Alzheimers
SymptomsThere are three stages when Alzheimers develops, the early,
the intermediate and the late (or severe)
stage. In the early stage the most striking symptom
is loss of recent memory, such as a car key that is lost or glasses that cannot
be found, or the date that cannot be remembered and family members or colleagues
at work are constantly asked about these things. New information cannot
be retained, word retrieval is becoming a problem. There are personality changes
and mood swings, which make it socially very difficult for the person afflicted
with the disease to be accepted. At this stage, if formal testing of cognitive
functioning is done, loss of abstract thinking and proper judgment and some changes
in affect and behavior would be noted. In
the intermediate stage memory and learning are even
more affected, but not completely lost. This leads to frequent episodes where
the patient gets lost wandering around and is not finding his way back home, or
where the patient does not find the bedroom or bathroom. Without supervision the
Alzheimers patient could not function on his/her own at this stage. At this stage
sense of time and place is also lost. There is a loss of sensitivity to the cues
that normally help a person to get oriented. Patients stay ambulatory, but as
a result of confusion and lack of memorizing the space around them, they are at
risk for falls and accidents.In the late stage of Alzheimers disease debility
increases to the point where the patient often cannot walk any more. The ability
to take care of the activities of daily life is lost. Bladder and bowel control
might get lost completely. The patient has become a chronic care home patient.
24-hour supervision is needed as often the diurnal wake/sleep cycle is also greatly
disturbed. At this late stage the Alzheimers patient
is often turning mute and the doctor cannot rely on any verbalization of symptoms.
This makes it more difficult for the physician to know when the patient is sick.
For instance, with swallowing problems that are much more common at that stage
there is a good possibility that the patient would aspirate and get aspiration
pneumonia. However, if none of the staff have noticed what was going on, the patient
may just become more debilitated, but otherwise not have many symptoms as all
symptoms of any illness are more blunted with late Alzheimers disease. The physician
must therefore rely more on auscultation, secondary signs such as mild fever or
an increased heart rate. Auscultation would detect decreased air entry and abnormal
auscultatory findings. A chest X-ray can then be ordered and the pneumonia would
be detected and treated. In
the end stage of Alzheimers disease there will often
be a masked medical problem, such as a gallstone that perforates, a silent heart
attack, a stroke, a hidden fracture from an unwitnessed fall, all with atypical
presentations.
From there it is only a small step to a coma (=unconsciousness)
and eventual death. Often there are also hidden infections from the urinary tract,
from undiagnosed diverticulitis, from chronic bed sores, from infected gums or
undiagnosed yeast (Candida) infections that can lead to Candida septicemia. Any
of these infections in an Alzheimers patient are life threatening and often lead
to death because of the weakened immune system. Other factors to consider:
on the one hand Alzheimer patients are difficult to predict in their behavior
as there can be anger outbursts, psychiatric symptoms of depression, anxiety or
psychosis depending in which way the brain reacts.
Management of
the Alzheimer patient is further complicated by the fact that the patient is very
sensitive to drug toxicity and drug interactions. Over prescribing should be avoided,
even though it might be tempting to calm an agitated patient down with antipsychotics
or tranquilizers. However, many of these medications including some of the over
the counter medications such as antihistamines, have anticholinergic side-effects
leading to Parkinson disease like conditions including a worsening confusion.
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