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Caring for Alzheimer's (Part 2)

By Edited May 9, 2016 1 0

Alzheimer's care

Of course it is not simply up to the average person to recognize the effects of Alzheimer’s in family members; testing and diagnosis have become much more advanced and prevalent in recent years. To make a diagnosis of Alzheimer’s disease, the physician in question uses a series of questions and tests (MMSE or Mini Mental State Examination) which can help assess the disease’s progression and severity. The clock drawing test is another simple tool to screen for Alzheimer’s as it provides insight into cognitive ability. The patient draws clock hands on a circle. A correct drawing indicates the absence of dementia. An abnormally completed clock calls for further evaluation. Another interesting new predictive test for early stages of Alzheimer’s involves the fact that early stage sufferers demonstrate a significant difference between left and right nostrils in ability to smell peanut butter, with left nostril being severely impaired and peanut butter having to be on average 10 cm closer to left nostril than it was to the right nostril for smell to be detected.

Once these tests are completed the physician then takes a medical and family history to discern if the patient is at a higher risk of getting Alzheimer’s. This includes a psychiatric history and history of cognitive and behavioral changes, which can usually be provided by a family member who knows their behavior and can spot if anything has changed. In addition the patient may also undergo an MRI scan to identify changes in the brain, like a tumor or evidence of a stroke, which could cause cognitive decline and thus the development of the disease.

Many changes have occurred since the 1980s when it comes to the diagnosis of Alzheimer’s disease, but there are two very important ones: identification of the three stages of Alzheimer’s disease, (discussed in part one) with the first stage occurring before symptoms like memory loss occur, and biomarker tests which indicate the existence or absence of the disease. The new criteria and guidelines identify two biomarker categories: biomarkers displaying the amount of beta-amyloid buildup in the brain, and biomarkers displaying nerve cells in the brain are damaged or are currently degenerating.

Apart from institutionalizing the patient, two other treatments are available. The first involves the drugs Aricept and Memantine, for example (there are many other options), which reduce the rate of deterioration on cognitive and functional measures and improve behavior (especially agitation). The first of these two drugs works by reducing the amount of acetylcholinesterase enzyme in the brain. This enzyme causes the breakdown of acetylcholine, an neuro transmitter crucial to the function of the whole body. Smokers, for example, have a reduced risk of developing AD because nicotine's shape is quite similar to that of acetylcholine, so it can perform many of the same roles in the body. The second drug, Memantine, works by blocking NMDA receptors, which are stimulated by glutamate. In Alzheimer's patients there is too much glutamate activity, causing excitotoxicity; the drug reduces this problem. However, these two treatment are not 100% effective, rather they are usually moderately useful and have a host of side effects, and they generally must be started at the first sign of AD. The second treatment requires surgical intervention. The procedure is performed so as to stimulate the hippocampus (so named because it resembles a seahorse), a major memory center in the brain.

Hippocampus

If all else fails, the patient is usually put into a home, a burden that the family must know how to face correctly. AD patients struggle to hold onto “threads” of memory. So keeping them in their homes surrounded by familiar objects and routine is important. Unfortunately once enough deterioration has occurred, most people do not have enough money to pay for care in their own homes. When AD patients are at their most vulnerable, they must be moved into facilities. It is important to remember that person with the illness make the decision, and that you can’t stop living because you’re dealing with someone with Alzheimer’s. It does not mean you can’t care for them, it means you care enough to pay for professionals to help him. The transition to a care facility can be very hard; patients often take up to a year to settle in. In the early days and weeks they can be very frustrated and quite aggressive. Often they try to break out of their room or try to escape every time the security doors open. For AD patients to settle in, two things have to happen. First, they have to forget what they have lost. And second, they have to feel safe in their new home.

 Despite the debilitation of the patient, it is important to maintain a proper Alzheimer’s etiquette. Remain patient, friendly and understanding. Give clear instructions using simple, short sentences and adopt a caring, firm and clear tone, repeating important information if necessary. Allow long intervals of time (minutes, not seconds) for reaction or reply. Ensure consistency and routine in the patient’s daily life; simple rules and firmly established habits are very helpful for all elderly people – but especially for patients with dementia. Most importantly, one must remember that patients need the mental stimulation of conversation with other people.

There are very few upsides to such a disease. Many wish their loved ones would have died instead of having to live with the horrible disease. Perhaps the only lesson AD teaches us is to live in the moment because, really, it is all AD patients have. They have no memory of a past and no anticipation of a future. So when you visit an AD patient all you “have” is the time you are with them. Though this may not be the life anyone would have chosen for them, AD patients can still, in their own way, experience happiness and joy in their daily lives, despite their reduced circumstances. 

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