Diagnosis of Alzheimer’s disease can never really be certain in life. The only definite diagnosis can come from autopsying the individual’s brain after death. Five samples of tissue are taken from each hemisphere of the brain and studied under a microscope at 250x magnification. The number of senile plaques (an extracellular mass of dead and dying neurons surrounding a core of beta-amyloid protein) and neurofibrillary tangles (an intracellular tangle of microtubule fibers that leads to neuronal death) are counted and if they exceed a certain number specified by the individual’s age, diagnosis of AD can be made.
During life, diagnosis is by process of exclusion. All other possible etiologies of dementia must be ruled out in order to diagnose the person with Alzheimer’s disease. According to Swihart, in order to be diagnosed in life, the individual must be older than forty years. The diagnostic workup includes a complete and in depth history documenting how the dementia started and that it has had a progressive course. A general physical examination, laboratory tests, neuro-imaging, and a lumbar culture are done to rule out any other possible causes of dementia. A neurological examination is also done to determine if the cognitive changes are focal or global. If they are focal, it is indicative of something other than Alzheimer’s disease. Some possible causes of dementia that are ruled out include drug overdose, hyperthyroidism, kidney disease, vitamin B12 deficiency, normal pressure hydrocephalous, multiple strokes, tumors, chronic meningitis, and HIV. After these things are ruled out, the patient is sent for a neuropsychological workup. The neuropsychologist determines if the memory loss is more than would be normally expected for a person of that age, that depression is not causing a pseudodementia, and documents the dementia and that it is indeed Alzheimer’s disease and not something else.
After a person has been diagnosed with Alzheimer’s disease, he or she often wants to know what to expect for the future. Unfortunately, the course of AD is not a nice one. It begins in what is called the forgetfulness stage. The symptoms in this stage are usually mild and the person experiencing them may be the only one to notice. This stage is not usually functionally disabling; social skills and job performance is not significantly affected. The person may experience anomia (a word finding difficulty) along with mild language comprehension problems. Anxiety is common because the person realizes that there is a problem and that his or her memory loss is not normal. The length of this stage varies, but on average lasts from two to four years.
The next stage of Alzheimer’s disease is commonly referred to as the confusional stage. It is during this stage that other people begin to notice that there is a problem. The individual may need help with completing daily tasks and higher level activities. Anomia is so severe that speech often becomes “empty,” losing meaningful content but not structure. Spatial problems develop making driving a risk. The individual may have decreased attention span and concentration and may have difficulty with orientation to person, place, and time. Anxiety and depression often decrease during this stage because the individual cannot stay focused on one train of thought long enough to remain depressed. This stage lasts an average of four years.
The last stage of Alzheimer’s disease is the dementia stage. Individuals in this stage have such severe deficits that they require 24-hour supervision. They lose all memories of the past, can no longer recognize the faces of close family members and friends, and become so aphasic and anomic that they lose the ability to speak altogether. They often wander without purpose and can become easily lost in once familiar places. Motivation to eat, bathe, and use a toilet is lost. They may develop paranoia and hallucinations, become passive or agitated, and become socially withdrawn. Sensorimotor abilities are also impaired until they ultimately lose the ability to ambulate and become bedridden. Death is usually a result of pneumonia, sepsis, or urinary tract infection, among other physical complications that are a consequence of being bedridden. This stage lasts anywhere from six months to two years or more.
There is not much positive information that can be given to an individual who has been diagnosed with Alzheimer’s disease. There are some available medications that can slow the progression of the disease, but there is no cure and no medications are able to significantly improve memory or stop progression of the disease altogether. By simplifying the tasks and environment of a person with AD, he or she can be safer and maintain some level of independence for a longer time. The most important thing to teach family members caring for a person with this disease is to take care of themselves first. “Because they have neglected their own medical problems, caregivers often predecease a spouse who has dementia.”
Good luck with everything! Alzheimer's is a horrible disease, but with appropriate treatment, these individuals can live more independently for a longer period of time. If you are going to be caring for her at home, make sure to look for day respite services or ask other family members to help once a week so you do not get burned out. Also, an occupational therapist can help you to modify the environment and increase visula cues in the environment to increase her independence.
· 1 decade ago