Misty VanderPloeg
Professor Staab
Psychology
April 28, 2012
Prolonging the Inevitable
Alzheimer’s disease was named after a German neuropathologist and psychiatrist by the name of Aloysius Alzheimer who is credited with identifying two symptoms of the disease; amyloid plaques and neurofribrillary tangles in the brain. It is important to understand that Alzheimer’s disease is not a type of dementia; it is simply a disease that causes dementia. Alzheimer’s disease is an incurable progressive disease that can take up to twenty years to advance, but typically takes between eight to ten painful years for the Alzheimer’s sufferer and their family. Christian Nordqvist author of What is Alzheimer’s Disease? What Causes Alzheimer’s Disease? states that “During the course of the disease plaques and tangles develop within the structure of the brain. This causes brain cells to die. Patients with Alzheimer’s also have a deficiency in the levels of some vital brain chemicals with are involved with transmission of messages in the brain – neurotransmitters” (1). The disease is typically broken down into three common stages that people experience: mild, moderate, and severe. As well as the duration, the length of each stage can vary depending on the person, as Rosemary Blieszner and Peggy A. Shifflett confirm in their article The effects of Alzheimer’s Disease on Close Relationships Between Patients and Caregivers, “This disease is very unpredictable in terms of duration and nature of symptoms, with some patients living many years after the onset” (58). Every person that is diagnosed with Alzheimer’s disease needs to be treated individually for that reason. Each case is different and sufferers need to be treated with respect to their unique needs throughout the entire duration of their painfully frustrating disease.
Alzheimer’s disease is extremely common and affects millions of people all over the world, so it is very possible that someone you love and care for could eventually be diagnosed with the disease. Dennis J. Selkoe, author of The Aging Mind: Deciphering Alzheimer’s Disease & Its Antecedents, insists “ Alzheimer’s disease is still the most common neuropatholoical basis for late-life dementia in the United States and most developed countries” (62). If you have any suspicion that there may be a decline in a loved one, there are many symptoms that you can look for in order to start treatment. As stated earlier, there is no cure for Alzheimer’s at this time so it is important that a loved one starts medical treatment in the earliest stages of the disease. Although a person can have Alzheimer’s for years before any recognizable symptoms occur, if one starts to notice that there is an increase in memory loss and difficulty with performing activities they are familiar with, a doctor should be consulted in order to start the proper care. There are several new medicines that have been developed to slow the disease process during the three stages of Alzheimer’s. There are two types of common pharmacological treatments: cholinesterase inhibitors and memantine. According to Nordqvist, cholinesterase inhibitors “improve the levels of neurotransmitters in the brain,” and memantine is medication that “protects brain cells from damage caused by glutamate, a chemical messenger” (11,12). One medication, Aricept, is approved to treat all stages, where other cholinesterase inhibitors, such as Razadyne and Exelon, are only approved to treat mild and moderate Alzheimer’s disease. Axura, Akatinol, Namenda, Ebixa, and Memox are examples of memantive medications and are only approved for moderate to severe Alzheimer’s disease. Like with all medications, people tolerate them differently, so it is important to find the medication that works best for you. If you have any severe side effects, your doctor should be notified and medication should be stopped immediately.
Once a person is diagnosed with Alzheimer’s disease, there is a vast adjustment that has to be made by the Alzheimer’s sufferer, but mainly their caregiver. Usually, during the mild and even, in some cases, moderate stages, caregivers are usually spouses and/or family members that stay with the person to help them with their activities of daily living (ADL’s), but as the disease progresses from mild/moderate into severe, caregivers usually become exhausted and in many cases start to have medical problems of their own, so they have to make the hard decision to move their loved one into a residential care center. Though it is hard for the caregiver to follow through with the life changing decision, I believe it is even harder for person who is already suffering and frustrated with remembering ADL’s, to be moved into an unfamiliar facility with unfamiliar faces that change on a regular basis. The amplification of frustration and fear must be unbearable for these people.
Working as a Certified Nurse’s Aide, I have had the opportunity to take care of several Alzheimer’s patients, so once I become one of their caretakers, I feel that it is very important for me to understand the disease and all that it entails. Although they are moved into a facility, they are usually fairly high functioning and can still do quite a few of their ADL’s, so this is an important time for you to get to know them and understand their likes and dislikes, which helps you develop a trusting relationship for when their memory deteriorates further to where they don’t know you, but they recognize your familiar face. According to Alzheimer’s Association, “ For the person, it is important to focus on preserving quality of life and dignity. He or she should always be treated with compassion and respect” (alz.org). This seems like a simple concept, but for some people that take care of Alzheimer’s residents, they feel that if they don’t remember, they don’t need the care and compassion. You develop relationships with these people and you take care of them as if they were part of your family. This is important, especially in long term care facilities that you develop a caring relationship since there is a very good possibility that you will be taking care of your Alzheimer’s resident for many years.
As the stages progress, the care changes and can often times become very challenging for you and your Alzheimer’s resident both. This is the reason why I discussed the types of medication that are available and what stages of Alzheimer’s they are approved for. I completely support medicating early stages of the disease. Treating and slowing problems related to memory, thinking, language, and judgment are essential at Alzheimer’s onset. Nordqvist states, “Experts believe cholinesterase inhibitors may delay or slow worsening symptoms by about six to twelve months” (11). This is an amazing achievement in medicine, but as the disease progresses into its later stages, the quality of life that Alzheimer’s sufferers have to endure on a daily basis must be agonizing, so at this point I do not understand medicinal treatment. Serious consideration by family members and the primary physician about continued use of medication.
My question is at what point should these cholinesterase inhibitors and memantine medications be stopped? At what point are they hurting these Alzheimer’s patients instead of helping? Every day I go to work I wonder why these patients have to take medication to prolong the amount of time of being fed when they don’t want to be, given a bath when they thought they just had one, and urinary and bowel incontinence, just to name a few. It especially bothers me when they are allowed to wander aimlessly all night and day. I know that that is part of the disease, but when they are wandering in other resident’s rooms, where do their rights end and the other residents begin? Personally, I believe this is when Alzheimer’s medication should be discontinued. I know I would not want to live that way any longer than I had to. At this point, there is a possibility that the medication may not be working anyway. Sidney T. Bogardus, Jr. in his article When should one stop cholinesterase inhibitor in patients with Alzheimer’s disease? emphasizes, “One of the challenges in using these medications is that it is extremely difficult to tell in individual cases whether the medication is helping” (1). Once medication is started there is really no way that an accurate analysis can be done since medications react differently with every person and there are no tests to see how fast or slow the disease is progressing.
At the point when Alzheimer’s residents reach a stage that their life has no quality, doctors and all other people involved with their medical treatment, need to put their selves in the resident’s position. They need to think about what kind of care they would want and if they would want to prolong the agony. Not being able to remember might have some benefits, but everything that goes along with it is very painful and frustrating. Alzheimer’s Association suggests, “aggressive medical treatment may feel like torture to an individual who is in unfamiliar surroundings and does not understand the intentions of the care providers.” If only medical providers would take this seriously. Maureen Dezell and Carrie Hill, Ph.D., authors of The Middle to Late Stages of Alzheimer’s agrees that “medical care for people with advanced Alzheimer’s should concentrate on daily care and comfort, not treatments that will cure illness or prolong, life” (Netplaces.com)
In my opinion, doctors do not treat geriatrics with respect. It is almost like they are forgotten and that should never be the case with anyone. This is the time in their life when they need a strong support system and caregivers that actually care. Alzheimer’s can be a very long and painful disease, that with the correct medication can be slowed on onset when functioning is high, but once the disease has progressed into the later stages when there is no quality of life, a decision should be made to do what is best for the resident.

Works Cited
Blieszner, Rosemary, and Peggy A. Shifflett. “The Effects of Alzheimer's Disease on Close Relationships between Patients and Caregivers.” Family Relations.39.1 (1990): 57-62. JSTOR.Web. 29 Apr. 2012.

Bogardus, Jr., Sidney T. “When should one stop cholinesterase inhibitors in patients with Alzheimer’s Disease?” Journal of Psychiatry &Neuroscience. 26.5 (2001) n.pag. Web. 29 Apr. 2012.
Dezell , Maureen, and Carrie Hill, Ph.D. “The Middle to Late Stages of Alzheimer’s.” Netplaces.com. The New York Times Company. N.d. Web. 29 Apr. 2012.
Nordqvist. “What Is Alzheimer’s Disease? What Causes Alzheimer’s Disease?” Medical News Today. Medilexicon, Intl., 31 Jul. 2009. Web. 29 Apr. 2012.

Selkoe, Dennis J. “The Agind Mind: Deciphering Alzheimer’s Disease & Its Actecedents.”Daedalus.The MIT Press/American Academy of Arts & Sciences. 135.1 (2006) 58-67. JSTOR. Web. 29 Apr. 2012.