Alzheimer’s Disease Memory – Effect of Alzheimer’s on Cognition
The statement by Ronald Reagan that he had Alzheimer’s disease spurred the American public into identifying their own exposure in a way no other public figure has done. Norman Rockwell and Rita Hayworth, both victims of Alzheimer’s disease (AD), were beloved and admired, but they were not former presidents of the United States and did not have the aura of the former president. As a direct consequence of this announcement, President Reagan challenged politicians and lawmakers to properly fund research into the cause and treatment of this disease. (Petersen)
Alzheimer’s disease is often referred to as the “disease of the century.”
To realize how critical memory and the act of remembering are, one need only consider instances in which people have lost their ability to remember parts of their pasts. Patients suffering from Alzheimer’s disease (AD) are one such population: they constitute the heart of this study. Previous studies examining the language of these patients have been largely psycholinguistic in nature, and their primary focus has been on explaining the patients’ deteriorating linguistic skills in terms of failing cognitive skills. Only in recent years has attention been devoted to examining some sociolinguistic dimensions of Alzheimer disease.
Alzheimer’s disease is a kind of dementia that Bayles (1999) defined as a “condition of chronic progressive deterioration of intellect, memory, and communicative function” (p. 209). The term dementia signifies a set of behavioral abnormalities often associated with old age. In the late 1800s, Emil Kraeplin (2000) distinguished between two kinds of dementia: senile and pre-senile dementia.In addition to affecting the patient and caregivers, AD has very significant social and economic implications. It is identified as “dementia of the Alzheimer’s type” in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). AD illustrates and emphasizes the concept of the global village: when a person is afflicted by AD, it is not only that person who suffers, but also the family, neighbors, friends, relatives, and society by and large (McKhann et al, ).
Alzheimer’s Disease And Cognition
Indeed, it is now widely acknowledged that AD is not characterized by a global cognitive deterioration but that the disease can selectively impair specific cognitive processes or systems, while sparing others. In other words, preserved cognitive abilities may be observed in AD patients.
AD is the most common cause of cognitive deterioration It now afflicts nearly 4 million Americans. These numbers are expected to increase dramatically as the U.S. population ages. By the year 2050 approximately 14.5 million people will suffer from AD. (Bookheimer et al, 450–456)
AD is not part of the normal aging process, although it affects predominantly elderly people. Whereas only 10% of those 65 years of age and older are affected by this disease, the percentage may be as high as 48% in those 85 years of age and older.
Several factors increase the likelihood that AD will develop in an individual. These include head injuries and age. A family history of AD or Down syndrome is a significant risk factor. Women have a higher incidence than men. Moderate coffee and alcohol consumption and exposure to medications have not been shown to be risk factors, and the jury is still out on smoking.
Affected individuals find it increasingly difficult to concentrate on tasks, learn information, or acquire skills. Their work performance may deteriorate. They may become anxious or depressed. Personality changes are often also present in the very early stages.
As the disease progresses, victims tend to lose track of current events. The personality changes become more obvious, judgment is impaired, and patients are no longer able to balance their checkbooks or perform complex tasks (Bookheimer et al, 450–456). As the disease progresses still further, victims are no longer able to care for themselves and may inadvertently expose themselves (and others) to a number of physical hazards. Sleep patterns are often disrupted.
Eventually a stage is reached when caregivers can no longer care for their loved ones at home and institutionalization in a health care facility becomes necessary. Many patients spend their last five years in a nursing home or need 24-hour home care.
People have known for centuries that the human brain is the primary organ of thought (cognition) and emotion. The brain grows to weigh approximately 3 pounds by the time a person reaches age 30, and then it slowly begins to lose tissue. By using the brain’s capacity for complex planning, problem solving, and communicating, humans have been able to travel to the moon, solve medical mysteries, and build elaborate computer networks, but much still needs to be learned about how the brain actually works. A great deal of what people have already learned about the brain has come through the study of brain lesions caused by injuries or diseases such as AD, Parkinson’s disease, and others that affect the nervous system.
AD is distinguished by a subtle beginning with a slow but relentless decrease in memory and other facets of cognitive function that is adequate enough to damage activities of daily living. The decreasing speed is not necessarily steady, being slower in the early and sophisticated stages of the disease evaluated with the middle stage. An early characteristic is memory damage for current events and poor preservation of new information. Memory for more older happenings is normally conserved in the early stages. Slight variations in personality may happen with a decrease in confidence and array of interests. A commotion in executive function is normal, causing troubles when facing multifaceted tasks, such as cooking a meal, working with finances or driving. Due to impaired spatial and visuo-perceptual ability driving may also be damaged or impaired. Aphasia take place and are occasionally quite significant even in the early phases of the disease. They mostly influence word fluency and cause complexity in finding the right words. As AD builds up, there are increasing transformations in activities and in more individual behavior of daily lives, for instance dressing and eating. Additional medical circumstances must be taken care of carefully, including hypertension, atrial fibrillation, diabetes, and vision and hearing abnormalities (McKhann et al, 939?944)
Memory complaints are common in the geriatric primary care setting, and their frequency typically rises with advancing age of the patients. Depending on its severity, memory loss can be disabling, can precipitate depression, and can herald the impending onset of Alzheimer’s disease (AD). For some older patients, memory loss may be the primary complaint; others may allude in passing to incidents indicative of memory decline. Mild Cognitive Impairment (MCI) is a state distinguished by mild current memory loss devoid of dementia or important impairment of other cognitive functions to a degree that is ahead of that estimated for age or educational background. The following MCI criteria is assigned by R. C. Petersen: memory illness; regular activities of daily living; ordinary general cognitive performance; abnormal memory for age; not uncontrolled.
Because there are several types of memory, and decline of one does not necessarily signify decline of another nor indicate a nascent pathology, investigation of such complaints is not always straightforward. (Petersen, 728-36)
Although the two hemispheres and other more exact brain areas are specialized for certain functions, the entire cerebral cortex governs cognition, or thinking. Because AD often affects, selectively and prominently, the temporoparietal areas of the brain, working memory, language, and visuo-constructive functions are usually disrupted in various combinations and degrees.
The Peripheral and Central Nervous System Drugs Advisory Committee has declared that above 80% of patients with mild cognitive impairment build up Alzheimer’s disease in 10 years at a pace of 11% to 16% of patients annually. With a data like this, some medical experts might analyze mild cognitive impairment as early Alzheimer’s disease relatively than a separate condition.
Whether MCI is actually early stage Alzheimer’s or a separate disorder is still uncertain. Researchers do concur that the resolving the secrecies of MCI may also guide to signs in the cure of Alzheimer’s. Specialists guesstimate that besides the four million Americans with Alzheimer’s another eight million suffer from MCI.
Where nearly every MCI patient has problem is with temporary recollection, tests have been developed that can assess the level of impairment, but until now the drugs that are being used in the cure of the disease only have mild, momentary effects. (Wilcock et al, 1445-9)
Cognitive impairment owing to AD is a grave medical issue that will be of rising worry to the world Treatment policies are needed that successfully stop or overturn the declines associated with this disorder.
For many older persons, loss of mental function is one of the most unsettling aspects of aging. Depending on the individual, some decline in cognitive status (e.g., age-associated cognitive decline) may be inevitable. Others may develop mild cognitive impairment (MCI), which is characterized by memory loss in the absence of dementia. Distinguishing between these two mental states is not a straightforward process, but diagnosing MCI can be facilitated by using various instruments designed to assess cognitive status. New research efforts are investigating possible methods of slowing MCI progression. For now, an awareness of the condition and an understanding of its implications will aid patient management and education about MCI.
At present, there are no definite known factors that provide protection against AD. However, the following variables are reported to have an inverse association with AD or cognitive impairment over time: a high level of education; presence of the Apo E-?2 allele; antioxidant substances, such as vitamins E and C, beta-carotene, zinc, and selenium; and the use of non-steroidal anti-inflammatory drugs. The possible neuroprotective effect of estrogen replacement therapy in postmenopausal women and the role of vitamin E in slowing the progress of the disease is under investigation.
The exact causes of cognitive disorders continue to be an ambiguity. A proper perceptive of the disorder would be more effectual in developing a treatment. There is no question that individuals are only interested in “what will make them better” and just want a quick cure.
Bayles K. “Language and dementia”. In A. Holland (Ed.), Language disorders in adults: Recent advances (pp. 209-244). San Diego, CA: College Hill Press. (1999)
Bookheimer, S. Y., Strojwas, M. H., Cohen, M. S., Saunders, A. M., Pericak-Vance, M. A., Mazziotta, J. C., & Small, G. W. Patterns of brain activation in people at risk for Alzheimer’s disease. The New England Journal of Medicine, 343, (2000) 450–456.
Kraeplin E. Dementia praecox and paraphrenia. Huntington, NY. Krieger. (2000)
McKhann, G. et al: Clinical diagnosis of Alzheimer’s disease, Neurology 34:939?944, 1999.
Petersen, R.C. Disorders of memory, chap. 137. In: Samuels MA, Feske S, (eds). Office practice of neurology. New York: Churchill Livingstone, 1997: 728-36
Wilcock, G. K, et al. Efficacy and safety of galanthamine in patients with mild to moderate Alzheimer’s disease: multicentre randomized controlled trial. BMJ December 9, 2000; 321:1445-9.