Alzheimer’s disease (AD) is the most common type of dementia seen in older adults. An estimated 5.4 million Americans of all ages had Alzheimer’s disease in 2012. Nearly half (45%) of people over the age of 85 have AD. By 2050, the number of individuals age 65 and over with Alzheimer’s could range from 11 million to 16 million unless science finds a way to prevent or effectively treat the disease. One in eight older adults has AD, and it is the sixth leading cause of death in the United States (Alzheimer’s Association, 2012). Those affected with AD may live from 3–20 years or more after diagnosis, making the life span with this disease highly variable.
Advanced age is the single most significant risk factor for AD (Alzheimer’s Association, 2012). More women than men have AD, but this is because women live longer than men, not because gender is a risk factor. Family history and heredity are also identified risk factors for AD, as are head trauma and poor cardiac health.
Alzheimer’s disease is characterized by progressive memory loss. The person affected by AD is gradually less able to remember new information and memory lapses begin to affect daily function. It is a terminal disease that over its course will eventually leave a person completely dependent upon others for care.
Initially, the clinical progression of the disease is slow with mild decline; however, deterioration increases the longer the person lives, with an average life span of 8 years after diagnosis (Cotter, 2002; Fletcher, Rapp, & Reichman, 2007). The underlying pathology is not clear, but a growth of plaques and fibrillary tangles, loss of synapses, and neuronal cell loss are key hallmarks of AD that interfere with normal cell growth and the ability of the brain to function. Absolutely definitive diagnosis is still through autopsy, although clinical guidelines make diagnosis easier than decades ago when less was known about the disease. Primary care physicians generally make the diagnosis through a thorough history, physical exam, cognitive testing, and labs. New criteria for diagnosis include staging the disorder and biomarkers (beta amyloid and tau in the cerebrospinal fluid and blood) (Alzheimer’s Association, 2012b). An MRI of the brain may be ordered to rule out other causes of symptoms.
The clinical course of AD is divided into several stages, depending on the source consulted. In the early course of AD, the person may demonstrate a loss of short-term memory. This involves more than common memory loss, such as where the keys were put, and may involve safety concerns such as forgetting where one is going while driving. The inability to perform math calculations and to think abstractly may also be evident. In the middle or moderate phase, many bodily systems begin to decline. The person may become confused as to date, time, and place. Communication skills become impaired and personality changes may occur. As cognitive decline worsens, the person may forget the names of loved ones, even their spouse. Wandering behavior as well as emotional changes, screaming, delusions, hallucinations, suspiciousness, and depression are common. The person with AD is less able to care for her- or himself and personal hygiene suffers. In the most severe and final phase, the person becomes completely dependent upon others, experiences a severe decline in physical and functional health, loses communication skills, and is unable to control voluntary functions. Death eventually results from body systems shutting down and may be accompanied by an infectious process. Although there is no single test, and the diagnosis may be one of exclusion, early diagnosis is important to maximize function and quality of life for as long as possible. Persons experiencing recurring and progressing memory problems or difficulties with daily activities should seek professional assistance from their physician.
Treatment for AD is difficult. There are several medications (such as Aricept, Namenda, Razadyne, and Exelon) that may help symptoms (such as memory), but they do not slow the course of the disease. There is currently no cure; however, research continues to occur in pharmacology, nonpharmacology, and the use of stem cells to manage symptoms and perhaps one day eradicate the disease.
Treatment will focus on symptom management, particularly in the areas of behavior, safety, nutrition, and hygiene. Behavioral issues such as wandering and outbursts pose a constant challenge. Many long-term care facilities have special “memory care” units to care for Alzheimer’s patients from the early to late stages of the disease. These units provide great benefits such as consistent and educated caregivers with whom the patient or resident will be familiar, a safe and controlled environment, modified surroundings to accommodate wandering behaviors, and nursing care 24 hours a day. Additionally, nurses are present to manage medications and document outcomes of therapies. However, many family members wish to care for their loved ones at home for as long as possible.
Thus, another important aspect of care in AD is care for the caregivers. Howcroft (2004) suggested that “support from carers is a key factor in the community care of people with dementia, but the role of the caregiver can be detrimental to the physical, mental, and financial health of a carer” (p. 31). She goes on to say that the caregivers of persons with AD would benefit from training in how to cope with behaviors that arise in these patients and how to cope with practical and legal issues that may occur.
Research has shown that ongoing skills are needed by family caregivers to deal with the progressive decline caused by AD. In fact, “a 63% greater risk of mortality was found among unpaid caregivers who characterized themselves as being emotionally or mentally strained by their role versus noncaregivers” (National Conference of Gerontological Nursing Practitioners & National Gerontological Nursing Association, 2008b, p. 4). Adapting to stress, working on time management, maximizing resources, and managing changing behavior were all skills caregivers needed to develop in order to successfully manage home care of their loved ones. When interventions and resources were not used by caregivers in the early stages of the care recipient’s AD, the risk of a healthy patient being institutionalized due to caregiver burden was higher (Miller, Rosenheck & Schneider, 2012). Caregivers needed not only to acquire knowledge and skills, but also to make emotional adjustments themselves to the ever-changing situation.
Such findings suggest that nurses should focus a good deal of time on educating caregivers of persons with AD to cope with, as Nancy Reagan put it, “the long good-bye.” Scientists continue to explore the causes of AD and hope in the near future to be able to isolate the gene that causes it. In the meantime, results from a fascinating longitudinal study (called the Nun study) on aging and AD, which used a group of nuns who donated their brains to be examined and autopsied after death, has suggested that there is a connection between early “idea density” and the emergence of AD in later life. That is, essays the nuns wrote upon entry to the convent were analyzed and correlated with those who developed AD. It was found that those with lower idea density (verbal and linguistic skills) in early life had a significantly greater chance of developing AD (Grossi, Buscema, Snowdon, & Antuono, 2007; Snowdon, 2004). The nun study has allowed researchers to examine hundreds of brains so far in nuns who died between 75 and 107 years of age and discover other important facts such as a relationship between stroke and the development of AD in certain individuals, and the role of folic acid in protecting against development of AD (Snowdon, 2004). Scientists from a number of fields continue to research the causes and possible treatments for AD and the Nun study project is continuing at the University of Minnesota. Snowdon’s research suggests that early education, particularly in verbal and cognitive skills, may protect persons from AD in later life.
Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L.
Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Sudbury, MA: Jones and Bartlett Publishers. Used with permission.
Many people assume that dementia is a disease in itself, but it’s not.
Dementia is more of a blanket term used to describe several conditions affecting the brain, typically characterized by the loss of cognitive functioning.
People living with dementia often have problems thinking, reasoning, and remembering, often to the point where it interferes with their daily lives.
Even behavioral abilities are affected by dementia, with some having difficulty controlling their emotions.
At its earliest stage, dementia would be starting to affect cognitive abilities. As it progresses, the symptoms become worse.
By the time the affected person reaches dementia’s most severe stage, they would be dependent on in-home dementia care for the most basic functions of living, like brushing their teeth and taking care of their personal hygiene and grooming.
There are several types of dementia, the most common of which include:
1. Alzheimer’s Disease
Alzheimer’s disease is the most common type of dementia, as it makes up 60 to 80 percent of all dementia cases..
A progressive and irreversible condition, Alzheimer’s affects that part of our brain responsible for language abilities, formation of short-term memories, and comprehending and remembering information.
Apart from the diminished ability to understand and remember information, other signs and symptoms of Alzheimer’s include:
- Inability to remember recent events
- Eventual loss of memories of long-term life events
- Reduced decision-making abilities
- Inability to perform simple tasks
- Difficulty following a conversation
- Disinterest in favorite activities and hobbies
- Repetitive words and sentences
- Reduced fine motor skills
2. Vascular Dementia
As its name suggests, vascular dementia is associated with reduced blood flow in the brain, typically caused by a stroke or atherosclerotic disease.
Next to Alzheimer’s, vascular dementia is the second most common type of dementia, and it causes, among other things, confusion and disorientation, inability to concentrate for extended periods, difficulty completing tasks, and vision problems.
3. Lewy Body Dementia
About 5-15% of all dementia cases are classified as Lewy Body Dementia, which occurs when abnormal protein deposits in nerve cells affect the area of the brain responsible for thinking and physical movement.
These deposits prevent the brain from sending chemical signals to the body, leading to memory loss and delayed reactions.
On top of memory loss and diminished language and reasoning abilities, people living with Lewy Body dementia also experience insomnia, depression and anxiety, and symptoms similar to Parkinson’s disease, including feelings of weakness, difficulty walking, and tremors.
4. Parkinson’s Disease
Parkinson’s disease is caused by nerve cell loss in the substantia nigra, the part of the brain that plays a crucial role in movement. When people living with Parkinson’s reach the disease’s advanced stage, they will likely develop dementia.
Aside from dementia, Parkinson’s patients also experience symptoms such as difficulty comprehending visual information, irritability, paranoia, depression, trouble walking and speaking, and tremors, which could affect any part of the body but are most common in the hands.
5. Frontotemporal Dementia
Frontotemporal Dementia affects the brain’s front and side areas, which are tasked with controlling a person’s behavior and language.
While its cause has not yet been identified, frontotemporal dementia is already known to run in families and affect individuals as young as 45-years-old.
As frontotemporal dementia affects the parts of the brain responsible for behavior and language, behavioral issues such as loss of motivation and inhibition and speech problems are common symptoms among those who have the condition.
These are the most common types of dementia, and there are several other subtypes and rare forms.
If you suspect that a loved one has dementia, it’s best to bring them to a neurologist for immediate diagnosis.