Alzheimer, Alois

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Alzheimer, Alois

(alts'hi?mer)
Ger. neurologist, 1864–1915.

Alzheimer disease

Abbreviation: AD
A chronic, progressive, degenerative cognitive disorder that accounts for more than 60% of all dementias. The most common form occurs in people over 65; the rate of incidence increases with age. The illness affects more than 4 million older Americans, causes significant functional disability, and costs $80 billion to $100 billion for health care and lost wages in the U.S. annually. The number of patients is expected to more than triple in the next 30 years (14 million by 2050) as more people live into their 80s and 90s. Synonym: senile dementia of the Alzheimer type, positron emission tomography for illus.;

Etiology

In most cases of Alzheimer disease, a number of factors seem to interact to cause the disease, and there are certain heritable risk factors. The central biochemical problem in the disease appears to be a defect in the metabolism of alpha-amyloid precursor protein.

Symptoms

The disease begins with a mild memory loss (Stage I), which then progresses to deterioration of intellectual functions, personality changes, and speech and language problems (Stage II). In the terminal stage (Stage III), patients depend on others for activities of daily living. Seizures, hallucinations, delusions, paranoia, or depression can occur in either Stage II or III. Persons with Alzheimer disease will eventually develop macular degeneration See: table

Diagnosis

The diagnosis is usually made by ruling out other causes of cognitive dysfunction although a variety of laboratory tests are also employed in some settings.

Pathophysiology

Characteristic pathophysiological changes in the brain include neuritic plaques, neurofibrillary tangles, and marked cerebral atrophy. In addition to structural changes, abnormalities in cranial neurotransmitters may occur. Acetylcholine, for example, may be reduced by as much as 75%, contributing to cognitive impairment.

Treatment

The treatment of Alzheimer disease includes environmental structuring and drug therapy. Environmental structuring means provision of a safe, stimulating milieu that offers consistency and comfort for the patient. Drug therapy is to improve memory rather than cure the disease. Several cholinergic drugs, e.g., donepezil HCl (Aricept), are used to slow the decline in cognitive function. Antidepressants and psychotropic medications are used to treat patients who have secondary diagnoses such as depression and hallucinations.

Patient care

Reality orientation is helpful for patients in early stages of the disease. Validation therapy is most appropriate for patients in Stage II or III.

In collaboration with the physical and occupational therapists, the nurse assesses the patient's need for assistance with activities of daily living. Self-care, exercise, and other activities are encouraged as much as possible. If sleep disturbances occur, the patient should rest between daytime activities, but sleeping during daytime hours is to be discouraged. Neurological function, including mental and emotional states and motor capabilities, is monitored for further deterioration. Vital signs and respiratory status are assessed for pneumonia and other infections. The patient is evaluated for gastrointestinal or urinary problems (anorexia, dysphagia, and urinary or fecal incontinence); fluid and food intake is monitored to detect imbalances. The nurse or assistive nursing personnel takes the patient to the bathroom or bedside commode before and after meals and every 2 hr in between. Skin is inspected for evidence of trauma. The occupational therapist, home health nurse, or case manager assesses the patient's living environment to eliminate hazards and teaches the family to monitor the patient's activity to prevent falls, burns, and other injuries. Expectations should not exceed the patient's ability to perform tasks. Because the patient may misperceive the environment, health professionals should speak softly and calmly and allow sufficient time for answers because of the patient's slowed thought processes and impaired ability to speak. The case manager or nurse evaluates the caregiver's ability to manage the patient at home and makes the appropriate referrals to available local resources such as counseling, support groups, and respite care.

Loneliness, helplessness, and boredom, all associated with institutionalization, can be reduced by incorporating into the environment plants, pets, aviaries, and children as well as opportunities to handle objects having different tactile surfaces. A decor similar to the patient's familiar surroundings may provide comfort. Music therapy may enhance emotional and physical well-being, cognitive skills, ability to communicate, and social functioning. Activity therapy should include the patient’s known earlier interests and preferences. Such activities benefit the patient by encouraging interaction with others and by providing intellectual stimulation.

If mild cognitive impairment or early stage Alzheimer disease is suspected, the person should be evaluated by his physician or referred to a neurologist or gerontologist for evaluation. Early diagnosis allows family members to plan and prepare for the future. The physical and emotional health of the primary caregiver is an additional concern for the health team. Support groups can be a great help to family members by discussing care issues and exchanging information and by considering the caregivers’ feelings and coping skills in an accepting atmosphere. Caregivers experience grief and loss during and after the illness and need help in expressing their grief and pain. Some male caregivers may face unique challenges in taking over many of the tasks traditionally done by an ill wife or mother. All caregivers share the struggle with the common elements of acceptance: accepting the diagnosis, the devastating changes, the limited understanding of others, the progression of the disease, and the need for placement in a nursing home if this becomes necessary. Support groups can help with this process. Respite care can give life-sustaining relief to both partners. Friends who want to help may not even know what to offer, and caregivers must learn how to ask for help with specific tasks.

The local chapter of the Alzheimer's Disease and Related Disorders Association (ADRDA), sometimes simply referred to as the Alzheimer's Association, is an excellent resource. A list of local chapters can be found through the national ADRDA at 919 N. Michigan Avenue, Suite 1000, Chicago, IL 60611-1676 or at their web site at www.alz.org.

early-onset Alzheimer disease

Alzheimer disease that occurs before the age of 65.

late-onset Alzheimer disease

Abbreviation: LOAD
Alzheimer disease occurring after the age of 65. It is the most common form of the disease
StageCommon Behaviors
Stage I (early stage, mild dementia)Loss of short-term memory
Decreased judgment (safety concern)
Inability to perform mathematical calculations
Inability to comprehend abstract ideas
Stage II (middle stage, moderate dementia)Difficulty with speech and language (aphasia, anomia)
Labile personality changes
Changes in usual grooming habits
Inability to remember purpose of items (apraxia)
Urinary incontinence
Wandering
Seizures
Psychotic behaviors, such as hallucinations and paranoia
Depression
Stage III (late stage, severe dementia)Inability to perform activities of daily living, such as eating, dressing, and bathing; requires total care
Inability to walk, toilet, swallow
Minimal or no communication
Eventually becomes bedridden and develops complications of immobility, such as pneumonia, pressure ulcers, and constipation

Alzheimer,

Alois, German neurologist, 1864-1915.
Alzheimer dementia - Synonym(s): Alzheimer disease
Alzheimer disease - progressive mental deterioration. Synonym(s): Alzheimer dementia; presenile dementia; primary neuronal degeneration; primary senile dementia
Alzheimer sclerosis - hyaline degeneration of the medium and smaller blood vessels of the brain.
References in periodicals archive ?
She is the Assistant Administrator and Research Coordinator of the Alois Alzheimer Center.
La enfermedad de Alzheimer recibio su nombre de Alois Alzheimer (1864-1915), medico aleman que estudio las celulas y tejidos del sistema nervioso central.
Clumps of large, sticky proteins forming senile plaques have been observed in the brains of people with Alzheimer disease ever since neurologist Alois Alzheimer first described the disorder nearly a century ago.
existed long before 1906, when German psychiatrist Alois Alzheimer reported presenile dementia in a 51-year-old woman.
It was first described by a German doctor, Alois Alzheimer, in 1906 and '07.
Miles de investigadores trabajan todos los dias sobre el mal que diagnostico en 1906 el medico aleman Alois Alzheimer, pero hasta el momento nadie sabe nada de cierto, solo hay hipotesis: un viras, una deficiencia de los neurotrasmisores, un exceso de aluminio (presente en mucho de lo que consumimos todos los dias y sobre todo en las latas de refrescos y cervezas), una enfermedad genetica que se trasmite, como el sindrome de Down, a traves del cromosoma 21.
In the 90 years since Alois Alzheimer first described the disease that bears his name, very little has been accomplished in ameliorating the dreadful effects of this disease.
Alois Alzheimer was aged two when John Langdon Haydon Down described the characteristic phenotype of Down's Syndrome (now known as Down Syndrome).
These neurofibrillary tangles were first described in 1906 by Alois Alzheimer, a German neurologist.
This incurable, degenerative, and terminal disease was first described by German psychiatrist and neuropathologist Alois Alzheimer in 1906 and was named after him.
German psychiatrist Alois Alzheimer was the first to connect dementia to abnormal protein deposits in brain tissue back in 1906, but it took another 80 years for scientists to understand where the protein, known as beta amyloid, was made and to see it as a potential target in treating Alzheimer's disease.
Ominous deposits of the protein (along with tangles of another protein, called tau, that has also garnered a fair share of investigation) were what caught the eye of German physician Alois Alzheimer when he first described the disease a little over a century ago.