Alzheimer's Disease Research Paper 6q5945

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009

INTRODUCTION “Memory is a way of holding on to the things you love, the things you are, and the things you never want to lose.” -Kevin Arnold Memories are the things we uphold. Whether it’s bad or good, those memories are engraved in us and can’t be stolen from us. But what if as times goes by, those memories are losing? Worst, you’re even losing your language skills, ability to recognize familiar things and you feel a sense of depression. This means, as a person grow old he/she experiences deterioration in one’s self. Now, we are currently living in the age of technology. Our advancements in the past few decades overshadow everything learned in the last 2000 years. This increase has brought with it a large increase in diseases associated with old age. Alzheimer's disease (AD) is one of the most common and feared diseases afflicting the elderly community. AD, once thought to be a natural part of aging, is a severely debilitating form of mental dementia. Although some other types of dementia are curable or effectively treatable, there is currently no cure for the Alzheimer variety. A general overview of Alzheimer's disease including the clinical description, diagnosis, and progression of symptoms, helps one to further understand the treatment and care of patients, the scope of the problem, and current research. Dementia and Alzheimer’s disease may be similar in some ways. It is important to

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009

compare dementia vs. Alzheimer's disease to realize the differences between the two conditions. Alzheimer's is the most common form of dementia marked by memory loss in older people. Dementia is the gradual loss of intellectual function. Alzheimer's statistics show that the disease can strike a person as early as 45, while dementia generally takes hold after age 70. The most confused form of dementia is Multi-Infarct Dementia or MID. This condition also attacks the blood vessels in the brain. Both disorders require testing to determine the best course of treatment. But the clinical definition of dementia is "a deterioration in intellectual performance that involves, but is not limited to, a loss in at least 2 of the following areas: language, judgment, memory, visual or depth perception, or judgment interfering with daily activities" (Institute, 1996, p.4). While, Alzheimer’s disease (AD) is a slowly progressive disease of the brain that is characterized by impairment of memory and eventually by disturbances in reasoning, planning, language, and perception. Many scientists believe that Alzheimer's disease results from an increase in the production or accumulation of a specific protein (beta-amyloid protein) in the brain that leads to nerve cell death. The likelihood of having Alzheimer's disease increases substantially after the age of 70 and may affect around 50% of persons over the age of 85. Nonetheless, Alzheimer's disease is not a normal part of aging and is not something that inevitably happens in later life. For example, many people live to over 100 years of age and never develop Alzheimer's disease. A person with AD usually has a gradual decline in mental functions, often

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009

beginning with slight memory loss, followed by losses in the ability to maintain employment, to plan and execute familiar tasks, and to reason and exercise judgment. Communication ability, mood, and personality may also be affected. Most people who have AD die within eight years of their diagnosis, although that interval may be as short as one year or as long as 20 years. AD is the fourth leading cause of death in adults after heart disease, cancer, and stroke. When comparing dementia vs. Alzheimer's disease it is very important to discuss the differences between the two diseases. Although they have many similarities, there are a number of differences that must be noted. Alzheimer's disease is defined as a form of dementia characterized by the gradual loss of several important mental functions. It is perhaps the most common cause of dementia in older Americans, and goes beyond just normal forgetfulness, such as losing your car keys or forgetting where you parked. Signs of Alzheimer's disease include memory loss that is much more severe and more serious, such as forgetting the names of your children or perhaps where you've lived for the last decade or two.Another way to compare dementia vs. Alzheimer's disease is to realize that dementia is a medical term used to describe a number of conditions characterized by the gradual loss of intellectual function. Certain symptoms, as defined by the American Medical Association, of dementia include memory impairment, increased language difficulties, decreased motor skills, failure to recognized or identify objects, and disturbance of the ability to plan or think abstractly. Yet another way to determine the

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 History of Alzheimer’s Disease Progressive mental deterioration in old age has been recognized and described throughout history. However, it was not until 1906 that a German physician, Dr. Alois Alzheimer, specifically identified a collection of brain cell abnormalities as a disease. One of Dr. Alzheimer’s patients died after years of severe memory problems, confusion and difficulty understanding questions. Upon her death, while performing a brain autopsy, the doctor noted dense deposits surrounding the nerve cells (neuritic plaques). Inside the nerve cells he observed twisted bands of fibers (neurofibrillary tangles). Today, this degenerative brain disorder bears his name, and when found during an autopsy, these plaques and tangles mean a definite diagnosis of Alzheimer's disease (AD). Since its discovery more than 100 years ago, there have been many scientific breakthroughs in AD research. In the 1960s, scientists discovered a link between cognitive decline and the number of plaques and tangles in the brain. The medical community then formally recognized Alzheimer’s as a disease and not a normal part of aging. In the 1970s, scientists made great strides in understanding the human body as a whole, and AD emerged as a significant area of research interest. This increased attention led in the 1990s to important discoveries and a better understanding of complex nerve cells in the brains of AD patients. More research was done on AD susceptibility genes, and several drugs were approved to treat the cognitive symptoms of the disease. Over the last decade, scientists

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 have substantially progressed in understanding potential environmental, genetic and other risk factors for AD, the processes leading to formation of plaques and tangles in the brain, and the brain regions that are affected. Specific genes related to both the early-onset and late-onset forms of AD have been identified, but genetic risk factors alone do not fully explain its causes, so researchers are actively exploring environment and lifestyle to learn what role they might play in the development of this disease. More effective treatment options have been approved by the Food and Drug istration (FDA). However, AD is still incurable. The drugs currently in use treat only the symptoms, not the cause of the disorder, and they only slow the progression of cognitive decline.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009

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BODY About Alzheimer’s Disease Alzheimer's disease is a progressive, degenerative neurological disorder, meaning that the disorder gets worse over time. Alzheimer's disease is the most common cause of dementia among people over the age of 65 and it is thought that up to 4.5 million people have Alzheimer's disease, according to the National Institutes of Health (NIH). Five percent of people aged 65 to 74 and roughly 35 to 50 percent of people aged over 85 have the disorder, according to the National Institute of Neurological Disorders and Stroke (NINDS). However, despite the high prevalence of Alzheimer's dis disease among elderly people, Alzheimer's disease is not a normal part of aging. Alzheimer's disease occurs when neurons in the brain die or break their connections with other neurons. This occurs because people with Alzheimer's disease experience atrophy of a part of the brain called the hippocampus.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 The hippocampus produces a neurotransmitter called acetylcholine. This chemical carries electrical signals from one neuron to another and is essential for memory, judgment and learning. In people with Alzheimer's disease, the cells that produce acetylcholine are

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damaged or killed and levels of the chemical gradually decline in the brain. This means that the electrical signals are not transmitted effectively from one neuron to another, causing the breakdown of neuron connections and the gradual atrophy of other parts of the brain. The symptoms of Alzheimer's disease reflect where neuron connections are broken. For example, memory loss, a common early stage symptom, is caused by the disruption of neurons in the temporal and parietal lobes, which are associated with memory. Language problems, on the other hand, are thought to be caused by the disruption of the large networks of neurons that are associated with understanding and producing language. People with Alzheimer's disease also have abnormal lesions called beta-amyloid plaques and neurofibrillary tangles. Beta-amyloid plaques are sticky pieces of protein and other matter than surround the neurons. Neurofibrillary tangles are twisted fibers also made from protein that build up inside the neurons. These plaques and tangles work together to disrupt brain function and are known to increase in quantity as the Alzheimer's disease progresses. Certain factors of brain dysfunction in Alzheimer's disease are known, but much about the disease is unknown. The known factors include the onset and progress of dementia in

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 patients and the presence of the plaques and tangles in their brains, which may be detected at autopsy. But specific causes remain unknown and the role of plaques and tangles, as either cause or result, are not well understood. It is thought that these amyloid plaques form very early in the disease stage and set of a cascade of inflammation and cell death

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throughout the affected portions of the brain. However, no one knows why the amyloid plaques form. Similarly, very little is understood about the tangles in the brain, or how they relate to the plaques. The symptoms of Alzheimer's disease usually begin to appear around the age of 60. However, some people develop a condition called early-onset Alzheimer's disease as early as their 20s. Early-onset Alzheimer's disease is thought to be caused by a genetic disorder. Alzheimer's disease can progress slowly or rapidly, depending on the individual. Patients generally live for an average of eight years after they are diagnosed with Alzheimer's disease, although they may live for up to 20 years. During the final stages of the disease, most patients require constant supervision and help performing basic self-care tasks such as bathing and feeding. Most people do not die as a direct result of Alzheimer's disease. Instead, people with Alzheimer's disease are more likely to contract other medical conditions that can be fatal. Many people with Alzheimer's disease die from aspiration pneumonia (pneumonia caused

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 by breathing in vomit or other fluids) because of the reduced ability to swallow in the later stages of the disease. In 2004, the most recent year for which figures are available, Alzheimer's disease was the fifth leading cause of death among people over 65 and the seventh leading cause of death overall, according to the Centers for Disease Control and Prevention (CDC). Women are more commonly diagnosed with Alzheimer's disease than men, although this may be because women tend to live longer than men. Although Alzheimer's disease is the

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leading cause of dementia, other conditions may cause dementia, including stroke, brain tumors and infections. Causes and Risk Factors The initial cause of AD symptoms is a result of the progressive deterioration of brain cells (neurons) in the cerebral cortex of the brain. This area of the brain, which is the largest and uppermost portion, controls all our thought processes, movement, speech, and senses. This deterioration initially starts in the area of the cortex that is associated with memory and then progresses into other areas of the cortex, then into other areas of the brain that control bodily function. The death of these cells causes an interruption of the electrochemical signals between neurons that are a key to cognitive as well as bodily functioning. Currently AD can only be confirmed at autopsy. After death the examined brain of an

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 Alzheimer victim shows two distinct characteristics. The first is the presence of neuritic plaques in the cerebral cortex and other areas of the brain including cerebral blood vessels. These plaques consist of groups of neurons surrounded by deposits of beta-amyloid protein. The presence of these plaques is also common to other types of dementia. The second characteristic, neurofibliary tangles, is what separates AD from all other forms of dementia. Neurofibliary tangles take place within the disconnected brain cells themselves. When examined under a microscope diseased cells appear to contain spaghettilike tangles of normally straight nerve fibers. The presence of these tangles was first discovered in 1906 by the German neurologist Alois Alzheimer, hence the name Alzheimer's disease. Although the characteristics listed above are crucial to the diagnosis of AD upon death, the clinical diagnosis involves a different process. The diagnosis of AD is

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only made after all other illnesses, which may have the same symptoms, are ruled out. The initial symptoms of AD are typical of other treatable diseases therefore doctors are hesitant to give the diagnosis of Alzheimer's in order to save the patient from the worsening of a treatable disease through a misdiagnosis. Some of the initial symptoms include an increased memory loss, changes in mood, personality, and behavior, symptoms that are common of depression, prescription drug conflict, brain tumors, syphilis, alcoholism, other types of dementia, and many other conditions. The onset of these symptoms usually brings the patient to his family doctor. The general practitioner runs a typical battery of urinalysis and blood tests that he sends off to the lab. If the tests come back negative, and no other cause of

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 the symptoms is established, the patient is then refereed to a specialist. The specialist, usually a psychiatrist, will then continue to rule out other possible illnesses through testing. If the next battery of tests also comes back negative then the specialist will call on a neurologist to run a series of neurological examinations including a PET and CAT scan to rule out the possibility of brain tumors. A spinal tap is also performed to determine the possibility of other types of dementias. The patient will also undergo a complete psychiatric evaluation. If the patient meets the preliminary criteria for AD an examination of the patients medical history is also necessary to check for possible genetic predispositions to the disease. The psychiatric team finally meets with the neurological team to discuss their findings. If every other possible disease is ruled out, and the results of the psychiatric evaluation are

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typical to that of a person with AD, the diagnosis of Alzheimer's disease is given. The initial symptoms of AD are usually brushed off as a natural part of aging. The myth that a person's memory worsens over time is just that - a myth (Myers,1996, p.100-101). AD's victims are mostly over the age of 65 and many delay treatment by attributing their problems to age. A victim might forget a well known phone number or miss an important appointment. These symptoms eventually escalate to the total disintegration of personality and all patients end up in total nursing care.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 In descending order, the patient goes from (1) decreased ability to handle a complex job to (2) decreased ability to handle such complex activities of daily life as (3) managing finances, (4) complex meal preparation and (5) complex marketing skills. Next comes (6) loss of ability to pick out clothing properly, (7)or to put on clothing properly, followed by (8) loss of ability to handle the mechanics of bathing properly. Then (9) progressive difficulties with continence and (10) toileting occur, followed by (11) very limited speech ability and (12) inability to speak more than a single word. Next comes (13) loss of ambulatory capability. Last to go are such basic functions as (14) sit up, (15) smile and (16) hold up one's head (Brassard,1993,p.10). The average time from diagnosis to inevitable death is 8 years. The family of the victim is usually able to care for the victim for an average period of about 4 years (Alzheimer's, 1996,p.44).During the progression of the disease between 10% and 15% of patients hallucinate and suffer delusions, 10% will become violent and 10% suffer from seizures (Alzheimer's,1996,p.46).

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Once a person is diagnosed as having AD, an assessment is made of the disease's stage of progression and of the strengths and weaknesses of the victim and the victim's family. There are different types of assessments available to evaluate the level of dysfunction of the patient. Based on one of these assessments a care plan is put together by a team consisting of a family member, a paid or unpaid care provider, and the victim's physician. Throughout the progression of the disease, and depending on the needs of the patient, a wide range of

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 expensive medication, such as psychoactive drugs to lift depression and sedatives to control violence, may be required. Unfortunately, although a wide range of treatments have been tested, most prove to be ineffective. At the beginning of the disease the family is able to look after the patient without much effort. Frequently families will hire a care giver in order to alleviate some of the work. Simple changes in the home can make life much easier for the sufferer, help them keep their self esteem, and prolong their stay at home. Examples of low-cost modifications to the environment include reducing the noise levels in the home (telephones, radios, voices, etc.); avoiding vividly patterned rugs and drapes; placing locks up high or down low on doors leading outside (AD sufferers are known to wander off); clearing floors of clutter; reducing the contents of closets in order to simplify choices (Alzheimer,1992, p.17). These costs are paid for by the victim's family. Many of these, and other more expensive modifications are introduced in long-term care settings. They help in maintaining the safety and security of the victim as well as reducing their confusion. The patient's and the family's condition should be assessed every six months (Alzheimer,1992, p.21). In response to constantly changing needs, the aspects of care must be constantly modified. Other issues that usually arise during the care

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of the patient are assessment of the competence of the victim, power of attorney, and response to and prevention of abuse (Aronson,1988, p.124). Eventually the victim's condition deteriorates to the point where home care is no longer possible and they must be moved to a long-term care facility. In Canada care, and information for victims and

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 their families comes from the health care system and the Alzheimer's Society of Canada. The care giver must obtain information and education about the disease in order to effectively care for the victim. During the course of the disease victims might wander, hallucinate, become suspicious. This behavior can place a large strain on the care giver as well as causing depression and deterioration of their own health (Aronson,1988, p.132). An AD group is crucial to alleviating some of the stress on the care giver. Through a group the care giver is given the emotional and practical help needed to accomplish the large task of looking after the victim for as long as possible. Currently there are 300,000 persons in Canada with AD. This figure is more than that of Parkinson's disease, cancer and multiple sclerosis combined. With continuous growth in the percentage of Canadians over the age of 65, this figure could hit 700,000 by the year 2020 (Carlton,1996,p.17). These large and increasing figures translate into a large burden on the health care system. Even when using the most conservative estimates of the average number of years spent in an institution and the number of afflicted Canadians, the costs to health care are immense. At $33,000 (1989) per patient per year in an institution and with an average stay of three years until death, the cost of AD will amount to $3 billion over the next three years; and if the entry into the disease state remains

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constant, it will cost the Canadian taxpayer [an added] $1 billion per year thereafter.(Brassard,1993,p.11)

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 There have been many studies that conclude that the number of incidences of AD is on the rise. A very high incidence was reported in a U.S. survey conducted in East Boston by the Harvard Medical school. It showed the incidence of AD to be 3% for people between the ages of 65-74, 18.7% for those between 75-84, and 47.2% for those over 84 (Evans,1989,p.4). AD is a democratic disease. It affects persons of both sexes and all races and ethnic backgrounds. The major risk factors for AD are age and heredity. Persons with a high incidence of AD in their family history are most susceptible. A specific subtype of AD exists that is solely connected to heredity. This subtype is known as Familial Alzheimer's disease (FAD). FAD is also known as Early Onset Alzheimer’s disease, named so because its symptoms start to develop much earlier than in the regular sporadic type. Only 5%-10% of all cases are of this type. FAD is suspected when AD can be traced over several generations and there is a history of, among previously affected family , a similar age of onset and duration of the disease ( usually 4 years ) . Approximately 50% of the children of an affected parent go on to develop the disease (Pollen,1993,p.89). Much research has been conducted in an attempt to locate the gene that is responsible for FAD. Currently, researchers have isolated genes 1, 14, and 21 (Alzheimer's,1996,p.36), however, the evidence still remains inconclusive (Statement,1996, p.2). There is also a possibility that a specific genetic mutation merely puts a person at risk to

the

disease

and

AD

is

triggered

14

by

an

external

force

e.g.

a

head

injury.(Statement,1996,p.4). Finding the specific location of the gene

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 will pave the way for a diagnostic or even predictive test for FAD. Similar genetic tests already exist for cystic fibrosis and muscular dystrophy. Locating the AD gene will also allow scientists to study why the particular gene is not functioning properly and may give clues to treatment and cure. The long term goal of this research is the same as that of any other genetic research and that is gene therapy - which is the possibility that science could one day alter our genetic make-up. The other much more common type of AD is Sporadic Alzheimer's Disease (SAD). This includes all other types of the disease which are not linked to heredity. Genetic research is also playing a major role in the progress towards a diagnostic or predictive test for SAD. Recently, a gene involved in the transport of cholesterol has been identified to be associated with AD. Apolipoprotein E is located on chromosome 19 and seems to contribute to the succeptability of a persons to AD (Statement,1996,p.6). The gene exists in three different forms or alleles (Apo E 2,3,4) and each person has a combination of two of the three. Thus an individual can have any one of the following combinations: Apo E 2/2, 3/3, 4/4, 2/3/, 3/4 or 2/4. Researchers have found a relationship between the number of copies of the 4 allele and the person’s probability of developing the disease. Although scientists are unsure of the initial cause of Alzheimer's disease, it is known that the symptoms of Alzheimer's disease are caused by the disconnection and death of neurons in the brain. Based on what scientists understand about Alzheimer's disease, the

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 following have been established as risk factors for the disease: •

Age. By far the greatest risk factor for developing Alzheimer's disease is age. The number of people with Alzheimer's disease doubles every five years after the age of 65, according to the National Institute of Neurological Disorders and Stroke (NINDS).

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Family history. People who have a sibling or parent with Alzheimer's disease are more likely to develop the disease themselves. This risk is greater if more than one member of the family has been diagnosed with Alzheimer's disease. Although the phenomenon is still being studied, it is thought to be related to a slight variation in the genes of certain people that makes them especially susceptible to the disease.

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Head injury. There is strong evidence that suggests that people who sustain serious head injury are more likely to develop Alzheimer's disease later in life. However, this link has not been firmly substantiated by medical research and is more commonly linked to other forms of dementia.

•

Lifestyle factors. Although this is somewhat controversial, a number of lifestyle factors might play a role in the development of Alzheimer's. These include lack of exercise, lack of access to a social network, and lack of mentally stimulating activities. For example, numerous studies have shown that people with advanced degrees are less likely to develop Alzheimer's, possibly due to increased brain

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 elasticity. In addition, there may be a link between obesity and the metabolic syndrome and Alzheimer's disease. •

Environmental factors. There have been some reports linking aluminum to an increased risk of developing Alzheimer's disease. Aluminum is a common element that is found naturally in the environment as well as in various household products. Although toxic levels of exposure to aluminum is known to cause some neurological symptoms, the role of aluminum in the development of Alzheimer's disease is not fully understood. Many experts believe that the risks associated with normal aluminum exposure are low.

Symptoms Symptoms of Alzheimer's disease usually begin to appear around the age of 60. Alzheimer's disease is primarily marked by the onset and progression of dementia, a decline in mental function that may interfere with the ability to perform daily functions. Dementia involves both cognitive (intellectual) and psychiatric symptoms. Cognitive symptoms of Alzheimer's disease may include memory lose is often the first sign of having an alzheimer’s disease. Memory can be categorized in two ways: short-term memory and longterm memory. Short-term memory is the ability to events that occurred a short time ago or to recall things that were recently learned (such as a person’s telephone number or the name of a restaurant). Short-term memory is stored in the temporal lobe in the brain.

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 This is often the first part of the brain to be affected by Alzheimer's disease. Long-term memory is theability to events that happened in the distant past or recall things that were learned earlier in life. Long-term memory is stored in both the temporal and parietal lobes of the brain. It is usually lost during later stages of the disease. Loss of the ability to use and understand language or known as Aphasia. This is usually the result of neuron damage to the left side of the brain, which is associated with language. People with Alzheimer's disease may forget words and have difficulty communicating with others (extensive aphasia). They may also have problems understanding spoken or written words (receptive aphasia). People also experience Agnosia or the loss of ability to recognize familiar people, places or things. It is usually the result of neuron damage in the occipital or parietal lobes. Agnosia also involves an inability to interpret signals from the body, such as when the bladder is full or pain signals that imply serious conditions (e.g., chest pain). This also includes Apraxia, an impaired ability to carry out motor activities, even when motor functioning remains intact. The psychiatric symptoms of dementia are most likely caused by imbalances in brain chemistry and are often the most distressing for the patient and the patient’s family and friends. Some people with Alzheimer's disease do not experience all or any of these symptoms. Psychiatric symptoms may be treated using antipsychotic, anti-anxiety or antidepressant medication. They may include personality changes. This is often a marker of the

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 early stages of Alzheimer's disease. Changes in personality may include irritability, apathy and a tendency to withdraw from the company of friends and relatives. They may also experience depression. Most people with Alzheimer's disease show some signs of depression throughout the progression of the disease. This may be mistaken as a reflection of recent events, especially if the person has recently lost a loved one. The development of depression is a risk factor for further psychiatric symptoms, including hallucinations and delusions. These usually occur during the middle stage of Alzheimer's disease. Hallucinations may be visual or aural and may be exacerbated by loss of hearing or sight. Although people with Alzheimer's disease may sometimes be aware that the hallucination is false, in later stages of the disease they may have a strongly held belief in things that are not real. This is called delusion. A significant percentage of Alzheimer's patients suffer from paranoid delusions, in which they imagine their home has been invaded, that personal items have been stolen, or that loved ones have been replaced by impostors. These can be extremely upsetting to both care-givers and Alzheimer's patients. People with Alzheimer's disease may also experience apraxia, which is an inability to perform tasks on demand. This symptom occurs when the neuron connections in the parietal lobe of the brain are affected. The first element that is affected by Alzheimer's disease is usually complex motor skills such as those required to perform most daily tasks (e.g., writing, brushing hair). Next, a person may be unable to

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 complete tasks that were learned during childhood, such as tying a shoelace or brushing teeth. The last element of motor function to be lost is instinctive motor function such as chewing, swallowing or walking. Certain symptoms of Alzheimer's disease may be mistaken for the changes in memory function and mild confusion that people may experience as they get older. Most older people occasionally misplace items or forget the exact details of something that happened in the past. These minor changes are different from Alzheimer's disease because Alzheimer's disease progressively gets worse until the person is unable to function without a permanent caregiver. Stages of Alzheimer's Disease Experts have documented common patterns of symptom progression that occur in many individuals with Alzheimer’s disease and developed several methods of “staging” based on these patterns. Progression of symptoms corresponds in a general way to the underlying nerve cell degeneration that takes place in Alzheimer’s disease. Nerve cell damage typically begins with cells involved in learning and memory and gradually spreads to cells that control other aspects of thinking, judgment and behavior. The damage eventually affects cells that control and coordinate movement. Within this framework, we have noted which stages correspond to the widely used concepts of mild, moderate, moderately severe and severe Alzheimer’s disease. We have

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009

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also noted which stages fall within the more general divisions of early-stage, mid-stage and late-stage categories. Stage 1: No cognitive impairment Unimpaired individuals experience no memory problems and none are evident to a health care professional during a medical interview. Stage 2: Very mild decline Individuals at this stage feel as if they have memory lapses, forgetting familiar words or names or the location of keys, eyeglasses or other everyday objects. But these problems are not evident during a medical examination or apparent to friends, family or co-workers. Stage 3: Mild cognitive decline Early-stage Alzheimer’s can be diagnosed in some, but not all, individuals with these symptoms. Friends, family or co-workers begin to notice deficiencies. Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical interview. Common difficulties include: • Word- or name-finding problems noticeable to family or close associates. • Decreased ability to names when introduced to new people.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 • Performance issues in social and work settings noticeable to others. • Reading a age and retaining little material. • Losing or misplacing a valuable object. • Decline in ability to plan or organize. Stage 4: Moderate cognitive decline

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(Mild or early-stage Alzheimer’s disease) At this stage, a careful medical interview detects clear-cut deficiencies in the following areas: • Decreased knowledge of recent events. • Impaired ability to perform challenging mental arithmetic. For example, to count backward from 100 by 7s. • Decreased capacity to perform complex tasks, such as marketing, planning dinner for guests, or paying bills and managing finances. • Reduced memory of personal history. • The affected individual may seem subdued and withdrawn, especially in socially or mentally challenging situations.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 Stage 5: Moderately severe cognitive decline (Moderate or mid-stage Alzheimer’s disease) Major gaps in memory and deficits in cognitive function emerge. Some assistance with dayto-day activities becomes essential. At this stage, individuals may: • Be unable during a medical interview to recall such important details as their current address, their telephone number, or the name of the college or high school from which they graduated. • Become confused about where they are or about the date, day of the week or season. • Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s. • Need help choosing proper clothing for the season or the occasion.

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• Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children. • Usually require no assistance with eating or using the toilet.

University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 Stage 6: Severe cognitive decline (Moderately severe or mid-stage Alzheimer’s disease) Memory difficulties continue to worsen, significant personality changes may emerge, and affected individuals need extensive help with daily activities. At this stage, individuals may: • Lose most awareness of recent experiences and events as well as of their surroundings. • Recollect their personal history imperfectly, although they generally recall their own name. • Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces. • Need help getting dressed properly; without supervision, may make such errors as putting pajamas over daytime clothes or shoes on wrong feet. • Experience disruption of their normal sleep/waking cycle. • Need help with handling details of toileting (flushing toilet, wiping and disposing of tissue properly). • Have increasing episodes of urinary or fecal incontinence. • Experience significant personality changes and behavioral symptoms, including suspiciousness and delusions (for example, believing that their caregiver is an impostor);

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University of perpetual Help System DALTA- Molino Campus Molino 3, Bacoor, Cavite S.Y. 2008-2009 hallucinations (seeing or hearing things that are not really there); or compulsive, repetitive behaviors such as hand-wringing or tissue shredding. • Tend to wander and become lost. Stage 7: Very severe cognitive decline (Severe or late-stage Alzheimer’s disease) This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak, and, ultimately, the ability to control movement. • Frequently individuals lose their capacity for recognizable speech, although words or phrases may occasionally be uttered • Individuals need help with eating and toileting and there is general incontinence • Individuals lose the ability to walk without assistance, then the ability to sit without , the ability to smile, and the ability to hold their head up. Reflexes become abnormal and muscles grow rigid. Swallowing is impaired.

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