| Introduction to Alzheimer's Disease Dementia vs. Normal Aging As people grow older, they worry that forgetting the phone number of a best friend o the name of a person they should know must mean they are becoming demented or getting Alzheimer's disease. Forgetfulness due to aging or increased stress is not normal aging, nor is it dementia. "Dementia" is an encompassing term for numerous forms of memory loss. There are many types of dementia such as Alzheimer's disease, Multi-Infarct dementia or Parkinson's disease. When a person has dementia, he/she will lose the ability to think, reason and remember and will inevitably need assistance with everyday activities such as dressing and bathing. Changes in personality and mood are also symptoms of dementia. Many dementias are treatable and reversible. Alzheimer's Disease is the most common form of untreatable, irreversible dementia. Overview History Alzheimer's disease (AD) was first discovered in 1906 by a German doctor named Alois Alzheimer. It is a disorder of the brain, causing damage to brain tissue over a period of time. The disease can linger from 2 to 25 years before death results. AD is a progressive, debilitating and eventually fatal neurological illness affecting an estimated 4-5 million Americans. It is the most common form of dementing illness. Statistics In America alone, Alzheimer's disease affects four million people. It is estimated that more than 370,000 Floridians have Alzheimer's disease or some other form of dementia, and that the disease affects 2,500 persons in Leon County. For those with the disease, a diagnosis of Alzheimer's can mean from two to 25 years of decline. For their families and caregivers, diagnosis is just the beginning of an increasingly heavy physical, emotional and financial burden. Alzheimer's disease is characterized clinically by early memory impairment, followed by language and perceptual problems. This disease can affect anyone - it has no economic, social, racial or national barriers. Causes There is no one cause for Alzheimer's disease. AD may be sporadic or passed through the genetic make- up. The disease causes gradual death of brain tissue due to biochemical problems inside individual brain cells. The symptoms are progressive, but there is great variation in the rate of change from one person to another. Although in the early stages of Alzheimer's the victim may appear completely healthy, the damage is slowly destroying the brain cells. The hidden process damages the brain in several ways:
The size and shape of the brain alters - the cortex appears to shrink and decay Understandably, as the brain continues to degenerate, there is a comparable loss in mental functioning. Since the brain controls all of our bodily functions, people in the later stages of Alzheimer's will have difficulty walking, talking, swallowing and controlling bladder and bowel functions. They become quite frail and prone to infections such as pneumonia. Diagnosis There are numerous conditions that present with symptoms of dementia. Conditions such as stroke, vascular diseases, toxins, nutritional deficiencies, infections and depression can all have symptoms that simulate dementia. Ten to fifteen percent of these conditions can be well managed or cured. For this reason, it is most important that a thorough examination be done in order to rule out any treatable condition. The diagnosis of Alzheimer's disease is one of excluding other conditions that may be responsible for producing the symptoms such as memory loss, confusion and personality change. A definite diagnosis of Alzheimer's disease is still only possible during autopsy when the hallmark plaques and tangles can be detected. But with techniques now available, physicians and patients can count on 85 to 90 percent accuracy, according to studies in which clinical diagnosis was later confirmed by autopsy. Clinicians diagnose "possible Alzheimer's disease" and "probable Alzheimer's disease" using criteria established in 1984 by the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association guidelines. The most effective way to diagnose AD is now through Memory Disorder Clinics, (MDC), such as the ones funded by the State of Florida. The clinic evaluation is a team approach to diagnosis of memory impairment. Whether the diagnosis is Alzheimer's disease, Multi-Infarct dementia, Parkinson's disease or any other form of dementia, the Memory Disorder Clinic professionals will assist the patient and family with services and resources specifically for their situation. The evaluation will include:
A summary evaluation conference will be conducted with the patient and caregiver by the MDC team (Neurologist, Neuropsychologist, Social Worker, Clinical Nurse Specialist, other specialists as needed). A community resource management plan will be offered to the patient and caregiver and a report will be sent to the patient and referring physician. Research and Treatment There is continually new research being performed to determine the exact cause of Alzheimer's disease, which is not yet known. Some drugs and over-the-counter vitamins and/or medications have been introduced to help the symptoms of Alzheimer's disease. Nothing has been found to "cure" the disease, but some drugs may improve a person's communication skills and ability to perform activities of daily living. It is best to discuss new medications or vitamin treatment with your physician for benefits, drug interactions and side effects prior to treating Stages of Progression Alzheimer's Disease can be characterized as having early, middle, and late stages through which the patient gradually progresses, but not at a predictable rate. The range of the course of the disease is two to 25 years. NOTE: Stages very often overlap. Everyone progresses through these stages differently. First Stage: This is a very subtle stage usually not identified by either the impaired person or the family as the beginning signs of the disease. Subtle changes in memory and language along with some confusion occur at this time. The family usually denies or excuses the performance deficiencies at this stage.
Second Stage: As Stage 1 moves onto Stage 2, there is usually a particular significant event that forces the family (and impaired person) to consider that something is really wrong. At this time, they usually go to a doctor to diagnose the problem.
Third (Final) Stage: This stage is the terminal stage and may last for months or years. The individual will eventually need total personal care. They may no longer be able to speak or recognize their closest relatives.
Other Related Dementias Multi-Infarct Dementia (MID): In MID, blockages in the small arteries of the brain cause a loss of circulation beyond the blocked area. When the blood supply is blocked off for a long time, the cells die. Individuals with a history of arrythmias, irregular heart rhythms, heart disease or high blood pressure may be particularly vulnerable to this type of problem. This may be referred to as a series of small strokes. (Cohen, Donna, PhD and Eisdorfer, Carl PhD, MD: The Loss of Self, 1986.) Parkinson's Disease: This is a chronic disorder of the central nervous system of variable progression and severity. Clinically, the disease is characterized by rigidity, a resting tremor and gait disorder. Persons with Parkinson's disease have a higher level of dopamine, a chemical in the brain that controls movement. There can also be speech impairment. There is a growing awareness of dementia among Parkinson's disease patients, however, other mental changes may also occur such as drug related episodic confused states. Depression frequently accompanies Parkinson's disease. (Reisberg, Barry, MD: Alzheimer's Disease: The Standard Reference, 1987. Heilman, MD, Doty, PhD, Stewart, MD, Bowers, PhD, Gonzalez-Rothi, PhD: Helping People with Progressive Memory Disorders: A Guide for You and Your Family, 1996.) Lewy Body Disease: Lewy body disease presents symptoms similar to Parkinson's and Alzheimer's diseases. It is an irreversible brain disorder caused by protein deposits in the brain cells. Lewy body disease can be characterized by an early development of hallucinations and difficulty with motor skills. Patients with Lewy body disease are often sensitive to the side effects of strong tranquilizers such as an antipsychotic medication. (Heilman, MD, Doty, PhD, Stewart, MD, Bowers, PhD, Gonzalez-Rothi, PhD: Helping People with Progressive Memory Disorders: A Guide for You and Your Family, 1996.) Progressive Supranuclear Palsy (PSP): Problems that are common symptoms of PSP are unsteady gait, backward falls because of poor balance, visual disturbances, slurred speech and forgetfulness. The average duration from onset to death is approximately 6 years. Bronchopneumonia is shown as the most usual cause of death recorded on death certificates. All patients with supranuclear palsy have down gaze and often have dementia. (Maher, E.R., BSC, MRCP and A.J. Lees, MD, MRCP: Neurology, July 1986.) Binswanger's Disease: Binswanger's disease is caused by a decrease in blood flow to the central portion of the brain. Motivation and memory loss are usually the first symptoms of this disease, followed by decreased cognitive functioning. Other characteristics of Binswanger's disease include depression, sudden outbursts of anger or restlessness and language problems as the disease progresses. (Heilman, MD, Doty, PhD, Stewart, MD, Bowers, PhD, Gonzalez-Rothi, PhD: Helping People with Progressive Memory Disorders: A Guide for You and Your Family, 1996.) Pick's Disease: Another progressive dementia, Pick's disease affects the frontal and temporal lobes of the brain. Initial signs of this disease are lack of motivation, personality changes, impulsive or spontaneous behavior, amnesia and/or speech difficulties. Medications can help manage some of the problem behavior. (Heilman, MD, Doty, PhD, Stewart, MD, Bowers, PhD, Gonzalez-Rothi, PhD: Helping People with Progressive Memory Disorders: A Guide for You and Your Family, 1996.) Creutsfeldt - Jakob Disease(CJD): CJD is a rare, fatal brain disorder caused by an unknown organism, possibly a virus. The disease causes a mental deterioration and a variety of neurological symptoms and usually leads to death within a year of onset. CJD can produce memory loss, motivational-intentional disorders or cognitive impairment. In addition, it is not uncommon for a person with CJD to experience jerking muscle movements, leg and arm spasms, extra sensitive reactions to loud noises and lack of coordination. (Heilman, MD, Doty, PhD, Stewart, MD, Bowers, PhD, Gonzalez-Rothi, PhD: Helping People with Progressive Memory Disorders: A Guide for You and Your Family, 1996). Corticobasal Degeneration: Also known as Rebeitz Syndrome, Corticobasal degeneration is one of the uncommon forms of progressive dementia. It is caused by changes in the brain cells of the cortex (the cerebrum) and the basal ganglia. Symptoms include apraxia, rigidity, involuntary movements, dystonia, the 'alien limb' sign, dysarthria and subranuclear disorder of the eye movement. Mental impairment occurs late in the course of the disease but some patients lose language early. There are swollen cells similar to Pick cells but no Pick bodies. This disease usually affects people in their 60's to 80's. Males and females are equally affected. (Rossor, Martin, MD, MA, FRCP: C.A.N.D.I.D. Counseling and Diagnosis in Dementia, The National Hospital for Neurology and Neurosurgery, London 1998. Heilman, MD, Doty, PhD, Stewart, MD, Bowers, PhD, Gonzalez-Rothi, PhD: Helping People with Progressive Memory Disorders: A Guide for You and Your Family, 1996). Huntington's Disease: This disease affects the basal ganglia and frontal lobe areas of the brain. Huntington's disease is characterized by emotional changes, like depression, and sporadic muscle activity. Late in the disease process, persons experience progressive dementia with bouts of amnesia and lack of motivation. Huntington's disease affects nearly 25,000 people in America. Onset usually occurs during middle age. (Heilman, MD, Doty, PhD, Stewart, MD, Bowers, PhD, Gonzalez-Rothi, PhD: Helping People with Progressive Memory Disorders: A Guide for You and Your Family, 1996). |
Alzheimer's Disease Index & Resource Handbook of the Big Bend Area - 17th Edition (2007) Leon County Project Lifesaver Overview |
22nd Annual Alzheimer's Disease Education & Training Conference February 23, 2008 8 a.m. - 3 p.m. Was held at Florida State University College of Medicine |
| Information & Resources of The Alzheimer's Project, Inc. |
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