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Alzheimer’s Disease: A Psychological Perspective Alzheimer’s disease (AD) affects older adults and is characterized by memory loss and dementia. It is a progressive disease and the effects are irreversible. Alzheimer’s disease affects a person’s life both psychologically and physically. The disease causes much anxiety and sometimes depression. A person with Alzheimer’s disease can also become violent towards loved ones and caregivers. There is no definite way to diagnose Alzheimer’s disease until an autopsy can be performed at the death of the afflicted person. Specialists can correctly diagnose the disease up to 90% of the time. There is no cure for the disease, but with early diagnosis the progression can be slowed by drugs. The drugs (Cognex®), donepezil (Aricept®), rivastigmine (Exelon®), or galantamine (Razadyne®, formerly known as Reminyl®) may help in the early to middle stages of Alzheimer’s disease. Sever Alzheimer’s may be treated by the drug memantine (Namenda®) or donepezil. Researchers are constantly trying to find new methods for Course: PSYC 2000: Research Psychological Methods “Alzheimer’s disease is a disease of older adults that causes dementia as well as progressive memory loss” (Sternberg, 2006, p. 185). This paper will further discuss what the symptoms of Alzheimer’s disease are and how they affect a person’s life both physically and psychologically, how is Alzheimer’s disease diagnosed, and what drug options are available to help slow the progression of Alzheimer’s disease. A case report in the Journal of Psychiatry in Clinical Practice, Jainer, Onalaja, and Noushad (2005) describe a specific case of Alzheimer’s disease affecting Mrs. X, a 58-year-old woman. In April of 2002, she was referred to the psychiatric services by her general practitioner for her 2 ½ year history of anxiety symptoms. She was accompanied by her husband. Her symptoms of anxiety included shakes, palpitations, and sweating, which lasted from 45 minutes to an hour. She reported that her father and sibling had anxiety problems as well. The case report goes on to describe her: She had a normal childhood. She had been treated with the serotonin reuptake inhibitor citalopram, 20 mg once a day, 2 months prior to the clinic visit. Her Mental State Examination was normal except for occasional restlessness. She was continued on citalopram. Four weeks later, she reported that her anxiety attacks had reduced to one in 10 days. Her husband died few months later. During subsequent visits, she started complaining of memory problems. She was finding it difficult to cope Mrs. X’s family began to raise concerns about her forgetfulness. The family also mentioned that they believed her memory lapses had began long before the death of her husband. This suggests he may have covered up her lapses in memory during the previous meetings with the psychiatrist. Her memory problems were now quite clear. “Her short-term memory was impaired. She scored 16/30 on the Mini Mental State Examination (MMSE). It was reported that she was unable to cook, shop, and find her way back home. She was suspected to have early onset dementia was urgently referred to The Young Onset Dementia Team revealed that she was “forgetting events, becoming repetitive, misplacing valuable possessions like her purse, mismanaging finances, and burning food.” On top of this, she had also lost weight due to her scattered eating habits. They reported that she was also disoriented in time, place, and person. The functions of her language had also declined. She had mood swings and could become aggressive towards her loved ones. Her score on the MMSE was a 10/30. After doing brain MRI scans they reported “sever atrophy affecting the supratentorial brain. The atrophy was global but with more involvement of the temporal lobe and hippocampus. There were hardly any ischaemic changes. The overall appearance was consistent with a fairly advanced Alzheimer’s type neurodegenerative disorder” (Jainer et al., 2005). This is a fairly typical case of Alzheimer’s disease. As you can see, the onset of the disease brings great anxiety to the afflicted person. The problem with diagnosing Alzheimer’s disease is that a loved one can cover up the memory lapses making it The National Institute on Aging (2006) gives seven warning signs of Alzheimer’s disease in a publication titled Understanding Stages and Symptoms of Alzheimer’s Disease. The seven warning signs of Alzheimer’s disease are: 1. Asking the same question over and over again. 2. Repeating the same story, word for word, again and again. 3. Forgetting how to cook, or how to make repairs, or how to play cards – activities that were previously done with ease and regularity. 4. Losing one’s ability to pay bills or balance one’s checkbook. 5. Getting lost in familiar surroundings, or misplacing household objects. 6. Neglecting to bathe, or wearing the same clothes over and over again, while insisting that they have taken a bath or that their clothes are still clean. 7. Relying on someone else, such as a spouse, to make decisions or answer questions they previously would have handled themselves. In a meta-analysis study done by Swedish neuropsychologists (American Psychological Association, 2005) they found the following results, “people can show early warning signs across several cognitive domains years before they are officially diagnosed, confirming that Alzheimer’s causes general deterioration and tends to follow a stable preclinical stage with a sharp drop in function.” Lead author Lars Backman, PhD explains, “There are no clear qualitative differences in patterns of cognitive impairment between the normal 75-year old and the preclinical AD counterpart. Rather, we think of the normal elderly person, the preclinical AD person, and the early clinical AD patient as representing three instances on a continuum of cognitive capabilities. This presents an obvious challenge for accurate early diagnosis.” Early diagnosis of Alzheimer’s disease is important. From a therapeutic point of view it is extremely important because most cognitive enhancers are only beneficial in patients with mild to moderate Alzheimer’s disease. There is only one definite way to diagnose Alzheimer’s disease and that is to find whether there are plaques and tangles in the brain tissue. The downfall to this approach is that in order for scientists to look at the brain tissue they must wait until the person dies and they can do an autopsy (National Institute on Aging, Diagnosis). This presents an obvious problem to the persons living with Alzheimer’s disease. There are specialized centers where doctors can correctly diagnose Alzheimer’s Doctors use several tools to diagnose ‘probable’ Alzheimer’s disease including: (a) questions about the person’s general health, past medical problems, and ability to carry out daily activities; (b) tests to measure memory, problem solving, attention, counting, and language; (c) medical tests – such as tests of blood, urine, or spinal fluid; and (d) brain scans (National Institute on Aging, Diagnosis). After a diagnosis is made, treatment options can be discussed. Currently, there is no treatment that has been proven to cure Alzheimer’s disease. The Alzheimer’s disease education department in the National Institute of Aging (Treatment, 2006) says: For some people in the early and middle stages of the disease, the drugs tacrine (Cognex®), donepezil (Aricept®), rivastigmine (Exelon®), or galantamine (Razadyne®, formerly known as Reminyl®) may help prevent some symptoms from becoming worse for a limited time in some patients. Another drug, memantine (Namenda®) has been approved to treat moderate to severe AD, although it also is limited in its effects. And the FDA recently approved the use of donepezil to treat moderate to There are other strategies that are being researched to determine if they are safe for treatment on Alzheimer’s disease. They are anti-inflammation medication, antioxidants, ginkgo biloba or estrogen treatments. There is some evidence that suggest that inflammation of the brain may attribute to Alzheimer’s disease damage. Clinical trials have been examining whether or not nonsteroidal anti-inflammatory drugs (NSAIDs) help to slow the progression of Alzheimer’s. So far, research has not yet confirmed a benefit from these drugs. “Several years ago, a clinical trial showed that vitamin E slowed the progress of some consequences of AD by about 7 months” (National Institute on Aging, Treatment, 2006). Researchers are now studying whether antioxidants such as vitamin E, vitamin C, and selenium can prevent Alzheimer’s disease or cognitive decline or slow the There is no concrete support that leaves from the ginkgo biloba tree may help treat Alzheimer’s disease symptoms, but earlier studies did suggest this. Scientists are now trying to find evidence in clinical trials to show that ginkgo biloba can delay cognitive decline or prevent dementia in older persons (National Institute on Aging, A handful of studies have revealed that when women use estrogen to treat menopausal symptoms, the estrogen may also protect the brain. Some experts wonder whether estrogen may have positive effects for preventing Alzheimer’s disease. So far there is no proof, and some research actually shows adverse effects. There are also medicines that do not directly treat Alzheimer’s disease, but they do help the afflicted person feel more at ease (Alzheimer’s Disease Education and Referral Center, 2006). These medicines include anti-anxiety medication, anti- depressants, or pills to aid your sleeping. These medications do not slow the progression of the disease, but they help the person be more comfortable and ultimately have a better A person with Alzheimer’s disease has both psychological and physical symptoms. The dementia associated with Alzheimer’s disease can cause a lot of anxiety and/or depression. Diagnosis can be tricky, and there is no way to make a definite diagnosis until an autopsy can be performed after the person dies. The progression of the disease is irreversible, but it can be slowed somewhat by certain drug treatments. Researchers are constantly trying to find other ways to help those afflicted with Alzheimer’s disease. We can only hope that someday soon we will find a cure to this Alzheimer’s Disease Education and Referral Center. (2006). Understanding Alzheimer’s American Psychological Association. (2005, March 13). Brain imaging suggests how higher education helps to buffer older adults from cognitive declines. Retrieved http://www.apa.org/topics/topicalzheimers.html. American Psychological Association. (2005, July 31). Early warning signs of Alzheimer’s show up across cognitive areas years before official diagnosis. Retrieved Monday, February 26, 2007 from http://www.apa.org/topics/topicalzheimers.html. American Psychological Association. (2005, September 25). Psychologists find more sensitive tests for predicting Alzheimer’s as well as subtle changes in cognition. Retrieved Monday, February 26, 2007 from http://www.apa.org/topics/topicalzheimers.html. Bowirrate, A., Marlene, O., & Logroscino, G. (2006). Association of depression with Alzheimer’s disease and vascular dementia in an elderly Arab population of Wadi-Ara, Israel [Electronic version]. International Journal of Geriatric Cotrell, V., & Hooker, K. (2005). Possible Selves of Individuals with Alzheimer’s disease. Psychology and Aging, 20(2), 285-294. Retrieved Wednesday, February 07, 2007 from the PsycARTICLES database. Gallo, D., Shahid, K., Olson, M., Solomon T., Schacter, D., & Budson, A. (2006). Overdependence on degraded memory in Alzheimer’s disease. Neuropsychology, 20(6), 625-632. Retrieved Wednesday, February 07, 2007 from the Jones, S., Livner, A., & Backman, L. (2006). Patterns of prospective and retrospective memory impairment in preclinical Alzheimer’s disease. Neuropsychology, 20(2), 144-152. Retrieved Wednesday, February 07, 2007 from the PsycARTICLES Lesser, J., & Hughes, S. (2006). Psychosis, agitation, and disinhibition in Alzheimer’s disease: Definitions and treatment options [Electronic version]. Geriatrics, Loneliness associated with increased risk of Alzheimer’s disease. (2007, February 07). Retrieved Monday, February 26, 2007 from Science Daily website McFarlane, J., Welch, J., & Rodgers, J. (2006). Severity of Alzheimer’s disease and effect on premorbid measures of intelligence [Electronic version]. British Journal of Clinical Psychology, 45, 453-463. The National Cell Repository for Alzheimer’s Disease. (2003). The genetics of Alzheimer’s Disease. Retrieved Monday, January 29, 2007 from National Institute on Aging. (2006, August 29). Alzheimer’s information. Causes. http://www.nia.nih.gov/Alzheimers/AlzheimersInformation/Causes. National Institute on Aging. (2006, August 29). Alzheimer’s Information. Diagnosis. http://www.nia.nih.gov/Alzheimers/AlzheimersInformation/Diagnosis. National Institute on Aging. (2007, January 14). Research information. Scientists find new genetic clue to cause of Alzheimer’s disease. Retrieved Monday, January 29, http://www.nia.nih.gov/Alzheimers/ResearchInformation/NewsReleases. National Institute on Aging. (2007, January 17). Publications. Understanding stages and symptoms of Alzheimer’s disease. Retrieved Monday, January 29, 2007 from http://www.nia.nih.gov/Alzheimers/Publications/stages.htm. National Institute of Health. (2006). Genes, lifestyles, and crossword puzzles: Can Alzheimer’s disease be prevented? [Brochure]. Rascovsky, K., Salmon, D., Hansen, L., Thal, L., & Galasko, D. (2007). Disparate letter and semantic category fluency deficits in autopsy-confirmed frontotemporal dementia and Alzheimer’s disease. Neurpsychology, 21(1), 20-30. Retrieved Wednesday, February 07, 2007 from the PsycARTICLES database. Robinson, L., Clare, L., & Evans, K. (2005). Making sense of dementia and adjusting to loss: Psychological reactions to a diagnosis of dementia in couples [Electronic version]. Aging & Mental Health, 9(4), 337-347. Selwood, A., Thorgrimsen, L., & Orrell, M. (2005). Quality of life in dementia – a one- year follow-up study [Electronic version]. International Journal of Geriatric Shimabukukoro, J., Awata, S., & Matsuoka, H. (2005). Behavioral and psychological symptoms of dementia characteristic of mild Alzheimer patients [Electronic version]. Psychiatry and Clinical Neurosciences, 59, 274-279. Sternberg, R. (2006). Alzheimer’s disease. In M. Taflinger (Ed.), Cognitive psychology (pp. 185-186). Belmont, CA: Thomson Wadsworth. Strategies for optimizing functionality in patients with psychotic disorders: An evidence- based approach [Electronic version]. American Journal of Health-System Tales, A., Snowden, R., Brown, M., & Wilcock, G. (2006). Alerting and orienting in Alzheimer’s disease. Neuropsychology, 20(6), 752-756. Retrieved Wednesday, February 07, 2007 from the PsycARTICLES database. White, A., & Bush, A. (2006).The metallobiology of Alzheimer’s disease: From bench to clinic [Electronic version]. Current Medical Literature: Neurology, 89-97. Zacks, J., Speer, N., Vettel, J., & Jacoby, L. (2006). Event understanding and memory in healthy aging and dementia of the Alzheimer type. Psychology and Aging, 21(3), 466-482. Retrieved Wednesday, February 07, 2007 from the PsycARTICLES

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