- Dementia
- Alzheimer's Disease
- Mild Alzheimer’s Disease
- Moderate Alzheimer’s Disease
- Moderately Severe to Severe Alzheimer’s Disease
Dementia
Dementia itself is not a disease. It is a term used to
define a set of symptoms marking the deterioration of a wide
range of cognitive (thought) functions that is serious enough
to impair a person's ability to perform the normal daily
tasks that were once within the person's capabilities.
There are many causes for dementia, including vascular
diseases, nutritional disorders, head injury, and infectious
diseases. In some cases dementia is reversible in some it
is not. The most common cause of dementia in the elderly
is Alzheimer's disease. While the term dementia refers to
a large number of symptoms, not all symptoms are present
in all dementing illnesses.
Dementia includes symptoms of short and long- term memory
loss, and decline in learning ability, abstract thought processes,
problem solving, attention, concentration, coordination,
judgment, language, orientation, motor integration and social
skills.
Dementia may also include changes in personality and behavior
that can result in depression, anxiety, agitation, restlessness,
suspicion, withdrawal from social activities, inappropriate
behaviors, wandering and changes in sleep patterns. Delusions
and hallucinations are also common features of dementia.
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Alzheimer’s Disease
Alzheimer's disease is characterized by progressive pathological
changes in the brain that translate into clinical signs of
decline in cognitive abilities (memory, concentration, orientation),
functional abilities (shopping, preparing meals, getting
dressed), mood, behavior, and finally physical
changes(stiffness, loss of the ability to walk, or smile).
The pathological changes in the Alzheimer's brain include
deterioration and loss of neurons (nerve cells) leading to
brain atrophy (shrinkage); and the abnormal accumulation
of proteins formingneurofibrillary
tangles and amyloid
plaques. Pathologists look for these changes in the brain
when diagnosing Alzheimer's disease, and scientists study
the causes of these changes in hope of finding a cure for
the disease.
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Diagnosis
An Alzheimer’s disease diagnosis is
based on the results of a variety of diagnostic tests in
conjunction with the observations of an experienced clinician.
There is no single diagnostic test for Alzheimer's disease.
Rather, an AD diagnosis is based on the results of a variety
tests that include neurological examinations, mental status
examinations, neuropsychological and psychiatric evaluations,
physical examination including laboratory tests, the patient's
past medical history and medications that the patient is
currently taking.
Extremely important to the diagnosis of AD is the clinician’s
evaluation of the patient’s symptoms in relation to
the results of diagnostic testing. The clinician must accurately
investigate the onset of symptoms (sudden or gradual), the
presentation of symptoms (how do symptoms occur), and the
progression of these symptoms over time.
A diagnosis of either probable or possible Alzheimer’s
disease is given once the diagnostic tests and clinical observations
have been made. A diagnosis of probable Alzheimer's
disease is given when all other causes for dementia have
been ruled out and the cause is most likely Alzheimer's disease.
A diagnosis of possible Alzheimer's disease is given
when symptoms of Alzheimer's disease may be complicated by
another disorder.
Alzheimer's diagnoses given at specialized research facilities
are up to 90% accurate. A diagnosis of definite Alzheimer's
disease, however, can only be given by examination of brain
tissue obtained through autopsy.
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Progression
Alzheimer's disease gradually affects different areas
of the brain. Initially Alzheimer's disease affects functioning
in the areas of the brain associated with memory, language
comprehension, and emotion. Further progression leads to
changes in functions such as orientation in space, problem
solving, and personality.
Alzheimer's disease is often described and discussed by
clinicians in terms of the severity of changes in the brain,
and the severity of decline in cognitive and functional abilities
.
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Causes
The cause of Alzheimer's disease is not yet known, but
scientists are hoping to find the answers by studying the
characteristic brain changes that occur in a patient with
Alzheimer's disease. In rare cases when the disease emerges
before the age of sixty-five, these brain changes are caused
by a genetic abnormality. Scientists are also looking to genetics as
well as environmental factors for possible clues to the cause
and cure of Alzheimer's disease.
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Care and Treatment Options
At present, there is no cure for Alzheimer's disease,
but several treatment options exist for both the cognitive
and behavioral symptoms of the disease. Drugs such as donepezil
(Aricept© ), rivastigmine (Exelon© ), and galantamine
(Reminyl© ) are used to treat cognitive symptoms in
Alzheimer's disease. Antidepressants, anti-anxiety medications,
and antipsychotics are used to treat the symptoms of depression,
anxiety, agitation, and the hallucinations and delusions
that may occur in Alzheimer's disease patients. For stage
specific information about treatments, see below.
In addition to the treatments already available, many clinical
trials of new drugs, studies of non-pharmacologic
treatments and psychosocial
interventions are continuously being conducted in specialized
Alzheimer's disease research centers around the world.
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Mild Alzheimer’s Disease
Maintaining present health. Symptoms of mild
Alzheimer's disease can now be treated with medications such
as donepezil (Aricept© ), rigavistimine (Exelon© )
and galantamine (Reminyl© ); and many more medications
are currently being tested in clinical trials. Symptoms of
depression and anxiety that may result from Alzheimer's disease
can also be treated with medication.
Because early stage Alzheimer's disease can be difficult
and emotionally trying for people with the illness and their
family members, the Alzheimer's Association sponsors both
early-stage support groups for people with the disease, and
caregiver support groups for families involved in the healthcare
of people with Alzheimer's disease.
For people with Alzheimer's disease who are living alone,
there are many support
services available
that make daily tasks easier to manage. The Safe Return
Program sponsored by the Alzheimer's Association provides
added security for people who routinely go out alone.
Planning for the future. Since Alzheimer’s
disease is characterized by a progressive decline that eventually
compromises a person’s ability to make decisions, planning
for future care should take place as early in the disease
as possible. Completing a healthcare
proxy, a living will or power of attorney for healthcare
and/or finances can help ensure that a person's healthcare
needs are met when a person becomes unable to voice wishes
on their own.
Other legal and financial planning can be completed with
the help of an elder care attorney who understands many of
the legal and financial issues associated with long-term
elder care, and can advise the person about his/her options
based on individual information about the person's present
situation.
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Why is an evaluation important for people with
mild Alzheimer’s disease?
Because there are now treatments available for mild Alzheimer's
disease, it is critical that people exhibiting symptoms have
an evaluation and start treatment as soon as possible. An
evaluation at this stage provides information about the nature
and severity of symptoms, and provides guidelines for appropriate
care and treatment plans. Evaluations conducted periodically
can help monitor these symptoms.
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Why is it important for researchers and clinicians
to understand mild Alzheimer’s disease?
Early symptoms often indicate the first observable signs
of Alzheimer's disease and so it is extremely important for
researchers and clinicians to study and understand the diagnostic
test results of individuals in this stage. The collection
of large amounts of data about the earliest signs of Alzheimer's
disease may provide answers about what causes the disease
and ways to treat or cure it.
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Moderate Alzheimer’s Disease
Maintaining present health. Pharmacologic treatments
available for symptoms of moderate stage Alzheimer’s
disease include donepezil (Aricept© ), rigavistimine
(Exelon© ) and galantamine (Reminyl© ). Other new
drugs for moderate stage Alzheimer’s disease are being
tested in clinical
trials.
This stage of Alzheimer’s disease may be accompanied
by symptoms of depression and anxiety or may result in a
person experiencing hallucinations and delusions that can
be treated with antidepressants, anti-anxiety medications,
and anti-psychotics.
Because a person at this stage experiences an increasingly
serious decline in cognitive and functional abilities, and
may no longer be able to perform most complex tasks of daily
life, a person may feel anger and frustration that can result
in outbursts and other behavioral problems. Many non-pharmacologic
treatments and psychosocial
interventions have focused on managing and/or avoiding
behavioral symptoms of people in this stage of Alzheimer’s
disease.
Formal care for people with moderate stage Alzheimer’s
disease living at home include daily home care provided by
home health aides and adult day programs that provide social,
recreational and therapeutic activities specifically geared
toward people with this disease. Depending on the severity
of a person’s symptoms, or the presence of other illnesses
that may effect a person’s physical health, formal
care options may also include assisted living facilities
or nursing homes that provide housing and care for people
with Alzheimer’s disease.
Informal care, provided by family, or trusted long-term
friends, usually includes scheduling and coordinating daily
activities, supervising home health aides, providing personal
care, accompanying the person with AD to medical and other
important appointments, and managing finances and legal matters.
The Safe Return Program sponsored by the Alzheimer’s
Association provides security for people who tend to wander
and may get lost.
Planning for future care . Healthcare and financial
planning are extremely important to the well-being and security
of people with Alzheimer’s disease and their families. Healthcare
proxies, living wills and powers of attorney for healthcare
and/or finances can help ensure that a person's healthcare
needs are met when the person becomes unable to voice wishes
on their own.
Legal and financial planning can be completed with the
help of an elder care attorney who understands many of the
legal and financial issues associated with long-term care,
and can advise the person with Alzheimer’s disease
and his/her family about long-term care options based on
individual information about the person’s or family’s
present situation.
As Alzheimer’s disease progresses into the moderate
stage, it is increasingly more difficult for people with
the disease to make complex decisions. A diagnostic evaluation
at this stage will help to determine a person’s existing
cognitive and functional abilities. An elder care attorney
may be able to provide guidelines about who is considered
competent to sign legal documents and under what circumstances.
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Why is an evaluation important for people with
moderate Alzheimer’s disease?
Symptoms of this stage of Alzheimer’s disease indicate
serious changes in both mental and physical
functioning . An evaluation at this stage provides extremely
important information for patients and their families about
the extent of decline in a person's physical and mental abilities,
and an accurate picture of a person's existing capabilities
in these areas. Because there are treatments available for
some of the symptoms exhibited in this stage, it is very
important that people with Alzheimer's disease are properly
evaluated and begin treatment as soon as possible.
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Why is it important for researchers and clinicians
to understand moderate stage Alzheimer’s disease?
It is extremely important for researchers and clinicians
to track the changes that occur in the bodies and minds of
people at this stage in order to understand the progression
of Alzheimer's disease, to provide appropriate care using
the treatments currently available, and to develop new treatments
and cures in the future.
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Moderately Severe to Severe Alzheimer’s
Disease
Maintaining present health . Although there are
no pharmacologic treatments for moderately severe to severe
Alzheimer’s disease approved for sale in the United
States, a new drug, Memantine,
has recently been tested in clinical
trials and has shown promise. In the near future, another
drug, galantamine, (Reminyl© ) will also be tested in
clinical trials for its effectiveness in treating moderately
severe to severe Alzheimer's disease.
Because a person at this stage experiences serious decline
in cognitive and functional abilities, and is no longer able
to perform the complex tasks of daily life, a person may
feel anger and frustration that can result in outbursts and
other behavioral problems. Many non-pharmacologic
treatments and psychosocial
interventions have focused on managing and/or avoiding
behavioral symptoms of people in this stage of Alzheimer’s
disease. Hallucinations and delusions which often accompany
this stage of Alzheimer's disease can be treated with anti-psychotics.
For people with moderately severe Alzheimer’s disease
who are living in their own homes, formal care options include
personal care provided by home health aides, and, if the
person is still able to participate, adult day programs that
provide social, recreational and therapeutic activities specifically
geared toward people with this disease. Depending on the
severity of a person’s symptoms, or the presence of
other illnesses that may effect a person’s physical
health, formal care options may also include nursing homes
that provide housing and care for people with Alzheimer’s
disease.
Informal care, provided by family, or trusted long-term
friends, usually includes providing personal care, supervising
home health aides, coordinating daily activities, arranging
for and supervising medical care, and managing finances and
legal matters.
As a person's symptoms progress into severe Alzheimer's
disease, physical movement becomes increasingly restricted,
until complete care is necessary. If the person remains at
home this care is provided through the formal care of a skilled
nurse, and a home health aide or the care of family members.
At-home hospice programs offer palliative care provided by
a team of trained professionals. Nursing homes provide personal
care and housing to persons with severe stage Alzheimer's
disease who are unable, for any reason, remain in their own
homes. Palliative care is also offered in nursing homes.
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Why is an evaluation important for people with
moderately-severe to severe Alzheimer’s disease?
The moderately-severe to severe stage of Alzheimer's disease
is marked by very serious loss of mental and physical functioning.
An evaluation at this stage helps determine a persons remaining
abilities, and establishes an appropriate care and treatment
plan.
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Why is it important for researchers and clinicians
to understand moderately-severe to severe stage Alzheimer’s
disease?
Only through a complete understanding of the progression
of Alzheimer's disease and the effect it has on the mind
and body at each stage can researchers and clinicians develop
new treatments and provide proper care and treatment options
to those with the disease.
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