The Symptoms, Prevention, and Treatment of Alzheimer’s Disease
...he disease. “The only way to accurately diagnose Alzheimer’s disease is to physically examine the brain of a probable Alzheimer’s sufferer after the patient has died.” (Herlick, 2004) Although there are some test that are helpful in predicting if a person is at high risk of getting Alzheimer’s later in life. The test is for identifying if the ApoE4 variant is present which supposedly means a person is more prone to the disease. This test isn’t conclusive however, such as the research shows, “The test is controversial, because it’s not certain that a person carrying one or even two copies of the ApoE4 will end up developing the disease, and many people who do get Alzheimer’s do not even have the ApoE4 variant.” Staying physically active is a main goal in the prevention of Alzheimer’s disease. “Until recently, there was little evidence that the disease could be prevented, but a study has found that strokes—which are avoidable in most cases—are a big contributor to Alzheimer’s.” (Frishman, 1997) Maintaining a healthy lifestyle can help suppress this growing number of patients with Alzheimer’s and keep many from ever getting the disease. “If scientists can postpone the onset of Alzheimer’s by just five years, the total number of people who develop the disease could be significantly reduced—mainly because many of them will succumb to other illnesses before Alzheimer’s has a chance to strike.” (Frishman, 1997) This healthy lifestyle includes maintaining a exercise program, keeping blood pressure down, maintaining low cholesterol, less toxins in the body, and a good diet. Low cholesterol is significantly important, “People with high cholesterol levels are more likely to develop the disease, and epidemiological studies suggest that lowering cholesterol levels, particularly by taking drugs from the statin family, reducing one’s risk.” (Helmuth, 2002) She goes on to emphasize how important maintaining low cholesterol is, “An autopsy study presented here by Miguel Pappolla of the University of South Alabama in Mobile indicated that every 10% increase in blood cholesterol levels doubles the risk of having B-amyloid deposits in the brain. If the elderly followed these rules their death would probably be the cause of some other natural cause.”(Helmuth, 2002) Once an individual has the Alzheimer’s disease their fate is pretty much sealed. The only hope is to prolong the disease as long as possible. Only in the past decade have all these different kind of medications arouse to slow the disease down. Before there were all the medications there was only behavior therapy. These behavioral therapy techniques are used by nurses, social workers, and psychologists. Most of the therapies are based on holding on tightly to what the patient has left. If they don’t use the skills that they have then they will degenerate faster. Therefore staying active and learning is vital. These behavior therapies and treatments not only help in slowing down the regression of Alzheimer’s disease, but also help in reducing disruptive behaviors. “Research done in the past decade also shows that behavioral strategies can reduce many disruptive behaviors common in Alzheimer’s patients, such as screaming, wandering or hitting.” (Barinaga, 1998) Before this time there wasn’t as much comprehension on why the patients were being so disruptive. It is unpleasant, but in earlier times many patients were given anti-psychotic drugs, some were even physically restrained. This was quite obviously the cause of the patients to be even more irritated. The behavior treatments are now designed to find out why the patient gets upset, and to avoid from triggering them into their disruptive behavior. As a patient slowly degenerates into Alzheimer’s it can be viewed as they are making their way back to childhood. The patient may be described as being in a certain developmental stage, so we again look back at Piaget. If the caregiver understands what developmental stage the patient is in then they can treat him or her better to their specific needs. This will help the patient to hold on to what skills they have left, longer. For a large number of individuals, their families don’t have the means to support an elderly member in an expensive private care. There is a growing alternative. Many parts of the country have day care centers for patients with Alzheimer’s. It is in actuality much like the day care for children. They focus on involving the patient with developmental-age-appropriate activities. This slows the degeneration of the disease but also has other encouraging effects as well. They are less irritable and agitated, they have opportunities for socialization, and they have a lot more resources for starting conversations with their family. A fine example of conforming to specific patient needs was when caregivers gave Alzheimer’s patients the same steps as retarded children to maintain their ability to be toilet trained. “In the late 1980’s, Jack Schnelle of the University of California, Los Angeles, showed that a method called “prompted voiding,” in which aides visit patients every 2 to 3 hours to offer to take them to the restroom, helped some incontinent patients retain bladder control. The technique is different from merely taking the patient to the restroom on a schedule, says psychologist Louis Burgio of the University of Alabama, Tuscaloosa, who has studied prompted voiding. By asking whether the patient need to go, he explains, “it tries to use what is left of the patients self-knowledge, so you don’t make them overly dependent on staff.”(Barinaga, 1998) Another common problem of patient with Alzheimer’s is forgetting how to put on their clothes. A nurse named Cornelia Beck did some research. She thought that patients lost their ability to dress and other necessary skills because they weren’t encouraged to use these skills. She tried to retrain her Alzheimer’s patients to do these necessary skills. The patients were encouraged to dress on their own by either suggesting that their arm or leg goes in their pant or sleeve, or by copying the aide. The results showed great improvement. “After 6 weeks, 50% of the patients improved their ability to dress themselves by 1 to 3 points on an 8-point scale ranging from helplessness to independence; 25% improved by 4 to 6 levels. Patients who had been dependent on aides to dress them could now dress themselves, with guidance.” (Barinaga, 1998) Behavior treatment and therapy is not only used for the slowing down of the regression of Alzheimer’s disease but also to control behavioral problems in patients with the disease as well. Some of these behavioral problems are a direct physical consequence of the disease. An example of such a problem is infantile reflexes, which are caused by paranoia a muscle stiffness that comes with Alzheimer’s. Caregiver’s frequently think that the patient is resisting, or fighting with them which is not true. An example of this reflex is when a patient might grab a caregiver’s hair, and a normal person would think of this as violent or aggressive. In actuality, it’s just part of the diseases’ physical decline of the patient. Another common behavioral problem amongst patients is the recurrent fits. One psychologist did a in depth study on this dilemma. “Cohen-Mansfield suspected that these behaviors were driven by unmet needs. She had assistants watch patients around the clock, noting what triggered their behaviors. Patients tended to scream or moan, for example, when it was dark and they were alone. Thinking that this might reflect fear or loneliness, Cohen-Mansfield tried three interventions; Assistants would either stop by and visit the patients at the problem time, play the videotape of a family member talking to them, or play music they had once enjoyed. “It really made a difference,” she says. The patients responded to all three approaches; as a group, their screaming or moaning dropped by roughly half in response to one-on-one interactions with the videotape, and by one-third in response to music.” (Barinaga, 1998) There are two main drugs for Alzheimer’s disease which is Cognex and Aricept. “While neither drug can stop the disease, clinical trials have shown that Aricept alleviates the symptoms in some mild to moderate cases and has fewer adverse effects than Cognex.” (Frishman, 1997) There are several studies comparing donepezil to rivastigmine. Usually donepezil drugs such as Aricept are preferred because their isn’t as many drugs need to go with it. “Concurrent psychiatric medication use showed that the donepezil-treated patients required fewer additional medications to control behavior problems compared to rivastigmine.” (Bishop, 2003) There are drugs besides Cognex and Aricept that are undergoing clinical trials. In order for these drugs to be approved they must go through four phases of clinical trials. It will be several years before these experimental drugs may be approved by the FDA(Food and Drug Administration). Another form of treatment is estrogen therapy. It is believed that estrogen increases the blood flow in the brain. “She points out that animal and cell studies suggest that estrogen helps neurons make connections and interferes with the production of B amyloid.” (Helmuth, 2002) In the following two studies they experiment the effects of estrogen on older women. “In the first study, Columbia University researchers followed 1,124 post menopausal women for five years and found that those who took estrogen had a 30%-40% lower risk of developing Alzheimer’s, and a later age of onset, than women who did not take the hormone. In a small, controlled experiment, investigators from the U.S. Department of Veterans Affairs and the University of Washington focused on 12 older women with the Alzheimer’s disease. Six received estrogen via a skin patch for two months while the others got a placebo. Memory and attention sharpened significantly for those on estrogen therapy, and the improvements declined when the women stopped taking the hormone. No changes were observed in the placebo group.”(Frishman, 1997) Although estrogen seems like it has nothing but positive effects, there are still some side effects. “But the approach became more problematic this summer when leaders of the Women’s Health Initiative announced that they were suspending a long-term, placebo-controlled trial of hormone replacement therapy(HRT) due to an unacceptable risk for breast cancer, heart attack, and stroke( Science, 19 July, p.325).” (Helmuth, 2002) Estrogen in the future may battle the effects of Alzheimer’s but more research and clinical trials must still be done. Another common theory is that oxidative stress contributes to the development Alzheimer’s disease. This is why Antioxidants have also been a growing trend in treatment of Alzheimer’s. The three most popular antioxidants include selegiline, vitamin E, and ginkgo. Besides the theories of oxidative stress, and inflammation for the developing causes of Alzheimer’s, there is a theory of the protein called B amyloid that participates in the development of Alzheimer’s disease. These proteins accumulate in the brain causing plaques on the brain’s neurons. High cholesterol accelerates the formation of these plaques. Furthermore, B amyloid is made of two enzymes. “B Amyloid is produced by two enzymes that clip it from a longer protein called, straight forwardly enough, B- amyloid precursor protein(APP), the function of which is currently unknown. Researchers believe that blocking one or both of these enzymes, dubbed B- and y- secretase, will decrease the amount of B amyloid in the brain and thus either prevent Alzheimer’s disease or slow its progression” (Helmuth, 2002) Researchers are trying to find inhibitors for both the secretases but there has been more success on the y-secretase. Plaques in the brain are caused by the B amyloid, but they are also linked to metal ions such as zinc, and copper which increase with age. “What’s more, the combination of B amyloid with metal ions produces huge amounts of hydrogen peroxide in the brain, causing oxidative damage.” (Helmuth, 2002) There is a drug that assists in removing these ...