Alzheimer's Dementia Compassion Care  
            "Those who forget should not be forgotten"

 What is Alzheimer’s Disease?

    Alzheimer’s Disease (AD), the major cause and form of dementia, is a progressive degeneration of the cerebral cortex of the brain. The cause of AD is not entirely known, but is thought to include both genetic and environmental factors. Pathologic changes as described below are hallmarks of AD. It is known that there are genetic components, the APO E gene being a prime example; more genetic research is likewise being done. Early onset AD (before age 50) is definitely considered genetic. Unfortunately, there is no known cure and  medical treatments are of  limited value. 


  Dementia is not a specific disease, but rather a group of symptoms described as a steady, progressive decline in mental functioning, often involving memory and other cognitive functions that result in a change in the ability to conduct one's usual activities (driving, shopping, balancing a checkbook, working, etc.) and relationships.  



















Warning Signs

     Mild cognitive impairment (MCI) (Stage 2) is a condition in which a person has problems with memory, language, or another mental function severe enough to be noticeable to other people and to show up on tests, but NOT serious enough to interfere with daily life. About half of all people diagnosed with MCI deteriorate into Alzheimer's disease within five to seven years. The Institute for Dementia Research and Prevention predicts that 1 in 6 women, and 1 in 10 men, who live past the age of 55 will develop dementia in their lifetime.
    This accelerated deterioration in memory and other mental functions is not found in people who do not develop Alzheimer's disease. Even though not everyone diagnosed with MCI goes on to develop AD, MCI may be thought of as a possible middle phase of AD and a precursor to third phase AD. Recognition of MCI is thus important for possible future AD management. (More on Staging below)

  AD: The 10 most common early stage symptoms:

       * Memory loss
       * Difficulty planning or problem solving
       * Difficulty completing familiar tasks
       * Loss of orientation to time or place
       * Difficulty with visual processing and spatial relationships  
       * Language difficulties
       * Misplacing objects
       * Impaired judgment
       * Social withdrawal
       * Personality changes

 The most common symptoms of AD and how AD affects patients and their families are:

  • Patients with Alzheimer's disease begin to misplace things, forget names, get lost even in previously familiar surroundings,  have difficulty remembering recent events, have difficulty concentrating, get irritable, agitated, paranoid, and may experience hallucinations.
  • People with AD lose the ability to drive a car, cook a meal, or even read a newspaper. They may get lost easily and find even simple things confusing.
  • They have difficulty learning and retaining new information while long-term memory may be preserved until the later stages of the disease.
  •  Ultimately they become dependent and need assistance for their daily activities of living.
  • Fear or embarrassment are sometimes associated with Alzheimer's disease. Often patients and families are hesitant to accept the diagnosis and to seek help.
  • Caregiver stress can be high and depression is common among both caregivers and patients (see: Why In-Home?

 Diagnosis









In July 2010 it was reported that measuring certain proteins (beta amyloid and tau) in spinal fluid can accurately diagnose Alzheimer's 
and predict which patients with memory problems may develop the fatal brain-wasting disease. As reported in the Archives of Neurology, the spinal fluid tests may also help identify early signs of the disease in healthy people. Brain imaging (PET scan) is now available through investigators as another early alternative diagnostic tool.

     A separate July 2010 study reported that high levels of a blood protein called clusterin are linked to the development of AD — a finding which could pave the way for doctors to detect the disease before it takes hold. Researchers from the Institute of Psychiatry at King's College London said that while doctors are around 5 years away from being able to use the discovery for a blood test to identify future Alzheimer's sufferers, the finding was a big step along the way.

   Pathology











  Early in the disease, Alzheimer's pathology is first observed in the hippocampus, the part of the brain important to memory, and gradually spreads to the cerebral cortex, the outer layer of the brain. The damage eventually affects cells and synapses that control and coordinate movement. It is known that "plaques" formed of the protein beta-amyloid accumulate in the brains of individuals with the disease, and the extent of these plaques correlates with the severity of symptoms. These plaques are the hallmark of Alzheimer's disease. They are always accompanied by neurofibrillary tangles, insoluble twisted fibers composed of dead neurons. These tangles consist primarily of a protein named Tau, which holds the neuronal axon together. Evidence exists that mitochondrial alterations and oxidative damage may be involved in the neurodegeneration associated with AD.

This is why taking antioxidants and other supplements  play a key role in the mitigation of Alzheimer's.

  To further complicate our understanding of AD, as many as a third of people with amyloid plaques in their brains do NOT developed Alzheimer’s symptoms by the time they die. More recent 2011 research from studies with mice suggests that free-floating protein clumps called oligomers may be the culprit rather than plaques and tangles. This will take years to confirm in humans.  A recent study published in Oct '11 suggests that AD may be due to infectious exposure! 

    Of interest is a new field of medicine, often referred to as Functional Medicine, which states that inflammation and hormonal inbalances are major contributing factors for abnormal brain disorders. They further maintain that certain food types and environmental toxins cause brain inflammation, and that chronic brain inflammation is a major component of Alzheimer's disease, dementia, psychiatric disorders and a host of other brain abnormalities. Tenets of functional medicine are treating underlying systems and not symptoms.

 (New) Staging and Progression
    
  In April 2011 AD was redefined in an attempt to start to identify it earlier and earlier. Guidelines issued  by the National Institute on Aging and the Alzheimer’s Association now divide the disease into 3 stages which may develop over 20 years.
(Stages 0 and SNAP are suggested by the Mayo Clinic)  

    Stage 0: Normal Alzheimer’s biomarkers and no evidence of subtle cognitive impairment
     SNAP: Suspected Non-Alzheimer’s Pathophysiology - denotes subjects with normal amyloid PET imaging, but abnormal neurodegeneration biomarker studies.

    Stage 1 (Pre-clinical) — The pre-clinical stage only applies to research settings. It describes a phase in which brain changes, including amyloid buildup and other early nerve cell changes, may already be in process. There are no obvious symptoms of dementia. In some people, amyloid buildup can be detected with PET scans and analyzing cerebrospinal fluid (CSF). The revealed biomarkers tell much to researchers. Notwithstanding, development and standardization of such biomarkers are still at an early stage. Therefore, they are only used in the lab.

     Stage 2 or Mild Cognitive Impairment (MCI) —Clarifications of the guidelines for MCI are growing in importance in the clinical setting. When a person has symptoms of memory problems, enough to be noticed and measured on tests, but not compromising a person’s independence, they are typically facing MCI. People with MCI may or may not progress to Alzheimer's dementia. Biomarker technologies, using PET scans, MRIs, and CSF analysis are rapidly progressing to offer increasingly accurate diagnosis of these early stages. Researchers are now focused 
on developing and standardizing such biomarkers. The goal is accurate diagnosis of MCI symptoms.

    Stage 3 or Alzheimer's Dementia — The criteria for this stage outline methods for doctors to approach evaluating the causes of a patient’s Alzheimer’s. In addition, they offer the language necessary to treat or research progression of cognitive decline. The guidelines are a significant upgrade. Alzheimer's dementia’s most central characteristic used to be memory loss. Now, declines in areas of cognition that are first diagnosed include impaired reasoning or judgment, word-finding and vision/spatial issues. Today, doctors are beginning to use biomarker tests to increase their certainty about an Alzheimer's diagnosis, in addition to distinguishing Alzheimer's from other types of dementias.

   In the study leading up to their recommendations, the Mayo Clinic worked with a sample of 450 people. In the sample, the stages broke down as follows:
    Stage 0: 43%
    SNAP: 23%
    Stage 1: 16%
    Stage 2: 12%
    Stage 3: 3%

   The National Institute on Aging Director Richard J. Hodes, M.D., summed up the importance of this undertaking, saying,
    "Alzheimer's research has greatly evolved over the past quarter of a century. Bringing the diagnostic guidelines up to speed with those advances is both a necessary and rewarding effort that will benefit patients and accelerate the pace of research."













 Progression to more advanced stages will disable the patient further, where more and more faces, places, and events will be forgotten to a greater degree. Many of the other behavioral and cognition changes continue to worsen. 
  •        Bladder or bowel control problems may arise. 
  •        They may start to wander or become restless and perform repeated movements.
   
   While historically the staging of AD may described in different ways for variety of  reasons, these distinctions are more useful to medical  professionals for diagnostic or treatment purposes.  For the family that has to deal with the day to day effects of this debilitating condition, the most important consideration is not  the stage, but how to cope with chronic and newly manifested symptoms to help and care for their loved ones. 

   It is to this end that we direct our efforts. One of our goals besides innovative and proactive client care and family caregiver relief is to try to slow down the progression of Alzheimer's Disease through the use 
of different modalities as described in Our Services.

   Parkinson's disease dementia (PDD)  is a type of dementia that occurs when a patient with Parkinson's disease develops a progressive dementia at least two years after a diagnosis of Parkinson's disease has been made, and other causes of dementia have been ruled out. The presence of Lewy bodies in the brain characterize this disease.

  Approximately 25-30% of all patients with Parkinson's disease also have dementia, but after having Parkinson's disease for 15 years, the prevalence of PDD increases to 65-70%.

  PDD is usually different in how it presents itself from Alzheimer's disease: In PDD people usually have major problems with attention, executive functioning, and memory retrieval. In Alzheimer's disease, the memory problem is more often one of storing memories. People with PDD may also have more insight into having a memory problem than people with Alzheimer's disease. 

Alzheimer's Dementia Specialized                                          In-Home Care
    Although there are different causes of dementia, Alzheimer's disease is by far the most common cause (75-80%) in the United States and in most countries in the world. Although some memory loss is a normal part of aging, changes due to aging are usually not severe enough to interfere with basic levels of daily functioning.  Parkinson's disease can also lead to dementia (see PDD at end of this page)
    Some people don’t know they have Alzheimer’s disease, blaming their forgetfulness on old age. Towards the end of the Stage 2 symptoms may become evidenced by a change in personality of the person suffering from the disease. Thus he or she may exhibit strange or new behaviors or quirks and behave in a manner that is not their usual self. They may lose sense of etiquette or may speak or act inappropriately with lack of judgment, including sexual references or aberrant sexual behavior. Paranoia may develop and especially be directed towards the primary caregiver. Not liking to bath is also not uncommon.
Until recently AD was diagnosed by mental function tests, brain MRIs and/or exclusion of other illnesses.  Accumulating research now suggests that brain changes seen in  Alzheimer’s start around 20 years before mental impairment is evident.
   The staging of AD has traditionally been categorized in different ways: 3 stages (mild or early stage, moderate and severe or late stage) or in 7 stages. Each successive stage shows a progression in symptoms and a deterioration of lifestyle.  Stages are not set in stone and may overlap.
   The number of dementia sufferers is expected to balloon in future decades as populations around the world age. Currently there are around 5.8 million people with AD in the USA. Alzheimer's Disease International predicts numbers will almost double every 20 years to 66 million in 2030 and over 115 million in 2050.
      Progression of symptoms corresponds in a general way to the underlying brain degeneration that takes place in this disease. Nerve cell (neuron) damage typically begins with cells involved with learning and memory and gradually spreads to cells that control every aspect of thinking, judgment, and behavior. 
 Forget-Me-Not