Alzheimer’s disease (AD) is the most common neuro-degenerative brain disorder. It affects 5.2 million Americans and 25 million people worldwide. By 2050, it is predicted that there will be an estimated 16 million Americans with AD. It is imperative for those who are involved in caring for people with AD to understand as much as possible about the disease and disease process in order to provide the best care possible for their patient.
Professionals who are typically involved in AD care include, but are not limited to: physicians, physician’s assistants, nurse practitioners, social workers, geriatric care managers, and care givers. Given the complexity of the disease, it is crucial for each member of the care team to have a clear understanding of the nature of the disease, progression, fluctuation and overall management.
In the beginning or mild stage of AD, patients are initially not aware of occasional forgetfulness, and this can go unnoticed by patients, family members and even healthcare providers. However, patients with more information on early detection are able to get help when it is most effective. Some patients go through a period of denial and blame their failing memory on aging or stress factors.
More than just the memory is affected in AD; other cognitive functions such as speech, word finding, judgment and problem solving are also affected. Typically, the primary caregiver will begin the search for help when it’s apparent that there is significant cognitive decline.
We live in a culture that views forgetfulness as a normal part of aging. Some physicians might miss the early warning signs. Others may feel that since AD it is an incurable disease, treatment is futile. As physicians, we need to build an alliance with patients and their caregivers in order to address relevant issues. These include medication management as well as addressing behavioral issues such as sleep disturbance, eating difficulties, weight loss, agitation, paranoid delusions, hallucinations and inter-current illnesses (i.e. urinary tract infections and pneumonia).
Although, the medications currently approved for the treatment of AD have only modest effect, research has shown that these drugs do in fact help improve the overall quality of life for patients.
There are demonstrated improvements in behavior, personality and cooperativeness when these medications are initiated. Evidence also proves that the earlier the treatment is initiated, the more robust the benefits.
Primary care physicians and geriatricians see approximately 85% of the patients with AD. Neurologists and psychiatrists see the remaining 15%. As the first line of caregiving defense, primary care physicians and personal caregivers should learn and utilize all available resources and research to help provide a comprehensive care plan that allows for the best quality of life for both the person with AD and their caregiver.
M. Reza Bolouri, MD
Alzheimer’s Memory Center