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Dementia itself is not a disease. It is a term used to define a set of symptoms marking the deterioration of a wide range of cognitive (thought) functions that is serious enough to impair a person's ability to perform the normal daily tasks that were once within the person's capabilities. There are many causes for dementia, including vascular diseases, nutritional disorders, head injury, and infectious diseases. In some cases dementia is reversible in some it is not. The most common cause of dementia in the elderly is Alzheimer's disease. While the term dementia refers to a large number of symptoms, not all symptoms are present in all dementing illnesses. Dementia includes symptoms of short and long- term memory loss, and decline in learning ability, abstract thought processes, problem solving, attention, concentration, coordination, judgment, language, orientation, motor integration and social skills. Dementia may also include changes in personality and behavior that can result in depression, anxiety, agitation, restlessness, suspicion, withdrawal from social activities, inappropriate behaviors, wandering and changes in sleep patterns. Delusions and hallucinations are also common features of dementia. Alzheimer’s Disease Alzheimer's disease is characterized by progressive pathological changes in the brain that translate into clinical signs of decline in cognitive abilities (memory, concentration, orientation), functional abilities (shopping, preparing meals, getting dressed), mood, behavior, and finally physical changes (stiffness, loss of the ability to walk, or smile). The pathological changes in the Alzheimer's brain include deterioration and loss of neurons (nerve cells) leading to brain atrophy (shrinkage); and the abnormal accumulation of proteins forming neurofibrillary tangles and amyloid plaques. Pathologists look for these changes in the brain when diagnosing Alzheimer's disease, and scientists study the causes of these changes in hope of finding a cure for the disease. Diagnosis An Alzheimer’s disease diagnosis is based on the results of a variety of diagnostic tests in conjunction with the observations of an experienced clinician. There is no single diagnostic test for Alzheimer's disease. Rather, an AD diagnosis is based on the results of a variety tests that include neurological examinations, mental status examinations, neuropsychological and psychiatric evaluations, physical examination including laboratory tests, the patient's past medical history and medications that the patient is currently taking. Extremely important to the diagnosis of AD is the clinician’s evaluation of the patient’s symptoms in relation to the results of diagnostic testing. The clinician must accurately investigate the onset of symptoms (sudden or gradual), the presentation of symptoms (how do symptoms occur), and the progression of these symptoms over time. A diagnosis of either probable or possible Alzheimer’s disease is given once the diagnostic tests and clinical observations have been made. A diagnosis of probable Alzheimer's disease is given when all other causes for dementia have been ruled out and the cause is most likely Alzheimer's disease. A diagnosis of possible Alzheimer's disease is given when symptoms of Alzheimer's disease may be complicated by another disorder. Alzheimer's diagnoses given at specialized research facilities are up to 90% accurate. A diagnosis of definite Alzheimer's disease, however, can only be given by examination of brain tissue obtained through autopsy. Progression Alzheimer's disease gradually affects different areas of the brain. Initially Alzheimer's disease affects functioning in the areas of the brain associated with memory, language comprehension, and emotion. Further progression leads to changes in functions such as orientation in space, problem solving, and personality. Alzheimer's disease is often described and discussed by clinicians in terms of the severity of changes in the brain, and the severity of decline in cognitive and functional abilities. Causes The cause of Alzheimer's disease is not yet known, but scientists are hoping to find the answers by studying the characteristic brain changes that occur in a patient with Alzheimer's disease. In rare cases when the disease emerges before the age of sixty-five, these brain changes are caused by a genetic abnormality. Scientists are also looking to genetics as well as environmental factors for possible clues to the cause and cure of Alzheimer's disease. Care and Treatment Options At present, there is no cure for Alzheimer's disease, but several treatment options exist for both the cognitive and behavioral symptoms of the disease. Drugs such as donepezil (Aricept© ), rivastigmine (Exelon© ), and galantamine (Reminyl© ) are used to treat cognitive symptoms in Alzheimer's disease. Antidepressants, anti-anxiety medications, and antipsychotics are used to treat the symptoms of depression, anxiety, agitation, and the hallucinations and delusions that may occur in Alzheimer's disease patients. For stage specific information about treatments, see below. In addition to the treatments already available, many clinical trials of new drugs, studies of non-pharmacologic treatments and psychosocial interventions are continuously being conducted in specialized Alzheimer's disease research centers around the world. Mild Alzheimer’s Disease Maintaining present health. Symptoms of mild Alzheimer's disease can now be treated with medications such as donepezil (Aricept© ), rigavistimine (Exelon© ) and galantamine (Reminyl© ); and many more medications are currently being tested in clinical trials. Symptoms of depression and anxiety that may result from Alzheimer's disease can also be treated with medication. Because early stage Alzheimer's disease can be difficult and emotionally trying for people with the illness and their family members, the Alzheimer's Association sponsors both early-stage support groups for people with the disease, and caregiver support groups for families involved in the healthcare of people with Alzheimer's disease. For people with Alzheimer's disease who are living alone, there are many support services available that make daily tasks easier to manage. The Safe Return Program sponsored by the Alzheimer's Association provides added security for people who routinely go out alone. Planning for the future. Since Alzheimer’s disease is characterized by a progressive decline that eventually compromises a person’s ability to make decisions, planning for future care should take place as early in the disease as possible. Completing a healthcare proxy, a living will or power of attorney for healthcare and/or finances can help ensure that a person's healthcare needs are met when a person becomes unable to voice wishes on their own. Other legal and financial planning can be completed with the help of an elder care attorney who understands many of the legal and financial issues associated with long-term elder care, and can advise the person about his/her options based on individual information about the person's present situation. Why is an evaluation important for people with mild Alzheimer’s disease? Because there are now treatments available for mild Alzheimer's disease, it is critical that people exhibiting symptoms have an evaluation and start treatment as soon as possible. An evaluation at this stage provides information about the nature and severity of symptoms, and provides guidelines for appropriate care and treatment plans. Evaluations conducted periodically can help monitor these symptoms. Why is it important for researchers and clinicians to understand mild Alzheimer’s disease? Early symptoms often indicate the first observable signs of Alzheimer's disease and so it is extremely important for researchers and clinicians to study and understand the diagnostic test results of individuals in this stage. The collection of large amounts of data about the earliest signs of Alzheimer's disease may provide answers about what causes the disease and ways to treat or cure it. Moderate Alzheimer’s Disease Maintaining present health. Pharmacologic treatments available for symptoms of moderate stage Alzheimer’s disease include donepezil (Aricept© ), rigavistimine (Exelon© ) and galantamine (Reminyl© ). Other new drugs for moderate stage Alzheimer’s disease are being tested in clinical trials. This stage of Alzheimer’s disease may be accompanied by symptoms of depression and anxiety or may result in a person experiencing hallucinations and delusions that can be treated with antidepressants, anti-anxiety medications, and anti-psychotics. Because a person at this stage experiences an increasingly serious decline in cognitive and functional abilities, and may no longer be able to perform most complex tasks of daily life, a person may feel anger and frustration that can result in outbursts and other behavioral problems. Many non-pharmacologic treatments and psychosocial interventions have focused on managing and/or avoiding behavioral symptoms of people in this stage of Alzheimer’s disease. Formal care for people with moderate stage Alzheimer’s disease living at home include daily home care provided by home health aides and adult day programs that provide social, recreational and therapeutic activities specifically geared toward people with this disease. Depending on the severity of a person’s symptoms, or the presence of other illnesses that may effect a person’s physical health, formal care options may also include assisted living facilities or nursing homes that provide housing and care for people with Alzheimer’s disease. Informal care, provided by family, or trusted long-term friends, usually includes scheduling and coordinating daily activities, supervising home health aides, providing personal care, accompanying the person with AD to medical and other important appointments, and managing finances and legal matters. The Safe Return Program sponsored by the Alzheimer’s Association provides security for people who tend to wander and may get lost. Planning for future care. Healthcare and financial planning are extremely important to the well-being and security of people with Alzheimer’s disease and their families. Healthcare proxies, living wills and powers of attorney for healthcare and/or finances can help ensure that a person's healthcare needs are met when the person becomes unable to voice wishes on their own. Legal and financial planning can be completed with the help of an elder care attorney who understands many of the legal and financial issues associated with long-term care, and can advise the person with Alzheimer’s disease and his/her family about long-term care options based on individual information about the person’s or family’s present situation. As Alzheimer’s disease progresses into the moderate stage, it is increasingly more difficult for people with the disease to make complex decisions. A diagnostic evaluation at this stage will help to determine a person’s existing cognitive and functional abilities. An elder care attorney may be able to provide guidelines about who is considered competent to sign legal documents and under what circumstances. Why is an evaluation important for people with moderate Alzheimer’s disease? Symptoms of this stage of Alzheimer’s disease indicate serious changes in both mental and physical functioning. An evaluation at this stage provides extremely important information for patients and their families about the extent of decline in a person's physical and mental abilities, and an accurate picture of a person's existing capabilities in these areas. Because there are treatments available for some of the symptoms exhibited in this stage, it is very important that people with Alzheimer's disease are properly evaluated and begin treatment as soon as possible. Why is it important for researchers and clinicians to understand moderate stage Alzheimer’s disease? It is extremely important for researchers and clinicians to track the changes that occur in the bodies and minds of people at this stage in order to understand the progression of Alzheimer's disease, to provide appropriate care using the treatments currently available, and to develop new treatments and cures in the future. Moderately Severe to Severe Alzheimer’s Disease Maintaining present health. Although there are no pharmacologic treatments for moderately severe to severe Alzheimer’s disease approved for sale in the United States, a new drug, Memantine, has recently been tested in clinical trials and has shown promise. In the near future, another drug, galantamine, (Reminyl© ) will also be tested in clinical trials for its effectiveness in treating moderately severe to severe Alzheimer's disease. Because a person at this stage experiences serious decline in cognitive and functional abilities, and is no longer able to perform the complex tasks of daily life, a person may feel anger and frustration that can result in outbursts and other behavioral problems. Many non-pharmacologic treatments and psychosocial interventions have focused on managing and/or avoiding behavioral symptoms of people in this stage of Alzheimer’s disease. Hallucinations and delusions which often accompany this stage of Alzheimer's disease can be treated with anti-psychotics. For people with moderately severe Alzheimer’s disease who are living in their own homes, formal care options include personal care provided by home health aides, and, if the person is still able to participate, adult day programs that provide social, recreational and therapeutic activities specifically geared toward people with this disease. Depending on the severity of a person’s symptoms, or the presence of other illnesses that may effect a person’s physical health, formal care options may also include nursing homes that provide housing and care for people with Alzheimer’s disease. Informal care, provided by family, or trusted long-term friends, usually includes providing personal care, supervising home health aides, coordinating daily activities, arranging for and supervising medical care, and managing finances and legal matters. As a person's symptoms progress into severe Alzheimer's disease, physical movement becomes increasingly restricted, until complete care is necessary. If the person remains at home this care is provided through the formal care of a skilled nurse, and a home health aide or the care of family members. At-home hospice programs offer palliative care provided by a team of trained professionals. Nursing homes provide personal care and housing to persons with severe stage Alzheimer's disease who are unable, for any reason, remain in their own homes. Palliative care is also offered in nursing homes. Why is an evaluation important for people with moderately-severe to severe Alzheimer’s disease? The moderately-severe to severe stage of Alzheimer's disease is marked by very serious loss of mental and physical functioning. An evaluation at this stage helps determine a persons remaining abilities, and establishes an appropriate care and treatment plan. Why is it important for researchers and clinicians to understand moderately-severe to severe stage Alzheimer’s disease? Only through a complete understanding of the progression of Alzheimer's disease and the effect it has on the mind and body at each stage can researchers and clinicians develop new treatments and provide proper care and treatment options to those with the disease. |
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