Aloysius Alzheimer
14 June 1864 – 19 December 1915
Case of “presenile dementia”
The disease would not become known as Alzheimer’s disease until 1910,
when Kraepelin named it so in the chapter on “Presenile and Senile Dementia” in the 8th edition of his Handbook of Psychiatry.
By 1911, his description of the disease was being used by European physicians to diagnose patients in the US.
https://en.wikipedia.org/wiki/Alois_Alzheimer
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ALZHEIMER’S DISEASE
Proteins build up in the brain
to form structures called ‘plaques’ and ‘tangles’.
Alzheimer’s Disease (AD) Continuum
Symptoms
The symptoms of Alzheimer’s disease are
generally mild to start with,
but they get worse over time
and start to interfere with daily life.
For most people with Alzheimer’s,
the earliest symptoms are memory lapses.
In particular,
they may have difficulty
recalling recent events
and learning new information.
These symptoms occur because the early damage
in Alzheimer’s is usually to a part of the brain
called the hippocampus,
which has a central role in day-to-day memory.
Memory for life events
that happened a long time ago is
often unaffected
in the early stages of the disease.
Memory loss due to Alzheimer’s disease
increasingly interferes with daily life
as the condition progresses.
The person may:
• lose items (for example, keys, glasses) around the house
• struggle to find the right word in a conversation or forget someone’s name•
• forget about recent conversations or events
• get lost in a familiar place or on a familiar journey
• forget appointments or anniversaries.
Although memory difficulties are usually the earliest symptoms of Alzheimer’s,
someone with the disease will also have
• or go on to develop –
problems with other aspects of
thinking,
reasoning,
perception or
communication.
They might have difficulties with.
• language
• struggling to follow a conversation or repeating themselves
• visuospatial skills
• problems judging distance or seeing objects in three dimensions; navigating stairs or parking the car become much harder
• concentrating, planning or organizing
• difficulties making decisions, solving problems or carrying out a sequence of tasks (such as cooking an meal)
• orientation
• becoming confused or losing track of the day or date.
A person in the earlier stages
of Alzheimer’s will often
have changes in their mood.
They may become anxious,
irritable or depressed.
Many people become withdrawn
and lose interest in activities and hobbies.
Later stages
As Alzheimer’s progresses,
problems with
memory loss,
communication,
reasoning
and orientation
become more severe.
The person will need
more day-to-day support
from those who care for them.
Some people start to believe things
that are untrue (delusions)
or – less often –
see or hear things which are not really there (hallucinations).
Many people with Alzheimer’s
also develop behaviours
that seem unusual
or out of character.
These include agitation
(for example, restlessness or pacing),
calling out,
repeating the same question,
disturbed sleep patterns
or reacting aggressively.
Such behaviours can be
distressing or challenging
for the person and their carer.
They may require separate treatment
and management to memory problems.
In the later stages of Alzheimer’s disease
someone may become much less aware
of what is happening around them.
They may have
difficulties eating
or walking without help,
and become increasingly frail.
Eventually,
the person will need help
with all their daily activities.
How quickly Alzheimer’s disease progresses,
and the life expectancy of someone with it,
vary greatly.
On average,
people with Alzheimer’s disease
live for eight to ten years
after the first symptoms.
However, this varies a lot,
depending particularly
on how old
the person was when they first developed
Alzheimer’s.
There are some common symptoms
of Alzheimer’s disease,
but it is important to remember
that everyone is unique.
Two people with Alzheimer’s are
unlikely to experience the condition
in exactly the same way.
What is Alzheimer's disease?
Alzheimer’s is a progressive disease. This means that gradually, over time, more parts of the brain are damaged. As this happens, more symptoms develop, and they also get worse.
https://www.alzheimers.org.uk/about-dementia/types-dementia/alzheimers-disease
- Facing Alzheimer’s Disease is very stressful for both the patient and family members.
- There is no cure for the disease, and patients will need more care and support as time goes on.
- Palliative care can be started any time after a diagnosis of Alzheimer’s Disease,
- but the earlier the better because a palliative care team can work as part of your support structure from the very beginning.
- The team helps manage your symptoms, but members of the team also focus on conversations about your goals, concerns and treatment options.
- They help you discuss what is important to you, how and where you want to be cared for and what level of care you would want in the future.
https://getpalliativecare.org/whatis/disease-types/alzheimers-disease-palliative-care/
SEVERE ALZHEIMER’S DEMENTIA
In the severe stage of Alzheimer’s dementia,
individuals need help
with activities of daily living
and are likely to require around-the-clock care.
The effects of Alzheimer’s disease
on individuals’ physical health
become especially apparent in this stage.
Because of damage to areas of the brain involved in movement,
individuals become bed-bound.
Being bed-bound makes them
vulnerable to conditions including
blood clots,
skin infections
and sepsis,
which triggers body-wide inflammation
that can result in organ failure.
Damage to areas of the brain
that control swallowing
makes it difficult to eat and drink.
This can result in
individuals swallowing food
into the trachea (windpipe)
instead of the esophagus (food pipe).
Because of this,
food particles may be deposited
in the lungs
and cause lung infection.
This type of infection is called
aspiration pneumonia,
and it is a contributing cause of death
among many individuals with Alzheimer’s.
As Alzheimer’s patients near the end of life, their appetites decrease, or they begin to refuse food or to choke on it. Patients “forget” how to chew or how to swallow. Family caregivers can find this change quite difficult, challenging the very human desire to comfort and nurture others by offering food. Families may or may not want to offer artificial hydration and nutrition-or the patient may have expressed preferences in an advance directive. In either case, health care providers must address loved ones’ concerns and fears.
• http://mywhatever.com/cifwriter/content/66/4375.html
Alzheimer’s is
a disease for which
there is no effective treatment whatsoever.
To be clear,
there is no pharmaceutical agent,
no magic pill that a doctor can prescribe
that will have any significant effect
on the progressive downhill course of
this disease.
• David Perlmutter
https://doi.org/10.1016/j.cger.2018.06.006
Resources:
https://bmcpalliatcare.biomedcentral.com
https://www.geriatric.theclinics.com
https://pubmed.ncbi.nlm.nih.gov
Palliative Care for Alzheimer Disease
Download:
https://drive.google.com/file/d/1zomcSyCwLkZ3fsPY6xYb_KC_Bo_Rx0pN/view?usp=sharing
Neurological conditions are group of long term conditions resulting from injury or disease of the nervous system which will affect a person for the rest of their life. They include:
☛ Sudden onset conditions (e.g. acquired brain injury of any cause including stroke, and spinal cord injury)
☛ Intermittent conditions (e.g. epilepsy)
☛ Progressive conditions (e.g. motor neurone disease (MND), multiple sclerosis (MS), Parkinson’s disease and other neurodegenerative disorders)
☛ Stable conditions with or without age related degeneration (e.g. polio or cerebral palsy)
Managing the symptoms of neurological conditions that cause distress and pain, as with palliative care for any condition, can greatly reduce suffering and improve quality of life, while a team approach to providing palliative care will optimise the overall management of the condition.
THE ROLE OF ALLIED HEALTH PROFESSIONALS
The Palliative Care Australia Service Delivery Guidelines acknowledges the role of allied health professionals in meeting the needs of people living with a life-limiting illness:
- ☛ providing support to manage physical symptoms including support related to medication, nutrition, communication, and mobility;
- ☛ assisting people with a life-limiting illness to maintain function and independence;
- ☛ providing a wide range of psychological support, social support, pastoral care, and bereavement support;
- ☛ providing therapies that focus on improving the quality of life that support people, families, and carers to achieve their goals; and
- ☛ sharing information about disease progression and providing education for people living with a life limiting illness, their families, and carers.
CONTRIBUTIONS OF PSYCHOLOGISTS
Contributions of psychologists to palliative care delivery.
1. Prior to life-limiting illness
☛ Health promotion
☛ Advance care planning
☛ Public awareness and education programming
2. After diagnosis
☛ Supporting patients and their families
☛ Offering consultation/training for professionals
☛ Facilitating patient-professional communication
3. During advanced illness/dying
☛ Psychosocial work with patients and their families
☛ Interventions addressing:
• Anticipatory grief and adjustment reactions
• Existential and spiritual issues
• Mental disorders
• Pain and physical symptom management
• Advance care planning
• Life review
• Unresolved life concerns
4. Bereavement
☛ Identifying bereaved persons at risk
☛ Grief therapy
People with dementia
may not report their pain
so it is always important to ask them.
They may not associate their experience
with the word pain,
so use alternative words such as
aching, hurting, sore, and uncomfortable.
Focus on current pain
and ensure assessment is made during
both periods of activity and of rest.
Visual tools in the form
of rating scales
(numerical rating scale,
verbal rating scale,
pain thermometer),
body diagram,
descriptive words
and pictures
may support people
with communication difficulties
to self-report their pain.
When a person
is not able to accurately
report how they feel,
observing their behaviour
can indicate when they are distressed.
https://web.archive.org/web/20201001235028/http://www.yhscn.nhs.uk/media/PDFs/mhdn/Dementia/Documents%20and%20links/Guidelines%20for%20Healthcare%20Professionals%20FINAL.pdf
Neurological conditions are group of long term conditions
resulting from injury or disease
of the nervous system which will affect a person
for the rest of their life.
They include:
Sudden onset conditions
(e.g. acquired brain injury of any cause
including stroke, and spinal cord injury)
Intermittent conditions
(e.g. epilepsy)
Progressive conditions
(e.g. motor neurone disease (MND),
multiple sclerosis (MS),
Parkinson’s disease
and other neurodegenerative disorders)
Stable conditions
with or without age related degeneration
(e.g. polio or cerebral palsy)
https://web.archive.org/web/20210515234131/https://www.msaustralia.org.au/sites/default/files/Palliative%20Care%20NAA%20Position%20Statement.pdf
END OF LIFE CARE,
according to One Chance To Get It Right
(Leadership Alliance, 2014)
should ‘Improve people’s experience of care
in the last few days and hours of life’.
It enables the supportive and palliative care needs
of both patient and family to be identified
and met throughout the last phase of life
and into bereavement.
It includes management of pain and other symptoms
and provision of psychological, social, spiritual and practical support.’
https://web.archive.org/web/20210516224451/https://www.england.nhs.uk/north/wp-content/uploads/sites/5/2018/06/palliative-care-guidelines-in-dementia.pdf
EATING AND DRINKING
Eating and drinking needs as dementia
progresses and towards the end of life
Some difficulties may have already appeared
at earlier stages of dementia
(eg needing prompts around mealtimes,
support with food preparation or adapting cutlery).
However, it is often towards the end of life
when more difficulties around eating and drinking
might develop and it can become more time-consuming
to support someone with eating.
https://web.archive.org/web/20210519211214/https://www.ucl.ac.uk/psychiatry/sites/psychiatry/files/eating_and_drinking_final.pdf
https://web.archive.org/web/20210519211219/http://dementiacarers.co.uk/documents/dementia-eatinganddrinking.pdf
https://web.archive.org/web/20210519211221/https://www.alzheimers.org.uk/sites/default/files/pdf/factsheet_eating_and_drinking.pdf
https://web.archive.org/web/20210519211220/https://www.alzheimers.org.uk/get-support/help-dementia-care/end-life-care
Okay kan, Bro!
IKA SYAMSUL HUDA MZ
