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Alzheimer's and Dementia

Introduction

Alzheimer’s disease is a brain disorder named for German physician Alois Alzheimer, who first described it in 1906. Scientists have learned a great deal about Alzheimer’s disease in the century since Dr. Alzheimer first drew attention to it. Today we know that Alzheimer’s:

  • Is a progressive and fatal brain disease. As many as 5.3 million Americans are living with Alzheimer’s disease. Alzheimer's destroys brain cells, causing memory loss and problems with thinking and behavior severe enough to affect work, lifelong hobbies or social life. Alzheimer’s gets worse over time, and it is fatal. Today it is the seventh-leading cause of death in the United States
  •  Is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer’s disease accounts for 50 to 70 percent of dementia cases. Other types of dementia include Vascular Dementia, Mixed Dementia, Dementia with Lewy bodies, Frontemporal Demetia, Mild Cognitive Impairment (MCI), Parkinson's Disease, Creutzfeldt-Jakob Disease(CJD), Normal Pressure Hydrocephalus, Huntington's Disease and Wernicke-Korsakoff Syndrome.
  • Has no current cure. But treatments for symptoms, combined with the right services and support, can make life better for the millions of Americans living with Alzheimer’s. There is an accelerating worldwide effort under way to find better ways to treat the disease, delay its onset, or prevent it from developing.

Alzheimer's and the brain


Just like the rest of our bodies, our brains change as we age. Most of us notice some slowed thinking and occasional problems with remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work are not a normal part of aging. They may be a sign that brain cells are failing.

The brain has 100 billion nerve cells (neurons). Each nerve cell communicates with many others to form networks. Nerve cell networks have special jobs. Some are involved in thinking, learning and remembering. Others help us see, hear and smell. Still others tell our muscles when to move. In Alzheimer’s disease, as in other types of dementia, increasing numbers of brain cells deteriorate and die.

Causes

No one factor appears to cause Alzheimer's disease. Instead, scientists believe that it may take a combination of genetic, lifestyle and environmental factors to trigger the onset of symptoms. While the causes of Alzheimer's are poorly understood, its effect on brain tissue is clear. Alzheimer's disease damages and kills brain cells.

 

Two types of brain cell (neuron) damage are common in people who have Alzheimer's:

 

Plaques - Clumps of a normally harmless protein called beta-amyloid may interfere with communication between brain cells. Although the ultimate cause of neuron death in Alzheimer's isn't known, mounting evidence suggests that the abnormal processing of beta-amyloid protein may be the culprit.

 

Tangles - The internal support structure for brain cells depends on the normal functioning of a protein called tau. In people with Alzheimer's, threads of tau protein undergo alterations that cause them to become twisted. Many researchers believe this may seriously damage neurons, causing them to die.

The role of plaques and tangles

Two abnormal structures called plaques and tangles are prime suspects in damaging and killing nerve cells. Plaques and tangles were among the abnormalities that Dr. Alois Alzheimer saw in the brain of Auguste D., although he called them different names.

  • Plaques build up between nerve cells. They contain deposits of a protein fragment called beta-amyloid (BAY-tuh AM-uh-loyd). Tangles are twisted fibers of another protein called tau (rhymes with “wow”).
  • Tangles form inside dying cells. Though most people develop some plaques and tangles as they age, those with Alzheimer’s tend to develop far more. The plaques and tangles tend to form in a predictable pattern, beginning in areas important in learning and memory and then spreading to other regions.

Scientists are not absolutely sure what role plaques and tangles play in Alzheimer’s disease. Most experts believe they somehow block communication among nerve cells and disrupt activities that cells need to survive.

10 Signs of Alzheimer's

 

Memory loss that disrupts daily life is not a typical part of aging. It may be a symptom of Alzheimer's, a fatal brain disease that causes a slow decline in memory, thinking and reasoning skills. Every individual may experience one or more of these signs in different degrees. If you notice any of them, please see a doctor.

 

Memory loss that disrupts daily life

One of the most common signs of Alzheimer's is memory loss, especially forgetting recently learned information. Others include forgetting important dates or events; asking for the same information over and over; relying on memory aides (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own.

What's typical? Sometimes forgetting names or appointments, but remembering them later.

 

Challenges in planning or solving problems

Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before.

What's typical? Making occasional errors when balancing a checkbook.

 

Difficulty completing familiar tasks at home, at work or at leisure

People with Alzheimer's often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game.

What's typical? Occasionally needing help to use the settings on a microwave or to record a television show.

 

Confusion with time or place

People with Alzheimer's can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there.

What's typical? Getting confused about the day of the week but figuring it out later.

 

Trouble understanding visual images and spatial relationships

For some people, having vision problems is a sign of Alzheimer's. They may have difficulty reading, judging distance and determining color or contrast. In terms of perception, they may pass a mirror and think someone else is in the room. They may not realize they are the person in the mirror.

What's typical? Vision changes related to cataracts.

 

New problems with words in speaking or writing

People with Alzheimer's may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a "watch" a "hand-clock").

What's typical? Sometimes having trouble finding the right word.

 

Misplacing things and losing the ability to retrace steps

A person with Alzheimer's disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time.

What's typical? Misplacing things from time to time, such as a pair of glasses or the remote control.

Decreased or poor judgment

People with Alzheimer's may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean.

What's typical? Making a bad decision once in a while.

 

Withdrawal from work or social activities

A person with Alzheimer's may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced.

What's typical? Sometimes feeling weary of work, family and social obligations.

Changes in mood and personality

The mood and personalities of people with Alzheimer's can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone.

What's typical? Developing very specific ways of doing things and becoming irritable when a routine is disrupted

 

Stages of Alzheimer’s Disease

 

Experts have documented common patterns of symptom progression that occur in many individuals with Alzheimer’s disease and developed several methods of “staging” based on these patterns.

Staging systems provide useful frames of reference for understanding how the disease may unfold and for making future plans. But it is important to note that not everyone will experience the same symptoms or progress at the same rate. People with Alzheimer’s die an average of four to six years after diagnosis, but the duration of the disease can vary from three to 20 years.

 

 

Early Stage (2-4 years leading up to and including diagnosis)

 

Symptoms:

  • Moderate memory loss with increased loss of recent events.
  • Difficulty performing familiar tasks.
  • Problems with language.
  • Some difficulty with time and place.
  • Poor or decreased judgment.
  • Difficulty with problem solving.
  • Changes in personality, mood and behavior.
  • Anxiety and depression about symptoms.
  • Loss of initiative.

Examples:

  • Forgets thing more often and becomes more forgetful as disease progresses.
  • Paying bills and writing checks becomes more difficult and contain errors.
  • Loses things.
  • Arrives at wrong time or place and constantly rechecks calendar.
  • Difficulty starting or completing activities or chores.
  • Routine chores become more difficult and take longer to complete.
  • May be easily frustrated or irritated.
  • Gets lost or confused especially in new environment.
  • Gets lost driving.

Care Needs:

Individuals can generally live alone but may need supervision for driving, taking medications, oversight of finances, and/or housekeeping/lawn care chores.

 

 

Middle Stage (2-10 years)

 

Symptoms:

  • Increasing memory loss, confusion or shorter attention span.
  • Problems recognizing friends/family.
  • Disorientation to time, place and situation.
  • More impaired judgment and problem solving skills.
  • Difficulty organizing thoughts, actions, and thinking logically.
  • Personality and behavioral changes.
  • May be suspicious, irritable and restless.
  • Loss of impulse control.
  • May see or hear things not present.
  • May develop problems with bathing or receiving physical care from others.
  • Becoming more dependent on others for assistance with physical care and home chores.  

Examples:

·        Memory loss becomes more severe.

·        May ask the same questions over and over again.

·        Difficulty with personal care such as bathing, dressing or personal hygiene.

·        Difficulty shopping, preparing meals, caring for home, managing finances.

·        Can’t find the right words.

·        Can’t follow instructions.

·        Problems with numbers.

·        Suspicious – may accuse spouse of hiding things or infidelity.

·        Loss of impulse control, sloppy manners, may undress at inappropriate times.

·        Sleep disturbance at night – may wake up and wander.

  

Care Needs:

Needs 24hr supervision, structure and routine. May respond to verbal reminders to initiate and/or complete daily living skills.

 

 

Late Stage: (1-3 years)

 

Symptoms:

  • Severe memory loss.
  • Minimal or no speech.
  • Increased feeding and/or swallowing problems.
  • Knows self only.
  • No judgment or problem solving skills.
  • Unable to control bladder or bowels.
  • May place items in mouth.
  • May not be able to walk or need maximum amount of assistance to walk.
  • May be prone to infection or skin breakdown.
  • May have seizures.
  • Dependent for all care needs.

Examples:

  • Looks into mirror or talks to own image.
  • Speaks very little or makes no sense.
  • May scream, groan or make grunting sounds (this may indicate pain)
  • May hold food in mouth or forget to chew or swallow.
  • May start to sleep more.

Care Needs:

Needs 24-hour supervision and total assistance with all care needs. Depending on symptoms, Hospice evaluation can be initiated.

 

 

Terminal Stage

 

Symptoms:

  • Generally has most/all of late stage symptoms and any of the following:
    1. pneumonia
    2. bladder infection
    3. general infection
    4. bed sores
    5. fever after treating with antibiotics
    6. weight loss and inability to maintain sufficient fluids  

Examples:

  • Bed bound or wheelchair bound
  • Frequent infection or fever
  • Unexplained weight loss
  • Not able to swallow or begins to choke.

Care Needs:

Needs 24-hour supervision and total assistance for all care needs. Person should qualify for Hospice program.



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