Alzheimer’s disease is a progressive, irreversible, degenerative neurologic disease that begins insidiously and is characterized by gradual losses of cognitive function and disturbances in behavior and affect. Alzheimer’s disease is not found exclusively in the elderly; in 1 % to 10% of cases, its onset occurs in middle age. A family history of Alzheimer’s disease and the presence of Down syndrome are two established risk factors for Alzheimer’s disease.
Of family members have at least one other relative with Alzheimer’s disease, then a familial component, which non- specifically includes both environmental triggers and genetic determinants, is said to exist. Genetic studies show that autosomal- dominant forms of Alzheimer’s disease are associated with early onset and early death. In 1987, chromosome 21 was first implicated in early-onset familial Alzheimer’s disease. Soon after, the gene coding fro amyloid precursor protein or APP was also found to be on chromosome 21.
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Not until 1991 was an actual mutation in association with familial Alzheimer’s disease found in the APP gene of chromosome 21. For those with this gene, onset of Alzheimer’s disease began in their 50’s. Only a few of the cases of familial Alzheimer’s disease have been found to involve this genetic mutation. In 1992, chromosome 14 was found to contain an unidentified mutation also linked to familial Alzheimer’s disease. Since 1995, molecular biologists have been discovering even more- specific genetic information about the various forms of Alzheimer’s disease, including genetic differences between early- and late- onset Alzheimer’s disease.
These genetic differences are helping to pinpoint risk factors associated with the disease, although the genetic indicators are not specific enough to be used as reliable diagnostic markets. A. Causes/ Risk Factors Symptoms of AD are usually subtle in onset and often progress slowly until they are obvious and devastating. The changes characteristic of AD into three general categories: cognitive, functional, and behavioral. Reversible causes of AD include alcohol abuse, medication use, psychiatric disorders, and normal- pressure hydrocephalus.
Increasing age is the leading risk factor of people getting Alzheimer’s disease. II. Symptoms, Changes by Psychological and Behavioral A. Dementia Symptoms are usually subtle in onset and often progress slowly until they are obvious and devastating. The changes characteristics of dementia fall into three general categories: cognitive, functional and behavioral. In the early stages of Alzheimer’s disease, forgetfulness and subtle memory loss occur. The patient may experience small difficulties in work or social activities but has adequate cognitive function to hide the loss and can function independently.
Depression may occur at this time. With further progression of the disease, the deficits can no longer be concealed. Forgetfulness is manifested in many daily actions. These patients may lose their ability to recognize familiar faces, places, and objects and may get lost in a familiar environment. They may repeat the same stories because they forget that they have already told them. Trying to reason with the person and using reality orientation only increase the patient’s anxiety without increasing function. Conversation becomes difficult, and there are word- finding difficulties.
The ability to formulate concepts ad think abstractly disappears; for instance, the patient can interpret a proverb only in concrete terms. The patient is often unable to recognize the consequences of his or her actions and will therefore exhibit impulsive behavior. For example, on a hot day, the patient may decide to wade in the city fountain fully clothed. The patient has difficulty with everyday activities, such as operating simple appliances and handling money. Personality changes are also usually evident. The patient may become depressed, suspicious, paranoid, hostile, and even combative.
Progression of the disease intensifies the symptoms: speaking skills deteriorate to nonsense syllables, agitation and physical activity increase, and the patient may wander at night. Eventually, assistance is needed for most ADL’s including eating and toileting, since dysphagia occurs and incontinence develops. The terminal stage, in which the patient is usually mobile and requires total care, may last for months or years. Occasionally, the patient may recognize family or caretakers. Death occurs as a result of complications such as pneumonia, malnutrition, or dehydration.
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