August 2014

Alzheimer Disease

What Is Alzheimer's  Disease?

 

Alzheimer's is a chronic degenerative disease often called senile dementia. This process involves atrophy of the brain and progressive, irreversible memory loss, deterioration of intellectual functions, apathy, speech and gait disturbances and disorientation. Generally, Alzheimer's Disease begins gradually and usually leads to general debility with loss of memory for recent events or familiar tasks as well as multiple other functional disabilities. Its rate of advance varies from person to person. However, in most cases the eventual course is confusion, personality and behavior changes and impaired judgment. Communication often becomes difficult as the affected person struggles to find words, finish thoughts or follow directions. This process can occur over as little as four months but may take many years. Eventually, most people with Alzheimer's become unable to care for themselves and ultimately die of this process. 

Alzheimer's most commonly begins between age 40 and 60, but may occur earlier or later in individuals. It has been estimated that somewhere between 10% and 11% of persons over age 65, and 20% to 47% of people over 85, suffer from Alzheimer's Disease. Alzheimer's Disease must be differentiated from vascular dementias, called multi-infarct (stroke syndrome) dementias, which make up 15% to 20% of all dementias, as well as all other causes of dementia.

Other causes of dementia or conditions that may mimic Alzheimer's Disease are:

  • Depression
  • Psychiatric problems
  • Simple hearing loss
  • Metabolic disturbances
  • Endocrine abnormalities (such as thyroid dysfunction or hyper parathyroid disease)
  • Nutritional deficiencies (especially, vitamin B12, niacin, riboflavin and thiamin deficiencies and post alcoholic
         syndrome)
  • Trauma or injury to the brain
  • Brain tumor
  • Infection
  • Cerebrovascular accident (CVA) or strokes.
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    Typical Alzheimer's Disease is characterized primarily by a gradual onset of symptoms, including memory loss and decline in cognitive abilities, such as thinking, understanding, and decision- making. Not as well known are the behavioral symptoms such as agitation, aggression, depression, sundown affect and wandering which are often, but not necessarily part of this process. Most families are usually unprepared for these symptoms and loss of function hence they often create great amount of strain and conflict for all. Often family members are unaware that all of the symptoms and problems associated with Alzheimer's Disease generally worsen over a period of years.

    Early recognition of symptoms and an accurate diagnosis is extremely important. Even though the onset of Alzheimer's disease cannot yet be stopped or reversed, an early diagnosis can improve chances of more effective treatment and allow time to plan for the future.

     

    Treating Alzheimer's Disease

    Today's treatment is primarily designed to alleviate symptoms, improve memory and slow down the progression of symptoms. No one drug, however, can treat all of the symptoms of Alzheimer's effectively. There are now drugs available for treatment of the cognitive symptoms and in many cases they may also help alleviate some behavioral symptoms. Although most treatment programs provide only symptomatic relief, newer generations of treatments may ultimately delay onset or slow progression by protecting nerve cells. Currently, there are about a dozen medications that are being studied to help individuals affected by Alzheimer's disease.

     

    Diagnosing Alzheimer's Disease

    Currently, there is no one diagnostic test that can detect Alzheimer's disease. However, new diagnostic tools and criteria are now making it possible for physicians to make a positive clinical diagnosis of Alzheimer's with an accuracy of 85-90%. The diagnostic process, however, is often lengthy and sometimes taxing. It will generally involve your primary care physician and possibly other specialists, such as psychiatry and neurology. Alzheimer's requires a multi-disciplinary approach and the diagnosis often includes the following:

  • Medical history
  • Neurological examination
  • Mental status evaluation, Mini Mental Status Exam (MMSE)
  • Laboratory tests
  • Physical examination
  • Psychiatric, psychological and other evaluations
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    Laboratory tests can be important as they can provide information about other conditions that may cause dementia. Blood and urine tests can assess for anemia, infection, diabetes, kidney and liver disorders, nutritional deficiencies (specifically vitamin B12), and abnormally high or low levels of thyroid hormone. A brain imaging exam, such as an MRI or CT scan, may be ordered to rule out the presence of tumors, stroke, blood clots, or other factors that may be causing memory and thinking problems. The diagnosis of Alzheimer's is as much a diagnosis of exclusion as inclusion.

    Psychiatric, neurologic, and psychological evaluations are essential to rule metabolic and other illnesses such as depression, which cause symptoms similar to those seen in Alzheimer's. These evaluations test memory, reasoning, writing, vision-motor coordination and the ability to express ideas, and usually provide more in-depth information than the mental status evaluation. These are essential not only for making a diagnosis of Alzheimer's Disease but also for accessing the individuals potential, capacities, limitations and prognosis.

     

    The Diagnosis of Alzheimer's Has Been Made, What Is Next?

    A diagnosis of Alzheimer's disease often leaves the person and their families feeling overwhelmed and confused. Knowing who to talk to and what questions to ask can help. As soon as the diagnosis has been made, it is important to start putting legal and financial documents, such as a living will and power of attorney, into place. An elder law attorney, one who specialize in legal issues related to Alzheimer's disease, can help you and your family plan for the future. While it may seem inappropriate to think of legal aspects first, it is not. As the disease progresses legal and financial issues can become paramount and many families are torn a part because of poor planning. Proper planning can make for much less conflict and disturbance and this can be healing for everyone involved. It is important to check with legal, accounting and medical professionals regarding the following:

  • What documents are needed, i.e., will, power of attorney, etc., before dementia progresses?
  • What is legal capacity and how is it determined?
  • Who will care for the patient, where will he or she live and what resources are available?
  • What long term care services are and are not covered by Medicare or health insurance?
     
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    Summary

    Alzheimer's affects the entire family. It can present a great deal of difficulties for all involved. However, it can also be an opportunity for family and friends to give love and caring, support and compassion in helping their loved one. The key is early accurate diagnosis and appropriate use of medications and alternative treatments such as gingko biloba, herbs and vitamins, music and physical therapy and effectively putting the patients estate and legal affairs in order.