Alzheimer_Write_Up

Alzheimer’s: What are the current available treatments to help relieve Alzheimer symptoms'” Introduction: Alzheimer’s is the most common form of dementia; it is an incurable, degenerative, and terminal disease. Generally, it is diagnosed in people over 65 years of age, although the less prevalent early onset Alzheimer's can occur much earlier. In 2006, there were 26.6 million sufferers worldwide, as of 2009 those figures have nearly doubled and it is now estimated that there are 35.5 million Alzheimer sufferers worldwide. With the advances in technology and science a cure for Alzheimer’s is in development. The Problem: What are the current available treatments to help relieve Alzheimer symptoms'” [pic]Fig. 2 As you can see the cortex and the hippocampus shrivels and this will have a severe effect on thinking, planning and remembering. http://scrapetv.com/News/News%20Pages/Health/Images/alzheimers-brain.jpg [2] Medicinal treatments: Cholinesterase Inhibitors Cholinesterase inhibitors may improve cognitive function and memory in some patients. Four are available; donepezil, rivastigmine and galantamine are equally effective, tacrine is rarely used due to its toxicity to the patient. These are drugs that block the activity of an enzyme in the brain called cholinesterase [7]. Cholinesterase breaks apart the neurotransmitter acetylcholine, which is vital for the transmission of nerve impulses. The recommended dose is 5 mg once/day for 4 to 6 weeks, and then increased to 10 mg once/day. Treatment should be continued if functional improvement is observed after several months, otherwise it should be stopped due to common adverse side effects which range from nausea, vomiting, diarrhoea, weight loss, upset stomach, weakness etc. [7] Figure 3 summarises the drugs available to treat Alzheimer’s are cholinesterase inhibitors and memantine. Donepezil is the first type of drug used in treatment as it is generally well tolerated by patients. [pic] Fig 3 shows the drugs available at the moment that treat Alzheimer’s and their effectiveness. http://www.merck.com/mmpe/sec16/ch213/ch213c.html#tb_213-006 [7] Memantine Memantine is a drug approved for treatment of moderately severe to severe Alzheimer's in the European Union. Memantine appears to protect the brain’s nerve cells against glutamate, a messenger chemical released in excess amounts by cells damaged by Alzheimer’s disease or certain other neurological disorders.  Memantine appears to slow the progression of Alzheimer's disease. The dose is 5 mg once/day, which is increased to 10 mg after 4 weeks. For patients with kidney problems, the drug should be avoided. Memantine can be used with a cholinesterase inhibitor. [7] A study conducted by Winbald B and Poritis N (Fig 4) shows us that the treatment using memantine shows more improvement than treatment using a placebo. [3] [pic]Fig. 4 Is from a study conducted by Winblad B, Poritis N (1999) and it shows the effectiveness of memantine and a placebo when used by mild to severe Alzheimer sufferers. http://www.alzheimerioliga.lt/axura/clinical_studies/international_studies/winblad-poritis/index.htm [3] Benefits and Risks of Medicinal Treatment The trial above and prospective, randomized, placebo controlled trials have shown that the cholinesterase inhibitors, donepezil and galantamine, can provide behavioural benefits for patients with mild to moderate Alzheimer's disease (See Fig 3). Of the medicinal treatments, both donepezil and galantimaine are generally well tolerated by the patients and seem to provide the most beneficial effects for people who are suffering from early to moderate Alzheimer’s disease. [7] However cholinesterase inhibitors do not come without side effects which range from nausea, vomiting, diarrhoea, weight loss, upset stomach, weakness etc. [8] On the other hand without the drug treatment the life expectancy of people who are diagnosed with Alzheimer’s can become significantly shorter. Memantine however is well tolerated by people with alzheimer's disease; people taking memantine experienced a low rate of gastrointestinal side effects also it has a low potential to interact with other medication so it is safe for people to take memantine, with other Alzheimer's medication such as cholinesterase inhibitors. [9] Economic Implications The BBC suggested in 1998[6] that by the year 2020 more than 75% of people suffering from Alzheimer's disease will come from developing countries. Fast forward to 2007 and a study conducted by the Kings College of London and LSE shows that as the UK's population ages the number of people with dementia will grow substantially. [10] It also shows that dementia costs the UK £17 billion a year. [10] A report in 2009 conducted by the Alzheimer’s Association stated that the annual spending in America for the care of Alzheimer is $148 billion. [11] (See Fig.5) The greatest origin of costs for society is the long term care by health care professionals, the graph below shows us that Alzheimer’s is one of the most costly diseases in America today, $25000 spent on average per person each year. Institutionalisation, accounts for 2/3 of the total costs for society. The cost of living at home is also very high, especially when immeasurable costs, such as care giving time and caregiver's lost earnings, are taken into account. As dementia severity and the presence of behavioural disturbances increase, so does the care giving time required for the provision of physical care, which impacts on the families finances. [11] So any treatment that slows cognitive decline, delays institutionalisation or reduces caregivers' hours will have economic benefits. [pic]Fig. 5 Shows us the yearly cost per patient of selected medical conditions and at the top is Alzheimer’s which makes it one of the most costly disease in America.[5]By World Health Organization, 2003 http://www.omh.state.ny.us/omhweb/Statewideplan/2005/images/figure4.2.gif Social Implications Families caring for a person with Alzheimer's disease soon discover that it is unlike any other illness. Coping with a degenerative brain disease is different from dealing with a physical disability, the book “Living in the Labyrinth” details the struggles an average Alzheimer patient would have to endure. [14] Alzheimer's is more disruptive and has greater impact on the family than other chronic diseases. Caring for sufferers has a high financial, social, and emotional price. Families must work toward effectively coping with Alzheimer’s, containing the harmful effects, and keeping family conflicts to a minimum. Support groups can provide families with much-needed information on the disease, emotional and practical support, and legal advice. Formal services can help relieve some of the burden of caring for an Alzheimer's patient. Many books have been written by doctors detailing the duty and roles of a patient carer and what to do during specific times. [4] However, family members must remember that there is no right way to care for a person with Alzheimer's, and each family must determine, with the help of the appropriate professionals and services, how to best meet its own needs. Alternative Treatments Cognitive Therapy Cognitive therapy is an intervention to facilitate learning and retain information. It uses a spaced retrieval method for retention of names of common objects, location of objects and face name association, and cognitive stimulation. Improved clinical assessment in early stages of Alzheimer's disease and other forms of dementia, increased cognitive stimulation of the elderly, and the prescription of drugs to slow cognitive decline have resulted in increased detection in the early stages. Although the opinions of the medical community are still divided over cognitive therapies used for dementia patients, recent international studies have started to create optimism. Reminiscence Therapy This refers to recollections of memories from the past. [12] For people with Alzheimer’s disease encouraging the act of reminiscence can be beneficial as it involves exchanging memories with the old and young, friends and relatives, with caregivers and professionals, passing on information, wisdom and skills. It is about giving the person with Alzheimer’s a sense of value, importance, belonging, power and peace. Biologically it also encourages the use of certain synoptic connections in the brain, thus maintaining the processes involved in memory. It is often used in hospitals in the United Kingdom for example, especially those specialising in medical care for the elderly. In one approach, participants are guided by a trained person to reflect on a variety of aspects relating to their lives. [12] This may be themed and centre on one period in time or it may be wider and reflect a guided discussion through an issue. The therapist may use music, photographs, replica documents, drama and sensory gardens to stimulate debate and discussion for the participants, which again stimulates different regions of the brain encouraging neural connections. Reality Orientation Therapy Over time individuals with Alzheimer's disease may withdraw from contact with others and the environment as they become increasingly disoriented. This withdrawal results in a lack of sensory stimulation. [13] To prevent under stimulation, a therapy called reality orientation was developed. It is based on the belief that continually and repeatedly telling or showing certain reminders to people with mild to moderate memory loss will result in an increase in interaction with others and improved orientation. Other materials, such as family pictures, flash cards, Scrabble games, a globe, large piece jigsaw puzzles, and illustrated, large-print dictionaries, are also helpful. This in turn can improve self esteem and reduce problem behaviours. Reality orientation can be taught to caregivers and family members by a psychotherapist or other health care provider trained in these techniques. It can be performed in the home and should be structured around the area in which the person with Alzheimer's spends most of his or her time. In reality orientation, people with Alzheimer's are surrounded by familiar objects that can be used to stimulate their memory. [13] Evaluation In my research I have found out that the treatment for relieving Alzheimer symptoms depends on the severity/ stage of the disease and the behavioural symptoms that the patient is currently suffering from. However evidence from my sources points towards the drug donepezil as having the most beneficial effects for people suffering from early to moderate Alzheimer’s. [7] This source is reliable because it agrees with other sources such as [15] “Patients treated with donepezil showed dose-related improvements in the Alzheimer's Disease Assessment Scale-cognitive subscale score (ADAS-cog) and in MMSF scores.” Also the source [7] has been published in “The Merck Manuals Online Medical Library” which shows us that the source is trustable as it has been approved by medical practioners. I have also found that the source “Alzheimer’s Disease Facts and Figures, by Alzheimer’s Association, 2009” [11] to be very helpful due to it giving me statistical resource for US data regarding Alzheimer’s. It provided specific information regarding Alzheimer care givers and the economic implications of Alzheimer’s. This source [11] is valid because the report has been reviewed by a writer [16]. However what’s important is that this is a non profit organization which focuses on care, support and research for Alzheimer's disease which means that most of them are familiar in the field of Alzheimer’s and hence the source [11] is assumed to be genuine and valid. Bibliography [1] Alzheimer’s Association, September 21 2009 http://www.tricitypsychology.com/blog/2009/09/21/september-21st-is-world-alzheimers-day/ [2] Date Viewed March 1 2010 http://scrapetv.com/News/News%20Pages/Health/Images/alzheimers-brain.jpg [3] Memantine in severe dementia: Results of the M-BEST Study, Winblad B, Poritis N, 1999 http://www.alzheimerioliga.lt/axura/clinical_studies/international_studies/winblad-poritis/index.htm [4] Therapeutic Care giving: a Practical Guide for Caregivers of Persons with Alzheimer's and Other Dementia Causing Diseases, by Barbara J. Bridges Mill Creek, Washington, 1995 [5] http://www.omh.state.ny.us/omhweb/Statewideplan/2005/images/figure4.2.gif [6] BBC News Dementia, September 25, 1998 http://news.bbc.co.uk/1/hi/health/180386.stm [7] Dementia, By Alexander Auchus, August 2007 http://www.merck.com/mmpe/sec16/ch213/ch213c.html#tb_213-006 [8] Alzheimer’s Disease Research, Common Alzheimer Treatments, Date Viewed March 3 2010 http://www.ahaf.org/alzheimers/treatment/common/ [9] Date Viewed March 3 2010 http://www.namenda.com/sections/30/side-effects.shtml [10] Dementia UK the Full Report 2007 by LSE and Kings College http://alzheimers.org.uk/site/scripts/download_info.php'fileID=2 [11] Alzheimer’s Disease Facts and Figures, by Alzheimer’s Association, 2009 http://www.alz.org/national/documents/report_alzfactsfigures2009.pdf [12] NHS Evidence - Mental health, 20 Apr 2005 http://www.library.nhs.uk/MENTALHEALTH/ViewResource.aspx'resID=236843 [13] Reality Orientation, By Marilynn Larkin, 1994 http://www.zarcrom.com/users/alzheimers/t-02.html [14] Living in the Labyrinth: a Personal Journey through the Maze of Alzheimer's, By Diana Friel McGowin, 1993 [15] The efficacy and safety of donepezil in patients with Alzheimer's disease, By Rogers SL, Friedhoff LT, 1996 http://www.ncbi.nlm.nih.gov/pubmed/8915035 [16] Review: Alzheimer's Facts and Figures: New 2009 Report, By Annette Smith, September 18, 2009 http://www.associatedcontent.com/article/2174307/alzheimers_facts_and_figures_new_2009.html'cat=5