Case study of alzheimers disease

Case study of alzheimers disease My first administrative position in mental health was working on a Geriatric Psychiatric unit of the local hospital. Many of the patients were elderly patients with Alzheimers. This was my first experience with Alzheimers disease and the effects it has on their families. Alzheimers is the most common type of dementia and is incurable, degenerative, and terminal (Wikipedia) . Symptoms of Alzheimers begin slowly and become worse until they interfere with daily life and patients are unable to even carry on conversations. Families become caregivers for their loved ones who dont know who they are any more. The prognosis is not good for patients afflicted with this type of dementia but researchers continue to look for new treatments and possible preventions. A few of the Alzheimers patients I worked with on the Geriatric unit are very memorable. There was a gentleman who was in the moderate to severe stage of the disease. His job for most of his life was that of a hospital administrator. M y office door was always open and some patients would wonder in time and again. My office must have triggered something in him because he would come in and need to sign papers. He would sit in my office for hours and sign papers. Another patient was a woman who had 12 children. She was always wondering the unit looking for her babies. The nurses bought her a baby doll and she carried it everywhere and it also calmed her down. Another aspect of Alzheimers is sundowners syndrome. Many of the Alzheimers patients would start to get agitated between 4:00 and 5:00 p.m. They would become more aggressive, oppositional and agitated. Sundowners syndrome is an increased time of memory loss, confusion, agitation, and even anger. For family members who care for Alzheimers patients, witnessing an increase in their loved ones symptoms of dementia at sunset can be nothing short of troubling, if not also painful, frightening, and exhausting (Sundowners Syndrome). Alzheimers is not a new disease. Alz heimers was first described by German psychiatrist and neuropathologist Alois Alzheimer in 1906. In 1901, Alzheimer observed a patient at the Frankfurt Asylum named Mrs. Auguste Deter. The 51-year-old patient had strange behavioral symptoms, including a loss of short-term memory. This patient would become his obsession over the coming years. In April 1906, Mrs. Deter died and Alzheimer had the patient records and the brain brought to Munich where he was working at Kraepelins lab. Together with two Italian physicians, he would use the staining techniques to identify amyloid plaques and neurofibrillary tangles (Wikipedia). Amyloid plagues are extracellular deposits that consist of a dense core of a protein known as B-amyloid, surrounded by degenerating axons and dendrites, along with activated microglia and reactive astrocytes, cells that are involved in destruction of damaged cells. Neurofibrillary tangles consist of dying neurons that contain intracellular accumulations of twisted f ilaments of hyperphosphorylated tau protein (Carlson, 2008). These abnormal structures are also found in brains of patients with Down syndrome. Unlike Down syndrome, Alzheimers is a progressive degenerative disease that gradually destroys a persons memory and daily functioning. Currently Alzheimers is diagnosed by symptoms, and only confirmed by brain examination after death. There are warning sides of Alzheimers disease that include memory loss that disrupts daily life. Challenges in planning or solving problems when there were no problems before. Difficulty completing familiar tasks or leisure activities they a person used to do. Confusion with time and place, which is what most people know about Alzheimers. This is when family members forget where they are going or days of activities. Trouble understanding visual images and spatial relationships or new problems with words speaking or writing. Misplacing things and the inability to retrace steps. Decreased or poor judgment and wit hdrawal from work and social activities. Changes in mood and personality, which is another warning sign that most people are also familiar with from media, etc. Grandma turns from sweet to irritable (Stages and Warning Signs of Alzheimers). The Alzheimers Association is a strong national organization that supports and funds Alzheimers research. Their website has a vast amount of information on symptoms, treatment, prevention and research of this disease. Taken from their website there are seven stages of Alzheimers. They include: Stage 1 where there is no impairment. Stage 2 there is very mild decline. Stage three there is mild decline. Stage four there is moderate decline. Stage five there is moderately severe decline and stage six and stage seven there is severe decline and very severe decline (Stages and Warning Signs of Alzheimers). The current major treatment for Alzheimers is medication management and each stage of Alzheimers requires a different medication. Mild to moderate A lzheimers is treated with cholinesterase inhibitors. These types of medications are prescribed because they may help delay or prevent the symptoms from becoming worse for a time and also help manage behaviors. The medications include: Razadyne (galantamine), Exelon (rivastigmine), and Aricept (donepezil). Another drug, Cognex (tacrine), was the first approved cholinesterase inhibitor but is rarely prescribed today due to safety concerns (Alzheimers Disease Medications Fact Sheet, 2010). Most people have heard of Aricept because is used often and advertised on the media more so than others. Moderate to severe Alzheimers is treated with a drug that regulates glutamate, an important brain chemical. The medication known as Namenda (memantine), an N-methyl D-aspartate (NMDA) antagonist. Aricept has also been approved by the FDA to treat moderate to severe Alzheimers. These drugs main effect is to delay progression of some of the symptoms and they may allow patients to maintain certain da ily functions a little longer than they would without the medication. The medication may help a patient in the later stages of the disease maintain his or her ability to use the bathroom independently for several more months, a benefit for both patients and caregivers (Alzheimers Disease Medications Fact Sheet, 2010). There is research going on to provide diagnosis by a simple blood test, this was reported by American researchers just last month. Also, other researchers have shown spinal fluid tests, which require a spinal tap, can detect early changes that signal the onset of Alzheimers. Imaging companies such as privately held Avid Radiopharmaceuticals, General Electrics GE Healthcare and Germanys Bayer are racing to finish clinical trials on new agents that can make brain lesions called plaques visible on positron emission tomography or PET scanners (Anonymous, 2010). Researchers also are looking at any possible prevention or slow down of the disease. Currently at Rush University is leading a nationwide clinical trial of a nutritional drink to determine whether it can improve cognitive performance in people with mild to moderate Alzheimers. The study follows recently released results from an earlier trial conducted in Europe showing that the drink, called Souvenaid, improved verbal recall in people with mild disease who were followed for three months (Anonymous., 2010). Alzheimers affects approximately 10 percent of the population above the age of 65 and almost 50 percent of people over the age of 85 years (Carlson, 2008). The number of Americans age 65 and older who have this condition will increase from the 5.1 million today to 13.5 million by mid-century. A recent report from the Alzheimers Association states that the cost of Alzheimers to the United States will be $20 trillion over the next 40 years. Changing the Trajectory of Alzheimers Disease: A National Imperative shows that in the absence of disease-modifying treatments, the cumulative costs of car e for people with Alzheimers from 2010 to 2050 will exceed $20 trillion, in todays dollars (Report: Alzheimers disease to cost United States $20 trillion over next 40 years, 2010). Statistics taken from the Alzheimers Association break it down as follows; Alzheimers disease costs business $24.6 billion in health care. In the US 7 out of 10 people with Alzheimers live at home where 75% of costs are absorbed by the family. The remaining 25% of care costs cost an average $19,000 a year. It is estimated that Alzheimers caregivers cost business $36.5 billion. This includes the costs of absenteeism and lost productivity. The average cost of a nursing home in the US is $42,000 a year. However in some areas those costs can be at least $70,000. Medicare costs for beneficiaries with Alzheimers disease were $91 billion in 2005. Medicare costs are expected to increase by 75% to $160 billion in 2010. Medicaid expenditures on residential dementia care were $21 billion in 2005. These costs are est imated to rise by 14% to $24 billion in 2010( (Kennard, 2010). The stress of caregivers for loved ones with Alzheimers is high. The frustration and challenges of caring for an adult who no longer complies with reasonable requests is a daily consequence of a loved one with Alzheimers. There are many support groups and resources for caregivers. Some tips for managing an Alzheimers patient is to have patience, be flexible, reduce frustration, reduce choices, reduce distractions to create a safe environment (Research, 1998-2010). Patience and flexibility are easy to figure out. Patience because a patient with Alzheimers will be oppositional at times, will not know their caregiver at times as well as not remember family members. The Alzheimer patients mood and reactions to daily tasks will change sometimes daily as the disease progresses. Flexibility with caring for Alzheimers patients is tied into their changing needs and abilities from day to day. Reducing frustration, choices and dist ractions would be like raising a toddler. Not too many choices or distractions for them to be overwhelmed with. A safe environment is pretty clear and we hear about Alzheimers patients wandering off reported on the news more often. Alzheimers patients who have been left in an unsecured house or got into a unlocked car. Doors should always be locked so the Alzheimers patient is unable open or figure out how to open. The car is easy to figure out, keep it locked! Take the car keys are keep them on you or hidden. There was a poem on the Geriatric unit wall where I worked. The author is unknown and it is taken from Coach Frank Broyles Playbook for Alzheimers Caregivers. The poem is a good reminder of what Alzheimers is all about and a good conclusion to this report. Do not ask me to remember. Dont try to make me understand. Let me rest and know youre with me. Kiss my cheek and hold my hand. Im confused beyond your concept. I am sad and sick and lost. All I know is that I need you, to be with me at all cost. Do not lose your patience with me. Do not scold or curse or cry. I cant help the way Im acting, cant be different though I try. Just remember that I need you, that the best of me is gone. Please dont fail to stand beside me, love me till my life is done.