FREE ESSAY ON ALZHEIMERS DISEASE

ALZHEIMERS DISEASE

Alzheimer's Disease
We are currently living in the age of technology. Our advancements in the past few
decades overshadow everything learned in the last 2000 years. With the elimination of
many diseases through effective cures and treatments, humans can expect to live a much
longer life then that of their grandparents. The population of the United States
continues to rise, and with the baby boom era coming of age, the number of elderly people
is rising as well. This increase has brought with it a large increase in diseases
associated with old age. Alzheimer's dementia is one of the most common and feared
diseases afflicting the elderly community. Alzheimer's disease, once thought to be a
natural part of aging, is a severely debilitating form of mental dementia. Although some
other types of dementia are curable or effectively treatable, there is currently no cure
for the Alzheimer variety. 
A general overview of Alzheimer's disease including the clinical description, diagnosis,
and progression of symptoms, helps one to further understand the treatment and care of
patients, the scope of the problem, and current research.
The clinical definition of dementia is a deterioration in intellectual performance that
involves, but is not limited to, a loss in at least 2 of the following areas: language,
judgment, memory, visual or depth perception, or judgment interfering with daily
activities. (Institute, 1996, p.4). The initial cause of Alzheimer's disease symptoms is
a result of the progressive deterioration of brain cells (neurons) in the cerebral cortex
of the brain. This area of the brain, which is the largest and uppermost portion,
controls all our thought processes, movement, speech, and senses. This deterioration
initially starts in the area of the cortex that is associated with memory and then
progresses into other areas of the cortex, then into other areas of the brain that
control bodily functions. The death of these cells causes an interruption of the
electrochemical signals between neurons that are a key to cognitive as well as bodily
functioning.
Currently Alzheimer's disease can only be confirmed at autopsy. After death the examined
brain of an Alzheimer victim shows two distinct characteristics. The first is the
presence of neuritic plaques in the cerebral cortex and other areas of the brain
including cerebral blood vessels. These plaques consist of groups of neurons surrounded
by deposits of beta-amyloid protein. The presence of these plaques is also common to
other types of dementia. The second characteristic, neurofibliary tangles, is what
separates Alzheimer's disease from all other forms of dementia. Neurofibliary tangles
take place within the disconnected brain cells themselves. When examined under a
microscope, diseased cells appear to contain spaghetti-like tangles of normally straight
nerve fibers. The presence of these tangles was first discovered in 1906 by the German
neurologist Alois Alzheimer, hence the name Alzheimer's disease.
Although the characteristics listed above are crucial to the diagnosis of Alzheimer's
disease upon death, the clinical diagnosis involves a different process. The diagnosis of
Alzheimer's disease is only made after all other illnesses, which may have the same
symptoms, are ruled out. The initial symptoms of Alzheimer's disease are typical of other
treatable diseases. Therefore doctors are hesitant to give the diagnosis of Alzheimer's
in order to save the patient from the worsening of a treatable disease through a
misdiagnosis. Some of the initial symptoms include an increased memory loss, changes in
mood, personality, and behavior, (symptoms that are common in depression) prescription
drug conflict, brain tumors, syphilis, alcoholism, other types of dementia, and many
other conditions. 
The onset of these symptoms usually brings the patient to his family doctor. The general
practitioner runs a typical battery of urinalysis and blood tests that he sends off to
the lab. If the tests come back negative, and no other cause of the symptoms is
established, the patient is then referred to a specialist. The specialist, usually a
psychiatrist, will then continue to rule out other possible illnesses through testing. If
the next battery of tests also comes back negative, then the specialist will call on a
neurologist to run a series of neurological examinations including a PET and CAT scan to
rule out the possibility of brain tumors. A spinal tap is also performed to determine the
possibility of other types of dementias. The patient will also undergo a complete
psychiatric evaluation. If the patient meets the preliminary criteria for Alzheimer's
disease, an examination of the patients' medical history is also necessary to check for
possible genetic predispositions to the disease. The psychiatric team finally meets with
the neurological team to discuss their findings. If every other possible disease is ruled
out, and the results of the psychiatric evaluation are typical to that of a person with
the disease, the diagnosis of Alzheimer's disease is given.
The initial symptoms of Alzheimer's disease are usually brushed off as a natural part of
aging. The myth that a person's memory worsens over time is just that - a myth (Myers,
1996, p.100-101). Alzheimer's disease victims are mostly over the age of 65 and many
delay treatment by attributing their problems to age. A victim might forget a well known
phone number or miss an important appointment. These symptoms eventually escalate to the
total disintegration of personality and all patients end up in total nursing care.
In descending order, the patient goes from (1) decreased ability to handle a complex job
to (2) decreased ability to handle such complex activities of daily life as (3) managing
finances, (4) complex meal preparation and (5) complex marketing skills. Next comes (6)
loss of ability to pick out clothing properly, (7) or to put on clothing properly,
followed by (8) loss of ability to handle the mechanics of bathing properly. Then (9)
progressive difficulties with continence and (10) toileting occur, followed by (11) very
limited speech ability and (12) inability to speak more than a single word. Next comes
(13) loss of ambulatory capability. Last to go are such basic functions as (14) sitting
up, (15) smiling and (16) holding up one's head (Brassard, 1993, p.10).
The average time from diagnosis to inevitable death is 8 years. The family of the victim
is usually able to care for the victim for an average period of about 4 years
(Alzheimer's, 1996, p.44). During the progression of the disease between 10% and 15% of
patients hallucinate and suffer delusions, 10% will become violent and 10% suffer from
seizures (Alzheimer's, 1996, p.46).
Once a person is diagnosed as having Alzheimer's disease, an assessment is made of the
disease's stage of progression and of the strengths and weaknesses of the victim and the
victim's family. There are different types of assessments available to evaluate the level
of dysfunction of the patient. Based on one of these assessments a care plan is put
together by a team consisting of a family member, a paid or unpaid care provider, and the
victim's physician. Throughout the progression of the disease, and depending on the needs
of the patient, a wide range of expensive medication, such as psychoactive drugs to lift
depression and sedatives to control violence may be required.
Unfortunately, although a wide range of treatments have been tested, most prove to be
ineffective. At the beginning of the disease the family is usually able to look after the
patient without much effort. Frequently families will hire a care giver in order to
alleviate some of the work.
Simple changes in the home can make life much easier for the sufferer, help them keep
their self esteem, and prolong their stay at home. Examples of low-cost modifications to
the environment include reducing the noise levels in the home (telephones, radios,
voices, etc.); avoiding vividly patterned rugs and drapes; placing locks up high or down
low on doors leading outside (Alzheimer's disease sufferers are known to wander off);
clearing floors of clutter; and reducing the contents of closets in order to simplify
choices (Alzheimer, 1992, p.17). Costs are typically paid for by the victim's family.
Many of these, and other more expensive modifications are introduced in long-term care
settings. They help in maintaining the safety and security of the victim as well as
reducing their confusion.
The patient's and the family's condition should be assessed every six months (Alzheimer,
1992, p.21). In response to constantly changing needs, the aspects of care must be
constantly modified. Other issues that usually arise during the care of the patient are
assessment of the competence of the victim, power of attorney, and response to and
prevention of abuse (Aronson, 1988, p.124). Eventually the victim's condition
deteriorates to the point where home care is no longer possible and they must be moved to
a long-term care facility.
Any care giver must obtain information and education about the disease in order to
effectively care for the victim. During the course of the disease victims might wander,
hallucinate, or become suspicious. This behavior can place a large strain on the care
giver as well as causing depression and deterioration of their own health (Aronson, 1988,
p.132). An Alzheimer's disease support group is crucial to alleviating some of the stress
on the care giver. Through a support group the care giver is given the emotional and
practical help needed to accomplish the large task of looking after the victim for as
long as possible. 
An estimated four million Americans currently have Alzheimer's disease, and about one in
every 10 Americans 65 and older has the disease (Evans, 1989, p.131). But that overall
figure is misleading. According to a large survey of retired individuals, risk of
Alzheimer's disease changes considerably during the older years: From age 65 to 74, about
3% of people are affected. From age 75 to 84, the figure rises to 19%, and for those 85
and older, Alzheimer's afflicts 47% (Evans, 1990, p. 4). Currently the U.S. population is
aging, with people over 85 becoming the nation's fastest-growing age group. Because this
is also the group most affected by Alzheimer's disease, experts warn that unless
researchers discover how to prevent the disease, by the year 2050, as many as 15% of
those over 65 might have Alzheimer's.
These large and increasing figures translate into a large burden on the health care
system. Even when using the most conservative estimates of the average number of years
spent in an institution and the number of afflicted Americans, the costs to health care
are immense. At $33,000 per patient per year in an institution and with an average stay
of three years until death, the cost of Alzheimer's disease will amount to $3 billion
over the next few years; and if the entry into the disease state remains constant, it
will cost the American taxpayer [an added] $1 billion per year thereafter (Brassard,
1993, p.11).
Alzheimer's disease is a democratic disease. It affects persons of both sexes and all
races and ethnic backgrounds. The major risk factors for Alzheimer's disease are age and
heredity. Persons with a high incidence of the disease in their family history are most
susceptible. A specific subtype of Alzheimer's disease exists that is solely connected to
heredity. This subtype is known as Familial Alzheimer's disease (FAD). FAD is also known
as Early Onset Alzheimer's disease, named so because its symptoms start to develop much
earlier than in the regular sporadic type. Only 5%-10% of all cases are of this type. FAD
is suspected when Alzheimer's disease can be traced over several generations and there is
a history of (among previously affected family members) a similar age of onset and
duration of the disease (usually 4 years). Approximately 50% of the children of an
affected parent go on to develop the disease (Pollen, 1993, p.89).
Much research has been conducted in an attempt to locate the gene that is responsible for
FAD. Currently, researchers have isolated genes 1, 14, and 21 (Alzheimer's, 1996, p.36).
However, the evidence still remains inconclusive (Statement, 1996, p.2). There is also a
possibility that a specific genetic mutation merely puts a person at risk to the disease
and Alzheimer's disease is triggered by an external force, like a head injury (Statement,
1996, p.4). Finding the specific location of the gene will pave the way for a diagnostic
or even predictive test for FAD. 
Similar genetic tests already exist for cystic fibrosis and muscular dystrophy. Locating
the Alzheimer's disease gene will also allow scientists to study why the particular gene
is not functioning properly and may give clues for treatment and possible cures. The long
term goal of this research is the same as that of any other genetic research and that is
gene therapy - which is the possibility that science could one day alter our genetic
make-up.
The other much more common type of the disease is Sporadic Alzheimer's Disease (SAD).
This includes all other types of the disease which are not linked to heredity. Genetic
research is also playing a major role in the progress towards a diagnostic or predictive
test for SAD. Recently, a gene involved in the transport of cholesterol has been
identified to be associated with Alzheimer's disease. Apolipoprotein E is located on
chromosome 19 and seems to contribute to the susceptibility of a person with Alzheimer's
disease (Statement, 1996, p.6). The gene exists in three different forms or alleles (Apo
E 2,3,4) and each person has a combination of two of the three. Thus an individual can
have any one of the following combinations: Apo E 2/2, 3/3, 4/4, 2/3, 3/4 or 2/4.
Researchers have found a relationship between the number of copies of the 4 allele and
the person's probability of developing the disease. For example a 75 year old individual
with the Apo E 4 genotype has approximately a 20% chance of remaining normal; Apo E 3/4
or 2/4, 40%; 2/2, 3/3 or 2/3, a 75% chance (Institute, 1996, p. 6). 
For many years, scientists believed that aluminum was at the root of Alzheimer's disease.
High levels of aluminum were detected in the areas surrounding the beta-amyloid plaques
associated with neural atrophy (Pollen, 1990, p.77). Recently however, this theory has
been abandoned. Scientists concluded that the build-up of aluminum was a direct result of
the wrongful use of a particular test agent employed in the studies (Brown, 1992, p.6).
Some of the current pursuits of research are in the areas of viral infection, malfunction
of the immune system, and chemical imbalances. One of the hardest theories to disprove is
that Alzheimer's disease is the result of a slow acting virus present at birth (Carlton,
1996, p.13). Others believe that Alzheimer's disease is an immune system disorder.
Support for this theory comes from the presence of beta-amyloid plaques identical to
those found in Alzheimer-diseased brains in the post-mortem examinations of
immuno-deficiency disease victims (Alzheimer's, 1996, p.22).
The detection of lower neurotransmitter substances such as acetylcholine, serotonin,
norepinephrine and somatostatin in Alzheimer's sufferers forms the basis of another
theory that says Alzheimer's disease is brought on by a chemical imbalance in the brain.
Treatment of patients with drugs that block the breakdown of neurotransmitter substances
in the brain have been met with limited success (Brassard, 1993, p.16). 
Alzheimer's disease is an enormous social and economic problem. As the population ages,
the number of victims will steadily increase, imposing a massive burden on the health
care system. Until a cure and effective treatment are found, Alzheimer's will remain a
terrible disease that slowly eats away at that which is the very essence of a person:
their mind, leaving in its wake a mere empty shell of that person. It takes away from all
of us the insightful wisdom of one of society's most prized possessions - the elderly.
Bibliography
References
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Aronson, Miriam.(1988). Understanding Alzheimer's Disease. New York: Scribner's,
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Brassard, Daniel.(1993). Alzheimer's Disease. Library of Parliament, Science and
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Brown, Phyllida.(1992, November 7). Alzheimer's May Not be Linked to Aluminum. New
Scientist Supplement, 6.
Carlton University Department of Health Sciences. (1996). Internet.
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