Alzhiemers Disease

Basic Information

Alzheimer's Disease is a degenerative brain process that produces, usually slowly over time, dementia or senility. It is also known as senile dementia. The brain is disrupted from the way it normally works -- mental function becomes impaired -- and the patient's memory, ability to think clearly and sometimes the patient's language is impaired.

The causes of Alzheimer's are still not known -- but we do know that the disease produces physical change in the brain. There is shrinking in some areas and widening in the others. When the brain shrinks or widens, connections inside the brain are broken, causing disruption of the electrical signals in the brain.

Alzheimer's is the most common cause of dementia -- it is estimated that between 5% to 10% of the U.S. population over 65 will experience some kind of dementia -- and half of these cases can be attributed to Alzheimer's. The average duration of this disease is 8--12 years and while the incidence of getting it increases with age, usually affecting those over 65, Alzheimer's in a more rapidly progressing form can affect adults in their late 30s and early 40s as well.

This disease is thought to be inherited in the majority of cases, though it does not mean that because either a mother or father has it that the child will automatically develop it.

Alzheimer's is the fourth leading cause of death in the U.S. for adults, meaning that millions of people are affected by this disease.

Symptoms

The three types of initial symptoms are:

1. Memory loss -- This is the most common symptom and the symptom most often exhibited by patients over 65. Patients may not remember to keep appointments, forget people's names, forget where an object was placed, forget recent events or ask repetitive questions.
2. Language disturbance -- This usually follows memory loss but can be an initial symptom in both those under 65 and in inherited cases. Words are forgotten or words other than the ones intended are used.
3. Visual impairment -- A visual/spatial impairment occurs. For example a patient in the early stages of this disease will have difficulty drawing a clock which shows the correct time.

Patients brought to a health care provider, usually by a concerned family member or members, will usually exhibit one or all of the above early symptoms. In addition depression may be a common early symptom as well. These early symptoms of mental deterioration may be the only signs present -- they can last for a long time and be the only indicators of the disease.

But Alzheimer's is a progressive illness. Over time other symptoms may be present. Watch out for the three "I"s: indifference, irritability and isolation. Patients often withdraw after confusing and disorienting incidents; for instance patients often get lost when driving the car in new surroundings, then typically get lost in familiar surroundings.

In later stages, outbursts of anger can be frequent, anxiety and insomnia can occur regularly, visual hallucinations can occur as well as paranoia. Some neurological signs may appear, such as awkwardness in walking, the slowing of cognitive functions, incontinence or the degeneration of motor skills. Eventually the inability to recognize familiar people or even the inability to care for oneself will occur and nursing home care may be necessary.

Diagnosis/Treatment

The diagnosis of Alzheimer's requires clinical expertise. Other diseases that cause central nervous system conditions that cause memory loss include Parkinson's disease and Huntington's disease; other diseases that cause dementia and may mimic symptoms of Alzheimer's include Vitamin B deficiency, HIV infection, a hyper thyroid or neurosyphilis. In the aged a mild forgetfulness that is a "natural" part of aging may be confused with the more serious, debilitating loss of memory that occurs with Alzheimer's. Thus it is often by the help of ruling out other illnesses that your health care provider can come to diagnose Alzheimer's. Perhaps your health care provider will refer you to a gerontologist (one who specializes in the care of the older adult) to confirm the diagnosis. Certain tests may be administered to evaluated the patient's recall, language, attention (such as counting backward or repeating the days of the week backward and forward), or ability to perform and complete tasks. These test results may be indicative of Alzheimer's in early, middle or late stages. But to diagnose this disease the health care provider will want to be able to document changes that have occurred in the mental or cognitive levels of the patient.

No cure exists for Alzheimer's disease today, though new medications show some promise in treatment such as reversible cholinesterase inhibitors which improve a patient's function level. But the success of these new medications have been mild and there can be some other problems associated with use of these inhibitors, such as an elevation of liver enzymes. Your health care provider must carefully monitor any Alzheimer patient to determine whether it is in the patient's best interests to continue or stop the usage. Sometimes anti-depressants or medication used to control anger and anxiety are prescribed and can be helpful.

But treatment today focuses on contributing problems -- creating a consistency in the daily routine and living environment. This consistency, combining emotional support with logistic support, is best implemented by primary care givers. Alzheimer's patients will need assistance in maintaining the highest level of functioning in day-to-day living routines. Safety concerns are a priority -- some patients are not steady on their feet. Some may benefit from the assistance of a walker or having the home or living quarters equipped with handrails. It has been found that routine visits to an adult day care center are beneficial to the patient.

If the patient is living at home both the needs of the family and/or the primary care givers are important -- as well as those of the patient. A family needs emotional support while living with a loved one who has this debilitating illness. Support groups, such as an Alzheimer's Association group, for families of those suffering from Alzheimer's are recommended. Also, ideally there should be more than one care giver for the patient, so that the family can arrange for periods of rest for the primary care giver. This is important -- no quality treatment can occur if the care giver is emotionally or physically depleted. The family, with the aid of their health care provider, will over time determine what routine is best for them to follow: this will include deciding how often they need to bring in a care giver (a few hours a day, once a week) so that they can have a break. They also will find they might benefit by moving the patient to a care facility for a short period or a longer one.

It is important to allow the patient to remain as active and as independent as possible. It is advisable to have them wear a medical alert bracelet or a tag that lists name and address should they wander off and become lost.

Behavioral techniques and adaptations in the environment (such as writing down one's task and important daily reminders) can be helpful. Large calendars and big clocks can provide frequent reminders. Following a strict schedule during the day may be helpful in maintaining the patient's daily interactions and skills. A defined bedtime and a rising time are important. And do not change the patient's living environments if at all possible, as this can create confusion and disruption in the daily routines you are trying to establish.

A thorough review of the patient's medications should be taken by the health care provider, and all that are deemed unnecessary should be discontinued. In addition, one must be very cautious of multiple practitioners prescribing (seeking health care from several different providers and not informing them of all the prescriptions the patient might be on).

If someone you know exhibits signs of Alzheimer's, remember -- dementia can have other causes. Do not attempt a diagnosis of your own. Contact your health care provider and arrange to have the possible patient professionally evaluated.

Additional Resource(s):

• The Alzheimer's Foundation (AF) 918-481-6031
• Alzheimer's Association 800-272-3900
• Washington University in St. Louis Alzheimer page
• Alzheimers.com