Thesis Statement This research thesis focuses on the scope, nature and pattern of treatment issues related with patients suffering with Alzheimer disease, briefly elaborating each of them and finding their relevance and role in treatment of the disease. Introduction Alzheimer disease, named after the German physics Alois Alzheimer is perhaps among the most challenging diseases that medical world has so far faced, particularly due to the vulnerability of the patients before and after the disease strikes.
The disease predominantly strikes people who are over 65 years of age, and hence already past their prime, having lost their youthful capabilities and energy to naturally fight off diseases and recuperate from its effect. Further, the disease the is a big challenge to the caretakers and care givers who find it exceedingly difficult to administer treatment to people who are increasingly incapable to recognize their present and past, relatives and friends and even their own self.
It’s a terminally unpromising situation for them, because the disease takes it toll with certitude in reducing the patients to mere walking bodies, depriving them of the force and substance of life. Therefore the treatment of Alzheimer’s disease involves many issues that range from recognizing the symptoms, identifying patients, their proper medical care and finally understanding the condition and disease of such patients who have entirely no recollection of themselves to give them the care, compassion and love which they require most to deal with such a devastating disease.
Because such patients become totally dependent on their doctors and caretakers, its important that these issues are identified and made to known on the widest scale to better conditions for 4 million people who are struggling with Alzheimer’s disease in USA alone and many more in the world. Issues in treatment of Alzheimer’s disease Alzheimer’s disease is called often referred to as the disease of the century due to its associated genetic, medical and social complexity that jointly make it overall a very challenging and complicated phenomena (Parson and Tanzi, 2000; Edwards et al., 1998).
It’s been recognized as the chief cause of the middle and old age dementia, which was early merely attributed to simple aging process, but for which now better evidence exist that its handiwork of the fatal and dangerous Alzheimer’s disease (Selkoe, 2006). Almost hundred years of research and studies in the cause and treatment of this disease has helped medical personnel to discover various issues associated with it that can be useful in its treatment as well as providing a significant avenue of hope for the patients and their family members (Keltner and Beth).
Some of the major important issues as identified are (Juillerat, Linden and Mulligan, 2003) (a) Clinical aspects; (b) Cognitive-neuropsychological aspect; (c) Psychiatric and behavioral aspects (d) Socio-demographic and economic aspects (e) Role of caregivers-ethical, legal and stress related issues (f) Family and friends of the patient (g) Proper health care to avoid Alzheimer’s disease
(a) Clinical aspect: Complaints by patients on failing memory, inability to register minute and progressively larger details failure to recognize their peers and relatives and increasing dementia should be clinically monitored for all the people in higher age group with regular follow ups to both the individual and the family. However it is not advised to use brief cognitive tests such as Mini Mental State Examination or routine screening of people for cognitive memory loss just on the basis of suspicion and in the absence of any reporting by patients or their family members (Gautheir, 2003).
In case of any reporting of Alzheimer’s disease, a medical professional should enquire for the previous 12 months report of the patient’s mental state and identify if any observable decline and possible pattern of the decline if it has taken place (Gautheir, 2003) . A medical diagnosis is done on two areas of checking 1. Certain decline in memory. and 2. Decline in at least one of the intellectual faculties such as speech, praxis, gnosis, or executive functioning, that interfere significantly in social or occupational functioning (American Psychiatric Association, 1994).
In all the cases of mental dementia, family members are most useful resource for a medical examiner as patients themselves are unaware of some of degenerations they are suffering. Quoting Bouchard and Rossor (1999) Gautheir states that the family members should be quizzed over on patient’s performance at work (when applicable), changes in executing in complex hobbies, and in important routine every day activities, such as handling money issues, completing household chores, attending the telephone, meeting visitors, going on an outing, and taking their meal (Gautheir, 2003).
The patient is also assessed on various other cognitive and functional activities of past year such as difficulty in finding, recognizing and recalling words, disorientation in time management, and inability to travel alone. It is also important to check for other signs of dementia that are not directly related to memory impairment. These effects include apraxa, acalculia and visual impairment that indicate towards possible advent of Alzheimer’s Disease (AD). For negative cases the case can be temporarily closed with reassurance, baseline MMSE and follow up after a year.
However if the tests are positive and the individual is identified with minimal cognitive Impairment (MCI), it requires careful monitoring and clinical referral because many of such patients may progress towards more than 40 percent dementia over 3 years. Currently extensive clinical trias are being conducted to find that whether drugs like alpha-tocopherol, cyclo-oxygenase 2 selective inhibitors, and cholinesterase inhibitors, such as donepezil, rivastigmine, or galantamine are useful in containing MCI and not allowing it to degenerat to Alzheimer disease (Gautheir, 2003).
If all the examinations confirm the possibility of dementia, the medical professional may need to contact patient’s family medical practitioner on their general medical background followed by careful assessment of patient’s neurological, neurobehavioral, psychiatric, nutritional and drug history along with also studying the family history for congenital illnesses such as depression, Down syndrome and dementia, especially parents and siblings. Its general observation at the clinical level that patients with AD have a pattern of decline in their cognitive abilities although its very hazy in the early stages of development of the disease.
(b) Cognitive -Neuropsychological aspect : The fact that Alzheimer impairs the brain and hence cognitive and psychic abilities of a person has led to research in cognitive and neurological areas. Attempts have been on to identify a typical psycho neurological pattern in different stages of development of Alzheimer. However, it has come to notice that there is no definite pattern in its growth. In fact, the disease has been known to cause selective impairment of some particular cognitive abilities (Collette, Linden, Juillerat, and Meulemans 2003).
Its now accepted that Alzheimer’s disease cause selective weakening of different cognitive abilities and that further this selection varies over different patients, thereby creating a heterogeneous profile of Alzheimer’s patients. (c) Psychiatric and behavioral aspect: The medical examiner should also carefully elicit information on patient’s energy level, quality of sleep, interest levels and moods. In case of patients with signs of dementia, energy and interests are very low marked by restless sleep and high level of frustration.
Some patients also report extreme behavioral traits such as hallucination, delusions, paranoia and jealously which have often been identified in early stages of AD. Although its difficult to say that appearance of such conditions are necessarily associated with AD, yet they can be tracked and prove useful indicators in combination with event of memory decline. Neuropsychological and neurological disorders are characteristically associated with the Alzheimer’s disease and they are considered as important precursor to the final onset of the fatal disease (Roberts, 2003).
In the diagnosis phase, AD patients have been reported with instances of behavioral and psychological disorders such as dementia, delusion, delirium and depressed moods. (d) Socio-demographic and economic aspects: Alzheimer’s disease is a unique syndrome that for all practical purpose stultifies individuals, robbing them of their cognitive abilities, intellect, and personality. The disease assumes frightening implications as its non-curable and almost always fatal, in the sense that it ends with the death of the patient.
The instances of the disease is highest in industrialized nations with US alone reporting more than 4 million cases of Alzheimer (Michel, Gold, Herrmann, Zekry, Mulligan and Giannakopoulos, 2003). The cost of disease is not merely in economic terms of providing long term and institutional care, medication and research and trials but also on quality of life lost, the years snatched away and the sufferings of the patients as well as the family members endured in the process.
A possible cure of Alzheimer would dramatically change the situation by lifting stress from the medical institutional system and families while re-integrating the lost individuals back in the society. (e) Issues related with caregivers: Caregivers face the most challenging task in the treatment of Alzheimer’s disease. Elder people are difficult to care for even if they are perfectly normal, and under the state of AD, taking their daily care, attending to their every day needs, helping them with their daily chores, and dealing with their complex problems, all of which involve various ethical issues and guidelines (Turnbull, 1998).
It is of prime importance that rights of elderly people are not infringed or violated, their needs understood, and their condition cared for. However, this requires maturity, compassion and empathy on the part of the caregiver, without loosing their patience level and constantly keeping in view the delicate condition of the patients they are dealing with. Certainly there are no fixed rules and set formulas to achieve this as behavior of patients suffering from AD doesn’t not follow any set pattern and its predominantly situational. Yet the caregivers should keep in consideration following points (Turnbull, 1998)
1. Respect for the patient- Preserving the dignity and integrity of person 2. Beneficence-Real quality in the service of caregiver 3. Equity-benefits of care is freely and equally distributed From the point of view of caregivers, the task is not easy. Irrespective of all of their efforts the patient may not respond accordingly, may sustain periods of irritation, anger, stubbornness or depression, each of which may rub on attitude of the caregiver and negate the effectiveness of the care given and constitute heavy emotional stress on caregivers.
Caring is especially arduous and draining on emotional resources when the care giver are close family members and they are seeing with certainty the patients degenerating condition and inevitable journey towards the final end. However, the realization that caregivers are preserving a life for as long as possible, and adding value to it through their efforts may help to carry out their functional in more committed and beneficial way.
It is believed that although there is no cure for the disease itself, yet adequate care-giving can help to make the period of disease much more manageable and stress free, for the patient, family and the society. (f ) Self care: As repeatedly stated, the care issue in treatment is most delicate and important aspect. It is also realized that the care provided by family members cannot be compensated by that in institutional setups. However, another aspect of care is self care among aging people through following simple steps which can help to keep the disease away.
These steps include eating proper diet, taking daily physical exercise, doing work that provides mental stimulation, maintaining social contacts, not unnecessarily taxing memory and maintain daily calendars, list of daily and weekly important activities, creating a comfortable environment around and participating in group activities (Alzheimer’s disease, 2007. ).
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