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The a physical and neurological exam, and test (such

The
Stages and Treatments of Alzheimer’s Disease

Katelyn
Tipton

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Keiser
University

Abstract

Alzheimer’s disease is the most
common form of dementia. Alzheimer’s is not just a disease of old age. Many
factors play a role in determining the diagnosis, such as medical history, the patient’s
temperament, physical and neurological exams, as well as other tests. There are
five stages of Alzheimer’s disease which range from preclinical to severe
Alzheimer’s. As the stages advance, many of the symptoms progressively worsen.  Internationally, there are significant
differences between which countries and cultures are more or less affected by
Alzheimer’s disease. Currently there are no treatments to cure Alzheimer’s
disease but, there are forms of treatment that can to help to slow the
progression of the disease, as well as improve daily life. In addition to the
effects of Alzheimer’s on the patients themselves, emotional and financial
factors also take a toll on Alzheimer’s caregivers.

 

The
Stages and Treatments of Alzheimer’s Disease

Alzheimer’s
disease is the most common form of dementia. 
It is a slowly progressing disease that affects the brain.  It starts with mild symptoms, like forgetting
important dates and asking the same questions over and over again. The memory gradually
worsens as the disease progresses. 
Eventually the Alzheimer’s patient will need full-time care for everyday
life tasks. Symptoms of this disease include the following: “impaired memory,
thinking and behavior, confusion, restlessness, personality and behavior
changes, impaired judgment, impaired communication, inability to follow
directions, language deterioration, impaired thought processes that involve
visual and spatial awareness, and emotional apathy” (Johns Hopkins Medicine, n.d., para. 6). These
symptoms are the difference between normal aging and Alzheimer’s disease.  If any of the symptoms listed above are
happening frequently, it is time to speak with a doctor.

Steps for
diagnosing Alzheimer’s disease include: “a thorough medical history, mental
status and mood testing, a physical and neurological exam, and test (such as
blood test and brain imaging) to rule out other causes of dementia-like
symptoms” (Alzheimer’s Association, 2018a, para. 2). These are not the only
tests needed to determine if the person has Alzheimer’s disease: “Having
trouble with memory does not mean you have Alzheimer’s. Many health issues can
cause problems with memory and thinking. When dementia-like symptoms are caused
by treatable conditions – such as depression, drug interactions, thyroid
problems, excess use of alcohol or certain vitamin deficiencies- they may be
reversed” (Alzheimer’s Association, 2018a, para. 4). A good place to start in
getting an Alzheimer’s diagnosis is making an appointment with a primary care
provider and locating the local Alzheimer’s Association as they can provide a
list of Alzheimer’s specialist in the area. According to the Alzheimer’s
Association (2018a), “Experts estimate a skilled physician can diagnose
Alzheimer’s with more than 90% accuracy” (para. 5). It is important for
patients to find a specialized provider with whom they feel very comfortable, “Specialist
include neurologists, psychiatrists, and psychologists” (Alzheimer’s
Association, 2018a, para. 7). An early diagnosis is imperative so treatment can
begin. Most diagnosis’ begin around the age of 65: “Alzheimer’s disease is the most common form of dementia, affecting 5.2 million Americans over the
age of 65, as well as hundreds of thousands under the age of 65 who have early-onset
Alzheimer’s” (Johns Hopkins Medicine, n.d., para. 1). With numbers this high,
Alzheimer’s disease is becoming an epidemic.

People do not get
Alzheimer’s just by aging: “Alzheimer’s is not just a disease of old age.

Alzheimer’s affects people younger than age 65″ (Alzheimer’s Association, 2018b,
para. 1). Studies show that: “It is estimated that approximately 200,000 people
have early-onset. Those with early onset are between the ages of 40-50 years of
age” (Alzheimer’s Association, 2018b, para. 2). While age can be a factor in
whether or not a person gets Alzheimer’s, it is not the only determinate.  Other factors include; “family history,
genetics, and head injuries” (Alzheimer’s Association (2018c, para. 3).  Studies have shown that Latinos and
African-Americans are more at risk for Alzheimer’s: “Older Latinos are about
one-and-a-half times as likely as older whites to have Alzheimer’s and other
dementias, while older African-Americans are about twice as likely to have the
disease as older whites. The reason for these differences is not well
understood, but researchers believe that higher rates of vascular disease in
these groups may also put them at greater risk for developing Alzheimer’s” (Alzheimer’s
Association, 2018c, para. 20). One way to help keep one’s risk low for
Alzheimer’s is living a healthy lifestyle and staying active.  This practice may include eating a healthy
diet, exercising the body and mind, limiting alcohol consumption and avoiding
tobacco.

The five stages of
Alzheimer’s are preclinical, mild cognitive impairment, mild dementia, moderate
dementia, and severe dementia. During the preclinical stage, a person may not
notice the signs and symptoms nor will the people around them: “This stage of Alzheimer’s can last for years, possibly
even decades. Although you won’t notice any changes, new imaging technologies
can now identify deposits of a protein called amyloid beta that is a hallmark
of Alzheimer’s disease” (Mayo Clinic, 2015, para. 5). There are also genetic
tests that can tell if a person a higher risk for Alzheimer’s disease.  The next stage is mild cognitive impairment.

During this stage, “people with mild cognitive impairment have mild changes in
their memory and thinking ability” (Mayo Clinic, 2015, para. 8).  These changes are big enough to drastically
affect their relationships.  They may
start forgetting conversations and events that should be easily remembered. The
next stage is mild dementia, where the symptoms start to become clearer to the people
around them. In addition to the symptoms listed above, they will experience: “memory
loss of recent events, difficulty with problem-solving, complex tasks and making
sound judgments, changes in personality, difficulty organizing and expressing
thoughts, and getting lost or misplacing belongings” (Mayo Clinic, 2015, para.

12).  Moderate dementia shows even more
progressive signs and symptoms: “People grow more confused and forgetful and
begin to need more help with daily activities and self-care” (Mayo Clinic,
2015, para. 13). They will need help with daily grooming tasks such as bathing
and using the bathroom as well as other self-care needs; “During this stage,
some individuals occasionally lose control of their bladder or bowel movements”
(Mayo Clinic, 2015, para. 17). The last stage of dementia is severe.  During this stage, mental function decreases
rapidly and starts severely impacting movement and physical capabilities:  “They may become unable to walk, sit up and
even hold their head up without support, and eventually they lose the ability
to swallow” (Mayo Clinic, 2015, para. 23). 
The progression rate of these stages varies from patient to patient, but
“On average, people with Alzheimer’s disease live eight to 10 years after
diagnosis, but some survive 20 years or more” (Mayo Clinic, 2015, para. 24).

Since each stage is different, it is important to monitor the signs and
symptoms and make sure they are getting the care that is needed.

Internationally,
there are significant differences between which countries and cultures are more
or less affected by Alzheimer’s disease. 
For example, “The rates of dementia differ greatly around the world,
from the lowest rates in Africa, India, and South Asia, to the highest rates in
Westerns Europe and especially North America” (Greger, 2015, para. 1).

According to Dr. Michael Greger, “Globally,
the lowest validated rates of Alzheimer’s in the world are rural India, where
they eat low meat, high grain, high bean, high
carb diets” (Greger, 2015, para. 5). 
It is believed that the reason for the higher rate of occurrence in
North America and Western Europe versus Africa, India, and South Asia is diet. 

There are currently no treatments available to stop the
progression of Alzheimer’s disease. 
However, there are many ways to manage the symptoms, thereby improving
the lives of people with Alzheimer’s. 
The following are ways to improve life with Alzheimer’s: “Early
diagnosis in order to promote early and optimal management, optimizing physical
health, cognition, activity and well-being, identifying and treating
accompanying physical illness, detecting and treating challenging behavioral
and psychological symptoms, and providing information and long-term support to
caretakers” (World Health Organization,
2017, para. 15). Since life with Alzheimer’s is confusing and the
symptoms vary between each stage, it is vital for a patient to seek therapy and
keep their mind and body moving.  According to Kaur, Garnawat, Bhatia, and Sachdev (2013), “Physical therapy for Alzheimer’s can provide
interventions for secondary problems such as loss of strength, Range of Motion,
and active daily living, posture, balance and co-ordination” (p. 168).  Exercise is beneficial to one with
Alzheimer’s.  It will result in better
cognition and quality of life.  In fact, “It
was observed that a moderate exercise program conducted twice a week
significantly slows, by approximately one-third, the progressive deterioration
in ability to perform active daily living tasks in people. Combined
interventions, including physical activity, have led to better physical health,
lower depression, or better functional mobility in an Alzheimer’s disease
population” (Kaur et al., 2013, p. 168). The fact that exercise can help slow
the progression of the disease is very important for an Alzheimer’s patient.

As a caregiver of someone with Alzheimer’s disease, the
emotional cost is stress, physical exhaustion, and emotional exhaustion.  In fact, “76% of female care givers report
either physical or emotional exhaustion from their caregiving duties”
(Alzheimer’s Foundation of America, 2013, para. 3).  Many times, caregivers have no time to take
care of themselves and their own health suffers greatly: “Caregivers’ most
common health changes as a result of behavioral and cognitive symptoms of the
person they care for are as follows: fatigue, headaches, weight gain, difficulty
sleeping, and back pain” (Alzheimer’s Foundation of America, 2013, para. 3).  It is best to have a team of people to help
with the amount of supervision a person with Alzheimer’s needs, which leads to
the extreme financial costs.  According
to the Alzheimer’s Foundation of America (2013), “The average cost of care per
dementia case in 2010 was between $41,000 and $56,000” (para. 2). Caring for
someone with Alzheimer’s takes both an emotional and financial toll.

            The disease of Alzheimer’s is a lengthy
progressive disease that attacks the brain. 
A diagnosis can take some time to figure out and may be affected by a
person’s age and health. The time it takes for a person to progress through the
stages of Alzheimer’s varies from person to person.  Treatments for Alzheimer’s include the use of
physical therapy and daily activities which may help improve the quality of
life for people with Alzheimer’s. Because there currently is no cure for
Alzheimer’s, drug and non-drug therapies are currently the only known methods
for slowing the progression of the disease. It is significant for Physical
Therapists and Physical Therapist Assistants to know about Alzheimer’s disease as
therapy can help improve an Alzheimer’s patient’s daily life.

References

Alzheimer’s Association. (2018a). Diagnosis of Alzheimer’s disease and
dementia. Retrieved January 15, 2018, from https://www.alz.org/alzheimers_disease_diagnosis.asp

Alzheimer’s Association. (2018b). Younger/Early Onset
Alzheimer’s & Dementia.

Retrieved

            January 15,
2018, from https://www.alz.org/alzheimers_disease_early_onset.asp

Alzheimer’s Association. (2018c). Risk factors. Retrieved January 15,
2018, from https://www.alz.org/alzheimers_disease_causes_risk_factors.asp

Alzheimer’s
Foundation of America. (2013). Alzheimer’s
disease care costs add up PDF file.

Retrieved from http s://alzfdn.org/wp-content/uploads/2017/04/Care_Costs_-_Alzheimer_s_Disease.pdf

Greger, M. (2015, November 12). Where are the lowest rates of Alzheimer’s in
the world? Retrieved January 15, 2018, from
https://nutritionfacts.org/2015/11/12/where-are-the-lowest-rates-of-alzheimers-in-the-world/

Johns Hopkins Medicine. (n.d.). Alzheimer’s disease. Retrieved January
15, 2018, from https://www.hopkinsmedicine.org/healthlibrary/conditions/adult/nervous_system_disorders/alzheimers_disease_85,p00772

Kaur, J., Garnawat, D.,
Bhatia, M. S., & Sachdev, M. (2013). Rehabilitation in Alzheimer’s disease.

Delhi Psychiatry Journal, 16(1),
166-170. Retrieved from http://medind.nic.in/daa/t13/i1/daat13i1p166.pdf

Mayo Clinic. (2015, November 24). Alzheimer’s stages: How the disease
progresses. Retrieved January 15, 2018, from
https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers-stages/art-20048448?pg=1

World Health Organization. (2017, December). Dementia. Retrieved January 15, 2018,
from

http://www.who.int/mediacentre/factsheets/fs362/en/

 

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