Essay/Term paper: Alzheimer's disease: "where has yesterday gone"

Essay, term paper, research paper:  Psychology

Alzheimer's Disease: "Where has Yesterday Gone"


Memory loss, like old age is a condition which mankind has always
reluctantly recognized and always – with resignation. Memory loses are sometimes
trivial and meaningless and go unrecognized. However, when these loses are so
great that a person does not know who or where they are the concerns are quite
grave. Although it is realize that Alzheimer's disease destroys the brain memory
function, many do not realize precisely how the memory is destroyed once one is
aware of the process, it becomes faster to work forward to alleviate the
destruction.
"Without memory there is no knowledge to recreate or reproduce past
perceptions, emotions, thoughts and actions that are so vital to live a full and
functioning life. Memory is the key that unlocks doors that keep us functioning,
not only mentally but physically (Corrick 32)."
"Memory loss is not a sign of decay (Freedman 10)." As we get older,
there is some mild impairment in our recollection of recent events, such as
forgetting why one went into a room or misplacing a person's eye glasses, which
even young are guilty of doing. As reported by Larry Squire, "forgetting is
quite normal and usually develops in the third decade of life, and by one
estimate 85 percent of the healthy elderly – those over 65—suffer some memory
impairment (59)."
According to Dr. Seligmann, "forgetting is the process through which
information in memory becomes inaccessible, either because it is stored but is
not at that time retrievable (51)." This is one of the most important factors in
forgetting. Memory loss is rapid at first and then gradually levels off. There
are many types of "dismembering" enemies that hamper ones recall and retrieval
system. "Forgetting may be increased by interference from proactive inhibition,
that is material learned beforehand, like trying to remember a soup recipe
(51)."
In remembering stories or events there is a tendency for distortions to
occur. Cutler explains that studies made by Elizabeth Loftus reveal, "what you
learn today may actually distort your memory of what happened to you yesterday. .
. (62)." People tend to remember the events that they regard as the most
important. They attempt to reconstruct the event, usually what knowledge they
have, with the result being what would have been expected rather than what
actually happened.
Dr. Siegfried reports that "Neural decay is another enemy to the memory.
Sensory receptors, such as visual, auditory and smell, provide you with sharply
etched neural impressions or the world around you. But this pattern of neural
firing is quickly destroyed in one of two ways; the receptor neurons adapt to
the input (10- 11)." The brain can register only one item at a time. If two
events are occurring at the same time the storage of the information will depend
on the importance of information to the individual. "Neural decay is perhaps the
simplest types of forgetting (Seligmann 51)."
As explained by Dick Gilling, "the short-term memory "holds' items until
a person decides how important they are and if they need to be transferred to
the long-term memory for permanent storage (15)." According to the experience,
the brain has made a mental index card for each category experience. "These
index categories are used when someone wants to retrieve an item from memory
storage banks. Sometimes these "mental index cards' get catalogued in the wrong
way, that is misfiled, or even lost (14)."
When someone has learned too many things at once, cataloging errors
frequently occur (Hamdy 93). For example, if a person is introduced to a dozen
unfamiliar people at a party, mistakes will be made trying to attach the right
names to proper faces. If a person were to meet one new individual a day for a
dozen days, the chances will be greater of getting the file cards filed out
correctly.
"Misfiling also occurs, and people have trouble locating items in their
memory banks. The more similar two items are, the more likely it is that one of
them will be filed in the place supposedly reserved for the other (Gilling 14)."
All the changes of aging that occur in the brain should not interfere
with everyday living, "as there is ample organ function left to go on to ripe
old age as long as there is no disease to accelerate the aging process (Gold
12)." We lose some brain cells as we age, but "there are millions of healthy
ones left for our intellectual endeavors. . . However, a disease such as
Alzheimer's can take away a person's memory, leaving them with no past, present,
or future of any type (Gold 12- 13)." A person becomes nothing but an empty body
with no mind inside.
Until recently, explains James A. Corrick, "it was accepted that with
the aging process along with senility. Some people will revert back to childhood
and remembering things well and thinking clearly will no longer happen. What we
call senile dementia is really Alzheimer's disease (26)." It can strike people
in their middle forties. Alzheimer's disease is incurable and irreversible for
now, but neuroscientists are hoping to develop a vaccine against the disease.
"Everyone would be vaccinated at birth. . . (27)," and as neurosurgeon Dr. J.
Eric Holmes notes, "almost nobody would suffer a decline in intellect and
personality as they got older. We would all be bright as a tack as we got to be
eighty or ninety. . . (28)." The only thing that would kill us is if our system
gave out.
Dr. Siegfried states that Dr. Lewis Thomas, the former Dean of the Yale
School of Medicine and now Chancellor of Memorial Kettering Center, has
described Alzheimer's disease as the "disease of the century: . . .the worst of
all diseases, not just for what it does to the victim, but for its devastating
effects on families and friends (13). It begins with the loss of learned skills
progresses inexorably to a total shutting down of the mind. "It is, unmercifully,
not lethal. Patients go on and on living, essentially brainless but otherwise
healthy, into advanced age, unless luckily enough to be saved by pneumonia
(14)."
There are three important changes that occur in the brains of
Alzheimer's patients. "These changes include senile plaques, neurofibrillary
tangles and granulovaculoar degeneration (Frank 15)."
Lawrence Galton describes "senile plaques as a development in the nerves
of the brain. This is actually a scar, a mark resulting from degeneration,
rather than a cause of it. Senile plaques are multiple small islands of dead
materials containing specific compounds,. . . (8)." Their origin is unknown.
These plaques consists of a chronic infection. "It has been estimated that 80
percent of patients over the age of sixty- five have senile plaques (9)."
However, "Alzheimer's brains have a very heavy concentrated amount of senile
plaques in the hippocampus are of the brain where the normal does not (10)."
Another change that takes place in the brain is the abnormal
neurofibrillary tangles in the nerve cells. A normal nerve cell looks like a
small plant with branches, stem and many roots. "As aging occurs, the roots,
which are called dendrites, begin to shorten and lose some of their structure.
Eventually, the ends of the roots of these dendrites begin to accumulate into a
sort of halio that resembles a small starfish (Cutler 14)." They become thick
and intertwined. Although plaques and tangles appear in normal brains and
gradually increase with the age Alzheimer's patient seems to have highly
concentrated amount in the. . . "hippocampus portion of the brain, that the seat
of memory, the short- term memory (Cutler 24).
The third characteristic that changes in the brain of the Alzheimer's
patient is the "granulovaculor degeneration (Gilling 13)." According to Gold,
certain changes inside the cells themselves are taking place. The interior of
the cell is undergoing changes and become crowed with fluid filled "vacuoles" as
well as granular material. An increased concentration of granulovaculoar
degeneration is also found in the hippocampus area of the brain (82).
The changes in the brain found in Alzheimer's patients are concentrated
in the hippocampus are which also appears to be the "primary anatomic locus of
short- term memory (Gilling 14)." Short- term memory loss may, however, be the
earliest sign of a more catastrophic event occurring in the brain, especially if
forgetfulness is severe and progressive (14).
According to Dr. Siegfried, "The following seven stages are adopted from
the scale measuring Alzheimer's disease that was developed by Drs. Barry
Reisberg, Steven H. Ferris, Mony J. de Leon, and Thomas Crook (22)." Stage one
is "a state of clinical normality (24)." The second stage is the "forgetfulness
stage (24)." This phase is common and usually occurs over the age of forty- five.
One might forget names of well known friends, however, this does not create a
serious handicap for a person working ability. Sometimes the patient is not
aware of what is happening. "In stage three, a mild cognitive decline or an
early conditional state happens (24)." In this stage a person's ability to
remember someone's name after being introduced to them is hampered, also, a
person begins to misplace items and concentration declines." In this stage,
denial symptoms, as well as anxieties, occur. If a person was tested at this
stage it would be impossible to diagnose Alzheimer's disease, especially if
someone was sixty years or older (26)." However, the testing would conclude that
there may be evidence of memory deficiency.
"During the fourth stage, there is an increased cognitive decline (
Cohen 32)." Abnormalities are definitely found during testing. For example,
there might be an inability to continue serial subtraction, to travel, handle
personal finances, and an overwhelming decrease in knowledge of current and
recent events. However, a person will be able to recognize familiar faces and
friends, and there will be no disorientation about where the person is. "In this
stage denial is very strong and complex tasks. . . (32)," which were easy to
perform in the past cannot be done at all. "In stage five the patient cannot
survive without some assistance (32)." People cannot recall their phone numbers
or their addresses. In some cases a person cannot, recall family members' names
or names of schools they attended. There may also be some confusion as to what
day, time or season it is. However, major facts are still retained. Usually, a
patient will know their spouse and sometimes their children and still attend to
their personal needs. "There might be some difficulty in choosing clothes and
shoes (32)." "In stage six there is severe cognitive decline. . . (32)."
Assistance for daily activities is required. The patient may not remember their
spouse's name and has complete unawareness of recent events and experiences.
Past knowledge will be vague in this stage. Night and day become confusing and
the patient may become incontinent. "Amazingly, the patient does remember their
own name and simple daily cleaning activities may take place (Siegfried 28)."
Unfortunately, at this stage delusional and sometimes violent behavior along
with anxiety symptoms and agitation occur due to the inability to carry on a
thought pattern. Stage seven, the most severe stage, the patient may lose their
speech and walking ability. Assistance with feeding is required and bladder
control is lost. "The brain is totally separated from the body. . . (Siegfried
29)." "The patient may survive for a long time in this stage, but will
eventually die from either respiratory arrest or some other organ failure
(Siegfried 30)."
Any one of the stages may continue on for years. There is no certain
time limit on any of the stages, making a hardship on the family unbearable. It
is not known if a person will stay in one stage or progress to another. This
thief of the mind robs a person of their mind little by little, leaving them
with no dignity or identity. A person with no memory can create or reproduce
items that make a full and functioning life as we know it.
I was fortunate enough to have the privilege an experience of
interviewing a good friend of my mom's, Mary, whose mother is a victim of
Alzheimer's disease. She shared with me, some very private and emotional
feelings that her mother, sister, and she experienced and are still experiencing
while confronting Alzheimer's disease. Mary was able to explain, from her point
of view, what it was like caring for a person with Alzheimer's disease.
Mary began by stating, her mother was a fifty- four year old, mother of
two daughters that was losing her mind by the handfuls. It took just six months
time for her mother to go from a vital, radiant and full functioning person to
someone recognizable only in physical form.
The first signs that developed were forgetting phone numbers and
unledgable handwriting. Missing appointments occurred regularly and items began
to get misplaced. Mary's mother would be gone all day and then not remember
where she had gone. The three and four day disappearances were the convincing
data needed to realize something was wrong with her mother.
Her and her sister took their mother to the best neurologist in the
state. She was diagnosed as having Alzheimer's disease. The doctor told Mary and
her sister that in order to understand their mother's behavior, each of them
would have to imagine a woman contemplating losing her mind. The mind will not
tolerate this conclusion, and the result is denial, the question, the constant
question, which are an appeal for some confirming sign that she is not losing
her mind. She cannot retain the answers, and she cannot remember that she had
just asked a question. Basically, Dr. Ruben told the two daughters that their
mother was losing her short- term memory.
Mary's mother continued to change everyday for the worse. She had to
have full time nursing care. The daughters would visit their mother every day,
hoping to spark some kind of response from their mother, however, Mary's mother
just sat and stared at the window.
Finally a good friend of the family talked the daughters into putting
their mother in a home, where people could take care of their mother and give
her some stimulation, which she needed desperately. It was the hardest and most
painful decision the girls had to ever make, but deep down they knew it was the
best decision for all concerned. This horrible disease had robbed their mother
of her self identity and is suffering from the humiliation of having her dignity
wrenched from her.
As our conversation came to a close, I asked Mary if she knew of Dr.
Kevorkian and of his work with the suicide machine. Mary was well aware of Dr.
Kevorkian and his work. She was in full agreement that he did the right thing by
helping Jane Adkins end her life before Alzheimer's did. With tears in her eyes,
Mary stated, I know if my mother would have had the choice like Jane Adkins did
to end her life with dignity, she would have taken the choice (Personal
Interview)."
The treatment for Alzheimer's disease is unknown. Through the efforts of
researchers, worldwide, some of the mysteries of this disease have begun to
unfold. At times tranquilizers can lessen agitation, anxiety, and reduce
incidence of undesirable behavior. "It is a degenerative disease of the brain
(Parke- Davis 6)." "Deficiency of cortical acetylcholine is believed to account
for clinical manifestation of mild to moderate dementia (Cognex 3)."
Cognex is the only drug of choice presently used for treatment of
Alzheimer's patients. "Cognex presumably acts by elevating acetylcholine
concentration in cerebral cortex by slowing the degradation which is released by
enact chelinergic neurons (Cognex 3)."
Approximately "5,600 patients were on clinical trails about 17% were
improved with memories. . ." and " 40% stayed the same no change and about 20%
had been "withdrawn" with adverse reaction (Cognex 4)."
In conclusion, when is memory loss, whether it is great or small, it
takes away the ability to recreate or reproduce to some extent our emotions,
past experiences, thoughts and actions that we take for granted. It gives us far
more then we give it. The mind needs knowledge to keep us functioning and in
return will perform amazing feats for us. Although the cause of Alzheimer's
diseases unknown care, research is ongoing, worldwide. "There is no evidence
that Cognex alters the course of the underlying demeaning process (Cognex 3)."