Alzheimer's Disease Research

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009

INTRODUCTION “Memory is a way of holding on to the things you love, the things you are, and the things you never want to lose.” -Kevin Arnold Memories are the things we uphold. Whether it’s bad or good, those memories are engraved in us and can’t be stolen from us. But what if as times goes by, those memories are losing? Worst, you’re even losing your language skills, ability to recognize familiar things and you feel a sense of depression. This means, as a person grow old he/she experiences deterioration in one’s self. Now, we are currently living in the age of technology. Our advancements in the past few decades overshadow everything learned in the last 2000 years. This increase has brought with it a large increase in diseases associated with old age. Alzheimer's disease (AD) is one of the most common and feared diseases afflicting the elderly community. AD, once thought to be a natural part of aging, is a severely debilitating form of mental dementia. Although some other types of dementia are curable or effectively treatable, there is currently no cure for the Alzheimer variety. A general overview of Alzheimer's disease including the clinical description, diagnosis, and progression of symptoms, helps one to further understand the treatment and care of patients, the scope of the problem, and current research. Dementia and Alzheimer’s disease may be similar in some ways. It is important to

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009

compare dementia vs. Alzheimer's disease to realize the differences between the two conditions. Alzheimer's is the most common form of dementia marked by memory loss in older people. Dementia is the gradual loss of intellectual function. Alzheimer's statistics show that the disease can strike a person as early as 45, while dementia generally takes hold after age 70. The most confused form of dementia is Multi-Infarct Dementia or MID. This condition also attacks the blood vessels in the brain. Both disorders require testing to determine the best course of treatment. But the clinical definition of dementia is "a deterioration in intellectual performance that involves, but is not limited to, a loss in at least 2 of the following areas: language, judgment, memory, visual or depth perception, or judgment interfering with daily activities" (Institute, 1996, p.4). While, Alzheimer’s disease (AD) is a slowly progressive disease of the brain that is characterized by impairment of memory and eventually by disturbances in reasoning, planning, language, and perception. Many scientists believe that Alzheimer's disease results from an increase in the production or accumulation of a specific protein (beta-amyloid protein) in the brain that leads to nerve cell death. The likelihood of having Alzheimer's disease increases substantially after the age of 70 and may affect around 50% of persons over the age of 85. Nonetheless, Alzheimer's disease is not a normal part of aging and is not something that inevitably happens in later life. For example, many people live to over 100 years of age and never develop Alzheimer's disease. A person with AD usually has a gradual decline in mental functions, often

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009

beginning with slight memory loss, followed by losses in the ability to maintain employment, to plan and execute familiar tasks, and to reason and exercise judgment. Communication ability, mood, and personality may also be affected. Most people who have AD die within eight years of their diagnosis, although that interval may be as short as one year or as long as 20 years. AD is the fourth leading cause of death in adults after heart disease, cancer, and stroke. When comparing dementia vs. Alzheimer's disease it is very important to discuss the differences between the two diseases. Although they have many similarities, there are a number of differences that must be noted. Alzheimer's disease is defined as a form of dementia characterized by the gradual loss of several important mental functions. It is perhaps the most common cause of dementia in older Americans, and goes beyond just normal forgetfulness, such as losing your car keys or forgetting where you parked. Signs of Alzheimer's disease include memory loss that is much more severe and more serious, such as forgetting the names of your children or perhaps where you've lived for the last decade or two. Anotherway to compare dementia vs. Alzheimer's disease is to realize that dementia is a medical term used to describe a number of conditions characterized by the gradual loss of intellectual function. Certain symptoms, as defined by the American Medical Association, of dementia include memory impairment, increased language difficulties, decreased motor skills, failure to recognized or identify objects, and disturbance of the ability to plan or think abstractly. Yet another way to determine the

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 History of Alzheimer’s Disease Progressive mental deterioration in old age has been recognized and described throughout history. However, it was not until 1906 that a German physician, Dr. Alois Alzheimer, specifically identified a collection of brain cell abnormalities as a disease. One of Dr. Alzheimer’s patients died after years of severe memory problems, confusion and difficulty understanding questions. Upon her death, while performing a brain autopsy, the doctor noted dense deposits surrounding the nerve cells (neuritic plaques). Inside the nerve cells he observed twisted bands of fibers (neurofibrillary tangles). Today, this degenerative brain disorder bears his name, and when found during an autopsy, these plaques and tangles mean a definite diagnosis of Alzheimer's disease (AD). Since its discovery more than 100 years ago, there have been many scientific breakthroughs in AD research. In the 1960s, scientists discovered a link between cognitive decline and the number of plaques and tangles in the brain. The medical community then formally recognized Alzheimer’s as a disease and not a normal part of aging. In the 1970s, scientists made great strides in understanding the human body as a whole, and AD emerged as a significant area of research interest. This increased attention led in the 1990s to important discoveries and a better understanding of complex nerve cells in the brains of AD patients. More research was done on AD susceptibility genes, and several drugs were approved to treat the cognitive symptoms of the disease. Over the last decade, scientists

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 have substantially progressed in understanding potential environmental, genetic and other risk factors for AD, the processes leading to formation of plaques and tangles in the brain, and the brain regions that are affected. Specific genes related to both the early-onset and late-onset forms of AD have been identified, but genetic risk factors alone do not fully explain its causes, so researchers are actively exploring environment and lifestyle to learn what role they might play in the development of this disease. More effective treatment options have been approved by the Food and Drug Administration (FDA). However, AD is still incurable. The drugs currently in use treat only the symptoms, not the cause of the disorder, and they only slow the progression of cognitive decline.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009

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BODY About Alzheimer’s Disease Alzheimer's disease is a progressive, degenerative neurological disorder, meaning that the disorder gets worse over time. Alzheimer's disease is the most common cause of dementia among people over the age of 65 and it is thought that up to 4.5 million people have Alzheimer's disease, according to the National Institutes of Health (NIH). Five percent of people aged 65 to 74 and roughly 35 to 50 percent of people aged over 85 have the disorder, according to the National Institute of Neurological Disorders and Stroke (NINDS). However, despite the high prevalence of Alzheimer's dis disease among elderly people, Alzheimer's disease is not a normal part of aging. Alzheimer's disease occurs when neurons in the brain die or break their connections with other neurons. This occurs because people with Alzheimer's disease experience atrophy of a part of the brain called the hippocampus.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 The hippocampus produces a neurotransmitter called acetylcholine. This chemical carries electrical signals from one neuron to another and is essential for memory, judgment and learning. In people with Alzheimer's disease, the cells that produce acetylcholine are damaged or killed and levels of the chemical gradually decline in the brain. This means that

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the electrical signals are not transmitted effectively from one neuron to another, causing the breakdown of neuron connections and the gradual atrophy of other parts of the brain. The symptoms of Alzheimer's disease reflect where neuron connections are broken. For example, memory loss, a common early stage symptom, is caused by the disruption of neurons in the temporal and parietal lobes, which are associated with memory. Language problems, on the other hand, are thought to be caused by the disruption of the large networks of neurons that are associated with understanding and producing language. People with Alzheimer's disease also have abnormal lesions called beta-amyloid plaques and neurofibrillary tangles. Beta-amyloid plaques are sticky pieces of protein and other matter than surround the neurons. Neurofibrillary tangles are twisted fibers also made from protein that build up inside the neurons. These plaques and tangles work together to disrupt brain function and are known to increase in quantity as the Alzheimer's disease progresses. Certain factors of brain dysfunction in Alzheimer's disease are known, but much about the disease is unknown. The known factors include the onset and progress of dementia in

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 patients and the presence of the plaques and tangles in their brains, which may be detected at autopsy. But specific causes remain unknown and the role of plaques and tangles, as either cause or result, are not well understood. It is thought that these amyloid plaques form very early in the disease stage and set of a cascade of inflammation and cell death throughout the affected portions of the brain. However, no one knows why the amyloid plaques form. Similarly, very little is understood about the tangles in the brain, or how they relate to the plaques.

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The symptoms of Alzheimer's disease usually begin to appear around the age of 60. However, some people develop a condition called early-onset Alzheimer's disease as early as their 20s. Early-onset Alzheimer's disease is thought to be caused by a genetic disorder. Alzheimer's disease can progress slowly or rapidly, depending on the individual. Patients generally live for an average of eight years after they are diagnosed with Alzheimer's disease, although they may live for up to 20 years. During the final stages of the disease, most patients require constant supervision and help performing basic self-care tasks such as bathing and feeding. Most people do not die as a direct result of Alzheimer's disease. Instead, people with Alzheimer's disease are more likely to contract other medical conditions that can be fatal. Many people with Alzheimer's disease die from aspiration pneumonia (pneumonia caused

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 by breathing in vomit or other fluids) because of the reduced ability to swallow in the later stages of the disease. In 2004, the most recent year for which figures are available, Alzheimer's disease was the fifth leading cause of death among people over 65 and the seventh leading cause of death overall, according to the Centers for Disease Control and Prevention (CDC). Women are more commonly diagnosed with Alzheimer's disease than men, although this may be because women tend to live longer than men. Although Alzheimer's disease is the leading cause of dementia, other conditions may cause dementia, including stroke, brain tumors and infections. Causes and Risk Factors

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The initial cause of AD symptoms is a result of the progressive deterioration of brain cells (neurons) in the cerebral cortex of the brain. This area of the brain, which is the largest and uppermost portion, controls all our thought processes, movement, speech, and senses. This deterioration initially starts in the area of the cortex that is associated with memory and then progresses into other areas of the cortex, then into other areas of the brain that control bodily function. The death of these cells causes an interruption of the electrochemical signals between neurons that are a key to cognitive as well as bodily functioning. Currently AD can only be confirmed at autopsy. After death the examined brain of an

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 Alzheimer victim shows two distinct characteristics. The first is the presence of neuritic plaques in the cerebral cortex and other areas of the brain including cerebral blood vessels. These plaques consist of groups of neurons surrounded by deposits of beta-amyloid protein. The presence of these plaques is also common to other types of dementia. The second characteristic, neurofibliary tangles, is what separates AD from all other forms of dementia. Neurofibliary tangles take place within the disconnected brain cells themselves. When examined under a microscope diseased cells appear to contain spaghettilike tangles of normally straight nerve fibers. The presence of these tangles was first discovered in 1906 by the German neurologist Alois Alzheimer, hence the name Alzheimer's disease. Although the characteristics listed above are crucial to the diagnosis of AD upon death, the clinical diagnosis involves a different process. The diagnosis of AD is only made after all other illnesses, which may have the same symptoms, are ruled out. The initial symptoms of AD are typical of other treatable diseases therefore doctors are hesitant to give the diagnosis of Alzheimer's in order to save the patient from the worsening of a

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treatable disease through a misdiagnosis. Some of the initial symptoms include an increased memory loss, changes in mood, personality, and behavior, symptoms that are common of depression, prescription drug conflict, brain tumors, syphilis, alcoholism, other types of dementia, and many other conditions. The onset of these symptoms usually brings the patient to his family doctor. The general practitioner runs a typical battery of urinalysis and blood tests that he sends off to the lab. If the tests come back negative, and no other cause of

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 the symptoms is established, the patient is then refereed to a specialist. The specialist, usually a psychiatrist, will then continue to rule out other possible illnesses through testing. If the next battery of tests also comes back negative then the specialist will call on a neurologist to run a series of neurological examinations including a PET and CAT scan to rule out the possibility of brain tumors. A spinal tap is also performed to determine the possibility of other types of dementias. The patient will also undergo a complete psychiatric evaluation. If the patient meets the preliminary criteria for AD an examination of the patients medical history is also necessary to check for possible genetic predispositions to the disease. The psychiatric team finally meets with the neurological team to discuss their findings. If every other possible disease is ruled out, and the results of the psychiatric evaluation are typical to that of a person with AD, the diagnosis of Alzheimer's disease is given. The initial symptoms of AD are usually brushed off as a natural part of aging. The myth that a person's memory worsens over time is just that - a myth (Myers,1996, p.100-101). AD's

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victims are mostly over the age of 65 and many delay treatment by attributing their problems to age. A victim might forget a well known phone number or miss an important appointment. These symptoms eventually escalate to the total disintegration of personality and all patients end up in total nursing care.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 In descending order, the patient goes from (1) decreased ability to handle a complex job to (2) decreased ability to handle such complex activities of daily life as (3) managing finances, (4) complex meal preparation and (5) complex marketing skills. Next comes (6) loss of ability to pick out clothing properly, (7)or to put on clothing properly, followed by (8) loss of ability to handle the mechanics of bathing properly. Then (9) progressive difficulties with continence and (10) toileting occur, followed by (11) very limited speech ability and (12) inability to speak more than a single word. Next comes (13) loss of ambulatory capability. Last to go are such basic functions as (14) sit up, (15) smile and (16) hold up one's head (Brassard,1993,p.10). The average time from diagnosis to inevitable death is 8 years. The family of the victim is usually able to care for the victim for an average period of about 4 years (Alzheimer's, 1996,p.44).During the progression of the disease between 10% and 15% of patients hallucinate and suffer delusions, 10% will become violent and 10% suffer from seizures (Alzheimer's,1996,p.46). Once a person is diagnosed as having AD, an assessment is made of the disease's stage of progression and of the strengths and weaknesses of the victim and the victim's family. There are different types of assessments available to evaluate the level of dysfunction of the patient. Based on one of these assessments a care plan is put together by a team consisting

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of a family member, a paid or unpaid care provider, and the victim's physician. Throughout the progression of the disease, and depending on the needs of the patient, a wide range of

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 expensive medication, such as psychoactive drugs to lift depression and sedatives to control violence, may be required. Unfortunately, although a wide range of treatments have been tested, most prove to be ineffective. At the beginning of the disease the family is able to look after the patient without much effort. Frequently families will hire a care giver in order to alleviate some of the work. Simple changes in the home can make life much easier for the sufferer, help them keep their self esteem, and prolong their stay at home. Examples of low-cost modifications to the environment include reducing the noise levels in the home (telephones, radios, voices, etc.); avoiding vividly patterned rugs and drapes; placing locks up high or down low on doors leading outside (AD sufferers are known to wander off); clearing floors of clutter; reducing the contents of closets in order to simplify choices (Alzheimer,1992, p.17). These costs are paid for by the victim's family. Many of these, and other more expensive modifications are introduced in long-term care settings. They help in maintaining the safety and security of the victim as well as reducing their confusion. The patient's and the family's condition should be assessed every six months (Alzheimer,1992, p.21). In response to constantly changing needs, the aspects of care must be constantly modified. Other issues that usually arise during the care of the patient are assessment of the competence of the victim, power of attorney, and response to and prevention of abuse (Aronson,1988, p.124). Eventually the victim's condition deteriorates to the point where home care is no longer possible and they must be moved to a long-term care facility. In Canada care, support and information for victims and

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 their families comes from the health care system and the Alzheimer's Society of Canada. The care giver must obtain information and education about the disease in order to effectively care for the victim. During the course of the disease victims might wander, hallucinate, become suspicious. This behavior can place a large strain on the care giver as well as causing depression and deterioration of their own health (Aronson,1988, p.132). An AD support group is crucial to alleviating some of the stress on the care giver. Through a support group the care giver is given the emotional and practical help needed to accomplish the large task of looking after the victim for as long as possible. Currently there are 300,000 persons in Canada with AD. This figure is more than that of Parkinson's disease, cancer and multiple sclerosis combined. With continuous growth in the percentage of Canadians over the age of 65, this figure could hit 700,000 by the year 2020 (Carlton,1996,p.17). These large and increasing figures translate into a large burden on the health care system. Even when using the most conservative estimates of the average number of years spent in an institution and the number of afflicted Canadians, the costs to health care are immense. At $33,000 (1989) per patient per year in an institution and with an average stay of three years until death, the cost of AD will amount to $3 billion over the next three years; and if the entry into the disease state remains constant, it will cost the Canadian taxpayer [an added] $1 billion per year thereafter.(Brassard,1993,p.11)

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 There have been many studies that conclude that the number of incidences of AD is on the rise. A very high incidence was reported in a U.S. survey conducted in East Boston by the Harvard Medical school. It showed the incidence of AD to be 3% for people between the ages of 65-74, 18.7% for those between 75-84, and 47.2% for those over 84 (Evans,1989,p.4). AD is a democratic disease. It affects persons of both sexes and all races and ethnic backgrounds. The major risk factors for AD are age and heredity. Persons with a high incidence of AD in their family history are most susceptible. A specific subtype of AD exists that is solely connected to heredity. This subtype is known as Familial Alzheimer's disease (FAD). FAD is also known as Early Onset Alzheimer’s disease, named so because its symptoms start to develop much earlier than in the regular sporadic type. Only 5%-10% of all cases are of this type. FAD is suspected when AD can be traced over several generations and there is a history of, among previously affected family members, a similar age of onset and duration of the disease ( usually 4 years ) . Approximately 50% of the children of an affected parent go on to develop the disease (Pollen,1993,p.89). Much research has been conducted in an attempt to locate the gene that is responsible for FAD. Currently, researchers have isolated genes 1, 14, and 21 (Alzheimer's,1996,p.36), however, the evidence still remains inconclusive (Statement,1996, p.2). There is also a possibility that a specific genetic mutation merely puts a person at risk to

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AD

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triggered

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external

injury.(Statement,1996,p.4). Finding the specific location of the gene

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 will pave the way for a diagnostic or even predictive test for FAD. Similar genetic tests already exist for cystic fibrosis and muscular dystrophy. Locating the AD gene will also allow scientists to study why the particular gene is not functioning properly and may give clues to treatment and cure. The long term goal of this research is the same as that of any other genetic research and that is gene therapy - which is the possibility that science could one day alter our genetic make-up. The other much more common type of AD is Sporadic Alzheimer's Disease (SAD). This includes all other types of the disease which are not linked to heredity. Genetic research is also playing a major role in the progress towards a diagnostic or predictive test for SAD. Recently, a gene involved in the transport of cholesterol has been identified to be associated with AD. Apolipoprotein E is located on chromosome 19 and seems to contribute to the succeptability of a persons to AD (Statement,1996,p.6). The gene exists in three different forms or alleles (Apo E 2,3,4) and each person has a combination of two of the three. Thus an individual can have any one of the following combinations: Apo E 2/2, 3/3, 4/4, 2/3/, 3/4 or 2/4. Researchers have found a relationship between the number of copies of the 4 allele and the person’s probability of developing the disease. Although scientists are unsure of the initial cause of Alzheimer's disease, it is known that the symptoms of Alzheimer's disease are caused by the disconnection and death of neurons in the brain. Based on what scientists understand about Alzheimer's disease, the

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 following have been established as risk factors for the disease: •

Age. By far the greatest risk factor for developing Alzheimer's disease is age. The number of people with Alzheimer's disease doubles every five years after the age of 65, according to the National Institute of Neurological Disorders and Stroke (NINDS).

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Family history. People who have a sibling or parent with Alzheimer's disease are more likely to develop the disease themselves. This risk is greater if more than one member of the family has been diagnosed with Alzheimer's disease. Although the phenomenon is still being studied, it is thought to be related to a slight variation in the genes of certain people that makes them especially susceptible to the disease.

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Head injury. There is strong evidence that suggests that people who sustain serious head injury are more likely to develop Alzheimer's disease later in life. However, this link has not been firmly substantiated by medical research and is more commonly linked to other forms of dementia.

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Lifestyle factors. Although this is somewhat controversial, a number of lifestyle factors might play a role in the development of Alzheimer's. These include lack of exercise, lack of access to a social network, and lack of mentally stimulating activities. For example, numerous studies have shown that people with advanced degrees are less likely to develop Alzheimer's, possibly due to increased brain

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 elasticity. In addition, there may be a link between obesity and the metabolic syndrome and Alzheimer's disease. •

Environmental factors. There have been some reports linking aluminum to an increased risk of developing Alzheimer's disease. Aluminum is a common element that is found naturally in the environment as well as in various household products. Although toxic levels of exposure to aluminum is known to cause some neurological symptoms, the role of aluminum in the development of Alzheimer's disease is not fully understood. Many experts believe that the risks associated with normal aluminum exposure are low.

Symptoms Symptoms of Alzheimer's disease usually begin to appear around the age of 60. Alzheimer's disease is primarily marked by the onset and progression of dementia, a decline in mental function that may interfere with the ability to perform daily functions. Dementia involves both cognitive (intellectual) and psychiatric symptoms. Cognitive symptoms of Alzheimer's disease may include memory lose is often the first sign of having an alzheimer’s disease. Memory can be categorized in two ways: short-term memory and longterm memory. Short-term memory is the ability to remember events that occurred a short time ago or to recall things that were recently learned (such as a person’s telephone number or the name of a restaurant). Short-term memory is stored in the temporal lobe in the brain.

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 This is often the first part of the brain to be affected by Alzheimer's disease. Long-term memory is theability to remember events that happened in the distant past or recall things that were learned earlier in life. Long-term memory is stored in both the temporal and parietal lobes of the brain. It is usually lost during later stages of the disease. Loss of the ability to use and understand language or known as Aphasia. This is usually the result of neuron damage to the left side of the brain, which is associated with language. People with Alzheimer's disease may forget words and have difficulty communicating with others (extensive aphasia). They may also have problems understanding spoken or written words (receptive aphasia). People also experience Agnosia or the loss of ability to recognize familiar people, places or things. It is usually the result of neuron damage in the occipital or parietal lobes. Agnosia also involves an inability to interpret signals from the body, such as when the bladder is full or pain signals that imply serious conditions (e.g., chest pain). This also includes Apraxia, an impaired ability to carry out motor activities, even when motor functioning remains intact. The psychiatric symptoms of dementia are most likely caused by imbalances in brain chemistry and are often the most distressing for the patient and the patient’s family and friends. Some people with Alzheimer's disease do not experience all or any of these symptoms. Psychiatric symptoms may be treated using antipsychotic, anti-anxiety or antidepressant medication. They may include personality changes. This is often a marker of the

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 early stages of Alzheimer's disease. Changes in personality may include irritability, apathy and a tendency to withdraw from the company of friends and relatives. They may also experience depression. Most people with Alzheimer's disease show some signs of depression throughout the progression of the disease. This may be mistaken as a reflection of recent events, especially if the person has recently lost a loved one. The development of depression is a risk factor for further psychiatric symptoms, including hallucinations and delusions. These usually occur during the middle stage of Alzheimer's disease. Hallucinations may be visual or aural and may be exacerbated by loss of hearing or sight. Although people with Alzheimer's disease may sometimes be aware that the hallucination is false, in later stages of the disease they may have a strongly held belief in things that are not real. This is called delusion. A significant percentage of Alzheimer's patients suffer from paranoid delusions, in which they imagine their home has been invaded, that personal items have been stolen, or that loved ones have been replaced by impostors. These can be extremely upsetting to both care-givers and Alzheimer's patients. People with Alzheimer's disease may also experience apraxia, which is an inability to perform tasks on demand. This symptom occurs when the neuron connections in the parietal lobe of the brain are affected. The first element that is affected by Alzheimer's disease is usually complex motor skills such as those required to perform most daily tasks (e.g., writing, brushing hair). Next, a person may be unable to

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 complete tasks that were learned during childhood, such as tying a shoelace or brushing teeth. The last element of motor function to be lost is instinctive motor function such as chewing, swallowing or walking. Certain symptoms of Alzheimer's disease may be mistaken for the changes in memory function and mild confusion that people may experience as they get older. Most older people occasionally misplace items or forget the exact details of something that happened in the past. These minor changes are different from Alzheimer's disease because Alzheimer's disease progressively gets worse until the person is unable to function without a permanent caregiver. 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. Progression of symptoms corresponds in a general way to the underlying nerve cell degeneration that takes place in Alzheimer’s disease. Nerve cell damage typically begins with cells involved in learning and memory and gradually spreads to cells that control other aspects of thinking, judgment and behavior. The damage eventually affects cells that control and coordinate movement. Within this framework, we have noted which stages correspond to the widely used concepts of mild, moderate, moderately severe and severe Alzheimer’s disease. We have

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009

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also noted which stages fall within the more general divisions of early-stage, mid-stage and late-stage categories. Stage 1: No cognitive impairment Unimpaired individuals experience no memory problems and none are evident to a health care professional during a medical interview. Stage 2: Very mild decline Individuals at this stage feel as if they have memory lapses, forgetting familiar words or names or the location of keys, eyeglasses or other everyday objects. But these problems are not evident during a medical examination or apparent to friends, family or co-workers. Stage 3: Mild cognitive decline Early-stage Alzheimer’s can be diagnosed in some, but not all, individuals with these symptoms. Friends, family or co-workers begin to notice deficiencies. Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical interview. Common difficulties include: • Word- or name-finding problems noticeable to family or close associates. • Decreased ability to remember names when introduced to new people.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 • Performance issues in social and work settings noticeable to others. • Reading a passage and retaining little material. • Losing or misplacing a valuable object. • Decline in ability to plan or organize. Stage 4: Moderate cognitive decline

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(Mild or early-stage Alzheimer’s disease) At this stage, a careful medical interview detects clear-cut deficiencies in the following areas: • Decreased knowledge of recent events. • Impaired ability to perform challenging mental arithmetic. For example, to count backward from 100 by 7s. • Decreased capacity to perform complex tasks, such as marketing, planning dinner for guests, or paying bills and managing finances. • Reduced memory of personal history. • The affected individual may seem subdued and withdrawn, especially in socially or mentally challenging situations.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 Stage 5: Moderately severe cognitive decline (Moderate or mid-stage Alzheimer’s disease) Major gaps in memory and deficits in cognitive function emerge. Some assistance with dayto-day activities becomes essential. At this stage, individuals may: • Be unable during a medical interview to recall such important details as their current address, their telephone number, or the name of the college or high school from which they graduated. • Become confused about where they are or about the date, day of the week or season. • Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s. • Need help choosing proper clothing for the season or the occasion.

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• Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children. • Usually require no assistance with eating or using the toilet.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 Stage 6: Severe cognitive decline (Moderately severe or mid-stage Alzheimer’s disease) Memory difficulties continue to worsen, significant personality changes may emerge, and affected individuals need extensive help with daily activities. At this stage, individuals may: • Lose most awareness of recent experiences and events as well as of their surroundings. • Recollect their personal history imperfectly, although they generally recall their own name. • Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces. • Need help getting dressed properly; without supervision, may make such errors as putting pajamas over daytime clothes or shoes on wrong feet. • Experience disruption of their normal sleep/waking cycle. • Need help with handling details of toileting (flushing toilet, wiping and disposing of tissue properly). • Have increasing episodes of urinary or fecal incontinence. • Experience significant personality changes and behavioral symptoms, including suspiciousness and delusions (for example, believing that their caregiver is an impostor);

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 hallucinations (seeing or hearing things that are not really there); or compulsive, repetitive behaviors such as hand-wringing or tissue shredding. • Tend to wander and become lost. Stage 7: Very severe cognitive decline (Severe or late-stage Alzheimer’s disease) This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak, and, ultimately, the ability to control movement. • Frequently individuals lose their capacity for recognizable speech, although words or phrases may occasionally be uttered • Individuals need help with eating and toileting and there is general incontinence • Individuals lose the ability to walk without assistance, then the ability to sit without support, the ability to smile, and the ability to hold their head up. Reflexes become abnormal and muscles grow rigid. Swallowing is impaired.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 What Tests Are Used to Diagnose Alzheimer's Disease?

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In spite of the fact that it is so common, Alzheimer's disease often goes unrecognized or is misdiagnosed in its early stages. Many doctors and nurses, patients, and family members mistakenly view the early symptoms of Alzheimer's disease as the inevitable consequences of aging. Some disorders that can result in dementia -- such as depression, poor nutrition, and drug interactions -- are curable, but Alzheimer's disease is not. Therefore, it is very important to diagnose the cause of the dementia early and correctly. In addition, some Alzheimer's disease symptoms -- such as incontinence and depression -- can be effectively treated, so it's better to identify these as soon as possible. An early and accurate diagnosis of the cause of dementia is important for the following reasons: •

To rule out Alzheimer's disease and ease the patient's and family's concern.

•

To identify any treatable condition and initiate treatment as appropriate.

•

To identify Alzheimer's disease at the earliest possible stage; this gives the patient and family time to plan for the future needs and care of the patient. This also allows the patient to start using some medicines that are only useful in the earlier stages of Alzheimer's.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 Alzheimer's disease cannot be definitely diagnosed until after death, when the brain can be closely examined for certain microscopic changes caused by the disease. However, through thorough testing and a "process of elimination," doctors today can diagnose what they refer to as probable Alzheimer's disease with almost 90% accuracy.

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The following things may be used to help make a diagnosis of Alzheimer's disease: Patient History A history from the patient helps the doctor assess a person's past and current health situation. It also helps the doctor evaluate whether there are any medical problems, develop a plan of treatment, and monitor the patient's health over time. During this evaluation, the doctor asks the person a series of questions. A thorough patient history includes: •

Patient's identifying information.

•

Information about the main problem, including any difficulties in daily living.

•

Information about other symptoms.

•

History of any current illness.

•

Past medical history.

•

Medications being taken.

•

Current health status.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 •

Psychosocial history -- like marital status, living conditions, employment, sexual history, important life events.

•

Mental state -- this is a series of questions that the doctor will ask to determine if the person is experiencing any evidence of psychiatric illness, like depression.

•

Family history (including any illnesses that seem to run in the family).

Mini-Mental State Examination

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This is a very brief test that the doctor can use to test a person's problem solving skills, attention span, counting skills and memory. It will give the doctor insight into whether there has been damage to different areas of the brain. Physical Exam The physical examination is part of the patient care process. The exam enables the doctor to assess the overall physical condition of the patient. If the patient has a medical complaint, the physical exam provides the doctor with more information about the problem, which helps him determine an appropriate plan of treatment. The physical exam includes an examination of the following: •

Vital signs (temperature, blood pressure, pulse)

•

Height and weight

•

Skin

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 •

Head, eyes, ears, nose

•

Throat/neck

•

Chest, including lungs and heart

•

Breasts

•

Abdomen

•

Bones and muscles

•

Neurological evaluation

•

Rectal/genital area

Chest X-ray

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An X-ray is a test in which an image of the body is created by using low doses of radiation. X-rays can be used to diagnose a wide range of conditions, from bronchitis to broken bones. When viewing X-ray images of the chest, doctors can the view the structures inside the chest, including the heart, lungs, and bones. This test may be used by the doctor to help rule out other disorders that may be causing symptoms similar to those of Alzheimer's disease. Laboratory Tests When a doctor is diagnosing an illness, he or she often orders laboratory tests on certain fluids and tissue samples from the body. These tests can help identify problems and

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 diseases.There are hundreds of laboratory tests available to help doctors make a diagnosis. The most common are blood tests and urinalysis. Blood tests involve a series of tests routinely done on blood to look for abnormalities associated with various diseases and disorders. Blood tests may also be used to look for the presence of a specific gene that has been identified as a risk factor for Alzheimer's disease. A urinalysis is a test in which a urine sample is evaluated to detect abnormalities, such as abnormal levels of sugar or protein. This test may be used by the doctor to help rule out other disorders that may be causing symptoms similar to those of Alzheimer's disease. In some cases, obtaining and testing a small amount of spinal fluid may be helpful. Computed Tomography (CT or CAT) scan A computed tomography (CT or CAT) scan is a technique in which multiple X-rays of the body are taken from different angles in a very short period of time. These images are

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then fed into a computer, which creates a series of images that look like "slices" through the body. CT scans can show certain changes that are characteristic of Alzheimer's disease in its later stages. These changes include a reduction in the size of the brain, referred to as atrophy.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 Magnetic Resonance Imaging (MRI) Magnetic Resonance Imaging (MRI) is a test that produces very clear pictures, or images, of the human body without using X-rays. Instead, MRI uses a large magnet, radio waves, and a computer to produce these images. MRI is beneficial in ruling out other causes of dementia, such as tumors or strokes. It also may help to show the structural and functional changes in the brain that are associated with Alzheimer's disease. Electroencephalography (EEG) Electroencephalography (EEG) is a medical technique that measures brain function by analyzing the electrical activity generated by the brain. This activity is measured through special electrodes applied to the scalp. EEG can be used repeatedly in adults and children with virtually no risks and is helpful in diagnosing seizures, which may be contributing to behavioral changes seen in the patient. Neuropsychological Testing Neuropsychological testing studies the relationship between the brain and behavior. It is used when the patient is having serious problems with memory, concentration, remembering words and names, understanding language, visual-spatial issues, and a variety of other symptoms. These tests help in the diagnosis and treatment of conditions that affect

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thinking, emotion, and behavior. These include Alzheimer's disease, various psychiatric problems,

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 like depression and anxiety, problems caused by medicines, substance abuse, strokes, and tumors. Neuropsychological tests accompany a comprehensive interview with the patient and may include tests to assess memory, language, the ability to plan and reason, and the ability to modify behavior, as well as assessments of personality and emotional stability. Neuropsychological testing also can help the doctor and family better understand the effect of a disorder on a patient's everyday functioning. There are additional tests that may be done to help diagnose and monitor the progression of Alzheimer's disease. The following tests are not done routinely and are more often used for research purposes: Positron Emission Tomography (PET) Scan PET scanning is a three-dimensional imaging technique that allows a doctor to examine the heart, brain or other internal organs. PET scans also can show how the organs are functioning; unlike X-ray, CT or MRI, which show only body structure. PET is particularly useful for the detection of cancer and coronary artery disease and can provide information to pinpoint and evaluate diseases of the brain. PET imaging can show the region of the brain that is causing a patient to have seizures and is useful in evaluating brain diseases like Alzheimer's, Huntington's, and Parkinson's. PET scans can show the difference in brain activity between a normal brain and one affected by Alzheimer's disease; it can also help differentiate Alzheimer's disease from other forms of dementia.

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 Single Photon Emission Computed Tomography (SPECT) Scan SPECT is a technique for creating very clear, three-dimensional pictures of a major organ, such as the brain or heart. SPECT scans involve the injection of a very small amount of a radioactive substance. Energy from the radioactive substance in the body is detected by a special camera, which then takes the pictures. SPECT can be used to see how blood flows in certain regions of the brain and is useful in evaluating specific brain functions. This may reveal abnormalities that are characteristic of Alzheimer's disease. Magnetic Resonance Spectroscopy Imaging (MRSI) MRSI is a test that allows the doctor to observe certain substances throughout the brain without the use of radioactive materials. MRSI is an imaging technique that is used to study changes caused by brain tumors, strokes, seizure disorders, Alzheimer's disease, depression, and other diseases affecting the brain.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 Alzheimer's Disease: Treatment Overview Is There a Cure for Alzheimer's Disease?

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Dementia is a condition of mental decline that causes progressive memory impairment and problems with learning, judgment, communication, and quality of life. Alzheimer’s disease, a progressive brain disorder, is the most common form of dementia, accounting for about 60% to 80% of cases. With Alzheimer’s disease, there is a decline in mental function and personality changes, which may include agitation, depression, and hallucinations. While there is no cure for Alzheimer's disease and no proven treatment to slow its progression, there are a number of medicines available that may help improve the mental function of people with Alzheimer's disease. If these medications are given early enough in the course of the disease, the drugs may enable people to carry out their daily activities and independent living for a longer period of time and may prolong the time that patients can be managed at home. There are also medicines available to help manage some of the most troubling symptoms of Alzheimer's disease, including depression and behavioral problems such as agitation and aggression. Although there is no cure for Alzheimer's disease, planning and medical/social management can help ease the burden on both patients and family members. Exercise, good nutrition, activities, and social interaction are important. A calm, structured environment

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 also may help the person with Alzheimer's disease to continue functioning as long as possible. How Is Alzheimer's Disease Treated? Your doctor will determine the best treatment for the Alzheimer’s patient based on various factors, including: •

The patient’s age, overall health, and medical history

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•

Extent of the disease

•

The patient’s tolerance for specific medicines, procedures, and therapies

•

Expectations for the course of the disease

•

The patient and his or her caregiver’s opinion or preference

What are the medicines used to treat Alzheimer's disease? •

Aricept. Aricept, a cholinesterase inhibitor, is the most widely used drug for Alzheimer's disease. Cholinesterase inhibitors stop the breakdown of acetylcholine, a chemical in the brain used for memory and other mental functions.These types of medications help increase the levels of acetylcholine. In Alzheimer’s disease there is a deficiency in acetlycholine in some areas of the brain, which accounts for some of the symptoms of the disease. Aricept works by slowing down the breakdown of acetylcholine. Aricept is the only treatment approved by the FDA for all stages of Alzheimer’s disease: mild,

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 moderate, and severe.Aricept doesn't cure Alzheimer's, but studies have shown that in some patients it can improve mental function, which includes effects on memory and daily living. Side effects are usually mild and include diarrhea, vomiting, nausea, fatigue, insomnia, and weight loss. •

Exelon and Razadyne (formerly Reminyl). These newer drugs also work by inhibiting the breakdown of acetylcholine. They are most effective when given in the earlier stages of Alzheimer's disease. They also have side effects similar to Aricept. In April 2005, Reminyl’s label (now marketed as Razadyne) was changed to include information about

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the deaths of 13 elderly patients who were taking the drug during a study. The deaths were due to various causes, including heart attack and stroke. •

Namenda. Namenda is prescribed to treat moderate-to-severe Alzheimer's. Namenda works by a different mechanism than other Alzheimer's treatments; it is thought to play a protective role in the brain by regulating a chemical called glutamate. Glutamate plays a role in learning and memory by acting as a kind of "gatekeeper" of some of the brain's other chemicals -- allowing certain amounts of these other chemicals (such as calcium, which is required for information storage) to enter the brain's nerve cells. People with Alzheimer's brain cells fire off too much glutamate. Namenda helps regulate glutamate activity. That, in turn, can improve the brain's ability to process information and retrieve memories. Namenda is the first drug to be approved for this stage of the disease; other

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 Alzheimer's drugs are indicated for mild-to-moderate symptoms. Namenda may have increased benefit when used with Aricept, Exelon, Razadyne, or Cognex. Side effects of Namenda include tiredness, dizziness, confusion, and headache. •

Cognex. Cognex, a cholinesterase inhibitor, also works by slowing the breakdown of acetylcholine. Side effects of the drug include nausea, vomiting, diarrhea, abdominal pain, skin rash, and indigestion. In addition, Cognex may cause liver damage, so your doctor will need to perform tests regularly to monitor liver function and make sure this isn't happening. Exelon, Razadyne, and Cognex seem to help only those with mild or moderate symptoms of Alzheimer's disease. Aricept is approved by the FDA to treat all stages of Alzheimer’s disease: mild, moderate, and severe. Namenda is prescribed for patients who have moderate-to-severe Alzheimer's. In addition to these medicines, the

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American Academy of Neurology has stated that vitamin E supplements (alphatocopherol) likely delay the time to clinical worsening in patients with Alzheimer’s disease.It is important to know that new research findings are giving reason for hope, and several drugs are being studied in clinical trials to determine if they can slow the progress of the disease, or improve memory or other symptoms for a period of time. An Alzheimer’s vaccine is also being studied. However, because of unwanted side effects, the initial clinical trial was stopped. Continued studies are under way to modify the vaccine for improved safety. A number of other therapeutic approaches are being actively investigated.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 Prevention Right now, there's no proven way to prevent the onset of Alzheimer's disease. Human trials of a promising vaccine against Alzheimer's had to be stopped several years ago because some of the people who received the vaccine developed a serious inflammation of the brain. However, you may be able to reduce your risk of Alzheimer's disease by reducing your risk of heart disease. Many of the same factors that increase your risk of heart disease can also increase your risk of dementia. The main players appear to be blood pressure, cholesterol and blood glucose levels. Keeping active — physically, mentally and socially — also seems to reduce the risk of Alzheimer's disease. Alzheimer’s Care and Planning for Families Alzheimer’s disease is a chronic, progressive illness and is the most common cause of dementia in older individuals. It is characterized by progressive intellectual deterioration

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together with declining activities of daily living. Most people with Alzheimer’s disease also exhibit psychiatric symptoms and behavioral changes.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 As with other chronically ill people, those with Alzheimer’s disease often need some type of chronic care. Chronic care differs from the acute care people receive in hospitals and doctor’s offices. Chronic care is characterized by daily personal-care assistance, supervision, help with taking medications, meal preparation, and companionship, shopping, cleaning and doing the laundry, for example. Chronic care in America varies from community to community. It includes communitybased and institutional care providers as well as state, federal, and private funding sources. Many Alzheimer’s patients are served by this system — in their homes, in special “dementia-care” programs, in adult day care facilities and in nursing homes. The health care professionals working in this system are typically social workers, nurses, therapists and case managers. Alzheimer’s disease is fast becoming the most prevalent and the most disabling chronic illness in America. 2-3% of persons aged 65 show signs of the disease, while 25 50% of persons aged 85 have symptoms of Alzheimer’s and an even greater number have some of the pathological hallmarks of the disease without the characteristic symptoms. As our chronic care system strains to capacity, people with Alzheimer’s disease and their families need to understand how they can more effectively to ensure the quality of their loved ones’ care. Here are a few tips to help a person care and plan for someone with Alzheimer’s disease.

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 Creating Advance Directives Alzheimer’s disease is a dementing illness. As it progresses, people will lose their memory, their ability to reason, and the ability to understand the consequences of their decisions. Once an individual with Alzheimer’s disease has lost competence, it is too late to designate the person he or she wants to make his or her health care, financial and estateplanning decisions. This is why choosing a decision-maker in advance of incapacity can be critical to maintaining the quality of life for a loved one with Alzheimer’s disease, as well as for his or her family. It is one of the best arguments supporting early diagnosis, since most people in the early stages of Alzheimer’s disease can execute advance directives before their illness has progressed too far. There are five advance directives to be concerned about: •

Power of attorney

•

Health care proxy

•

A will

•

A living will

•

Do Not Resuscitate (DNR) order For individuals with Alzheimer’s disease, empowering family members or trusted

friends to make health care decisions (health care proxy) and to do estate and financial

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 planning (power of attorney) ensures that the caregiving effort won’t freeze up due to a lack of resources or the absence of a decision maker. The proper execution of advance directives by an estate-planning attorney is often a critical component of any Alzheimer’s care plan. Taking an Estate Inventory Before charting the course for a loved one’s long-term care, you should first determine where you and the person with Alzheimer’s disease are. An estate inventory is a snapshot of the resources at one’s disposal that may be needed to subsidize caregiving. There are six long-term care resources: 1. Health insurance 2. Income and assets 3. Community resources 4. Family and friends (themselves a resource for caregiving) 5. The home environment 6. The person with Alzheimer’s disease’s capacity for self-care An estate inventory defines three of these resources — health insurance, income and assets, and community resource eligibility. The other three resources are established by the Care Assessment, the third step in the care planning process.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 A person cannot efficiently plan or manage long-term care without knowing how much care they can pay for themselves or how much can be subsidized by the community (local,

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state, federal programs). A clear snapshot of the person’s income from fixed sources (Social Security, 401(k), pension and other retirement income), of their assets (savings, investments, equity in the home, etc.), and what their health insurance will and won’t cover (including long-term care insurance) must be done before you can decide on caregiving arrangements for someone with Alzheimer’s disease. Creating a Care Assessment Both the amount and the type of care needed by a person with Alzheimer’s disease will change over time. In the early stages, periodic supervision and homemaking (shopping, cleaning, and laundry) may be all that’s needed. The level of care may gradually increase to include higher levels of supervision, personal care assistance, behavior management, or even placement in a specialized dementia-care facility or nursing home. A Care Assessment for a person with Alzheimer’s disease examines what the patient needs, how much care his or her family can provide, how the home is configured, and what the person is capable of. The assessment is best performed by family members or loved ones working in consultation with mental health and health care professionals skilled in Alzheimer’s care. Since many people with Alzheimer’s disease are still living in their homes

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 — either with spouses, with children or alone — the best place to turn for a care assessment is often a home care agency. A skilled assessment by a home care nurse, preferably with a dementia-care specialty, done in tandem with a home health care social worker, can often be ordered by a physician and paid for by Medicare. But if Medicare won’t cover it, the patient or family may have to

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pay. Spending a few hundred dollars for the advice of a seasoned home care professional is nearly always money well spent in determining the feasibility of home care, how it will be paid for and in setting limits for patients and caregivers alike. Families may also call upon independent care managers or their local elder service agencies (Area Agencies on Aging or AAA’s) to perform the care and needs assessment. Defining the Option With advance directives in place, resources organized, and the person’s care assessed, the actual planning can begin. It is best to take a short-term and a separate long-term approach to planning. Immediate needs must be met while plans for likely future needs are constructed. It is also best not to confuse planning with wishful thinking. The most effective approach is to hope for the best, but plan for the worst. Alzheimer’s disease is progressively debilitating. Planning for the worst-case scenario acknowledges that nursing home

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 placement may be required at some point in time (costing as much as $5,000+ per month in some areas) and that home care could become even more expensive. Realistic planning for the potentially high cost of long-term care forces the family to find the estate-planning and community-support solutions that can preserve the person’s independence as well as his or her savings (which may be needed for the caregiving effort, for the needs of a well spouse or a family’s future). Most care-planning options turn on two primary factors: cost and living environment. Mapping out a care plan often requires that a family compromises between competing priorities. Quality of care is usually the top priority and it is usually defined in

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terms of the venue of care. The home is most often preferred, but resource and caregiver limitations may force a compromise choice for placement in a more restrictive setting. There are many residential choices for people with Alzheimer’s disease. Residential choices will be governed first by concern for the individual’s safety in daily living. Safety is measured by actual physical risk for injury and also by behavioral and emotional stability. These risks are reduced by incrementally higher levels of supervision, personal care assistance, and restrictions on freedom of movement. Home care for a person with Alzheimer’s disease may not work if he or she cooks unsafely, smokes unsafely, or tends to wander. In such cases, the family may be forced to hire 24-hour supervision, or provide it

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 themselves. And even if this is affordable, it may not be the best choice for all concerned. The next least-restrictive setting may be an assisted living facility with some private-duty care. If a person’s cognitive function and self-care ability has declined to where he or she requires more supervision, a rest home or specialized dementia-care facility may work-still less restrictive (and less expensive) than a nursing home, but possibly safer and often less costly than 24-hour home care. And community programs may also subsidize all of these options for income- and asset-eligible patients. Behavior management often makes planning for Alzheimer’s care particularly difficult. But at the end stage of the illness, behavior management may become less of a challenge than basic personal care and intermittent nursing services. Care planning must anticipate a sequence of living arrangements that may, ultimately, result in a return to the home. Many people with Alzheimer’s disease become home care patients once again, for the final stage of the illness.

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Long-term, chronic care can be likened to an expedition. As with all good expeditions, planning is a prerequisite to success. For a plan to work it must be adaptable and it must be based on good information. The more knowledge one has about the nature and course of Alzheimer’s disease, the better. Combining knowledge with the basics of long-term care planning greatly increases the likelihood that a loved one will receive the best care available and that s family’s journey will be as smooth as possible.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 Alzheimer's Facts and Statistics We've all had times when we can't remember where we put our keys or when an appointment was supposed to be. These occasional memory lapses are a normal part of being human. So when should you worry about signs of Alzheimer's Disease? A simple example is: If you forgot where you put your glasses there is no great cause for concern ... but if you've forgotten you wear glasses you have significant reason to worry about your memory problem. A more extensive list of Alzheimer's Symptoms

is

as

follows:

a

chronic,

progressively worsening problem accompanied by disorientation, problems with judgement, concentration, language and mathematical skills, physical coordination, and sleeplessness, the repetition of the same ideas or movements, the tendency to wander off and get lost, "sunsetting" or restlessness and wandering off in the late afternoon and night, dramatic personality changes, and eventually the loss of the ability

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to perform basic self-care functions.

Alzheimer's disease is a type of dementia that

already affects millions of Americans and that is expected to affect millions more as the number of people over 50 continues to increase.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 After heart disease, cancer, and stroke, Alzheimer's is the fourth leading cause of death among the elderly in developed nations. Alzheimer's is most common in people over the age of 65 and affects 11% of those over 65 and 25-50% of those over the age of 85. Although this disease is one of the most common types of dementia among the elderly, it is difficult to diagnose since Alzheimer's-like symptoms are common to many other diseases (AIDS, brain cancer, Parkinson's disease, deficiencies of vitamin E, magnesium, and B vitamins, etc.). Generally, a diagnosis of Alzheimer's disease is only 85 to 90% accurate, since the only definite diagnoses comes from an after-death biopsy of the diseased brain. Those most at risk for Alzheimer's are the elderly. With advancing age, their risk of developing the disease increases to an alarming 47% by the age of 85. Family history also plays a role with 54% of those age 80 and over developing Alzheimer's if both parents had the disease. Alzheimer's Disease has increased 10-fold in this century and is sometimes referred to as "the disease of the 20th century," and it is projected to reach epidemic proportions.

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009

101 Things To Do With a Person with Alzheimer’s Disease 1.Clip coupons 2. Sort poker chips 3. Count tickets 4. Rake leaves 5. Use the carpet sweeper 6. Read out loud 7. Bake cookies 8. Look up names in the phone book 9. Read the daily paper out loud 10. Ask someone with a child to visit 11. Listen to Polka music 12. Plant seeds indoors or out 13. Look at family photographs 14. Toss a ball 15. Color pictures 16. Make homemade lemonade 17. Wipe off the table 18. Weed the flower bed 19. Make cream cheese mints 20. Have a spelling bee 21. Read from the Reader's Digest 22. Fold clothes 23. Have a friend visit with a calm pet 24. Cut pictures out of greeting cards 25. Wash silverware

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 26. Bake homemade bread 27. Sort objects by shape or color 28. Sing old songs 29. "Tell me more" when they talk about a memory 30. Put silverware away 31. Make a Valentine collage 32. Play favorite songs and sing 33. Take a ride 34. Make a cherry pie 35. Read aloud from Ideals magazine 36. Play dreidels 37. Make a basket of socks 38. Take a walk 39. Reminisce about 1st day of school 40. String Cheerios to hang outside for birds 41. Make a fresh fruit salad 42. Sweep the patio 43. Color paper shamrocks green 44. Fold towels 45. Have afternoon tea 46. Remember great inventions 47. Play Pictionary 48. Paint a sheet 49. Cut out paper dolls 50. Identify states and capitals 51. Make a family tree poster

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009

52. Color a picture of our flag 53. Cook hot dogs outside 54. Grow magic rocks 55. Water house plants 56. Reminisce about the first kiss 57. Play horse shoes 58. Dance 59. Sing favorite hymns 60. Make homemade ice cream 61. Force bulbs for winter blooming 62. Make Christmas cards 63. Sort playing cards by their color 64. Write a letter to a family member 65. Dress in your favorite football team's color 66. Pop popcorn 67. Name the presidents 68. Give a manicure 69. Make paper butterflies 70. Plant a tree 71. Make a May basket 72. Make homemade applesauce 73. Finish famous sayings 74. Feed the ducks 75. Mold with play dough 76. Look at pictures in National Geographic

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009

77. Put a puzzle together 78. Sand wood 79. Rub in hand lotion 80. Decorate paper placemats 81. Arrange fresh flowers 82. Remember famous people 83. Straighten out underwear drawer 84. Finish Nursery Rhymes 85. Make peanut butter sandwiches 86. Wipe off patio furniture 87. Cut up used paper for scratch paper 88. Take care of fish tank 89. Trace and cut out leaves 90. Ask simple trivia questions 91. Finish Bible quotes 92. Paint with string 93. Cut out pictures from magazines 94. Read classic short stories 95. Put coins in a jar 96. Sew sewing cards 97. Put bird feed out for the birds 98. Clean out a pumpkin 99. Reminisce about a favorite summer 100. Roll yarn into a ball 101. Make a birthday cake

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 People With Alzheimer's Disease - Helpful Tips For Encouraging Them to Remain Active Alzheimer's disease is a devastating condition that affects approximately 1-2% of the general population. It is one of several conditions that are called dementias, accounting for about 50% of reported cases of dementias. While the symptoms and outcomes of Alzheimer's disease are very serious, the assumption that people with the disease can no longer function is incorrect and unfair. People in the advanced stages of Alzheimer's are certainly very limited, but many other people can still be active with a little help from family or friends. Your ability to help a loved one or friend with Alzheimer's disease be as active as possible rests with the approach you take with her. By following these steps, you can greatly enhance your chances of success. 1. Keep it simple - break tasks such as cooking or performing personal hygiene down into specific milestones that can be followed in order. For example, telling someone with Alzheimer's to cook an omelet will be overwhelming to her and will probably not succeed while instructing the person to perform each specific task that goes into making the omelet will be easier to follow and less stressful.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 2. Be calm and reassuring - people with Alzheimer's disease can be very sensitive to the feelings of others and will react negatively to irritation or impatience.

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3. Familiarity and repetition - do not give up if the person does not succeed with the task or activity the first time. Repeating the task over time will often improve her ability to complete it successfully. 4. Do not argue or attempt to convince - if the person is not receptive to a task, do not push her too hard to do it. At this point, it is best to redirect her to something more familiar and safer and then try again with the original task at a later time. 5. Plan the activities - spontaneity is not a good approach to take with someone with Alzheimer's disease. Plan activities carefully and minimize interruptions and surprises. 6. Use visuals to stimulate and reinforce activities - people with Alzheimer's react positively to visual prompts. Posting signs around the home that provide instructions such as "brush teeth" or "wash face" can be very helpful. Also, a collage or scrap book of pictures can help to stimulate memories and turn into an enjoyable activity. There are a variety of activities that people with Alzheimer's disease can enjoy. Much of it depends on the individual's interests and level of functioning, and on the approach that is taken to encourage her to participate. Remember, process is more important than the

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 outcome when encouraging people with Alzheimer's to participate in activities. A kind, gentle, and supportive approach is usually far more successful than placing high expectations and providing negative feedback.

Conclusion The incidence of Alzheimer's disease is increasing at an alarming rate along with the aging of our population. The vast majority of Alzheimer's disease is acquired or classified

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as idiopathic (of unknown cause) by conventional medicine. There is much discussion about the cause of Alzheimer's disease and many consider that Alzheimer's disease may not be caused by a single agent. The causes discussed here encompassed many diverse medical theories, including the biochemistry of acetylcholine and neurotransmitters, inflammation, oxidative stress and free radicals, and homocysteine. Recent advances in lab testing may help identify the key areas on which to focus the therapies.

One interesting study showed that persons who had a love of reading and read frequently in childhood had a very decreased incidence of Alzheimer's disease. Regularly engaging in mental activity is necessary for preservation of brain function. Most of the medical treatments listed here are used only after Alzheimer's disease develops. Some, such as folic acid, vitamin B12, and antioxidants, are important in

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 preventing dementia also. We can’t really avoid a person from having an Alzheimer’s disease, if this happen to one of your family members you don’t have to panic nor be afraid. This is the time that hey needs us the most. Our love, care and acceptance is what they need from us. Sometimes things happen even if we don’t expect them to be. All we have to do is to strengthen our faith unto God. We must pray for Him to guide us and to help us in our everyday life. If it happens to us, we must not blame God, because everything happens for a purpose. In the not too distant future, it is very possible that Alzheimer's disease will be effectively treated and even prevented. Ongoing research is uncovering new and startling insights into Alzheimer's. Better understanding of the genetic and environmental risk factors

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will lead to much earlier diagnosis of the disease and treatment before cognitive functions of the brain begin to fade. In the future, Alzheimer's disease may be viewed as serious illness as heart disease is, that perhaps can be treated and even be prevented with proper therapies. And while were still young we live our life to the fullest, in a way that we live a meaningful and healthy life. We must take good care of our bodies for us not to experience many sicknesses when we grow old. Remember, we only have one life so let us make the most out of it.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 References "I Know What I Like": Stability of aesthetic preference in alzheimer's patients” Andrea R. Halperna, Jenny Lyb, Seth Elkin-Frankstonb and Margaret G. O'Connor Psychology Department, Bucknell University, Lewisburg, PA, 17837, USA Brain and Cognition,Volume 66, Issue 1, February 2008 “Reduced risk of Alzheimer’s disease with high folate intake: The Baltimore Longitudinal Study of Aging” María M. Corrada, Claudia H. Kawasab, Judith Hallfrischc, Denis Mullerd, Ron Brookmeyere Alzheimer's and Dementia |Volume 1, Issue 1, Pages 11-18 (July 2005)

Reduced Risk of Alzheimer Disease in Users of Antioxidant Vitamin Supplements Peter P. Zandi, PhD; James C. Anthony, PhD; Ara S. Khachaturian, PhD; Stephanie V. Stone, PhD;Deborah Gustafson, PhD; JoAnn T. Tschanz, PhD; Maria C. Norton, PhD; Kathleen A. Welsh-Bohmer, PhD; John C. S. Breitner, MD ARCH NEUROL/VOL 61, JAN 2004

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Effect of Physical Activity on Cognitive Function in Older Adults at Risk for Alzheimer Disease Nicola T. Lautenschlager, MD; Kay L. Cox, PhD; Leon Flicker, MBBS, PhD; Jonathan K. Foster, DPhil; Frank M. van Bockxmeer, PhD; Jianguo Xiao, MD, PhD; Kathryn R. Greenop, PhD; Osvaldo P. Almeida, MD, PhD JAMA. 2008;300(9):1027-1037.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 Preventing Alzheimer's: Exercise still best bet By Angela Lunde

Effects of short-term transcutaneous electrical nerve stimulation on memory and affective behaviour in patients with probable Alzheimer's disease E. J. A. Scherdera, A. Boumab and A. M. Steen Behavioural Brain Research Volume 67, Issue 2, March 1995, Pages 211-219

Art Awakens Alzheimer's Patients' Minds Bill Blakemore ABC News; July 2, 2006

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Early Symptoms of Alzheimer's Disease : 5 Main Symptoms to Watch Out for by Susan Nickerson

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Alzheimers Disease-Learn How to Fight It Today! by Sean Moronse

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Research and Markets: Analyse Profiles of 134 Companies Involved in Developing Diagnostics and Therapeutics for Alzheimer's Disease Are Presented along with 101 Collaborations.

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http://www.pdfcoke.com/doc/11569594/What-Really-Causes-Autism

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http://www.pdfcoke.com/doc/11459966/ABA-Autism-Speakers-Summary

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http://www.autismsocietycanada.ca/general_info/ten_common_questions/index_e.ht ml

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http://about-alzheimers.net/

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Normal Brain

Brain of a Person with AD

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An Actual AD Plaque

University of perpetual Help System DALTA- Molino Campus An AD Tangle Molino 3, Bacoor, Cavite S.Y. 2008-2009

Pet Scan of Normal Barain

Pet Scan of AD Brain

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