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Mental Health- Nursing: Neurodegenerative Disease

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Question:

Discuss about the Mental Health- Nursing for Neurodegenerative Disease.

 

Answer:

Dementia is the umbrella term that is used for several symptoms including loss of social, behaviour and cognitive skills and changes in the brain structure. The most common cause of dementia is not known to be Alzheimer’s disease. It is the progressive neurodegenerative disease of brain that severely damages the neurons, resulting in memory impairment, loss of executive skills, decreased ability to make decisions, altered speech and language difficulties. Currently, there is no permanent cure for Alzheimer’s disease. However, the symptoms can be improved temporarily by medications and management. It is necessary to help the patients of Alzheimer’s to manage the activities of daily living independently. The aim of the assignment is to develop the holistic care plan for Alzheimer’s disease. This is done by watching a movie and relating the same with the clinicians, researchers and their trials. The assignment presents the overview of the Alzheimer’s disease, the main theme of the movie named “Still Alice”, the clinical manifestations of the disease, current prevalence, influence of the cultural and spiritual factors on disease, treatment modalities, ethical dilemma associated with it and lastly recommendations for movie and disease.

Still Alice is the movie based on Alzheimer’s disease, which illustrates the people about the sufferings of patients. The story is centered on Alice Howland, smart, confident and talented women living a happy married life with three children. She works as linguistics professor at University of California, Los Angeles and is an independent woman. Alice spends her free time with word games.

Her life changes as the symptoms of Alzheimer’s tend to emerge. While teaching on several occasions she failed to recall words, and lost the speech sequences. Alice did not stop at these problems. She communicates with her youngest daughter Lydia about her future and career plan. On a usual day in New York, Alice unexpectedly lost herself. She tends to wander on streets, not knowing where to go and forgetting location. She somehow managed to get back to her house. Later on some more symptoms emerged that ultimately made her realise that something was wrong with her health. She visited the doctor and on presenting her health issues, several laboratory and diagnostic tests were conducted. She was diagnosed with Early-onset Alzheimer's disease. Alice was shocked by her diagnostic results and was devastated to know the genetic nature of her illness. The risk of transmitting the disease to her children was the biggest catastrophe for Alice. She met her daughters and family to announce about her diagnosis. She recommends her children to undergo health assessment and examination. Lydia, her youngest daughter refused to do the test. Her son was negative, while her elder daughter was positive. 

As the disease started to progress, Alice faced challenges with her job. She was unable to teach her students in usual organized manner. The students failed to comprehend her ideas and link with the study syllabus. It made them feel uncomfortable and the class turned noisy. Eventually, the diseases worsened Alice’s professional, social and married life. The disease was challenging and made her life really hard.

Alzheimer’s disease includes three stages and slowly progresses through each stage. The three different stages are early stage where the symptoms are mild, followed by middle-sage, where the disease progress moderately and in last stage, the disease turns severe. The symptoms of this neurodegenerative disease, worsens over time, where the symptoms in each patient is manifested differently. According to Stages of Alzheimer's (2016), a person diagnosed with Alzheimer’s can live for 4-8 years. As the factors of the disease vary from person to person, a person may also live upto 20 years with Alzheimer’s.

 

Alzheimer’s makes a patient’s life very challenging with increasing episodes of forgetfulness, difficulty word recall, wandering and lost. The patient suffers from anxiety and depression, with deterioration of the professional, social and personal life. It increases social isolation and loneliness while depriving the patients of their independence and self esteem. An individual with Alzheimer’s also struggle with the cultural and spiritual influences, which also have impact on the family and community. Spirituality has subjective nature and it is difficult to define this intangible multidimensional concept (Dyson, 1997). As per the literature evidence the people with Alzheimer’s fail to accept the illness, and they lose meaning of life. They struggle to find the purpose of life. They tend to lose interdependence, and the transcendence. The beliefs of the disease vary from culture to culture. In African/ American community, mostly people belief that it is normal to demonstrate the symptoms of Alzheimer’s with aging. In this community, People cope up with their illness by praying to God. In Islam, people consider everyone as similar irrespective of illness. Guided by Quran and Sunna, a Muslim must fulfil his or her responsibility towards others and parents, with love, support and sympathy.  People with illness are not viewed from different perspective in this community and care each other as they care Allah. They respect their God by caring for ill elders.

There is increasing incidence of Alzheimer’s in UAE. The prevalence of the disease is also increasing in different parts of the world. It is also highlighted in the National newspaper, that the Alzheimer’ cases may soar high by 2030 (Carroll, 2014). Based on the current statistics it is estimated that, by 2030 the number of cases of Alzheimer’s and other memory-loss disorders may increase from 4,300 to 32,000 (Carroll, 2014). The contributing factors of the Alzheimer’s are genetic predisposition, ageing, cardiovascular diseases like hypertension, diabetes as risk factor and severe head injuries. The pathophysiology underlying the cardiovascular disease is the increasing risk due to diabetes that damages the heart and blood vessels. Alzheimer’s results due to damage of blood brain vessels. There are multiple evidences on exacerbation of diseases. As per the International Diabetes Federation, currently in UAE, around 19.3% of the population are living with diabetes (Diabetes facts, 2011). Throughout the UAE there is an increase in Diabetes awreness initiatives, development of different prevention and management programs. In US the Alzheimer’s disease was recognised to be the 6th leading cause of death, in 2016. Currently, the strength of Americans living with Alzheimer’s exceeds 5 million. Every 66 seconds a person is newly diagnosed with Alzheimer’s (ALZHEIMER'S DISEASE FACTS AND FIGURES , 2016).

As Alzheimer’s is the progressive neurodegenerative disease, there is no permanent cure to prevent the progressive death of the brain cells. No treatment has been proved to be effective in delaying the onset or clinical manifestation of the disease. Alzheimer’s severely damages the cognitive function, which ultimately leads to behaviour and psychosocial stress in patients. The disease affects memory, speech, organising and planning ability, language, and ability to judge, logical thinking, reasoning ability and awareness. The behavioural symptoms may occur at later stages of the disease. In early stage, a patient is more likely to demonstrate the irritability, anxiety, and depression. In the last stage the sleep disorder is manifested, where the patients experience insomnia, like conditions. Insomnia is the condition characterised by wakefulness at night due to trouble falling asleep. In the later stages, hallucination and agitation becomes a frequent episode, where a patient may see or feel things that are unrealistic to other people. Delusions are other common clinical manifestations of Alzheimer in later stages, where a patient cultivates false beliefs about situations or events. Both pharmacological and non-pharmacological treatment is available for these symptoms.

 

The National Institute for Health and Care Excellence (NICE) and the US Food and Drug Administration (FDA), has approved three drugs for treating the cognitive symptoms of Alzheimer’s. Cholinesterase inhibitors are drugs administered to preserve adequate amount of acetylcholine. It helps in facilitating the nerve cells’ communications. The drug breaks the acetylcholine into chemical messenger for nerve cells and is essential for learning and memory. Donepezil (Aricept®), is one such drug. It is approved for use in mild stage of Alzheimer’s disease in 1996 and in 2006, it was approved for administering in severe stage (Alzheimer’s Association , 2015). Thr other drug rivastigmine (Exelon®) is used for management of the mild to moderate stages and galantamine (Razadyn) is also administered in these stages. In several cases, Cholinesterase inhibitors have been found effective and were highlighted in Alzheimer’s Society that this drug showed beneficial effect in 40-70% patients (Alzheimer’s society, 2015). The drug Memantine (Namenda®) belonging to glutamate regulator category is also approved to treat the Alzheimer’s symptoms particularly delusions and aggression. Glutamate acts as messenger and is released in high amount in respond to nerve cell damage in brain. In some cases, the combination of donepezil and memantine, is administered. It was approved for use in 2014 as it was found effective in managing patients with moderate to severe symptoms. In the movie Still Alice is taking this combination of drugs. According to Consumer Reports Best Buy Drugs, (2012) these drugs have side effects and people in 20 to 25 percent of cases stop taking the medications. One such drug that is avoided recently fir its side effects is tacrine (Cognex). It damages liver and is thus rarely prescribed nowadays. The minor side effects of the drugs prescribed in Alzheimer’s includes diarrhea, nausea, headache, vomiting and dizziness. Severe side effects of these drugs include gastric ulcer, dizziness, slow heart rate, unusual weakness and seizure. Therefore, the physicians must be careful when administering these drugs and consider the other health problems of the patients.

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