Alzheimer's Disease
Alzheimer's disease is a dementia or condition marked by the
decline of mental abilities. The hallmark of Alzheimer's disease is memory loss. An
estimated 11% of the general population under age 85 and 47% over age 85 may develop the
illness. At this time there is no known cause treatment, or exact diagnosis. Diagnosis can
only be confirmed by brain biopsy. Thus, diagnosis should include:
- A thorough physical examination
- A complete history (e.g., medication use, progression of symptoms,
previous illnesses, and exposure to toxins)
- A mental status examination
- Clinical tests (e.g., C.T. Scan, blood values, and Magnetic
Resonance Imaging)
- Special consultations (e.g., neurologist, psychiatrist, and
pharmacologist)
- Because other disorders look like Alzheimer's disease, a complete
examination is needed to rule out other disorders. An estimated 1 -3O% of patients with
dementia have symptoms that are reversible.
Topics Discussed in this article : You can use
these links to skip to specific topics
[Symptoms][Problems with diagnoses][Neurological
Changes]
[Progression of
Alzheimer's Disease][Down Syndrome and its Relationship to
Alzheimer's/Symptoms to Observe]
[Management
Pointers][References][Resources]
[Top]
Symptoms of Alzheimer's Disease
There are many symptoms associated with Alzheimer's disease poor
judgment, lack of abstract ability and personality changes. The four
"A's" of Alzheimer's disease describe the foremost symptoms.
| The Four "A's" of Alzheimer's Disease: |
- Amnesia: inability to remember. (Can you remember
where the house keys are?)
|
- Aphasia: inability to find words to use in
communication. (Can't remember the word for "lake.")
|
- Apraxia: inability to carry out a sequence of
activities. (Can't do sequence of actions to put food onto fork and into mouth.)
|
- Agnosia: inability to recognize objects or familiar
people. (Doesn't recognize spouse.)
|
[Top]
Problems with Diagnosis
As already noted, the diagnosis of Alzheimer's disease is very
difficult. There are many conditions that produce similar symptoms. Never assume that
Alzheimer's disease is present. Other conditions that may resemble Alzheimer's disease
are:
- Other disorders that may cause dementia: Some may
have no known cause. Others may include Pick's Syndrome and Huntington's Chorea.
- Delirium: Perceptual distortions and lack of
alertness.
- Multi-infarct dementia: Loss of cognitive function
in a step-like progression caused by many small strokes.
- Other neurological problems:These include head
trauma, stroke, and brain tumor.
- Alcoholism: Dementia or severe memory loss.
- Drug effects: Effects of drugs and their
interactions.
- Physical Illness: Thyroid disorders, some heart
conditions, anemia, strokes and infections can mimic dementia.
- Depression: Symptoms of depression may include:
apathy, psychomotor retardation, poor concentration, lack of appetite, delusions and
confusion.
[Top]
Neurological Changes
Changes in the brain occur during the progress of Alzheimer's
disease. The brain gradually atrophies (gets smaller) following a decline in the number of
nerve cells. This occurs most prominently in the regions of the brain where speech and
memory centers are located. There are some other striking brain changes:
- Neurofibrillery tangin: As the brain atrophies the
neuron degenerates. Structures called the neurofibrils become quite thick and twisted.
- Senile plaques: Microscopic granular particles which
surround the irregular center of the neuron.
- Decline in neurotransmitters: Loss of the chemicals
necessary for brain function occurs.
- Presence of amyloid: This is often found at the
core of senile plaques.
[Top]
Progression of Alzheimer's Disease
The effects of Alzheimer's disease upon individuals occur at
different rates with potentially different combinations of landmarks occurring:
- Initial: The initial symptoms are often gradual.
There is mild memory loss, particularly recent memory. The person may experience
difficulty in finding words during casual conversation. Job performance may suffer.
Behavior changes may occur. This period may last up to five years.
- Progression: These symptoms are more obvious.
Distinct language difficulties mark the transition to this stage. The person begins to
have trouble naming objects, using grammar and pronouncing words. Individuals become
easily disoriented (don't know where they are) and confused. Memory loss becomes even more
marked. Individuals may experience incontinence. Paranoia (suspiciousness) and delusions
may occur. This period may last up to twelve years.
- Terminal: Basic skills such as eating or drinking
are forgotten. Body weight may diminish by 20-30%. The person eventually loses the ability
to walk and maintain balance, thus becoming bedridden. Loss of recognition of others,
environment, and oneself may occur. Death is usually the result of inactivity, increasing
risk of infection, and pneumonia. Death is likely to occur in three years.
[Top][ITC][Home]
Down Syndrome and its Relationship to Alzheimer's Disease
In the general population, Alzheimer's disease is not common in
individuals less than 65 years of age. However, the prevalence of Alzheimer's disease with
individuals having Down Syndrome is significantly higher, manifesting itself at a younger
age. Research has shown that neurofibrillary tangles and plaques can be seen in almost all
persons with Down Syndrome who died after the age of 30. While some persons with Down
Syndrome may develop signs of Alzheimer's disease at an early age, others may live longer
without exhibiting symptoms.
Symptoms to Observe in Down Syndrome Cases
The onset of symptoms reported in the literature has shown a wide
variance of age- from 32 to 55 years of age. The language and comprehension skills of
individuals with Down Syndrome may make examinations more difficult As persons with Down
Syndrome age, some may show slight declines on intelligence testing while not manifesting
dementia. The strict routine followed by an individual in a very structured program may
mask confusion in usual daily activities. Symptoms to observe include:
- Emotions: Irritability, social withdrawal, tantrums,
inappropriate mood changes, and impaired judgment. All are often reactions to an inability
to adapt to the environment. Lack of eye contact may be a key indicator.
- Daily Using Skills: Routine tasks become difficult
as do learning new skills (especially complex or multiple tasks) are even more difficult.
- Memory: Recent memory loss is significant. The
individual clings to familiar persons and places for validation of familiar routine and
social contacts.
- Communication: Speech patterns already challenged by
Down Syndrome may be further complicated by Alzheimer's disease; mumbling and repetition
may occur.
- Physical signs: A decrease in spontaneity and in
former interests combined with wandering may occur. This may seem random (in reaction to
boredom) or purposeful (ready for work). Wandering, sleeplessness, and nighttime
incontinence may occur. Initially, the incontinence may result from impaired judgment, but
ultimately is caused by neurological damage. Seizures, uncommon in the general population
diagnosed with Alzheimer's disease, may occur. Fatigue and loss of balance may also
appear.
- Intelligence: It is difficult to measure
intellectual decline in IQ since many of these individuals perform so poorly on
standardized tests, even at an early age. With that in mind, slight declines on the
Stanford-Binet Intelligence Scale appear after 35 years of age in approximately 33 percent
of those with Down Syndrome. Approximately 40 percent of those over 50 years of age show
declines in these scores, but do not show any signs of dementia.
| It is important to have some baseline information about
the individual with which to compare observations of behaviors. Thus, it is important that
persons who know the individual are involved. |
[Top][ITC][Home]
Management Pointers:
There are a number of ways to enhance the life of an older
individual with Down Syndrome who exhibits dementia, particularly in the early periods of
Alzheimer's disease. Here are a few pointers. More details are found in resources listed
in the Annotated References.
- Exercise:Daily exercise provides activity and
promotes self-esteem. Motivation to exercise may not be present, even in normally athletic
individuals. Exercise may provide a familiar routine, for example, if walking the same
route is performed daily. Group exercise with music can be effective, since rhythm and
counting can be incorporated. Activities with a group or leader offer a model for the
individual to mimic the routine. Incorporating former habits or hobbies can be reassuring
to the individual.
|
- Maintenance of Skills and Activities:Use of
remaining skills should be encouraged. If the person can still play checkers, encourage
this activity. Try experiential things that may be of interest to the individual: bring in
flowers to smell, try wading in water -- anything in which the person might feel a
motivation to participate. Remember, the person with Alzheimer's disease may find new
skills or new information more difficult to learn.
|
- Safety:Structure your house to assure safety. Put
medicines, cosmetics, household cleaners, sharp objects, etc. not only under lock,but out
of sight. Put breakables away. Provide ample illumination, but be sensitive to glare. Put
handrails on stairs.
|
- Sleep Patterns:Sleeplessness and night wandering can
be serious problems. Sleep and wakeful cycles are disrupted. Avoid caffeine. Assure
physical activity during the day. Try to limit sleep periods to the night. Take the person
to the bathroom immediately prior to bedtime. Windows and doors should be locked at night.
Consider using assistive devices that alert staff to wandering behavior (e.g., pressure
sensitive pads).
|
- Communication:The speaker should simplify speech,
and speak clearly and slowly while minimizing distractions. Do not ignore the
presence of the individual when communicating in a group. Allow time, supply or help guide
words, observe non-verbal cues, and provide positive reassurance and support.
|
- Nutrition:Some ways to help the individual attend to
eating include: minimize distractions; limit choices; allow more time to eat; provide
models to mimic eating behavior; make food attractive; and use spices and ingredients the
person likes.
|
- Caregiver Emotional and Physical Health:Care
providers should assure their own health by practicing good habits -- adequate nutrition,
sleep, and exercise. Support groups and respite care can aid emotionally.
|
[Top][ITC][Home]
Annotated Selected References:
Down Syndrome and the dementia of Alzheimer's disease, by
Arthur Dalton & Henry Wisniewski. International Review of Psychiatry (1990), 2, pages
43-52
This is an excellent review of the field. The historical
background and review of research findings are presented. The diverse findings include
when the disease begins and what are mortality and survival rates. Studies of declines in
intellectual and cognitive functioning and daily living skills are reported. other areas
addressed include psychiatric symptoms, personality change, communication, loss of
spontaneity, and physical dysfunction.
Alzheimer's disease: A guide for families, by Lenore Powell & Katie
Courtice.
Reading, MA: Addison-Wesley Publishing Co.
This book describes AD, the emotions faced by caregivers and
patients, specifically describing the denial, anger, depression and guilt surrounding the
disease. other sections present concrete aids to help the family -what to do about memory
loss, how to safely-proof your home, how to structure life to cope with and enhance
remaining skills. Final chapters focus on how care providers should care for themselves.
The 36-hour day: A family guide to caring for persons with Alzheimer's disease,
related dementing illnesses and memory loss In later life, by Nancy Mace &
Peter Rabins. Baltimore: Johns Hopkins University Press.
This book has an excellent section on what types of evaluations
are performed when assessing for the presence of this disease. A practical guide to the
physical and behavior problems is covered.
Understanding difficult behaviors, by Mne Robinson, et al. YpsalanU, MI:
Eastern Michigan University, Geriatric Education Center.
This guide provides detailed information regarding identification
of sources and management of behaviors common in persons with dementia.
[Top][ITC][Home]
Other Resources and Supports
- A list of various family support groups is found in the Missouri
Directory of Family Support Groups by Christine Rinck, Ph.D.(Kansas City, MO:
University of Missouri-Kansas City Institute for Human Development) and can be obtained
from:
- Missouri Planning Council for Developmental Disabilities
- 1706 East Elm, P.O. Box 687
- Jefferson City, MO 65102
- (314) 751-8611
- The Missouri Division of Aging operates a statewide
toll-free Information and referral (I&R) service in conjunction with those I&R
services provided locally by Area Agencies on Aging. The Division's I&R phone is
answered from 8:00 A.M. until midnight seven days per week:
1-800-235-5503
The illustration at the top of this page is used with the
permission of the artist, Martha Perske of Perske and Associates, Daren, Connecticut
06820.