Dementia of the Alzheimer’s type

Alzheimer's disease affects 6% to 10% of the population over age 65 in the United States, and, unfortunately, the number of the people suffering from this disease has risen dramatically through the middle of the 21st century. There is no specific test that diagnoses dementia, as well as no medical cure for this disease. This paper will discuss Alzheimers dementia, its risk factors, signs, major diagnosis strategies as well as nursing guidelines concerning management of this disease.

 
 

Alzheimer's disease (AD) is a neurodegenerative type of dementia. It is a neurological disorder characterized by progressive death of brain cells; it causes memory loss and cognitive decline as well as other cognitive disabilities. Although aging is one of the risk factors for Alzheimer's, AD is not a normal part of aging. People who suffer from AD are approximately 65 or older. However, 5% of the people with Alzheimer's have early-onset disease and are from 40 to 50 years old.

There are ten major warning signs of Alzheimer's disease according information provided by the Alzheimers Association. Loss of memory is one of the most widespread signs especially in the early stages. Early diagnosis is vitally important. In this case, the person forgets recently learned information, significant events or dates, and may ask about the information repeatedly. Problem management is impaired, meaning that the patient with the disease is not as quick in solving problems as used to be, forgets to pay bills or has problems with simple math calculations. Poor daily task management can be a sign of dementia too. The person has difficulties with simple day-to-day tasks at work, at home or leisure such as dressing oneself, eating, recording a favorite TV show or driving to a familiar place. Disorientation in time and place is another sign of the disease. The person cannot tell which day of a week it is, confuses the passage of time, the past and present. People with AD can get lost in a familiar place and often do not remember how they got there. Troubles with vision lead to a person being not able to recognize himself or herself in the mirror, having problems with reading and identifying distance or confusing colors. Language troubles may become a warning sign of Alzheimer's. People with AD can have difficulty to write or speak, like finding the right words, ability to hold or continue the conversation. A person with AD can lose things and not be able to retrace the last steps or actions. Another signal is poor decision making in dealing with finances or inability to make the right judgments from time to time. A person with AD can give up his or her hobbies, avoid social activities, sports or job projects. Significant personality changes and mood shifts is another sign of the disease. In such case, a person is highly irritable, fearful or depressed.

There are three major stages of AD according to the disease progression, such as preclinical, mild cognitive impairment (MCI) and dementia. During the preclinical stage, the person is able to be a part of the society, work or drive independently, but has memory problems like concentration or planning issues. MCI is the longest stage of Alzheimer's disease and includes such symptoms as forgetfulness, confusing words, changes in behavior. In the late stage of AD, the person requires 24/7 care because of the lost ability to perform routine actions, disability to communicate as well as poor physical abilities. However, AD affects people in different ways, so each person experiences progress and symptoms of the disease individually.

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There are factors that may have direct connection to the Alzheimer's disease. Researchers are still struggling to understand the risk factors of this illness. However, they managed to define a few of them. The biggest risk factors associated with Alzheimer's disease include age and genes, often classified as unavoidable. It has been clinically proven that people who have at least one member with Alzheimers disease are more likely to get ill. There are certain genes, the presence of which puts a person into the risk group of having Alzheimer's. As for the age, a greater number of people over 85 have AD than people over 60. However, there is a group of Alzheimer's risk factors, which can be modified or even potentially avoided. Vascular factors are connected with blood vessel diseases such as diabetes, high blood pressure or cholesterol. Physical head injuries can become one of the risk factors as well as sleep disorders. People with low level of occupational and educational attainment are in the risk groups as well. It is quite hard to diagnose Alzheimers, especially at the early stages. However, early revelation of the disease can help to prevent its development significantly. According to newly found criteria, AD process starts years before any of the clinical symptoms appear, and can be detected by specific biomarkers. Unfortunately, the only definite method to diagnose AD is to reveal the presence of plaques and tangles in the brain tissue by autopsy after the patients death. Therefore, diagnosis of Alzheimer's disease is rather probable than precise. Mostly, neurologists study the medical history and conduct neurological and memory status tests to find out if there are any cognitive problems and a number of secondary symptoms of AD. They can also perform general blood and urine tests and brain scans to see if there are any visible abnormalities in the brain. However, there are no specific medical tests to identify the disease.

As for the treatment of Alzheimer's, only symptomatic approach is available, since scientists still are working on finding the reasons of this disease. However, symptoms of AD are treated both in a pharmacological and non-pharmacological ways. As for pharmacology, there is no medication able to cure AD, however, scientists continue with the research. Thus, the approved drugs for treating dementia are those that modulate acetylcholine or glutamate or neurotransmitters. The secondary symptoms of AD such as agitation, sleep disorders, depression, aggression, hallucinations, are treated with other types of medicine, such as antidepressants, antiparkinsonian agents, anxiolytics, beta-blockers, neuroleptics and antiepileptic drugs (to influence behavior). Besides pharmacological, there are specific behavioral interventions that are used in AD treatment. These are patient-centered approaches and caregiver trainings to help manage cognitive and behavioral manifestations of AD. These interventions are often combined with the more widely used pharmacological interventions.

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Mental exercises are very important when treating Alzheimer's at the early stages. During this stage patients are usually treated with prevention drugs that help to preserve cognitive activities as long as possible diagnosis. However, experts assume that interactive mentally challenging activities can reduce risks of getting AD. Patients do brainteasers or crossword puzzles that allow them to recognize and fix mistakes. Mental activities should preferably be designed in a way that does not irritate patients when they cannot solve their tasks. Even physical activity is considered to have positive effects of patients with middle AD diagnosis. None of the therapy implemented to cure people with dementia has proved to give certain positive results.

The role of nursing patients with Alzheimer's disease is very important, because people with this diagnosis partially or fully lose the ability to function independently and require assistance. Family caregivers of people with dementia can often develop poor health, stress, and have financial troubles. That is why they should receive assistance from professional nurses. There is a special psychoeducational program for primary caregivers fort them to receive a more effective understanding of AD and to be able to cope better with this challenge. However, the program had no effect on patients' activities of daily living. According to the middle-range theory of transitions, caregivers should be aware of the predictable disease stages and transitions, since that can become useful in planning. Caregivers should become aware of the diagnosis; make financial and healthcare planning; know when to end driving; understand behavioral symptoms; know when to make changes in settings; prepare for end-of-life. Of course, there are long-term care facilities for people with dementia where they can receive professional care. If patients medical condition is unstable, then it is possible to hospitalize him/her. In cases when patients can be threats to themselves or others, they might be hospitalized and checked by the doctors if they need their medication adjusted. Patients who require constant supervision can be admitted to special facilities. Nowadays, the focus is on the high quality care offered to people with AD. Alzheimers Society research has found that independence, ability to stay at home and good quality of life are among priorities for people with AD and caregivers.

In conclusion, Alzheimer's dementia is a disease that implies brain damage and has several stages, eventually resulting in death. There are neither special blood tests that identify Alzheimers, nor a specific medicine to cure the disease. It can be diagnosed only as probable by means of complex psychological tests conducted by the doctor. Moreover, there are guidelines provided by the special institutions like Alzheimers Assistance for the families to define most likely signs of AD. Experts attempt to prove scientifically causes of Alzheimer's, inherited or acquired. AD cannot be prevented or cured, that is why pharmacological and non-pharmacological treatments of Alzheimers are aimed at delaying or eliminating the Alzheimers symptoms. People with dementia require specific care and attention, thus their family caregivers should be trained to withstand the difficulties connected with AD. Eventually, patients can be treated either at their homes or in special facilities.

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