THHS Health - 2nd

Widya Sujatma, Anila Thomas, Judy Wang, Raven Shan 4/20/11 Alzheimer's/Dementia

What is Dementia/Alzheimer's? Dementia isn't a specific disease, but it is a group of symptoms with an underlying cause that impairs cognitive and social function enough to cripple every day living. Most cases of dementia are degenerative, and are often caused by Alzheimer's Disease or other medical conditions that affect the brain. Symptoms start off mild with little memory loss, but as the disease progresses, people lose the ability to communicate, identify loved ones, and take care of themselves due to increased and severe impairment of cognitive function. The symptoms of dementia or Alzheimer's are NOT a natural part of aging, contrary to popular belief, though the greatest known risk factor is advancing age. Dementia is usually seen in older individuals of 60 and above, and the risk of dementia increases with age. Alzheimer's is the most common form of dementia and accounts for 50-80% of all dementia cases. It is prevalent in people 65 and above, a range under that of Dementia, but 5% of Alzheimer's cases occur in younger people in their 40's and 50's, known as early onset Alzheimer's. There is no current cure for Alzheimers (or dementia-related illnesses in general), but there are medication and treatment plans that delay the deterioration of the symptoms and the disease itself and provide comfort to the afflicted individuals and their caregivers. Symptoms and Diagnosis While the diagnosis for dementia or Alzheimer's is only exactly definitive after death, the methods and tools used to determine them are still fairly accurate. Dementia is diagnosed with a history and physical exam by a trained physician to determine whether a person with memory problems has probable Alzheimers Disease, meaning no other cause for dementia is found. Doctors ask questions about the person's past medical problems, their overall health, any difficulty in carrying out daily act ivies, and changes in personality and behavior. They will also conduct cognitive tests that include

memory, attention, counting, problem solving, and language. Medical tests of blood, urine, or spinal fluid are also carried out, as well as brain scans, such as CT's or MRI's. All of these tests may be repeated so doctors are able to detect how a person's brain function is changing over time. Early diagnosis is highly recommended for two reasons: starting treatment in the early stages of Alzheimer's Disease can preserve life and brain function for a longer period of time, and allows families to plan for the future, handling financial plans and living arrangements, and provides people greater opportunities to participate in clinical trials, where they are given experimental treatments to test their efficiency in the pursuit of a definitive cure. The most common early symptom of both dementia and Alzheimer's is memory loss, specifically difficulty in remembering new information, since they generally begin in the part of the brain that affects learning. The early symptoms of dementia include misplacing items, language problems, forgetting the name of common or familiar objects, getting lost on familiar routes or places, changes in personality, loss of interest in previously enjoyable activities, and diminished social skills. The problems often start mild and do not greatly interfere with normal living. However, if the dementia is caused by a full blown disease like Alzheimer's and progresses, the symptoms become more severe and every day activities become difficult to perform. Symptoms include forgetting events in the individuals own life history, poor judgment of danger, difficulty in pronunciation and speech, difficulty doing basic tasks such as driving and preparing meals, experiencing hallucinations, and violent behavior. In the most severe form of Alzheimer's, the affected person is no longer able to recognize family members and friends, or perform any basic activities, or communicate at all. Their brain tissue will have shrunk significantly and amyloid plaques and neurofibrillary tangles are evident throughout the brain. The person may be in bed most or all of the time until their body finally shuts down. Treatment Options While no cure for Dementia or related diseases like Alzheimer's has been found, there are treatments that serve to maintain mental function, manage behavioral symptoms, and delay the onset of

the disease. Certain drugs have been approved by the FDA that include antipsychotics, stimulants, serotonin-affecting drugs, and mood stabilizers to help control behavioral problems caused by confusion, lack of judgment, and increased impulsivity of actions. Treating behavioral symptoms helps make the person suffering from dementia/Alzheimers feel more comfortable and alleviates stress from their caregivers. There are other drugs and treatment options that slow the rate of the degeneration, which include cognitive training, physical activity, immunization therapy, cardiovascular and diabetes treatments, and antioxidants. Lifestyle Changes Dementia/Alzheimer's lead to complications that conflict with daily activities and mental problems such as deterioration of emotional health, leading to depression, confusion, paranoia, frustration, and anxiety since the disease causes changes in behaviors and personality, and the changes can either be caused by the actual degeneration happening in a person's brain or reactions to the emotional challenges that result. Inadequate nutrition and reduced hygiene are also problems for people living with the disease, since nearly everyone with dementia will at some point stop eating and drinking. An advanced form of dementia or Alzheimer's causes people to lose muscle control so they face difficulty in chewing and swallowing, putting them at risk of choking and blocking their breathing. In people with Alzheimer's or moderate to severe dementia, they completely lose the ability to care for themselves and may no longer be able to dress, brush their teeth, bathe, or go to the toilet on their own. Other complications include difficulty taking medication, since their memory is affected, delirium, caused by a decline in attention, mental clarity, lack of awareness, disruption in sleeping patterns and sleep disorders like insomnia and sleep apnea, and difficulty communicating, since the ability to remember the names of people may be diminished, which is also hard on the caregiver trying to understand their needs, feelings, or simply to communicate socially with the patient. The disease greatly impairs judgment and reduces the capacity of problem-solving and decision making, leading to personal safety challenges in situations such as cooking, driving, falling, and getting around obstacles.

Impact on Family The effects of dementia/Alzheimer's Disease are devastating to both the patient and their family, and they experience staggering financial, emotional, and psychological costs. Family caregivers make heavy sacrifices as they often take time off of work and forego pay to devote 47 hours per week on average to care for their afflicted family member. The initial diagnosis is traumatizing for everyone, and the family often focuses on coming to terms with the disease, leaning about it, and preparing for the future. Some patients may begin to become angry either from the disease itself or as a reaction to it, and lash out their loved ones, leading to strained relationships and internalized wounds, but to prevent this, the family must differentiate their family member from the disease. As Alzheimer's Disease (or another form of dementia) progresses, the stress on their family and caregivers becomes greater, frequently feeling isolated and hopeless as they watch their family member slip out of reality. Since safety becomes a major issue to the person suffering from the disease, family members are forced to approach their loved one as a hapless child, and consider daycare or nursing home options if they are unable to effectively care for their family member anymore due to the increasing severity in symptoms. The later stages of Alzheimer's requires extensive supervision if the family chooses to care for the patient at home. Families must be constantly available to feed, clean, move, and diaper the patients. Some families choose for hospice care or a nursing facility at the end of the patient's life, where adequate care and supervision is provided. All throughout the stages of life of the Alzheimer's patient, tremendous emotional support for both the individual impacted by the disease and the family is imperative, either by means of counseling or support groups, excellent resources to help the family maintain a strong relationship with the patient and avoid isolation that often comes from caring for the individual. Relationship to Other Diseases

As dementia is a descriptive term that covers a broad range of symptoms that can be caused by various neurological disorders, it is not limited to only Alzheimers disease. Additional related degenerative disorders of the brain include Parkinson's, and Huntington's disease. Parkinsons disease is defined as a disorder of the brain that leads to tremors and difficulty with walking, movement, and coordination. It occurs when the nerve cells of the brain that are responsible for dopamine production, gradually become damaged. Without dopamine, a neurotransmitter essential for the normal functioning of the central nervous system, the nerve cells in the brain cannot properly send messages to the rest of the body. Muscle function gradually decreases, and the disease eventually worsens. Generally after age 70, an estimated 20-30% of patients diagnosed with Parkinsons disease will develop the symptoms of dementia, but since it is a secondary dementia, the relationship between Parkinsons and the symptoms isnt completely understood. If the disease does develop into dementia, the symptoms generally take about 10-15 years to detect. Dementia is also linked to the inherited disorder, Huntingtons disease. This is a progressive degenerative disease of cognition, emotion, and movement, transmitted by a single dominant gene on chromosome 4. Symptoms often include fluctuations in behavior and personality, including depression, irritability, and anxiety. Vascular disorders, or blood-related disorders, linked to dementia include multi-infarct disease. Multi-infarct disease, caused by multiple strokes in the brain, is the second most common cause of dementia, aside from Alzheimers. Generally affecting people between ages 55 and 75, a stroke is the blockage or interruption of the blood supply in any part of the brain (also known as an infarct). If the blood flow is stopped for a long span of time, oxygen cannot make its way to the brain. This causes permanent damage to the brain cells over time. Infections that affect the central nervous system, such as HIV and Creutzfeldt-Jakob disease can also be linked to dementia. In early stages of infection, the HIV virus enters the central nervous system. Thus, patients with the human immunodeficiency virus can usually suffer from neurological and

psychiatric complications. Cognitive impairment associated with HIV disease is also known as AIDS dementia complex (ADC). Other symptoms include behavioral changes, and motor involvement. Creutzfeldt-Jakob disease (CJD) is a very rare, degenerative, and fatal brain disorder. CJD symptoms include loss of memory, behavioral changes, lack of coordination and visual disturbances; all symptoms associated with dementia. As time progress, CJD worsens and a severe onset of effects appears: involuntary movements, blindness, weakness of extremities, and sometimes coma. About 90% of people suffering from Creutzfeldt-Jakob disease die within a year. Addiction to alcohol or drugs are another disease linked to dementia, but not as common as Alzheimers. The symptoms include memory loss, language issues, impaired judgment and personality changes. Dementia caused by chronic substance abuse is similar to general dementia. Hence, the dementia can be effectively treated if it is detected in its early stages. However, if left untreated for a long time, the effects may be permanent. Prevention Most cases of dementia or Alzheimer's Disease are not preventable, but the risk of being diagnosed with a type of dementia, vascular dementia, can be reduced by controlling diabetes, high blood pressure quitting smoking, and even eating a healthy diet and exercising regularly.

Works Cited "Alzheimer's Disease Fact Sheet." Nia.nih.gov/. National Institute on Aging. Web. 18 Apr. 2011. <http://www.nia.nih.gov/Alzheimers/Publications/adfact.htm>.

"Alzheimer's Disease." FCA.org. Family Caregiver Alliance. Web. 21 Apr. 2011. <http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=567>. "Dementia: Complications." MayoClinic.com. Web. 18 Apr. 2011. <http://www.mayoclinic.com/health/dementia/DS01131/DSECTION=complications>. "Dementia." Ncbi.nlm.nih.gov. National Center for Biotechnology Information. Web. 20 Apr. 2011. <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001748/>. "Multi-infarct Dementia - PubMed Health." Web. 01 May 2011. <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001754/>. "Parkinson's Disease with Dementia." Caregiver.com - For Caregivers, about Caregivers, by Caregivers. Web. 01 May 2011. <http://www.caregiver.com/articles/parkinsons/parkinsons_disease_with_dementia.htm>. "Risk Factors." Alz.org. Alzheimer's Association. Web. 20 Apr. 2011. <http://www.alz.org/alzheimers_disease_causes_risk_factors.asp>. "Types of Dementia." Cleveland Clinic. Web. 01 May 2011. <http://www.clevelandclinic.org/health/health-info/docs/2300/2340.asp?index=9170>. "What Is Alzheimer's?" Alz.org. Alzheimer's Association. Web. 19 Apr. 2011. <http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp>.