We are currently living in the age of technology. Our advancements in the
past few decades overshadow everything learned in the last 2000 years. With the
elimination of many diseases through effective cures and treatments, Canadians
can expect to live a much longer life then that of their grandparents. In 1900
about 4% of the Canadian population was over the age of 65. In 1989 that figure
tripled to 12% and the government expects that figure to rise to 23% by the year
2030 (Medical,1991,p.13). This increase has brought with it a large increase in
diseases associated with old age. Alzheimer\'s dementia (AD) is one of the most
common and feared diseases afflicting the elderly community. AD, once thought to
be a natural part of aging, is a severely debilitating form of mental dementia.
Although some other types of dementia are curable or effectively treatable,
there is currently no cure for the Alzheimer variety.
A general overview of Alzheimer\'s disease including the clinical
description, diagnosis, and progression of symptoms, helps one to further
understand the treatment and care of patients, the scope of the problem, and
current research.
The clinical definition of dementia is "a deterioration in intellectual
performance that involves, but is not limited to, a loss in at least 2 of the
following areas: language, judgement, memory, visual or depth perception, or
judgement interfering with daily activities" (Institute,1996, p.4).
The initial cause of AD symptoms is a result of the progressive
deterioration of brain cells (neurons) in the cerebral cortex of the brain. This
area of the brain, which is the largest and uppermost portion, controls all our
thought processes, movement, speech, and senses. This deterioration initially
starts in the area of the cortex that is associated with memory and then
progresses into other areas of the cortex, then into other areas of the brain
that control bodily function. The death of these cells causes an interruption of
the electrochemical signals between neurons that are a key to cognitive as well
as bodily functioning.
Currently AD can only be confirmed at autopsy. After death the examined
brain of an Alzheimer victim shows two distinct characteristics. The first is
the presence of neuritic plaques in the cerebral cortex and other areas of the
brain including cerebral blood vessels. These plaques consist of groups of
neurons surrounded by deposits of beta-amyloid protein. The presence of these
plaques is also common to other types of dementia.
The second characteristic, neurofibliary tangles, is what separates AD from
all other forms of dementia. Neurofibliary tangles take place within the
disconnected brain cells themselves. When examined under a microscope diseased
cells appear to contain spaghetti-like tangles of normally straight nerve fibers.
The presence of these tangles was first discovered in 1906 by the German
neurologist Alois Alzheimer, hence the name Alzheimer\'s disease.
Although the characteristics listed above are crucial to the diagnosis of
AD upon death, the clinical diagnosis involves a different process. The
diagnosis of AD is only made after all other illnesses, which may have the same
symptoms, are ruled out. The initial symptoms of AD are typical of other
treatable diseases therefore doctors are hesitant to give the diagnosis of
Alzheimer\'s in order to save the patient from the worsening of a treatable
disease through a misdiagnosis. Some of the initial symptoms include an
increased memory loss, changes in mood, personality, and behavior, symptoms that
are common of depression, prescription drug conflict, brain tumors, syphilis,
alcoholism, other types of dementia, and many other conditions.
The onset of these symptoms usually brings the patient to his family doctor.
The general practitioner runs a typical battery of urinalysis and blood tests
that he sends off to the lab. If the tests come back negative, and no other
cause of the symptoms is established, the patient is then refereed to a
specialist. The specialist, usually a psychiatrist, will then continue to rule
out other possible illnesses through testing. If the next battery of tests also
comes back negative then the specialist will call on a neurologist to run a
series of neurological examinations including a PET and CAT scan to rule out the
possibility of brain tumors. A spinal tap is also performed to determine the
possibility of other types of dementias. The patient will also undergo a
complete psychiatric evaluation. If the patient meets the preliminary criteria
for AD an examination of the patients medical history is also necessary to check
for possible genetic predispositions to the disease.
The psychiatric team finally meets with the neurological team to discuss
their findings. If every other possible disease is