Alzheimer’s Disease (AD)

1. Alzheimer’s Disease (AD) An Understanding of Alzheimer’s Disease By Elizabeth M

2. What Is AD? • It is a disease that forms plaque in the brain. • Forms abnormal clumps called amyloid plaques and tangled bundles of fibers called neurofibrillary tangles in the brain. • Nerve cells die in areas that are important for memory and simple tasks that need to be performed. • The levels of the chemicals which carry the messages across the synapses from neurons decrease.

3. The History and Background • It was discovered by Dr. Alois Alzheimer, a German doctor, in 1906. • It is believed 4.5 million older Americans have AD. • The average age that people get Alzheimer’s is after the age of 60. • For every 5 years over the age of 65 the risk doubles. • Nearly half over 85 may have the disease, yet it is not a normal part of getting older.

4. What Causes AD? • Age is the number one risk factor. • A family history of having AD is another risk factor. • Scientists don’t know exactly what causes the disease, and there is still a lot of research to be done. • We do know that the main cause of brain cell death is an accumulation of the protein A-Beta. • Once a brain cell dies it doesn’t come back, so AD causes a gradual loss of brain function.

5. Initial Symptoms • The initial symptoms include mild forgetfulness and having trouble remembering recent events, activities, and the names of people. • The AD patient might not be able to solve simple math problems. • These symptoms may not be enough to cause alarm.

6. Advanced Symptoms • As the disease progresses the symptoms are more easily noticed. • The AD patient might forget how to brush their teeth or comb their hair. • They may not be able to think clearly and may fail to recognize familiar people or places. • People with AD can become anxious or aggressive or wander away from home.

7. How is AD Diagnosed? • Someone who thinks they may have AD can go to a specialized center where doctors can diagnose “probable” AD using tools such as: • Asking questions about the person’s general health, any past medical problems, and the ability to do daily activities • Memory tests, problem solving strategies, attention, counting, and language • Tests of blood, urine, or spinal fluid • Brain scans

8. How Does AD Affect the Body? • The brain literally deteriorates, which can affect a person’s ability to speak, be independent, balance themselves, and understand directions. • For older people, AD can cause falling, which can be serious and damage the brain even more. • Some patients are unable to control basic bodily functions and can need fulltime care.

9. Cures or Treatments • There really is no cure or treatment for AD but there are some things that can slow it down or prevent it. Those include exercising daily, being intellectually active, having positive emotions, playing games, reading, dancing, and more.

10. Current Research for a Cure of Treatment • According to a recent study, diet may affect the risk of getting AD. • A study showed that Americans who followed the Mediterranean Diet (MeDi), consisting of lots of fruits and vegetables, legumes, cereals, some fish and alcohol, and little dairy and meat, had a significantly reduced risk for Alzheimer's disease as they got older.

11. How is the Person’s Daily Life Affected by AD? • Walking, getting out of bed or a chair, writing, and using utensils are no longer easy to perform for a person with AD. • Their sense of smell can be damaged and they may lose their appetite as a result. • Daily and simple tasks might have to be performed with the help of a caregiver.

12. Mental and Financial Cost of AD • Some mental costs include cell loss, memory loss, and eventually death. • Annual financial costs of AD can average $25,000 for home care and $50,000 for nursing homes. • People usually live with AD anywhere from 2-10 years, but some can have it as long as 20.

13. Who Takes Care of the Caregiver? • More than 70% of AD patients live at home and receive care from loved ones. • Caregivers suffer from isolation, fatigue, stress, and feelings of guilt. • Studies show caregivers benefit from information and outside support. • Without support for caregivers, AD patients are often sent to institutions. The intervention group of caretakers received information pamphlets and 9 home visits from AD specialists, and had a large improvement in quality of life over the control group.

14. A Normal Brain and an AD Affected One • In the normal brain there is a lot of healthy brain tissue in the language area. In the AD affected brain there is little in that area. • There are many differences between the two brains including the memory, sulcus, gyrus, ventricle, and language areas. In the AD brain, these are either shrunken or stretched out to unhealthy measures.

15. The Interview Liz: One book that I read says that there’s no cure for Alzheimer’s, and another book says that there is. What should I believe?  Dad:When we thought your grandfather had Alzheimer’s Disease (AD), the theory was that more than one drug would help slow the disease down, like Namenda and Aricept. It seemed to help him be more alert. It turns out that playing music, reading, exercising, and staying active socially helped Grandpoppa to fight the disease. He would write fantastic poems, sonnets, but at the same time, forget that he’d e-mailed me a question, and would send the same e-mail many times.

16. The Interview (continued) Liz:How do you tell if you have Alzheimer’s? Dad: Grandma Holley took Grandpoppa to a psychiatrist, because he seemed to be very forgetful. After he died, we found stacks of 3x5 cards with little reminders to himself about things he was supposed to do. The only test they had at the time was a psychological exam. Grandpoppa resented having the exam, so when asked to give five words with the same letter, he started to repeat the same curse word five times. Later, he called the psychiatrist Nurse Rachet (from the movie One Flew Over the Cuckoo’s Nest). Paranoia is also a sign of Alzheimer’s. We were all convinced that he had AD. After doing some research on it himself, Grandpoppa found that by using an MRI, they could tell for sure. MRI is magnetic resonance imaging, which is a technique that allows the doctors to tell something about brain activity. As it turns out, the MRI showed no Alzheimer’s Disease, but that he’d had a small stroke at some time in the past. I hadn’t really thought about it, but he had had a small atrial fibrillation problem in 1997, right on my birthday. It was when we first moved out here to California, so maybe he had some stress about us going.

17. The Interview (continued) Liz: So didn’t Grandpoppa die of pancreatic cancer? Dad:Yes. Not long after getting a clean slate with regard to AD, Grandpoppa’s stomach started hurting him. He’d lost a lot of weight. He’d also injured his arm…torn rotator cuff, I think, so had swum himself back to health. He’d swim a couple of hours every day, and he’d lost lots of weight. We didn’t know that it was really cancer…until he got sick. He died only a month or so after his stomach started hurting him. As it turns out, pancreatic cancer can show some similar signs to Alzheimer’s and depression. Think about it. Without the pancreatic juices, you don’t digest your food very well, which is why he lost so much weight. But it also impairs your brain function, and makes you depressed, and that’s probably why it seemed like Alzheimer’s disease. Your Uncle Ben seems to have Alzheimer’s, and my grandfather, your great grandfather had Alzheimer’s. It turned an otherwise very sweet man into a very demanding and sometimes mean spirited person.

18. The Interview (continued) Liz: What would have happened if Grandpoppa had lived and had Alzheimer’s like your grandfather? Dad:That’s the hard part. Grandpoppa didn’t want to live life without his full faculties. He didn’t want to depend for everything on my Grandma Holley. He wrote out a living will, and was clear that he didn’t want to be resuscitated if he fell very ill or required a machine to keep him alive. As we all know, Ronald Reagan lived for many years with the disease, but it was a tremendous burden on everyone. Grandpoppa didn’t want it to be that way. When he found out he had cancer, he decided he wanted to go home to die in his own bed. His last hours were spent picking out hymns for his memorial service. He was a minister, so he’d lead many such services. It was the way he wanted it. Cancer is a horrible disease, but it took him so fast, faster than if he’d lingered with Alzheimer’s. In some ways, it was a blessing.

19. The Interview (continued) Liz: So if he had lived longer, he would have been in pain? Dad:No, not really pain. He was a very scholarly man, perhaps the smartest person I ever knew. He held 3 or 4 masters’ degrees, and PhD, and a Doctorate of Divinity. He spoke seven languages, so it was very painful for him to start losing his mind, something he prized very highly. It wasn’t pain he avoided, it was being a burden, or not being the person he had been.

20. The Interview Liz: In the picture that you have on your desk, that Grandpoppa is in, where is the plaque, which has the poem he wrote, located? Dad: That was a picture in front of NCCAT, North Carolina Center for the Advancement of Teaching. He wrote the poem that went on the plaque when the building was dedicated. He put a lot of work into the center. (Picture is located on next slide)

22. My Conclusion I picked Alzheimer’s disease because my great-grandfather and my grandfather both had Alzheimer’s. Also my step dad's, dad may have it. The most interesting thing that I learned from this project was that every 5 years after the age of 65 the risk doubles of getting the disease.

23. For More Information… For more information on Alzheimer’s Disease go to: http://www.alz.org or http://www.omrf.org

24. Bibliography Barclay, Laurie. “Mediterranean Diet may Reduce Risk of Developing Alzheimer Disease.” Medscape.http://www.medscape.com/viewarticle/530121. 2006 “Inside the Brain: An Interactive Tour.”http://www.alz.org/brain. Alzheimer’s Association. 2006 Milner, Ed, interview; December 11, 2006, Mountain View, CA. National Institutes of Health, Alzheimer’s Disease Education & Referral Center, Fact Sheet No.06-3431, pgs. 1-16. July 2006 Scarmeas, Nikolaos; Stern, Yaakov; Tang, Ming-Xin; Mayeux, Richard; Luchsinger, Jose."Mediterranean Diet and risk of Alzheimer's disease." Annals of Neurology. April 2006 Soliz, Adela. Alzheimer’s Disease, pgs. 7-123. 2006

25. Special Thanks To… My dad for letting me interview him. My brother for helping me edit and proofread. My mom for giving me helpful tips on the writing of this presentation. My step dad for finding cool websites that I used.