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- Nervous Diseases -

June 5th, 2018


Alzheimer Disease – the Memory Thief

 

Alzheimer Disease– the Memory Thief

Alois Alzheimer

 

German psychiatrist and neurologist Alois Alzheimer received scant attention in 1906 when he published the case of a 51-year-old woman he had followed for five years until her death. The woman, he wrote, had trouble remembering her name, could not report what she was eating, could not write her husband’s name, and could not remember familiar objects after a few minutes. Alzheimer examined her brain after her death and presented the findings in this first reported case of Alzheimer Disease.

 

Prevalence

 

Alzheimer disease is the most common form of dementia. It affected over 6 million Americans in 2017. It was the sixth leading cause of death and produced an economic cost of $259 billion. Some studies suggest a higher incidence among women; however, some attribute this to women’s longer life expectancy. Medicare data suggest incidence of 11.5% among Hispanics, 9.4% among African-Americans, and 6.9% among Caucasians. Persons over 60 years of age constitute 90% of Alzheimer patients.

 

Causes

 

Physicians and scientists have no firm answers about the causes of Alzheimer, but do have some associations. As far back as 1906, Alois Alzheimer noted that the brain of his deceased patient contained irregularities known as amyloid plaques and neurofibrillary tangles. Although other aged people have these plaques and tangles, Alzheimer patients have them in increased

numbers and specific brain locations.

 

Risk Factors

 

Although science has not identified the causes of Alzheimer, it has identified certain risk factors. These are:

       Advancing age

       Family history

       Presence of certain genes

       Obesity

       Insulin resistance

       High blood pressure

       Down syndrome

       Traumatic brain injury

 

Symptoms

 

The symptoms of Alzheimer increase from the mild, through the moderate, and into the severe stages of the disease.

 

  • Mild stage symptoms include:
  •        Memory loss
  •        Confusion about location of familiar places
  •        Bad decisions
  •        Mood and personality changes

 

Moderate stage symptoms advance to:

  •        Short attention
  •        Difficulty recognizing friends and family
  •        Difficulty with language and numbers
  •        Inability to organize thoughts
  •        Difficulty coping with unexpected situations
  •        Loss of impulse control

 

Finally, severe stage symptoms culminate in:

  •        Weight loss
  •        Difficulty swallowing
  •        Lack of bowel and bladder control

 

Tests for Alzheimer

 

Currently, only autopsy or brain biopsy can make a definitive diagnosis of Alzheimer disease. Lumbar puncture, or spinal tap, can secure samples of spinal fluid for analysis; but this is helpful mostly in research. MRI and CT may be useful for ruling out other, potentially treatable diseases. Sometimes PET scanning helps to differentiate Alzheimer from other dementias.

 

Treatment

 

Available treatments for Alzheimer can only lessen the primary symptoms; they do not cure the disease or arrest its progress. Donepezil, rivastigmine, and galantamine are cholinesterase inhibitors. They work by slowing the breakdown of certain chemicals needed by nerve cells to function. Another drug, memantine, works by blocking brain cell absorption of a damaging chemical known as glutamate.

 

Other drugs simply alleviate secondary Alzheimer symptoms, such as depression, aggression, delusions, and sleep disorders.

 

Coping

    

Coping skills and strategies are central because Alzheimer is an incurable, progressive disease that extracts energy from both patient and caregivers.

Helpful coping tips are:

  •        Be realistic. Recognize that things will not be the same and that satisfactorymay take precedence over perfection.       
  •        Be clear, concise, and repetitious in communication.
  •        Use visual cues, such as gesturing, as well as verbal cues, in communication. 
  •        Reminisce about the past with photographs and videos.
  •        Be prepared to change, as measures that were effective at one stage may begin to fail as the disease progresses.

 

Conclusion

 

The conquest of Alzheimer disease will likely come slowly with progress on several fronts. These may consist of:

  •        Development of better coping strategies and education of caregivers in their use.
  •        Improved medications to lessen primary symptoms.
  •        Discovery of means to reduce the frequency of the disease.
  •        Development of methods to slow or arrest the progress of the disease.
  •        Invention of a biochemical cure for Alzheimer.
  •        Optimistically, but improbably, development of means to reverse damage done by the disease.

 

Success over Alzheimer will involve the mobilization of multiple resources, including, economic, sociological, political, educational, scientific, medical, and nursing. Moreover, it will involve the insightful proportioning of funds among these resources. Further, it will involve the proportioning of funds among many societal problems. In summary, the program against Alzheimer is far more than a medical commitment; it is a societal commitment.

 

Thomas Falasca, DO

Thomas Falasca, DO

 

References

 

Alzheimer Disease: Practice Essentials, Background, Anatomy. (2018, April 20). Retrieved from https://emedicine.medscape.com/article/1134817-overview

 

Coping Strategies for Alzheimer's Disease Caregivers. (n.d.). Retrieved from https://www.ucsfhealth.org/education/coping_strategies_for_alzheimers_disease_caregivers/

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