Alzheimer's Disease

What is Alzheimer's disease?

Alzheimer's disease is a progressive, neurodegenerative disease that occurs in the brain and often results in the following:

• impaired memory, thinking, and behavior
• confusion
• restlessness
• personality and behavior changes
• impaired judgment
• impaired communication
• inability to follow directions
• language deterioration
• impaired visiospatial skills
• emotional apathy

When Alzheimer's was first identified by German physician, Alois Alzheimer, in 1906, it was considered a rare disorder. Today, with one in 10 persons over age 65 (and nearly half of persons over age 85) affected, Alzheimer's disease is recognized as the most common cause of dementia (a disorder in which mental functions deteriorate and breakdown).

How is Alzheimer's different from other forms of dementia?

Alzheimer's disease is distinguished from other forms of dementia by characteristic changes in the brain that are visible only upon microscopic examination during autopsy. Brains affected by Alzheimer's disease often show presence of the following:

• fiber tangles within nerve cells (neurofibrillary tangles)
• clusters of degenerating nerve endings (neuritic plaques)

Another characteristic of Alzheimer's disease is the reduced production of certain brain chemicals necessary for communication between nerve cells, especially acetylcholine, as well as norepinephrine, serotonin, and somatostatin.

What causes Alzheimer's disease?

Although intense investigation has been underway for many years, the causes of Alzheimer's disease are not entirely known. Suspected causes often include the following:

• age and family history
• certain genes
• abnormal protein deposits in the brain
• other risk and environmental factors

What are the warning signs or symptoms of Alzheimer's disease?

• memory loss that affects job skills
• difficulty performing familiar tasks
• problems with language
• disorientation to time and place
• poor or decreased judgment
• problems with abstract thinking
• misplacing things
• changes in mood or behavior
• changes in personality
• loss of initiative

The symptoms of Alzheimer's disease may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is Alzheimer's diagnosed?

There is not a single, comprehensive test for diagnosing Alzheimer's disease. However, physicians, or other specialists, with expertise in dementia can obtain a diagnosis of probable Alzheimer's disease with approximately 90 percent accuracy. The only way to confirm a diagnosis of Alzheimer's disease is through autopsy.

Examination and evaluation are essential in determining the cause of dementia. In addition to a complete medical history and physical examination, diagnostic procedures for Alzheimer's disease may include the following:

• mental status test
  
  
• neuropsychological testing
  
  
• blood work
  
  
• brain imaging with computerized tomography or magnetic resonance imaging

Prevention of Alzheimer's:

Because the cause of the disease is unknown, there are no prevention protocols to follow at this time. Prospective population studies are showing that diet, exercise, mental activity, and treatment of high blood pressure may be beneficial in delaying the onset of Alzheimer's disease. However, these interventions have not yet been verified in randomized studies.

Treatment for Alzheimer's:

Specific treatment for Alzheimer's disease will be determined by your physician based on:

• your age, overall health, and medical history
  
  
• extent of the disease
  
  
• your tolerance for specific medications, procedures, or therapies
  
  
• expectations for the course of the disease
  
  
• your opinion or preference

At this time, there is no cure for Alzheimer's and no treatment available to reverse the deterioration of Alzheimer's disease. New research findings give reason for hope, and several drugs are being studied in clinical trials to determine if they can slow the progress of the disease or improve memory for a period of time. Currently, there are four prescription medications approved by the Food and Drug Administration for the treatment of symptoms associated with mild-to-moderate Alzheimer's disease: Tacrine, donepezil, galantamine and rivastigmine. All of these medications work by increasing the amount of acetylcholine in the brain. These medication help to maintain functionality in individuals with moderate Alzheimer's disease.

There are some medications available to assist in managing some of the most troubling symptoms of Alzheimer's disease, including the following:

• depression
• behavioral disturbance
• sleeplessness

In managing the disease, physical exercise and social activity are important, as are proper nutrition, health maintenance, and a calm and well-structured environment.

Alzheimer's rehabilitation:

The rehabilitation program for persons with Alzheimer's differs depending upon the symptoms, expression and progression of the disease. These variables determine the amount and type of assistance needed for the Alzheimer's individual and family.

With Alzheimer's rehabilitation, the caregiving team must keep in mind the following considerations:

• In managing the disease, physical exercise and social activity are important, as are proper nutrition and health maintenance.

• Planning daily activities helps to provide structure, meaning, and accomplishment for the individual.

• As functions are lost, activities and routines should be adapted to allow the individual to participate as much as possible.

• Activities should be kept familiar and satisfying.

• Individuals should complete as many things by himself/herself as possible. The caregiver may need to initiate an activity, but he/she should allow the individual to complete it as much as he/she can.

• "Cues" should be provided for desired behavior (i.e., label drawers/cabinets/closets according to their contents).

• The individual should be kept out of harm's way by removing all safety risks (i.e., car keys, matches).

• As a caregiver (full-time or part-time), it is important to understand and act accordingly to your own physical and emotional limitations.

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