Alzheimer Disease Primer! Basic Facts
History of Alzheimer's disease - In 1906, Dr. Alois Alzheimer noticed changes in the brain tissue of a woman who died of mental illness. Upon autopsy, amyloid plaques and tangles were found. Eventually, the underlying cause of death identified as dementing illness/brain destruction.
Basic theories are as follows: 1) Plaques - protein build up outside the nerve cell of the brain which interrupts information flow; 2) Tangles - protein build up inside the nerve cell of the brain which short circuits the information flow; and 3) Neurotransmitters (chemicals connection to help carry information from one nerve cell to another in the brain are disrupted. Possible contributors include: Age; Head trauma; Disability; Cardiovascular; Ethnicity; Education level; Heredity; Gender; and Genetics (APOE).
Signs/Symptoms: Anxiety; Confusion; Sad mood; Loss of interest in activities; Neglect of hygiene; Weight change; Crying; and Difficulty concentrating. Alzheimer's based dementia is often confused with Depression and Delirium. Depression often complicates and may mimic Alzheimer's dementia. Often, depression goes undiagnosed and if identified, 80% don't receive treatment. For delirium, the sudden onset of a temporary state of confusion with possible causes include stroke, medication; fever; illness; and sleep deprivation.
Diagnosis is done by exclusion first which is 95% accurate or by autopsy. Otherwise, it is done through evaluation tests of the following body systems: Neurological, Labs (amyloid protein levels), Diagnostic tests (PET, MRI, CAT Scan); Mini mental; Psychiatric; Physical; Cerebrospinal fluid; and Informant Questionnaire in Cognitive Decline in elderly.
Early stage signs include: Memory recent loss; Problems finding words; Poor judgment; Poor decision making; Time/Place disorientation; Depression/Apathy; Loss spontaneity; Not perform familiar tasks/need reminders; Decreased concentration; and Misplacing things.
Middle stage signs include: Risk to self/unsafe to be left alone; Increase in memory loss, names, and places; Mood disturbances; Increased difficulties finding words; Problems tracking conversations; Calculation difficulty; Reading may stop; Visual-spatial perception problems (visually process letters and words); Repetitive behaviors; Inability to recognize self in mirror; Hyperorality (inserting inappropriate items in mouth);
Middle-Later stage signs include: Behavioral outbursts (catastrophic reactions to small stressors); Anxiety / Agitation; Depression; Paranoia / Hallucination; Get lost easily; Wandering; Considerable weight loss; Increased risk for falls; Incontinence; Assistance with ADL's; Simplified instructions; and Loss of inhibitions.
End-stage signs include: Unable to perform ADL's independently; Immobility; Inability to perform purposeful movement; Swallowing difficulties; Fragile skin; Need for "high touch" care; and Limited communication.
Functional memory impairment deficiencies include the following comparative perspective of AAMI and Dementia related memory impairments. For AAMI, deficiencies include: 1) Sensory loss to include gradual losses in vision, hearing, touch, smell, taste; 2) Memory loss to include mild forgetfulness but still able to use reminders, delayed recall but may forget parts of experience but often remembers; 3) Thinking to include continued ability to follow written or spoken directions; 4) Paranoia / Hallucinations to include some related to vision, hearing loss (i.e. think to hear his name being called); and 5) Self care capacity to include ability to perform or assist with all self care activities daily tasks.
For Dementia, deficiencies include: 1) Sensory loss to include gradual loss in vision, hearing, touch, smell, and taste; 2) Memory loss to include progressive memory loss, gradually unable to use reminders, no recall, forgetting whole experience, and rarely remembers; 3) Thinking to include gradual loss of thinking skills, gradual loss of ability to make decisions and to follow directions, and difficulty with abstract thinking; 4) Paranoia / Hallucinations which vary for each person; and 5) Self care capacity to include progressively unable to care for themselves.
Pharmacology treatment & therapy: Antipsychotic medication are used to treat the behaviors of dementia (e.g., agitation, psychosis, and aggression). Antipsychotic drugs (e.g., Risperdal) are best at its lowest effective dose, when there is harm to self or others, persistent distress, significant decline in function, and assessed often to reduce prolonged use. It is commonly supplemented by Antidepressant drugs (e.g., Zoloft). Stage-related drug therapy are as follows: Donepezil (Aricept) is approved for all stages; Rivastigmine (Exelson) approved for mild to moderate; Galantamine for mild to moderate; and Namenda (Memantine) for moderate to severe.
Commonly, individuals with dementia are at a higher risk of relapsing once the medication is stopped. Prolonged use of benzodiazepines (e.g., sleep medication, anti-anxiety medications) has been linked to Alzheimer's disease.
Possible potential delay of onset include: Keep learning; Exercise/low fat diet; Mental activity; Stay social; Manage stress; Not smoke; Sleep; Competitive games; Timed activities; Playing musical instruments; "Googling"; Reading; "Brain Food" & Antioxidants, C&E, B vitamins, and Protein (improve memory and reaction time, balance, coordination, focus and concentration).
References:
Office of the Study of Aging, The Arnold School of Public Health, University of South Carolina.
AAMI or Age Associated Memory Impairment.