Introduction
Alzheimer’s disease is a known common cause of loss of mental function that is broadly known as dementia. It is a disease that gradually proceeds in stages that destroy memory, reason, judgment, abstract thinking, and the ability to perform simple tasks. Dementia is a group of symptoms that are often characterized by a decline in intellectual functioning that may interfere with the daily activities and the social interactions of a person. Statistics indicate that Alzheimer’s disease was the underlying cause of more than 83,000 deaths in 2010 and thus identified as the sixth leading cause of death in the US (Tejada-Vera 5). It has been noted that there is no cure for the disease and no proven ways to prevent the onset of the disease as well.
The cause of Alzheimer’s disease is characterized by a complex series of events that take place over a long period of time, eventually resulting in the progressive death of brain tissue. From a pathological perspective, the disease is characterized by an abnormal accumulation of amyloid plaques, the disease-specific proteins and the tangles of neurofibrillary in the brain regions that may be considered vulnerable (Huang and Mucke 1204). The brain is characterized by billions of neurons which are interconnected and depend on chemical neurotransmitters to facilitate communication within the complex network of neurons in the brain. These neurotransmitters are essential for the effective functioning of the brain and the development of brain tissues. In the onset of the disease, the body reacts in a defensive move to stop the deterioration of the brain cells by producing Amyloid, which is a body protein. In the process, the amyloid deposits build up as the body progressively acts in defense. The buildup of the amyloids leads to the accumulation of amyloid deposits, which is referred to as plaques. The plaques cause the brain cells to form tangles as they shrink up. This causes changes in the structure of the brain, in turn leading to the death of brain cells. It also leads to the prevention of the production of neurotransmitters and thus communication within the brain network of neurons is disrupted. Resultantly, it affects the normal brain functioning and progressively affects the cognitive abilities of a person. The internal biological interferences can be elevated by old age and head injuries that may affect the brain biological structure.
Diagnosis
The first symptoms of dementia would include forgetfulness and difficulties in carrying out simple tasks such as word-finding. This means that physical symptoms may not be part of the diagnosis picture until late in the disease progress. The gradual onset of dementia is one factor that characterizes Alzheimer’s disease. However, the clinical manifestation of dementia is subtle and, therefore, the diagnosis of dementia requires an accurate patient history as well as neurological and physical examination (Rowland and Pedley 7). Alzheimer's disease is often diagnosed by exclusion, a procedure in which various tests are performed with the aim of ruling out other definitely known disorders (Medifocus.com 29). In this process, the useful aspect is that the history of the patient can be obtained from family members or caregivers who can help to describe the progression of symptoms. However, the diagnosis cannot be confirmed until death, when pathologic findings come to light at autopsy.
Clinical neurochemical laboratory and biochemical findings can be useful in the identification of the neurodegenerative process of the disease. This can also help to define the preclinical state of the disease. Patients with Alzheimer's disease often show a number of abnormalities on brain imaging that include cortical atrophy and leukoaraiosis, which are frequently reported as evidence of cerebrovascular disease. However, imaging tests cannot be definitively used to identify Alzheimer’s disease because in most cases, by the time of diagnosis of the disease, there is a high probability that a large percentage of the neurons at risk may have already degenerated.
Treatment
There is no definitive cure or treatment for Alzheimer's disease. However, some classes of drugs such as Cholinesterase inhibitors have been approved as agents that treat the cognitive symptoms that characterize the disease. Cholinesterase inhibitors such as galantamine prevent the excess of chemicals in the brain region that is associated with the buildup of the amyloids. Alternative treatment includes surgery and dietary supplements. Dietary supplements such as vitamin D supplements may help the brain cells to defend themselves from attacks. Surgical treatment involves neurosurgery, which is focused on the identification and elimination of the structural pathologies of the brain (Laxton, Stone and Lozano 269). Surgical procedures can be used based on procedures such as electrical neural stimulation and tissue grafting to influence neuronal activities within the brain’s pathological circuit that may be associated with Alzheimer’s disease.
Prognosis
The advancement of Alzheimer’s disease is described by a steady deterioration in cognitive abilities, which is often evident in cognitive function tests. However, some of the characteristics may be linked in similarity to aging factors that may also limit the cognitive abilities. For individuals who have the disease, it begins with an insidious onset of dementia followed by a more or less downhill course where the cognitive abilities continue to deteriorate. Usually, the mean length of time from the insidious onset of dementia to death may range from 5-8 years (Savva et al. 2302). For older individuals, the onset of dementia may be further elevated due to aging factors and this means that the older individuals may die sooner than younger individuals after the onset of the disease.
Ethical Issues
In dealing with Alzheimer’s disease, ethical issues emerge in early and severe stages. The major ethical issues in the early stages lie in the aspect of the diagnostic disclosure. The process of diagnostic disclosure is complicated since it does not involve the simple transmission of information from the patient to a doctor or vice versa. The complexity lies in the aspect of trust. When presenting information to a patient with less knowledge about the disease, the conversation may bring confusion and despair, especially in regard to the fact that there may be no certain cure for the disease. There are physicians and care providers who may fear to tell the truth to the patient about the disease condition because of the fear that it may be distressing to the patient and this may make it difficult to manage the disease. In addition, the diagnosis of the disease may restrict the autonomy of the patient (Growdon 869). This is because the patients with the disease may be limited to participate in everyday activities such as driving because of their brain condition.
In the severe stages of the disease, the ethical issues lie in the aspect of ending life care and enrolling in research. In the aspect of ending life care, certain care/medical decisions have to be made to prolong life. However, the ethical concerns are raised because, in most cases, the decisions made about the treatment will determine the circumstances and time of the individual’s death (Berlinger, Jennings and Wolf 1). These decisions will shape the experience of an individual in the remaining life and can conflict with individual autonomy. It also means that some of the decisions made may be unclear, especially when the patient has his or her wishes that contradict the care decisions made by the medical professionals. In addition, research into the condition and progression of the disease often involves the patients. However, it is not simply a straightforward matter particularly in regard to the aspect of individual consent and autonomy. Medical professionals will in most cases engage patients in the research process sometimes without their consent. This raises important ethical issues as the health care sector seeks to understand the disease more in relation to the autonomy of the patients.
Conclusion
Alzheimer’s disease that is characterized by dementia is one that is challenging in many aspects. From the analysis above, it may be safe to assume that the disease is one that can be confused with everyday cases of forgetfulness. This complicates the problem of the disease because early onset may be assumed as either being something that is normal due to aging. To clinicians, the provision of care for patients may be complex because cases might be presented to them in severe stages. Although numerous researches into the treatment and care provision strategies for patients are underway, there are ethical issues that come up that may limit research processes and in turn make management of the disease in future just as complex as it is today. An important aspect that has been overlooked in the clinical field is the possibility of recognition of the tangles in the brain due to the buildup of the amyloids that characterize the disease 10 years before any cognitive changes are eminent (Growdon 868). This means that early screening of individuals is arguably one of the most effective ways to facilitate effective management of the disease. In the meantime, extensive research is warranted in regard to Alzheimer’s disease.
Works Cited
Berlinger, Nancy, Bruce Jennings and Susan M. Wolf. The Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life. 2nd ed. New York: Oxford University Press, 2013. Print.
Growdon, Matthew E. "Ethical Issues in the Early Diagnosis of Alzheimer Disease." American Journal of Ethics-Virtual Mentor 13.12 (2011): 868-872. Web.
Huang, Yadong and Lennart Mucke. "Alzheimer Mechanisms and Therapeutic Strategies." Cell 148.6 (2012): 1204-1222. Web.
Laxton, Adrian W., Scellig Stone and Andres M. Lozano. "The Neurosurgical Treatment of Alzheimer's Disease: A Review." Stereotactic and Functional Neurosurgery 92.5 (2014): 269-281. Web.
Medifocus.com, Inc. Staff. Medifocus Guidebook On: Alzheimer’s Disease. Silver Spring, MD: Medifocus.com, Inc., 2011. Print.
Rowland, Lewis, P. and Timothy A. Pedley, eds. Merritt’s Neurology. Philadelphia, PA: Lippincott Williams & Wilkins, 2010. Print.
Savva, George, M., Stephen B. Wharton, F.R.C. Path, Paul G. Ince, Gillian Forster, Fiona E. Matthews and Carol Brayne. "Age, Neuropathology, and Dementia." The New England Journal of Medicine 360.22 (2009): 2302-2309. Web.
Tejada-Vera, Betzaida. Mortality from Alzheimer's disease in the United States: Data for 2000 and 2010. National Center for Health Statistics Data Brief, no. 116. Hyattsville, MD: National Center for Health Statistics, 2013. Web.
