Alzheimer's disease

Overview

Alzheimer's erases a lifetime of memories

Alzheimer's disease is a progressive brain disorder that causes a gradual deterioration of the ability to reason, remember, imagine, and learn. Alzheimer's disease is distinguished from the mild forgetfulness, known as benign senescent forgetfulness, normally observed in older people. Over the course of the disease, victims may become unable to recognize themselves or much about the world around them. Depression, anxiety, and paranoia often accompany these symptoms. Although it cannot be cured, there are a number of new palliative treatments that help ameliorate Alzheimer's symptoms and slow its progression.

Detailed Description

Alzheimer's disease is a degenerative neurological condition, and the most common form of dementia. It is characterized by "senile plaques" made of abnormal proteins and irregular tangles of abnormal brain cells. For reasons not well understood these neurofibrillary tangles and plaques take over healthy brain tissue, resulting in massive loss of function in the areas of the brain associated with intellectual function (thinking, reasoning, remembering, imagining, and learning).

While Alzheimer's disease usually affects those over age 65, a rare and rapidly progressive form of Alzheimer's can occur in some people in their 40s and 50s. Alzheimer's disease progresses slowly, taking between 3 to 18 years to advance from the earliest symptoms to death. The average duration of the disease is 8 years. Death results not from the disease itself but from some secondary illness such as pneumonia, urinary tract infection, or infected decubitus ulcers. At present, treatment of Alzheimer's disease focuses on slowing the progression of the disease and coping with its symptoms.

How Common Is Alzheimer's?

At the present time, over four million people are living with Alzheimer's disease. It is the most common form of dementia, and is the fourth leading cause of death in the United States. Experts predict that as baby boomers age, Alzheimer's may affect as many as 14 million people. Alzheimer's is widespread, affecting 5% or more of those over age 70 and up to 20% of those over age 80. Slightly more women than men have Alzheimer's disease. Its increasing prevalence has led epidemiologists to call Alzheimer's "the disease of the century."

Conventional Treatment

Goals of Treatment

Treatment for Alzheimer's disease focuses on preserving an overall quality of life as long as possible. Treatment is limited to relief of some of the more adverse symptoms of the illness.

Medications can help improve alertness, clarity and memory, and regulate mood and behavioral disturbances.

Treatment Overview

Since there are so few clinical treatments for Alzheimer's disease, much of the available therapies attempt to improve the quality of patients' lives, keep them safe, and make caring for them easier. The primary care doctor will closely monitor the progress of the patient to check for medical complications, adjust medications to achieve the lowest effective dosage and assess any changes in drugs used. The doctor may do mental status tests routinely to chart the course of the illness. Support for the main caregiver is also a concern, and the doctor will help determine at what point the person with Alzheimer's disease may need professional nursing care outside the home.

Drug Therapy

Drugs most commonly prescribed
Aricept
Indocin
buy Lexapro
Prozac
Naprosyn
Lipitor http://www.nmihi.com/a/atorvastatin.html
Paxil http://www.nmihi.com/p/paroxetine.html
Desyrel
Celexa
Zoloft http://www.nmihi.com/s/sertraline.html
Seroquel
Zyprexa
Tegretol
BuSpar

Antidepressants may be appropriate if depression is a problem. Antipsychotic drugs are used only if absolutely necessary, and sedative drugs are avoided.

Activity & Diet Recommendations

Physical activity should be continued as long as possible, both to prevent muscle atrophy and to stave off complications. Exercise also promotes a normal day and night routine, and may help to boost mood. Repetitive exercise such as walking, indoor bicycling or folding laundry may decrease patients' anxiety because they don't need to make a decision about what to do next.

In early stages, memory aids such as notebooks and posted daily reminders are helpful. Calm and repetitive reassurance is important. As the disease progresses, activities will need to be increasingly supervised. People with Alzheimer's disease must eventually stop driving, sometimes against their will. Loss of independence and the changes made to their daily routine may worsen their confusion and agitation.

No special diet is required, just well-balanced meals with adequate fiber. If the person with Alzheimer's disease is hyperactive, stimulants such as coffee, tea, cola, and chocolate should be avoided. Limiting the number of foods served to an Alzheimer's patient at any one time may reduce anxiety over decision making.

Possible Complications

Some complications are also symptoms of the illness, ranging from agitation and belligerence to hostility and even violence. Complications such as increased disorientation after sundown and wandering may be observed. Falls may cause bruises and broken bones. Medical complications include drug toxicity. Malnutrition and dehydration may result from absentminded dietary patterns. In the early stages depression can manifest itself, possibly leading to suicidal tendencies. In the late, bedridden stage there is risk of pressure sores, contractures, pneumonia, and urinary tract infection.

Quality of Life

In the early and middle stages of Alzheimer's disease, victims may be painfully aware of their intellectual failings and what is yet to come. At this stage and throughout the course of the illness, it is vitally important to attend to victims' mental well-being with the help of their doctor, social worker, or psychological counselor.

The longer people with Alzheimer's can remain independent, the better, as long as they're safe. Maintaining a routine and keeping it simple will help the patient feel less stress about making decisions.

Self care & Prevention

Screening for Alzheimer's Disease

Family members who want to learn about their chances of getting Alzheimer's should consult their doctors. Genetic screening for the presence of the E4 allele of apolipoprotein E gene and other genetic traits may indicate a greater chance of the disease. Those who carry the allele may be at a greater risk to be diagnosed with Alzheimer's.

Self-Care Measures for Caregivers

Avoiding environmental and lifestyle triggers can help decrease the occurrence of seizures. Alcohol and drugs should be eliminated as they can effect medication and cause seizures. Vigorously treat infections anywhere in your body. Eat a consistent, healthy diet with regularly scheduled meals. In addition, the following tactics may help:

Alzheimer's affects not only the person with the disease, but their loved ones and caretakers. As the disease progresses, demands on family members will increase. Because caring for a person with Alzheimer's disease is so difficult, the well-being of the caregiver also needs much attention to make sure he or she has adequate help and support. The strategies below can help you and your loved ones cope with the changes to come.

• Don't expect to be perfect — you won't be. Caring for a loved one with Alzheimer's is one of the hardest things you can do. Every caregiver makes mistakes. Forgive yourself.
• Get help. Recruit family members to help with caregiving. Consider hiring a house cleaner and a yard person to free you from those tasks. If possible, hire neighborhood teens or adults so they can get to know your loved one.
• Take time off. Caring for a loved one with Alzheimer's can be overwhelming. You can't do a good job unless you get your emotional batteries recharged regularly. Be sure to preserve some social activities, and work to maintain friendships and interests outside of caregiving. Get someone else to look after the person at least one night a week, preferably more.
• Get regular exercise. It will elevate your mood, give you energy, and relieve some of the stress of caregiving. Try taking a 40-minute walk every day — ideally with the Alzheimer's patient.
• Join a support group. Your friends and relatives may not be able to fully understand what you're going through, but anyone caring for an Alzheimer's person will. Support groups help solve caregiving problems, point the way to good resources, and provide tremendous emotional support. To find one near you, contact your local Alzheimer's Association office or the national office in Chicago (www.alz.org).
• Personal counseling can help you deal with the feelings of loss you may experience as the person's condition progresses.