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ALZHEIMER'S DISEASE.
Term Paper ID:24875
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Essay Subject:
Causes, symptoms, behavioral changes, treatment; case history of 71-year-old patient.... More...
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Paper Abstract:
Causes, symptoms, behavioral changes, treatment; case history of 71-year-old patient.
Paper Introduction:
ALZHEIMER’S: CAUSES, EFFECTS, TREATMENTS, & CASE HISTORY
Introduction
This research reviews literature relative to Alzheimer’s Disease and analyzes a case history of Alzheimer’s Disease reported in the literature. With respect to the literature review, causes and effects of Alzheimer’s Disease, as well as treatments for Alzheimer’s Disease are addressed.
Causes of Alzheimer’s Disease
Alzheimer’s disease is a form of senile dementia (American Psychiatric Association, 1994). At present, it is not known whether Alzheimer’s disease is becoming more widespread, or merely being better diagnosed. The American Medical Association, however, estimates that nearly one in two persons over-85 years old suffers from some stage of Alzheimer’s. Bec
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Regarding the efficacy of repetition for memory, Hulme, Lee, and Brown(1993) conducted a study in which rehearsal (repetition) was used toconvert information into long-term memory in samples of normal subjects andsubjects with Alzheimer's Disease. Otherabnormalities, according to Kalaria (1996) entail profound irregularitiesin the course of microvessels, unexplained inclusions in the basementmembrane and changes in unique proteins and membrane lipids associated withthe blood-brain barrier. The subject of the case study was a 71 -year-old white man who wasadmitted with a diagnosis of Primary Degenerative Dementia, Alzheimer'stype. 99). Annals ofNeurology, 23, 138-144. P. 1 ). The dominant changes, according to Kalaria (1996)include alterations in composition of connective tissues and smooth muscleof large vessel walls, thickening of the vascular basement membrane,thinning of the endothelium in some species, loss of endothelialmitochondria and increased pericytes. This finding indicates that a problem existedwith the acetylcholine system. (1988).Clinical pathological, and neurochemical changes in dementia: A subgroupwith preserved mental status and numerous neocortical plaques. Dwyer (1994) found that weight loss over time was highly associatedwith mortality, even when medical diagnoses that might explain the weightloss were taken into account. The subject had been marriedto the same woman for 4 years, and his wife described their marriage ashappy. (1994, January). N. Reported staff data were collectedconcurrently" (Rossby, Beck, & Heacock, 1996, p. Casby, J. Disruptive behavior was defined as behavior resulting in "negativeconsequences for the resident, caregiver, or other residents and wasmeasured by the Disruptive Behavior Scale""(Rossby, Beck, & Heacock, 1996,p. Hulme, C., Lee, G., & Brown, G. B. One postulated cause of the degenerative Alzheimer's Disease type(DAT) disorder is acetycholine depletion (Carson & Butcher, 1996). Archives ofPsychiatric Nursing, 6(2), 98-1 7. Effects of individualizedmusic on confused and agitated elderly patients. Aluminum is a prime nominee in thecontemporary period, but a causal relationship has not been established. Adverse effects of donepezil were comparable withthose of placebo. Archives of PsychiatricNursing, 7(5), 284-291. (1997, December). Abnormal psychology and modernlife. Observation periods were 4 hours long and covered a 24-hour time span. Such a focus prevents identification ofindividual resident needs and deficits that may be used in planninginterventions to manage or prevent disruptive behavior" (p. New York: HarperCollins Publishers, Inc. N. AmericanJournal of Occupational Therapy, 48(1 ), 883-889. 1 3). During the six-to-eight weeksprior to the initiation of this case study, however, the subject began towithdraw. Effects of Alzheimer's Disease "For both patient and caregiver, Alzheimer's Disease has beencharacterized as the disease from Hell" (Levine, 1993, p. Alzheimer's Disease: Rhythm, timing and music astherapy. he complexities of disruptivebehaviors require holistic assessments of residents that includedescriptive information on the characteristics of disruptive behavior.Frequently, residents with cognitive impairment are treated as a homogenousgroup with identical needs. E. D. A. The effect of music onrepetitive disruptive vocalizations of persons with dementia. His present physical health statuswas good with only a recurrent urinary tract infection. Neuropsychologia, 31(2),161-172. Music therapy has been suggested as an intervention for patientsexperiencing anxiety, depression, agitation, and violence (Covington,1997). Disruptivebehaviors of a congenitively impaired nursing home resident. Biopsychosocial characteristics described included the cognitivestatus, depression, functional ability, and activity involvement.Additional biopsychosocial characteristics considered in the case studywere "age at onset of dementia, subtype of disease, other psychiatricsymptoms, gender, age, physical health status, premorbid personalitytraits, social support network, sleep patterns, psychotropic drug use, andphysical restraint" (Rossby, Beck, & Heacock, 1996, p. A. At present, it is not known whether Alzheimer'sdisease is becoming more widespread, or merely being better diagnosed. The reported that 87 percent of thedisruptive behaviors observed were in four behavior categories: walkingaimlessly; using obscene or profane language; making repetitive movements;and making repetitive noises. Music therapy as a nursing intervention. Donepezil is a cholinesterase inhibitorthat is selective and specific for acetylcholinesterase. "He had been assigned a private room because of his disruptivebehavior. During the subjects initial stay in the institution, he interactedwith the other residents and helped them. Robinson, B. Hulme, Lee, and Brown (1993) concluded that the verbal short-termmemory deficit found in Alzheimer's patients has two components. Thesubject's incontinence and impaired communication are consistent withfindings that incontinence and impaired communication are associated withdisruptive behavior .... Alzheimer's Disease: Case History Analysis Rossby, Beck, and Heacock (1992) reported a case study of a 71 yearold Alzheimer's patient. (1992, April). Autopsies of Alzheimer's patients have found a decrease ofacetylcholine in the brain. TheAmerican Medical Association, however, estimates that nearly one in twopersons over-85 years old suffers from some stage of Alzheimer's. Strategies to detect and preventmalnutrition in the elderly: the Nutrition Screening Initiative. L. A., & Holm, M. (1994, October). (1997). It is metabolizedby hepatic isoenzymes CYP2D6 and CYP3A4 and undergoes glucuronidation. Dwyer (1994) foundalso that protein-calorie malnutrition and vitamin and mineraldeficiencies, while less common, also were present in some elders, and thatone of the disease-related causes was Alzheimer's Disease. that state that most disruptivebehaviors occur during the day and during assistance with ADLs. (1998, January). The subjecthad a history of good physical health. (1994). Lifetime risk of dementia andAlzheimer's Disease. Robinson (1997) indicated that the treatable causes ofdementia may be structural, metabolic, toxic, infectious, nutritional,psychiatric, or drug-related. Levine, K. Kalaria (1996) reported that brain imaging andpermeability studies show no clear functional evidence to support thestructural and biochemical anomalies, but that it is plausible that focaland transient breach of the blood-brain barrier in aging generally, andmore especially in Alzheimer's Disease, occurs. This admission was preceded by a 4-year decline in cognitivefunctioning with increased confusion and problematic behavior. Patient Care, 29(11), 12 -129. (1993, 8 February). Annals of Pharmacotherapy, 32(1), 7 -77. Thus far,however, no causal factor has been established with certainty. Family history waspertinent for Alzheimer's disease in his mother" (Rossby, Beck, & Heacock,1996, p. Gerdner, L. Short-term memoryimpairments in Alzheimer-type dementia: Evidence for separable impairmentsof articulatory rehearsal and long-term memory. 99). Casby and Holm (1994) studied the effects of classical and favoritemusic on three vocally disruptive elderly dementia patients in a long-termcare facility. Pharmacology and Therapeutics, 72(3), 193-214. Roy, O., & Collin, F. Barner and Gray (1998) reported on the use of Donepezil for thetreatment of Alzheimer's patients. Causes of Alzheimer's Disease Alzheimer's disease is a form of senile dementia (American PsychiatricAssociation, 1994). The institutional staff reported a noticeable increase in thefrequency of incontinence with increased resistance to diaper changes. dark-colored matter that are part of thedebris of damaged nerve terminals, (b) a tangling of "normally regularpatterning ... (1993). Therapies and management proceduresother than pharmacological medications and physical restraint aredesirable. 32). These behaviors include anxiety,depression, agitation, and violence. 138-144) of the autopsy findings in 137 nursing homeresidents who had been classified during life as demented or non-dementedon the basis of careful neuropsychological assessment found that, of the 29subjects who had been classified as non-demented, the autopsy findings in1 (34 percent) were characteristic of Alzheimer's Disease. 499). One incident occurred during assistance with eating, and the remainderoccurred during assistance with bathing, diaper changes, and dressing.Because all incidents involved interventions considered an invasion of thesubject's personal space, this is consistent with the finding that mostaggressive behaviors occur in response to a perceived invasion of personalspace during assistance with ADLs ... Rossby, Beck, and Heacock (1996) observed in the patient 13 of the 56disruptive behaviors identified on the Disruptive Behavior Scale at leastonce during the observation period. The daily administration of psychotropic drugsand physical restraints in the subject is consistent with liberal use ofrestraints and psychotropic drugs in residents with disruptive behaviorreported in several studies ..." (p. Neurology, 49(6), 1498-15 4. The findings of this studyillustrate the difficulties associated with differentiating betweenAlzheimer's Disease and non Alzheimer's dementia in diagnosis. Guideline for initial evaluation ofthe patient with memory loss. Cole, S. (1996). Carson, R. A., Beiser, A., Au, R., McNulty, K., White, R.,& D'Agnostino, R. The firstcomponent was a deficit in the rate of rehearsal, while the secondcomponent was an impairment in the long-term memory component of short-termrecall. (1 th ed.). DSM-IV. Although not explicit fromcurrent studies, according to Kalaria (1996), it is likely that the brainvasculature is continually modified by growth and repair mechanisms inattempts to maintain perfusion during aging and disease. Further, the characteristic deposition of amyloid invessels in Alzheimer's subjects may exacerbate the decline in vascularfunction and promote chronic hypoperfusion. The subject's age at onset of Alzheimer's Disease was 66 years old.With the onset of dementia, the subject began to withdraw slowly andprovided indications that he was troubled when his wife was absent fromhome. Aldridge (1994) found that the quality of life of Alzheimer's patientsis significantly improved through the application of music therapy. Thus, one of the reasons that Alzheimer's patients suffer suchmemory deficits is that the disease interferes with the ability of theirbrains to benefit from repetition. Kalaria, R. Conversely, ofthe 1 8 subjects who had been classified as demented, 12 (11 percent)showed no pathological changes in the autopsy. The subject was a retired Army Major who had coached and taught highschool Social Studies and Physical Education. Dwyer, J. Barner and Gray (1998) concluded that donepezil is aneffective symptomatic treatment for some patients with Mild-to-moderateAlzheimer's Disease. Treatment for Alzheimer's disease Very little is known about the pathophysiology of Alzheimer's Disease. The presence of sleep problems is consistent withthe relationship between overall lack of sleep, interruptions of sleep, andamounts of agitation .... Kalaria (1996) reported that the causes ofthese changes largely remain unknown, and that, while previous studiesrecorded aging-related impairments, such as atherosclerosis and loss ofinnervation in basal surface arteries of the brain, it only recently hasbeen realized that a number of subtle alterations in both the intracranialresistance vessels and the smaller capillaries is apparent in both easinganimals and humans. Journalof Psychosocial Nursing, 35(3), 34-37. Theproblem in the context of this hypothesis, however, is linking suchdepletion to a specific cause. (1994, September-October). She also reported that, althoughhe had lots of friends, he could also be very private and did not like todiscuss problems" (Rossby, Beck, & Heacock, 1996, p. (1996), Cerebral vessels in ageing and Alzheimer'sDisease. The literature of indicates that, although the consequencesof identified brain lesions are broadly predictable, clear exceptions tothe rule are not uncommon. Kalaria (1996) reported that the integrity of the cerebral vasculatureis crucial to the maintenance of cognitive functions during aging.Reported also was that the prevailing evidence suggests thatcerebrovascular functions decline during normal aging, with pronouncedeffects in Alzheimer's disease. within neuronal cell bodies," and (c) anabnormal appearance of small holes in neuronal tissue (Carson & Butcher,1996, p. Covington, H. C., & Butcher, J. 1 ). Theyconcluded from the results of their study that individualized music is apotential alternative approach to the management of agitation in confusedelderly patients. 1 6) References Aldridge, D. The study concluded that music therapy was an effectivemethod of decreasing vocal disruptions without resorting to physicallyrestrictive methods. These elements are (a) a widespreadappearance of "senile plaques ... Sandoz researching four drugs to treatAlzheimer's Disease. Alzheimer's: Causes, Effects, Treatments, & Case History Introduction This research reviews literature relative to Alzheimer's Disease andanalyzes a case history of Alzheimer's Disease reported in the literature.With respect to the literature review, causes and effects of Alzheimer'sDisease, as well as treatments for Alzheimer's Disease are addressed. The subject was aware of the disease and of his gradual loss ofcognitive function (Rossby, Beck, & Heacock, 1996). L., & Gray, S. Donepezil use inAlzheimer's Disease. Geriatrics, 52(12), 3 -32, 35-36, 39.as Rossby, L., Beck, C., & Heacock, P. Thus, according to Kalaria(1996), circumscribed neuronal populations in certain brain regions couldbecome vulnerable. (1994). The findings of the case study implied, according to Rossby, Beck, andHeacock (1996) that a "heightened awareness of potential unmetbiopsychosocial needs will enable psychiatric nurses to work towarddeveloping interventions to prevent need deficits and, thereby, decreasethe potential for disruptive behaviors. Barner, E. One of the findings of the study wasthat while repetition of the material to be memorized repeatedly operatedto increase recall and recognition of the material for the normal subjects,Alzheimer's patients showed very little benefit from repetition of thelists. A., & Swanson, E. Alzheimer'sDisease as a type of dementia "involving global impairment of intellect orpersonality without an impairment of consciousness-a multi-factorialdisease that affects behavioral, cognitive, and quality-of-life issues"(Levine, 1993, p. Gerdner and Swanson (1993) studied the effects of individualizedmusic on five confused and agitated elderly long-term care patients. Diagnostic and statisticalmanual of mental disorders. She reported no major emotional or financiallystressful events during their marriage. Some of these attributes appear moreaffected in Alzheimer's subjects than in other aging subjects. "She reported that the subject had interacted and helped care fortheir four children. Katzman R., Terry, R., DeTeresa, R., Brown, T., & Davies. Data collection included (1) chart review bythe primary investigator of this study; (2) interviews with staff membersand subject's wife by the primary investigator of this study; (3) testing;and (4) direct, nonparticipative, structured observation of the subject'sbehavior, including personal interactions with staff and residents.Unobtrusive, mobile positioning was used during observation. All observational data were collected by the primaryinvestigator of this study. Behavioral disturbances in Alzheimer'sdisease. In15-week and 3 -week trials, donepezil was found to be effective in patientswith mild-to-moderate Alzheimer's Disease as shown by improvements onstandard assessment instruments (the Alzheimer's Disease Assessment Scale-Cognitive Subscale, and the Clinical Interview-Based Impression of Changewith Caregiver Input). The setting of the case study was "a locked, 46-bed, long-term nursingcare unit of a federally funded tertiary care hospital, located in asouthern metropolitan city. (1995, 15 June). (1997, December). One study (Katzman, Terry, DeTeresa, Brown, &Davies, 1988, pp. The case study was descriptive in character, andthe subject of the case suffered with Primary Degenrative Alzheimer'sDementia. American Psychiatric Association. 1 ). Thestudy found further that music therapy, when based on clear treatmentobjectives, can reduce the need for pharmacological therapy and enhance theattainment of rehabilitation goals. As a consequence, there is little effective therapy for the disease(Levine, 1993). Seshadri, S., Wolf, P. neurofibrils ... At about the same time as the withdrawal began, the subject'sclosest friend among the other patients had died (Rossby, Beck, & Heacock,1996). Genetic inheritance is another suggested causal factor. (1993). No otherpsychiatric symptoms accompanied his dementia. Continuousrecording of behavior occurred during seven observation periods on 6different days. Alzheimer's patients exhibit a range of behaviors that createdifficulties for caregivers (Cole, 1995). Washington: American PsychiatricAssociation. Drug Topics, 137(3), 32-33. The aged patient with dementia.Canadian Nurse, 9 (1), 39-43. Rossby, Beck, and Heacock (1996) reported that all "disruptivebehaviors directed toward staff occurred during assistance with ADLs withthe exception of one incident, which occurred during suppository insertion. Many Alzheimer's patients who are severely impaired in factual memoryshow relatively preserved capacity for perceptuomotor learning (Roy &Collin, 1994). 16). The question that has not been answereddefinitively is whether Alzheimer's Disease is the cause of decreasedacetylcholine in the brain or if the decrease in acetylcholine in the braincauses Alzheimer's Disease (Levine, 1993). NutritionToday, 29(5), 14-24. B. Biomedicine and Pharamcotherapy, 48(7), 275-281. 32). The neuropathology of Alzheimer's Disease in the brain has threeelements (Carson & Butcher, 1996). Becausethe disease attacks the mind rather than the body, it tends to have a longduration, with the average Alzheimer's patient live for eight more yearsafter diagnosis, and often requiring round-the-clock care (Seshadri, Wolf,Beiser, Au, McNulty, White, & D'Agnostino, 1997). "Further analysis revealed that weight losswas particularly highly associated with mortality over 2 years amongelderly residents with dementia or Alzheimer's Disease, many of whomrequired assistance with feeding" (Dwyer, 1994, p.
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