Alzheimer’s Disease
is a progressive, degenerative disease that attacks the brain and results in
impaired memory, thinking and behavior (Internet). It is a degenerative disease
affecting nerve cells of the frontal and temporal lobes of the cerebrum of the
brain. The disease is the major cause of presenile dementia (i.e., the loss of
mental faculties not associated with advanced age) and is thought to be the
largest single cause of senile dementia as well (Britannica, 306). It causes the
connections between cells to become ineffective and the cells themselves to
shutdown and eventually die (Davies, 1). Alzheimer’s is a progressive,
irreversible, fatal neurologic disorder that affects an estimated 4 million
American adults. It is estimated by 2040,approximately 14 million Americans will
be diagnosed with Alzheimer’s Disease. Approximately 9% of the population
older than 55 years and 20% of those older than 85 years have Alzheimer’s
Disease. The duration of AD averages 2 to 10 years but can be up to 20 years. By
1992, Alzheimer’s Disease was the fourth leading cause of death among adults
(more than 100,000 American deaths per year). It is projected that the number of
people with Alzheimer’s Disease will triple in the next 50 years. This
epidemic of dementia is not confined to sex, race, social, or economic class.
The public knows this disorder as “senility”, although the term
Alzheimer’s is becoming more common (Rosdahl, 1356). According to a quote from
Hasselbring “ Alzheimer’s disease.” Medical Self-Care 53-
57,January-February, 1986, a 61-year-old woman in early stages of Alzheimer’s
disease stated, “My mind goes to an empty and horrible place. When I come
back, I’m in a room full of strangers. I fell so lost and afraid.” Many
Alzheimer’s patients echo these sentiments. The disease is frightening and
disabling (1356). Alois Alzheimer, a German neuropathologist, originally
described the disease in 1906. In the autopsy of a 55-year-old patient who had
died with severe dementia, Alzheimer noted the presence in the brain of two
abnormalities (Britannica, 306). Recent studies have shown that in the autopsies
of the brain of people who have died from Alzheimer’s, there is much higher
concentration of aluminum than is normal (Weiner, 17). Accounting for about half
of all dementia cases, Alzheimer’s is more common in certain groups. Women are
at higher risk, so are those who have a first-degree relation with the disease,
or a history of head trauma (RN magazine, 26). Unfortunately, many people fail
to recognize that these symptoms indicate something is wrong. They may
mistakenly assume that such behavior is a normal part of the aging process; it
isn’t. Or, symptoms may develop gradually and go unnoticed for a long time.
Sometimes people refuse to act even when they know something is wrong. It’s
important to see a physician when you recognize these symptoms. Only a physician
can properly diagnose the person’s condition, and sometimes are reversible.
Even if the diagnosis is Alzheimer’s disease, help is available to learn how
to care for a person with dementia and where to find assistance. Ten warning
signs to watch for are: (1) memory loss, (2) difficulty performing familiar
tasks, (3) problems with language, (4) disorientation of time and place, (5)
poor or decreased judgement, (6) problems with abstract thinking, (7) misplacing
things, (8) changes in mood or behavior, (9) changes in personality, (10) loss
of initiative (Internet). Typical problems that should alert us that a person
needs some kind of help are repeated car accidents, getting lost, losing things
and not recalling the previous day (Davidson, 13). Symptoms of the illness
represent deficits in many areas of how a person remembers and thinks. For
instance, problems with memory may be manifested as forgetting names, dates,
places, whether a bill has been paid for, or something said over and over.
Intellectual abilities are lost eventually. Reasoning with the affected person
is no longer a successful way to understand and deal with his problems.
Judgement about common everyday situations is drastically diminished. The
individual’s capacity to express himself verbally gradually shrinks. Neither
is he able to comprehend what others say to him. As the disease progresses, he
may gradually lose the ability to speak. Psychiatric symptoms such as delusions
and hallucinations can occur. The person can become anxious, restless, agitated,
and may even appear to be depressed. His personality will change. In fact, he
may not seem to be the same person (Gruetzner, 9). Alzheimer’s disease begins
insidiously and progresses slowly but inexorably, until the sufferer cannot
attend to the simplest details of self-care and may not even remember his or her
name. Although the symptoms may vary from patient to patient and from day to day
in an individual, there are certain common features in all patients, and the
disease follows a somewhat predictable path. Initially, the victim may just
exhibit a lack of energy, drive, and initiative, and neither he nor his family
may be aware that anything is really wrong. The individual may just avoid new
challenges and seek refuge in familiar situations. For example, he may want to
visit only family members and close, old friends rather than go to new places
and meet new people. However, with time, greater changes in mental function and
behavior begin to appear, and the disease can traditionally be divided into
three clinical stages. The individual will forget the names of persons well
known to him; he will also be unable to remember where he puts carious objects,
such as the car keys or his wallet, or what day of the week, month or year it
is. He will start forgetting to attend appointments he has made or get lost
trying to find places that were once very familiar. In the beginning, such
episodes of forgetfulness may just be minor annoyances to the individual and his
family, and he may still be able to function reasonably well. Eventually though,
lapses of memory will become debilitating (Weiner, 27). The symptoms of
Alzheimer’s disease include gradual declines in memory, learning, and
attention, and judgement; disorientation in time and space: word-finding and
communication difficulties: and changes in personality. These symptoms may be
somewhat vague at first and mimic mental illness or stress-related problems. For
example, an executive may not be managing as well as he once did, making bad
decisions with increasingly frequency and missing deadlines. Insidiously but
inexorably, the changes become unable to add two numbers together. Similarly, a
previously talented hostess may no longer be able to set a table. The
personality of the patient may change markedly: an outgoing, vivacious person
may become quiet and withdrawn; a gentle, caring partner may become aggressive
and indifferent. Emotional symptoms, including depression, paranoia, and
agitation, may occur intermittently. During the course of the illness, the
patient’s needs for care escalate. Of the four-plus million Americans with
dementia, one-third are so impaired that they can no longer manage without
assistance in the simplest daily routine activities of eating, dressing,
grooming, and toileting (Aronson, 6). Alzheimer’s disease appears to run in
families. Immediate (“first-order”) relatives of a patient with the disease
have a great risk of developing the disorder themselves. But the incidence of
the disease as it occurs in both identical and fraternal sets of twins, though
somewhat elevated, is not convincingly high enough to “prove” a hereditary
link. It is thought that the disease may be inherited in some families as an
autosomal (any chromosome other than those that determine the sex) dominant
gene.