General Health should be able to detect clear-cut symptoms in several areas: • Forgetfulness of recent events. • Impaired ability to perform challenging mental arithmetic - for example, counting backward from 100 by sevens. • Greater difficulty performing complex tasks, such as planning dinner for guests, paying bills or managing finances. • Forgetfulness about one’s own personal history. • Becoming moody or withdrawn, especially in socially or mentally challenging situations. Moderately severe cognitive decline (moderate or mid-stage Alzheimer’s disease) Gaps in memory and thinking are noticeable, and individuals begin to need help with day-to-day activities. At this stage, those with Alzheimer’s may: • Be unable to recall their own address or telephone number or the high school or college from which they graduated. • Become confused about where they are or what day it is. • Have trouble with less challenging mental arithmetic; such as counting backward from 40 by subtracting 4s or from 20 by 2s. • Need help choosing proper clothing for the season or the occasion. • Still remember significant details about themselves and their family. • Still require no assistance with eating or using the toilet. MoSevere cognitive decline (moderately severe or mid-stage Alzheimer’s disease) Memory continues to worsen, personality changes may take place and individuals need extensive help with daily activities. At this stage, individuals may: • Lose awareness of recent experiences as well as of their surroundings. • Remember their own name but have difficulty with their personal history. • Distinguish familiar and unfamiliar faces but have trouble remembering the name of a spouse or caregiver. • Need help dressing properly and may, without supervision, make mistakes such as putting pyjamas over daytime clothes or shoes on the wrong feet. • Experience major changes in sleep patterns - sleeping during the day and becoming restless at night. • Need help handling details of toileting (for example, flushing the toilet, wiping or disposing of tissue properly). • Have increasingly frequent trouble controlling their bladder or bowels. • Experience major personality and behavioural changes, including suspiciousness and delusions (such as believing that their caregiver is an impostor), or compulsive, repetitive behaviour like hand-wringing or tissue shredding. • Tend to wander or become lost. Very severe cognitive decline (severe or late-stage Alzheimer’s disease) In the final stage of this disease, individuals lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement. They may still say words or phrases. At this stage, individuals need help with much of their daily personal care, including eating or using the toilet. They may also lose the ability to smile, to sit without support and to hold their heads up. Reflexes become abnormal. Muscles grow rigid. Swallowing impaired. Treatments While there are currently no treatments to cure or to stop Alzheimer’s disease from progressing, medication can be used to treat symptoms, such as memory loss and confusion, for a limited time. Types of drugs Two types of medications — cholinesterase inhibitors and memantine — are used to treat the cognitive symptoms (memory loss, confusion, and problems with thinking and reasoning) of Alzheimer’s disease. As Alzheimer’s progresses, brain cells die and connections among cells are lost, causing cognitive symptoms to worsen. While medications cannot stop the damage Alzheimer’s causes to brain cells, they may help lessen or stabilise symptoms (for St age One No impairm ent (normal function) The person does not experience any memory problems. An interview with a medical professional does not show any evidence of symptoms of dementia. St age TWO Very mild cognitive decline (may be normal age-related changes or earliest signs of Alzheimer’s disease) The person may feel as if he or she is having memory lapses — forgetting familiar words or the location of everyday objects. But no symptoms of dementia can be detected during a medical examination or by friends, family or co-workers. St age THRE Mild cognitive decline (early-stage Alzheimer’s can be diagnosed in some, but not all, individuals with these symptoms) Friends, family or co-workers begin to notice difficulties. During a detailed medical interview, doctors may be able to detect problems in memory or concentration. Common Stage 3 difficulties include: • Noticeable problems coming up with the right word or name. • Trouble remembering names when introduced to new people. • Having noticeably greater difficulty performing tasks in social or work settings. • Forgetting material that one has just read. • Losing or misplacing a valuable object. • Increasing trouble with planning or organising. Moderate cognitive decline (mild or early-stage Alzheimer’s disease) At this point, a careful medical interview St age FIVE St age FOU R St age SI X St age SEVEN a limited time) by affecting certain chemicals involved in carrying messages among the brain’s nerve cells. Medications for early to moderate stages Prescription medications currently approved to treat Alzheimer’s symptoms, in early to moderate stages, are all from a class of drugs called cholinesterase inhibitors. Cholinesterase inhibitors are prescribed to treat symptoms related to memory, thinking, language, judgement and other thought processes. Cholinesterase inhibitors Prevent the breakdown of acetylcholine (a-SEAtil KOH-lean), a chemical messenger important for learning and memory. This supports communication among nerve cells by keeping acetylcholine levels high. Delay worsening of symptoms for 6 - 12 months, on average, for about half the people who take them. Are generally well tolerated. If side effects occur, they commonly include nausea, vomiting, loss of appetite and increased frequency of bowel movements. Medication for moderate to severe stages A second type of medication, memantine is used for treatment of moderate to severe Alzheimer’s. Memantine is prescribed to improve memory, attention, reason, language and the ability to perform simple tasks. It can be used alone or with pindaramagazine.com.au Pindara Magazine 19
Pindara Private Hospital Magazine - Issue Three
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