Taking Care

In an effort to lessen the impact this has on the results of the study, the estimates from East Boston were applied to a high, middle, and low series interval of the population. The high, middle, and low series intervals are given to buffer the results of the study. The population may not grow at the rate at it is expected to so the high interval is given in case the population grows at a rate higher than expected, and the low interval in case the population grows at a slower rate than expected. This gives a broader set of results that may be more accurate. Though the results of this study are not exact, the trend that they show is correct and useful. With the baby boomer generation steadily reaching post-retirement age, more people are being diagnosed with Alzheimer’s disease and the issue of their care becomes a concern to them and their families. This raises many questions: What is Alzheimer’s disease? Is it different from senility or amnesia? What causes it? Does a person with Alzheimer’s disease need special care? Can that care be provided for in the home, by family members? Is this a practical way to care for the patient2? After Alzheimer’s is diagnosed in a parent, or other elderly family member, the caregiver has the task of deciding what the best form of care for the patient is. In order to do this they have to fully understand what the disease Taking Care Alzheimer’s Disease Essay

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Alzheimer’s Association (2010) explains that Alzheimer’s disease is a brain’s disease which affects the way people think, remember and behave. Finally, people living with Alzheimer’s do not know themselves; do not able to perform everyday activities, which means that they always have to be under control. All of these are caused by improper function of the brain. This disease leads to the death. Nowadays, the 7th cause of death in United States of America is Alzheimer’s disease. There is no method of curing yet, but it was proved that life of people living with the disease and caregivers can become better if good care and aid are provided during the whole period of the illness (Alzheimer’s Association, 2010).Taking Care Alzheimer’s Disease Essay

November is Alzheimer’s Awareness Month. It can be stressful to care for someone with dementia. Caregivers who understand the disease process of dementia and how to approach the person as the disease progresses are better able to provide an environment that helps the person live as full a life as possible. Remember that everyday activities become more challenging and confusing to a person with Alzheimer’s. Here are some practical tips for caregivers.
When performing daily activities like bathing, it is best to maintain old routines and make bathing relaxing. Simplify the task by assisting as much as needed. Don’t expect participation — even if yesterday they were willing. Every day is different. Assure safety to avoid falls. The person may be more frightened of getting into a tub or shower. A safety assessment should be done regularly as the disease progresses. In addition, people with dementia do not tolerate the cold so make sure the bathroom is warm.Taking Care Alzheimer’s Disease Essay
If you are helping someone get dressed, lay out clothes in the order they are to be put on and avoid clothes with complicated fastenings. If the person has “favorites” they insist on wearing, consider buying multiples of the same garments. You’ll also want to assess footwear to assure it provides support and safety as the disease progresses. For example, loose-fitting slippers may become dangerous.
Issues that come along with using the bathroom may arise, and for a person with dementia, it can be frightening and embarrassing. People with Alzheimer’s may lose their ability to recognize when to go to the bathroom, forget where the toilet is or what to do when they get there. Hand over hand assistance will be needed.
Tips for assisting in the bathroom include creating a bathroom schedule, leaving the bathroom door opened so the toilet is always visible and making sure clothing can be easily pulled down.
When assisting with eating, people with dementia often forget they have eaten and demand more food or refuse to eat at traditional meal time. They also may forget how to use utensils. Chewing and swallowing challenges will most likely arise as the disease progresses.Taking Care Alzheimer’s Disease Essay
To make mealtime go smoothly you may have to remind the person how to eat and try using finger foods as much as possible, serving one type of food at a time. Make sure diet consistency is reassessed regularly. Allow the person to eat what they want as long as it is integrated into the person’s daily plan.
With regards to sleeping, wandering is not uncommon at night. This is a safety concern and can also be disruptive to others. Lack of sleep can also cause behavioral challenges during the day. As a caregiver, you can discourage sleep during the day. To make sure the person sleeps soundly at night, try and schedule long walks or add more physical activity to the day. Also, assess what makes the person comfortable in their room as well as what bothers them.Taking Care Alzheimer’s Disease Essay
Delusions and hallucinations may accompany dementia. A delusion is a fixed false belief — such as the person believing someone wants to harm them or that someone is stealing from them. The delusions are very real to a person with dementia. Hallucinations are seeing things or hearing things that are not there.
When these happen don’t argue with the person you’re caring for about what is real or not; give comfort with a calm voice and gentle touch. Try and distract from the delusion or hallucination by drawing attention to something else. You may want to remove unnecessary furniture or items that can cause hallucinations in the dark.
A person with Alzheimer’s may be aggressive or become violent as a result of the disease. The sense of realizing something is happening to them that is causing loss of control can cause anxiety that leads to aggression. This can also be due to a loss of control, loss of ability to understand their environment and loss of ability to understand actions of others around them. If this happens, give the person space and stay calm. Search for what is causing it so you can find solutions and avoid future issues.
Shelley VanLare is a registered nurse at The Arc of Monroe. She has been with The Arc for seven years.Taking Care Alzheimer’s Disease Essay

What is Dementia?
If you, or a friend or relative, have been diagnosed with dementia, you may be feeling anxious or confused. You may not know what dementia is. This factsheet should help answer some of your questions about dementia, including what causes it and how it is diagnosed.
The term ‘dementia’ describes a set of symptoms which include loss of memory, mood changes, and problems with communication and reasoning. These symptoms occur when the brain is damaged by certain diseases, including Alzheimer’s disease and damage caused by a series of small strokes.
Dementia is progressive, which means the symptoms will gradually get worse. How fast dementia progresses will depend on the individual person and what type of dementia they have. Each person is unique and will experience dementia in their own way. It is often the case that the person’s family and friends are more concerned about the symptoms than the person may be themselves.Taking Care Alzheimer’s Disease Essay
Symptoms of dementia may include the following:
Loss of memory − this particularly affects short-term memory, for example forgetting what happened earlier in the day, not being able to recall conversations, being repetitive or forgetting the way home from the shops. Long-term memory is usually still quite good.
Mood changes − people with dementia may be withdrawn, sad, frightened or angry about what is happening to them.
Communication problems − including problems finding the right words for things, for example describing the function of an item instead of naming it.
In the later stages of dementia, the person affected will have problems carrying out everyday tasks and will become increasingly dependent on other people.

Introduction
Carers face very different caring challenges at each stage of the illness. Adjusting to the diagnosis and coping with the changes the illness will bring can cause a great deal of stress, but if you are well prepared and know what you may need to provide in the way of care it can help a great deal. Having a good network of family and friends who know how they can help you is also very important.Taking Care Alzheimer’s Disease Essay

About dementia

Why you should look after yourself
Caring for a person with dementia can become a very stressful and exhausting experience, although it must be emphasised that many carers report positive sides to being a carer. Carers say that being able to manage and feeling like they are doing a good job has helped them cope with caring. Understanding the importance of looking after themselves by taking regular breaks, keeping fit, having regular check-ups, accepting help, maintaining their own interests and social lives all help carers to cope with their caring role.
One of the problems often described by carers is that either their GP referred the person with dementia too late for services or they themselves left it too late before asking for help. This can result in a crisis situation where the carers feel they can’t cope even when the services are put in place to help them.Taking Care Alzheimer’s Disease Essay

An Overview of Alzheimer’s Disease

Alzheimer’s disease is a known health issue that affects a significant percentage of the aging population. It is described as the most common cause of dementia, or a type of it. The symptoms of Alzheimer’s disease tend to worsen over time to the extent where they interfere with the patient’s daily life (Keegan, 2017). As with most illnesses, the impact of Alzheimer is not limited to the patients themselves. As the patients’ condition deteriorate, they will require more care by both professional caregivers and family members.Taking Care Alzheimer’s Disease Essay

Background and significance of the disease

Alzheimer’s disease can be defined as a mental deterioration that can occur in middle or old age, due to generalized degeneration of the brain (Oxford Dictionaries). It is a progressive, degenerative disorder which attacks the brain cells, resulting in a decline in a number of cognitive functions, including loss of memory, judgment, language skills, in addition to behavioral changes, where the behavior of patients becomes unpredictable (Alzheimer’s Foundation of America). Aging is known to be the main cause of the disease, and it has been largely known to be irreversible. However, a glimpse of hope showed when a clinical trial on Alzheimer patients could restore many of the lost functions within a few months (BBC, 2016).Taking Care Alzheimer’s Disease Essay

Background

The disease is named after Dr Alois Alzheimer, who discovered it back in 1906, when one of his patients died of a mental illness that was unknown back then. After her death, Dr Alzheier conducted an autopsy on her brain and discovered changes in her brain tissues. He found abnormal clumps and tangled bundles of fiber, which today are known as known amyloid-beta plaques, and neurofibrillary tangles (National Institute on Aging).

The disease is described as degenerative as both the synapsis between neurons and neurons themselves degenerate. The loss of neurons often occurs in the neocortex and limbic system.The causes of this neurodegeneration can be attributed to formation of amyloid-β (Aβ)-containing plaques and neurofibrillary tangles composed of hyperphosphorylated tau (Crews, L., & Masliah, E., 2010). Furthermore, recent studies have found that alterations in adult neurogenesis in the hippocampus could also be considered as a factor.Taking Care Alzheimer’s Disease Essay

Signs:

The signs of Alzheimer could include difficulty sleeping, significant mood changes, loss of memory, and increasing confusion.

The loss of memory usually disrupts daily life, particularly short term memory. Other symptoms include weakened ability to solve problems and do planning activities. This is due to the decline in the executive function. It is usually associated with difficulty concentrating. Also, the patient may have difficulty doing familiar tasks such as managing a budget. Confusion with time or place such as not being able to tell which day it is, or not being able to know the location, are also common signs. The patient may have visual problems that could impact their daily tasks such as driving. People with Alzheimer could misplace things and forget where they left them, and might accuse others of stealing. Poor judgement also occurs among Alzheimer patients, and because of the changes they are going through, they will often withdraw from social activities. And also changes in mood is among the signs (Alzheimer’s association).Taking Care Alzheimer’s Disease Essay

NOW

However, those sings should not be confused with normal changes that occur with aging. In particular, the signs of Alzheimer are more sever and longer lasting (Alzheimer’s association).

Types of Alzheimer’s disease:

Alzheimer’s disease is hardly straightforward. It affects different people differently. However, eventually everyone with Alzheimer will experience the same symptoms such as memory loss and confusion. There are mainly two types of Alzheimer’s (WebMD).Taking Care Alzheimer’s Disease Essay

First, early onset Alzheimer, patients of this type tend to have more of the brain changes associated with Alzheimer. This type also appears to be related to gene changes (WebMD).

Second, late onset Alzheimer, which affects people above 65 years of age. No particular genetic associations have been found with this disease (WebMD).

Prevalence and impact of the disease (statistics)Taking Care Alzheimer’s Disease Essay

Today, more than 5 million people suffer from the disease in America alone, according to Alzheimer’s Foundation of America (2016). The risks of this disease are exasperated knowing that the risk for its occurrence increases with age, and knowing that the percentage of aging population is likely to increase in the US in the following years. In 2014, statistics showed that 14.5% of American population is above 65 years of age. It is projected that this percentage will rise up to 21.7% by 2040. In 2060, it is expected that we will have more than twice as much of people above 65 years of age as we had in 2014, i.e. around 98 million persons in 2016 (Administration of Community living, 2014). The increase in aging population is likely to be associated with the increase in the occurrence of the disease. The toll will likely increase.

The following table shows statistics of patients with Alzheimer in the state of Rhode Island, USA with projections (Alzheimer’s association):Taking Care Alzheimer’s Disease Essay

Year 65 – 74 75 – 84 Above 85 Total (rounded)
2014 2500 8000 11000 22000
2020 3200 9000 11000 24000
2025 3600 11000 12000 27000

The percentage of seniors who suffer from the disease in Rhode Island is 13%, and the number of deaths in Rhode Island caused by Alzheimer in 2010 was 338. It is estimated that in the year 2013, around 52000 persons provided unpaid care to Alzheimer’s patients. Those caregivers provided 60 million hours of care, with value estimated at $744 million (Alzheimer’s association).Taking Care Alzheimer’s Disease Essay

Provided the above statistics, and given the fact that Alzheimer’s disease is the most common form, it is clear that the impact of this disease on the individual, their family members, and the public health system is large. Adding to that toll, the need for caregiving increases as the disease progresses, and there is workforce shortage and inadequate training to provide this care. Around 64% of beneficiaries living in nursing homes are Alzheimer’s patients (Alzheimer’s association).

Surveillance methods

The current surveillance methods of the disease include collecting and compiling data on the occurrence of the disease, related risk factors and health behaviors, in addition to burden of the disease. It is worth noting that there is still insufficient data on the state level in the US regarding the disease.

To collect information about risk factors, behavioral risk factor surveillance system (CDC) is used. Through this system, data is collected about health-related risk factors, chronic health conditions, and use of preventive service.Taking Care Alzheimer’s Disease Essay

The cognitive decline model of the behavioral risk factor surveillance system contains questions about confusion or memory loss, impact on daily activities, need for assistance and caregiving, and is usually discussed with a health professional.

Diagnosis

According to Fisher Center for Alzheimer’s Research Foundation, current diagnostic tests such as brain scans and spinal taps help diagnose the illness. However, no available test is 100% accurate of foolproof. For that reason, differential testing is preferred, which relies on varied testing methods and eliminates other possible causes of the symptoms.Taking Care Alzheimer’s Disease Essay

Sometimes specialists from different fields, such as neurology, psychology, and psychiatry in addition to the main health professional, in order to provide more accurate and efficient evaluation. The evaluation relied on input from different sources including: medical history, physical examination, neuropsychological testing, and brain imaging scan (Fisher Center for Alzheimer’s Research Foundation).

The medical history part investigates previous medical problems, and any challenges in going through daily activities, in addition to any medications used such as supplements or over-the-counter medications (Fisher Center for Alzheimer’s Research Foundation). Family history with Alzheimer’s disease is known to increase predisposition to the illness.Taking Care Alzheimer’s Disease Essay

The physical examination part of the evaluation assesses hearing and vision, in addition to heart and lung, and other vital measures such as blood pressure and pulse readings. Urine tests and blood tests are often used to eliminate other possible causes (Fisher Center for Alzheimer’s Research Foundation).

In neuropsychological testing, doctors test the memory, abstract thinking skills, problem solving skills, and others. The purpose to get an in-depth understanding of the patient’s cognitive skills and be able to spot weaknesses in some of them, if they exist, leading to a better identification of underlying causes. A common test is the MMSE, which includes many assessment questions. A copy of the assessment is attached to this paper (Fisher Center for Alzheimer’s Research Foundation).Taking Care Alzheimer’s Disease Essay

The MMSE test appears to cover many important cognitive skills to check how much the symptoms interfere with the patient’s daily life, and they help provide a more specific assessment of which skills are more impaired and thus help craft a more individualized treatment plan. It also provides more detailed information about the severity of cognitive impairment and the need for care.

The fourth evaluation approach is brain-imaging scan, such as using MRI and CT scans. Those scans examine the structure of the brain closely and can identify any abnormalities (Fisher Center for Alzheimer’s Research Foundation).Taking Care Alzheimer’s Disease Essay

Action plan

Provided the gravity of this epidemic and its serious social and economic costs, public health should take more proactive action towards dealing with it. The plan should focus on prevention as well as treatment to ensure high effectiveness.

In May 2012, the US department of Health and Human Services (HHS) revealed its National Plan to Address Alzheimer’s disease (National Institute on Aging). It was updated in 2013. The plan contains two important aspects: research and care providing.

In my own practice, I will remain up to date and also work towards to achieving the goals of the plan set out by HHS. In addition, I will take the following steps with patients to whom I shall provide care.Taking Care Alzheimer’s Disease Essay

I will help patients make better dietary choices that will halt or slow their cognitive decline. Some studies have shown that herbal with anti-amyloidogenic activites, such as green tea, turmeric, Salvia miltiorrhiza, and Panax ginseng, have the potential to achieve that purpose (Hugel, 2015).
Also, to increase the effectiveness of the diet, I will encourage and assist the patients to exercise regularly. These exercise provide the much needed stimulation to spur activity in brain regions (Ali, N, 2012)
I will also take training in communication strategies with Alzheimer’s patients. Research have supported that this training could produce positive impact (J Zientz, A Rackley, SB Chapman, T Hopper, N Mahendra, ES Kim, and S Cleary, 2007).Taking Care Alzheimer’s Disease Essay
Conclusion

There is still plenty of work to be done in order to effectively prevent and treat Alzheimer’s disease. The social and economic impact of this disease make it an issue that should be a concern of many professionals beyond the health sphere. Collaboration from the scientific community is required, but collaborations from different agents from a wide spectrum of fields could lead to remarkable breakthroughs. Making the best of our available resources is essential. And there is a lot of potential in a largescale collaboration to finally reach an Alzheimer-free country.

Overview of Alzheimer’s Disease
Alzheimer’s disease (AD), the most common form of dementia, is a degenerative
disorder of the brain that leads to memory loss1
. AD affects 5.3 million Americans and is the
seventh leading cause of death in the United States. There are two main forms of the disease.Taking Care Alzheimer’s Disease Essay
Familial AD affects people younger than 65, accounting for nearly 500,000 AD cases in the
United States alone1
. The remainder of AD cases occur in adults aged 65 and older and is
classified as sporadic AD. The prevalence of AD varies among many different factors, including
age, co-morbidities, genetics, and education level. There is no way to definitively diagnose AD
without performing an autopsy. There is no cure for AD, however promising research and
development for early detection and treatment is underway.
History
Alzheimer’s disease was discovered in 1906 by Alois Alzheimer, a German neurologist
and psychiatrist2
. The disease was initially observed in a 51-year-old woman named Auguste D.
Her family brought her to Dr. Alzheimer in 1901 after noticing changes in her personality and
behavior. The family reported problems with memory, difficulty speaking, and impaired
comprehension. Dr. Alzheimer later described Auguste as having an aggressive form of
dementia, manifesting in memory, language and behavioral deficits3
. Dr. Alzheimer noted many
abnormal symptoms, including difficulty with speech, agitation, and confusion4
. He followed her
care for five years, until her death in 1906. Following her death, Dr. Alzheimer performed an
autopsy, during which he found dramatic shrinkage of the cerebral cortex, fatty deposits in blood
vessels, and atrophied brain cells2
. He discovered neurofibrillary tangles and senile plaques,
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which have become indicative of AD4
. The condition was first discussed in medical literature in
1907 and named after Alzheimer in 1910.Taking Care Alzheimer’s Disease Essay
Alzheimer’s Disease vs. Dementia and Normal Aging
Alzheimer’s disease is often confused with normal aging and dementia. Severe memory
loss, characteristic of AD, is not a symptom of normal aging. Healthy aging may involve the
gradual loss of hair, weight, height and muscle mass. Skin may become more fragile and bone
density can be lost. A decrease in hearing and vision may occur, as well as a decrease in
metabolic rate. It is common to have a slight decline in memory, such as slower recall of
information, however cognitive decline that impacts daily life is not a normal part of the aging
process5
.
Dementia is defined as the significant loss of cognitive abilities severe enough to
interfere with social functioning6
. It can result from various diseases that cause damage to brain
cells. There are many different types of dementia, each with its own cause and symptoms. For
example, vascular dementia is caused by decreased blood flow to a part of the brain, as caused
by a stroke. Dementia may also be present in patients with Parkinson’s disease and
hydrocephalus. AD is the most common form of dementia, caused by the build-up of beta
amyloid plaques in the brain1 Taking Care Alzheimer’s Disease Essay
.
Disease Presentation
AD progresses gradually and can last for decades. There are three main stages of the
disease, each with its own challenges and symptoms. By identifying the current stage of the
disease, physicians can predict what symptoms can be expected in the future and possible
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courses of treatment. Each case of AD presents with a unique set of symptoms, varying in
severity.
Early-Stage Alzheimer’s disease
This mild stage, which usually lasts 2 to 4 years, is often when the disease is first
diagnosed. In this stage, family and friends may begin to realize that there has been a decline in
the patient’s cognitive ability. Common symptoms at this stage include2,7
:
 Difficulty retaining new information
 Difficulty with problem solving or decision making. Patients may start to have trouble
managing finances or other instrumental activities of daily living.
 Personality changes. The person may begin to withdraw socially or show lack of
motivation.
 Difficulty expressing thoughts
 Misplacing belongings or getting lost. The patient may have difficulty navigating in
familiar surroundings.
Moderate Alzheimer’s Disease  Taking Care Alzheimer’s Disease Essay
Lasting 2 to 10 years, this is longest stage of the disease. Patients often experience
increased difficulty with memory and may need help with activities of daily living. Symptoms
frequently reported during this stage include2,7:
 Increasingly poor judgment and confusion. The patient may begin to confuse family
members, lose orientation to time and place, and may begin wandering, making it unsafe
for them to be left alone.
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 Difficulty completing complex tasks, including many of the instrumental activities of
daily living, such as managing finances, grocery shopping, planning, and organization.
 Greater memory loss. Patients may begin to forget details of their personal history.
 Significant personality changes. The person may become withdrawn from social
interactions and develop unusually high suspicions of caregivers.
Severe Alzheimer’s Disease
In this final stage of the disease, cognitive capacity continues to decline and physical
ability is severely impacted. This stage can last between 1 and 3 years. Due to the family’s
decreasing ability to care for the patient, this stage often results in nursing home or other long
term care facility placement. Common symptoms appearing in this stage include2,7:
 Loss of ability to communicate. The patient may still speak short phrases, but are unable
to carry on a coherent conversation.
 Reliance on others for personal care, such as eating, bathing, dressing, and toileting.
Many patients become incontinent.
 Inability to function physically. The person may be unable to walk or sit independently.
Muscles may become rigid and swallowing can eventually be impaired.Taking Care Alzheimer’s Disease Essay
Changes in the Brain
AD causes two distinct deformities in the brain, neurofibrillary tangles and senile
plaques. The neurofibrillary tangles are found in the cytoplasm of neurons in the entorhinal
cortex. There are two different kinds of plaques, neuritic and diffuse. Neuritic plaques are
spherical structures that contain neurites, which are surrounded by an abnormal protein known as
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amyloid3
. Diffuse plaques lack neurites and have an amorphous appearance. Both types of
plaques are found in the neocortex of the brain.
As the number of plaques and tangles increases, healthy neurons begin to function less
effectively. The neurons gradually lose their ability to communicate and consequently die,
resulting in an overall shrinkage of brain tissue. Neuron death, particularly in the hippocampus,
restricts the patient’s ability to form new memories.
Death from Alzheimer’s Disease
Deaths from Alzheimer’s disease as the underlying cause have increased dramatically
since 1991. The changes in the brain caused by AD are not usually the primary cause of death.
AD often causes complications, such as immobility and trouble swallowing. These can lead to
malnutrition and increased risk of pneumonia, resulting in death in these patients1
.
Risk Factors
Age
The single greatest risk factor for developing Alzheimer’s disease is age. Most cases of
AD are seen in older adults, ages 65 years or above. Between the ages of 65 and 74,
approximately 5 percent of people have AD. For those over 85, the risk increases to 50 percent2 Taking Care Alzheimer’s Disease Essay
.
Genetics
In sporadic AD, there does not appear to be a genetic pattern of inheritance. A connection
has been found between a gene called Apolipoprotein E (ApoE) and the development of AD.
This gene is responsible for the protein that carries cholesterol in the blood. One form of the
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gene, ApoE4, has been shown to increase the chances of developing the disease. However, the
ApoE2 form protects from the disease7,8
.
In the cases occurring before age 65, a mutation of chromosomes may be to blame. This
rare form of the disease is called Familial Alzheimer’s disease and it affects less than 10 percent
of AD patients. It is caused by mutations on chromosomes 1, 14, and 21. If one chromosome
mutation is inherited, the person will most likely develop AD. Offspring have a 50 percent
risk9,10
.
Education
There may be a connection between educational level and the risk of developing AD.
People with fewer years of education seem to be at a higher risk. The exact cause for this
relationship is unknown, but it is theorized that a higher education level leads to the formation of
more synaptic connections in the brain. This creates a “synaptic reserve” in the brain, enabling
patients to compensate for the loss of neurons as the disease progresses1,7 Taking Care Alzheimer’s Disease Essay
.
Coexisting Health Problems
There is a strong link between cardiovascular health and brain health. Having heart
disease, high blood pressure or high cholesterol can increase the risk of developing AD. This is
caused by damage to blood vessels in the brain, resulting in less blood flow and possible brain
tissue death. Type 2 diabetes may also increase the risk for AD. Inefficiency of insulin to convert
blood sugar to energy may cause higher levels of sugar in the brain, causing harm.
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Diagnosis
Diagnostic Criteria
The only method of definitively diagnosing AD is a brain autopsy. However, mental and
behavioral tests and physical examinations allow physicians to make an accurate diagnosis of
AD in 90 percent of cases8
. The criterion for diagnosing mental disorders can be found in the
Diagnostic and Statistical Manual of Mental Disorders (DSM-III), published by the American Taking Care Alzheimer’s Disease Essay
Psychiatric Association. In this manual, AD falls into the category of primary degenerative
dementia. The diagnostic criterion includes dementia, insidious onset with progressive
deterioration, and exclusion of all other types of dementia by history and physical examination9
.
A diagnosis of dementia includes a loss of intellectual abilities severe enough to interfere with
social or occupational functioning, memory impairment, and a variety of other symptoms9
.
The first step in finding a diagnosis is obtaining the patient history. During this time, the
physician will determine what symptoms are present, when they began, and how they have
progressed over time. The family history of illness is also pertinent. The physician will perform a
physical examination, including blood tests and urinalysis. This is done to rule out other potential
causes of dementia, such as hormone imbalance, vitamin deficiency, and urinary tract infections.
Brain scans may also be performed to exclude tumors, cerebrovascular accidents, traumatic brain
injury, and infections. These scans are also helpful in identifying the characteristic tangles and
plaques seen in AD. Structural imaging scans, including magnetic resonance imaging (MRI) and
computed tomography (CT), provide information about the shape and volume of the brain.Taking Care Alzheimer’s Disease Essay
Functional imaging allows the physician to determine how effectively the brain cells are
working. A functional MRI or positron emission tomography (PET) scan can be used10
.
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Neuropsychological examinations may be used to identify cognitive symptoms. The most
commonly administered test is the Mini-Mental State Exam (MMSE). The physician begins by
asking a series of questions designed to test the patient’s ability to recall and name a list of
objects, perform simple arithmetic, and follow instructions. The patient is then assigned a score
out of 30 possible points, with a score of less than 12 indicating severe dementia. AD patient’s
scores typically decrease 2 to 4 points every year2
.
The physician may also use the Alzheimer’s disease Assessment Scale (ADAS) to
measure the severity of the disease. The ADAS evaluates the patient’s orientation, memory,
reasoning and language on a scale of 0 to 70. A higher score represents a higher level of
cognitive impairment. The cognitive portion of the ADAS is sensitive to a wide array of
symptoms and assesses many cognitive skills, including spoken language ability, recall of
instructions, ability to find correct words, following commands, and orientation to surroundings Taking Care Alzheimer’s Disease Essay
and time10
.
In addition to mental tests, the doctor may perform a neurological exam to assess the
function of the patient’s brain and nervous system. This exam will test reflexes, coordination and
balance, sensation, muscle strength, speech, and eye function.
Detection Techniques
Neuroimaging is a promising area of research for detecting AD. There are multiple brain
imaging procedures that can be used to identify abnormalities in the brain, including PET, MRI,
and CT scans. Each scan involves a unique technique and detects specific structures and
abnormalities in the brain. Brain imaging is not currently a standard part of AD testing, however
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current clinical studies have shown promising results that may change the procedure used by
physicians to diagnose the disease.
PET
Positron emission tomography (PET) uses radiation signals to create a three-dimensional
color image of the human body11. The patient is injected with a radiotracer, composed of a
radioactive medicine bound to a naturally occurring chemical. For the study of AD, the chemical
is usually glucose. The radiotracer travels to the organs that use that specific molecule for
energy. As the compound is metabolized, positrons are emitted. The energy from these positrons Taking Care Alzheimer’s Disease Essay
is detected by the PET scan, which converts the input to an image. This image reflects the
function of the patient’s body by showing how effectively the radiotracer is broken down. The
amount of positron energy emitted creates a variety of colors and intensities, which reflects the
extent of brain activity. A PET scan has the capacity to detect changes in metabolism, blood
flow, and cellular communication processes in the brain11
.
A study published in the 1996 Journal of Clinical Psychiatry described the method of
using a PET scan to detect the changes in glucose metabolism in the brain of an AD patient. In
the parietal, temporal, and posterior cortices, an abnormally low metabolic rate of glucose was
found. The rate was further decreased in patients who had an advanced stage of the disease and
affected more locations in the brain12. Small and his colleagues discovered that a PET scan could
be used to detect the changes in glucose metabolism well before the clinical presentation of
symptoms. In addition to diagnosis, a PET image could also be implemented in determining the
effectiveness of AD treatments13 Taking Care Alzheimer’s Disease Essay
.
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PET Pros and Cons
A PET scan can be an effective choice for diagnosing AD because it can detect multiple
metabolic processes and can be used with several different labels. However, this procedure is
invasive in that it requires the use of radioactive isotopes. The resolution produced on the image
is also limited by the type of radiotracer used14
.
PET Accuracy
PET scans that test the utilization of glucose in the brain have produced accurate
diagnoses in ninety-percent of AD cases studied, according to a study at the University of Utah14
.
This technique uses a radiotracer called fluorodeoxyglucose (FDG), which mimics glucose in the
body. The scan then detects how well the tracer is metabolized in the brain. This technique is
especially effective in distinguishing between frontotemporal dementia (FTD) and AD. In cases
of FTD, decreased glucose metabolism will be seen in the front of the brain. Abnormalities in
AD are seen in the back of the brain14
. The researchers concluded that the addition of this test to
the clinical diagnostic criteria would increase the accuracy of diagnosis.Taking Care Alzheimer’s Disease Essay
CT
A computed tomography (CT) scan takes a series of cross-sectional images of the body15
.
With the help of a computer, the individual scans are integrated into one detailed image. The CT
scan provides the physician with information about the density of tissues in the body. For
improved clarity, a contrast dye may be injected to provide a distinction between similar tissues3
.
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CT Pros and Cons
A CT scan is one of the most reasonably priced neuroimaging techniques available. It is a
quick and painless procedure and can produce detailed images of bone and soft tissue. However,
several risks do exist with this system. The patient may have an allergic reaction to the dye used
and is exposed to radiation. The test results may also be misinterpreted and cannot be utilized for
every disease.Taking Care Alzheimer’s Disease Essay
CT Accuracy
CT scans can be accurate in diagnosing AD and ruling out other possible causes of the
symptoms. However, this type of scan is more effective during the later stages of the disease.
This technique is most often used to identify the neurofibrillary tangles and beta-amyloid plaques
seen during advanced stages of AD. In early diagnosis, research has shown that both the MRI
and PET scans are more effective.
MRI
Magnetic resonance imaging (MRI) techniques, first used in 1977, create two or threedimensional images of the body that can be used to diagnose injury and illness. The essential
component of the MRI system is the superconducting magnet, which produces a large and stable
magnetic field16. There are smaller gradient magnets that create weaker magnetic fields. These
magnets allow for different parts of the body to be scanned. The human body is composed of
billions of atoms. However, it is the hydrogen atoms that are altered by the magnetic field.Taking Care Alzheimer’s Disease Essay
Hydrogen atoms are each randomly spinning around an axis, but inside the magnetic field of the
MRI, the molecules are lined up with the direction of the field. Half of the atoms point towards
the patient’s head, and half point toward the feet, cancelling each other out. A few atoms out of
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every million are not cancelled out. The machine then emits a radio frequency pulse specific to
hydrogen, which causes these protons to spin in a different direction. When the spinning ceases,
the protons release energy, which is interpreted by the system. Using a contrast dye, each type of
tissue responds differently and appears as a unique shade of gray when the image is created11 Taking Care Alzheimer’s Disease Essay
.
Knowing how the system works, researchers are able to determine if an MRI can
effectively detect the structural changes and cellular death seen in the brain of an AD patient.
Atrophy of the hippocampus is often seen in AD, even before the appearance of clinical
symptoms10
. The Nun Study, conducted in 2002, collected postmortem MRI scans of 56
participants with varying degrees of cognitive impairment. The MRI was used to detect the
hippocampal volume and determine its significance as an indicator of AD neuropathology17. The
results indicated that the scans could be used to identify non-demented elderly with AD
neuropathology who have not yet presented with memory impairment. By identifying the risk for
these patients to develop AD well before the appearance of symptoms, physicians may be able to
administer treatment to slow the progression of the disease.
A more recent study conducted in 2009 by the Departments of Radiology and Neurology
at the University of Pennsylvania investigated the use of sodium magnetic resonance imaging in
the detection of AD. This imaging technique uses the same principle as discussed above.
However, instead of measuring the hydrogen atoms, this technique uses naturally abundant
sodium, 23Na. This ion was chosen because of the ability of sodium in the brain to detect tumors
and track cell death18. The participants included five healthy elderly adults and five who had a
probable diagnosis of AD. When neuronal death occurs, the intracellular space is decreased.Taking Care Alzheimer’s Disease Essay
Therefore, there is an increased concentration of sodium in the extracellular space, causing
stronger signal intensity from the MRI for patients who have AD. Though this technique is not
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yet perfected, studies are being conducted to determine if the increased signal intensity is caused
by a change in ion concentration or a change in volume1 Taking Care Alzheimer’s Disease Essay

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