1 Sarah Niels Prof. Presnell Engl 1103 12 Nov.

2012 Inquiry One Draft Start with why I am writing this essay. My great aunt Ruth was diagnosed with Alzheimers disease when I was very young. I didnt understand why she couldnt remember anything and it always angered me when she didnt know who I was. Over the years, she progressively grew worse. Her daughter eventually put her in a nursing home and stopped tending for her. My grandmother, mother, and I would go at least once a month to visit aunt Ruth. She was sad all the time. The smell of the nursing home was sickening; I couldnt fathom how she lived in a place like that. Sometimes I wonder if there is anything we should consider while ageing, possibly preventing this disease form occurring to our loved ones or us. I saw my Aunt Ruth die with no memories, she had nobody to love or tell a last request to. I dont want to relive another family member like that. Explain what Alzheimers disease is. Alzheimers is a progressive brain disease connected with dementia. Once it begins, you cannot reverse the loss of cognitive functioning or behavioral abilities. It is not apparent as to why this disease occurs in only certain people but scientists believe the process of damage begins ten years before Alzheimers becomes apparent. Toxic changes occur in the brain in this

2 period; thus, the symptoms are not apparent in this stage. Within time, proteins in the brain are built up, forming amyloid plaques. This build up interferes with the transfer of information between neurons in the brain. Another abnormal occurrence forms tau tangles; this is an irregular amount of tau, which holds up microtubule structures (they allow for transportation of nutrients in the brain). In the early stages of Alzheimers disease, the patient will experience memory problems. This is usually the first warning sign for a decline of thinking, remembering, and reasoning (all part of the cognitive loss). Sometimes, people will be diagnosed with MIC (amnestic Mild Cognitive Impairment) and later develop Alzheimers disease. The disease may cause the person to have trouble with word finding, their vision and spatial aspects may be affected, and their judgment is questionable. The disease will worsen to a mild Alzheimers, meaning their memory will continue to decline alone with other cognitive abilities. The patient may easily become lost, they may repeat themselves, or normal tasks would take more time than necessary to complete. Paying bills would be extremely difficult, money handling may be an obstacle, and their judgment would be impaired. With time, Alzheimers disease will reach to its moderate state and spread to damage the ability to control language, reasoning, sensory processing, and conscious thought. The patients ability to remember grows even less; eventually, they wont be able to recognize their family members or friends.

3 Carrying out day-to-day activities may be impossible, whereas they lack the ability to learn new tasks. The final stage of Alzheimers disease is when it reaches severe stage and the brain is taken over by the plaques and tangles. There is a significant amount of brain tissue diminished and the person with Alzheimers is completely dependent on the help of others. A brief history of the disease/discovery Born on June 14, 1864 in Germany, Alois Alzheimer studied medicine, later becoming a physician. He had a variety of interests such as psychoses, forensic psychiatry, epilepsy, birth control, and dementia of degenerative and vascular origin. Alzheimer had a patient Auguste D- admitted on November 25, 1901 whom he examined until her death on April 8, 1903. She entered with multiple symptoms some of which are disorientation, varied behavior, hallucinations, and reduced comprehension. Alzheimer conducted tests relative to her ability to recall information or recent events as well as tests for processing information or producing information. Auguste D would lose herself in the middle of writing her name or she would repeat a line she already read in a book. After her death, Alzheimer had the patients brain sent to Munich and he examined it. He was the first to discover the abnormal neurofibrils in the brain. Logged in his reports, Alzheimer said, In the center of an otherwise almost normal cell there stands out one or several fibrils due to their characteristic thickness and peculiar impregnability. After 90 years

4 of these records being lost, they were recovered on December 19,1995 and the case was reinvestigated by scientists today. Theories of causation There are a few beliefs as to why Alzheimers happens to only certain people. Some scientists have found a gene called apolipoprotein E (APOE) and linked it to late-onset Alzheimers disease after the age of 60. Most cases have revealed this gene present; yet, people have developed Alzheimers and they didnt carry the APOE gene. Scientists have undergone an investigation regarding how we farm our food sources; they believe a connection may be made linking the nitrogen fertilizers and Alzheimers disease. In the previous years, the carbon dioxide levels have been rising, harming the quality of food and the plants ability to create protein from nitrate. Nitrogen is a key element plants need to survive and grow, and with an increase in the carbon dioxide I the atmosphere (by 50 percent increase) there is a decline of nitrogen status in plants. These scientists believe the increase of nitrates in our food and in our environment may be associated with deaths due to Alzheimers. Our generation has been exposed to a high amount of nitrogen, and along with this increased exposure has followed an increase of people suffering from Alzheimers disease. The preservation of foods also contains a high amount of nitrogen intake of humans, which adds to our health risk. Meats and fish contain sodium nitrates used to preserve, color, and flavor meats. A simple reduction of nitrate levels in fertilizer and water, and also detoxifying tap water and food

5 from common environmental toxins should help lower our risks. This does not cause Alzheimers disease; it is only a trend between an increase of nitrogen use and amount of Alzheimers patients. What can the doctor do for the patient Determining whether or not a patient has Alzheimers disease is no easy task due to the lack of technology we currently have. We can only be sure after the patient has died and can do an autopsy on the brain to confirm the tangles and plaques are there. Testing memory and ruling out other problems the patient may have are the first steps the doctor should do. If the patient experiences difficulty with communicating, remembering to eat, or doing everyday tasks, take them to be examined. Treatments? Even though we have made huge strides in discovering about Alzheimers, there are currently no cures for this progressive disease. Doctors have developed a few options for patients to try in the meantime. First, the patient should avoid places they are unaware of; the unfamiliar setting would cause excess stress. Avoid situations where the patient may become embarrassed or over excited and also keep the patient away from illnesses or infections that may be contracted. There are anti-anxiety drugs or antidepressants for those patients who display behavioral problems. Unless it is extremely necessary for the patient to take drugs for antipsychotic needs, avoid them at all costs. They are known to increase the risk of death for those with dementia.

6 The final option for a person with Alzheimers is to take generic donepezil or generic galantamine (both of which are Alzheimers drugs). These two drugs are relatively inexpensive and are proven to have less side affects than other drugs. If there is no improvement within three months of taking the drugs, it is very unlikely the person will show any progresses. Most patients stop taking the drugs at this point. Overall, drugs dont delay the onset of Alzheimers disease or improve the patients mental condition. What do you do now There are many concerns as to whether or not a family should place the Alzheimers patient into a nursing home, if they should allow them to live on their own, or if they should continue to tend to them personally. Hiring a private nurse can be very helpful but also extremely expensive. After conducting a study for the longevity of patients with Alzheimers disease living in a nursing home against those who stay at home, the experimenters concluded there is no difference. As long as the nursing home has appropriate living conditions, it significantly does not make a difference from living home or in a nursing home. As long as you consider the services provided, administration and staff, the medication policies, and health ratings of the nursing home, the patient should live just as long as they would at home. As a family member, keep a positive attitude while around the Alzheimers patient. They do not need negativity, which would only lead to depression. Approach the patient at the same level, they want to be considered equal and

7 may be easily frightened. Speak calmly and dont keep pressuring them to remember something. They cannot remember because their brain has shrunk and it only frustrates the patient when they cannot recall an event or person.

Point to consider. What happens when a patient suddenly recalls someone after years of not knowing who he or she is? Is it a miracle? Could they possibly have shown improvements?