Alzheimer<\/a>\u2019s Disease<\/p>\nThe course of this degenerative disease is divided into four main stages, with progressive manifestations of cognitive and functional impairments. The four stages of Alzheimer\u2019s disease are as follows:<\/p>\n
1. Pre-Dementia<\/p>\n
As previously mentioned, the first symptoms of Alzheimer\u2019s disease are often attributed to aging or stress, without suspecting something more serious. According to detailed neuropsychological testing, a person can experience mild cognitive difficulties for up to eight years before fulfilling the clinical criteria for an AD diagnosis. Such early symptoms can affect the more complex daily activities, with memory loss as the most prevalent deficit. At first, memory loss occurs as difficulty in remembering recent events and recently learned facts, as well as an inability to learn new things.<\/p>\n
Other symptoms of pre-dementia include subtle issues with the executive functions of attentiveness, planning, abstract thinking, and flexibility. Sufferers also experience impairments in semantic memory, i.e. remembering meanings and concept relationships. Apathy also occurs during this stage, and continues as the most persistent neuropsychiatric symptom throughout the entire disease progression. This pre-dementia stage is also referred to as mild cognitive impairment.<\/p>\n
2. The Early Stages<\/p>\n
People affected by Alzheimer\u2019s disease experience an increasing, progressive impairment of learning and memory, eventually leading to a definitive diagnosis. A small portion of patients experience difficulties with language, executive functions, perception or execution of movements as the more prominent symptoms rather than memory difficulties. It\u2019s also important to note that AD does not affect all memory capacity equally. New facts and memories are generally more affected than older memories (episodic memory), previously acquired information (semantic memory) and the memory of the body on how to do things, such as using kitchen utensils to eat (implicit memory).<\/p>\n
Language problems usually unfold as a shrinking vocabulary and decreased word fluency. In time, these difficulties lead to a general impoverishment of both oral and written language capabilities. Alzheimer\u2019s patients are still able to communicate basic ideas properly at this stage. As the disease progresses, patients may be able to continue performing a number of tasks independently, but may need assistance in more cognitively demanding activities.<\/p>\n
3. The Moderate Stage<\/p>\n
The disease eventually trumps independence as it progresses, as subjects become unable to perform even the most common tasks of daily living. Speech difficulties become obvious due to the patient\u2019s inability to recall vocabulary, which leads to paraphasias (incorrect word substitutions). Sufferers also progressively lose reading and writing skills during this stage. As time passes and the disease progresses, complex motor sequences become less coordinated, which in turn increases the risk of falling. Memory problems also worsen in this stage, and the patient may fail to recognize even close relatives such as one\u2019s own children. Long-term memory, which was unaffected until this phase, now becomes impaired as well.<\/p>\n
In this phase of Alzheimer\u2019s disease, behavioral and neuropsychiatric changes become increasingly prevalent. Common manifestations of such changes include irritability, wandering, labile effect leading to crying, outbursts of aggression, or resistance to care giving and assistance. Roughly 30 percent of AD patients also develop illusionary misidentifications or other delusional symptoms. Patients are no longer aware of their disease process and limitations, and experience increased frustration. All of these symptoms can produce great stress for close relatives and caretakers, and in many cases the person is moved from home care to specialized long-term care facilities.<\/p>\n
4. The Advanced Stage<\/p>\n
During the advanced and final stage of Alzheimer\u2019s disease, the patient is entirely dependent upon caregivers. Language and vocabulary becomes limited to simple phrases or single words, until the subject eventually loses speech completely. Despite this loss of verbal language abilities, however, patients can often understand and react emotionally. Aggressiveness may still persist, but extreme apathy and exhaustion are more common. Muscle mass and mobility deteriorate to the point that AD patients are bedridden and lose the ability to feed themselves. Alzheimer\u2019s disease is a terminal illness, but the cause of death is generally an external factor such as pneumonia or infection of pressure ulcers, not the disease itself.<\/p>\n
Managing and Treating Alzheimer\u2019s Disease<\/p>\n
As there is no cure for AD, available treatments aim to offer symptomatic benefit, remaining palliative in nature. Currently there are five medications for treating the cognitive manifestations of the disease: four treatments are acetylcholinesterase inhibitors \u2013 tactrine, rivastigmine, gelantamine and donepezil \u2013 while the other, memantine, is an NMDA receptor antagonist. None of these drugs or others has shown any indication of delaying or stopping the progression of AD. According to the French Pharmacoeconomic Committee, these medications provide low benefits.<\/p>\n
Antipsychotic drugs, meanwhile, are relatively useful in reducing aggression and psychotics associated with Alzheimer\u2019s disease, but they can carry serious side effects such as cerebrovascular events, movement difficulties or cognitive decline.<\/p>\n
Caregiving<\/p>\n
Alzheimer\u2019s disease gradually renders patients incapable of tending to their needs, which means proper caregiving is crucial and must be carefully managed throughout the course of AD. During the early stages of the disease, for instance, changes to the living environment and lifestyle can increase safety and make things easier for the caretaker. Such modifications may include placing safety locks, adhering to simplified routines, labeling household items and other such measures. Sufferers may no longer be able to feed themselves, and serving food in smaller pieces or pureed may prove helpful. In some cases, feeding tubes are required if the patient experiences difficulties swallowing. Using physical restraints is rarely indicated, regardless of the stage of the disease, but in some cases they are necessary to prevent harm to the AD patient or their caregivers. During the final stages of Alzheimer\u2019s disease, treatment focuses on relieving discomfort until death.<\/p>\n