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Let's
Talk Facts About...
ALZHEIMER'S
DISEASE
What
is Alzheimer's disease?
Alzheimer's disease is a progressive disorder that slowly
kills nerve cells in the brain. First identified in
1907 by the German physician Alois Alzheimer, the illness
afflicts some 4 million Americans today. At least one
in 20 adults aged 65 and older suffers from the disease;
one study found that some 47 percent of those over age
85 have Alzheimer's disease.
Symptoms
At first, people suffering from Alzheimer's disease
develop almost imperceptible personality changes and
memory loss. They seem more easily tired, upset, or
anxious. Their memory loss differs from normal age-related
memory problems (see chart A). They can't cope well
with change: they can follow familiar routes but traveling
to a new place confuses them and they easily become
lost. They grope for the words they want in conversation.
Often, they try to cover up their memory lapses by denying
forgetfulness or by blaming it on events or people.
Later,
memory losses worsen, and Alzheimer's patients may repeatedly
ask the same questions. They can't make good decisions
but may become angry when family members try to help
with such accustomed tasks as balancing the checkbook
or filling out tax forms. Driving becomes more dangerous,
because they can't react quickly or appropriately to
traffic dangers, and the freedom to operate a motor
vehicle may become a thing of the past. At this stage,
people with Alzheimer's disease begin to forget the
names of longtime friends. Social life becomes more
difficult, and they may become more isolated.
In
the early stages of their illness, people with Alzheimer's
disease are particularly susceptible to depression.
Their condition may also be aggravated by reactions
to medications or an unsuitable living environment,
and the erosion of their intimate relationships may
increase their suffering.
Dementia-a
syndrome characterized by deterioration of reasoning,
judgment and impulse control as well as changes in memory
and personality-becomes more apparent in the next stage.
A number of illnesses may cause dementia, but among
older people Alzheimer's disease is the most common
cause. People afflicted with dementia lose the ability
to read words or music. They can no longer identify
the date or season. As they lose recent memory, they
seem to lose entire blocks of time, forgetting, for
instance, who the current president is. Emotional problems
may become more severe as the person with Alzheimer's
disease tries to make sense of failing reality. They
may have long crying spells, become increasingly agitated,
anxious, suspicious, and develop paranoid notions about
things being stolen or hidden, or about their food being
poisoned. Their sleep may be disrupted, and they may
wander at night.
In
later stages, people with Alzheimer's begin to lose
physical coordination and need help with dressing and
bathing. More and more often, they can't identify their
family and friends, though they may still smile, laugh
and enjoy company. Physical impairments can increase
until walking is impossible. Eventually, the Alzheimer's
patient completely loses touch with reality, and requires
constant care.
Reversible
Dementias
Anyone who suspects a loved one may be suffering from
Alzheimer's disease should not jump to conclusions too
quickly. Many other illnesses mimic Alzheimer's disease.
Physicians must rule out these treatable conditions
before diagnosing Alzheimer's disease. They include:
- Depression
- Reactions
to medications or to drug interactions with other
medicines
- Chemical
imbalances, caused by poor nutrition or illnesses
such as pernicious anemia (vitamin B12 deficiency),
diabetes, an imbalance of sodium or calcium, or decreased
or increased thyroid levels
- Heart
and lung problems that deprive the brain of adequate
amounts of nutrition or oxygen
- Head
injury from falls; exposure to environmental pollutants
such as lead, mercury, carbon monoxide, some pesticides
and industrial pollutants; chronic alcoholism, or
illnesses such as meningitis. Dementias arising from
many of these causes may be as irreversible as Alzheimer's
disease.
Not
all true dementias are caused by Alzheimer's disease.
Brain damage caused by impaired circulation-called multi-infarct
dementia-causes between 12 and 20 percent of dementia
in older people. Other conditions, including multiple
sclerosis, Parkinson's disease, Huntington's disease,
and Creutzfeldt-Jakob disease, also cause progressive
dementia.
Diagnosing
Alzheimer's Disease
Research on Alzheimer's disease has established that
all people with the disease develop characteristic microscopic
changes in the brain, called "plaques" and
"neurofibrillary tangles" which develop as
brain cells die. The ultimate reason for the premature
death of brain cells isn't yet known. However, because
plaques or tangles develop deep within the brain, doctors
don't normally test for them. As a result, physicians
must carefully review a person's symptoms and take a
thorough medical history. Psychiatrists and other physicians
will only diagnose probable Alzheimer's disease after
a thorough medical, psychiatric and neurological evaluation
has ruled out other conditions that mimic the disease.
At the best established medical centers with Alzheimer's
disease specialty programs, clinical diagnosis can be
quite accurate-90 percent or better.
Research
Looks for Causes
The tangles and plaques of Alzheimer's disease appear
inside the nerve cells in large numbers in parts of
the brain that regulate thinking, learning, sleep, and
memory. When magnified, these tangles look like pairs
of filaments that have been twisted around each other.
The plaques are made of a protein called amyloid which
is surrounded by what appear to be debris from dying
cells.
Psychiatric
researchers have focused on amyloid in plaques because
this protein has been associated with several other
diseases such as tuberculosis, Hodgkin's disease and
cancer. Some researchers think amyloid regulates growth
in nerve cells and could be part of the cells' attempts
to defend themselves. Others have found that abnormal
proteins associated with amyloid are toxic to nerve
cells. They think amyloid may contribute to brain cells'
death. Finally, researchers have found amyloid in the
skin and intestines of some Alzheimer's disease patients,
but not in healthy people, leading some doctors to hope
they may some day diagnose Alzheimer's disease by detecting
amyloid in other parts of the body.
Other
studies also have focused on imbalances in calcium.
If Alzheimer's disease changes the calcium regulatory
system, it may cause too much calcium to build up in
brain cells and, eventually, kill them. Also, the presence
of abnormally high concentrations of aluminum in the
brain tissues of some with Alzheimer's disease has led
some researchers to investigate a possible link. Researchers
speculated that aluminum-ingested along with food and
drinks stored in aluminum cans-might be causing or aggravating
the illness. Research has suggested, however, that if
there is any connection, it probably stems from Alzheimer's
disease making brain tissues more permeable to aluminum,
rather than from aluminum causing the illness.
Still
other studies have found imbalances of certain brain
chemicals called neurotransmitters. People suffering
from Alzheimer's disease have low levels of the neurotransmitter
acetylcholine, which are critical to the proper functioning
of memory, thoughts and other higher intellectual functions.
Alzheimer's patients also have low levels of serotonin,
the neurotransmitter that regulates aggression, mood
and sleep. Scientists think a serotonin imbalance could
contribute to the sleep disturbances, mood changes and
aggressive behavior that appear in some Alzheimer's
patients.
Finally,
researchers have found that some Alzheimer's disease
victims have low levels of norepinepherine in their
brains. Deficiencies in this neurotransmitter can contribute
to anxiety, depression, excessive sleepiness, and difficulty
in focusing attention.
Treatments
May Be on the Horizon
What do these findings mean? Some have guided studies
to develop medicines that alleviate symptoms of Alzheimer's
disease by bringing acetylcholine, serotonin or norepinepherine
back into balance.
Scientists
have seen mixed results in medications' ability to halt
the progression of Alzheimer's disease. Some increase
the amount of acetylcholine in the brain, but offer
only modest improvements in mental alertness and memory.
Others keep existing acetylcholine from degenerating,
improve visual and verbal memory and help certain types
of learning.
More
recently, researchers have learned that a chemical known
as Alcar (acetyl-l-carnitine) imitates the action of
acetylcholine in rats and seems to slow the death rate
among nerve cells. While it is too early to tell if
this avenue of research will lead to a treatment, Alcar
studies are continuing in the U.S. to learn whether
it can reduce Alzheimer's symptoms.
Coping:
A Team Approach Works Best
Even though scientists don't fully understand how Alzheimer's
disease begins and what causes its symptoms, patients
and their loved ones can do much to cope with the illness
and its effects.
Choosing
Your Physician
One of the most important steps is finding a qualified
physician. Older people have special health needs, so
family members should seek medical care from a physician
who understands and has expertise in the health of the
elderly. The doctor may be a primary care physician,
a neurologist or a psychiatrist who has an interest
in geriatrics.
A
psychiatrist is often the first choice when Alzheimer's
disease begins with its prominent changes in personality,
mood, or behavior. As a medical doctor with specialized
training in the diagnosis and treatment of mental and
emotional illness, a psychiatrist also knows how to
identify physical ailments that may require attention
from other physicians. A psychiatrist can also identify
and treat major depression, an illness that is common
among Alzheimer's victims and their families (see Chart
B). If unrecognized and untreated, depression can mimic
or intensify other problems. A psychiatrist can modify
treatment to meet each individual's needs.
In
addition, psychiatrists have expertise in prescribing
and monitoring psychiatric medications that help manage
the behaviors that can develop from Alzheimer's disease.
The prescription written by the psychiatrist or other
physician is designed to control symptoms without causing
unnecessary side effects. Families should make sure
they understand why these medications are prescribed
and which side effects to watch for and report.
Symptoms
of Depression That Can Mimic or Complicate Alzheimer's
Disease:
- Unexplained
weakness or fatigue
- dizzy
spells
- low
energy
- Stomach
aches
- indigestion
- constipation
- urinary
disturbances
- Change
in eating habits
- appetite
and weight
- Sleeping
disturbances
- Slowed
or more agitated movement
- Slowed
speech
- softened
lowered or monotone voice
- incomplete
responses
- Feelings
of tension
- anxiety
- irritability
- Loss
of initiative
- inability
to enjoy activities once enjoyed
- Indecisiveness
- apathy
- boredom
- indifference
- Poor
attention and concentration
- Tendency
to cry and become upset over minor issues and events
- low
self-esteem
- feelings
of worthlessness
- hopelessness
- helplessness
- inappropriate
guilt
- Thoughts
of suicide
Check-List
of Alzheimer's Disease Symptoms
- Loss
of short term memory occurs: person can't learn new
information
- Loss
of long-term memory occurs: person can't remember
personal information such as birthplace or occupation
- Judgment
is impaired
- Aphasia
develops: patient can't recall words or understand
the meaning of common words
- Apraxia
develops: patient loses control over muscles and can't,
for example, button shirts or operate zippers
- Patients
lose spatial abilities and can't assemble blocks,
arrange sticks in a certain order or copy a three-dimensional
figure
- Personality
changes: patient may become unusually angry, irritable,
quiet, confused
Presence
of any or all of these symptoms is not a sure indicator
of Alzheimer's disease; only a complete examination
by a psychiatrist or other physician can confirm the
diagnosis.
Counseling
and Support Are Vital
Psychiatric medications should not be the only treatment.
Both patients and loved ones may need the help of support
groups and counseling.
By
taking advantage of group support, education and-if
needed-psychotherapy, patients and loved ones can prepare
themselves for the disease and its progression. They
can learn ways to manage the emotional and behavioral
changes that accompany this disease. For example, they
can learn to alleviate negative behavior by responding
to the underlying causes, such as fear or low self-esteem.
They can also identify and cope better with feelings
of loss and grief related to permanent changes in a
loved one's function and personality.
A
person suffering from Alzheimer's disease and his or
her family or friends should not feel they must cope
with this illness alone. Numerous organizations across
the country provide friendship, support, and fellowship.
Community resources can help patient and family as they
struggle with the emotional and behavioral roller coaster,
the medical and social service maze, and the legal and
financial intricacies that accompany Alzheimer's disease.
With
proper diagnosis and intervention, Alzheimer's disease
patients and their loved ones can help prolong the time
during which people with Alzheimer's can enjoy productive,
fulfilling lives. With a solid understanding of the
illness, the patients and their loved ones can cope
more effectively with the symptoms and avoid some of
the complications that may come with the disease's later
stages.
Bibliography
Resources published by the Alzheimer's Disease Research
and the American Health Assistance Foundation, 22512 Gateway Center Drive, Clarksburg, MD 2087, (800) 227-7998,
(301) 948-3244:
Alzheimer's
Family Relief Program: Helping to Meet the Cost of Alzheimer's
Patient Care (describes a financial assistance program
offered by the American Health Assistance Foundation)
Other
booklets available through ADR/AHAF:
Alzheimer's Disease: A Family Survival Guide
Alzheimer's
Disease: the ABCs of Diagnosis
Caring
for an Alzheimer's Patient Across the Miles
Caring
for the Alzheimer's Patient at Home: Tips for Coping
The
Hardest Choice: Selecting A Nursing Home for an Alzheimer's
Patient
Understanding
Alzheimer's Disease
Publications available through the Alzheimer's Association
919 N. Michigan Ave.,
Chicago, IL 60611:
Care for Advanced Alzheimer's Disease
From
Theory to Therapy: The Development of Drugs for Alzheimer's
Disease (information kit on drug therapies currently
under testing)
Guidelines
for Dignity (guidelines for specialized Alzheimer's
disease care in nursing homes and other residential
settings)
Standing
by You: Family Support Groups
Pertinent
books published by the American Psychiatric Press, Inc.,
1400
K St., NW,
Washington, DC 20005
The Psychiatric Treatment of Alzheimer's Disease, GAP
Report # 125. Group for the Advancement of Psychiatry
Committee on Aging. 1988. 160 pages.
The
Elderly Mentally Ill, Psychiatric Services. 1985. 56
pages.
Progress
in Alzheimer's Disease and Similar Conditions. American
Psychopathological Association. 1997. 368 pages.
Other
publications:
Caring Home Booklet: Environmental Coping
Strategies
for Alzheimer's Caregivers. Pynoos, J., E. E. Cohen,
and C. Lucas; Los Angeles, Program in Policy and Services
Research, Andurs Gerontology Center, University of Southern
California, 1988.
(213) 743-6060.
Alzheimer's
Disease: Help for Caregivers. Alzheimer's Disease International,
Division of Mental Health, World Health Organization,
Geneva, 1994.
Progress
Report on Alzheimer's Disease.
Alzheimer's Disease Education and Referral Center, P.
O. Box 8250, Silver Spring, MD, 20907-8250, 1996. (800)
438-4380 or (301) 495-3311.
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