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ALZHEIMER'S DISEASE.
Term Paper ID:22176
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Essay Subject:
Symptoms, discovery in 1906, possible cause, incidence, research, predictive tests, impact on family, diagnosis, treatment.... More...
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8 Pages / 1800 Words
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Paper Abstract:
Symptoms, discovery in 1906, possible cause, incidence, research, predictive tests, impact on family, diagnosis, treatment.
Paper Introduction:
Alzheimer's disease presents a challenge for patients, caregivers, health professionals, and society. It is a devastating disease that results in a total loss of self-identity for the afflicted. Despite decades of medical research, no curative treatment exists for Alzheimer's disease, and even the etiology of the disorder remains a mystery.
Alzheimer's disease causes progressive deterioration of the brain and usually affects people older than 60. The progression of Alzheimer's is slow but relentless. Symptoms include forgetfulness and loss of memory. Eventually, the disease destroys all memory, particularly for recent events. For example, a patient may retain the ability for vivid recall of childhood memories yet lack the capacity to remember events of the previous hour. As the disease progresses, the patient is
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1-12. New York: Continuum; 1989.----------------------- 1 Researchers are optimistic about the results of early-stage tests forthe presence of Alzheimer's disease. Estimates of the cumulative incidence of Alzheimer's disease vary;however, approximately four million patients in the United States have beendiagnosed with the disorder (4:62). In a study of middle-aged volunteersgenetically and symptomatically predisposed to Alzheimer's disease,researchers successfully identified diminished brain activitycharacteristic of Alzheimer's using PET (positron emission tomography)scans (4:62). In scanning the brain, physicians look for enlarged dark areas typical ofthe presence of Alzheimer's disease. Predictive tests of Alzheimer's disease raise ethical questions forthe medical profession. As one health professional observes,"Alzheimer's disease causes, above all, the loss of the very essence thathelps make the victim a unique 'self' among others. Nancy Mace. The physician's role in treatingAlzheimer's consists of taking actions that ameliorate the symptoms ordelay the premature expression of the disease. Potential drug therapies for the treatment of Alzheimer's disease arebeing studied. Wall Street Journal. By age 85, between 15percent and 2 percent of the elderly succumb to the disease; some studiesplace the rate of incidence at 5 percent (6:181). Given the current lifeexpectancy of 79 years and 72 years for men and women, respectively,experts suggest that 16 percent of women and 6 percent of men will developat least mild symptoms of Alzheimer's in their lifetimes (2:B3). Clinical Management of Alzheimer's Disease. The use of anti-inflammatory drugs and estrogen therapy for postmenopausal women are otheravenues of exploration (4:62). Researcherswho adhere to the genetic theory of the etiology of Alzheimer's disease areworking with a major pharmaceutical company to design a drug that mimicsthe beneficial effects of a version of the Apo-E4 gene. For those in their late 7 s, the annualincidence rate rose to 2 percent and increased to 8.4 percent for thoseolder than 85. Epidemiology and prevention of Alzheimer's disease. Beardsley, T. New York: Oxford University Press; 1993.7. Studies have shown thatAlzheimer's disease shortens life expectancy (3:9). Nash, J. Representative samples from the groups who performedpoorly on the tests and those who performed well on the test were followedand periodically tested to determine what percentage of those who showed noevidence of Alzheimer's disease eventually developed the disorder. Inthe late stages of the disease, total mental and physical incapacitationensue, necessitating patient institutionalization. In addition, the compartmentalization of the medical professionprecludes critical interaction between related disciplines. Therefore, medical intervention in the process ofAlzheimer's disease focuses on the treatment of other conditions thatplague the patient in an attempt to improve the quality of his or herremaining lifespan. Alzheimer's disease presents a challenge for patients, caregivers,health professionals, and society. The current state ofAlzheimer's research resembles the stage of cancer research during the197 s--physicians were loathe to inform their patients of cancer diagnoses,fearing adverse psychological reaction to the news of terminal illness. Baltimore: Johns Hopkins University Press; 199 .6. Patterson, M., and Whitehouse, P. According to one researcher, "Previous incidence estimatesfor either dementia in general or for Alzheimer's disease have variedwidely, but in general, the rates reported herein are substantially higher"(2:B3). Kern, D. Dementia Care: Patient, Family, and Community. As the disease progresses, the patient is overcome by confusion anddisorientation. 3-21. Later,autopsy studies revealed that the dementia occurring in younger patientsand the dementia occurring in the elderly were manifestations of the samedisease. TheBoston study found that .6 percent of subjects in their 6 s developAlzheimer's disease annually. Dealing with ethics committees, facility administrators,opposing family members, and the judicial system can try even the mostdedicated professional's patience" (3:11). For example, a patient may retain the ability for vivid recall ofchildhood memories yet lack the capacity to remember events of the previoushour. Gone are memories oflife's experiences and the capacity to behave in a thoughtful, reflective,'civilized' way" (7:19). Although the initial diagnosis of Alzheimer's disease may be met withsome relief by caregivers, problems related to the family support systemultimately arise. Since the mid-196 s doctors have documentedlarge numbers of families with familial Alzheimer's disease occurring inmidlife. Rockville, MD: Aspen Publishers; 1988.4. 62; April 3, 1995.5. Symptoms include forgetfulness and loss of memory.Eventually, the disease destroys all memory, particularly for recentevents. Alzheimer's disease: A practical guide for those who help others. To know your own fate. For example, a patient whowas once ambitious and fastidious may become lazy as a result ofAlzheimer's symptoms. The disease is a form of dementia, a condition thatrefers to any state of decreased mental ability. A study by researchers from Rush University in Chicago, the Centersfor Disease Control in Atlanta, and Harvard University indicates that therate of Alzheimer's disease may be higher than previously assessed (2:B3).Researchers studied a group of 3,6 people 65 and older in Bostonbeginning in 1982. Unfortunately, investigation into the etiology and treatment ofAlzheimer's disease is hampered by professional rivalry. Putting Alzheimer's to the tests. Memory tests were administered to the subjects over atwo-year period. The term Alzheimer'sdisease was initially used only to describe pre-senile dementia, the onsetof diminished mental capacity occurring before the age of 65. Hannah's heirs: The quest for the genetic origins of Alzheimer's disease. Some families may fear the financial burden of extendedcare for the Alzheimer's patient. Currently, only the drug tacrine has been approved for use. Researchers now believe that the disease is linked to thepresence of a gene called Apo-E4. Both patient and family undergo a period of increasing concern. Emotional counseling of the Alzheimer's victim requires anunderstanding of the psychosocial developmental issues of late adulthood tohelp ameliorate the unavoidable feelings of stagnation and despair. B3; May 3, 1995.3. As one physician puts it, "Questions of patientcompetence, advance directives, and determining the patient's bestinterests abound. Or a patient may exhibit peculiar or inappropriatebehavior in an attempt to restore his or her self-image. In Alzheimer's disease there appears to be a deficiency of at leastone major neurotransmitter within the brain. Further,the genetic basis of the disease puts those with immediate family memberswho developed late-onset Alzheimer's at a substantially greater risk (threetimes the average) of developing this disorder (6:182). Atpresent, a diagnosis of Alzheimer's disease is also considered terminal.Therefore, people diagnosed with the disease in midlife are often facedwith critical decisions, e.g., whether to have children. A post mortem evaluation ofAlzheimer's is the only definitive means of diagnosing the presence of thisdeficiency: "Because brain biopsies--the only clear means of identifyingthe neural changes caused by the disease--are rarely performed, definitivediagnosis must wait until after a patient dies" (1:12). Supportive andcustodial care often imposes a terrible emotional burden on families asthey witness the heavy toll that Alzheimer's disease exacts on a loved one: "The feelings of sadness, anger, fatigue, guilt, and despair thataccompany grief are restimulated each time another element vanishes thatmakes the [Alzheimer's] patient a person" (7:36). The progression of Alzheimer's isslow but relentless. These dark regions indicate impairedblood flow and diffuse atrophy of the brain. Time. Physicians whocare for Alzheimer's patients and their families rarely get involved withDNA analysis; likewise, laboratory geneticists are isolated from patientsuffering caused by the disease. In thefinal stages of life, adults strive to achieve a sense of integrity byreviewing their lives and accepting responsibility for past actions. In the words of one patient,"Because I know I'm at risk this insidious threat runs through every day ofmy life" (4:62). Further, approximatelyhalf of all Alzheimer's patients exhibit other chronic and acute medicalillnesses (3:9). Alzheimer's disease causes progressive deterioration of the brain andusually affects people older than 6 . Despitedecades of medical research, no curative treatment exists for Alzheimer'sdisease, and even the etiology of the disorder remains a mystery. Identifying possible genetic links for Alzheimer's disease has provenone of the most fruitful avenues of biomedical research in predicting theoccurrence of the disorder. The drug provides only mild, temporary relief of symptoms. Elderly people with one copy of the genehave a 5 percent chance of developing Alzheimer's; for those with twocopies of the gene, the probability rises to 9 percent by age 8 (4:62). It is a devastating disease thatresults in a total loss of self-identity for the afflicted. In 1 years, this number is expectedto reach 14 million (1:13). Littlecooperation exists between scientific groups. By age 7 , approximately 5 percent of theelderly population is affected by Alzheimer's. Alzheimer's disease has such a devastating personal impact because itaffects a patient's sense of self. Becausethe initial behavioral changes of Alzheimer's disease are so subtle, theyare often dismissed or attributed to senility. Ed. Family members also must come to grips with decisionsabout potential institutionalization of a loved one. As one neurologist pointsout, "Misunderstanding between researchers, delays in honoring commitmentsto share valuable resources, and, too frequently, strained personalrelationships between various scientists continue to slow the pace"(6:238). The loss or change of aspirations and self-concept sometimes has themost painful impact on the patient's family. In 1994, an explosion of research on Alzheimer's disease occurred.This intensification of interest accompanies the publicity generated by thediagnosis of former President Ronald Reagan with the disease. In another study, a neurologist reports the accuracy of aDNA predictive test for familial Alzheimer's in adults and in fetuses withan accuracy rate of over 9 percent (6:253). Dementia ofunexplained etiology occurring after age 65 was referred to as seniledementia and considered a normal function of the aging process. In livingpatients, a clinical diagnosis of Alzheimer's disease is valid only afterrepeated exclusion of other possible diseases which cause dementia, such ashigh blood pressure, diabetes or alcoholism. Ladislav Volicer, Kathy Fabiszewki, Yvette Rheaume, and Kathryn Lasch. For example, aformerly thrifty person may begin hoarding insignificant items.Intellectual disability also exerts a profound impact on the psychosocialfunctioning of the Alzheimer's patient. The stress and strain of copingwith the needs of the dementia patient are considerable. Pollen, D. All higher thought processes degenerate, and over time thedisease affects reasoning ability, speech, concentration, and handwriting.Secondary psychiatric symptoms such as hallucinations, illusions, paranoia,delusions, and affective signs are also present (5:7). Patients in theadvanced stages of Alzheimer's disease sometimes wander away from home orpose a threat to their own safety; constant supervision is required. Longstandingpersonality traits may become exaggerated or problematic. The patient's history must beobtained and blood tests performed, followed by an EEG(electroencephalogram) or CAT (computerized axial tomography) of the brain. Bishop, J. Parental role reversal is another area ofemotional impact. M. The first phase of dementia occurs prior to clinical diagnosis whenpatients or family members note the presence of cognitive changes. In caring for victims of Alzheimer's disease, the family remains themajor target of health care intervention. Ronch, J. Most patientsreact to the diagnosis with feelings of dread and an almost incapacitatingsense of fear as they approach old age. The diagnostic assessment of patients with dementia. Alzheimer's disease was first described by German physician AloisAlzheimer in 19 6. The Alzheimer's disease process is relentless and will progress overtime despite medical intervention. Literature Cited1. Legal questions must be resolvedregarding who will handle the patient's finances and the extent of patientinvolvement in decisionmaking. During the early stages ofAlzheimer's, the patient may suspect that insanity is the root cause of theproblem. Researchersare optimistic that a cure for Alzheimer's disease is forthcoming,unfortunately not soon enough to help the current generation of victims. Rate of Alzheimer's may be higher than thought. Only after all othertreatable causes are excluded can physicians make the diagnosis ofAlzheimer's: "Very early dementia is often difficult to discriminate fromnormal age-related changes on the initial evaluation and requires follow-upto establish the rate of progression of the impairment to make thediagnosis" (5:5). Eds. For instance, anxiety, depression,and stress are all exacerbated by the patient's inability to participate inmeaningful conversation. AsAlzheimer's disease progresses, patients suffer the loss of opportunitiesfor fulfilling life's aspirations: "They watch helplessly as 'what couldhave been' (the real and unrealistic fantasies and expectations about thefuture) becomes 'what will never be'" (7:34). Scientific American, 12-13; February 1995.2.
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