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| 'I
knew something was wrong with me, but I didn't want this to be seen by
anyone else. I wanted to stay 'normal,' but I found it was [long pause]
hard. A struggle. [Pause] I had to make lots of lists and keep them in
the house or car. We argued a lot because I never wanted to go out.
Scared you see. I was always terrified my wife would find out.' - 67-year-old man with Alzheimer's disease (State of the Art in Dementia Care) |
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| Named for Dr. Alois Alzheimer, who first identified the disease in 1907, Alzheimer's disease is a neurodegenerative disorder characterised by the destruction of brain cells. Alzheimer's disease is accompanied by the impairment of short- and long-term memory and other intellectual capabilities. As the brain cells die, the individual's ability to function worsens progressively, leading eventually to a loss of most functional skills, including an understanding of spatial relationships. It is also accompanied by incontinence and the inability to read, reason and communicate. The immune system deteriorates, and the eventual outcome is death. |
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Diagnosing and Treating Alzheimer's Disease Although research is under way, little is known about causes and treatments for Alzheimer's disease. Even diagnosis is difficult. A definitive diagnosis depends on an analysis of tell-tale senile plaque and neurofibrillary tangles found in brain tissue after death. A careful clinical examination, however, can result in a possible or probable diagnosis, based on deficits in cognitive abilities and the presence or absence of a second illness that can cause dementia. (See appendix for diagnostic criteria.) Risk Factors Risk factors are difficult to assess because data is often reliant on third-party reports. Screening and diagnostic criteria also differ. The most recent EURODEM study, an analysis of dementia in Europe, assesses comparable data from several European studies to arrive at probable risk factors. (Launer 1999) 1.
Age. 2.
Heredity. 3.
Gender. 4.
Education. 5.
Smoking. 6.
Head trauma. Diagnosis
Although early diagnosis is difficult in many cases, it can allow some patients to make necessary arrangements for care. Some can also benefit from new medications that may provide a measure of symptomatic relief. Unfortunately, many general practitioners are not trained to recognize the disorder and do not diagnose it until the condition has become severe. In addition, the availability and quality of specialist care varies greatly from country to country as well as within countries. A physical examination can rule out other dementias, such as those related to drug interactions, hypertension and other disorders. Physicians look for signs of deterioration in memory, language and thought. For example, people suffering from Alzheimer's disease tend to lose short-term memory, forget what words mean, become unable to recognise familiar people and objects and unable to orient themselves spatially. As deterioration continues, their ability to carry out such simple activities of daily living as dressing, bathing, toileting or even chewing and swallowing is increasingly impaired. Changes in mood, personality and behaviour are all too common. People with Alzheimer's disease are prone to wander at any time of day or night. They may be incontinent, disoriented in time and space or demonstrate uncharacteristically aggressive behaviour. Alzheimer's patients tend to lose weight and muscle tone. Vision is often affected. They become more vulnerable to infection, making them prone to other diseases. Treatment The primary treatment is non-pharmacological - the millions of families, paid and unpaid carers, day and long-term care centres and clinical practitioners who perform the difficult task of caring for those with Alzheimer's disease. There is, as yet, no cure for Alzheimer's disease. That is not to say there is no light on the horizon. Treatments continue in development. Drugs designed to interfere with the progression of the disease and alleviate some of the symptoms are available. These drugs, which work by inhibiting the brain's production of acetylcholinesterase, an enzyme implicated in Alzheimer's disease, have been of benefit to some patients for short periods of time, but side effects often prove difficult. Long-term outcomes of drug therapy are not yet known. A further difficulty is the importance of introducing drug therapy early in the disease. Most general practitioners, however, do not diagnose Alzheimer's disease early enough for any treatment to be effective. In addition, too many doctors do not treat their older patients aggressively, attributing diseases amenable to cure to 'old age.' Extensive research on new treatments is ongoing. Investigators are evaluating other potentially promising approaches, including examining genetic abnormalities associated with the disorder, looking at drugs now used to treat other diseases, studying the female hormone estrogen, trying combinations of treatments and studying relationships between Alzheimer's and cardiovascular disease. Researchers are studying proteins, such as apolipoprotein E4 (apoE4) and ubiquitin, that have been shown to be associated with Alzheimer's disease, as well as beta-amyloid, the major component of senile plaque, and its relationship to serum cholesterol levels, for clues to improved diagnosis and treatment. |
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