Alzheimer's Dementia Research Paper

Alzheimer’s Dementia

Alzheimer 's disease is a progressive brain disorder that damages and eventually destroys brain cells, leading to memory loss and changes in thinking and other brain functions. It usually develops slowly and gradually gets worse as more brain cells wither and die. Ultimately, Alzheimer 's is fatal, and currently, there is no cure. Alzheimer 's disease is the most common type of dementia, a general term used to describe various diseases and conditions that damage brain cells. Alzheimer 's disease accounts for 50 to 80 percent of dementia cases . Given the advancing age of the baby boom generation, by 2050, 14 million older Americans and 81 million adults worldwide are expected to have the
disease.
The classic neuropathological signs of Alzheimer’s disease are amyloid plaques and neurofibrillary tangles. Plaques consist largely of the protein fragment beta-amyloid. This fragment is produced from a parent molecule called amyloid precursor protein . Tangles consist of tau, a protein normally involved in maintaining the internal structure of the nerve cell. While tau is normally modified by phosphorylation, or the attachment of phosphate molecules, excessive phosphorylation appears to contribute to tangle formation and prevents the protein from carrying out its normal functions . Oxidative stress, or damage to cellular structures by toxic oxygen molecules called free radicals, is also regarded as a pathology characteristic of Alzheimer’s. Individuals with Alzheimer’s typically experience brain inflammation. Many of the oldest patients with Alzheimer’s show signs of cerebrovascular disease in addition to classic Alzheimer 's neuropathology . Research into treatments aimed at preventing or reversing Alzheimer’s is limited by lack of knowledge about the mechanisms involved in development of the disease, and by lack of clarity about the roles of abnormal proteins such as beta-amyloid and tau.

It often is difficult to separate the normal aging process from conditions in which age, in combination with genetics, lifestyle and environmental exposures, is a risk factor. Examples of truly age-related changes are thinning and graying hair, sagging skin and changes in vision, hearing and taste. Other changes, such as incontinence and certain types of memory loss, are not a normal part of aging. The forgetfulness associated with normal aging involves minor lapses such as misplacing the car keys. However, having continual problems with remembering doctor appointments, regularly scheduled social events or having significant word-finding difficulties may be more serious than the memory gaps associated with normal aging.
Alzheimer’s Dementia (AD) is an irreversible and progressive brain disease characterized by memory loss and eventual declines in language, visuospatial and executive function or decision-making capabilities.
Using various psychometric tests to assess the behavioral and cognitive declines associated with AD results in a clinically probable rather than a definitive or confirmed diagnosis. Dementia is associated with signs and symptoms that vary between individuals, and over time, but generally include: Cognitive impairment, affecting memory, speech, language and orientation to time and place. Behavioral and neuropsychiatric effects: mood disorder, psychoses, agitation, wandering or incessant pacing. Impaired self-care: loss of ability to perform household tasks, bathing, dressing,
eating.
There are numerous conditions that may contribute to cognitive impairment in the older adult and that can be mistaken for, or contribute to, worsened impairment in dementia. Any diagnosis of dementia must have previously excluded these conditions, many of which are treatable: Effect of drugs or alcohol, depression, delirium, hypothyroidism, subdural hematoma, cerebral tumor or normal pressure hydrocephalus vitamin B12 deficiency. For hospitalized patients, or those in long-term care, there may be some misperceptions around differences between dementia, depression and delirium. It is important to distinguish between these. Delirium or severe depression may present similarly to dementia, they may be present at the same time, and each may contribute to worsening of the other conditions . Behavioral disturbances and psychological changes occur in about 80 percent of patients with dementia. It is distressing for patients and caregivers, and leads to increased risk of harm, reduced quality of life, earlier institutionalization and increased use of health resources. Symptoms include aggression, agitation, anxiety, depression, wandering, repetitive vocalization, hallucinations or delusions and sleep disturbances. The use of antipsychotic medication to treat episodes has been prevalent, and often resulted in long-term therapy. Between 20-50 percent of people with dementia may be prescribed antipsychotics. These medications are only effective in reducing psychosis, aggression and agitation, and will not reduce behavioral psychological symptoms of dementia such as wandering, pacing or vocalization, nor do they improve cognition. Aside from their cardiovascular and cerebrovascular effects, antipsychotics are also associated with increased confusion, sedation and movement disorders, such as tardive dyskinesia .
There are non-pharmacological interventions that are supported by evidenced based practices that include reducing noise and other environmental stimulation, especially during care episodes; increasing signs and access to toilets; improving lighting; prominent placement of clocks and calendars; continuity with caregivers; meaningful and enjoyable recreational activity like gardening, music or art; and behavioral management interventions (rewarding desired behaviors).
Weaker evidence was found for lifestyle factors and medications to protect against Alzheimer’s, though moderate wine consumption, high level of physical activity, and educational attainment have been shown to reduce the relative risk of the disease. Dietary factors such as the Mediterranean diet or intake of antioxidants, polyunsaturated fatty acids, cereals, vegetables, and omega-3 fatty acid have also been shown to reduce the incidence of dementia in population and observational studies.
The social, economic and personal costs of dementia are increasing as the population ages. Our understanding of the causes and progression of this group of diseases is poor, adversely affecting the development of treatments to prevent, reverse or cure dementia. Therapies for dementia are limited to modifying the behavioral and psychological symptoms. Drugs in development that might treat the disease itself have had limited success in trials. An understanding of these limitations allows nurses to support patients and family with
education about treatment choices.

References
Alzheimer 's Association. (2013, January 1). alz.org Alzheimer 's Association . Retrieved February 19, 2013, from alz.org Alzheimer 's Association : http://www.alz.org/what-is-dementia.asp
Casey, G. (2012). Alzheimer 's and other dementias. Kai Tiaki Nursing New Zealand, 20-24.
Shagam, J. (2009). The many faces of dementia. Radiologic Technology (81) 2, 153-168.
Wierenga, C. E., & Bondi, M. W. (2011). Dementia and Alzheimer 's Disease: What We Know Now. Generations, 37-45.