Alzheimers Disease and Family - Article Example

Alzheimer's disease and family members [name of the author] [Department name and section number of course] [Name of the supervisor and date] related literature The review of related literature covers various information on Alzheimer’s disease basically involving discussion of nine articles equally divided from three various sources i.e. medical journals, public health journals and communications journals. Information from these literatures is concisely presented to provide a good literature background about the disease as well to find similarities and differences in the article’s views or presentation of Alzheimer’s disease. A. Literature from Medical Journals 1. Review and discussion of information The article from the New England Journal of Medicine talks about the early onset of Alzheimer’s disease written by Claudia H. Kawas, M.D. The clinical problem of Alzheimer’s disease is the major factor in cases of dementia. It is said that the disease develops into dementia especially for patients diagnosed with mild case of cognitive impairment. The risk is higher after the age of 65 years old. Kawas cited the National Institute of Neurologic and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association in establishing the criteria for onset of Alzheimer’s disease in a patient which said that “the cognitive loss must have an insidious onset and gradual progression” (Kawas, C. , 2003:1058) which means that the person’s ability to perceive has been affected dangerously resulting to changed behavior through the years. Thus, it is important to note the history of the patient’s actions to be able to determine the symptoms of Alzheimer’s disease. Diagnosis should be aided by an in depth neuropsychological evaluation of the patient. Management of patients with Alzheimer’s disease includes prescribing mild medications which usually include sleeping pills, anti-anxiety medication and over-the-counter medications for sleep and cold symptoms. The Food and Drug Administration (FDA) approved the use of Cholinesterase inhibitor, an effective drug for the treatment of mild to moderate Alzheimer’s disease (Kawan, C., 2003). Antioxidants is another pharmacological treatment that helps reduce the production of free radicals in patients with Alzheimer’s disease that usually cause damage to the brain. Clinician’s judgment is a crucial factor in determining the dosage and length of treatment of symptoms of the disease. Also, safety precautions are important in managing patients with Alzheimer’s disease particularly in supervising the daily activities of the patient including driving, handling of household appliances or simply wandering around the neighborhood. People with Alzheimer’s disease tend to forget how to do these things and might eventually harm themselves. The second article reviewed was about the use of memantine in moderate to severe Alzheimer’s disease (Reisberg, B., Doody, R., Stoffler, A., Schmitt, F., & Ferris, S., Mobious, H.,2003). There is still no known cure for cognitive and functional capacity impairments of patients with advance stages of Alzheimer’s disease wherein patients are continuously distressed which becomes a burden to caregivers. This study tested the effect of memantine in the treatment of such stage of the disease. N-methyl-D-aspartate or NMDA is a brain receptor stimulated by the neurotransmitter glutamate which affects Alzheimer’s disease. Memantine is an antagonist to the NMDA-receptor which can assist in the therapy of patients with Alzheimer’s disease. It was administered to 252 patients’ ages 50 years old with clinically diagnosed Alzheimer’s disease within a 28 week period across 32 centers in the United States of America. The study showed the patients taking memantine showed better results in terms of cognition, function, and behavior. Thus, concluding that “antiglutamatergic treatment reduced clinical deterioration in moderate to severe Alzheimer’s disease” (Reisberg, B. et al, p.1333.). The third article talks about the result of a randomized trial on using estrogen replacement therapy for treatment of women beset with Alzheimer’s disease in its mild to moderate stage (Mulnard, R., Cotman, C., Kawas, C.,Van Dyk, C., Sano, M., Doody, R., Koss, E., Jin, S., Garnst, A., Grundman, M., Thomas, R., & Thal, L., 2000). The controlled study composed of 120 women with mild to moderate Alzheimer’s disease covering 32 sites in the USA showed that estrogen did not slow down the progression of the symptoms of the disease as well as showed no changes in the “global, cognitive, or functional outcomes in women with mild to moderate Alzheimer’s disease within one year” (Mulnard, R. et al., 2000:1007). Thus, there is no evidence to support the role of estrogen in the treatment of women with mild to moderate Alzheimer’s disease. 2. Conclusion The literatures discussed above from three medical journals are similar in a sense that majority of the information discuss the use of inhibitor drugs such as memantine and cholinesterase to effectively treat the symptoms of Alzheimer’s disease, hence improving cognitive ability of the patient. On the other hand, the articles differ in addressing the levels of Alzheimer’s disease as well as the population type being addressed in the study conducted. The first two articles address the first onset and mild to moderate level of Alzheimer’s disease respectively. Also, these articles addresses the general population affected by the disease which is 65 years old and above while the last article targeted the discussion to women affected by the disease. It should be noted, though, that the first article provided a concise background about the disease that helps in understanding the presentations of the succeeding articles from the various journals. All of the articles from the medical journals, however, address the concern of improving the cognitive, functional and behavioral abilities of persons with Alzheimer’s disease. B. Public Health Journals 1. Review and discussion of information Zick, et al looked into the impact of genetic testing of Alzheimer’s disease on the behaviors of individuals in purchasing long term-care insurance (2005). A total of 162 adults with one parent suffering from Alzheimer’s disease located in three cities in the USA participated in the study. The results of the study showed that participants who are more likely to suffer Alzheimer’s disease in the future based on positive results of their genetic testing are more likely to make changes in their long-term care insurance (Zick., et al, 2005:486). This result have implications on policy related to insurance coverage particularly on the concern of insurers that keeping the results of genetic testing from them could result to inaccurate actuarial calculation of insurance premiums and face amounts subsequently leading to the non-profitability of the insurance market. On the other hand, releasing genetic testing results to insurers would result to higher amount of insurance premiums and lower face amounts of long term care insurance for this type of population. Lindsay, et al (2002) conducted a study in Canada on the risk factors for Alzheimer’s disease wherein approximately 4,000 participants aged 65 years old participated in a two tier study conducted in 1991 and 1996. The study found that “increasing age, low educational level, and APOE4” (Lindsay, et all, 2002: 449) are highly associated to high incidence of Alzheimer’s disease. On the other hand, “arthritis, regular use of NSAIDs, wine consumption, coffee consumption and regular physical activity were associated with reduced risks (page 449). APOE4 stands for apolipoprotein E4 allele while NSAIDs stands for no steroidal anti-inflammatory drugs. This result insinuates that socio demographic and economic condition can partly be considered as factors for high risk of Alzheimer’s disease while lifestyle can lessen its risks. Fuller, et al (2007) discussed various studies that presents the potential of androgen replacement therapy in improving the cognition ability of males with low levels of androgens particularly testosterone. Testosterone is the major androgen among males and is very important in cognition. However, it decreases gradually during the middle adult life of men, a stage known as Androgen Decline in Aging Males or Andropause. Due to its important relation to cognition, low levels of androgen can also be associated with Alzheimer’s disease. In fact, one study identified low levels of androgen as directly related to higher risk of vascular dementia which bring into focus the importance of Androgen Replacement Therapy to improve cognition in vascular dementia patients (Fuller, et al, 2007:103). Consequently, patients with Alzheimer’s disease are known to have low testosterone levels which is said to occur before the disease even start. Thus, Androgen Replacement Therapy is considered as a necessary preventive measure against Alzheimer’s disease. 2. Conclusion The three literatures discussed above are similar in nature in the sense that it discusses the importance of socio-economic as well as genetic factors associated to high or low risk with Alzheimer’s disease. Further, it can be related towards the role of public policies towards addressing Alzheimer’s disease as a national agenda in every country instead of limiting it as a natural medical phenomenon within the household. The article on genetic testing sharing as having direct impact to the long term care insurance industry requires public policy intervention to find a balance between the needs of the insurer and the insured. Consequently, identifying socio economic conditions and lifestyles as direct factor to advance and decrease the risk of onset of Alzheimer’s disease is a good information that could help governments in identifying programs to improve social and economic reforms particularly access to education as a preventive measures in addressing Alzheimer’s disease. The role of lifestyle changes and diet in curving the onset of the disease is good information that can help establish advertising strategies to create awareness in the prevention of Alzheimer’s disease. Consequently, the information that levels of testosterone plays an important role in preventing the disease is also important to incorporate awareness among middle adult men to have themselves constantly monitoring their androgen levels as a preventive measure for Alzheimer’s disease. C. Health Communications Journals 1. Review and discussion of information The Regional Health Forum of World Health Organization considered the emerging importance of Alzheimer’s disease (Vas, C., Rajkumar, S., Tanyakitpisal, P, & Chandra, V) wherein it dispelled the various myths and misconceptions about the disease. It reiterates that Alzheimer’s disease is not a normal phase of old age and a person beset by it can seek medical help just by recognizing the signs and symptoms of the cognitive and functional behaviors of a person. Alzheimer’s disease, though, should not be related to slight forgetfulness which is common during old age. It reiterates, though, that Alzheimer’s disease commonly causes dementia. Connel, et al designed a multi-media educational outreach to disseminate information about Alzheimer’s Disease by putting up health kiosks via the “Michigan Interactive Health Kiosks Project” as cited in Upfront (Meltzer,2003:1). This project provides the public easy access to information related to the disease at the same using interactive multi-media is beneficial due to fast changing information on the disease as a result of various studies conducted on it. Kiosks put up in various key locations within the State increases access to information about Alzheimer’s disease and will help enlighten the public on its prevention, treatment and management. The key steps in implementing this project is recruiting a public figure to publicly lead the information dissemination as well as applying feedback mechanisms from target audience. On the other hand, Clark, et al examined the association of the blood levels of serum total homocysteine and its determinants such as folate and vitamin B12 to Alzheimer’s Disease using a controlled study participated by 164 patients with average age of 55 years old clinically diagnosed with Alzheimer’s Disease. The study concluded that “low levels of folate and vitamin B12 and elevated levels of serum total homocysteine were associated with Alzheimer’s disease” (Clarke, et al, 1998:1449). This signifies that these three biological components in the body should be well balanced to prevent the onset of Alzheimer’s disease or even manage it effectively. 2. Conclusion The above articles are similar in a way that their contents can be used as a tool for an effective information dissemination campaign to increase the awareness of Alzheimer’s disease and its prevention, treatment and management. Thus, putting higher importance to the disease. The article of the World Health Organization, in particular, puts importance to understanding Alzheimer’s disease in every parts of the world so that people will not be complacent in accepting it as just part of the normal aging process. Instead, it emphasize on the importance of getting treatment to alleviate the symptoms of the disease as well as become aware of the preventive measures in its onset. The organization has a wider audience and outreach, thus its message of giving importance to the disease in an international context opens further investigation or studies into the disease to enable the world to understand it better and manage it effectively. It addresses the concern on the macro level by putting it in an international context. On the other hand, the article on putting up interactive multi-media kiosks in Michigan is a micro or domestic approach to disseminate information towards the public about Alzheimer’s disease. However, if you look at it the vehicle that these two articles are benchmarking on to reach out to people’s awareness of the disease is by using a method of popularity to accelerate dissemination of information. The former uses its institutional political and international popularity in the field of world health while the latter uses the popularity of individuals to benchmark the acceleration of the campaign to further elicit awareness and usage of the kiosks. On the other hand, the third article providing information on the correlation of serum blood levels and other forms of vitamins in combating the onset of Alzheimer’s disease is powerful information to equip in its depth information dissemination both at the domestic and international level. Overall, the nine articles or literatures reviewed share some facets of information and perspectives. Although, some information might look different from each other but by looking at it thoroughly, one can see the connection among information from these articles. Further, all of these articles showed the potential of providing treatment to Alzheimer’s disease and that studies are continuously being conducted to help the public understand its treatment and management better, hence giving hopes to people that eventually its incidence can be curved in the long run. References 1. Kawas, C. H., M.D. (September 11, 2003). Early Alzheimer’s Disease. The New England Journal of Medicine. Volume 349: 1056-1063, Number 11. 2. Reisberg, Barry M.D., Doody, Rachelle M.D., Ph.D., Stöffler, Albrecht M.D., Schmitt, Frederick Ph.D., Ferris, Steven Ph.D., Möbius, Hans Jörg M.D., Ph.D.. Memantine in Moderate to Sever Alzheimer’s Disease. The New England Journal of Medicine. April 3, 2003, Volume 348:1333-1341 Number 14. 3. Mulnard, R., Cotman, C., Kawas, C.,Van Dyk, C., Sano, M., Doody, R., Koss, E., Jin, S., Garnst, A., Grundman, M., Thomas, R., & Thal, L. Estrogen Replacement Therapy for Treatment of Mild to Moderate Alzheimer’s Diseases: A Randomized Controlled Trial. Journal of the American Medical Association, February 23, 2000, Volume 283(8): 1007-1015. 4. Zick, C., Mathews, Charles, Scott Roberts, J., Cook-Deegan, R., Pokorski, R., and Green, R. Genetic Testing for Alzheimer’s Disease and Its Impact on Insurance Purchasing Behavior. March/April 2005. Health Affair’s Journal, Volume 24, Number 2. 5. Lindsay, J., Laurin, D., Verreault, R., Hebert, R., Helliwell, B., Hill, G., & Mcdowell, I. Risk Factors for Alzheimer’s Disease: A Prospective Analysis from the Canadian Study of Healtha and Aging. May 9, 2002, Volume 156 Number 5. 6. Fuller, S., Tan, R. and Martins, R. Androgens in the Etiology of Alzheimer’s Disease in Aging Men and Possible Therapeutic Interventions. Journal of Alzheimer’s Diseases. 2007 Volume 12:129-142. 7. Vas, C., Rajkumar, S., Tanyakitpisal, P, & Chandra, V. Alzheimer’s Disease: Of Emerging Importance. Regional Health Forum World Health Organization South East Asia Region, September 2006, Volume 6, Number 1. 8. Connel, Shaw, Holmes, Hudson, Derry and Stretcher. The Michigan Interactive Health Kiosks. Cited in Upfront Section of Journal of Health Communications, 2003 Volume 8:5-10 9. Clarke, R., Smith, D., Jobst, Kim, Refsum, H. Sutton, L. and Ueland, P. Folate, Vitamin B12, and Serum Total Homocysteine Levels in Confirmed Alzheimer’s Disease. Journal Watch Psychiatry, November 24, 1998. Volume 55-1449-1455. Read More