ALZHEIMER'S
DISEASE
A family's struggle to understand
loss.
Does this sound familiar to you?
" Mom, how are you today?"
" Good honey. Where's your dad?"
" Dad's been gone for some time Mom."
" Oh yeah, well when's your aunt coming to visit me?"
" Mom, your sister's gone, too."
" Who are you?"
" Mom it's me, your daughter."
" Good to see you again, it's been so long."
" I was just here yesterday, Mom. But it's good to see you again,
too."
Unfortunately, this conversation is all too common and something
I've seen frequently in my 15 years practicing emergency medicine.
Emergency Departments across the United States are filled with
elderly patients who have complex medical problems, many which
require hospitalization and comprehensive therapy. Along with
this aging population, comes another disease process, Alzheimer's
disease (AD).
Over 4.5 million Americans currently suffer from AD and this number
will grow to 16 million by the year 2050. A study just released
has shows the relationship between diabetes and the progression
of an AD. Diabetics face a 65% increase in the chance of developing
Alzheimer's. Unfortunately, there is no cure for the disease,
but the research continues.
Let's look a little more closely at AD.
What is Alzheimer's disease? AD is
a progressive neurologic disease that affects the brain and is
universally fatal. The brain begins
to degenerate and there is impaired loss of memory, impaired thinking,
diminished cognition, and unusual behavior. This is the most common
form of dementia seen in patients over the age of 65 years. It
is very unusual to see this problem in younger folks. Once diagnosed,
the average lifespan with the disease is 8 years.
AD is named after the German physician, Alois Alzheimer, who first
discovered the process in 1906. It was once a rare problem, but
is now considered a major health care issue among the elderly.
Dementia is a generalized term that is used to describe altered
thought process. In addition to cognition, changes in behavior
are also seen ranging from depression to agitation.
What are the risks and causes? There is no
known cause for AD, but it is known that the number one risk factor
is progression
of age. Each person with AD is affected differently and it is
difficult to predict how each person will respond and progress
throughout the illness.
It is known that AD has a genetic predisposition and it does run
in families. There is an early form of AD that can be present
between the ages of 30-60 years and this has a definite genetic
origin. The more common type of AD that presents after the age
or 65 has less genetic prevalence. Some studies have shown a protein
link in the blood between patients, but more research is required
to further identify this link.
How is it diagnosed? There is no specific
test that can aid the health care provider with an easy diagnosis.
As with most conditions,
a comprehensive history must be taken followed by a physical examination.
A battery of baseline laboratory studies will be run and a CT
Scan of the brain will be completed. All of this is done to rule
out any other reversible metabolic or medical condition. A primary
care provider will complete a great deal of the initial work up
and then a Neurologist (brain specialist) may be consulted. Next,
a variety of mental function tests will be performed to confirm
the diagnosis.
What are the warning signs of AD? The
Alzheimer's Association has identified ten warning signs of AD.
These signs include memory
loss and difficulty in performing simple familiar tasks. There
may be signs of problem with language and word finding. Eventually,
a person may have trouble with orientation to time and place.
There may be changes in judgment and abstract thinking. Later
on, there may be changes in mood, personality, and behavior. Lastly,
one may see a change in motivation and initiative with regard
to activities of daily life. Ultimately, if you begin to observe
any of these warning signs in those that are close to you, it
would be wise to pursue an evaluation.
What is the treatment? At the present
time, there is no cure for AD. There are certain medications that
have been used to slow
the progression of the disease or stabilize it. They work on certain
brain chemicals and many patients have responded favorably to
those medications.
Once the diagnosis is made, it is essential to involve the patient
and the family in planning for the future. Advanced directives
should be in place to help with end of life decisions during times
of crisis. Early disclosure to family and friends is important
in allowing everyone to gain an understanding in process.
In time, families and patients may need to made decisions for
additional care arrangements at an appropriate facility. In addition,
this a very stressful situation for family members and they too
will need support during this time of need.
For more information on AD, or resources for living with AD, visit
the Alzheimer's Association website at www.alz.org. This website
will provide you with information on the nationwide network of
more than 80 support groups and 220 local points of service.
