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ALZHEIMER'S DISEASE.
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Risk factors, causes, survival rates, symptoms, dementia mechanisms, treatment & caregiving.... More...
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Paper Abstract:
Risk factors, causes, survival rates, symptoms, dementia mechanisms, treatment & caregiving.
Paper Introduction:
ALZHEIMER'S DISEASE
Introduction
Alzheimer's disease (AD) is thought to be the fourth leading cause of death in the United States, with approximately 4.5 million Alzheimer's disease victims. This represents a major public health problem that results in an annual expense of over $100 billion. The problem is expected to grow as the baby boomer generation reaches ages of maximum prevalence of Alzheimer's disease (expected over 9 million by the year 2030). Most cases of AD occur after the age of 65 years and are sporadic rather than familial. AD is still considered to be poorly understood by family members and many health care workers. Antecedents may vary and include genetic factors, factors related to aging, and environmental factors (Brumback & Leech, 1994; Sobel, Davanipour,
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Specification ofbehaviors linked to managing dementia-related problems is needed(Hinrichsen & Niederehe, 1994). Most casesof AD occur after the age of 65 years and are sporadic rather thanfamilial. Isolated languagedisturbance and visuospatial abnormalities may also be present (Becker,Bajulaiye, & Smith, 1992). Nursing homes need to be examined as well. Additional studies have indicated that risk of death in AD is higherin persons with severe cognitive impairment and cachexia. Extreme feelings ofburden may be alleviated with changes in tendencies of family members to beunwilling to relinquish even minimal aspects of patient care to availableformal or informal care providers. The survival rate (14 yearfollow-up) for AD was 2.4 percent rather than an expected rate of 16.6percent. Antecedents Risk factors in Alzheimer's disease (AD) have been confirmed asadvanced age, a family history of dementia, and Down's syndrome. American JournalPsychiatry, 152(1), 37-44.Molsa, P. Cerebral vasodilators were used unsuccessfully in the past with themistaken believe that reduced cerebral blood flow was the cause of AD.Current studies show that agents such as dihydroergotamine mesylate(Hydergine), nafronyl, and vincamine, do not improve AD or any other typeof neurodegenerative dementia. Culturally inappropriate ways of touching,gesturing, and expressing may be experienced by both staff and patient;symptoms of physical and mental diseases may be expressed through aculturally mediated filter. The Gerontologist, 33(3), 4 9-414.Hinrichsen, G. Journal Okla State Medical Association, 87, 1 3-111.Connell, C. Alzheimer Disease and Associated Disorders, 8(1), S41 -S416.Henderson, J. Health belief systems may reflect ethnic-specific folk beliefsthat influence behavior (Henderson, 1994). Studies show that those who live aloneare more likely to use social services such as meals on wheels, casemanagement, and in-home support services (Webber, Fox, & Burnette, 1994). Over thecourse of this illness, many services are needed to include: comprehensivediagnosis and assessment, physical, occupational, or speech therapy,respite care, caregiver education, support groups, legal services, homehealth aides, transportation, skilled nursing care, and autopsy services.Difficulty exists in the obtainment of information and referrals for theseservices, due to inadequate coordination. W. J., & Rinne, U. Home sewing machines, hair dryers, electric clocks, electricblankets, and electric mixers also produce significant magnetic fieldexposures. D., & Lee, P. Knowledgeand recognition of remaining abilities will assist caregivers of ADpatients (Baum, Edwards, & Howell, 1993). Long-term survivaland predictors of mortality in Alzheimer's disease and multi-infarctdementia. The Gerontologist, 34(1), 8-14.----------------------- 1 Clearcommunication is needed in terms of language and symbols, particularly inresponding to the challenging behavioral aberrations and psychosocial needsof dementia residents. Men showed a less favorable survival prognosis; the risk of dyingfor women was half of that for men. Alzheimer's disease (AD) survival rates were studied by Molsa,Marttila, and Rinne (1995). Future studies need to include human trials withgangliosides for treatment of AD (Brumback & Leech, 1994). Symptoms Emotional and behavioral changes occurring in Alzheimer's disease(AD) are important factors in the study and management of this disease.Psychiatric symptoms in (AD) vary with different reports. There is an increased need for community-based and/or long-term care services. AD results in marked reduction innumbers of synapses connecting neurons, a consequence of massive death ofcerebral cortical neurons. Such interference could explain the death of basal forebraincholinergic neurons resulting in memory disturbance found in AD. In this case pathogenic exposures would be morelikely to be detected when neuronal changes of ageing are the greatest asin later-onset AD. Sporadic AD was correlated with starvation/malnutrition andhead injury (Henderson, Jorm, Korten, Creasey, McCusker, Broe, Longley, &Anthony, 1992). Differences are found in levels of anxiety, neighborhood patterns,and tolerance of symptoms among ethnic minorities. E. Hereditary factors are also considered. Studies show that up to one-third of clinically diagnosed casesof neurodegenerative dementia will have a disorder other than AD atautopsy. Cultural diversity amongstaff and residents continues to be a source of potential conflict. S., Jorm, A. Age of onset was not related tosurvival. Longitudinal analysis ofa two-component model of the memory deficit in Alzheimer's disease.Psychological Medicine, 22, 437-445.Brumback, R. (1995). Interference withneurotrophic factor functioning is a cause of unhealthy neurons;experimental blockade of neurotrophic factors results in nerve cell damageand death. F., & Howell, N. Caregiving issues in culturally diverse populations. This program represents one strategy hoping toincrease coordination of service delivery networks for dementia. Objectives need to include: community competence andempowerment; identification of goals, problems, and issues, and creating acritical consciousness among the public (Ballard, Nash, Raiford & Harrell,1993; Connell, Kole, Benedict, Holmes, Gilman, & Beane, 1994). It was concluded thatpremorbid personality disorders did not pose a risk factor for depressionafter onset of dementia (Migliorelli, Teson, Sabe, Petracchi, Leiguarda, &Starkstein, 1995). A 1978 survey discovered that minority individuals made up 6 percentof a group of 2,3 caregivers using community services to assist AD orother types of dementia. Possible etiological relevance to this exposure is thatelectromagnetic fields may have biologic plausibility since they mayadversely influence calcium homeostasis and inappropriately activate immunesystem cells such as microglial cells which initiates events resulting inneuronal degeneration. Management of thepatient with criticism is found to be related to poorer adjustment andmanagement with encouragement results in the opposite. Patients with major depression had higherfrequencies of depression before onset of dementia than those withdysthymia. Currently it remains unclear as to why nerve cells die in AD.Biochemical studies of the brains of victims point to the analysis of theamyloid protein core in the neuritic plaques. Cultural andlanguage barriers, discrimination, etc. Data from a case-control study of AD was analyzed and later-onset ADwas found to be positively correlated with starvation/malnutrition and nose-picking and negatively with analgesics; earlier-onset was correlated withphysical underactivity (during and before the last 1 years), and nervousbreakdown. Henderson, Mayka, Garcia, and Boyd (1993) developed a model for ADsupport groups in African-American and Hispanic populations. (1992). It is concluded that AD results from interaction of this geneticloading and environmental factors. A. Risk factors for AD include advanced age, family history of AD,Down's syndrome, starvation, underactivity, nervous breakdown, and possiblyexposure to low frequency electromagnetic fields. Presently, caretakers face the problems associatedwith a lack of cooperation of services; minorities are even less likely toreceive outside assistance. Intravenous infusions of physostigmine have produced very short-lived improvements in cognitive functioning in some AD patients. Coordination of services in needed for the care of AD. E. Treatment Problems regarding the treatment of AD include infrequency of earlydetection, variable disease progression and uncertain diagnosis (untilautopsy). Antecedents may vary and include geneticfactors, factors related to aging, and environmental factors (Brumback &Leech, 1994; Sobel, Davanipour, Sulkava, Erkinjuntti, Wikstrom, Henderson,Buckwalter, Bowman, and Lee, 1995). The risk of death was higher with theoccurrence of primitive reflexes. Initial emphasis on caregiving was based on the assumption that fewAD patients live alone. Minority tend to avoid outside resources andturn to their immediate family, friends, and the church. A., Fox, P., & Burnette, D. American Journal of Epidemiology, 142(5), 515-523.Webber, P. L., Nash, F., Raiford, K., & Harrell, L. N. Deficits are presumed as resulting from a loss of normalinterconnections of cerebral neurons. The Community Outreach Education Program (COEP), in Michigan, wasdesigned to disseminate information and skills related to: diagnosis,assessment, management, and treatment of dementia patients with appropriatehealth care providers. Protective effects of education arenoted regarding mutations in the amyloid precursor protein; littleinformation is known regarding environmental risks (Brumback & Leech,1994). Both methodsagreed on symptoms of suspiciousness, irritability, argumentativeness, andbelligerence. (1995). With this view, environmental damage compounds effects of age-related neuronal losses. Environmental risk factors for Alzheimer's disease: their relationship to age of onset and to familial or sporadic types. Furthermore,clinicians working with families have little research findings from whichto draw specific clues on how to assist family members. (1995). Only 25 percent of the patients had a history of personalitydisorders (obsessive-compulsive, dependent, narcissistic, and avoidant);there was no predominant type of personality disorder. In later-onset Type I AD, familyhistory of dementia is believed to be less common and thereforeenvironmental factors may pose a greater risk (Henderson, Jorm, Korten,Creasey, McCusker, Broe, Longley, & Anthony, 1992). (1992). It issuggested that learning is paired with increased numbers of corticalneuronal synapses with elevated levels of neurotrophic substances; a longerperiod of time is then required for AD processes to interfere withincreased levels of neurotrophic factors (Brumback & Leech, 1994). A studywith two groups in China demonstrated that the uneducated group (comparedto educated group) experienced a marked increased prevalence of AD. AD symptoms, mechanisms, treatment,consequences, and implications are also considered. AD Mechanisms Brumback and Leech (1994) report regarding dementia mechanisms.Dementia is viewed as a progressive loss of intellectual or cognitiveabilities which result in impaired social and work performance. Psychostimulants have also been used totreat AD, resulting in deterioration of cognitive abilities. B., Gilman, S., &Beane, E. Abnormal cortical metabolic activity may becorrelated with variable patterns of impairment. Patients with dysthymia showed more awareness of cognitivedeficits. Community-based approaches areneeded to involve a broad representation from health care professionals,service providers, and staff of voluntary agencies and communityorganizations. Community support groups conducted in traditionalbureaucratic manners, would be perceived as cold and inhumane by the ethnicminority. The Gerontologist, 33(3), 4 3-4 8.Becker, J. Conclusion Current research appears to provide a comprehensive understanding ofthe problems inherent in AD. Hinrichsen and Niederehe (1994) reported their findings regardingmanagement strategies for family members of AD patients. Currently, therapeutic trials infusing nerve growth factor into theventricles in AD patients is underway in Scandinavia; several years areneeded to determine whether the disease progression has been altered.Gangliosides, with a variety of effects which include stimulating outgrowthof neuronal processes, inducing axonal regeneration, and protecting neuronsfrom toxin-induced and hypoxia-induced cell death, have demonstratedclinical improvement for treatment of stroke and peripheral neuropathies,in human trials. Success wasbased on perseverance, personal contact with caregivers, and depth ofcultural knowledge regarding target populations. G., Garcia, J., & Boyd, S. Socialization abilities may include: engagement withothers in conversation and social activities. Different cultural beliefs also need to beconsidered; behavioral aberrations of dementia may be defined as normalaging to some cultures (Henderson, 1994). (1994). Seltzer and Buswell (1994) investigated this phenomenon and foundthat considerable differences exist between formal mental statusexaminations and caregiver questionnaires for determining prevalence ofpsychiatric symptoms in patients with dementia of the Alzheimer's type.Hallucinations and delusions were found to be extremely rare, and lessdepression, lack of insight, apathy, anxiety, disinhibition, andoveractivity were detected in formal clinical examinations. Based on Down'syndrome research, it is believed that the nerve cell loss in AD may occurover a 3 year period before clinical symptoms are apparent. Occupations with exposure to electromagnetic fields: a possible risk factor for Alzheimer's disease. (1993). Staff roles need to include communication andsocial interaction with skills in detecting and ameliorating psychosocialproblems; roles include quaisiphysical care, psychosocial care, andactivity therapists. Some studiesfind frequency of hallucinations ranging from 3 to 49 percent, otherreports find prevalence of depression vary from to 87 percent. Lessonslearned from implementation of the COEP will be used to refine thiscommunity-based outreach intervention strategy (Connell, Kole, Benedict,Holmes, Gilman, & Beane, 1994). This represents a major public health problem thatresults in an annual expense of over $1 billion. AD patients may be impaired in the acquisition and retention of newmaterial and may have deficits in short-term memory. The power of support. The authors studied long-term survival for 218 patients with ADand 115 patients with multi-infarct dementia. Sobel, Davanipour, Sulkava, Erkinjuntti, Wikstrom, Henderson,Buckwalter, Bowman, and Lee (1995) also studied environmental factorsassociated with Alzheimer's disease. Ethnocultural factors exist; foreign languages ordialects or unfamiliar vocabulary may increase confusion. Productive behaviors can also be determinedat different stages of the disease. Prevalence rates with future increases in theAD population represent a major public health concern. Additionalenvironmental antecedents are considered; some believe that AD is adisorder stemming from damage to the brain that is subclinical for decades,making those affected particularly prone to the consequences of neuronalattrition. Specialists are not wellinformed, and it is uncommon to find integration of acute care and long-term care facilities. A., Longley, W., & Anthony, J. F., Korten, A. A model for Alzheimer's disease support group development in African-American and Hispanic populations. A. Nootropics (piracetam and pramiracetam)are said to prevent amnesia and improve brain function and behavior;studies do not support this conclusion. Acta Neurologica Scandinavica, 91, 159-164.Seltzer, B. Cultural values mayprohibit the use of community helping resources and ethnic minority eldersmay not speak English. Pharmacotherapeutic treatment of AD attempts to improve cerebralmetabolism and neurotransmission, and to protect neurons from furtherdestruction (Brumback & Leech, 1994). These behaviors may not be present in every person, orat every stage of the disease. Research shows thatcoping related to dementia caregiving using emotion-focused strategies suchas wishful thinking, emotional ventilation, and avoidance, is related topoorer emotional adjustment. Others concludethat reduced survival risk factors include: increasing age, male sex,longer duration of disease, presence of physical illness, poor cognitivefunction, depression, apraxia, aphasia or dysmnesia. The culture of special care units: ananthropological perspective on ethnographic research in nursing homesettings. Biochemical studies have not offered much promise inthe past, however, current and future efforts regarding nerve growthfactors may offer improvement regarding neuronal destruction and loss ofcognitive functioning. A major feature considered in the distinction betweenType I and Type II AD, is age of onset. K., Marttila, R. Behaviors found in patients with senile dementia of the Alzheimertype are reported to include: aggressiveness, outbursts, assaultiveness,wandering, disturbed sleep, incontinence, agitation, insecurity, lessresponsiveness, less cheerfulness, irritability, selfishness, crudeness,and suspiciousness. Differences infrequency or type of personality disorders among patients with dysthymia,major depression, or no depression, were not found. No associations between depression and a family history ofdepression were found. The Gerontologist, 33(4), 561-565.Baum, C., Edwards, D. However, of the population believed to have AD, 1 to 25 percent are found to be living alone. Neuroleptics(chlorpromazine or haloperidol) have been used resulting in exacerbation ofconfusion and memory disturbance. Since AD patients suffer from cognitive impairment,those living alone may have reduced decision-making capacity, resulting inadditional problems regarding access to needed services. AD results in gradual, progressivedeterioration of cognitive functions; memory loss is usually the first andmost prominent feature. J. Aging Magazine, 363-364, 24-28.Henderson, J. Amyloid may not cause the disease,it may be a secondary phenomenon of sick neurons. For this study, associationsbetween working in occupations with probable medium to high exposure to lowfrequency electromagnetic fields (<3 Hz) and sporadic AD wereinvestigated. T., Bajulaiye, O., & Smith, C. (1992). Raciallydifferent care givers may also produce worsened behavior in the patientwith a cognitive disorder. Primitive reflexes are demonstrated in infancy and thenbecome inhibited. Depression was found in 51 percent of AD patients, with28 percent dysthymia and 23 percent major depression; both were more commonin women. Recruitmentof black elderly for clinical research studies of Dementia: the CERADexperience. There is a growingneed for cooperation among health services, and social and behavioralsciences. Psychological Medicine, 22, 429- 436.Henderson, J. (1994). Problem-solving abilitiesmay include: learning complex tasks without difficulty, knowing days of theweek or the date, independently makes complex decisions, problem solveswithout assistance, and problem solves with repeated assistance. Consequences Many problems are faced by caretakers of AD patients, and solutionsare few. Psychiatric symptoms in Alzheimer's disease: mental status examination versus caregiver report. Studiesmay vary due to inadequate mental status examinations; many symptoms may bereported by relatives or unstructured interviews or questionnaires (Seltzerand Buswell, 1994). When average lifeexpectancy was under 5 years, most would die before developing clinicalsymptoms. It has been found that mortality from and risk of dementing diseaseincrease with advancing age, however people are showing increased overalllongevity. K. (1993). Additional barriers to networking of serviceproviders include: rivalries, lack of skills, misconceptions, and fears(Connell, Kole, Benedict, Holmes, Gilman, & Beane, 1994). It is assumedthat the 3 + year destructive process in AD begins after the brain hasreached maximum growth, about the age of 2 years. The predominant occupations were seamstress, dressmaker, andtailor. Intervention programs attempt to change ways inwhich family members interact with the AD patient. (1994). Seminars in Speech and Language, 15(3), 216-225.Henderson, A. Living alone with Alzheimer's disease: effects on health and social service utilization patterns. Incidence of the primitive sucking reflex has been associated withpoor prognosis. AD is still considered to be poorly understood by family membersand many health care workers. REFERENCESBallard, E. Memory deficits found in Alzheimer's disease (AD) are characterizedas having multiple components. (1994). The primitive reflexes snout, sucking,and glabellar tap correlate with severity of dementia in AD; occurrence ofsucking reflex in AD predict excess mortality (Molsa, Marttila, and Rinne,1995). On the other hand, Migliorelli, Teson, Sabe, Petracchi, Leiguarda,and Starkstein (1995) studied depression among patients with Alzheimer'sdisease (AD) and found a high prevalence of dysthymia and major depressionamong this group. The Gerontologist, 34(1), 1 3-1 9.Sobel, E., Davanipour, Z., Sulkava, R., Erkinjuntti, T., Wikstrom, J., Henderson, V. Someevidence concludes that head trauma is also a risk factor. The Gerontologist,34(1), 95-1 2.Migliorelli, R., Teson, A., Sabe, L., Petracchi, M., Leiguarda, R., &Starkstein, S. w., Buckwalter, G., Bowman, J. further limited availability.Patients in rural areas also experience barriers to services; availabilityis limited and transportation is a concern. With current life expectancy of 75 years, many are expected topresent with clinical dementia from AD (Brumback & Leech, 1994). In these cases, AD patientsnot only suffer from cognitive, affective, and behavioral deficits, butthey are at risk for problems such as economic insecurity, loneliness anddepression. N. Patients thatlive alone are found to be poorer, more likely to be women, and more likelyto have non-familial caregivers. E., Creasey, H., McCusker, E., Broe, G. & Niederehe, G. Task performance abilities mayinclude: responsibility, performing work neatly and timely, concentration,and handling tools. (1993). Sustained responsibility for patients results in decreased well-being of family members. AD families demonstratemutations in the amyloid precursor protein gene on chromosome 21, 19, and14. & Buswell, A. M. Previous studies show a shorter lifeexpectancy for patients with dementia than those in the general population. Prevalence and correlates of Dysthymia and MajorDepression among patients with Alzheimer's disease. The prevalence of dementia among blacks is found to be greater thanamong whites and yet minorities face even more obstacles to accessing ADservice delivery systems. Previous studies indicate changes in personality afteronset. Syntheticacetylcholinesterase inhibitors with oral bioavailability and longer actionduration, have been developed; tetrahydroaminoacridine and its hydroxylatedderivative are widely studied; both drugs have hepatotoxicity attherapeutic doses with only minimal overall benefits (Brumback & Leech,1994). M., Mayka, M. Cholinergic therapy has beenconsidered, following the success of dopamine replacement in Parkinson'sdisease. Alzheimer's disease: pathophysiologyand the hope for therapy. (1994). The National Resource Center on Alzheimer'sDisease at the University of South Florida's Suncoast Gerontology Centerresponded to this situation with a project to organize support groupstailored for the needs of African American and Latin families. Laboratory experiments indicate thatelectromagnetic fields may be capable of causing responses that could beassociated with components of brain damage found in AD such as: neuronalloss, loss of synapses, cytoskeletal alterations; and formation ofneurofibrillary tangles and neuritic plaques (Sobel, Davanipour, Sulkava,Erkinjuntti, Wikstrom, Henderson, Buckwalter, Bowman, and Lee, 1995). ALZHEIMER'S DISEASE Introduction Alzheimer's disease (AD) is thought to be the fourth leading cause ofdeath in the United States, with approximately 4.5 million Alzheimer'sdisease victims. Stroke, coronaryheart disease or cardiac infarct are also associated with reduced survivalin AD. & Leech, R. Dementia management strategiesand adjustment of family members of older patients. Some believe that mutationsof the amyloid precursor protein molecule trigger breakdown of the proteinwith resulting accumulation of amyloid. The problem is expectedto grow as the baby boomer generation reaches ages of maximum prevalence ofAlzheimer's disease (expected over 9 million by the year 2 3 ). Culturalvalues were considered. AD symptoms includeemotional and behavioral changes, and cognitive destruction; depression isfound to be common. (1994). Cognitive-focused coping such as reframingthe problem, acceptance, and focus of the positive is found to be relatedwith better emotional adjustment, however, evidence is mixed. L., Benedict, C. Thesedeficits may result in memory loss, impaired abstract thinking, decreasedproblem solving ability, impaired judgment, language disturbance (aphasia),apraxia, agnosia, constructional difficulties, and personalitydisturbances. AD patients withamnesic syndromes have defects in learning and long-term memory, withintact short-term memory. Lessons learned from the project include: leavethe desk and get out into the community to become acquainted with ethnicgroups; and test intervention models in the literature before acting.Successful support groups were less formal, with frequent, loud, andanimated interactions, and more interpersonal contact (Henderson, 1992). (1994). N. While science attempts to resolve issues ofneuronal processing, current focus regarding coordination of communityprograms to help educate and provide services for AD patients and families,is needed. Hallmarks of AD are the neuritic plaques andneurofibrillary tangles representing the tombstones of dead and dyingneurons and their neuronal processes (axons and dendrites). Dysthymia may be a reaction to progressive cognitive declines;major depression may be associated with biological factors as well. The authors also studied the presence of personality disorders beforethe onset of AD. C. Other AD patients may have normal long-termmemory with deficiencies in problem-solving, cognitive resource allocation,rapid information processing, and shifting and maintaining central sets.Cognitive impairment in AD patients is found to change over time; changingpatterns are consistent with the idea that multiple independent systems aredeteriorating (Becker, Bajulaiye, & Smith, 1992). Reappearance in later life is a phenomena indicative ofwidespread diffuse cortical lesion. TheGerontologist, 34(5), 7 -7 6.Henderson, J. The processfor extending AD support to the ethnic minority included: knowledge ofsocial and cultural aspects for caregivers and patients of AD; personalcontact with ethnic minority caregivers; conducting meetings in neutrallocations that don't violate intraethnic variability of socialorganization; and flexibility of project design for evolving knowledge.This model was proven successful, after 24 months, ethnic minoritycaregivers began to participate in monthly support groups. Identification and measurement of productive behaviors in senile Dementia of the Alzheimer type. Increasing coordination of the Dementia service deliverynetwork: planning for the community outreach education program. M., Kole, S. J., Holmes, S.
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