DOWNLOAD PDF CURRENT PERSPECTIVES IN THE DIAGNOSIS AND TREATMENT OF ALZHEIMERS DISEASE

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1 Chapter 1 : Alzheimer's disease: Symptoms, stages, causes, and treatment Alzheimer's treatments - learn about drug and non-drug treatments that may help cognitive and behavioral symptoms of Alzheimer's and other dementias. Get information and resources for Alzheimer's and other dementias from the Alzheimer's Association. The full terms of the License are available at http: Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Information on how to request permission may be found at: Abstract Uncertainty appears to typify the experience of living with dementia. With an uncertain illness trajectory and unpredictable levels of deterioration and stability in symptoms, people with a diagnosis of dementia may live with uncertainty and anxiety and find it hard to make plans or decisions for their future. People with memory problems and caregivers seeking a diagnosis of dementia may also potentially find themselves navigating a labyrinth-like maze of services, practitioners, assessments, and memory tests, with limited understanding of test scores and little information about what support is available. This review distinguishes four meanings: Examples of these approaches are presented from UK dementia services with illustrations of existing care pathways and associated time points, specifically focusing on: We review the evidence around these themes, as well as discuss service pathways and referral routes used by some services in England and internationally. The growing numbers of people with dementia worldwide have recently attracted global interest â the World Alzheimer Report predicted worldwide estimates of 36 million people living with dementia in, doubling every 20 years to 66 million by and to million by As a consequence of these two trends, governments have expressed their commitment to sharing systematic approaches for preventing, diagnosing, and treating dementia and have developed national plans to achieve nationally specific aims. National dementia plans or strategies generally detail ambitions to promote timely identification and to provide effective interventions and support for people with dementia and their caregivers. Enabling and improving access to diagnosis and support appear in the national plans of Australia, England, France, the Netherlands, and Canada albeit with varying emphases, while those of Norway, USA, Finland, and Republic of Korea discuss clarifying existing pathways and referral routes. Shared policy goals include removing barriers to access and establishing clear care pathways and referral routes. Living with dementia is often reported as being beset with confusion and anxiety, from when individuals or family members begin to get worried about their memory problems or difficulties managing daily life, and then deciding to seek help for this. In the current context of encouraging individuals to set out advance care plans and to be explicit about their health and care preferences, many people with dementia and their family members, may appreciate a clearer picture of the prognosis and timelines to know when to make plans or when care and support need to be increased. Examples of these approaches are presented from UK dementia services. Over the last 30 years, the idea of a critical or care pathway has been used in different health settings. The terms care pathway, critical care pathway, clinical pathway, integrated care pathway ICP, or care map may suggest slightly different approaches, but overall they may be used interchangeably to systematically plan patient care, to modify or vary it, and organize follow-up. In this review we use the term care pathway as a general term, except when another term has been used in a document we use the original term. The aim of a care pathway is to enhance the quality of care across the continuum by improving risk-adjusted patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources. An overview on the history and concept of care pathways as complex interventions. International Journal of Care Pathways. Fragmented care pathways cannot exist. Unsurprisingly, the impression of clarity and certainty as suggested by a pathway is attractive to patients. However, a care pathway in dementia is not straightforward. Most health systems and health and care facilities determine their own service criteria, and even the referral routes to specialist care may vary considerably. Person-centered care and professional discretion, the guiding principles of good quality dementia care, complicate the suggestion of a care pathway as a unified approach. Page 1

2 In particular, individuals are likely to prefer different approaches to how they are assessed, referred, and diagnosed, 10 and they often have many other long-term conditions which impact on what they do and think about dementia symptoms. Globally, national dementia strategies have routinely stressed the importance of clear dementia pathways to support patients and caregivers as they seek a diagnosis of dementia. For instance, while the English strategy prioritizes timely diagnosis and reducing stigma, the Australian focus is on strengthening primary care and counseling support for people with dementia. These care pathways may be shared with potential patients in order to help them understand the assessment and diagnostic process. They may also be an effective way of organizing billing or reimbursement systems, and patient involvement here may be limited. One further development in dementia and other mental health services has been the ICP. This implies going beyond health services to cover other agencies supporting people with dementia. In Scotland, for example, the ICP mentions local government, and not-for-profit and profit-making services, as well as health services Healthcare Improvement Scotland Table 2. Reproduced from Integrated care pathways for mental health [webpage on the internet]. Accessed October 14, ICP, integrated care pathway. A further and important development in the UK has been the controversy over one particular care pathway, which had great relevance to people with dementia and their caregivers. The Liverpool Care Pathway was phased out, and at July it no longer exists. Time points along dementia care pathways There appear to be similar time points along most dementia care pathways, although there are some key differences. The NICE pathway also encourages postdiagnostic support such as promoting choice, maintaining independence, and supporting caregivers. This might be seen as a form of guided consumerism with messages about eligibility and expectations within it. Similarly, the Dementia Services Pathway produced by the Australian government 17 also includes end-of-life care in dementia, thereby depicting the care pathway not just as a route into services, but as a pathway throughout life with dementia. Taken together, the main points along a dementia care pathway from an individual perspective have been constructed as a linear route along services for a person seeking a diagnosis for their memory problems or similar difficulties and as an aid to clinicians. In an uncertain condition, the aim appears to be greater clarity for all. After all, there is wide variation in presenting symptoms of dementia, there is limited value of memory loss as an indicator of dementia, there are poor correlations between pathological changes in the brain and behavior, there is difficulty in separating depression and dementia at the beginning, and there is much variation in life expectancy following diagnosis. A lack of research evidence about the actual experiences of pathways means that we do not know how the idealized version of a care pathway is followed in practice or its outcomes, but understanding the points along this pathway may be a helpful analytical tool. For the purpose of this review, we outline four common points along dementia care pathways and the evidence behind them: Early symptom identification and first service encounters Assessment process Postdiagnostic support and appropriate interventions. Early symptom identification and first service encounters The global drive to timely identification and assessment of memory problems has led to widespread campaigns to raise the awareness of early symptoms to encourage people to seek help, the value of which was recently debated. Memory problems are the most common reasons cited for people seeking help themselves, 6, 10, 22 â 26 although trigger events can also often be emergency care, hospitalization, or bereavement. Studies have found that for multiple reasons doctors can be slow or reluctant to refer for specialist care, 34, 35 although not all have found this to be the case. The NICE dementia pathway is a good illustration of the clinical judgment and decision-making processes around diagnosis and assessments as it contains detail about tests that should be conducted and those that are not to be routinely undertaken. The primary care physician or General Practitioner GP is acknowledged as having a crucial role to play in facilitating access to this service. In a recent study, most GPs interviewed said they used the Map of Medicine pathway, yet data from the local Pathways Audit showed that many patients were referred without having undergone the steps set out in the Map of Medicine. Large reviews have also often missed this crucial aspect 3 as they tend to focus on early symptom recognition and the impact of the diagnosis and miss the role of the assessment process and the importance of it not promoting problems. We conducted one of the few Page 2

3 studies 5, 10 in this area and interviewed people moving from the state of having memory problems to receiving a diagnosis of dementia. Patients and caregivers were often dogged by long waiting times, and few knew where to turn for further information and advice, a finding replicated in later studies. Few were aware of what outcomes of tests would denote, and scores were meaningless to them. In light of the challenges of supporting people with learning disabilities, some clinicians have developed a pathway for referrals and part of this is designed to ensure appropriate information is gathered to aid the assessment of people with learning disabilities when dementia is suspected. Clinicians are recommended to use this to guide their practice and to document the assessment and diagnosis process. Diagnostic disclosure or communication The manner in which a diagnosis of dementia is communicated to the patient and the support offered at this time may be crucial in how people cope with the condition long-term. The process of diagnostic disclosure needs to be handled with skill, forthrightness, sensitivity, patience, and a person-centered approach. There appears to be growing public expectation that all diagnoses of dementia bring entitlement to medication, potentially resulting in disappointed expectations. Studies have also found consistently high demand for advice, social networks, and community and peer support. The Dementia Roadmap, http: Assess and identify patients who present with symptoms suggestive of dementia. Promote positive messages about remaining independent and living with dementia. This can help to prevent unnecessary admission to hospital for patients with memory problems in crisis. Provide support for carers caregivers to maintain their health and well-being and provide opportunities for respite for the person they care for local information about respite availability and criteria. Refer patients to specialist services where appropriate. Keep accurate records, coding patients who present with memory problems appropriately. Use case finding approaches with colleagues to identify patients with cognitive decline on the GP practice register. Reproduced from Dementia Roadmap [webpage on the Internet]. Although multidisciplinary teams are variable in their arrangements in the UK, the roadmap is intended to encourage integrated working between practitioners through better information sharing and delegation of powers to other social services and providers. These can be accessed via the Dementia Roadmap platform available from http: For researchers there is a need to carefully describe the content, purpose, and understandings of a pathway as well as considering its possible impacts. This review of care pathways suggests the risk of seeing them as presenting clarity in an otherwise labyrinth-like system or that there is a linear route into services. Overall, the notion of a pathway appears to be so enticing because patients, caregivers, and professionals themselves may be unaware of what to expect, when and from whom, or simply what to do. Waiting and watchfulness appears to be common for all those who encounter people with symptoms of dementia or who experience such symptoms, again with little certainty about timescales of prognosis or support, and so a pathway may offer hope that there is and will be clarity and continuity of care. Implementation questions about pathways remain, as well as fundamental questions about their suitability for people who are likely to be frail. For people with dementia with multimorbidity, there is a further complication of being under several possible pathways. In the UK context the links between pathway adherence and reimbursement are not well developed, and these may be the next step of pathway development in dementia care. There remains a need for more research in this area, because although studies have explored the different stages of dementia and how patients and caregivers experience these, robust evidence of the outcomes of care pathways as a whole and the effectiveness of these is required. However, the views expressed in this article are those of the authors and not necessarily those of the Department of Health. The authors have no known conflicts of interest in this work. World Alzheimer Report Policy Brief for Heads of Government: The Global Impact of Dementia â Psychosocial factors that shape patient and carer experiences of dementia diagnosis and treatment: From forgetfulness to dementia: Br J Gen Pract. The transition to dementia â individual and family experiences of receiving a diagnosis: The care pathway concept: International Journal of Integrated Care. What is an integrated care pathway? Int J Geriatr Psychiatry. Page 3

4 Chapter 2 : Alzheimer's disease - Diagnosis and treatment - Mayo Clinic Current Alzheimer's medications can help for a time with memory symptoms and other cognitive changes. Two types of drugs are currently used to treat cognitive symptoms: Cholinesterase inhibitors. It involves plaques and tangles forming in the brain. Symptoms start gradually and are most likely to include a decline in cognitive function and language ability. People can have more than one type of dementia. Other assessments may include a blood or urine test, a CT or MRI scan of the brain, and screening for depression. What is your age? What is the time, to the nearest hour? What is the year? What is the name of the hospital or town we are in? Can you recognize two people, for example, the doctor, nurse, or carer? What is your date of birth? In which year did a well-known historical event happen? Count backward from 20 down to 1 Repeat an address at the end of the test that I will give you now for example, "42 West Street" A number of assessment tools are available to assess cognitive function. Genetic testing In some cases, genetic testing may be appropriate. Using this test early could indicate the likelihood of someone having or developing the disease. However, the test is controversial, and the results are not entirely reliable. The death of brain cells cannot be reversed. However, there are therapeutic interventions that can make it easier for people to live with the disease. Cholinesterase inhibitors that are approved for symptomatic relief in the U. Donepezil Aricept Rivastigmine Exelon Tacrine Cognex A different kind of drug, memantine Namenda, an NMDA receptor antagonist, may also be used, alone or in combination with a cholinesterase inhibitor. Other therapy The need for quality-of-life care becomes more important as the person becomes less able to live independently. It is a neurodegenerative disease, which means there is progressive brain cell death that happens over time. The plaques are found between the dying brain cells, and they are made from a protein known as beta-amyloid. The tangles occur within the nerve cells, and they are made from another protein, called tau. Researchers do not fully understand why these changes occur. Several different factors are believed to be involved. You can access it here. Risk factors Unavoidable risk factors for developing the condition include: Page 4

5 Chapter 3 : Alzheimer disease: MedlinePlus Medical Encyclopedia 1 Khachaturian ZK: Perspectives on Alzheimer [s Disease: Past, Present and Future, In Hampel H, Carrillo MC (eds:) Biological Diagnosis and Treatment of Alzheimer's Disease. Drug treatments If you are prescribed a drug for dementia, treatment is usually started by a specialist doctor. Specialist doctors who see people with dementia include psychiatrists, geriatricians and neurologists. Once treatment has been started, it may be continued and monitored either by a specialist or by your GP. These drugs work by increasing the amount of a chemical called acetylcholine that helps messages to travel around the brain. Cholinesterase inhibitors do not prevent the disease from progressing, but may help people to function at a slightly higher level than they would do without the drug. They may see an improvement in thinking, memory, communication or day-to-day activities. Others may not notice an effect. The drugs may have side-effects in some people. The most common are feeling or being sick, being unable to sleep, having diarrhoea, muscle cramps or tiredness. Not everyone will have side-effects. Memantine does not stop the disease from progressing but can help with some symptoms. Some people taking memantine may not notice any effect at all. Others may find that their condition stays the same when they would have expected it to decline. People may experience side-effects when taking memantine. The most common side-effects are headaches, dizziness, drowsiness and constipation. These are usually short-term effects. Your doctor will advise on the best treatment and may prescribe both a cholinesterase inhibitor and memantine. This is sometimes called combination therapy. They are often group-based, with an emphasis on enjoyment. The activities might include games, group discussions or practical tasks such as baking. You can discuss your options with your doctor. Talking therapies, such as cognitive behavioural therapy CBT and counselling, can help with symptoms. They provide an opportunity for people to talk about their concerns with a specialist and develop different ways of coping, thinking and behaving. A doctor should carefully consider what may be appropriate. This helps to identify any causes or triggers, such as pain, another health problem, or something in their surroundings that distresses or angers them. Complementary therapies, such as aromatherapy, dance or music therapy, may also be considered. In some cases, antipsychotic drugs such as risperidone Risperdal may be used to relieve symptoms, especially if someone is very distressed or at risk of hurting themselves or others. These drugs are not suitable for everyone and may have serious side-effects. Page 5

6 Chapter 4 : Films Media Group - Alzheimer's Disease: A Current Perspective on the Research and Treatme Treatment of behavioral and psychological symptoms of dementia in Alzheimer's disease. Noncognitive neuropsychiatric symptoms or behavioral and psychological symptoms of dementia (BPSD) are common in all clinical stages of AD and even in amnestic mild cognitive impairment (MCI) (the predementia stage of AD) with increasing prevalence when dementia progresses. Information from references 21 through It is reasonable to discontinue treatment if there is no improvement within six to eight weeks. Therapy may be restarted if symptoms worsen after the medication is tapered, because acetylcholinesterase inhibitors may be more effective for symptomatic control than previously recognized. A Cochrane review concluded that memantine at a dosage of 20 mg per day over six months slightly improved cognition 3 points on the SIB and ability to do activities of daily living 1. The effect on cognition was statistically significant in patients with mild to moderate dementia 1 point on the ADAS-cog but is unlikely to have clinical significance. A small reduction in agitation was seen in patients taking memantine. Seventeen patients with moderate to severe Alzheimer disease would need to be treated for six months to prevent one episode of agitation. One study randomized patients taking donepezil for moderate to severe Alzheimer disease to receive 20 mg of memantine or placebo every day for 24 weeks. Another study evaluated the effectiveness and safety of 20 mg of memantine per day for 24 weeks in patients already taking donepezil, rivastigmine, or galantamine for mild to moderate Alzheimer disease. The lack of adverse effects was consistent with findings in other memantine monotherapy studies. A once-daily extended-release formulation of memantine was approved by the U. Food and Drug Administration in June A Cochrane review analyzed 17 double-blind, randomized, placebo-controlled trials evaluating selegiline at a dosage of 10 mg per day for the treatment of Alzheimer disease. The authors concluded that cognition improved at four to six weeks in some trials; however, there were no differences after six weeks. No differences in adverse effects were noted compared with placebo. Currently, there is not enough evidence to recommend selegiline for the treatment of Alzheimer disease. Food and Drug Administration for the treatment of Alzheimer disease, although they are commonly used to treat behavioral symptoms. Evidence suggests that olanzapine Zyprexa and risperidone Risperdal reduce aggression, and risperidone reduces psychosis in patients with Alzheimer disease. Patients were randomized to receive olanzapine, quetiapine Seroquel, risperidone, or placebo for up to 36 weeks. There were no clinically or statistically significant differences in functioning, care needs, or quality of life between patients taking antipsychotics and those taking placebo. Some clinical symptoms improved, such as anger, aggression, and paranoia. Patients taking olanzapine experienced worsening functional ability at week 12 compared with those taking placebo. A small randomized, double-blind, placebo-controlled trial failed to demonstrate effectiveness of quetiapine or rivastigmine for treatment of agitation in patients with Alzheimer disease in care facilities after 26 weeks. Older patients with dementia who are treated with atypical antipsychotics have a twofold higher mortality rate than those taking placebo. Other common adverse effects of antipsychotics include gait disturbances and extrapyramidal effects. Using atypical antipsychotics to treat behavioral symptoms such as agitation in patients with Alzheimer disease generally should be avoided because of adverse effects, although these agents may be appropriate in some situations. Page 6

7 Chapter 5 : Alzheimer's disease treatments Treatment of Alzheimer's Disease Current treatment approaches focus on helping people maintain mental function, manage behavioral symptoms, and slow or delay the symptoms of disease. In the News. Serious mental decline is not a normal part of aging. View a dementia definition and epidemiology statistics, including healthcare costs. Learn about amyloid plaques, neurofibrillary tangles, and neuron anatomy. Inflammatory processes may also play a role. Learn about pre-dementia or mild cognitive impairment MCI, early, moderate, and advanced stages. Diagnosis and Evaluation Diagnosis includes cognitive and family histories, mental status and neurological examinations. Learn about diagnosis criteria and neuroimaging techniques, including advantages and disadvantages. Treatment Options and Management Planning Psychosocial interventions include behavioral, emotion-oriented, and cognition-oriented treatments. Hundreds of compounds are being studied in clinical trials. Current treatment research focuses on amyloid beta reduction, neuroprotective agents, general cognitive enhancers and ultrasound and non-pharmaceutical treatments. Amyloid Beta Reduction Early human trials of the AN vaccine showed some efficacy. Improved imaging and biomarkers increase probability of identifying at risk individuals and monitoring the immunotherapy response. Clinically available agents include ACIs, memantine, and antioxidants. Cognitive Enhancing Drugs Adverse reactions lead to high drop-out rates. Human brains are more complex and the skull is thicker; stronger ultrasound could damage healthy brain tissue. It promotes non-amyloidogenic cleavage of the amyloid precursor protein, enhances amyloid beta-peptide clearance and reduces neuronal damage. Hear high-dose, long term clinical trial results. Competing hypotheses include genetics, cholinergic, amyloid, tau, and environmental factors. They affect amyloid beta processing or production. Acetylcholinesterase inhibitor drugs prevent acetylcholine breakdown, increasing neural cell function. However, cholinergic system disruption may be a disease consequence, rather than a cause. An updated version suggests an amyloid-related mechanism pruning neuronal connections may be triggered later in life. Recent research shows multiple pathologies contribute to AD. Oxidative stress may be involved; learn about antioxidant therapy. Dietary risk reduction factors are similar to those for heart disease. Hear toxic chemicals and metals inducing neuroinflammation and contributing to AD. Finding study participants remains an impediment to progress. A Current Perspective on the Research and Treatment Part 2 For additional digital leasing and purchase options contact a media consultant at press option 3 or sales films. Page 7

8 Chapter 6 : Alzheimer's Disease: A Current Perspective on Research and Treatment [PDF]Free Current Perspectives In The Diagnosis And Treatment Of Alzheimers Disease Satellite Symposium To The 5th International Symposium On Advances In Alzheimers Disease Therapy Insaat Geneva April Dementia Geriatric Cognitive Disorders S download Book. Physical and neurological exam Your doctor will perform a physical exam, and is likely to check your overall neurological health by testing your: Reflexes Ability to get up from a chair and walk across the room Sense of sight and hearing Coordination Balance Lab tests Blood tests may help your doctor rule out other potential causes of memory loss and confusion, such as thyroid disorders or vitamin deficiencies. Mental status and neuropsychological testing Your doctor may conduct a brief mental status test to assess your memory and other thinking skills. In addition, your doctor may suggest a more extensive assessment of your thinking and memory. Magnetic resonance imaging MRI. An MRI uses radio waves and a strong magnetic field to produce detailed images of your brain. MRIs are used to rule out other conditions that may account for or be adding to cognitive symptoms. A CT scan produces cross-sectional images slices of your brain. Positron emission tomography PET. The tracer may be a special form of glucose sugar that shows overall activity in various brain regions. However, these new PET techniques are generally found in research settings or in clinical trials. In special circumstances such as rapidly progressive dementia or very young onset dementia, a cerebrospinal fluid examination may be performed. Another important goal is to detect the disease before it causes the symptoms. New tools under investigation include: Two types of drugs are currently used to treat cognitive symptoms: The improvement is modest. Cholinesterase inhibitors can improve neuropsychiatric symptoms, such as agitation or depression, as well. Commonly prescribed cholinesterase inhibitors include donepezil Aricept, galantamine Razadyne and rivastigmine Exelon. The main side effects of these drugs include diarrhea, nausea, loss of appetite and sleep disturbances. In people with cardiac conduction disorders, serious side effects may include a slow heart rate and heart block. Side effects may include constipation, dizziness and headache. But some medications should only be used with great caution. For example, some common sleep medications â zolpidem Ambien, eszopiclone Lunesta and others â may increase confusion and the risk of falls. Anti-anxiety medications â clonazepam Klonopin and lorazepam Ativan â increase the risk of falls, confusion and dizziness. Always check with your doctor before taking any new medications. See if your doctor can simplify your medication regimen to once-daily dosing, and arrange for your finances to be on automatic payment and automatic deposit. Develop the habit of carrying a mobile phone with location capability so that you can call in case you are lost or confused and people can track your location via the phone. Make sure regular appointments are on the same day at the same time as much as possible. Use a calendar or whiteboard in the home to track daily schedules. Build the habit of checking off completed items so that you can be sure they were completed. Remove excess furniture, clutter and throw rugs. Install sturdy handrails on stairways and in bathrooms. Ensure that shoes and slippers are comfortable and provide good traction. Reduce the number of mirrors. Keep photographs and other meaningful objects around the house. Activities such as a daily walk can help improve mood and maintain the health of joints, muscles and the heart. Exercise can also promote restful sleep and prevent constipation. They may also forget to drink enough, leading to dehydration and constipation. High-calorie, healthy shakes and smoothies. You can supplement milkshakes with protein powders available at grocery stores, drugstores and discount retailers or use your blender to make smoothies featuring your favorite ingredients. Water, juice and other healthy beverages. Avoid beverages with caffeine, which can increase restlessness, interfere with sleep and trigger a frequent need to urinate. Request an Appointment at Mayo Clinic Clinical trials Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease. Lifestyle and home remedies Study results have been mixed about whether diet, exercise or other healthy lifestyle choices can prevent or reverse cognitive decline. Regular exercise, especially cardiovascular exercise, has Page 8

9 known benefits for heart health and may also help prevent cognitive decline. Exercise may also help improve mood. A diet low in fat and rich in fruits and vegetables is another heart-healthy choice that also may help protect cognitive health. Social engagement and intellectual stimulation may make life more satisfying and help preserve mental function. Some of the treatments that have been studied recently include: Omega-3 fatty acids in fish may help prevent cognitive decline. This herb comes from turmeric and has anti-inflammatory and antioxidant properties that might affect chemical processes in the brain. Ginkgo is a plant extract containing several substances. However, study results have been mixed, with only some showing this benefit. Further research into the safety of 2, international units daily of Vitamin E in a dementia population will be needed before it can be routinely recommended. Make sure you understand the risks and benefits of everything it includes. A calm and stable home environment can help reduce behavior problems. New situations, noise, large groups of people, being rushed or pressed to remember, or being asked to do complicated tasks can cause anxiety. Feelings of anger and guilt, stress and discouragement, worry and grief, and social isolation are common. Preparing for your appointment You may decide you want to talk to your doctor about memory loss or other cognitive changes, or you may seek care at the urging of a family member who arranges your appointment and goes with you. Here are some suggestions to help you get ready for your appointment and understand what to expect from your doctor. What you can do Be aware of any pre-appointment restrictions. When you make your appointment, ask if you need to fast for blood work or if you need to do anything else to prepare for diagnostic tests. Write down all of your symptoms. Make notes about some of the most important examples of forgetfulness or other lapses you want to mention. Do you have trouble finding your keys, or have you found your keys in the freezer? Try to remember when you first started to suspect that something might be wrong. If you think your difficulties are getting worse, be ready to explain why. Take along a family member or friend, if possible. Hearing from a relative or trusted friend can help your doctor learn the extent of your difficulties. Having someone along can also help you recall the information provided during your appointment. Make a list of your other medical conditions. Make a list of all your medications, including over-the-counter drugs and vitamins or supplements that you take, as well as the dosage of each medication. Questions to ask your doctor Writing down a list of questions can help you make the most of your appointment. Is my degree of memory change normal for someone my age? What tests do I need? Can you help me get a plan in place for ongoing care? What treatments or programs are available? How effective are these treatments? What are the possible side effects? Are there any clinical trials of experimental treatments I should consider? How will my disease likely progress over time? Will my new symptoms affect how I manage my other health conditions? Do you have any brochures or other printed material I can take home with me? What websites and support resources do you recommend? What to expect from your doctor Your doctor is also likely to have questions for you. Being ready to respond may free up time to focus on any points you want to talk about in-depth. Your doctor may ask: What kinds of memory difficulties and mental lapses are you having? When did you first notice them? Are they steadily getting worse, or are they sometimes better and sometimes worse? Have you stopped doing certain activities, like managing finances or shopping because these activities were too mentally challenging? Do you feel any sadder or more anxious than usual? Has anyone expressed unusual concern about your driving? Have you noticed any changes in the way you tend to react to people or events? Do you have more energy than usual, less than usual or about the same? What medications are you taking? Are you taking any vitamins or supplements? Do you drink alcohol? Have you noticed any trembling or trouble walking? Page 9

10 Chapter 7 : Perspectives Of Nanoneurotechnology For Diagnosis And Treatment Of Alzheimers Disease The present study aims to conduct a review of the epidemiology, pathophysiology, symptoms, diagnosis and treatment of Alzheimer's disease, emphasizing the research and development of new therapeutic approaches. Thyroid disease Vitamin deficiency CT or MRI of the brain may be done to look for other causes of dementia, such as a brain tumor or stroke. Sometimes, a PET scan can be used to rule out Alzheimer disease. The only way to know for certain that someone has Alzheimer disease is to examine a sample of their brain tissue after death. Treatment There is no cure for Alzheimer disease. The goals of treatment are: Slow the progression of the disease although this is difficult to do Manage symptoms, such as behavior problems, confusion, and sleep problems Change the home environment to make daily activities easier Support family members and other caregivers Medicines are used to: Slow the rate at which symptoms worsen, though the benefit from using these drugs may be small Control problems with behavior, such as loss of judgment or confusion Before using these medicines, ask the provider: What are the side effects? Is the medicine worth the risk? When is the best time, if any, to use these medicines? Do medicines for other health problems need to be changed or stopped? Someone with Alzheimer disease will need support in the home as the disease gets worse. Family members or other caregivers can help by helping the person cope with memory loss and behavior and sleep problems. It is important to make sure the home of a person who has Alzheimer disease is safe for them. Support Groups Having Alzheimer disease or caring for a person with the condition may be a challenge. You can ease the stress of illness by seeking support through Alzheimer disease resources. Sharing with others who have common experiences and problems can help you not feel alone. Outlook Prognosis How quickly Alzheimer disease gets worse is different for each person. If Alzheimer disease develops quickly, it is more likely to worsen quickly. People with Alzheimer disease often die earlier than normal, although a person may live anywhere from 3 to 20 years after diagnosis. The final phase of the disease may last from a few months to several years. During that time, the person becomes totally disabled. Death usually occurs from an infection or organ failure. When to Contact a Medical Professional Call the provider if: Alzheimer disease symptoms develop or a person has a sudden change in mental status The condition of a person with Alzheimer disease gets worse You are unable to care for a person with Alzheimer disease at home Prevention Although there is no proven way to prevent Alzheimer disease, there are some measures that may help prevent or slow the onset of Alzheimer disease: Stay on a low-fat diet and eat foods high in omega-3 fatty acids. Get plenty of exercise. Stay mentally and socially active. Wear a helmet during risky activities to prevent brain injury. Chapter 8 : Treatment of Alzheimer Disease - - American Family Physician Designed to update the reader on crucial aspects of research into Alzheimer's disease, this study discusses viable neurotransmitter treatment approaches and describes an innovative method of. Chapter 9 : Alzheimer's disease - Symptoms and causes - Mayo Clinic Dementia of Alzheimer's type (AD) affects memory, thinking and behavior. Scientists believe that changes in the brain may begin years before symptoms appear and AD is diagnosed. The need to diagnose and treat the devastating disease at an early stage is critical to manage and treat AD. Page 10