What is Alzheimer’s disease? To understand what Alzheimer’s disease is we need to start with some broader questions, what is dementia and what causes dementia? Dementia is not just getting old, dementia is a general term for a decline in mental ability severe enough to interfere with daily life according to alz.org. Alzheimer’s disease is a common type of dementia that is diagnosed in over 50% of dementia cases. According to the National Institute of Aging Alzheimer’s disease is “an irreversible, progressive brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks.” The disease itself is considered a neurodegenerative disease that is caused by progressive brain cell death causing the brain to shrink in overall size. There are no specific causes to the disease, but there are some risk factors to monitor for. Dementia and Alzheimer’s are known to run in families meaning that the risk for individual to suffer from the disease increases if they have relatives that are diagnosed. Another risk factor associated with Alzheimer’s is having a history of head injuries. This makes sense because any type of head injury has the potential to predispose an individual to brain cell death. The health of an individual’s heart is also associated with an increased risk factor to a future of Alzheimer’s disease. We’ll will talk about these risk factors shortly.
This disease is especially dangerous because we are all getting older everyday and unfortunately there is no known cure for this terrible disease. As a nurse who works on an Alzheimer’s unit I see new admissions who are diagnosed with this disease all the time. A lot of the time it is the family that is hit hardest by this diagnosis because they don’t understand the disease and believe that it is basically a death sentence. Thankfully that is not always the case and with early diagnosis and proper management a lot of elderly people can still lead productive lives with this disease.
In an article written by Brandon Pete he states that, “Alzheimer’s has been a thief of the mind for over a century now” (Pete, 72). Later in the article he goes on to explain that the disease is named after Alois Alzheimer, Alois Alzheimer was the first to notice the same symptoms that we use to diagnosis the disease today in 1906. Since the 1970s and 1980s the government has funding various programs and agencies to help try to understand the disease and although we have yet to find a cure there have been many advancements when it comes to managing and treating this disease. As the disease progresses the patient typically goes through 7 different phases. The stages get significantly worse as they progress as expected, but overall go from no impairment to very mild decline to mild decline and so on until the patient reaches very severe decline. It is very important for family members and caregivers to be able to identify the stages and understand what is happening. This way they can best work with their loved one or client to have the best possible outcome for both parties.
The first three stages of Alzheimer’s can be categorized together (No impairment, very mild decline, and mild decline). During these stages caregivers, most likely won’t be able to tell that the patient is suffering from the disease, but will just chop it up to the aging process. There will be minor instances of memory loss as well as small changes in cognitive function. It isn’t until stage four, moderate decline, do the symptoms become more noticeable. These symptoms include more in-depth memory loss as well as loss of ability to do simple math and handle bills and finances. Stages five and six are when most patients start to need caregivers to look after them, starting with helping with simple day to day activities and expanding to helping with toileting, bathing, mobility, and feeding. Most patients also need constant supervision at this point due to the level of confusion and the increased risk of getting lost. The seventh stage is unfortunately the final stage where most patients are unable to use comprehensible language and have trouble making their needs known. Due to their condition, they need help with almost all activities and may even lose the ability to swallow food and drinks toward the end of the disease. Due to how scary and overwhelming this disease can become it is important to diagnosis it early to try to slow the overall progression.
Due to family history being a strong risk factor associated with Alzheimer’s it is most important for individuals who have loved ones suffering to understand the disease and its process. If people understand the disease then the hope is that we as health care professionals and help diagnosis it early and in theory slow the progress. The first step in early diagnosis is undergoing genetic testing. According to the National Institute on Aging a child who has a parent with a genetic mutation associated with the Alzheimer’s gene has a 50/50 chance of inheriting that mutation. The Alzheimer’s gene is believed to be caused by a mutation of either of chromosomes 21, 14, or 1. Now if that mutation is inherited by the child it doesn’t necessarily mean that the individual will suffer from Alzheimer’s but it implies a strong possibility. This strong possibility sometimes discourages people from getting tested because they do not want to know that this disease is waiting for them in the future. As this disease can be scary, people need to understand that if Alzheimer’s is detected early the quality of that person’s life can be greatly improved as there are many ways the progression of the disease can be slowed.
To help with early diagnosis of the Alzheimer’s Disease it is important to educate individuals with what to watch for in their loved ones. In an article written by George Grossberg, he gives ten warning signs of Alzheimer’s Disease. These warning signs include memory loss, difficulty preforming familiar tasks, problems with language, disorientation to time and place, poor or decreased judgement, problems with abstract thinking, misplacing things, changes in mood or behavior, changes in personality, and loss of initiative (Grossberg, 198). Now some of these may seem like part of the normal aging process but each warning sign is considered with a much more severe deficit. These warning signs range from physical problems to psychological problems, the psychological problems hit loved ones the hardest because they start to have trouble recognizing someone who was once so dear to them.
Mind wandering is an early psychological symptom that many people who are diagnosed with Alzheimer’s suffer from which is exactly what it sounds like, when and individual’s mind shifts from the task at hand to a different unrelated topic. Now I know that this is something that everyone does from time to time but through a study performed by Mate Gyurkovics, David Balota, and Jonathan Jackson evidence was obtained that show that individuals who suffer from Alzheimer’s Disease also suffer from mind-wandering at a much higher rate than healthy individuals (Gyurkovics et all, 1). Mind wandering can lead to an increase in confusion and memory problems for the patient because they may begin to feel lost doing their own everyday activities or may even forget what they were doing altogether.
The confusion and memory loss problems are tough on all parties involved; the patient, caregiver, and family members. As a nurse that has worked on a unit at a nursing facility that strictly cares for those who suffer from Alzheimer’s I’ve seen the disease take its toll. I’ve been professionally trained to deal in these circumstances and understand the process of the disease but to see it progress through an individual is completely different than being trained on it. A resident’s short-term memory is most affected by the disease because they are unable to create new memories while retaining most of their long-term memories. This can be both good and bad. For example, a resident may eat lunch but once lunch is all cleaned up and everything is out of view they question when lunch will be served. As a staff member tries to redirect them and alert them they have already eaten some of the residents take it as an insult to their memory and become agitated. As time goes on staff members can visibly a resident’s short-term memory become worse and worse. On the other side, a lot of the resident’s long-term memory remains mostly intact. They can usually tell you about their family members, where they grew up, elementary school friends and other memories from before the disease.
As one’s memory starts to decline many other problems can arise like behavioral issues and changes in the individual’s mood. These are both psychological symptoms associated with Alzheimer’s which can both lead toward a major problem that many with this disease face, depression. Depression is a well-known disease that affects many seemingly healthy individuals worldwide but when seen in the Alzheimer’s population it causes rapid decline and especially affects the quality of life of those suffering. Thankfully there are ways to combat depression but with early diagnosis of Alzheimer’s people can plan for the future with the disease in an attempt to improve the quality of life for all.
Physical symptoms of Alzheimer’s Disease and also very important to notice in caring for loved ones. An article published by Joan Monin, Richard Schulz, and Trace Kershaw describe some physical symptoms as “confusion, pain, nausea, shortness of breath, dry mouth, and lack of appetite” (Monin et al. pg. 511). These are all minor physical symptoms that take close monitoring to notice but this article goes on to explain that if these symptoms are cared for then both the caregiver and recipient of care have more positive outcomes. This obviously improves the physical health of the patient but also helps with their mental health because there is an understanding that their needs will be cared for even if they can’t make their needs known. All of these symptoms above can be contributed to the disease itself for example, lack of appetite and dry mouth could possibility be due to unaware of need. If the caregiver helps with feeding and offering drinks occasionally then these symptoms seem to disappear. It is important for caregivers to understand all that is required of them when it comes to this disease.
Although this disease seems like a long and treacherous way toward the end there are many ways to manage the disease to improve your quality of life. As we go from day to day in our lives we must try to set a foundation for our elderly selves to benefit. We all know the idea of saving money over time so when we retire we can enjoy the life we worked hard for. This idea should be the same when pertaining to our health. If people take time to care for themselves throughout their life then the quality of life in their future will be exponentially better. There is no way to read the future and prepare for any awaiting problems but by taking care of oneself they can be ready to deal with these problems. Alzheimer’s is a disease that can be tracked through genetics to prepare some people but with others it’s a disease that just comes along unfortunately. There are many different ways to plan for and manage this disease in order to decrease some of the problems associated with it.
As we know physical activity can help with all aspects of a person’s wellbeing and can greatly benefit people as the aging process takes its toll. One study stated, “At a 5-year follow up, participants, who performed some level of exercise had less risk of cognitive impairment, AD, and dementia of any kind compared with participants with no regular exercise (Laurin, Verreault, Lindsay, MacPherson, & Rockwood, 2001). Physical activity and staying active is especially beneficial to those who may suffer from neurodegenerative disorders. By staying active individuals strengthen their muscles and this includes a person’s brain. Physical activity can be associated with strengthening the heart which as we know supplies blood throughout the body. An important recipient of that blood is the brain so if the heart isn’t at its strongest it can have problems getting the amount of blood necessary to the brain. If the brain is not receiving the amount of blood needed there will be unnecessary brain cell death. Through exercise and proper nutrition this unnecessary brain cell death can be avoided and quality of life in the early stages of the disease can be greatly improved. As it is important to strengthen the physical muscles let’s not forget about another important muscle, the brain. Brain plasticity is used to describe the brains ability to change when challenged. This is very important when the brain is dealing the Alzheimer’s Disease because of how it effects the brain. According to Le Carret et al, “evidence supports the concept that mental stimulation may increase cognitive reserve and decrease the rate of age related cognitive decline (Le Carret, Auriacombe, Letenneur, Bergua, Dartigues, and Fabrigoule, 2005). The article goes on to describe mental stimulation as an array of different activities that work an individual’s mind. A history of head injuries can also be a cause of premature brain cell death. If individuals care for their brain properly (e.g. wearing a helmet when necessary) then even though Alzheimer’s can’t be cured the effects of the disease are not expedited. Unfortunately, even by taking these precautions and trying to maintain a healthy lifestyle the disease can’t always be stopped.
Individuals who are diagnosed with this disease can still reap the benefits of maintaining a healthy lifestyle. By having improved muscle strength through staying active, patient’s that are diagnosed greatly reduce their risk for falls. This is so important because falls have been known to expedite the process of the disease. Falls not only cause physical injuries that are difficult for people of the elderly population to heal from but also can cause an increase in confusion for the patient. Each fall that an individual suffers from causes more and more damage making it tougher and tougher for an individual to return to their baseline.
Thankfully patients have help from many different sources when trying to return to their baseline. At the nursing facility that I work at we have a policy that after a resident has a fall they are to be evaluated by physical and occupational therapy. Working with these different therapies help Alzheimer’s patient improve their strength to help them try to recover. One article describes patients with Alzheimer’s as enjoying their exercise sessions, and showing signs of positive personal involvement. The researchers also describe these participant’s moods improving and associates that to the improved personal image (Lancioni, Singh, O’Reilly, Sigafoos, D’Amico, Addante, and Pinto, 2017). So, this is saying that when patients participate in exercise programs they not only improve their overall physical condition but also their mental wellbeing. As the disease progresses different disciplines must work together in order to provide the best quality of life for the patients.
As the process continues to unfold for the patient and their loved one’s health care professionals always continue to work to slow the progression. Once the patient starts to progress through the seven stages health care professional begin to focus less long-term prevention and more on slowing the day to day progression. This usually consists of working to reduce the symptoms that can cause the most harm to the patient as in depression, agitation, and anxiety. There are two basic types of management that help alleviate most of these problems which are nonpharmacological management and pharmacological management. Though these are just two basic methods there are many methods that extend from them.
Nonpharmacological management is a method used to alleviate symptoms without the use of drug treatment. This is the preferred method by most healthcare workers and can work well in many situations. At the facility that I work at we work with activities personnel to plan different activities that will help reduce agitation, anxiety, and depression that our patients are suffering from. The activities include art and aromatherapy, music therapy, massage therapy, having therapy animals come to the floor, among other activities. These activities also include memory games and physical activities that not only help improve the mood of patients but also works to strengthen important muscles that they use. An article by Amber Staedtler and Diane Nunez evaluates different types of nonpharmacological therapies and the effectiveness of these types of activities (Staedtler and Nunez, 114). The article goes into detail explaining all the benefits but also details how these therapies are difficult for nurse’s due to poor staff to resident ratios and poor funding. I am thankful that in the facility that I work at we have separate activities departments who help perform these types of therapies. If we didn’t have a separate activities department I believe that the residents would suffer due to inadequate staffing. Although nonpharmacological therapies are not always enough they can have many benefits for patients.
Another way that we try to reduce the symptoms associated with Alzheimer’s is through pharmacological therapy which includes the use of medications. There are many different medications that a doctor may prescribe for a patient dealing with Alzheimer’s. Some of the medications may be prescribed to slow the overall progress of the disease while others may be to directly treat the symptoms that a resident may suffer from. One of the first medications that are usually prescribed after diagnosis of Alzheimer’s disease is Donepezil. Donepezil is used to slow the progression of the disease by slowing the uptake of a particular neurotransmitter in the brain. An article titled New agents in the management of Alzheimer’s disease: a case study states, “the use of donepezil is not without risks. However, allied with patient and family involvement in decision-making, can result in an optimum outcome to the treatment” (Grainger and Keegan, 17). This medication is more effective in slowing the progression when started earlier in the disease process. Unfortunately, the medication doesn’t cure the disease so patients will still be at risk for suffering from anxiety and agitation throughout the disease process. These symptoms can also be managed with the use of drug therapy ranging from the use of antipsychotic medication to antianxiety medications. Antipsychotic medication is usually prescribed to be given on a scheduled basis to help reduce the instances of anxiety and agitation. Sometimes these instances are unavoidable so antianxiety medications can be ordered for patients to be given on an as needed basis. This would mean that if a patient is suffering from an episode of extreme anxiety then the caregiver could give a medication to help reduce some of that anxiety. Although medication also can’t always completely help with treating symptoms associated with Alzheimer’s Disease, using pharmacological and nonpharmacological therapies can work together to greatly reduce the instances of symptoms.
Although Alzheimer’s Disease has no cure there are ways to manage and slow the progression of the disease. This is not a disease that an individual should have to face alone and with the help of family members and many other disciplines the disease can become a lot less terrifying. Through the teamwork across many different disciplines we can find the best route for each patient to process and fight the disease. These disciplines include nursing, social work, pharmacists, doctors, politics, and administration. It’s easy to see the healthcare disciplines affect patients who suffer from Alzheimer’s but it is also controlled by politics and administration. Through administration due to the staffing that they provide for caring for the patients in the nursing home. Without adequate staff less individual care can be given to each patient. This affects a lot of the nonpharmacological therapies that help with management of the disease. Administration can also only do so much based on the funding provided by the government which is where we run into politics. It wasn’t until the 1980s when the first foundation for the disease was created called the Alzheimer’s Association (Pete, 73). Although the government does provide funding toward caring for patients many believe they don’t provide enough, which is surprising since we will all one day face old age and possibly this disease.
Through raising awareness about this disease, I hope that more people will take the initiative to get tested for the Alzheimer’s gene. This can start the process of early diagnosis, early treatment. Through early management of the disease we can provide a much better quality of life for those who are affected and we can also be more knowledgeable about the disease in general. My hope for those of you who have stuck with me through this post is that you understand how to lower your risk of being diagnosis and also how to fight the disease if you are diagnosed. Remember it’s not the end but the beginning of a new journey.
Grainger, M., & Keegan, K. (2011). New agents in the management of Alzheimer’s disease: a case study. Nurse Prescribing, 9(1), 12-18.
Grossberg, G. T. (2010). Recognizing the Early Signs and Symptoms of Alzheimer’s Disease in Long-Term Care. Best Practices, 196-205.
Gyurkovics, M., Balota, D. A., & Jackson, J. D. (2017). Mind-Wandering in Healthy Aging and Early Stage Alzheimer’s Disease. Neuropsychology, doi:10.1037/neu0000385
Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., D’Amico, F., Addante, L. M., & Pinto, K. (2017). Persons With Advanced Alzheimer’s Disease Engage in Mild Leg Exercise Supported by Technology-Aided Stimulation and Prompts. Behavior Modification, 41(1), 3-20. doi:10.1 177/0145445516649581
Laurin, D., Verreault, R., Lindsay, J., MacPherson, K., & Rockwood, K. (2001) Physical activity and risk of cognitive impairment and dementia in elderly persons. Archives of Neurology, 58, 498-504
Le Carret, N., Auriacombe, S., Letenneur, L., Bergua, V., Dartigues, J.F., & Fabrigoule, C. (2005). Influence of education on the pattern of cognitive deterioration in AD patients: The cognitive reserve hypothesis. Brain and Cognition, 57, 120-126.
Monin, J. K., Schulz, R., & Kershaw, T. S. (2013). Caregiving spouses’ attachment orientations and the physical and psychological health of individuals with Alzheimer’s disease. Aging & Mental Health, 17(4), 508-516. doi:10.1080/13607863.2012.747080
Pete, B. J. (2016). Alzheimer’s Disease. AMT Events, 33(2), 72-74
Staedtler, A. V., & Nunez, D. (2015). Nonpharmacological therapy for the management of neuropsychiatric symptoms of Alzheimer’s disease: linking evidence to practice. Worldviews On Evidence-Based Nursing, 12(2), 108- 115. doi:10.1111/wvn.12086