Introduction
Alzheimer’s disease (AD) is a degenerative and incurable disease that is characterized by the gradual loss of memory and a decline in the ability to think. There is no cure for AD and its disabling effects lead to significant personal and societal costs. The prevalence of AD has increased over the past decade because of the rise in aging populations. This paper will define Alzheimer’s disease and highlight some of the warning signs of the disease. It will also note the risk factors for the disease, diagnostic criteria and the interventions currently available.
Defining Alzheimer’s Disease
According to Goedert (2009), AD is a clinicopathological entity literally meaning “the loss of the ability to think” (p.1102). The loss of memory is caused by a loss of hippocampal and cerebrocortical neurons in the AD patient. Shan (2013) elaborates that these are the regions of the brain that control memory, thought, language, attention, perception, and consciousness. The structural changes in the brain that occur due to AD adversely affect these regions. An autopsy on the brain of a patient with severe AD will show that there are abnormal growths throughout the diseased brain and the overall size of the brain is less than that of a healthy person due to shrinkage (Goedert, 2009). AD is the most common form of senile dementia and the risk of developing the disease increases with age.
Age of Onset
Alzheimer’s disease is primarily confined to the elderly and very small minorities of Alzheimer’s patients are under 50 years of age. The disease is most prevalent in individuals over the age of 65 years old. Research indicates that 1% of those aged between 65 and 74 suffer from Alzheimer’s (Whitehouse & Maurer, 2010). This prevalence increases to 7% for those aged between 75 and 84 and rises to 25% for those over 85 years.
Warning Signs of Alzheimer’s Disease
The Alzheimer’s Organization (2013) gives a list of signs that can provide early warning to the onset of AD in an individual. A common warning sign is the loss of memory especially concerning recently acquired knowledge. The individual will have a tendency to ask the same questions incessantly since he forgets the answers. The second warning sign is that the individual will have difficulties in making plans or solving arithmetic or logic problems. Another sign is that the AD patient will have difficulty completing daily tasks and have trouble remembering things like familiar routes or rules in a game. The fourth warning sign is a loss of time and place awareness. The individual will at times forget where he is or how he got there and he can lose track of dates. The fifth sign is vision problems where the individual will have difficulty reading and judging spatial relationships. The person may also start experiencing troubles in determining colors.
The sixth warning sign is that the AD patient starts developing problems with written and spoken speech. He will struggle with vocabulary and often forget the correct terms for common objects. The seventh sign involves loss of ability to remember where things have been placed. The individual will constantly misplace items and may even accuse others of stealing the item whose location he cannot remember. The eighth sign is exhibiting of poor judgment especially concerning the use of money. The individual will also neglect personal hygiene. The ninth warning sign will be a gradual withdrawal from social activities and professional engagements. The final warning is a change in personalities and mood with the individual becoming confused and anxious for no apparent reason.
Stages
Researchers have grouped the symptoms of AD into three phases of progression, which are the early stage (mild dementia), the middle stage (moderate dementia) and the late stage (severe dementia) (Whitehouse & Maurer, 2010). In the early stage, the individual experiences slight memory loss and forgetfulness. He is also likely to exhibit slight confusion and some trouble in making decisions. In the early stage, the patient will be successful at hiding the symptoms from family and even clinicians.
In the middle stage, there is decreased functional ability. The patient exhibits increased confusion and memory loss. He is likely to suffer from illogical thinking patterns and have some delusions. The AD patient will show difficulty in completing simple tasks and he might require help for basic hygiene and body care tasks. By the late stage, the individual has severe cognitive decline and all verbal abilities will eventually be lost. The patient may forget how to perform basic activities of daily living and is unable to care for himself. The basic motor skills of walking, sitting and head control is lost and greater assistance is required. The person in this stage cannot survive without some assistance from others.
Risk Factors
The major risk factor for AD is increasing age since the rate of this disease increases significantly with advancing age. Genes also play a role in the development of AD and in some cases, heredity might influence the development of this disease. Whitehouse and Maurer (2010) state that the genetic basis of AD development has been identified by the discovery of some genetic markers which the disease has. As such, an individual who comes from a family that has certain genetic markers is likely to develop AD at a relatively early age.
Diagnostic Criteria
Diagnosis is difficult especially in the early stages since some of the symptoms are consistent with mild cognitive impairments that are a normal part of the ageing process. Health care professionals can use a threefold approach to diagnose the disease (Whitehouse & Maurer, 2010). The first is dementia, which is characterized by loss of intellectual abilities to such an extent that the person’s personal and professional life is affected. The second is the onset of the symptoms identified as warning signs of AD. Finally, all the other specific causes of dementia should be excluded. By ruling out all the other disorders that can bring on similar symptoms, the conclusion can be reached that a person is suffering from AD. Brain scans can be used to confirm the presence of AD since these scans can show alterations in brain structure which are consistent with AD. A CAT scan will reveal a shrunken brain with some tissue indentations.
Interventions
As of the moment, there is no known cure for Alzheimer’s disease and it is impossible to reverse the condition. However, there are treatments that can be used to alleviate most of the severe symptoms of the disease and enable the person with Alzheimer’s disease to cope with the disease. Medical treatment can be used to slow the progress of the disease and reduce the behavioral problems associated with AD (Shan, 2013).
The FDA has approved four drugs for the treatment of AD and they are Donepezil, Rivastigine, Galantamine, and Memantine (Shan, 2013). Except for Memantine, the other drugs work by enhancing the level of acetylcholine thereby increasing the level of cell-to-cell communication in the brain. This enhances brain function and temporarily improves cognition. These drugs can be used for treating mild to moderate AD. Memantine is used for treatment of moderate to severe AD. This drug blocks the action of glutamate, which is the chemical, believed to contribute to the death of neuronal cells. In addition to the AD medication, patients can be given psychotropic drugs to manage behavioral disturbances such as depression, agitation, and psychosis.
Non-pharmacological interventions include maintaining a healthy lifestyle. By eating a healthy, balanced diet, and exercising regularly, a patient can slow the progression of the disease and enjoy a better quality of life (Whitehouse & Maurer, 2010). The patient can also maintain a journal to record daily events and activities that should be done every day. This journal will be useful since it will enable the patient to retain some skills for longer as the disease progressed.
Other Considerations in Managing AD
Special consideration should be given to the family of the patient since thousands of AD patients are cared for by their families. Shan (2013) declares that offering support services to the family is an integral part of the medical management of AD process. The family should be given information and advice on the available treatment options for the patient. Therapy services should also be provided to the family to help them cope with the emotional strain caused by taking care of the patient. The patient and his family should be prepared for the eventual death of the individual due to AD. On average, the time between diagnosis and death is 8years (Shan, 2013). Family members and friends should be offered help as they experience anticipatory grief, which is the grief that occurs when a person is anticipating death.
References
Alzheimer’s Organization (2013). 10 Early Signs and Symptoms of Alzheimer’s.
Goedert M (2009) Oskar Fischer and the study of dementia. Brain, 132(4), 1102-1111.
Shan, Y. (2013). Treatment of Alzheimer’s disease. Primary Health Care, 23(6), 32-38.
Whitehouse, P.J., & Maurer, K. (2010). Concepts of Alzheimer Disease: Biological, Clinical, and Cultural Perspectives. NY: JHU Press.