The Journal of Neuroinflammation, published earlier in 2008, results concerning a study involving a new therapeutic molecule (cytokines). In particular the study focused on tumor necrosis factor-alpha (TNF). Patients in the study were given an injection of anti-TNF therapeutic called etanercept. This study revealed a dramatic and unprecedented therapeutic effect that occurred within minutes of the delivery of the injection into the spine. Etanercept has been FDA approved to treat immune-mediated disorders. Making use of these published results and seeking to improve the treatment plan of their patients is what radically improves the outlook for Alzheimer patients. Understanding the need for these studies and making available case studies for those who wish to participate leads to more discoveries such as this one.

Like any progressive disease, the treatment plan changes as the course of the disease progresses. The treatment plan by nature of the disease cannot remain static. Periodic review and updating is expected in order for the treatment plan to best address the needs of the patient currently and in the future.

Whenever a treatment plan is changed it becomes mandatory that the patient and those who care for the patient learn how to recognize new symptoms and report them promptly so that an evaluation can be made regarding importance of the symptom to the successful administration of the treatment plan.

As in most diseases, the patient must partner with the doctor or other healthcare professional in designing the treatment plan. In order for improvements to have a positive affect on the treatment plan, all parties much are aware of the need to carefully monitor the plan and to allow the plan to have importance regarding the outcome of the disease.

In the case of Alzheimer’s and most dementia diseases, as the disease progresses the family members or others in a care giving position for the patient, take a more active role in the day to day monitoring of the treatment plan.

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As you probably know already, Alzheimer’s disease is a progressive disease by nature and the symptoms associated with the disease worsen slowly over time. The changes in the afflicted individual’s memory, behavior and physical abilities will noticeably decline over time from being mild and hardly noticeable to being obvious that the individual needs a diagnosis and then the final stage where the individual is in dire need of supervision and assistance for total personal care. There are basically three stages to the disease mild, moderate and severe. There are common changes experienced in each of the three stages although individuals may not experience all of the symptoms or the degree of intensity as others in the same stage there are basic similarities in the progression from one stage to the next and some commonly recognized traits of Alzheimer’s that medical professionals and others can easily recognize in each of the three stages.

Mild Stage Changes to Expect:

The individual in the mild stage of Alzheimer’s may not even have been diagnosed yet or may be in the process of being diagnosed. The individual will begin to lose short-term, recent memories. There will be a slow decline in the ability to make decisions that require judgment such as those in the financial area. There will be times when it is difficult to learn new things or make new memories. The individual may start to notice that it is becoming increasingly difficult to find the right words when speaking or writing and may even compensate by not initiating or participating in conversations or by not continuing written correspondence, as may be the usual pattern to do. The attention span may become shorter and thus the individual loses interest in activities even favorite ones. He/she may become lost when going to familiar places or have difficulty organizing thoughts or thinking in a logical fashion. It may take the person longer to do routine chores and may even become unusually upset if things are out of place, or unexpected from the normal routine. It is common for the person who is in this mild stage of Alzheimer’s to forget where they have placed items or not be able to find them because they have placed them in odd places.

Moderate Stage Changes to Expect:

An individual will usually have been given the diagnosis of Alzheimer’s disease by the time they reach the moderate stage of the disease unless they have been a loner who is not receiving medical care. There is a noticeable change in the appearance, hygiene and sleep pattern of the individual in the moderate stage of Alzheimer’s. The individual often will confuse the identity of known individual such as thinking they are talking to a sibling when they are speaking with a son or daughter. They may experience safety issues when left alone such as leaving the stove on, or wondering around the streets lost, experiencing falls or they may self-neglect or exploit their personal body or space, possibly participating in risky sexual behavior or cheating and gambling when these behaviors are out of character. Repetitive actions like tearing paper over and over or repeating the same phrase numerous times. Is often restless especially in the late afternoon or evening. Cannot complete tasks or follow written instructions. May engage in inappropriate behavior such as hitting, kicking, biting, screaming or grabbing at others. May awaken at night thinking it is daytime and time to go to work. May not be able to distinguish private behavior anymore and might do things in public such as getting undressed completely or even masturbate or do other private behaviors in public places.

Severe Stage Changes to Expect:

Individuals in the severe stage of Alzheimer’s are usually hospitalized or in a nursing home or fulltime care facility. They do not recognize familiar faces even of spouses, sons or daughters. Speech patterns are not recognizable but sound more like gibberish or they become mute. They often refuse to eat because swallowing becomes difficult and they can choke easily. They also have no control over bladder or bowel habits (are incontinent). They usually lose weight. The skin can be damaged easily as it becomes thin. May not be able to stand or sit up. Individuals in the severe or sometimes called the last stage of Alzheimer’s typically sleep more, may have seizures, frequent infections and may also fall out of bed, or if they still are mobile (which most are not) may fall when walking. They need total personal care (assistance eating, dressing, bathing).

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The diagnosis for Alzheimer’s Disease (AD) comes from a professional who is experienced in the diagnosing of dementia type diseases. The diagnosis can be an accurate one, 80 to 90% of the time. The diagnosis is usually labeled as “probable” because a definitive diagnosis can only be done when a piece of brain tissue is examined which usually isn’t done until an autopsy is done after the individual has died. This brain biopsy can be done when the person is still living but it is a painful and also risky procedure. The probably diagnosis of AD is made using a medical history form, and an evaluation of the person’s presenting symptoms. Basic laboratory tests of blood and urine may be taken to help make the diagnosis as well as possibly a spinal fluid examination. Neuropsychological tests may be performed that center on evaluating the individual’s memory, attention span, ability to problem solve, and cognitive abilities that can help the medical professional to make the diagnosis. Brain scans such as a magnetic resonance imaging (MRI), computerized tomography (CT) scan or positron emission tomography (PET) may be done also as a means for making the diagnosis.

Designing the treatment plan:

The treatment plan will take into consideration the findings from the diagnostic proceedings. Typically the disease is a slowly progressing one but it can move faster and be aggressive in nature. This characteristic is different from one individual to the next. Some individuals have it long-term and others have it the last few years of their life.

The disease cannot be cured or stopped in its tracks. Scientists and researchers are always studying new ideas in order to develop better treatment options. Scientists also work with teaching hospitals and universities in an effort to study clinical trials and the experimental drugs associated with these trials. The more studies completed the more information is made available about Alzheimer’s.

Once diagnosed, individuals with AD should routinely see their medical professional treating them. Progressive diseases must be tracked and monitored carefully to assure the individual that the best course of action is being taken.

As the disease advances the type of care and amount of care needed increases.

It is important for you or someone you know to seek a diagnosis and treatment when Alzheimer’s is suspected. Time is precious and being robbed of memories and cognitive abilities is not a present thing to experience or watch. The sooner you seek medical evaluation, the sooner help can happen.

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At some point in the moderate stage of the disease the family must make a decision about where the patient will receive the best care available. This care is usually provided in a care home, nursing home or skilled care center, and also hospitals depending on the severity of the symptoms at each stage of the disease. The individual may also have other conditions or diseases that may determine the best placement.

There are four main categories of care that are required for the Alzheimer’s patient: daily care, preventing falls, mobility and safety.

Daily Care:

The individual will need to be supervised during the mild stage to be sure they are eating properly prepared and nutritious meals. This may require assistance with planning of meals, shopping, meal preparation and serving. As the disease progresses and cognitive abilities decline the individual will no longer be able to plan, shop for, or prepare meals. It will especially be unsafe to prepare meals as they often forget to turn off appliances such as oven and stoves. Personal hygiene may suffer if they are not assisted as they advance towards the moderate stage of Alzheimer’s disease. In the severe stage all daily needs and personal needs have to be done for them.

Preventing Falls:

In order to prevent falls the home or facility of care needs to have features that address the needs and symptoms of the Alzheimer’s patient. A ramp should be installed for each entrance into the home or building. A chair lift or elevator where practical is beneficial for getting the individual to multiple stories within the structure. Stairs are very dangerous and must be safeguarded by a gate at the top and handrails preferably on each side of the stairs. You can place non-skid strips on the stairs and paint the edge of each step with light paint or place a reflective tape on the edge to make seeing each step easier. Grab rails by the toilet in tubs and showers will help to prevent falls in the bathroom. All stairs and hallways should be well lit even at night.

Mobility:

As the disease progresses mobility often requires a walker or cane so it is important to plan walking areas well so that there are no rugs to slip on or objects to fall over. Bed rails installed on either side of the bed will allow the patient to get in and out of the bed without assistance longer. The individual will graduate from cane and walker to a wheelchair in order to maintain mobility longer and also to encourage independence. Keep in mind that low standing furniture is more difficult to see so if you have these move them to other locations away from walkways. Tie up loose electrical cords and remove all unnecessary objects from high traffic areas and walkways.

Safety:

Safety issues can revolve around keeping the individual from wandering outside and getting lost to making sure they are well cared for during respite times.

To keep them from wandering and encountering danger take the following precautions:

* Fence in all swimming pools no matter the size

* Lock all exit doors

* Install safety locks on all windows

* Place safety bars on upstairs windows

* Keep an identification card on the individual (in wallet, purse or pocket) at all times that state next of kin or emergency contact person

* Keep updated photos of the individual

* Notify local police that the individual suffers from Alzheimer’s and may wander so they are aware while out on patrol

When hiring for respite care check credentials carefully and interview several times allowing the interviewee to meet the patient only after they have been selected. Make sure safety guidelines are made available to all respite helpers.

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The disease when diagnosed by a qualified doctor is usually 90% accurate because to make the diagnosis doctors have to rule out all other diseases or causes for the presenting symptoms.

The diagnosis is made by using neuropsychological testing and physical, mental and behavioral evaluations. The person making the diagnosis is trained and educated to detect the nature and level of an individual’s physical, emotional and behavioral impairment.

Approximately 5% of individuals with Alzheimer’s were diagnosed with early stage of the disease because at this point in the disease the symptoms are not obvious. In the early stage the individual is typically younger than age 65.

Imaging procedures are commonly used in the diagnosis of the disease because they can detect subtle changes of the structure and size of the brain. These changes are characteristic of the disease.

Alzheimer’s is difficult to diagnose because other diseases or conditions must first be ruled out. Memory screenings must not be used to diagnose Alzheimer’s, however imaging technologies have advanced to the point that they are becoming more precise at diagnosing the disease.

Magnetic resonance imaging (MRI) can be used to detect early physical brain signs of the disease even before mental impairment shows up and becomes obvious to those evaluating the patient.

The Mini Mental State Exam (MMSE) is a commonly used mental status exam used by doctors who suspect that they may have a patient with Alzheimer’s disease.

The diagnosis may be assisted by the patient or loved one by supplying an accurate list of suspected symptoms along with the onset, duration and intensity of the symptoms.

Structural brain damage is a crucial element of the diagnosis. Unfortunately a brain segment biopsy is very painful and risky to be done on a live patient. There are occasions when this test is performed to confirm the diagnosis after the patient has died.

Often in the very early stages of the disease a person will say that they have senility, or that “old age is setting in”. The truth is that Alzheimer’s is not a normal state of aging. It is a disease that although it occurs more often in those who are older than 80 years of age the typical onset of early Alzheimer’s is age 65, which at today’s standards is not all that old. Rarely someone under 65 will develop early stage Alzheimer’s.

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Most individuals are diagnosed around age 65 or after. Your chance of developing the symptoms for Alzheimer’s increases with age. Did you know that there are two risk factors that if you have one or both of them it increases your risk for developing Alzheimer’s? These two risk factors are having a family member that has been diagnosed with Alzheimer’s disease or having Down syndrome.

A common sign that most individuals recognize as being associated with Alzheimer’s is short-term memory loss that has occurred gradually. Other symptoms or signs include not recognizing familiar objects, forgetting how to use simple tools such as writing implements or kitchen tools, habitually forgetting to turn off the stove or lock doors.

Symptoms that are less common and may vary include agitation, using poor judgment or having mood or personality changes such as getting angry when tired when this is an unusual trait for the individual.

Just because a person experiences one or more of the above symptoms on occasion does not mean they have Alzheimer’s disease. These signs or symptoms are significant when they progressively become worse over time or when they endanger the life of the individual or the lives of others. If you notice that you or someone else has these signs or symptoms it is a good idea to have a doctor discuss the possibilities, and make a diagnosis.

Clues that there may be a problem that needs to be addressed with your physician includes the above symptoms and signs as well as if you tend to forget appointments or conversations that you have had, have a difficult time remembering new information or are unable to handle complex (more than one step) tasks. Other signs that there may be a problem is the individual starts to get confused while driving such as not being able to navigate familiar roads or noticing that finding proper words becomes difficult when you are conversing with others. Someone with early stage of Alzheimer’s may also become easily irritated or may have a change in personality such as becoming dishonest or start behaviors like sexual promiscuity or relationship cheating.

If you or someone close to you experiences these signs or symptoms it can be very frightening and even dangerous especially when stoves are left on or the individual forgets how to operate a dangerous piece of machinery and attempts to do so.

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Early – onset Alzheimer’s typically runs in families so there is a genetic connection with researchers pinning it down to the apo E gene, although you can have this gene and not develop early – onset Alzheimer’s. You can receive genetic testing to see if you have the gene but anyone considering genetic testing should undergo genetic counseling before being tested so that they can understand all of the advantages and disadvantages of the testing before taking that step.

One of the most devastating aspects about early – onset Alzheimer’s is that it strikes at a time in life when career or relationships are at the most critical time period; although there is no good time to get dementia because dementia at such a young age is not expected in society the problems at work and in relationships are magnified as they are not so easily identified as being medical in nature until after individuals have been fired because of the symptoms losing all they have built towards that career including financial rewards or recognition for any achievements they have earned to that point. Relationship can also suffer between spouses or children because it is something that is not easily identified before damage has occurred in these relationships. At a time when intimate relationships should be full of romance and fulfillment the spouse often needs to turn into a caregiver.

Instead of the disease robbing the individual of the retirement years as is often the case with Alzheimer’s those who suffer from early – onset Alzheimer’s are in the prime earning years where the financial ramifications of such a disease can really cause significant damage. Another difficult situation financially is that most medical benefits or social-support programs do not provide assistance to those with Alzheimer’s unless they are over age 65. There are special waivers to get into these programs that can be applied for.

In order to get the support and treatment needed for those with early – onset Alzheimer’s it is critical to obtain an accurate diagnosis as soon as possible, to become educated about the disease and to advocate for support through organizations and community programs. Your doctor can help gain resources for both knowledge and to initiate a support system for the individual and the family.

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The goal of treatment is to improve the day-to-day functioning of the individual with Alzheimer’s and also to give the best quality of life possible for as long as possible through a combination of treatment methods based on symptoms and the severity of the symptoms. Treatments address slowing down the progression of the cognitive symptoms and managing the behavioral symptoms.

Part of treatment involves educating the patient and the patient’s family, friends and caregivers about the disease because when those around the patient can understand why they behave the way they do it is easier to help them and to have compassion for them.

Medications are used to treat the cognitive and the behavioral symptoms of Alzheimer’s. Non-medicated methods are also used to treat Alzheimer’s such as psychiatric therapy, relaxation exercises and physical therapy to help improve mobility. Research is constantly being conducted and clinical trials are being offered to help with new drugs.

Medications used for cognitive symptoms include memantine, galantamine, rivastigmine, donepezil and also tacrine.

Therapeutic activities may vary and are designed based on the symptoms the individual is experiencing. Activities may include music therapy, walking and other light exercise, relaxation techniques and pet therapy.

Treatment may also include exercise and diet recommendations to help maintain overall health and may include asking for a consultation with a nutritionist or registered dietician, a fitness instructor, an acupuncturist, or massage therapist.

Part of treating a person with Alzheimer’s disease is learning about how to communicate with them as the disease progress. Because the individual will lose ability to communicate it becomes even more important for all those caring for the individual to make every effort to communicate with the individual by trying to eliminate any potential communication problem in advance, use memory clues such as photographs and by leaving notes to remind the individual about routines or tasks that need to be accomplished like taking medication on time. Make use of various communication techniques to help improve the communication between patient, family and caregiver by using reality therapy, validation therapy, redirection, and memory cueing where appropriate.

When designing a treatment plan keep in mind that Alzheimer’s patients do well when there is structure in their lives and consistency in routine. Make sure there is a combination of both active and passive activities in the individual’s daily life.

Treatment options will change as the individual’s disease progresses. The plan will then need to be updated to include current needs and to address the symptoms that are currently being experienced. As the disease progresses the treatment will become more restrictive and involve more care.

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When treating a patient with Alzheimer’s the treatment plan will need to address the cognitive symptoms, behavioral symptoms, traditional medicated treatments, alternative treatments, being able to monitor carefully the progression of the symptoms, educating the patient, family and close friends as well as educating and caregivers. Care must be coordinated between all involved parties and end-of-life decisions must be made and incorporated into the treatment plan.

The cognitive symptoms of the disease are treated with cholinesterace inhibitors and NMDA receptor antagonists and sometimes vitamin E supplements. Commonly prescribed cholinesterase inhibitors include donepezil, rivastigmine, and galantamine.

Another drug used to treat Alzheimer’s is memantine, which is an uncompetitive low-to-moderate affinity N-methyl-D-aspartate (NMDA) receptor antagonist.

The behavioral symptoms of the disease are treated with non-drug therapies and strategies such as taking steps to identify the problem behavior, changing the living arrangements to be less disruptive, to monitor behavior and educate individuals living with them what to expect and how to monitor the behavior and how to safeguard the individual and all other parties living with them. Other therapies include redirecting the attention of the individual, simplifying tasks and daily routines of the individual, encourage the individual to take frequent rests and to see to the safety of the individual and all involved by installing safety locks and gates, removing all guns or knives from the environment and reducing the risk for fire by installing and monitoring closely smoke alarms and monitor usage of stove.

Alternative treatments that have been explored by the scientific and medical communities have been Gingo biloba, Huperzine A, Omega-3 fatty acids, Coenzyme Q10, phosphatidylserine, and coral calcium.

The caregiver must be involved in the treatment plan design, and in implementing the treatment plan because it is the caregiver who must be responsible to implementing the plan.

The doctor is an intricate part of the treatment plan not only because he/she designs it but also because it takes a real commitment to understand, and to stay on top of the changes concerning Alzheimer’s disease. The treatment plan must understandably change as the symptoms worsen.

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The usual first sign of Alzheimer’s is very mild forgetfulness and complaints of memory problems such as not remembering where something was placed, or not being able to remember where you parked the car, or not being able to remember the names of individuals that you recently met.

After the mild initial stage, which by the way is before the disease is usually diagnosed; the individual will slowly progress into the next stage of Alzheimer’s where others will start to notice that there is something “off” about the individual such as the person becomes easily confused, gets lost while driving or walking in familiar areas, work performance declines and the individual has difficulty reading or following instructions. The individual may deny these things when confronted.

The next stage is when the symptoms become obvious to the individual and to others and is when diagnoses usually take place for Alzheimer’s disease. Now that there is a diagnosis, there is a reason for the signs and symptoms and plans can be made to accommodate the individual and keep them safe.

The individual will need assistance with financial matters, and will not be able to travel alone. The individual will no longer be able to perform complex or dangerous tasks. The individual may exhibit anxiety or even denial in the face of these symptoms and signs.

As the disease progresses the individual will begin to repeat sentences or motions and may even occasionally forget family names such as the spouses or the names of sons and daughters.

In the later stages of Alzheimer’s disease the symptoms worsen to include dementia for place or time and the loss of all verbal ability or being able to perform daily self-care tasks, even the inability to swallow or sit up. This is when 24-hour care is necessary and most individual are placed in nursing homes or full-service care facilities.

Early diagnosis means that there can be more good years as certain medications prescribed for Alzheimer’s can slow the progression of the disease. There is ongoing research for new medications and for an eventual cure for Alzheimer’s disease.

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