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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Spanish version
Alzheimer's Disease
What is Alzheimer's disease?
Alzheimer's disease destroys brain cells. It causes a
decline in mental function that affects:
- memory
- thinking
- language
- behavior.
The disease can occur in people in their 40s and 50s, but it
most often affects those 65 and older. About 1 in 10 of those
over age 65 are diagnosed with Alzheimer's disease. For
every 10 years of life after age 65, the numbers double (2
in 10 over age 75, 4 in 10 people after 85, and so on).
Dementia, a general decline in mental ability, is the most
common reason people are placed in nursing facilities.
Alzheimer's disease, the most common cause of dementia,
affects more than 4 million people in this country.
How does it occur?
Changes in the chemistry and structures of the brain occur
in people with Alzheimer's disease. These changes hinder
the ability to process, store, and retrieve information. No
one knows why these changes happen.
Between 5% and 10% of people with Alzheimer's disease have a
family history of the illness and show signs of the disease
earlier in life, before age 65. In a small number of these
families, genes have been found that cause some of these
so-called familial forms of the disease.
What are the symptoms?
The symptoms of Alzheimer's disease vary from person to
person and change as the illness gets worse.
The first symptom is being forgetful. Almost all people
begin to have some memory problems as they get older. For a
person in the early stages of Alzheimer's disease, however, these
problems are more obvious than in others of the same age.
Forgetting people's names or the location of familiar items
is common. The attention span becomes shorter. The person
has a harder time concentrating. But at this stage of the
disease, being forgetful still has little impact on
lifestyle or work.
Over time the memory loss becomes more severe. Co-workers
and friends notice the memory loss and that the person has
problems dealing with written matter. He or she may
misplace or lose important objects. As the disease gets
worse the person can forget even major recent events and
personal history. He or she cannot handle money. In
general, recent memory is affected more than is long-term
memory.
In later stages of Alzheimer's disease the person becomes
disoriented and confused. The person can no longer recall
major facts about him- or herself and others. Objects and
people that once were familiar become unfamiliar. Changes
in emotions and personality may occur. The person may have
false beliefs (delusions) or see or hear things that aren't
there (hallucinations). He or she may be anxious and often
restless and active at night.
Someone with Alzheimer's disease may not see the need for care and
may resist help. At first, he or she can go to the bathroom
and eat without help. But in time, brain function declines
and the ability to talk, move, or do any self-care is lost.
How is it diagnosed?
A definite diagnosis of Alzheimer's disease can be made only by
examining brain tissue after death. However, probable
Alzheimer's disease can be diagnosed with a careful medical
history and physical exam.
While there is no one test to diagnose Alzheimer's disease,
memory testing can be helpful. Blood work and brain scans
can help show if there is a treatable cause of the decline
in brain function. It is especially important to rule out
major depression, a treatable condition that can cause
symptoms similar to Alzheimer's disease.
How is it treated?
There is no cure. The goal of treatment is to preserve
mental and physical function as much and as long as
possible. The best approach seems to include control of
other illnesses, a healthy diet, regular exercise, and
suitable activities.
Medicine may help. Some doctors believe medicines such as
donepezil (Aricept), galantamine (Reminyl), and rivastigmine
(Exelon) can be used early in Alzheimer's disease to slow
memory loss. These drugs are costly and have side effects.
Vitamin E and other medicines continue to be studied to see
whether they might be helpful. None of the medicines can
cure or reverse Alzheimer's disease. More often other
medicines may be used to help treat anxiety, depression, or
difficult behaviors.
Many people who have Alzheimer's disease are depressed,
especially in the earlier stages. Most do not show sadness
as much as a loss of pleasure and joy in life. When
depression occurs in late stages of Alzheimer's disease, the
person may be hostile or agitated and may often refuse food
and drink. Depression makes brain function much worse than
it otherwise would be. Treatment for depression is
available and works well.
Community resources are very important. The following
services may be coordinated through the doctor's office, the
local county health department, or visiting nurses
association:
- Social workers identify and organize help, including
possible financial aid.
- Home health care agencies provide the services of nurses,
medical social workers, and therapists. They also
provide home health aides for personal care.
- Out-of-home services include adult day care centers;
mental health services, including support groups for
patients and family caregivers; transportation; and
nursing homes.
How long will the effects last?
The brain function of a person who has Alzheimer's disease
continues to get worse until he or she dies.
What can be done to help take care of a person with this
disease?
While still possible, the person with Alzheimer's disease
should be involved in making decisions about the care he or
she will get. Someone with Alzheimer's disease fears
embarrassment due to losing independence. He or she needs to
be reassured sincerely and often.
Friends and family, as well as the person with Alzheimer's
disease, should join support groups as soon as possible
after the disease is diagnosed. A balance must be
maintained between the needs of the person with Alzheimer's
disease and those of family caregivers. The caregivers will
become emotionally and physically worn out if they have no
help or respite.
While the person with Alzheimer's disease is still able to
make legal decisions, he or she should sign a power of
attorney for medical and financial matters. If desired, a
living will should be made out as well. Ask the doctor for
more information about these documents.
For further information on coping with this disease,
contact:
Alzheimer's Association
919 N. Michigan Avenue
Suite 1000
Chicago, IL 60611-1676
Phone: 800-272-3900
Web site: http://www.alz.org.
What can be done to help prevent Alzheimer's disease?
We cannot prevent Alzheimer's disease until its causes are
better understood. People with a family history of
Alzheimer's disease should see their doctor regularly. Early
diagnosis will allow them to take advantage of new
treatments as they become available.
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