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“НАШЕ ЖИТТЯ”, КВІТЕНЬ 2015 WWW.UNWLA.ORG 33 ALZHEIMER'S DISEASE by Ihor Magun, MD, FACP Medicine can do more today than at any other time in history. Indeed, treatments of phys- ical ailments have advanced to such a degree that they are offered to all age groups. As average life expectancy continues to rise, people encounter more severe aging issues. Of particular note are conditions associated with mental decline, such as Alzheimer’s. It has been more than a century since this dreaded disease’s original discovery, yet we still face it. It was in 1906 that Dr. Alois Alz- heimer first noted changes in brain tissue of a woman who had died from an unusual type of mental malady that included symptoms of memory loss, unusual behaviors, and issues with communication. Upon examination of her brain at autopsy, he noted bundles of fibers and many abnormal clumps not found in normal-looking brains. His discovery was the first documentation of the disease and the origin of the chosen name for this condition. These abnormal pathological findings are referred to as amyloid plaques and neurofibrillary tangles. Alzheimer's disease is the most common cause of dementia in the elderly. The first symp- toms usually appear after age 65, but they can al- so appear at an earlier age. About five percent of men and women ages 65 to 74 have the ailment and nearly half of those aged 85 and older are es- timated to have some form of the disease. Epide- miologically, two thirds of patients are female and one third are male in the United States. The high- er incidence of the disease in women may be due to the fact that women live much longer than men. Risk factors for Alzheimer’s disease include a history of head trauma, smoking (smokers have a two- to fourfold increase in the incidence of the disease), cardiovascular disease, family history, down syndrome, and gene APOE4. Diagnosis incorporates several tools. Currently, the most definite diagnosis for Alz- heimer’s disease is made after death when exam- ining the brain for the above-mentioned tangles and clumps, as Dr. Alzheimer did in 1906. How- ever, cognitive tests can provide information on memory, language, and math skills. Other types of tests and scans may be needed to help differenti- ate from any treatable and manageable disease which has symptoms similar to Alzheimer’s. For instance, blood tests are useful in this regard, and radiological modalities utilize scans to rule out any tumors or strokes that mimic Alzheimer's. New diagnostic criteria divide the disease into stages. The first one is the preclinical stage where mental decline is quite evident to the pa- tient, but he or she can still score normal in cogni- tive tests. Early signs include repetition of the same questions; difficulty remembering things; losing objects and/or placing them in strange places; and having trouble handling bills and tasks requiring math skills. Later stages include confusion about time, place, and people; forget- ting activities of daily living like brushing your teeth or combing your hair; and wandering out- side of home and forgetting where one lives. A condition referred to as mild cognitive impairment can be an early sign of Alzheimer's, but it does not necessarily progress further. Memory issues associated with this impairment include problems with finding the proper words, misplacing objects, and forgetfulness—especially about appointments and meetings of various kinds. Several medications are available that may improve symptoms. They can delay but not prevent the progression of the disease. They are safe to take and should always be started sooner rather than later. Use of vitamins, over-the- counter medications, and herbal supplements has no proven benefit, but it is not discouraged. What is helpful in dealing with this dis- ease is addressing issues that can be corrected. Proper and periodical medical evaluations, regu- lar eye examinations, dealing with hearing issues, and the possible use of antidepressants in certain patients are all beneficial. Create a safe environ- ment, and provide advance directives for a living will and power of attorney. So what can be done for preventing Alz- heimer’s? Maintaining a healthy lifestyle, chal- lenging yourself mentally, and keeping physically active may reduce your risk for Alzheimer’s, but there is no definitive prevention for it. Ongoing research is addressing this and other issues relat- ed to the disease. In fact, the National Institutes of Health are recruiting all individuals affected by Alzheimer’s as well as healthy volunteers for sev- eral clinical trials. Call 1-800-438-4380 or go to http://www.nia.nih.gov/alzheimers/clinical-trails/ for participation and information about these re- search studies. Lastly, the individuals that are affected most by this devastating illness are the spouses, caregivers, and family members. Spousal and caregiver burnout is a real problem and needs to be addressed. The greatest gift that you could give to someone caring for a loved one with Alz- heimer’s is boundless emotional support and en- couragement.
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