Gerontology College Research Paper on Alzheimer’s Disease
Within this paper three areas pertaining to Alzheimer’s disease will be discussed: (1) the nature of the disease itself, (2) how the disease affects methods of living, and (3) difficulties that a caretaker must face. Most of the research was concentrated on the first topic, but the other two are touched upon in significant detail to make them worth mentioning here.
In order to discuss Alzheimer’s Disease, we must first begin by describing its causes and effects. Within his book entitled, “Understanding Alzheimer’s Disease,” Miriam K. Aronson discusses in depth many of the causes and effects of Alzheimer’s Disease. He begins by citing that Alzheimer’s Disease is the largest cause of demensia both for those people over years of age, and for those under 65 years of age. Demensia is defined by Aronson as follows: “…a progressive impairment in memory and thinking so severe that it interferes with occupational or social function.” Alzheimer’s Disease was originally described in 1906 by Alois Alzheimer.
As cited by Aronson, Alzheimer observed two distinct brain anomalies that are now associated with the disease bearing his name: (1) neuritic plaque, and (2) neurofibrillary tangle. Neuritic plaque consists of degenerating nerve terminals and and fibrous material called amyloid, surrounded by glial cells that bind nerve tissue together. A neurofibrillary tangle is simple stated by Aronson to be a structure within nerve cells that is stained heavily with silver stain. Both abnormalities are characteristic of Alzheimer’s Disease.
According to Aronson, there has been a large revival of interest in the disease that can be attributed mainly to the fact that America’s population is an aging one. He observes that eleven percent of the US’s population was over the age of 65 in 1980, and this figure has risen at an exponential rate since then. He also estimates that by the year 2000 over half of all people over age 65 will also be over age 75. This is significant because it is the group of people over age 75 that is most susceptible to the onset, and to the effects, of Alzheimer’s Disease. Therefore, it becomes obvious that progressive research into the nature of Alzheimer’s will be increasingly important as our nation’s population continues to age.
Alzheimer’s disease can manifest itself in a number of distinct ways. However, gradual declines in memory, learning, attention, and judgement are common, as well as disorientation in space and time, word-finding and communication difficulties, and changes in personality. Resulting from these symptoms is the following set of common emotional symptoms: depression, paranoia, and agitation. While the emotional symptoms are not directly caused by the disease, they may occur intermittently as a result of the physical symptoms of Alzheimer’s Disease.
According to Aronson, a good diagnosis is essential because of the wide range of symptoms that are associated with Alzheimer’s Disease. It is because of this wide range that no single diagnostic test exists for Alzheimer’s Disease. Aronson denotes the following tests as being crucial to a good diagnosis of the disease: a careful history, mental-status test, comprehensive physical examination, including blood test and spinal tap, computerized axial tomography test (CT), and Electroencephalography (EEG).
The purpose of each of these physical tests will be discussed briefly. A blood test will test for thyroid hormones and vitamin levels. A spinal tap will show abnormal cells or proteins. The computerized axial tomography exam can test for evidence of prior strokes or tumors. And the electroencephalography exam can check for abnormalities in the brain’s electrical activity. An addition to these physical examinations, a patient may be given various psychological and/or psychiatric examinations in order that any macroscopic emotional or cognitive deficiencies may be revealed. While these tests can give a good indication of the presence of Alzheimer’s Disease in a patient, the diagnosis can only be confirmed by a brain biopsy, or posthumously during an autopsy.
Now that the various symptoms and methods of detection have been discussed, let us turn to methods of treatment. There is in fact no established method of treating Alzheimer’s Disease, however there are a number of theoretical possibilities that exist, which may prove to be useful in the future. Following the disease’s first observation in 1906, there remained very little in the way of treating the disease itself, and very little in the way of treating the symptoms of the disease, until a breakthrough occurred in Alzheimer’s research in 1976.
In 1976, according to Aronson, it was discovered that there was in every Alzheimer’s patient a deficiency in the production of the chemical acetylcholine in several regions of the brain. Acetylcholine is a neurotransmitter that is used to transmit signals along to other nerve cells. Prior to this discovery it was known, through both human and animal experimentation, that interference with acetylcholine production can be a cause of memory impairment. It was consequently speculated that at least some of the symptoms of Alzheimer’s Disease, specifically those that are memory related, were due in part to that deficiency. This speculation was supported by evidence of a correlation between the degree of acetylcholine loss, the degree of demensia, and the degree of memory impairment. It is, however, unknown whether all neurotransmitters are affected by the onset of Alzheimer’s Disease, or just acetylcholine. According to Aronson, the emerging picture is this: that there is a dramatic loss of acetylcholine-producing cells in all cases of Alzheimer’s Disease, with lesser and variable involvement of other nerve cells, especially in late stage cases.
While the correlation between the above cell death and the cognitive symptoms of Alzheimer’s disease is well known, the cause of the onset of that cell death is as yet unknown. However, several current theories are described within Aronson’s book. A popular guess is that a viral infection is the cause of the cell death. A disease by the name of Creutzfeldt-Jakob’s Disease is known to be caused by a virus, and has been observed to be transmittable to animals. It can be between one and five years before the onset of this disease is noticed because the virus is not detectable by standard virus detection methods. However, Aronson doesn’t feel this conclusion to be likely because Alzheimer’s Disease has never been observed to be transmittable to animals in the way that Creutzfeldt-Jakob’s Disease is.
In a few cases there is evidence that a genetic error may be a cause of the onset of acetylcholine-producing cell-death. However, in the overwhelming majority of cases, the onset of Alzheimer’s Disease appears to be random, rather than genetically predictable.
There are several difficulties that arise while attempting to diagnose Alzheimer’s Disease. Chief among these is the nature of the first perceptible symptom, i.e., memory-loss. Often it can be exceedingly difficult to distinguish normal age-related memory-loss from memory loss that is caused by Alzheimer’s disease. It is only by a combination of the aforementioned tests that one would be able to diagnose Alzheimer’s with any degree of accuracy. This is a result of the fact that there are many other illnesses that cause symptoms that could easily be mistaken for those symptoms caused in the early stages of Alzheimer’s Disease. Thus, in addition to memory-loss, all other changes in cognition should be evaluated and tested. These other changes may take the forms of hallucinations, unusual or uncharacteristic agitation, getting lost, and/or personality changes.
Aronson offers a list of processes that, when combined, make a nearly complete clinical diagnosis of Alzheimer’s disease. A complete clinical diagnosis should consist of the following factors:
1) Establishing a history of illnesses consistent with Alzheimer’s Disease.
2) Documenting on a mental status exam those memory deficits and cognitive impairments that are consistent with Alzheimer’s Disease.
3) Documenting that certain other conditions, e.g., Parkinson’s Disease, Multiple Sclerosis, et cetera, are not present.
4) Lab tests to rule out disorders that may simulate Alzheimer’s Disease.
By following the above steps, one should be able to obtain a reasonably accurate diagnosis of Alzheimer’s Disease.
Following the diagnosis of Alzheimer’s Disease, there are only a small number of non-experimental treatment options available for the patient with Alzheimer’s Disease. Among the drugs that are available are Cyclospanol, Pavabid, and Vasodilan. Hydergine, an ergot alkaloid, is, according to Aronson, the most widely used medication for treating Alzheimer’s Disease. The evidence shows that there is at least a portion of the population that is very receptive to this drug, and who have shown good improvements upon taking it.
While there is only a limited number of treatments currently available, there are a large number of experimental treatment approaches that are currently being researched. Among these are nootropic agents, peptides, brain cell implantation, and Nerve Growth Factor (NGF). Nootropic agents are believed to improve cognitive functioning without the side effects that are characteristic of other psychoactive medications. Peptides tend to aid attention and mood rather than memory. Brain cell implantation has been shown in some cases to yield excellent results; however, those results were only temporary, and the effects of the disease returned within a few days. However, this high level of success, even if only for a few days, may show the right direction to take in searching for a treatment of the disease. Nerve Growth Factor, a peptide, has been shown to help stop the loss of the characteristic loss of acetylcholine associated with Alzheimer’s Disease. Thus, while current treatments are very limited, it seems as if there are at least two experimental treatment methods that have been shown in laboratory tests to be very promising in Alzheimer’s research, viz., brain cell implantation, and Nerve Growth Factor.
Now that the causes, effects, diagnosis, and treatment of Alzheimer’s Disease have been discussed, let us examine a more practical aspect of Alzheimer’s Disease, namely, how to prepare one’s home for the care of a patient with Alzheimer’s Disease. As listed in “The Complete Guide to Alzheimer’s-Proofing Your Home” by Mark L. Warner, preparing one’s home should begin with the analyzing of the home, and the determining whether one of the following major projects is necessary for the safe and healthy care of one’s loved one:
A) Adding a bathroom
B) Converting a room
C) Preparing a care-giver’s room
D) Adding a washer/dryer
A, B, and D above are crucial, should they be necessary, to the safe and supportive care of one with Alzheimer’s Disease. Demensia may cause one to forget simple things like the location of crucial places such as a bathroom, or laundry room. Thus, in order to prevent undue emotional stress, any or all of the above steps should be taken to ensure that the patient can find essential areas without a sense of spatial or temporal dislocation.
In addition to the preparation of the layout of a home, there are several cognitive issues that must be dealt with in order to ensure the safety and happiness of the Alzheimer’s patient. The most obvious of these is, of course, memory. Because of the deteriorating effects of Alzheimer’s Disease, objects and essentials may become difficult to locate within a house if an effort is not made to ensure that they are all placed in convenient, easy to locate places. A large amount of unnecessary agitation can be caused by poor placement of objects within a care home, since a patient will often get frustrated with himself/herself if he/she cannot find the object being looked for.
Another issue that must be dealt with is the tendency and desire of an Alzheimer’s patient to wander. While wandering should not be discouraged, steps should be taken to ensure that it may be done safely. For example, familiar and reassuring objects should be placed within the local area, e.g., within a garden, etc., in order to encourage wandering locally, rather than leaving open the possibility of wandering away from the care-giver without his/her being aware of it. Also, one must prevent wanderings by car, etc. for obvious safety reasons. A patient with severe Alzheimer’s Disease would be very dangerous if allowed to wander off in a motor vehicle without anyone’s being aware of it. On the subject of being aware, Warner advised that a care-giver prepare some method of alerting him/her of the wanderings of the patient, in order to assure a “sneaky escape attempt” is not made. Such alerting devices may take an active (audible signaling device, for example) or passive (silent alarm, etc.) form. The alerting device should be designed to match the individual needs of the patient. For example, if a patient had some sort of authority complex, it may be advisable to rig up a silent alarm in order not to reinforce his/her sense of non-independence.
A crucial safety factor is that of access denial. There are undoubtedly many items around a typical household that pose a potential threat to the memory deprived Alzheimer’s patient. Such dangers may include chemicals, sharp objects, etc. There are four main methods that Warner mentions that may be used to reduce the danger of these objects to the patient. These are: removing the danger, using diversions, camouflage, and hiding the locks. The first method seems to be intuitive; simply get rid of the object. Diversions may be used to distract the attention of the patent away from the hazards. Camouflage may be used to hide the objects from the patient. And one may need to hide the locks in order to reduce the temptation of the patient to get inside the locked enclosures.
Another aspect of Alzheimer’s Disease that was examined in my research is the role of the care-giver, and his/her responsibilities. In a bound pamphlet entitled, “Caring for the Care-giver,” published by Parke-Davis, the Caregiver’s Bill of Rights is given as follows:
I have the right:
1) To take care of myself. This is not an act of selfishness. It will give me the capability of taking better care of my loved one.
2) To seek help from others even though my loved one may object. I recognize the limits of my own endurance and strength.
3) To maintain facets of my own life that do not include the person I care for, just as I would if he/she were healthy. I know that I do everything that I reasonably can for this person, and I have the right to do some things just for myself.
4) To get angry, be depressed, and express other difficult feelings occasionally.
5) To reject any attempt by my loved one (either conscious or unconscious) to manipulate me through guilt, anger, or depression.
6) To receive consideration, affection, forgiveness, and acceptance for what I do from my loved one for as long as I offer these qualities in return.
7) To take pride in what I am accomplishing and to applaud the courage it has sometimes taken to meet the needs of my loved one.
8) To protect my individuality and my right to make a life for myself that will sustain me in the time when my loved one no longer needs my full-time help.
9) To expect and demand that as new strides are made in finding resources to aid physically and mentally impaired older persons in our country, similar strides will be made toward aiding and supporting caregivers.
There is a crucial message to the above statement, which is that caregivers are human, too. Because of that fact, if their needs as human beings are not met in addition to those of their loved ones, they will in fact be doing a disservice both to themselves and to their loved ones. This message also provides valuable aid and warning for the caregiver. Adhering to its maxims will result in a healthy and equal patient-caregiver relationship in which both partners are being treated fairly, and like human beings.
In addition to this “Bill of Rights,” the pamphlet also contains practical information and specifics on how to make the home safer for the Alzheimer’s patient, including such topics as hazards, bedding, meal preparation, etc. Although much of the information is too specific to be mentioned here, the important concept to be discovered is that there is support available for the caregivers of Alzheimer’s patients, and that they are not alone in helping their loved ones. Numerous resources are available, including internet resources such as the ones denoted in the bibliography, for the caregiver, and more often than not they are easy to locate.
There is a final aspect that is to be covered here, and that is the ethical dilemmas facing caregivers. Perhaps the most important issue occurs when legal counsel is required for some purpose. Oftentimes it is not exactly clear to the lawyer exactly who his/her client is in a given situation, the patient or his/her caregiver. One solution offered by Aronson in “Understanding Alzheimer’s Disease” utilizes the notion of legal capacity. The President’s Commission for the Study of Ethical Problems in Medicine and Biomedical Research states that “…decision-making capacity requires, to a greater or lesser degree: possession of a set of values and goals, the ability to communicate and to understand information, and the ability to reason and to deliberate about one’s choices.” Thus, unless these criteria are met, a patient ought not to be said to have the proper legal capacity required to manage his/her own affairs legally.
A solution to this problem that some states have put forth is that of guardianship. In certain cases it is possible for a caregiver to be appointed to the role of guardian, i.e., one who manages both finances and a personal care routine for the patient. Thus, following the appointment of a guardian, the question of legal responsibility may no longer apply to a given situation.
Patient/Physician privileged communications is another area cited by Aronson where caregivers and physicians both face a certain moral dilemma. How, for example, can a doctor maintain privileged communications with his/her patient if he/she lacks the cognitive faculties necessary to comprehend the gravity of his/her situation? Aronson offers no answer to this problem, but it must be agreed that this does present a difficult ethical problem for both physicians and caregivers.
In conclusion, it has been shown what exactly are the causes, effects, methods of diagnosis, and treatments of Alzheimer’s Disease. Certain steps that must be taken to make a care home safe for a patient have been shown, as well as the role of the caregiver and the problems/dilemmas that she must face in caring for a patient with the disease.
Bibliography:
Book References:
“Understanding Alzheimer’s Disease,” Miriam K. Aronson, Ed.D. 1988 by Alzheimer’s Disease and Related Disorders Association. ISBN 0-684-18475-3
“The Complete Guide to Alzheimer’s-Proofing Your Home,” Mark L. Warner. 1998 by Purdue University Press. ISBN 1-55753-127-7
“Caring for the Caregiver,” by Parke-Davis, a division of Warner-Lambert Co. No ISBN.
