Throughout history there have been reports of decreased memory and mental deterioration that accompanied old age. Alzheimer’s disease (AD) was named after Dr. Alois Alzheimer who described the symptoms in a woman in Germany in the 1907 but it was not until the 1970’s that AD was considered to be a major disorder and AD continues to be a major health concern worldwide (Reger, 2002).
The onset of symptoms is usually between 40 and 90 years of age, although onset before 65 years of age is considered to be the early onset form of the disease and onset at 40 is very rare (Reger, 2002). Characteristics of AD are extracellular deposits of senile plaques made of complexes of the ...view middle of the document...
, 2010). Patients are at risk for wandering off and forgetting where they are and how to get back so in order for these patients to remain out of assisted living they need to be under close supervision during this time there is the greatest probability of increased family and caregiver stress. Eventual progression is to return to a more infantile state that may require them to have assistance when performing basic tasks such as eating so as to prevent aspiration of food and the potential for the life-threatening development of pneumonia.
Diagnosis is based on performance in tests, such as the memory impairment screen (MIS) or the General Practitioner Assessment of Cognition (GPCOG), to determine cognitive function and based on recommended guidelines as published by the American Academy of Neurology (AAN) (Grossberg et al., 2010). Due to the slowly progressive nature of AD it is possible that diagnosis is not made during the mild or even moderate stages of the disease, which could have effects of the effectiveness of currently available treatments; thus the current recommendation is routine annual screening for development of AD.
As AD is a progressive disease with no currently known cure, all current treatments are aimed at slowing the progression of the disease; these treatments have been available since 1993 (Geldmacher et al., 2011). The desired outcome of treatment is to slow symptoms and to improve overall quality of life for the patient and thereby reduce caregiver stress. The most common type of medication that is currently under research and prescribed are cholinesterase inhibitors, which are most effective in early stages of the disease as such it is best if AD is diagnosed and treatment is begun early in the progression of symptoms.
CHOLINESTERASE INHIBITORS (CHEI)
There are a wide variety of available CHEI, which is the current standard of treatment for mild to moderate cases of AD; these include donepezil treatment, pioglitazone, galantamine therapy, and the rivastigmine patch. The use of acetylcholinesterase inhibitors enhances the actions of acetylcholine in the brain, which can then play an important role in attention and learning (Chu et al., 2007).
The study conducted by Behl et al. (2008) sought to elaborate and expand upon previous studies of CHEI that were all conducted in the short-term. They followed the use of CHEI in two cohorts over one and two-year time periods, a study which had not been previously performed. Previous research showed a deceleration in decline in short-term as such there is evidence that sustained treatment with CHEIs in AD may delay the need for institutionalization. The results of this study found that patients who received this treatment showed less decline in overall function, they were better able to plan in comparison to the group who were given the placebo and performed moderately to largely better in tests to access planning and initiation. They also concluded that CHEI long-term...