Essay/Term paper: Alzheimer's disease
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"Where has Yesterday Gone"
Memory loss, like old age is a condition which mankind has always reluctantly recognized and always â“ with resignation. Memory loses are sometimes trivial and meaningless and go unrecognized. However, when these loses are so great that a person does not know who or where they are the concerns are quite grave. Although it is realize that Alzheimer"s disease destroys the brain memory function, many do not realize precisely how the memory is destroyed once one is aware of the process, it becomes faster to work forward to alleviate the destruction.
"Without memory there is no knowledge to recreate or reproduce past perceptions, emotions, thoughts and actions that are so vital to live a full and functioning life. Memory is the key that unlocks doors that keep us functioning, not only mentally but physically (Corrick 32)."
"Memory loss is not a sign of decay (Freedman 10)." As we get older, there is some mild impairment in our recollection of recent events, such as forgetting why one went into a room or misplacing a person"s eye glasses, which even young are guilty of doing. As reported by Larry Squire, "forgetting is quite normal and usually develops in the third decade of life, and by one estimate 85 percent of the healthy elderly â“ those over 65â”suffer some memory impairment (59)."
According to Dr. Seligmann, "forgetting is the process through which information in memory becomes inaccessible, either because it is stored but is not at that time retrievable (51)." This is one of the most important factors in forgetting. Memory loss is rapid at first and then gradually levels off. There are many types of "dismembering" enemies that hamper ones recall and retrieval system. "Forgetting may be increased by interference from proactive inhibition, that is material learned beforehand, like trying to remember a soup recipe (51)."
In remembering stories or events there is a tendency for distortions to occur. Cutler explains that studies made by Elizabeth Loftus reveal, "what you learn today may actually distort your memory of what happened to you yesterday. . . (62)." People tend to remember the events that they regard as the most important. They attempt to reconstruct the event, usually what knowledge they have, with the result being what would have been expected rather than what actually happened.
Dr. Siegfried reports that "Neural decay is another enemy to the memory. Sensory receptors, such as visual, auditory and smell, provide you with sharply etched neural impressions or the world around you. But this pattern of neural firing is quickly destroyed in one of two ways; the receptor neurons adapt to the input (10- 11)." The brain can register only one item at a time. If two events are occurring at the same time the storage of the information will depend on the importance of information to the individual. "Neural decay is perhaps the simplest types of forgetting (Seligmann 51)."
As explained by Dick Gilling, "the short-term memory "holds" items until a person decides how important they are and if they need to be transferred to the long-term memory for permanent storage (15)." According to the experience, the brain has made a mental index card for each category experience. "These index categories are used when someone wants to retrieve an item from memory storage banks. Sometimes these "mental index cards" get catalogued in the wrong way, that is misfiled, or even lost (14)."
When someone has learned too many things at once, cataloging errors frequently occur (Hamdy 93). For example, if a person is introduced to a dozen unfamiliar people at a party, mistakes will be made trying to attach the right names to proper faces. If a person were to meet one new individual a day for a dozen days, the chances will be greater of getting the file cards filed out correctly.
"Misfiling also occurs, and people have trouble locating items in their memory banks. The more similar two items are, the more likely it is that one of them will be filed in the place supposedly reserved for the other (Gilling 14)."
All the changes of aging that occur in the brain should not interfere with everyday living, "as there is ample organ function left to go on to ripe old age as long as there is no disease to accelerate the aging process (Gold 12)." We lose some brain cells as we age, but "there are millions of healthy ones left for our intellectual endeavors. . . However, a disease such as Alzheimer"s can take away a person"s memory, leaving them with no past, present, or future of any type (Gold 12- 13)." A person becomes nothing but an empty body with no mind inside.
Until recently, explains James A. Corrick, "it was accepted that with the aging process along with senility. Some people will revert back to childhood and remembering things well and thinking clearly will no longer happen. What we call senile dementia is really Alzheimer"s disease (26)." It can strike people in their middle forties. Alzheimer"s disease is incurable and irreversible for now, but neuroscientists are hoping to develop a vaccine against the disease. "Everyone would be vaccinated at birth. . . (27)," and as neurosurgeon Dr. J. Eric Holmes notes, "almost nobody would suffer a decline in intellect and personality as they got older. We would all be bright as a tack as we got to be eighty or ninety. . . (28)." The only thing that would kill us is if our system gave out.
Dr. Siegfried states that Dr. Lewis Thomas, the former Dean of the Yale School of Medicine and now Chancellor of Memorial Kettering Center, has described Alzheimer"s disease as the "disease of the century: . . .the worst of all diseases, not just for what it does to the victim, but for its devastating effects on families and friends (13). It begins with the loss of learned skills progresses inexorably to a total shutting down of the mind. "It is, unmercifully, not lethal. Patients go on and on living, essentially brainless but otherwise healthy, into advanced age, unless luckily enough to be saved by pneumonia (14)."
There are three important changes that occur in the brains of Alzheimer"s patients. "These changes include senile plaques, neurofibrillary tangles and granulovaculoar degeneration (Frank 15)."
Lawrence Galton describes "senile plaques as a development in the nerves of the brain. This is actually a scar, a mark resulting from degeneration, rather than a cause of it. Senile plaques are multiple small islands of dead materials containing specific compounds,. . . (8)." Their origin is unknown. These plaques consists of a chronic infection. "It has been estimated that 80 percent of patients over the age of sixty- five have senile plaques (9)." However, "Alzheimer"s brains have a very heavy concentrated amount of senile plaques in the hippocampus are of the brain where the normal does not (10)."
Another change that takes place in the brain is the abnormal neurofibrillary tangles in the nerve cells. A normal nerve cell looks like a small plant with branches, stem and many roots. "As aging occurs, the roots, which are called dendrites, begin to shorten and lose some of their structure. Eventually, the ends of the roots of these dendrites begin to accumulate into a sort of halio that resembles a small starfish (Cutler 14)." They become thick and intertwined. Although plaques and tangles appear in normal brains and gradually increase with the age Alzheimer"s patient seems to have highly concentrated amount in the. . . "hippocampus portion of the brain, that the seat of memory, the short- term memory (Cutler 24).
The third characteristic that changes in the brain of the Alzheimer"s patient is the "granulovaculor degeneration (Gilling 13)." According to Gold, certain changes inside the cells themselves are taking place. The interior of the cell is undergoing changes and become crowed with fluid filled "vacuoles" as well as granular material. An increased concentration of granulovaculoar degeneration is also found in the hippocampus area of the brain (82).
The changes in the brain found in Alzheimer"s patients are concentrated in the hippocampus are which also appears to be the "primary anatomic locus of short- term memory (Gilling 14)." Short- term memory loss may, however, be the earliest sign of a more catastrophic event occurring in the brain, especially if forgetfulness is severe and progressive (14).
According to Dr. Siegfried, "The following seven stages are adopted from the scale measuring Alzheimer"s disease that was developed by Drs. Barry Reisberg, Steven H. Ferris, Mony J. de Leon, and Thomas Crook (22)." Stage one is "a state of clinical normality (24)." The second stage is the "forgetfulness stage (24)." This phase is common and usually occurs over the age of forty- five. One might forget names of well known friends, however, this does not create a serious handicap for a person working ability. Sometimes the patient is not aware of what is happening. "In stage three, a mild cognitive decline or an early conditional state happens (24)." In this stage a person"s ability to remember someone"s name after being introduced to them is hampered, also, a person begins to misplace items and concentration declines." In this stage, denial symptoms, as well as anxieties, occur. If a person was tested at this stage it would be impossible to diagnose Alzheimer"s disease, especially if someone was sixty years or older (26)." However, the testing would conclude that there may be evidence of memory deficiency.
"During the fourth stage, there is an increased cognitive decline ( Cohen 32)." Abnormalities are definitely found during testing. For example, there might be an inability to continue serial subtraction, to travel, handle personal finances, and an overwhelming decrease in knowledge of current and recent events. However, a person will be able to recognize familiar faces and friends, and there will be no disorientation about where the person is. "In this stage denial is very strong and complex tasks. . . (32)," which were easy to perform in the past cannot be done at all. "In stage five the patient cannot survive without some assistance (32)." People cannot recall their phone numbers or their addresses. In some cases a person cannot, recall family members" names or names of schools they attended. There may also be some confusion as to what day, time or season it is. However, major facts are still retained. Usually, a patient will know their spouse and sometimes their children and still attend to their personal needs. "There might be some difficulty in choosing clothes and shoes (32)." "In stage six there is severe cognitive decline. . . (32)." Assistance for daily activities is required. The
patient may not remember their spouse"s name and has complete unawareness of recent events and experiences. Past knowledge will be vague
in this stage. Night and day become confusing and the patient may become incontinent. "Amazingly, the patient does remember their own name and simple daily cleaning activities may take place (Siegfried 28)." Unfortunately, at this stage delusional and sometimes violent behavior along with anxiety symptoms and agitation occur due to the inability to carry on a thought pattern. Stage seven, the most severe stage, the patient may lose their speech and walking ability. Assistance with feeding is required and bladder control is lost. "The brain is totally separated from the body. . . (Siegfried 29)." "The patient may survive for a long time in this stage, but will eventually die from either respiratory arrest or some other organ failure (Siegfried 30)."
Any one of the stages may continue on for years. There is no certain time limit on any of the stages, making a hardship on the family unbearable. It is not known if a person will stay in one stage or progress to another. This thief of the mind robs a person of their mind little by little, leaving them with no dignity or identity. A person with no memory can create or reproduce items that make a full and functioning life as we know it.
I was fortunate enough to have the privilege an experience of interviewing a good friend of my mom"s, Mary, whose mother is a victim of Alzheimer"s disease. She shared with me, some very private and emotional feelings that her mother, sister, and she experienced and are still experiencing while confronting Alzheimer"s disease. Mary was able to explain, from her point of view, what it was like caring for a person with Alzheimer"s disease.
Mary began by stating, her mother was a fifty- four year old, mother of two daughters that was losing her mind by the handfuls. It took just six months time for her mother to go from a vital, radiant and full functioning person to someone recognizable only in physical form.
The first signs that developed were forgetting phone numbers and unledgable handwriting. Missing appointments occurred regularly and items began to get misplaced. Mary"s mother would be gone all day and then not remember where she had gone. The three and four day disappearances were the convincing data needed to realize something was wrong with her mother.
Her and her sister took their mother to the best neurologist in the state. She was diagnosed as having Alzheimer"s disease. The doctor told Mary and her sister that in order to understand their mother"s behavior, each of them would have to imagine a woman contemplating losing her mind. The mind will not tolerate this conclusion, and the result is denial, the question, the constant question, which are an appeal for some confirming sign that she is not losing her mind. She cannot retain the answers, and she cannot remember that she had just asked a question. Basically, Dr. Ruben told the two daughters that their mother was losing her short- term memory.
Mary"s mother continued to change everyday for the worse. She had to have full time nursing care. The daughters would visit their mother every day, hoping to spark some kind of response from their mother, however, Mary"s mother just sat and stared at the window.
Finally a good friend of the family talked the daughters into putting their mother in a home, where people could take care of their mother and give her some stimulation, which she needed desperately. It was the hardest and most painful decision the girls had to ever make, but deep down they knew it was the best decision for all concerned. This horrible disease had robbed their mother of her self identity and is suffering from the humiliation of having her dignity wrenched from her.
As our conversation came to a close, I asked Mary if she knew of Dr. Kevorkian and of his work with the suicide machine. Mary was well aware of Dr. Kevorkian and his work. She was in full agreement that he did the right thing by helping Jane Adkins end her life before Alzheimer"s did. With tears in her eyes, Mary stated, I know if my mother would have had the choice like Jane Adkins did to end her life with dignity, she would have taken the choice (Personal Interview)."
The treatment for Alzheimer"s disease is unknown. Through the efforts of researchers, worldwide, some of the mysteries of this disease have begun to unfold. At times tranquilizers can lessen agitation, anxiety, and reduce incidence of undesirable behavior. "It is a degenerative disease of the brain (Parke- Davis 6)." "Deficiency of cortical acetylcholine is believed to account for clinical manifestation of mild to moderate dementia (Cognex 3)."
Cognex is the only drug of choice presently used for treatment of Alzheimer"s patients. "Cognex presumably acts by elevating acetylcholine concentration in cerebral cortex by slowing the degradation which is released by enact chelinergic neurons (Cognex 3)."
Approximately "5,600 patients were on clinical trails about 17% were improved with memories. . ." and " 40% stayed the same no change and about 20% had been "withdrawn" with adverse reaction (Cognex 4)."
In conclusion, when is memory loss, whether it is great or small, it takes away the ability to recreate or reproduce to some extent our emotions, past experiences, thoughts and actions that we take for granted. It gives us far more then we give it. The mind needs knowledge to keep us functioning and in return will perform amazing feats for us. Although the cause of Alzheimer"s diseases unknown care, research is ongoing, worldwide. "There is no evidence that Cognex alters the course of the underlying demeaning process (Cognex 3)."
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Among the top 10 causes of death in the US, Alzheimer’s disease ranks the 6th. According to the realistic prognoses, the situation is not going to get any better over time. There are three major statements about Alzheimer’s disease that people should be aware of. Firstly, it is very common among the Americans. Secondly, Alzheimer’s is progressive and lethal. Thirdly, it affects not only patients diagnosed with it, but also their close relatives and the country in general. Let us view the three statements more closely below.
According to the recent reports, approximately 5.3 million of Americans have Alzheimer’s in 2015. 96% of this number is people aged 65 or older, and the rest 4% have an early onset of the illness. It is known that over ⅔ of the patients are women. It is also estimated that, by 2050, the number of people affected with Alzheimer’s may rise to 13.8 million, which is 2.6 times over a 35-year time period.
What makes these statistics so pessimistic is that Alzheimer’s is a progressive mental disease which results in dementia. Memory loss, which is often associated with aging, is only one of the symptoms. In a broader sense, the body of a person with Alzheimer’s disease forgets how to function, and even such automatic processes as swallowing are affected. Over 30% of elderly people die with dementia that is caused by Alzheimer’s or another progressive mental disease; in 60-70% of such cases, Alzheimer’s is the cause. While the disease is debilitating on its own, it is usually accompanied by other serious health conditions, such as hypertension, heart disease, diabetes, and osteoporosis.
While certain changes in the body that are caused by Alzheimer’s disease cannot go unnoticed, only less than half of people with Alzheimer’s are aware of their diagnosis. The main reason is that physicians and caregivers decide not to disclose the diagnosis to their elderly relatives, as many believe that it might frustrate and frighten them. In general, it is important to make a diagnosis like this the earliest, as this might even improve their quality of life.
It is crucial to provide proper care to patients with Alzheimer’s. Usually, relatives choose to stay with their elderly family members and care for them. This results in billions of hours of voluntary unpaid care (17.9 billion hours in 2014), which is not only an extreme financial burden on caregivers, but also an economic one on the national level. It has been calculated that families with at least one member diagnosed with Alzheimer’s spend three times as much on medical care as families where nobody has the disease. Apart from unpaid care and expenses on medical services and products, such people suffer from emotional stress and in some cases develop depression. In the broader context, this year’s economic loss due to Alzheimer’s and other dementias in the US has reached $226 billion (these are mainly Medicare costs, and individual expenses are not included). The sum is expected to grow four times by 2050.
Alzheimer’s is not just a lethal condition of the elderly people, but it is also a cause of significant psychological, social, and economic distress in people who deal with the disease in their family members. With millions of Americans slowly fading away with progressing dementia, hundreds of billions of dollars spent on care for Alzheimer’s patients, and billions of unpaid hours of looking after the ill family members, the disease hurts the country psychologically, socially, and economically. This calls for early diagnosis social programs and medical research aimed at finding a cure.
- Alzheimer’s Association. 2015 ALZHEIMER’S DISEASE FACTS AND FIGURES. Alzheimer’s Association, 2015.
- National Institute of Aging. Understanding Alzheimer’s Disease: What You Need to Know. NIH, 2011.
- Hamdy RC. Alzheimer’s Disease: A Handbook for Caregivers. Mosby, 1998.
- Brill MT. Alzheimer’s Disease. Marshall cavendish, 2005.
- Newport MT. Alzheimer’s Disease: What If There Was a Cure? Basic Health Publications, Incorporated, 2013
- Nowotny P, Kwon JM, Goate AM. “Alzheimer’s Disease.” Encyclopedia of Life Sciences. Nature Publishing Group, 2001.
- Williams JW et al. Preventing Alzheimer’s Disease and Cognitive Decline. Agency for Healthcare Research and Quality, 2010.
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