Dementia: Alzheimer’s Disease (AD) is a progressive neurodegenerative
disease characterized in the brain by clumps (amyloidal plaques) and tangled
bundles of fibrous neurofibrili composed of misplaced proteins. Age is the
most important risk factor for AD. The number of people with the disease doubles
every 5 years beyond age 65. Three genes have been discovered that cause early
onset (familial AD). Other genetic mutations that cause excessive accumulation
of amyloidal protein are associated with advanced age (sporadic AD). Symptoms
of AD include memory loss, language deterioration, and impaired ability to
mentally manipulate visual information, poor judgment, confusion, restlessness
and mood swings. Eventually AD destroys cognition, personality, and ability
to function. The early symptoms of AD, which include forgetfulness and loss
of concentration, are often missed because they resemble natural signs of aging.
Is there any treatment?
There is no cure for AD and no way to slow the progression of the disease.
For some people in the earlier and middle stages of AD, medication such as
Aricept, Exelon, and Reminyl may keep some symptoms from becoming worse for
a limited time. A new medication, Namenda, was recently approved. Combining
Namenda with the other AD drugs may be more effective than a single therapy.
Other medications may help control behavior symptoms such as sleepiness,
agitation, wandering, anxiety, and depression.
What is the prognosis?
AD is a progressive disease. Its course can vary from 5-20 years. The most
common cause of death in AD is infection. Patients with Alzheimer’s
live an average of 8 years after diagnosis although some people have lived
as many as 20 years after being diagnosed.
To help understand the changes,
AD is broken into stages: early, middle and late. It is important to understand
that the development of the symptoms differ from one person to another. During
each stage the symptoms will gradually progress over a period of years. It
is not unusual for people with AD to have good and bad days. For example,
a patient with early stage AD may not show any symptoms one day and the next
day the patient may have trouble remembering your name or finding the milk
in the refrigerator.
Early Stage Alzheimer’s
Symptoms include:
Trouble remembering recent events and conversations
Difficulty remembering the month or the day of the week
Loss of ability to manage finances
Withdrawal from social situations and general apathy
Cooking and shopping become more difficult
Poor judgment
Tendency to lose things
Middle Stage Alzheimer’s
Symptoms include:
Difficult behaviors emerge: Anger, suspiciousness, overacting, and paranoia
Wandering
Sundowning with agitation in the evenings
Fever of bathing
Hallucinations
Eating problems
Incontinence
Inappropriate sexual behavior
Will go from needing help in choosing clothes, remembering to change clothes,
to needing help getting dressed
Will progress from needing reminders regarding personal care to needing help
bathing, taking medications, brushing teeth, and toileting
Increased difficulty with verbal expression and comprehension
Loss of reading, writing, and arithmetic abilities
Loss of coordination
Will need 24 hour care 7 days a week
May not recognize family and friends
Late Stage Alzheimer’s:
Symptoms include:
Inability to communicate
Inability to recognize people, places and objects
Cannot participate in any personal care activities
Loses ability to walk
Muscles may become contracted and may lose ability to swallow
Seizures may occur
Majority of the time spent sleeping
Incontinence
Diagnosing Alzheimer’s Disease
Diagnosing Alzheimer’s Disease is reached through a combination of tests.
It must be differentiated from the occasional forgetfulness that occurs during
normal aging, and from depression, malnutrition, or the side effects from medications;
all of which can cause symptoms similar to those of early stage AD. The physician
often begins an evaluation by taking a history and performing a physical examination
as well as evaluating the patient’s cognitive abilities. This approach
can help the doctor determine whether testing is needed. An examination may
likely include a thorough medical evaluation and history followed by an extensive
neurological and neuropsychological testing. The testing may include imaging
of the brain with MRI, EEG testing, lab work-up, and recently approved for
difficult to diagnose cases – PET CT scanning.
Alzheimer’s Caregiver
AD is often a family disease because the chronic stress of watching your loved
one slowly decline affects everyone. Comprehensive treatment must therefore
address the needs for the entire family. This includes emotional support,
counseling, and more educational programs about Alzheimer’s Disease
for the individual’s family members as they strive to provide a safe
and comfortable environment at home. Through training, caregivers can learn
how to control unwanted behaviors, improve communication, and keep the person
with Alzheimer’s safe. Research has shown that caregiver’s benefit
from training and support groups and putting this patient in groups allows
caregivers to care for their loved ones at home longer. For valuable information
regarding caregivers, visit www.caregiver.org and search for Alzheimer’s
Disease.
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