Future Alzheimer's Disease

The Future Alzheimer’s Disease Sadly, while the number of deaths from nearly all other major disease have decreased over the last decade, deaths linked to Alzheimer’s has increased by an astonishing sixty eight percent. It is the only cause of death in the top ten causes in America that cannot be prevented, cured, or even slowed. The sheer amount of related deaths, and the cost going in to all aspects of it are absolutely staggering. The future of this disease, to put it in a single word is, scary.

A German psychiatrist and neuropathologist discovered Alzheimer’s disease in 1906; his name was Alois Alzheimer. Alzheimer’s disease is a form of dementia, and the most common one at that. It develops differently for every individual, but
is most common in people over the age of sixty-five. Before the disease is evident it develops for an unknown and variable amount of time in individuals. It goes undiagnosed for years in nearly all cases before it is full apparent. After being diagnosed an individual’s life expectancy is roughly seven years, and only ten percent of those diagnosed live longer than a decade. There is no known cause of the disease, and its progression is very unclear.
They’re four stages the disease is divided into based upon cognitive and functional impairments, pre-dementia, early, moderate, and advanced. There are no treatments available either that link directly to the disease. Individuals are only able to receive treatments on symptoms that they are experiencing, such as depression or aggression. Treatments come in the form of pharmaceuticals, psychosocial intervention, and caregiving. Pre-dementia is the first stage of Alzheimer’s disease. Early symptoms are often mistakenly linked to age related worries or even stress. The first symptom that an individual may have that shows concern toward the disease is memory loss. More specifically, trouble remembering recent information, and even the inability to learn new info. Frequent signs of pre-dementia are misplacing items and forget appointments often. Apathy is evident even at this stage, it being the most neuropsychiatric symptom of them
all. The second stage of Alzheimer’s disease is the ‘early’ stage. However this is the first stage when an individual has definitively been diagnosed. Extensive neuropsychological testing and various brain scans are what lead to this diagnosis. Increasing forgetfulness and inability to learn continue along with new symptoms such as depression and irritability. Motor skills and speech are also affected in a small number of cases at this stage. Episodic, semantic, and implicit memories are still affected at a lesser occurrence than new facts/ information and memories. Individuals are able to continue daily life with sheer independences with only minor supervision or assistance on highly demanding cognitive activities. The moderate or third stage of Alzheimer’s disease is where long-term memory lose becomes evident. Sufferers are unable to perform daily activities by themselves, forcing them to be under a caregivers watch nearly round the clock. Speech becomes affected during this stage as well as individuals are unable to recall previously learned vocabulary, thus affecting their reading and writing skills too. The risk of injury increases greatly as motor skills are progressively lost. Behavioral issues such a sudden crying, unpremeditated aggression or resistance, and sundowning become prevalent. Individuals will lose insight on their disease and even become delusional. The advanced stage of Alzheimer’s disease is where the individual loses all independences and becomes completely dependent upon the caregivers support. The ability to communicate is completely reduced to emotional signals, as all speech is lost. Even though apathy is present throughout the disease it most prevalent in this stage, with the person becoming very depressed and nearly always exhausted. Sufferers are bedridden as they lose nearly all muscle mass, even losing the ability to feed themselves.

In the picture above, it is easy to see the effects of Alzheimer’s disease on the brain; shrinking its mass and essentially deteriorating its ability to respond and operate. The affect of Alzheimer’s is felt far beyond the carriers of the terminal disease. This year alone the total cost to care for those with Alzheimer’s in America is a ridiculous two hundred an three billion dollars, and that number is set to increase to over a trillion dollars by 2050. There are currently nearly sixteen million caregivers in America, giving up seventeen billion hours of unpaid care. Just to put that amount of work into perspective, that would be an even more astonishing two hundred and sixteen billion dollars of medical care if the sufferer were in a nursing home or hospital. All together the total cost of paid and unpaid care of those with the disease will be in excess of four hundred and nineteen billion dollars this year alone. The table below shows the breakdown of paid medical care related to Alzheimer’s.

Even though there is no direct cure for Alzheimer’s, there are ways for the diagnosed to cope with the symptoms. Pharmaceuticals are one of the three treatment options, with five medications being offered to help alleviate the cognitive issues of the disease. Four of the five medicines are acetyl cholinesterase inhibitors; tacrine, rivastigmine, galantamine and donepezil. These medications fight the loss of acetylcholine, providing full evidence of efficacy in moderate cases and some evidence of efficacy in advanced cases of Alzheimer’s. The fifth medicine is memantine, an NMDA receptor antagonist. Donepezil is the sole medication approved for treatment for those in the advanced stage of the disease. Psychosocial intervention is used in addition to pharmaceuticals, with there being four distinct methods of approach; behavior, emotion, cognition, and stimulation. The behavioral method is used to reduce the negative outcomes of problematic behaviors such as outbursts. The emotion related methods are used to help the diagnosed come to reality with their illness. Under the emotion oriented interventions there are multiple therapies used such as; reminiscence, validation, supportive psychotherapy, sensory integration, and finally simulated presence therapy. Cognition related methods are used to encourage the reduction of cognitive deficits. Two of the most common cognition-oriented treatments used are reality orientation and cognitive retraining. Reality orientation is the presentation of information that helps the individual gain a greater understanding of their surroundings. Cognitive retraining is the exercising of ones impaired capacities to improve their mental abilities. The stimulation method is the use of recreational activities such as arts or music to help improve the individual’s mood. All of these methods have no direct correlation to the elongating of life expectancy; rather they are used to help improve the morals of those diagnosed. Caregiving is by far the most common management of Alzheimer’s disease. During the early and moderate stages of the disease, caregivers are allocated to helping the patient adjust to their new illness, such as creating daily routines or even labeling and modifying daily used objects. During the advanced stage of the disease, the patient become incapable of nearly all individual tasks, such as eating and bathing. Though the caregiver’s management is crucial for the safety and health of the patient it is centered on alleviating their ail until certain death. The amount of work that goes into being a caregiver should never be taken for granted either. Nearly all caregivers are working unpaid, and they themselves suffer greatly from depression and stress related to the job. This is evident in the graph below.

Alzheimer’s is the sixth leading cause of death in America.
Every sixty eight seconds another person is diagnosed with this cruel disease. We all know this is a deadly disease with absolutely no way to stop it, at least at this present time. Hopefully the future will hold information that will be used to fight Alzheimer’s, maybe not prevent or cure it but even slow its progression. The future does not look so good though with currently about five and a half million people living with Alzheimer’s in America, that number is set to triple by the year 2050; that being one in every eighty-five individuals with the
disease.

Work Cited
Ron Brookmeyer, Elizabeth Johnson, Kathryn Ziegler-Graham, and H. Michael Arrighi. "Forecasting the Global Burden of Alzheimer 's Disease" Alzheimer 's and Dementia 3.3 (2007): 186-191.
First, Micheal B., ed. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994. Web. 16 Oct. 2013. .
Gladstone, David J. Brain Antrophy in Advanced Alzheimer 's Disease. Digital image.KQED Pressroom. N.p., n.d. Web. 16 Oct. 2013. .