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ALZHEIMER'S DISEASE.

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Definition, causes, theories, detection, diagnosis, treatments of physical & psychological symptoms, last stage.... More...
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Paper Abstract:
Definition, causes, theories, detection, diagnosis, treatments of physical & psychological symptoms, last stage.

Paper Introduction:
Alzheimer's disease, its causes and cures, has long remained a mystery to medical practitioners. However, the efforts of researchers are beginning to reveal clues that may soon enable physicians to prescribe medications and other forms of treatment that will successfully delay the onset of the disease and may even reverse the course of the illness. Yet for the four million Americans currently diagnosed with the disease, future treatments are irrelevant. Fortunately, there are some effective options currently available that can treat the symptoms of Alzheimer's and/or slow its progression. If caught early enough, the patient can gain valuable time that they may have had the diagnosis been made at a later stage during the disease=s development. Unfortunately, because the symptoms can often be so easily

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Treatment for Alzheimer's can serve to not only improve the situationfor the patient but also for the caregiver. 429). Fortunately, there are some effective optionscurrently available that can treat the symptoms of Alzheimer's and/or slowits progression. 68). (1998, November 1). Huparzine A, which is derived from a plant known as club moss,targets the same areas. Medications from this group currently being explored includeVitamin E, selegiline, and ginkgo biloba. 789). Advances in the treatment ofAlzheimer's disease. O. However, more research is needed to determine its precisepharmocologic make-up, the active ingredient, and what, if any, long-termeffects exist. Thesegenetic mutations may result in a defective form of beta amyloid (Carlson,p. Archives of InternalMedicine. The first group includes cholinesterase-inhibiting drugs. Vitamin E taken alone has been noted as having the best results forlimiting free radical damage, followed by selegiline taken alone(Eldepryl), and then by a combination of both Vitamin E and selegilene(Kelly, p. More drugs will also become available withthe likelihood that disease progression could be delayed for many years(Sloane, 1577).Bibliography Carlson, N. This form is the version typically diagnosed in younger patients,those as young as forty. When forgetting small things becomes more serious. C. 68). Last stage treatment. American Family Physician. Examples include ibuprofen andaspirin. 127. It has been suggested that the goal during thelast stages of treatment should be to enhance the quality of life. Rose, V. 789. The prevalence doubles every five years beyond the age of sixty-five (Rose, p. Often these tests include a brain scan, which revealssubdural hematoma or neoplasia. Indeed,this should be the consideration during the entire course of treatment.This means that when the patient is in the terminal stage of the disease,it may be more humane to provide comforts that would normally not beoffered for other reasons. Journal of the AmericanMedical Association. The neuritic plaques and neurofibrillary tangles prevent nutrientsfrom getting delivered to the targeted brain cells and result in the cells=death. (1999, February 3). This allows easier passage ofnutrients to the brain cells and results in better cell performance(Sandroff, p. However, environmental modifications and behavioral techniques shouldbe tried first as the drugs that are available frequently physicallyagitate those above age sixty-five more so than those who are younger.Drug-free possibilities include a structured and consistent routine; theplacement of familiar objects like photos and favorite knick-knacks in thepatient's environment; orientation cues such as clocks and calendars; theuse of simple communication; validation of the patient; favorite music andfoods; and the ignorance of errors the patient makes, meaning the caregiverneed not correct their misperceptions or lost memories as these serve tofrustrate and confuse the patient further. In response, researchers feel an urgent need to confirm positivefindings and get drugs approved, but the process continues at its usualpace. One theory being explored isgenetic. 1577). The state ofdementia is established with a history and examination. (1999, March 3). However, the disease does not stop there. These Cholinesterase-inhibitors provide symptomatic relief, but donot alter the course of the disease; thus, if a patient stops taking themedication, his or her state will deteriorate to that of one had thedisease been allowed to progress unchecked (Richards and Hendrie, p. 68). The fourth group, antioxidants, also slows thedisease's progress by offering protection against free radical damage inthe brain. American Family Physician. In addition to being the most effective anti-oxidantmethod at this point, Vitamin E also has the benefit of producing fewerside effects than selegiline (Sloane, p. If research is accelerated, tests will become available to identifypersons at risk for Alzheimer's disease as well as those who have earlyonset of Alzheimer's disease. 127). However, the efforts of researchers arebeginning to reveal clues that may soon enable physicians to prescribemedications and other forms of treatment that will successfully delay theonset of the disease and may even reverse the course of the illness. Kelly, R. Early detection is beneficial in starting treatments that may delaythe progression of the disease and subsequent institutionalization. Women are twice as likely as mento be diagnosed with Alzheimer's, which may be a result of the role playedby estrogen. 789). Sloane, P. (1999, April 26). (1998, August19). These can be evidenced by emotional withdrawal, combativeness,paranoia, personality changes, mood disturbances, resistiveness, andagitation. 127). 1577. 789). Therefore family members must also be sure to care properly forthemselves, allowing themselves breaks, eating properly, and getting properamounts of nutrition, sleep, and exercise. Antioxidants. Robert E. Familial Alzheimer's disease, sometimes referred to as FAD,accounts for about ten percent of all Alzheimer's cases (JAMA, 1998, p.674). Physical or laboratorytests may be utilized to confirm the diagnosis and rule out otherpossibilities. 429). 68). However, when necessary,institutionalization is a valid option; it can provide the necessary careand supervision that a caregiver may be unable to give due to time orphysical restrictions. Kelly, MD, reports that cumulative datafrom ten studies suggests a twenty-nine percent reduced risk. 127). The brain develops neuritic plaques, which consist of a dense core ofprotein know as beta amyloid that is surrounded by degenerating axons anddendrites, along with activated microglia and reactive astrocytes (Carlson,p. Gingko biloba, a plant extract, has shown some success as a treatmentof the disease, possibly due to its antioxidant effects. Estrogen therapy. There are a number of possible causes for these developmentscurrently being examined by researchers. For instance, the physician can offer thepatient pain medication without worrying about addiction, or the caregivercan allow him or her to eat his or her favorite foods, which may go againsta prescribed low-salt or low-cholesterol diet, rather than feed themthrough a tube or allow them to remain undernourished because of a refusalto eat. 674. L. A diagnosis of Alzheimer's can be accurately diagnosed in seventypercent to eighty-five percent of cases (Kelly, p. Nonsteroidal anti-inflammatory drugs (NSAIDs). The hippocampus andneocortex undergo severe degeneration, especially the association betweenthe cortex of the frontal and temporal lobes (Carlson, p. Other theories suggest causes that may or may not beassociated with beta amyloid, such as: damage to the brain's arteries fromexcess levels of the stress chemical cortisol; damage to the brain tissueas a result of stroke or inflammation; the depletion of estrogen thatoccurs in women after menopause; and environmental hazards such asaluminum, pesticides, solvents, mercury dental fillings, andelectromagnetic fields (Sandroff, p. New hope for Alzheimer's. Additional treatment strategies include blockingthe abnormal phosphorylation of tau proteins, preventing amyloiddeposition, blocking amyloid toxicity, and lowering APOE[Epsilon]4 levels(Richards and Hendrie, p. 68). D. Neurofibrillary tangles can also be found. Journal of the American Medical Association. Sandroff, R. Patients diagnosed withAlzheimer's may also be afflicted with psychological disorders, such asdepression, which are often an indirect result of the disease. JAMA. Progress report on Alzheimer'sdisease. Alzheimer=spatients do not lose all cognitive function at once and are aware enoughduring the early stages of the disease to know what is happening and tofeel frustrated and/or depressed as a result. Unfortunately, because the symptoms can oftenbe so easily masked, this does not happen as often as it could.Symptoms and Causes Alzheimer's is characterized by a progressive loss of memory anddeterioration in other mental faculties. It typically occurs in peopleover age sixty-five, though it may be diagnosed in those as young as forty.Sufferers undergo increasing confusion and disorientation with regard totime and location; experience difficulty completing routine tasks, such asbalancing checkbooks; and develop language problems, often unable to findthe right words to express their thoughts. 68). Inaddition, an early discovery, before much damage has occurred to the brainand cognitive function, allows the patient to make arrangements thatinclude advance directives, such as whether or not to resuscitate or useAexcessive@ life-saving methods like ventilators, and appoint power ofattorney. Other potential medications include ergotalkaloids, neotropics, and vinaalkaloids (Richards and Hendrie, p. However, the treatment does notnecessarily improve cognition, and instead merely acts to slow thedisease=s progress (Kelly, p. Richards, S. 1577). The second group,nonsteroidal anti-inflammatory drugs (NSAIDs), has met success positivelyaffecting the progress of Alzheimer's. Foundation of Physiological Psychology,fourth edition Allyn and Bacon: Boston, 429-431. 4 2. Alzheimer's disease, its causes and cures, has long remained amystery to medical practitioners. Treatment of psychological symptoms. 1326. Many times the early signs areattributed to the normal course of aging. However, Dr. Philip Sloanestates that "the cornerstone of disease management is high-quality primarycare, meaning regular visits every four to six months, frequent contactwith family members, availability by telephone, general health maintenance,and the minimization of medication with potential effects in mood orcognition" (Sloane, 1577). R. JAMA. 127). 789). Another natural treatment, which may be foundin foods such as soy, rice, and green leafy vegetables, is phosphatidylserine, which works to strengthen and revitalize the membranes thatsurround brain cells (Sandroff, p. Risk factors includeage, family history, and Down Syndrome. Additional symptoms that may be a direct result of memory lossor result from the damage to the brain caused by the disease includeinappropriate social behaviors, delusions and hallucinations. Antioxidants can besupplied by a diet that is rich in fruits and vegetables. Diagnosis,management, and treatment of Alzheimer=s disease. Studies have shown that someonein their forties has poorer short-term memory than someone who is twenty-five; and those above sixty-five score even more poorly. (1999, July 15). It can reduce necessary healthcare and delay institutionalization. Many studies have suggested an inverse relationshipbetween estrogen replacement therapy and the relative risk of developingAlzheimer's disease. As a result of these inexplicable lapses, patients often developpsychological and/or behavioral problems that may serve as defensemechanisms. Barry Okenstudied a number of research projects that set out to determine the effectsof ginkgo biloba, and he reports that there is a slight but significantimprovement in cognitive function as a result of its ingestion (Oken, p.4 2). (1999, June). Donepezil isusually the first-course of treatment, meaning it is tried before tacrine.This is "due to its ease of administration, less titration, greatertolerability, relative lack of hepatotoxic side effects, and absence ofmonitoring requirement" (Richards and Hendrie, p. Yetfor the four million Americans currently diagnosed with the disease, futuretreatments are irrelevant. Cholinesterase-inhibitors. Estrogen therapy presents what may be a preventivesolution for women. 429). Estimates of thedisease's progression range from eight years to twenty years, though theaverage seems to be about ten. However, there are other possible causes of beta amyloid accumulationthat may include head injuries and/or infections, excessive use of alcoholand/or other drugs, exposure to toxic substances, and misfunction of theimmune system. 127). Since there are no definitive causes for the disease noted at thispoint, it is difficult to predict who will fall prey. The end result is the symptoms described above (Sandroff, p. Oken, B. Its late stages arecharacterized by few or no verbal abilities, an inability to recognizefamily members or caregivers, a non-ambulatory state of being (meaningbedridden), and agitated behavior. S., and Hendrie, H. 1577).Unfortunately, of those suffering mild to moderate cases of Alzheimer's, nomore than one-third of the patients has a clinically significant response(Kelly, p. 68. RonniSandroff refers to one study that suggests the risk could be reduced by asmuch as eighty percent (Sandroff, p. Phosphatidyl serine. 432) or overproduction of the beta amyloid precursor protein (Sloane, p.1577), which in turn is the cause of some of the physical deterioration inthe brain. 789).However, while the patient is undergoing treatment, the medication willreturn the patient's function to the level that was present between six andtwelve months before the medication was started (Sloane, p. VegetarianTimes. There are treatments currently being researched that may provide waysto prevent the progress of the disease or reverse its course. If caught early enough, the patient can gain valuabletime that they may have had the diagnosis been made at a later stage duringthe disease=s development. 1326). Metrifonate andrivastignine are in the last stages of testing for FDA approval.Heptylphysistigmine is a third undergoing clinical trials. There are two approvedfor use by the FDA: tacrine (Cagnex) and donepezil (Aricept). These enhance cholinergic pathways that are blocked bythe atrophy of cholinergic ventral forebrain neurons and partialdeafferentation of the hippocampus (Kelly, 127). As stated already, the disease is most prevalent in thoseover age sixty-five; five percent of this population is afflicted (Carlson,p. The disease is terminal. As one may notice, some of thesemay be found in the diet or taken as supplements. Alzheimer's is a difficult disease not only for the patient but alsofor the family members who must watch the deterioration of the person theyknow and love and who must also attempt to properly care for thatindividual. Physical effects of the disease are limited to the brain.Alzheimer's causes the nerve cells to degenerate and the brain matter toshrink, in the process affecting the areas of the brain that controlthought, memory, and language (JAMA, 1998, p.674). Keeping current in Alzheimer=sdisease. Patient Care. The history istaken with a reliable source, often a family member who can help determinewhether the progression of the dementia may be related to the use ofanticholinergics, sedatives/hypnotics, chronic alcohol abuse, certainantihypertensive agents, certain analgesic agents, psychotropicmedications, or illicit drugs (Kelly, p. Other tests the physician may find helpfulin confirming the diagnosis include physiologic scans, CSF analysis(examination of the cerebral spinal fluid), and apolipoprotein E.Treatment Once diagnosis is confirmed, there are a number of treatments thatare currently being utilized and researched. 68). E., MD. Eventually the patient becomescompletely dependent on others. With the diagnosis of former President Ronald Reagan, more attentionhas been focused on this disease. 789).Late-onset Alzheimer's, which typically does not afflict patients until theage of sixty-five, has been found to occur more frequently in thosecarrying the APOE[Epsilon]4 allele on chromosome 19, though this is not acertain indicator of the disease (Richard and Hendrie, p. The efficiency of ginkgo biloba incognitive function in Alzheimer's disease. However, it is not recommended that either betaken early as a preventive measure due to the possible side effects ofgastrointestinal toxicity (Sloane, p. It has been found to be associated with genemutations on chromosomes 21, 14, and 1 (Richards and Hendrie, p. As the "babyboomer" generation continues to age and the average length of lifecontinues to grow longer, more Americans will be diagnosed with thedisease. (1999). These psychological symptomsmay be treated with a variety of medications including antidepressants,antipsychotics, and acetylcholenesterase inhibitors. These are dyingneurons that contain intercellular accumulations of twisted proteinfilaments that formerly served as the cells' internal skeleton (Carlson, p.43 ). Other treatments. Studies suggest that it may bind more closely andspecifically to these specific cells (Sandroff, p. One study undertaken reported that an individual's risk waslowered by sixty percent when the medication was taken regularly for twoyears (Sandroff, p.

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