04 Castro – Dementia

Michelle CastroPSY 417 / 418December 2, 2018 DementiaThe current life expectancy for the average US resident is 78 years old. A number that has unexplainably increased over the years. Although the increase in longevity is a positive outcome, the downside is that more people are at risk for experiencing dementia which is still the 6th leading cause of death in the United States as of 2018. It is said stated that “1 in 3 seniors dies with Alzheimer’s or another dementia. It kills more than breast cancer and prostate cancer combined (Alzheimer’s Association, 2018). With increase in number of people comes increase in cost and hospice care. In 2018, the direct costs to American society of caring for those with Alzheimer’s will total an estimated $277 billion, including $186 billion in Medicare and Medicaid payments (Alzheimer’s Association, 2018). It is mentioned to be one of the costliest conditions to society and a lengthy illness to experience. A growing number of people are experiencing the unfortunate circumstances that comes with knowing someone with dementia which includes memory loss and limitedrecognition. Between 2000 and 2015 deaths from heart disease have decreased 11% while deaths from Alzheimer’s have increased 123% (Alzheimer’s Association, 2018). While dementia can be found in different forms the most common types of dementia include Alzheimer’s disease, Frontotemporal disorders and Lewy body dementia. Plassman et al. (2007) estimated that over 2.5 million Americans suffered from Alzheimer’s disease (AD) and that nearly 4 million had that and other forms of dementia in 2002. Given expected increases in the size of the older adult population, those numbers are expected to increase strikingly by 2050 (Alzheimer’s Association, 2009). Biochemical With high increase of dementia comes the question of what happens to the brain and body. Although many of us refer to the condition as severe memory loss, the biochemical aspects of dementia are much more complex. Alzheimer’s is thus far is one of the most researched categories that falls under dementia. As mentioned in an article called Biochemical Aspects of Dementia, <improper citation – use author’s name(s) and date of publication, not the name of the article> from a genetic point of view, AD may be subdivided into three forms according to the observed mode of inheritance: first, autosomal –dominant familial AD; second, familial AD without clear mendelian inheritance (familial aggregation); and third, sporadic AD without familial aggregation (Hock, 2018). Of these three types of Alzheimer’s disease conditions, it is said to most likely be inherited from a family member. Biochemical Aspects of Dementia continues to say that:These cases are caused by mutations in the genes encoding amyloid precursor protein (APP, located on chromosome 21), presenilin 1 (PSEN1, chromosome 14), and presenilin 2 (PSEN2, chromosome 1). In other cases, a different familial aggregation can be observed: relatives of AD patients show increased risk of developing dementia compared with relatives of healthy control subjects without clear autosomal-dominant inheritance (Hock, 2018). This type of familial aggregation may be due to shared genetic or environmental risk factors within families. Finally, the major proportion of AD cases is, however, sporadic, which is defined as the absence of evidence for familial aggregation. This group is nevertheless influenced by so-called susceptibility genes that confer a minor genetic risk associated with allelic variations in the form of single nucleotide polymorphisms (Hock, 2018). Research for such biochemical findings in this article was done with hamster ovary cells:The functional impact of fibrillar Aβ peptides was demonstrated by Walsh et alt. in a series of experiments using APP V717F Chinese hamster ovary cells. Intracerebroventricular microinjection of conditioned medium of these cells containing sodium dodccyl sulfate (SDS)–stable Aβ oligomers resulted in marked reduction in long-term potentiation (LTP) in the hippocampus, a measure of synaptic plasticity. Possibly, the formation of a pore-like morphology by Aβ protofibrils resembling cytolytic pore-forming toxins from bacteria plays a role in Aβ-mediated neurotoxicity. These experiments strongly suggest that Aβ aggregation drives the pathology of AD (Hock, 2018). Block quotes—which I asked you NOT to use—should be single-spaced, and include the page number of the quote. In simpler terms different types of dementia are associated with different types of brain cell damage in particular regions of the brain. For example, in Alzheimer’s disease, high levels of certain proteins inside and outside brain cells make it hard for brain cells to stay healthy and to communicate with each other. The brain region called the hippocampus is the center of learning and memory in the brain, and the brain cells in this region are often the first to be damaged. That’s why memory loss is often one of the earliest symptoms of Alzheimer’s (Alzheimer’s Association, 2018). What brain regions are affected by Alzheimer’s and in what progression?Research methodsStudies for a leading cause of dementia have not yet been found. Although many try to research what ultimately causes dementia, there is still very limited amount of information to work with. The idea that old age is also a factor restricts for solid ideas. An article on Dementia and Its Implications for Public Health suggests longitudinal research has revealed that between 23% and 47% of adults aged 75 and older were initially dementia free but manifested “ageing associated cognitive decline (Chapman et al., 2006). Researching the brain can be complex and brain imaging has not given researchers any concrete answers. On the other hand, there are some ways to detect if someone has dementia. One way of analyzing for dementia is the MMSE –this is a clinical instrument, not a research method which is a common way of testing for dementia. It’s popular because it only takes 5 – 10 minutes and doesn’t require any equipment or special training for doctors or nurses. The test has 30 questions, each worth 1 point. These questions test memory, orientation, and math skills (Daily Caring Editorial Staff, 2018). Even though the MMSE is widely used, it is still very inconsistent. The Daily Caring website mentions in an article of testing for dementia:The MMSE can’t be used alone to diagnose Alzheimer’s or dementia because the majority of questions test only memory and recall. Someone who knows what day it is, what a certain object is, or who can remember a short list of random things could do well on the test. But that doesn’t mean they don’t have dementia. Some types, like Lewy body dementia, affect judgement far more than memory (Daily Caring Editorial Staff, 2018). block quote – single spaced – should also have used a peer-reviewed academic sourceThe grading scale for the MMSE is based on points which identify the intensity of memory loss. Many of the interviews and assessments can be misinterpreted with old age. Due to the lack of inconsistency in some responses, longitudinal research is best. Other complicating factors that contribute to dementia can include: physical injuries, brain injuries, limited education, depression, language-barriers, etc. Physical conditions like sleep apnea which can cause memory or other cognitive problems are also a possibility.What about brain imagery (structural & functional), blood tests—there is a reliable genetic marker for AD— postmortem brain examination etc.PsychologicalSome of the common characteristics of someone with dementia includes depressive symptoms, delirium, mild cognitive impairment, etc. Sometimes we encounter these senior citizens in our local neighborhoods, which seem to be completely unaware of who they are and where they are. It is quite easy to determine if someone has dementia due to the very noticeable characteristics of unawareness. Being that dementia can spread into different categories, they each affect the brain differently. When dealing with Alzheimer’s disease Dementia and Its Implications for Public Health suggest that: Depression, insomnia, incontinence, delusions, and hallucinations may be manifest as the disease progresses, as may neurologic signs including sudden muscle contraction and gait disturbance. Because its initial presentation is subtle, information provided by someone close to the individual with mild AD may be vital to its early recognition. Impairments in recall of items on the Mini-Mental State Examination and names of relatives, difficulty with calculation (such as balancing a checkbook or maintaining household finances), making repetitious statements, getting lost while driving, and exhibiting poor judgment are among the constellation of symptoms associated with early AD (Chapman et al., 2006). Another block quote!!! It is truly unfortunate to know someone with dementia. In more extreme cases < in all advanced stages of the disease progression>, some may forget who their family members are making visitations and interactions very hard on the family. The article also mentions some psychological functions that are caused by Alzheimer’s disease which decrease the thought process:Characteristic brain pathology of AD includes the presence of neurofibrillary tangles (interweaving’s of filaments within the body of the nerve cell [neuron]) and plaques indicative of neuron degeneration. Degeneration is particularly prominent among neurons that release the neurotransmitter acetylcholine. Abnormalities in the transport of glutamate, the chief excitatory neurotransmitter in the brain, may also underlie the development of AD (Chapman et al., 2006). Block quote #4 – incomplete & taking up unnecessary space – this also belongs in the bio sectionAnother form of dementia called is called vascular dementia which accounts for a great number of people in itself. As mentioned each type of dementia can affect its own region causing different types of psychological impairments. In Dementia and Its Implications for Public Health they refer to this type of dementia as: Vascular dementia has been estimated to account for 15% to 20% of all dementias among older adults and is precipitated by some form of cerebrovascular disease. Most commonly, blockage of blood vessels in the brain yields the death of tissue, or infarction, in the affected region. Infarction underlying dementia may involve a single, strategic blood vessel or numerous smaller ones (multiple infarct dementia). Incomplete and incorrectly formatted block quote. You should have paraphrased all of the information from your block quotes. None of these quotes are important enough to have been directly quoted.Traditionally, VD <rarely is vascular dementia referred to as VD> has been characterized by sudden onset, stepwise progression, and focal neurological deficits associated with the region of the brain affected.When dealing with frontotemporal dementia we see the regions of the brain governing planning, social behavior, and language perception, frontotemporal dementia (FTD) includes the syndrome commonly referred to as Pick’s disease (Chapman et al., 2006). Unlike other forms of dementia Picks disease is seen earlier than most, making the average presentation age of 75 unlikely. <this statement is oddly out of context – no prior reference has been made to 75 as an average age of onset for any dementia, and suggests that this might have been directly copied (plagiarized) from the original source, rather than paraphrased> FTD may also include progressive deterioration of language function. Older adults with FTD may present with difficulties in word usage, precipitating reading and writing impairments that may culminate in mutism (Chapman et al., 2006). Lewy body dementia is yet another subcategory of dementia. As its name implies, Lewy body dementia is characterized by the presence of Lewy bodies <which are???> , proteins in the cerebral cortex which governs thought processing and brain stem which coordinates movement. Lewy bodies are also common among individuals with Parkinson’s disease (Chapman et al., 2006). All these different types of dementia can begin to look alike but there are differentiating factors that makes them different. <they do NOT look alike—there have different clinical histories & presentations and imagery—some of which you do touch on next> When taking a look at Alzheimer’s and Lewy body dementia we see that although its clinical presentation may be similar to that of AD, individuals with LBD can be distinguished from individuals with AD by marked cognitive fluctuations, prominent hallucinations, and the presence of parkinsonism (Chapman et al., 2006). Social/ Environmental It is unfortunate to see such an enormous number of increases in dementia. The numbers of caregivers and hospice care is also increasing with the population. Raising both the cost and limiting space for everyone in need. Our environment is definitely changing as we are experiencing higher life expectancy rates. Dealing with dementia is never easy and an article called Quality of Hospice Care for Patients with Dementia refers to it as:Caring for patients with dementia poses significant challenges to hospice providers because their needs may differ from those of other hospice patients and they may be less able to communicate their symptoms or provide information on symptom improvement following treatment (Albrecht et al., 2013). #6-see previous comments re block quotesIt is indeed a tough job when you consider the multiple factors such as depression, lack of cognitive awareness, anger, delirium, insomnia and many more. Those who develop a more severe type of dementia are unable to communicate and express themselves which can strain a relationship between caregiver and patient. Accommodations to the environment have to be made accordingly as a person with dementia can easily get lost or confused at any given time. An article called Creating a Supportive Environment using Cues for Wayfinding in Dementia states that environments such as senior residential buildings (independent living residences, assisted living residences, and skilled nursing facilities) are particularly challenging for wayfinding due to the design of long double-loaded corridors with equally spaced doors, a lack of distinctiveness of different areas of the buildings, and poor environmental cues (Passini et al., 2000). The environment is key when establishing these new senior housing and nursing homes. Those who still have their mobility can easily get lost and confused with the structure of the environment. The article Spatial Cognition and the Human Navigation Network in AD and MCI refers to this idea as the encoding of cognitive maps is highly dependent upon the hippocampus, which is in the medial temporal lobe of the brain. Changes within the hippocampal formation and related structures occur with age and with Alzheimer’s disease (Deipolyi et al., 2007). Influencing FactorsConsidering the many characteristics that come with dementia, it is unfortunate to see that a cure hasn’t been found. There are so many ideas as to what increases your chances of dementia from predisposed conditions to hereditary factors and old age. There is still not enough research to fully understand its origin. Research is limited to the active brain and post-brain activity doesn’t give us much information. Accommodations for our elderly population are very limited and dementia is only increasing. A great statement from the Alzheimer’s Association states: “Alzheimer’s disease, frontotemporal dementia, dementia with Lewy bodies, and prion diseases are age-related neurodegenerative disorders associated with a progressive decline of cognitive brain functions. Due to the increase in prevalence rates, and the rising costs associated with clinical and social care, treatments designed to prevent or reverse these diseases are urgently needed. The most common major biochemical characteristic of these neurodegenerative diseases is the deposition of abnormal protein aggregates in brain. The decryption of the mechanisms of aggregation and associated neurotoxicity may reveal new therapeutic targets, which will enable treatment for these devastating conditions” (Alzheimer’s Association, 2018). #7!The future of dementia is only escalating, and it would be great to see changes in the environmental aspect and in its research methods approach. If brain imaging isn’t sufficient I am hopeful for the many clinical trials that are being tested in hopes of finding better medication. Although a cure would be ideal, an alternative to slow down the disease would be equally helpful. The rate from which the disease seems to grow is part of what makes the disease such an unfortunate circumstance to experience both as an individual and an acquaintance. ReferencesAlbrecht, J. S., Gruber-Baldini, A. L., Fromme, E. K., McGregor, J. C., Lee, D. S., & Furuno, J. P. (2013). Quality of hospice care for individuals with dementia. Journal of the American Geriatrics Society, 61(7), 1060-5.Chapman, D. P., Williams, S. M., Strine, T. W., Anda, R. F., & Moore, M. J. (2006).Dementia and its implications for public health. Preventing chronic diseaseCoriat, I. H. (1911). The clinical and psychopathological aspects of dementia praecox. The Journal of Abnormal Psychology, 5(6), 361–364.https://doiorg.libproxy.csudh.edu/10.1037/h0068915DailyCaring. (2018). Testing for Dementia: The Mini Mental Status Exam – DailyCaring. https://dailycaring.com/testing-for-dementia-the-mini-mental-status-exam/Davis, R., & Weisbeck, C. (2016). Creating a Supportive Environment Using Cues for Wayfinding in Dementia. Journal of gerontological nursing, 42(3), 36-44.Deipolvyo, A. R, K. P. Rankin, L. Mucke, B. L. Miller, M. L. Gorno-Tempini (2007)Spatial cognition and the human navigation network in AD and MCINeurology. 69 (10) 986-997Hock, C. (2003). Biochemical Aspects of dementias. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181716/ Norton, S. Matthews FE, Barnes Det al. (2014). Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data. Lancet Neurol 2014;13:788–93.Plassman, B. L., Langa, K. M., Fisher, G. G., Heeringa, S. G., Weir, D. R., Ofstedal, M. B., Wallace, R. B. (2007). Prevalence of dementia in the United States: The Aging, Demographics, and Memory Study. Neuroepidemiology, 29, 125–132. S, Mitchell, S.H Ridley, R.M Sancho, M, Norton (2017) Journal of Public Health, Volume 39, Issue 4, 1 December 2017, Pages e275–e281, https://doi.org/10.1093/pubmed/fdw103What Is Dementia? (n.d.). Retrieved from https://www.alz.org/alzheimers-dementia/what-is-dementia

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