Tuesday, May 26, 2009

Alzheimers Disease







Known by many as "the long goodbye," Alzheimer's disease is increasing at an alarming rate in the United States. An estimated 5 million people in the United States are now living with Alzheimer's, and someone is diagnosed with the disease every 72 seconds.

Most people with Alzheimer's are age 65 or older, but at least 200,000 people under the age of 65 are also living with an early-onset form of the disease. By the year 2030, the number of individuals with Alzheimer's could approach 8 million; if scientists can't find a way to cure or prevent Alzheimer's, this number could range between 11 million and 16 million by the year 2050.


Alzheimer's versus Dementia

Alzheimer's disease is a progressive, degenerative disease of the brain that results in dementia. The terms Alzheimer's and dementia are often used interchangeably, but there's a distinct difference between them.

Dementia is a broader term than Alzheimer's and refers to any brain syndrome resulting in problems with memory, orientation, judgment, executive functioning, and communication. The consequences of Alzheimer's is dementia.



Causes of Dementia
Alzheimer's disease is the most common form of dementia -- according to the Alzheimer's Association, 60% to 70% of dementia cases are due to Alzheimer's. However, many other diseases can cause dementia, such as stroke, Parkinson's disease, and Wernicke-Korsakoff syndrome. Some infectious diseases can also result in dementia, such as HIV or the extremely rare Creutzfeldt-Jakob disease.When individuals are diagnosed with mixed dementia, more than one disease process is causing the dementia. For example, a person might have dementia due to both Alzheimer's and a stroke.

Causes
There are at least 10 Conditions That Can Cause Dementia to be considered.


Reversible Conditions that Resemble Alzheimer's
Sometimes symptoms that look like Alzheimer's are actually due to a reversible medical condition, such as depression or delirium. These conditions aren't types of dementia -- they're reversible problems that mimic Alzheimer's disease and other dementias.

Alzheimer's disease is a progressive neurological disorder that leads to personality changes, memory loss, intellectual slowing, and other Alzheimer's symptoms. Although each person with Alzheimer's is different, most progress through a series of stages, each of which is characterized by more serious Alzheimer's symptoms.

The following seven stages were developed by researchers and physicians to describe how you or your loved one will change over time. Your doctor might collapse the seven stages into early/middle/late or mild/moderate/severe, so these classifications are provided as well.

Stage 1 (Absence of Impairment)
There are no problems with memory, orientation, judgment, communication, or daily activities. You or your loved one is a normally functioning adult.

Stage 2 (Minimal Impairment)
You or your loved one might be experiencing some lapses in memory or other cognitive problems, but neither family nor friends are able to detect any changes. A medical exam would not reveal any problems either.

Stage 3 (Noticeable Cognitive Decline)
Family members and friends recognize mild changes in memory, communication patterns, or behavior. A visit to the doctor might result in a diagnosis of early-stage or mild Alzheimer's disease, but not always. Common symptoms in this stage include:


1)Problems producing people's names or the right words for objects
2)Noticeable difficulty functioning in employment or social settings
3)Forgetting material that has just been read
4)Misplacing important objects with increasing frequency
5)Decrease in planning or organizational skills

Stage 4 (Early-Stage/Mild Alzheimer's)
Cognitive decline is more evident. You or your loved one may become more forgetful of recent events or personal details. Other problems include impaired mathematical ability (for instance, difficulty counting backwards from 100 by 9s), a diminished ability to carry out complex tasks like throwing a party or managing finances, moodiness, and social withdrawal.

Stage 5 (Middle-Stage/Moderate Alzheimer's)
Some assistance with daily tasks is required. Problems with memory and thinking are quite noticeable, including symptoms such as:

1)An inability to recall one's own contact information or key details about one's history .
2)Disorientation to time and/or place
3)Decreased judgment and skills in regard to personal care

Even though symptoms are worsening, people in this stage usually still know their own name and the names of key family members and can eat and use the bathroom without assistance.

Stage 6 (Middle-Stage/Moderate to Late-Stage/Severe Alzheimer's)
This is often the most difficult stage for caregivers because it's characterized by personality and behavior changes. In addition, memory continues to decline, and assistance is required for most daily activities. The most common symptoms associated with this stage include:


1)Reduced awareness of one's surroundings and of recent events
2)Problems recognizing one's spouse and other close family members, although faces are still distinguished between familiar and unfamiliar.
3)Sundowning, which is increased restlessness and agitation in the late afternoon and evening
4)Difficulty using the bathroom independently
5)Bowel and bladder incontinence
6)Suspicion
7)Repetitive behavior (verbal and/or nonverbal)
8)Wandering


Stage 7 (Late-Stage/Severe Alzheimer's)
In the final stage, it is usually no longer possible to respond to the surrounding environment. You or your loved one may be able to speak words or short phrases, but communication is extremely limited. Basic functions begin to shut down, such as motor coordination and the ability to swallow. Total care is required around the clock.

Although the stages provide a blueprint for the progression of Alzheimer's symptoms, not everyone advances through the stages similarly. Caregivers report that their loved ones sometimes seem to be in two or more stages at once, and the rate at which people advance through the stages is highly individual. Still, the stages help us understand Alzheimer's symptoms and prepare for their accompanying challenges.


Diagnosis


There is no singular test that can definitively diagnose Alzheimer's disease, although imaging technology designed to detect Alzheimer's plaques and tangles is rapidly becoming more powerful and precise. Still, a comprehensive, competent diagnostic workup by a skilled physician can pinpoint the cause of Alzheimer's-like symptoms with over 90% accuracy. Diagnosis of Alzheimer's disease should include the following:

Medical history -- This should include questions about past illnesses, prior injuries and surgeries, and current chronic conditions in order to identify other possible causes for Alzheimer's-like symptoms. For instance, if you suffered a serious head injury any time in your past, it could account for the problems with memory or concentration that you're currently experiencing. If your loved one has heart disease, that could be reducing blood flow to the brain and causing forgetfulness.

Medication history -- This should include allergies, experienced side effects from past medications, and a list of current medications and dosages. Not only will this inform any future prescription decisions; it also might reveal a medication interaction or overdosage that accounts for your or your loved one's confusion and other symptoms.

Mood evaluation -- The evaluation should include an assessment for anxiety or depression, which can create Alzheimer's-like symptoms in older people as well as occur concurrently with Alzheimer's or another dementia. Depression, in particular, can result in a set of symptoms collectively known as pseudodementia. If a mood disorder is detected, it can be treated alongside other disorders, such as Alzheimer's.

Mental status exam -- To assess memory, concentration, and other cognitive skills. The mental status exam is a research-based set of questions that results in a score that indicates a general level of impairment. If you or your loved one scores high on a mental status exam, there is less of a chance that Alzheimer's is the culprit; another (possibly treatable) condition may be responsible for the symptoms. However, highly educated individuals have scored high on mental status exams even though they do have Alzheimer's disease.

Complete physical exam -- To assess hearing, vision, blood pressure, pulse, and other basic indicators of health and disease. A current physical exam can detect acute medical conditions such as an infection that might be causing Alzheimer's-like symptoms.

Appropriate laboratory tests -- These will vary according to your or your loved one's medical history and current symptoms. Blood tests are the most common laboratory tests ordered. For example, if you are exhibiting pre-diabetic symptoms, a blood glucose test would be ordered. Aside from blood tests, if your loved one's symptoms came on suddenly and include severe confusion, a urinalysis would probably be conducted to rule out a urinary tract infection.

Neurological exam -- This should include an examination of the motor system (movement), reflexes, gait (walking), sensory functioning, and coordination in order to detect problems with the nervous system that may be causing problems with thinking and behavior.


Imaging procedures -- Detailed pictures of the brain, such as a CT scan (computed tomography), an MRI (magnetic resonance imaging), or a PET scan (positron emission tomography) to identify changes in brain structure or size indicative of Alzheimer's, or to look for brain tumors, blood clots, strokes, normal pressure hydrocephalus (NPH), or other abnormalities that might account for Alzheimer's-like symptoms.

There is no particular kind of physician that specializes in Alzheimer’s disease. Many people first seek help from their primary care physician, who may oversee the total diagnostic process or refer the individual to any of the following specialists:


Neurologist -- Specializes in diseases of the nervous system, including Alzheimer’s, Parkinson’s, epilepsy, and stroke.
Psychiatrist -- Specializes in mental, emotional, and behavioral disorders.
Neuropsychologist -- Specializes in the brain-behavior relationship and can conduct neuropsychological testing to determine the type and level of impairment due to Alzheimer's, head injury, stroke, or other conditions.
The goal of a diagnostic workup is to explore every possible cause for the person's symptoms and to address any reversible condition or treatable problem. If a cause is not reversible or treatable, then the goal is to help the individual manage the symptoms through medical treatments or behavior management.

Treatment procedures in next blog.

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