Alzheimer’s Disease in the Philippines: “Not Only a Loss of Memory”

NWO State University
Ikariam City, Alpha Sever

Alzheimer’s Disease in the Philippines:

“Not Only a Loss of Memory”

Submitted By:

Biend2nd
SNDS Lover

Submitted To:

Kwon_yuri
Leader of SNDS Lover

February 29, 1801

T A B L E O F C O N T E N T S

I. Foreword

II. Introduction

III. Historical Background

IV. What is Alzheimer’s Disease

V. Symptoms

VI. Stages of Alzheimer’s Disease

VII. Diagnosing Alzheimer’s Disease

VIII. Treatment after Diagnosis

IX. The Alzheimer Caregiver

X. Conclusion

XI. World Organizations

XII. References

Foreword

The purpose of this research paper is to determine the history, causes, symptoms, diagnosis and Philippine scenario of Alzheimer’s Disease

The subject matter has been arranged so that the reader may easily understand the content of the research paper.

The references and Philippines Institutions were mentioned to be able to spread-out that the Philippine Government is serious on handling this disease.

Finally, I would like to thank my dear friend with initials M.B.S. and is a registered nurse by profession, (which he does not want to published his full name) who is now in United Arab Emirates for giving me data, information and a little discussion regarding this disease, to my family who always support me for my financial backing during this research, to my dreamed girl friend whom I always talked to in the chat room if I have some difficulties in handling this research.

Introduction:

Alzheimer 's disease, a neurodegenerative brain disease, is the most common cause of dementia. It currently afflicts about 5% of 4 million Filipinos and is the one of the leading cause of death in the Philippines. Furthermore, Alzheimer’s disease is the leading cause of mental impairment in elderly people and accounts for a large percentage of admissions to assisted living homes, nursing homes, and other long-term care facilities. Psychotic symptoms, such as delusions and hallucinations, have been reported in a large proportion of patients with this disease. In fact, it is the presence of these psychotic symptoms can lead to early institutionalization.

Learning about Alzheimer’s disease and realizing that it is much more that just a loss of memory can benefit the families of those with the disorder as well as society as a whole. The purpose of this paper is to look at the disorder, as well as to discuss the history, symptoms, diagnosis and hopes of a cure for Alzheimer’s disease.

Historical Background
Around the turn of the century, two kinds of dementia were defined by Emil Kraepin: senile and presenile. The presenile form was described more in detail by Alois Alzheimer as a progressive deterioration of intellect, memory and orientation. As a neuropathologist, Alzheimer studied the case a 51 year-old woman. When she died, Alzheimer performed an autopsy and found that she had “cerebral atrophy” (deterioration of the brain), “senile plaques” (protein deposits) and “neurofibrillary tangles” (abnormal filaments in nerve cells) in her brain -- three common pathological features of those who have Alzheimer’s Disease.

Today, as research on Alzheimer 's disease progresses, scientists are describing other abnormal anatomical and chemical changes associated with the disease. These include nerve cell degeneration in the brain 's nucleus and reduced levels of the neurotransmitter acetylcholine in the brains of Alzheimer 's disease victims (Alzheimer’s Disease). However, from a practical standpoint, conducting an autopsy of an individual to make a definitive diagnosis is rather ineffective.

What is Alzheimer 's Disease?
Alzheimer 's disease (AD) is an age-related, non-reversible brain disorder that develops over a period of years. Initially, people experience memory loss and confusion, which may be mistaken for the kinds of memory changes that are sometimes associated with normal aging. However, the symptoms of AD gradually lead to behavior and personality changes, a decline in cognitive abilities such as decision-making and language skills, and problems recognizing family and friends. AD ultimately leads to a severe loss of mental function. These losses are related to the worsening breakdown of the connections between certain neurons in the brain and their eventual death. AD is one of a group of disorders called dementias that are characterized by cognitive and behavioral problems. It is the most common cause of dementia among people age 65 and older.
There are three major hallmarks in the brain that are associated with the disease processes of AD. • Amyloidal plaques, which are made up of fragments of a protein called beta-amyloid peptide mixed with a collection of additional proteins, remnants of neurons, and bits and pieces of other nerve cells. • Neurofibrillary tangles (NFTs), found inside neurons, are abnormal collections of a protein called tau. Normal tau is required for healthy neurons. However, in AD, tau clumps together. As a result, neurons fail to function normally and eventually die. • Loss of connections between neurons responsible for memory and learning. Neurons can 't survive when they lose their connections to other neurons. As neurons die throughout the brain, the affected regions begin to atrophy, or shrink. By the final stage of AD, damage is widespread and brain tissue has shrunk significantly.

Symptoms

People with Alzheimer’s live an average of eight years after diagnosis, although some people may live for as many as 20 years after being diagnosed. To help people understand the changes that occur as the disease progresses, AD is broken into stages: early, middle and late. It is important to remember, however, that the development of symptoms will differ from person to person and that each stage will gradually progress over a period of years. It is also not unusual for people with AD to have “good days” and “bad days.” For example, a person with early-stage AD may not show any symptoms one day; the next he or she may have trouble remembering your name or finding the milk in the refrigerator.
The progression of Alzheimer’s disease is classified into three phases: forgetfulness, confusional, and dementia. The forgetfulness phase is the first stage and is characterized by a loss of short-term memory. Patients in this phase will often have trouble remembering names of well-known people and will misplace items on a regular basis. This stage also may include behavioral changes. Additionally, a loss of spontaneity and social withdrawal often occurs as the individual begins to become aware that there is something inherently wrong. Speech problems and difficulty with comprehension may also appear. Cleary, it is sometimes difficult to distinguish an Alzheimer’s patient from normal everyday people or people with other disorders.
In the confusional stage, the cognitive deterioration is more noticeable and memory loss is much more pronounced. Individuals in this stage will often have trouble recognizing where they are or remembering the date and day of the week. Poor judgment is also a noticeable trait at this state and the individual’s personality will likely change to some degree as well.
In the final stage of dementia, there are profound losses of memory and mental abilities. Patients will often not recognize their spouse or children or be able to read with comprehension. Eventually, individuals will become bedridden as brain functions disintegrate.
Stages of Alzheimer’s Disease

Early-Stage Alzheimer’s

• Trouble remembering recent events and conversations • Difficulty remembering the month or day of the week • Loss of ability to manage finances • Withdrawal from social situations and general apathy • Cooking and shopping become more difficult • Poor judgment – difficulty making wise decisions • Tendency to lose things • May become disoriented in familiar surroundings

Middle-Stage Alzheimer’s

• Difficult behaviors emerge o Anger, suspiciousness, overreacting and paranoia (e.g., believing that family members are stealing money or spouse is having an affair) o Wandering o Repeating questions or statements o Sundowning (i.e., restlessness or agitation in the evenings) o Fear of bathing o Hallucinations o Eating problems o Incontinence o Hoarding belongings o Inappropriate sexual behavior o Violent behavior • Will go from needing help choosing clothes and remembering to change clothes to needing help getting dressed. • Will progress from needing reminders regarding personal care to needing help bathing, taking medication, brushing teeth, toileting, etc. • Increased difficulty in verbal expression and comprehension • Spatial problems (e.g., having trouble setting the table) • Loss of reading, writing and arithmetic abilities • Loss of coordination • Will need care or supervision 24 hours a day, seven days a week • May not recognize family and friends at times

Late-Stage

• Inability to communicate • Inability to recognize people, places and objects • Cannot participate in any personal care activities • Loses ability to walk • Loses ability to smile • Muscles may become contracted • May lose ability to swallow • Seizures may occur • Weight loss • Majority of time spent sleeping • May exhibit a need to suck on items • Incontinence
As the symptoms of AD increase, the demands placed on the caregiver increase. Care becomes more physically demanding and more time-consuming. At some point, most caregivers require outside help.

Diagnosing Alzheimer’s Disease

A diagnosis of Alzheimer’s disease is reached through a combination of tests. It must be differentiated from the occasional forgetfulness that occurs during normal aging, and from depression, malnutrition, or the side effects of medications, all of which can cause symptoms similar to those of early-stage AD. The physician often begins the evaluation by taking a history and performing a physical examination, as well as evaluating the patient’s cognitive abilities. This approach can help the doctor determine whether further testing is needed. A primary care physician may suggest that a more extensive examination be performed at a designated Alzheimer’s evaluation center or by a dementia or geriatric specialist. The examination will likely include a thorough medical evaluation and history followed by extensive neurological and neuropsychological assessments. A dementia evaluation should include interviews with family members or others who have close contact with the person being evaluated.

Treatment After Diagnosis

Presently, researchers cannot definitively say what causes Alzheimer’s disease, and there is currently no cure. However, considerable progress has been made in the field of AD research in recent years, including the development of several medications for early-stage AD. While the ideal medication for AD would either prevent or cure it, have no side effects, be inexpensive and be readily available, researchers have not yet discovered the ideal treatment.
It is possible, however, to reduce some of the common symptoms of early-stage AD with medications. As of January 2002, the FDA had approved four drugs designed to improve memory and slow the progression of AD. The first one, approved in 1993, tacrine (Cognex) has many side effects, including potential liver damage and has shown disappointing memory results. For these reasons it is seldom prescribed. Three newer drugs, donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl), have proved beneficial in improving memory, and have fewer side effects. Unfortunately, these drugs are not effective for everyone, and their effectiveness is limited to the early and middle stages of AD. Another drug, memantine HCl (Namenda) is available. Originally considered for use in moderate to severe stage AD, it is sometimes prescribed for use earlier.
New medications are tested on an ongoing basis. People interested in participating in clinical trials should discuss the pros and cons with their physician and family. Many universities and medical schools are conducting research projects as well. Your physician may know of research trials seeking participation from Alzheimer’s patients and/or their family and caregivers.
It currently is possible to reduce some of the common emotional and behavioral symptoms associated with AD. For example, a doctor may prescribe drugs such as tranquilizers to reduce agitation, anxiety and unpredictable behavior. Drugs also can be prescribed to improve sleeping patterns and treat depression. Physicians may recommend taking Vitamin E, which may have some positive effects without unwanted side-effects if taken in reasonable quantities.
The dose of any medication given must be monitored closely. Older persons are affected differently by drugs than are younger persons—too much medicine may be dangerous. When a person is taking medication, it is important to keep the doctor informed of any changes in behavior or new symptoms.

The Alzheimer Caregiver

Alzheimer’s disease is often called a family disease, because the chronic stress of watching a loved one slowly decline affects everyone. Comprehensive treatment must therefore address the needs of the entire family. This includes emotional support, counseling, and educational programs about Alzheimer’s disease for individuals and family members as they strive to provide a safe and comfortable environment at home.
Through training, caregivers can learn how to control unwanted behaviors, improve communication, and keep the person with Alzheimer’s safe. Research has shown that caregivers benefit from training and support groups and that participation in these groups allows caregivers to care for their loved one at home longer. The resources listed at the end of this fact sheet can help you find classes and support groups.
The role of the caregiver changes over time as the needs of the person with AD change. The following suggestions can help caregivers prepare for the future.

Caregiving in the Early Stage

During the early stage of AD, both the caregiver and the care recipient can adjust to the diagnosis and make plans for the future: • Learning: The more you know about AD, the easier it will be for you as a caregiver. Learn as much as you can about the early and middle stages of AD—don’t worry about the late stage yet. Finding other caregivers to talk to can also be a great way to learn about and make sense of your own experience. One of the most difficult things to learn is to differentiate between the disease and your loved one: especially in the early stage, caregivers may find themselves thinking, “He’s doing this to spite me!” or “She is just being lazy.” In these cases, the behavior that is upsetting to the caregiver is usually a result of the disease process, not an attempt by the person with AD to hurt or frustrate the caregiver. • Emotional Support: A diagnosis of AD can be a heart-wrenching experience for both the person diagnosed and the caregiver. Getting appropriate emotional support through counseling, a support group or other family members is extremely important. The goal is to establish a system of emotional support that will grow and change with you as your care giving role and the emotional challenges of that role expand and change. • Family Roles: As the disease progresses, it will be harder for the person with AD to fulfill the roles they have typically played in the family. For example, if he or she was the only driver in the family, it will be important for family members to find alternative means of transportation (e.g., learning how to drive, recruiting volunteer drivers from among family and friends, using public transportation, etc.) If the person with AD was in charge of household finances, someone else will need to assume this role. If the person with AD customarily prepared all of the meals, now is the time for the caregiver to begin learning how to cook. Focusing on these issues early will allow the person with AD to help the caregiver prepare for the future. • Finances: AD can be an extremely costly disease. The life span of someone with Alzheimer’s can range from two to more than 20 years. It is important to begin mapping out strategies for meeting the increasing financial demands placed on the family as the disease progresses. Financial planning should include reviewing your insurance coverage (e.g., health, disability, long-term care, etc.). Be aware that Medicare does not cover long-term care or custodial care. • Legal: Eventually the person with AD will need help paying the bills, getting medical care, and making decisions. Two legal documents, Power of Attorney for Finances and Power of Attorney for Healthcare, can ensure that the person with AD is cared for by trusted family members or friends. Without these documents, caregivers may have to go through court proceedings to get the right to make decisions on behalf of the person with AD. The family may also lose access to bank accounts. Free and low-cost legal services are available to seniors. See the resource section of this fact sheet for organizations that can help with legal questions and services.

Caregiving in the Middle Stage

During middle stage of AD, the caregiver’s role will expand to full time. Keeping the person with AD safe will become a priority. Both the person with AD and the caregiver will need help and support. • Emotional Support: People caring for loved ones with AD frequently feel isolated, and it is common for caregivers to suffer from grief and loss as the person they are caring for changes. Getting emotional support and taking periodic breaks from the responsibilities of caregiving is crucial to the mental and physical health of caregivers. Be sure to speak to your physician if you feel depressed or anxious. • Respite Care: Caregivers need breaks, which is what “respite care” really is. Respite care includes adult day care programs, in-home help, and short nursing home stays. Other family members or friends, professional caregivers, or volunteer caregivers can provide respite care. The local Area Agency on Aging can provide information about the options available in the local community. • Safety: Creating a safe and comfortable environment is important. An occupational therapist can provide advice and help in making the home safer for both the caregiver and care recipient. Ask your physician, the local Alzheimer’s Association or the Area Agency on Aging for a referral to a professional experienced in home modification and assistive devices. For people with AD who wander, the local police should be advised, and the person should be registered with the Alzheimer’s Association’s Safe Return program. • Medical Care: The person with AD will need ongoing medical care both for AD and for any other health problems that might arise. The caregiver will become the spokesperson for the person with AD. It is important to develop relationships with physicians and other health care professionals who understand the caregiver’s role and who work with the caregiver as a team member in providing appropriate medical care. If the physician does not listen to you and respect your role as a caregiver, find a new physician. The stress of caregiving can affect your health. Be sure to take care of yourself. If you need to be hospitalized or need time off from your caregiving duties, emergency respite care can be arranged. Caregivers whose health is seriously affected may need to look at options for having a residential facility provide care for your loved one. • Planning for the Future: Many caregivers wish to keep their loved one at home with them; however, this is not always possible. If more care—or a different type of care—is needed than what you can provide at home, look into residential care options. Many facilities have special programs for individuals with dementia. Another option is to hire in-home help. Caregiving in the Late Stage • Hospice: Hospice services are designed to support individuals at the end of life. Services may include support groups, visiting nurses, pain management and home care. Hospice services are usually arranged through the treating physician, and are usually not available until the physician anticipates that a person has less than six months to live. Several organizations specialize in helping families deal with the challenges involved in end-of-life care. • Placement: Families caring for a loved one with end-stage Alzheimer’s should give thoughtful consideration to placement in a skilled nursing facility, where adequate management and supervision can be provided.
Alzheimer’s disease poses challenges for both the person diagnosed with AD and the caregivers. However, it does not mean that there will no longer be times of joy, shared laughter and companionship. AD develops gradually, which means that there is time to plan ahead, time to adjust to the diagnosis and time to enjoy being with each other.

Conclusion

Obviously, knowledge regarding Alzheimer’s disease has progressed far from thinking that it is just a loss of memory. This disease produces a full-blown dementia in its patients and affects millions of people and their families. These people and their families have special needs. Consequently, programs, environments, and care approaches must reflect this uniqueness. Developing an effective care/service plan for a person with dementia requires careful assessment of that person, a detailed plan, and attention to the individualized needs of persons with dementia. All individuals (including the person with Alzheimer’s disease, family, and staff) should be involved in the development, implementation, and evaluation of the assessment and care/service plan process.
World Organizations
|Alzheimer 's Disease Education and Referral Center (ADEAR) |National Institute of Mental Health (NIMH) |
|P.O. Box 8250 |National Institutes of Health, DHHS |
|Silver Spring, MD 20907-8250 |6001 Executive Blvd. Rm. 8184, MSC 9663 |
|[e-mail] |Bethesda, MD 20892-9663 |
|http://www.alzheimers.nia.nih.gov |[e-mail] |
|Tel: [phone] |http://www.nimh.nih.gov |
|Fax: [phone] |Tel: [phone]-8431 (TTY) |
| |Fax: [phone] |
|Alzheimer 's Association |Alzheimer 's Foundation of America |
|225 North Michigan Avenue |322 Eighth Avenue |
|Floor 17 |7th Floor |
|Chicago, IL 60601-7633 |New York, NY 10001 |
|[e-mail] |[e-mail] |
|http://www.alz.org |http://www.alzfdn.org |
|Tel: [phone] (24-hour helpline) TDD: |Tel: 866-AFA-8484 (232-8484) |
|312-335-5886 |Fax: [phone] |
|Fax: [phone] | |
|National Organization for Rare Disorders (NORD) |Family Caregiver Alliance/ National Center on Caregiving |
|P.O. Box 1968 |180 Montgomery Street |
|(55 Kenosia Avenue) |Suite 1100 |
|Danbury, CT 06813-1968 |San Francisco, CA 94104 |
|[e-mail] |[e-mail] |
|http://www.rarediseases.org |http://www.caregiver.org |
|Tel: [phone] Voice Mail 800-999-NORD (6673) |Tel: [phone] |
|Fax: [phone] |Fax: [phone] |
|Association for Frontotemporal Dementias (AFTD) |C-Mac Informational Services/Caregiver News [For Alzheimer 's-Type |
|Radnor Station Building #2 Suite 200 |Dementia Caregivers] |
|290 King of Prussia Road |120 Clinton Lane |
|Radnor, PA 19087 |Cookeville, TN 38501-8946 |
|[e-mail] |[e-mail] |
|http://www.FTD-Picks.org |http://www.caregivernews.org |
|Tel: [phone] | |
|National Family Caregivers Association |Well Spouse Association |
|10400 Connecticut Avenue |63 West Main Street |
|Suite 500 |Suite H |
|Kensington, MD 20895-3944 |Freehold, NJ 07728 |
|[e-mail] |[e-mail] |
|http://www.thefamilycaregiver.org |http://www.wellspouse.org |
|Tel: [phone] |Tel: [phone] |
|Fax: [phone] |Fax: [phone] |
|National Respite Network and Resource Center |American Health Assistance Foundation |
|800 Eastowne Drive |22512 Gateway Center Drive |
|Suite 105 |Clarksburg, MD 20871 |
|Chapel Hill, NC 27514 |[e-mail] |
|http://www.archrespite.org |http://www.ahaf.org/alzheimers/ |
|Tel: [phone] x222 |Tel: [phone]-437-AHAF (2423) |
|Fax: [phone] |Fax: [phone] |
|National Hospice and Palliative Care Organization /Natl. |Alzheimer’s Drug Discovery Foundation (formerly, Institute for the |
|Hospice Foundation |Study of Aging) |
|1731 King Street |1414 Avenue of the Americas |
|Alexandria, VA 22314 |Suite 1502 |
|[e-mail] |New York, NY 10019 |
|http://www.nhpco.org |[e-mail] |
|Tel: [phone] Helpline: 800-658-8898 |http://www.alzdiscovery.org |
|Fax: [phone] |Tel: [phone] |
| |Fax: [phone] |
|John Douglas French Alzheimer 's Foundation |Lewy Body Dementia Association |
|11620 Wilshire Blvd. |P.O. Box 451429 |
|Suite 270 |Atlanta, GA 31148 |
|Los Angeles, CA 90025 |[e-mail] |
|[e-mail] |http://www.lewybodydementia.org |
|http://www.jdfaf.org |Tel: Telephone: [phone] Helpline: 800-LEWYSOS (539-9767) |
|Tel: [phone] |Fax: [phone] |
|Fax: [phone] |The Alzheimer’s Disease Association of the Philippines |
| |Room 401 Medical Arts Building St. Lukes Medical Center, E |
| |Rodriguez, Boulevard, Quezon City, Philippines |

References: 1. Ramanathan, Vai. (1997). Alzheimer Discourse: Some Sociolinguistic Dimensions. Mahwah, New Jersey: Lawrence Erlbaum Assoc.

2. Alzheimer’s Disease. Electronic Format. http://vfair.com/tents/active_aging/alzheimers_disease.htm. [2000, November 22].

3. Heston, Leonard and June White. (1983). The Vanishing Mind; A Practical Guide to Alzheimer’s Disease and Other Dementias. New York: W. H. Freeman and Co.

References: 1. Ramanathan, Vai. (1997). Alzheimer Discourse: Some Sociolinguistic Dimensions. Mahwah, New Jersey: Lawrence Erlbaum Assoc. 2. Alzheimer’s Disease. Electronic Format. http://vfair.com/tents/active_aging/alzheimers_disease.htm. [2000, November 22]. 3. Heston, Leonard and June White. (1983). The Vanishing Mind; A Practical Guide to Alzheimer’s Disease and Other Dementias. New York: W. H. Freeman and Co.