, is less lively and more withdrawn. At the same time, he/she loses the ability to control moods and emotions. These changes may vary, change rapidly and become harder to predict. Sometimes the person may be sad, angry, laugh inappropriately, or worry a great deal over small things. At other times he/she may be suspicious of people he/she is close to. It may appear that the persons whole personality has changed.

            The changes in mental abilities and moods will result in changes in behaviour. The kinds of behaviour changes and the length of time they are present are different for each person. Any behaviour will be greatly influenced by the individual's physical abilities. These behaviours may include: pacing or wandering, repetitive actions, hiding things, disturbed sleep to mention a few. It is important to know that these changes are not intentional, they are caused by the disease.

   Over time Alzheimer Disease will cause a deterioration in physical ability, both in coordination and mobility. These difficulties will create problems performing activities of daily living such as bathing, dressing, eating. Slowly the person will become less and less able to move about. Bladder and bowel control will eventually be lost. Gradually people with Alzheimer Disease become totally dependent on those around for all their needs.

             Scientists around the world are looking for the cause of Alzheimer Disease. While the cause has not been found, scientists continue to learn more about the disease. Two things we do know about Alzheimer Disease are that as you grow older the chances of developing the disease increase, and that if you have a family member with the disease, your chances of developing the disease are greater than someone with no affected relative. Researcher now believe that the cause of Alzheimer Disease is multifactorial. Therefore the search for the cause is taking place on many fronts: 

            In the research of Alzheimers, Genetics  plays a big part. There are two types of Alzheimer Disease: Familial Alzheimer Disease (FAD) and Sporadic Alzheimer Disease. Familial Alzheimer Disease is a rare form of Alzheimer Disease, 5 to 10% of cases, which is known to be inherited.  It is passed on from through generation to the next by a dominant inheritance pattern, which means that if a parent is affected, each child has a 50% chance of receiving the defective gene. Sporadic Alzheimer Disease occurs in the rest of the cases. Recent findings have shown that the pattern of a specific allele APOE 4 can determine if an individual is at higher risk than another to develop Alzheimer Disease.

             External Environment Researchers are looking to the environment to see if there is something in the air, soil, or water that may trigger Alzheimer Disease. The Aluminium theory is one which most people are familiar with. To date, very little is understood about Alzheimer Disease to say with any certainty that Aluminium is the cause. There is no evidence either to indicate that using aluminium pots and pans will cause Alzheimer Disease. Other areas being explored include: the use of pesticides, fertilizers, zinc, mercury.

            Internal Environment Scientists are exploring the chemical imbalances in the brains of people with Alzheimer Disease, possible viral or immunological causes.