Two elderly gentlemen with Alzheimer’s disease lived together in a nice little flat. One of the men heard the sound of an ice cream van. He turned and said to the other man, “would you like anything from the ice cream van “. The other man replied “oh I’ll have and ice cream cone thanks but you better write that down cos I know what you’re like you’ll forget”. “No, no I won’t forget” said the first man and left to go to the ice cream van. Whilst he was leaving the second man shouted from the window
“Hey get me a chocolate flake as well, and write it down before you forget”. “I won’t I won’t” replied the first man. The second man then shouted again “oh yeah and some 100 and 1000’s and monkeys blood now you better write that down as I know you will forget that” Yet again the first man promised he would not forget and made his way to the ice cream van. Three hours passed and the first man eventually returned and gave the other man a mince pie in which he questioned “Where’s my chips”?
Although it is very easy to make fun and make up jokes about a disorder or disease as I have done here, but the actual truth and the real nature of suffering with Alzheimer’s disease is no joke at all. In this essay I am going to discuss the aetiology, pathology, and physiological response to a sufferer of this disease. History of a world of forgetfulness.
The case of a 51 year old woman who was suffering severe memory problems, confusion, unexplained paranoia and eventually profound dementia was presented by German psychiatrist Dr. Alois Alzheimer, (Mera S L 1997). After her death Alzheimer carried out an autopsy on her brain. He described degenerated nerve cells in the cortical areas of the brain; the dead neurons produced a number of neuritic plaques.
The inside of the nerve cell were twisted bands of fibres known as neurofibrillary tangles. Although the symptoms were first described by Emil Kraepelin the professor Alzheimer was working with, it was Alzheimer that first observed and described the characteristic neuropathology. It was then Kraepelin made the decision to name the disease after Alzheimer. Most of the last century Alzheimer’s disease was only referred to middle aged people whom presented symptoms of pre-senile dementia; this was considered to be a normal outcome of ageing.
However research throughout the 70’s and 80’s studies of the elderly showed that the lesions of a 50 year old sufferer were identical and in correlation with senile dementia in aged patients. It was the result of these studies that age has become the greatest risk factor of the development of the disease and a significant rise in the disease beginning at the age of 65 and above, (Smith and Perry 1998). Though there are other causes of dementia the diagnosis can still not defined without an autopsy.
If they forget how do we know? Though there are many different causes of dementia for example strokes, Parkinson’s disease, severe head trauma, and other causes such as drug use tumours and infection. Though shown in fig 1 Alzheimer’s disease actually accounts for 50% of all reported cases of dementia, (Mera S L 1997). Figure 1. Shows the percentage of causes of dementia.
Patients suffering with Alzheimer’s disease have the main symptoms of loss of recent memory (progressive amnesia), they begin to develop a difficulty in using and understanding words (aphasia), suffer with problems in carrying out normal movement tasks (apraxia) and then the development of problems recognising people’s face’s and objects (agnosia). As well as these main symptoms patients will also be likely to suffer from depression and become poor at time keeping and seem emotionless.
The long term memory of the patient seems intact and as a result sufferer’s spend there time dwelling on past memories. My Grand mother was a sufferer of Alzheimer’s and it was this that I found the hardest to deal with, when visiting her she never new who I was until I told her my name a hundred times. She would then turn around and ask why I was not at school. It was very difficult for her to comprehend that the little boy she was looking at was actually her 27 year old grandson. My Mother who cared for her until her death recalled she would always remember the dead people in her life and past events could be described vividly, but when it came to the daughter who was caring for her day after day my Grandmother couldn’t recognise her and always forget my Mothers name.
Even with symptoms like this patients are allowed to stay at home to prevent any distress that may be brought on by unfamiliar surroundings. However as there conditions deteriorate and there safety becomes an issue they are eventually institutionalised. After this the rate of progression of the disease will vary and it is normally a decade after diagnosis that the patient will die, (Mera S L 1997).