Living with Alzheimers
Living with Alzheimer's can get very difficult. Everyday tasks become much more difficult for the patient, and many precautions have to be taken into account for someone living with Alzheimer's.
To learn more about the lives of patients with Alzheimer's, Click on the video to the right. |
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Demographics and Incidence Rates
There are 35.6 million people have dementia worldwide; 58% of all dementia cases living in low- and middle-income countries. Every year, there are 7.7 million new cases. The total number of people with dementia is projected to almost double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050.
The percentage of people with dementia in the US illustrates the chances of having dementia increases with advanced age:
The percentage of people with dementia in the US illustrates the chances of having dementia increases with advanced age:
- 5-8% of individuals over age 65
- 20% of people age 75
- 25% of those age over 80%
- 37% for those age 90 and over
Test to Diagnose
There is no single test that can tell if a person have dementia or not. Poor memory is a sign of dementia; but it does not mean a person has dementia.
Screening tests
Brief and simple neuropsychological tests are normally used for the screening of dementia because they can be used in general practice.
-Mini Mental State examination (MMSE) is the most widely used screening instrument for dementia. It is a scored test in which the score ranges from 0 to 30 (0 being worst). The cutoff score below which dementia can be detected is 24. However, the test in recent years has been criticized for poor sensitivity and specificity. Another problem of the test is poor negative predictive value and positive predictive value (NPV and PPV)
-Memory impairment Screening test (MIS)
Memory impairment screening test is a brief, four item, delayed free and cued recall memory test. It is based on the principle of “encoding specificity” (when the information provided at the encoding of the memory is also at the retrieval of the memory, the memory tends to be easier to recall.)
-Mattis Dementia Rating scale assesses 5 cognitive domains: attention, initiation and perseveration, construction, conceptual thinking, memory
Battery tests
-The Cambridge Examination for mental Disorders of elderly (CAMDEX) is a standardized, structured interview and examination for diagnosing common mental disorders in later life. The goal of the CAMDEX is toestablish the type of dementia, describe key features common to dementia and other psychiatric syndromes of later life that are likely to overlap with and cause difficulty in the differential diagnosis of dementia, to diagnose dementia at an earlier stage, to provide a quantitative measure of performance on cognitive tests across a wide domain of cognitive functions, provide an estimate of clinical severity in dementia, to be applicable to both clinical and community based studies
-Alzheimers disease (AD) assessment scale (ADAS) is designed to measure the severity of the most important symptoms of AD which
consists of 11 tasks measuring disturbances of memory, language, praxis, and attention.
Brief and simple neuropsychological tests are normally used for the screening of dementia because they can be used in general practice.
-Mini Mental State examination (MMSE) is the most widely used screening instrument for dementia. It is a scored test in which the score ranges from 0 to 30 (0 being worst). The cutoff score below which dementia can be detected is 24. However, the test in recent years has been criticized for poor sensitivity and specificity. Another problem of the test is poor negative predictive value and positive predictive value (NPV and PPV)
-Memory impairment Screening test (MIS)
Memory impairment screening test is a brief, four item, delayed free and cued recall memory test. It is based on the principle of “encoding specificity” (when the information provided at the encoding of the memory is also at the retrieval of the memory, the memory tends to be easier to recall.)
-Mattis Dementia Rating scale assesses 5 cognitive domains: attention, initiation and perseveration, construction, conceptual thinking, memory
Battery tests
-The Cambridge Examination for mental Disorders of elderly (CAMDEX) is a standardized, structured interview and examination for diagnosing common mental disorders in later life. The goal of the CAMDEX is toestablish the type of dementia, describe key features common to dementia and other psychiatric syndromes of later life that are likely to overlap with and cause difficulty in the differential diagnosis of dementia, to diagnose dementia at an earlier stage, to provide a quantitative measure of performance on cognitive tests across a wide domain of cognitive functions, provide an estimate of clinical severity in dementia, to be applicable to both clinical and community based studies
-Alzheimers disease (AD) assessment scale (ADAS) is designed to measure the severity of the most important symptoms of AD which
consists of 11 tasks measuring disturbances of memory, language, praxis, and attention.
Stages of Alzheimer's Disease
The Clinical Director of New York University Dr. Barry Reisburg outlined the seven major clinical stages of the Alzheimer disease.
Here are the seven stages:
Here are the seven stages:
Stage 1 - The Normal Stage
At this stage the patient may not have any symptoms. Memory and cognitive ability appear normal. At this point, no evidence of upcoming dementia can be observed.
Stage 2 - Normal Forgetfulness / Mild Cognitive Decline
In this stage, no symptoms of dementia can be found in any clinical examination. Any close friends or family do not notice a difference in the patients, but the patient themselves can find minor memory problems. Although the patient can see minor changes, he/she will still test well in memory tests.
Stage 3 - Mild Cognitive Impairment (duration: 2 - 7 years)
In this stage, memory and cognitive problems can be noticed by friends and family. Memory and cognitive tests will be affected as well as medical examinations.
The patient will experience difficulty in the following areas: - choosing the right words during a conversation - remembering names of new acquaintances - planning and organizing - keeping track of personal belongings - job performance, if patient still carries a job |
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Stage 4 - Mild or Early Stage of Alzheimer's (duration: 2 years)
Symptoms of Alzheimer's become more accurate during this stage. The patient will have difficulty managing their daily life such as managing finances, and preparing meals. The patient will forget some life memories and suffer from poor short term memory. The patient will seem less emotional towards others due to personal frustrations.
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Stage 5 - Early Dementia / Mid Stage of Alzheimer's (duration: 1.5 years)In this stage, the patient will need help with daily activities. Patient in this stage will experience sever decline of numerical activities and decline in judgment skills. Some examples include:
- not being able to recall their own address or telephone number - need help choosing proper clothes for seasons or occasions However, patients in this stage still remember significant details about themselves, their families, and childhood memories. They do not need any assistance with eating or using the toilet. Stage 6 - Severe Alzheimer Disease (duration: 2 years)In this stage, The patients now needs professional care. Patients are unaware of their surroundings. They also cannot recognize close friends or relatives. They are also unable to recall most details about their personal history. Patients also suffer from loss of bowl and bladder control.
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Stage 7 - Very Severe Alzheimer's Disease (duration: 1 - 2.5 years)
Patients in this stage are near death. They do not have the ability to respond to their environment. They need assistance for all daily activities. The duration of this stage is impacted by the quality of healthcare the patient receives.
Treatments
There is currently no cure for Alzheimer's disease, but there are many treatments for the symptoms the disease brings.
Treatment for Memory Loss
There are two types of medications that are currently being used to help with memory loss. These include Cholinesterase inhibitors, and memantine. Vitamin E is also offered to Alzheimer's patients that suffer from memory loss.
- Cholinesterase inhibitors slow down the process of important neurotransmitters breaking down - Memantine regulates the activity of one of the neurotransmitters, glutamate. In Alzheimer's disease there is excess glutamate causing an overdose of calcium. This increases the rate of cells dying. Treatment for Behavioral ChangesThere are both drug and non-drug approaches to help with this symptom. There are side effects for all the drugs used to help with depression, irritability, anxiety, etc. These drugs include anti-depressants, anxiolytics, and antipsychotics. Especially with antipsychotics, the risk for stroke in dementia patients increase if the patient takes the drug.
Depression or anxiety can be risen from something is the patients environment. It is important to check for any negative influences the patient environment that can be causing the behavioral change. In this case, a non-drug approach would be more effective. These treatments include counseling, interventions, and changing the environment the patient is in. |
Social and Economic Impacts
Dementia has significant social and economic implications in terms of direct medical costs, direct social costs and the costs of informal care. In 2010, the total global societal costs of dementia was estimated to be US$ 604 billion which corresponds to 1.0% of the worldwide gross domestic product (GDP), or 0.6% if only direct costs are considered. The total cost as a proportion of GDP varied from 0.24% in low-income countries to 1.24% in high-income countries.