Understanding Alzheimer's Disease: Symptoms, Diagnosis, and Patient Care

Importance of Communication with Family Members for Effective Long-term Patient Care

The communication with the family members is an indispensible part of long term patient care that is effective for positive health outcomes. A clear communication with the family members helps them assess the situation better, overcome misconceptions, acts as a guide to the care and support to the patient, helps in understanding about the disease conditions and outcomes , understand the available treatment and care options and thus make informed decision and seek help. Patient family engagement makes treatment effectivity and the  cooperation more viable. In case of E.S the study of the case suggests that the son does not have a clear understanding of the condition. Using the knowledge of patho-physiology to explain the condition shall help clear the misconception. The pathophysiology shall be laid out in simple, clear terms for the family to understand (Aliyu,  et al., 2015).

Alzheimer's is  a neuro-degenerative disease that is the one of the most common cause of dementia. Around 65% -85% cases of dementia accounts up to Alzheimer's. The disease is progressive and affects cognitive functions and memory. The neuronal connections in the brain, and the brain cell degenerates over time and thus affecting the major mental capabilities to perform even day to day activities. Memory loss, confusion, aggressiveness, failure to identify with family and situations and even language comprehensibility are a cause of Alzheimer's. The two specific findings on the pathophysiology of Alzheimer's are beta amyloidal deposits that are extracellular and the presence of intracellular neurofibrillary tangles. The beta amyloidal deposits and tangles cause degeneration of synapses and neurons and subsequent atrophy of the brain (Twohig, & Nielsen, 2019).  

The diagnosis of Alzheimer's is made through a variety of test and interviews and is somewhat similar to the diagnosis of dementia. The tests includes assessing the mental and cognitive abilities o the individuals through Mental Status Testing, Neurophysiological Tests that access the cognitive problems and difficulties in memory and thinking capabilities and interviews with closed ones  to make proper clinical assessment of the symptoms (Gore, Vardy, & T O'Brien, 2015). The tests also include physical test examining the reflexes, muscle movement, balance and coordination, ability to perform normal tasks, sight and hearing tests in order to rule out other similar conditions. Blood Tests are conducted to rule out thyroid disorder and deficiency diseases. Brain-imaging tests like MRI (Magnetic resonance imaging), CT (Computerized tomography) and PET scans (Positron emission tomography) are conducted to rule out hemorrhage and strokes, to distinguish among various brain degenerative disorders and to investigate the amount of atrophy in the brain.

Biomarkers and their Role in Diagnosing Alzheimer's Disease in Living Individuals

PET scans are very effective in determing a definitive diagnosis of Alzheimer's in a living patient through the examination of metabolism of glucose to differentiate between other brain disorder with the use of radioactive substance to track as biomarkers in the body ,an example is the ''  fluorodeoxyglucose (FDG) PET scan'' Amyloid protein detectors are developed by an modernization of PET (Jack, et al., 2016). A definitive diagnosis can only be made post death through autopsy and examination of the brain tissue through clinical measure linkage. Assessment of biomarkers are the best way to diagnose Alzheimer's in Living individuals. (www.nia.nih.gov , 2021)

Alzheimer's and Delirium have a lot of common symptoms like confusion, erratic behavior, hallucination etc which make it hard to distinguish between the two condition. However there are some differences in various aspects of the diseases that can be recognized by an experiences medical professional (Lippmann, & Perugula, 2016).  

Alzheimer's diseases is a progressive illness that follows a gradual pattern of onset and has no known cure and is irreversible. The treatments are aimed at managing the disease and alleviating the symptoms like memory enhancing drugs, behavioral therapies etc.

Delirium follows an abrupt onset and is a temporary condition if treated properly on time. The key difference between Alzheimer's and Delirium is the former is irreversible and the latter is of short duration with efficient intervention. The symptoms are fluctuating in case of Delirium during the duration of the day and appears to be more severe during the night. The treatment approach is towards the causative agents (FitzGerald, et al., 2019).

Delirium is caused by other medical problems, toxicity , environmental factors, etc. Whereas Alzheimer's have various external factors mentioned above and underlying genetic disposition that causes anatomic and deeper structural changes of the brain resulting in the condition (Sims, Hill, & Williams, 2020).   Delirium affects attention whereas Alzheimer's is connected to loss of memory which is another distinct differentiation.

In terms of symptoms hallucinations are more common in delirium than dementia and the same trend is observed in case of slurred speech.

The interaction of the son with the E.S. and the case study reveals that there might be possible exposure of abuse that the lady must be facing. The son seemed to threatened the lady that there would be dire consequences and drastic steps would be taken. In another instance the son revealed that they were doing all that they could yet the lady was found to be wandering. The son mentioned that there was a mistake in closing the door after dishes, so that imo0lied that she was locked indoors. the son mentioned that the family and the wife had to take some major discussion in order to monitor her and could build up tensions and frustrations which might result in verbal or other elderly abuses (Corbi, et al., 2015). Examining the condition of the lady and the problems of the family it was evident that they were going through some distress and needed help. Being an advocate of the patient and committing to Beneficence of the patient it is imperative from legal and ethical perspective to report the abuse to appropriate bodies (Cho, et al., 2015).

Key Differences between Alzheimer's and Delirium

The son is concerned about developing the same disease as his mother . The mentions hat as he knows the genetically aspect of the disease he is skeptical that he might develop the disease (Guerreiro, et al., 2019). In this case I shall impart a lending ear to the son and assure him that there is no need to be frightful or assume that he shall definitely have the condition. I would advise him to consult appropriate clinician to help him evaluate his condition and chances of developing it , who can further assist him with diagnostic help and offer professional advice (Hsu, & A Marshall, 2017). At the same time I would recommend him to follow preventive measure like life style modification including diet and life style sensitivity and engaging in mental stimulating exercise like learning new things and making a habit to remember. Additionally I would recommend him to give up using toxins and constantly monitor his health.

I would help the family understand the best possible care for her so that they can handle the situation effectively. I shall recommend them to create a routine for her in order to maintain her daily life style as well as create repeated activities so that it might lessen her instance of getting confused (Cheng, et al., 2016). At the same time I would ask them to minimize distractions and modify the surroundings around her to lessen the chance of falling or get hurt or self-harming. Help her with a tracking device and an address pinned to her so that in drastic situations she can be returned home safely. Above all being patient and maintaining positive surrounding (Dawson, et al., 2015). I would also advise them to seek help and follow the doctor's recommendation on her medications and care.

References

Aliyu, D., Adeleke, I. T., Omoniyi, S. O., Samaila, B. A., Adamu, A., & Abubakar, A. Y. (2015). Knowledge, attitude and practice of nursing ethics and law among nurses at Federal Medical Centre, Bida. American journal of health research, 3(1-1), 32-37.

Cheng, S. T., Mak, E. P., Lau, R. W., Ng, N. S., & Lam, L. C. (2016). Voices of Alzheimer caregivers on positive aspects of caregiving. The Gerontologist, 56(3), 451-460.

Cho, O. H., Cha, K. S., & Yoo, Y. S. (2015). Awareness and attitudes towards violence and abuse among emergency nurses. Asian nursing research, 9(3), 213-218.

Corbi, G., Grattagliano, I., Ivshina, E., Ferrara, N., Cipriano, A. S., & Campobasso, C. P. (2015). Elderly abuse: risk factors and nursing role. Internal and emergency medicine, 10(3), 297-303.

Dawson, A., Bowes, A., Kelly, F., Velzke, K., & Ward, R. (2015). Evidence of what works to support and sustain care at home for people with dementia: a literature review with a systematic approach. BMC geriatrics, 15(1), 1-17.

FitzGerald, J. M., Perera, G., Chang-Tave, A., Price, A., Rajkumar, A. P., Bhattarai, M., ... & Mueller, C. (2019). The incidence of recorded delirium episodes before and after dementia diagnosis: differences between dementia with Lewy bodies and Alzheimer's disease. Journal of the American Medical Directors Association, 20(5), 604-609.

Gore, R. L., Vardy, E. R., & T O'Brien, J. (2015). Delirium and dementia with Lewy bodies: distinct diagnoses or part of the same spectrum?. Journal of Neurology, Neurosurgery & Psychiatry, 86(1), 50-59.

Guerreiro, R., Escott-Price, V., Hernandez, D. G., Kun-Rodrigues, C., Ross, O. A., Orme, T., ... & International Parkinson's Disease Genomics Consortium. (2019). Heritability and genetic variance of dementia with Lewy bodies. Neurobiology of disease, 127, 492-501.

Hsu, D., & A Marshall, G. (2017). Primary and secondary prevention trials in Alzheimer disease: looking back, moving forward. Current Alzheimer Research, 14(4), 426-440.

Jack, C. R., Bennett, D. A., Blennow, K., Carrillo, M. C., Feldman, H. H., Frisoni, G. B., ... & Dubois, B. (2016). A/T/N: an unbiased descriptive classification scheme for Alzheimer disease biomarkers. Neurology, 87(5), 539-547.

Lippmann, S., & Perugula, M. L. (2016). Delirium or dementia?. Innovations in clinical neuroscience, 13(9-10), 56.

Sims, R., Hill, M., & Williams, J. (2020). The multiplex model of the genetics of Alzheimer’s disease. Nature neuroscience, 23(3), 311-322.

Twohig, D., & Nielsen, H. M. (2019). α-synuclein in the pathophysiology of Alzheimer’s disease. Molecular neurodegeneration, 14(1), 1-19.

www.nia.nih.gov , 2021, How Is Alzheimer's Disease Diagnosed? Retrieved from: https://www.nia.nih.gov/health/how-alzheimers-disease-diagnosed