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An Overview of Alzheimer’s Disease

 

Alzheimer’s disease is a known health issue that affects a significant percentage of the aging population. It is described as the most common cause of dementia, or a type of it. The symptoms of Alzheimer’s disease tend to worsen over time to the extent where they interfere with the patient’s daily life (Keegan, 2017). As with most illnesses, the impact of Alzheimer is not limited to the patients themselves. As the patients’ condition deteriorate, they will require more care by both professional caregivers and family members.

Background and significance of the disease

Alzheimer’s disease can be defined as a mental deterioration that can occur in middle or old age, due to generalized degeneration of the brain (Oxford Dictionaries). It is a progressive, degenerative disorder which attacks the brain cells, resulting in a decline in a number of cognitive functions, including loss of memory, judgment, language skills, in addition to behavioral changes, where the behavior of patients becomes unpredictable (Alzheimer’s Foundation of America). Aging is known to be the main cause of the disease, and it has been largely known to be irreversible. However, a glimpse of hope showed when a clinical trial on Alzheimer patients could restore many of the lost functions within a few months (BBC, 2016).

Background

The disease is named after Dr Alois Alzheimer, who discovered it back in 1906, when one of his patients died of a mental illness that was unknown back then. After her death, Dr Alzheier conducted an autopsy on her brain and discovered changes in her brain tissues. He found abnormal clumps and tangled bundles of fiber, which today are known as known amyloid-beta plaques, and neurofibrillary tangles (National Institute on Aging).

The disease is described as degenerative as both the synapsis between neurons and neurons themselves degenerate. The loss of neurons often occurs in the neocortex and limbic system.The causes of this neurodegeneration can be attributed to formation of amyloid-β (Aβ)-containing plaques and neurofibrillary tangles composed of hyperphosphorylated tau (Crews, L., & Masliah, E., 2010). Furthermore, recent studies have found that alterations in adult neurogenesis in the hippocampus could also be considered as a factor.

Signs:

The signs of Alzheimer could include difficulty sleeping, significant mood changes, loss of memory, and increasing confusion.

The loss of memory usually disrupts daily life, particularly short term memory. Other symptoms include weakened ability to solve problems and do planning activities. This is due to the decline in the executive function. It is usually associated with difficulty concentrating. Also, the patient may have difficulty doing familiar tasks such as managing a budget. Confusion with time or place such as not being able to tell which day it is, or not being able to know the location, are also common signs. The patient may have visual problems that could impact their daily tasks such as driving. People with Alzheimer could misplace things and forget where they left them, and might accuse others of stealing. Poor judgement also occurs among Alzheimer patients, and because of the changes they are going through, they will often withdraw from social activities. And also changes in mood is among the signs (Alzheimer’s association).

However, those sings should not be confused with normal changes that occur with aging. In particular, the signs of Alzheimer are more sever and longer lasting (Alzheimer’s association).

Types of Alzheimer’s disease:

Alzheimer’s disease is hardly straightforward. It affects different people differently. However, eventually everyone with Alzheimer will experience the same symptoms such as memory loss and confusion. There are mainly two types of Alzheimer’s (WebMD).

First, early onset Alzheimer, patients of this type tend to have more of the brain changes associated with Alzheimer. This type also appears to be related to gene changes (WebMD).

Second, late onset Alzheimer, which affects people above 65 years of age. No particular genetic associations have been found with this disease (WebMD).

Prevalence and impact of the disease (statistics)

Today, more than 5 million people suffer from the disease in America alone, according to Alzheimer’s Foundation of America (2016). The risks of this disease are exasperated knowing that the risk for its occurrence increases with age, and knowing that the percentage of aging population is likely to increase in the US in the following years. In 2014, statistics showed that 14.5% of American population is above 65 years of age. It is projected that this percentage will rise up to 21.7% by 2040. In 2060, it is expected that we will have more than twice as much of people above 65 years of age as we had in 2014, i.e. around 98 million persons in 2016 (Administration of Community living, 2014). The increase in aging population is likely to be associated with the increase in the occurrence of the disease. The toll will likely increase.

The following table shows statistics of patients with Alzheimer in the state of Rhode Island, USA with projections (Alzheimer’s association):

 

Year 65 – 74 75 – 84 Above 85 Total (rounded)
2014 2500 8000 11000 22000
2020 3200 9000 11000 24000
2025 3600 11000 12000 27000

 

The percentage of seniors who suffer from the disease in Rhode Island is 13%, and the number of deaths in Rhode Island caused by Alzheimer in 2010 was 338. It is estimated that in the year 2013, around 52000 persons provided unpaid care to Alzheimer’s patients. Those caregivers provided 60 million hours of care, with value estimated at $744 million (Alzheimer’s association).

Provided the above statistics, and given the fact that Alzheimer’s disease is the most common form, it is clear that the impact of this disease on the individual, their family members, and the public health system is large. Adding to that toll, the need for caregiving increases as the disease progresses, and there is workforce shortage and inadequate training to provide this care. Around 64% of beneficiaries living in nursing homes are Alzheimer’s patients (Alzheimer’s association).

Surveillance methods

The current surveillance methods of the disease include collecting and compiling data on the occurrence of the disease, related risk factors and health behaviors, in addition to burden of the disease. It is worth noting that there is still insufficient data on the state level in the US regarding the disease.

To collect information about risk factors, behavioral risk factor surveillance system (CDC) is used. Through this system, data is collected about health-related risk factors, chronic health conditions, and use of preventive service.

The cognitive decline model of the behavioral risk factor surveillance system contains questions about confusion or memory loss, impact on daily activities, need for assistance and caregiving, and is usually discussed with a health professional.

Diagnosis

According to Fisher Center for Alzheimer’s Research Foundation, current diagnostic tests such as brain scans and spinal taps help diagnose the illness. However, no available test is 100% accurate of foolproof. For that reason, differential testing is preferred, which relies on varied testing methods and eliminates other possible causes of the symptoms.

Sometimes specialists from different fields, such as neurology, psychology, and psychiatry in addition to the main health professional, in order to provide more accurate and efficient evaluation. The evaluation relied on input from different sources including: medical history, physical examination, neuropsychological testing, and brain imaging scan (Fisher Center for Alzheimer’s Research Foundation).

The medical history part investigates previous medical problems, and any challenges in going through daily activities, in addition to any medications used such as supplements or over-the-counter medications (Fisher Center for Alzheimer’s Research Foundation). Family history with Alzheimer’s disease is known to increase predisposition to the illness.

The physical examination part of the evaluation assesses hearing and vision, in addition to heart and lung, and other vital measures such as blood pressure and pulse readings. Urine tests and blood tests are often used to eliminate other possible causes (Fisher Center for Alzheimer’s Research Foundation).

In neuropsychological testing, doctors test the memory, abstract thinking skills, problem solving skills, and others. The purpose to get an in-depth understanding of the patient’s cognitive skills and be able to spot weaknesses in some of them, if they exist, leading to a better identification of underlying causes.  A common test is the MMSE, which includes many assessment questions. A copy of the assessment is attached to this paper (Fisher Center for Alzheimer’s Research Foundation).

The MMSE test appears to cover many important cognitive skills to check how much the symptoms interfere with the patient’s daily life, and they help provide a more specific assessment of which skills are more impaired and thus help craft a more individualized treatment plan. It also provides more detailed information about the severity of cognitive impairment and the need for care.

The fourth evaluation approach is brain-imaging scan, such as using MRI and CT scans. Those scans examine the structure of the brain closely and can identify any abnormalities (Fisher Center for Alzheimer’s Research Foundation).

Action plan

Provided the gravity of this epidemic and its serious social and economic costs, public health should take more proactive action towards dealing with it. The plan should focus on prevention as well as treatment to ensure high effectiveness.

In May 2012, the US department of Health and Human Services (HHS) revealed its National Plan to Address Alzheimer’s disease (National Institute on Aging). It was updated in 2013. The plan contains two important aspects: research and care providing.

In my own practice, I will remain up to date and also work towards to achieving the goals of the plan set out by HHS. In addition, I will take the following steps with patients to whom I shall provide care.

  1. I will help patients make better dietary choices that will halt or slow their cognitive decline. Some studies have shown that herbal with anti-amyloidogenic activites, such as green tea, turmeric, Salvia miltiorrhiza, and Panax ginseng, have the potential to achieve that purpose (Hugel, 2015).
  2. Also, to increase the effectiveness of the diet, I will encourage and assist the patients to exercise regularly. These exercise provide the much needed stimulation to spur activity in brain regions (Ali, N, 2012)
  3. I will also take training in communication strategies with Alzheimer’s patients. Research have supported that this training could produce positive impact (J Zientz, A Rackley, SB Chapman, T Hopper, N Mahendra, ES Kim, and S Cleary, 2007).

Conclusion

There is still plenty of work to be done in order to effectively prevent and treat Alzheimer’s disease. The social and economic impact of this disease make it an issue that should be a concern of many professionals beyond the health sphere. Collaboration from the scientific community is required, but collaborations from different agents from a wide spectrum of fields could lead to remarkable breakthroughs. Making the best of our available resources is essential. And there is a lot of potential in a largescale collaboration to finally reach an Alzheimer-free country.

 

References:

Alzheimer’s Foundation of America (2016), About Alzheimer’s disease, Statistics, retrievable from: https://www.alzfdn.org/AboutAlzheimers/statistics.html

BBC Crew (2016), Small Trial Shows Memory Loss From Alzheimer’s Disease Can Be Reversed, Sciencealert, retrievable form: http://www.sciencealert.com/small-trial-shows-memory-loss-from-alzheimer-s-disease-can-be-reversed

Alzheimer’s Foundation of America, About Alzheimer’s disease, retrievable from: http://www.alzfdn.org/AboutAlzheimers/definition.html

Ali, N. (2012). Understanding Alzheimer’s : An Introduction for Patients and Caregivers. Lanham, Md: Rowman & Littlefield Publishers.

Oxford Dictionaries, Alzheimer’s, retrievable from: https://en.oxforddictionaries.com/definition/Alzheimer%27s

J Zientz, A Rackley, SB Chapman, T Hopper, N Mahendra, ES Kim, and S Cleary (2007), Evidence-based practice recommendations for dementia: educating caregivers on Alzheimer’s disease and training communication strategies

WebMD, Types of Alzheimer’s disease, retrievable form: http://www.webmd.com/alzheimers/guide/alzheimers-types

Fisher Center for Alzheimer’s research Foundation, Alzheimer’s Diagnostic Tests, retrievable from: http://www.alzinfo.org/articles/alzheimers-diagnostic-tests/

Crews, L., & Masliah, E. (2010). Molecular mechanisms of neurodegeneration in Alzheimer’s disease. Human Molecular Genetics, 19(R1), R12–R20. http://doi.org/10.1093/hmg/ddq160

Alzheimer’s Association, risk factors, http://www.alz.org/alzheimers_disease_causes_risk_factors.asp

Administration for Community Living, Aging statistics, retrievable from: https://aoa.acl.gov/Aging_Statistics/Index.aspx

Fisher Center for Alzheimer’s research Foundation, Alzheimer’s Diagnosis, retrievable form: http://www.alzinfo.org/understand-alzheimers/alzheimers-diagnosis/?mtc=alzheimers_diagnosis&gclid=CKKszMnRhdMCFRLgGwodSP8LoQ

Alzheimer’s Association, Rhode Island Alzheimer’s statistics, retrievable form: http://www.alz.org/ri/documents/alz_ff_rhodeisland.pdf

National Institute on Aging, The National Plan to Address Alzheimer’s Disease, retrievable from: https://www.nia.nih.gov/alzheimers/publication/2012-2013-alzheimers-disease-progress-report/national-plan-address-alzheimers

Helmut M. Hügel (2015), Brain Food for Alzheimer-Free Ageing: Focus on Herbal Medicines, Volume 863 of the series Advances in Experimental Medicine and Biology pp 95-116

Alzheimer’s association, 10 Early Signs and Symptoms of Alzheimer’s, retrievable from: http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp

Nathalie Keegan (2017), What are the early signs of dementia and Alzheimer’s disease? How to spot the symptoms and next steps, The Sun, Retrievable from: https://www.thesun.co.uk/living/2187987/early-signs-dementia-alzheimers-disease-symptoms/

National Institute on Aging, Alzheimer’s disease fact sheets. Retrievable from: https://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-fact-sheet

 

 

 


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