Psychology / Alzheimers And The Effect On Family
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Autor: anton 19 October 2010
Words: 1499 | Pages: 6
The hallmark Alzheimer's symptom is forgetfulness. Not the usual loss of keys in someone who has always lost his keys, or the forgetting a nephew's birthday, but true forgetfulness. According to the National Institute on Aging, there are seven danger symptoms of Alzheimer's. They are: Asking the same question over and over again. Repeating the same story, word for word, again and again, forgetting how to cook, or how to make repairs, or how to play cards - activities that were previously done with ease and regularity. Losing one's ability to pay bills or balance one's checkbook. Getting lost in familiar surroundings, or misplacing household objects. Neglecting to bathe, or wearing the same clothes over and over again, while insisting that they have taken a bath or that their clothes are still clean. Relying on someone else, such as a spouse, to make decisions or answer questions they previously would have handled themselves. Depending on the stage of Alzheimer's disease (mild, moderate, or severe), there are other symptoms such as personality changes, hallucinations, losing control of the bowel and bladder, and wandering away from home for no reason. (NIA Abstract, 2002)
Researchers do not yet know the cause of Alzheimer's disease. The most important risk factor appears to be age. According to the National Institute on Aging, the number of people with Alzheimer's doubles every 5 years after the age of 65. (NIA Abstract, 2002) Another risk factor or cause of Alzheimer's appears to be family history. A family form, or familial Alzheimer's disease, is a rare form of Alzheimer's that usually occurs earlyâ€”between the ages of 30 and 60--and can be inherited. The more common form of Alzheimer's, which occurs later in life, does not have an obvious link to family history.
However, one risk factor for this type of Alzheimerâ€™s disease is a protein or gene called the apolipoprotein E or the apoE gene. ApoE helps carry cholesterol in the blood. The apoE gene has three forms. One seems to protect a person from Alzheimer's. One appears to be neutral and neither protects nor assists in the development of the disease. And finally, the last form appears to make a person more likely to develop Alzheimer's. Without a doubt, there are other genes that increase the risk of AD that are yet to be discovered. Weight, environment, level of education, and gender are all associated with Alzheimer's. (Alzheimerâ€™s Society, 2003)
With the exception of gender (more women have Alzheimer's than men); these factors may slow down or speed up the course of the disease, rather than contribute to the cause of Alzheimer's. Recently, a study of women in Sweden revealed that obesity in women is associated with a decrease in brain matter-whether or not this will be associated with Alzheimer's remains to be seen, but it is an example of how overall health can affect the course of the disease. In another study, researchers discovered that the more formal education a person has the better his or her memory and learning ability will be, even in the presence of Alzheimer's disease. In other words, formal education preserved memory and function, even among those persons with Alzheimerâ€™s. There are no definitive imaging or laboratory tests for the diagnosis of Alzheimer's disease while the patient is alive. Definitive diagnosis is made by an autopsy of the brain, which occurs after the patient's death. The autopsy will reveal brain changes that include neurofibrillary tangles and neuritic plaques. While the patient is alive, tests can assist with diagnosis. At most Alzheimer's specialty clinics, the diagnosis of Alzheimer's disease is correct over 90% of the time.
Alzheimer's disease creates major stress in families. It can magnify conflicts, especially when family members have different ways of coping with caregiving responsibilities. By being honest about your feelings and working through them, you can minimize family conflicts. Then you can focus on caring for your loved one and enjoying your time together.
Alzheimer â€™s disease is a terminal illness because it does not get better and the individual diagnosed with Alzheimerâ€™s Disease will eventually die of medical complications due to the disease process. This raises a very interesting question in research currently because it has been discussed in geriatric literature that some individuals diagnosed with the disease live for long periods of time and eventually do die from complications like heart failure, kidney failure, pneumonia, dehydration and starvation. And then on the other side of the coin we have individuals who are diagnosed with Alzheimerâ€™s disease who die very rapidly after the diagnosis is given. Some examples would include people who simply live up to a year or less after the diagnosis. So an interesting question in research right now is this: "Is there more than one form of Alzheimerâ€™s disease, or are we looking at actually two different illnesses?" Alzheimerâ€™s is a deficiency in neurotransmitters, which is important for the reader to understand right off the bat. Neurotransmitters are brain chemicals, which send messages between neurons, or brain cells. Alzheimerâ€™s destroys neurons and neurotransmitters. An example of a neurotransmitter would be serotonin, which is responsible for mood and our sleep/wake cycle. Another neurotransmitter, which Alzheimerâ€™s destroys, is acetylcholine which is responsible for our cognition, our clarity in thinking, our ability to plan, short-term and long-term memory. Alzheimerâ€™s mainly attacks acetylcholine. It eventually attacks serotonin. Another neurotransmitter, which may be part of the clinical picture, is dopamine. This neurotransmitter is responsible for our psychomotor movement, and is associated more with Parkinsonâ€™s disease. It is important for the reader to appreciate the fact that Alzheimerâ€™s destroys neurotransmitters and neurons. Many behaviors, a lot of the language deficits and much of what is seen in terms of actions and behavior with the person diagnosed with Alzheimerâ€™s is actually a function of the neurotransmitter. The decrease of neurotransmitters, and the destruction of neurotransmitters, leads to the cognitive and behavioral changes and destruction of neurons. An example would be the resident in a long-term care situation who is attempting do to some type of personal care or ADL who picks up say, a fork, and attempts to brush their hair with a fork or brush their teeth with that fork. The neurons are no longer communicating with one another at that point. They are misfiring and miscommunicating.
Stage two of Alzheimerâ€™s disease includes the following characteristics: there is an increase of memory loss and confusion, the attention span starts to decrease, and now the individual develops problems recognizing family and friends. Restlessness, pacing, and fidgeting become a part of the clinical picture.
Dr. H evaluates a 92-year-old woman named Ms L. Ms. L has a seven- to eight-year history of progressive dementia of the Alzheimerâ€™s type. She was admitted to the facility four years ago after suffering a series of falls and a left hip fracture. Ms. L was taking donepezil 10 mg once daily for Alzheimerâ€™s dementia on admission to the facility, although her Mini-Mental State Examination (MMSE) was 5/30 and she required assistance with all aspects of activities of daily living. The donepezil was discontinued one year later after she suffered from progressive weight loss and developed an acute gastrointestinal hemorrhage due to a duodenal ulcer. Ms. L recovered after requiring an acute hospital stay, and has been remarkably stable for the past three years. She is alert and appears pleasant, but is only able to speak a few words. Her score on the MMSE has been 0/30 for the past two years. She is nonambulatory, hand-fed by staff, and requires total care. She participates in activity programs such as music and religious services. She responds to her name, smiles, and shakes hands. Staff members at the facility report that she likes to hold stuffed animals and dolls. Ms. Lâ€™s daughter is upset that the patient no longer remembers her name or those of her grandchildren. Nursing staff report that the patient appears to recognize the daughter as a familiar person, but has not been able to identify people by name or speak in full sentences. The daughter feels that use of memantine will result in improvement in her motherâ€™s memory and asks if it can be started immediately.
Dr. H meets with the daughter of Ms. L. He explains that her dementia is far more advanced than those patients who were studied in the clinical trials of memantine, and it is unlikely that any measurable benefit would be obtained. Ms. Lâ€™s daughter is clearly overwhelmed, still feels guilty about placing her mother in a nursing home, and feels that she â€œhas to do somethingâ€ if it might help. She insists that her mother receive memantine. Dr. H starts the memantine at 5 mg once daily and increases the dose to 10 mg the next week. Ms. L develops sedation, and staff members report that she requires two persons for transfer rather than one. After 3 weeks, Dr. H stops the drug and reassures the daughter that Ms. L will continue to receive appropriate stimulation, support, and comfort care.
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