Friday, November 28, 2008

National Alzheimer’s Disease Awareness Month

Have you ever had a moment where you experienced the inability to recall a name, find the right word or remember an event? Some people laugh it off and call it a senior moment. This can sometimes be contributed to something as simple as a lack of sleep or stress. As we get older, we also need to be aware of other more serious issues that are possible such as Alzheimer’s Disease (AD) which is the most common form of Dementia. Presently there is no cure or any definitive reason that causes these diseases. Scientists are learning more each day about these types of diseases in hoping to find a cure.

AD is a progressive brain disorder and over time the disease gradually abolishes the memory and mental abilities such as learning, reasoning, making judgments, carrying out daily activities and communicating. As the disease progresses some may also experience changes in personality and behavior.

In the United States there are some estimates that up to 5 million people are living with AD and projected to triple by 2050. Younger people may get AD but it is not very common. The risk of getting AD may start at about the age of 60, but this is still a small percent. The term early-onset refers to this group that occurs in a person under age 65. This early-onset may be in any stage of dementia; early, middle or late. The first notable age group is 65 to 74 with 5% being inflicted with AD and by age 85 almost 50% will have some level of AD.

The duration of AD can range from 3 to 20 years but the progression is widely different, with most people dying on an average 4 to 8 years after diagnosis. The first part of the brain to be affected is the area that controls thinking and memory. As this progression spreads to other regions, the brain cells die leading to the need for complete care of the individual. AD with no other illness will cause death from loss of brain function.

Experts have noted similar patterns of progression of symptoms as AD develops over the duration of the disease. These progressions have several stages but not all people progress at the same rate or experience all the same symptoms. Knowing the stages will help understand the progress of AD and give time to plan accordingly.

The seven stages were developed by Barry Reisberg, M.D., Clinical Director of the New York University School of Medicine’s Silberstein Aging and Dementia Research Center.

Stage 1: No impairment (normal function)

Unimpaired individuals experience no memory problems and none are evident to a health care professional during a medical interview.

Stage 2: Very mild cognitive decline (may be normal age-related changes or earliest signs of AD)

Individuals may feel as if they have memory lapses, especially in forgetting familiar words or names or the location of keys, eyeglasses or other everyday objects. But these problems are not evident during a medical examination or apparent to friends, family or co-workers.

Stage 3: Mild cognitive decline (early-stage AD can be diagnosed in some, but not all, individuals with these symptoms)

Friends, family or co-workers begin to notice deficiencies. Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical interview. Common difficulties include:

•Word or name finding problems noticeable to family or close associates
•Decreased ability to remember names when introduced to new people
•Performance issues in social or work settings noticeable to family, friends or co-workers
•Reading a passage and retaining little material
•Losing or misplacing a valuable object
•Decline in ability to plan or organize

Stage 4: Moderate cognitive decline (Mild or early-stage AD)

At this stage, a careful medical interview detects clear-cut deficiencies in the following areas:

•Decreased knowledge of recent occasions or current events
•Impaired ability to perform challenging mental arithmetic-for example, to count backward from 75 by 7s
•Decreased capacity to perform complex tasks, such as planning dinner for guests, paying bills and managing finances
•Reduced memory of personal history
•The affected individual may seem subdued and withdrawn, especially in socially or mentally challenging situations

Stage 5: Moderately severe cognitive decline (Moderate or mid-stage AD)

Major gaps in memory and deficits in cognitive function emerge. Some assistance with day-to-day activities becomes essential. At this stage, individuals may:

•Be unable during a medical interview to recall such important details as their current address, their telephone number or the name of the college or high school from which they graduated
•Become confused about where they are or about the date, day of the week or season
•Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s
•Need help choosing proper clothing for the season or the occasion
•Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children
•Usually require no assistance with eating or using the toilet

Stage 6: Severe cognitive decline (Moderately severe or mid-stage AD)

Memory difficulties continue to worsen, significant personality changes may emerge and affected individuals need extensive help with customary daily activities. At this stage, individuals may:

•Lose most awareness of recent experiences and events as well as of their surroundings
•Recollect their personal history imperfectly, although they generally recall their own name
•Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces
•Need help getting dressed properly; without supervision, may make such errors as putting pajamas over daytime clothes or shoes on wrong feet
•Experience disruption of their normal sleep/waking cycle
•Need help with handling details of toileting (flushing toilet, wiping and disposing of tissue properly)
•Have increasing episodes of urinary or fecal incontinence
•Experience significant personality changes and behavioral symptoms,including suspiciousness and delusions (for example, believing that their caregiver is an impostor); hallucinations (seeing or hearing things that are not really there); or compulsive, repetitive behaviors such as hand-wringing or tissue shredding
•Tend to wander and become lost

Stage 7: Very severe cognitive decline (Severe or late-stage AD)

This is the final stage of the disease when individuals lose the ability to:

•Respond to their environment, the ability to speak and, ultimately, the ability to control movement
•Recognizable speech, although words or phrases may occasionally be uttered
•Eating and toileting and there is general incontinence of urine
•Walk without assistance, then the ability to sit without support, the ability to smile, and the ability to hold their head up. Reflexes become abnormal and muscles grow rigid
•Swallowing is impaired

It is important to remember that AD is not a normal part of aging and new treatments are being worked on routinely. Some treatments are available that may improve the quality of life. Scientists have discovered several genes associated with AD. This could lead to treatments to block the progression of AD. Researches also have encouraging studies, which show a caregiver who provides effective care and support can improve an individual’s quality of life over the duration of AD.

With all the best efforts of a caregiver there may come a time when an individual with AD may wonder off on their own. This could become a frightening thought. As a caregiver you must do everything in your power to protect these individuals. Of course with all the best efforts things like this may occur. The best strategy is to better protect them in advance. That is where MedFN can have a role in the safety of those that are inflicted with AD. MedFN can communicate critical information for this person. MedFN can store information that they may not be able to recall. This may also be their voice in time of need if they are separated from their caregiver. With MedFN on their side, people with AD will have one more level of security with their information readily available.