So let's take a moment for Alzheimer's disease.
And what kind of changes are we going to be
seeing in a person who has that diagnosis?
Well, that person is going to have a
very difficult time making decisions.
It's going to impact their ability to recall recent
memories like dates or maybe who the president is
or maybe what season we are now in.
The person starts losing or misplacing personal items,
and we're not talking about 'where are my keys?'
Because so many people, we are not thinking where
am I putting my keys when I'm doing something.
It's not the fact that we are multitasking.
And now because of doing so
many things at the same time,
we are not able to remember where one thing is.
This loss or misplacement of personal
items is when a person actually knows that
they're putting something down but 20 minutes later
can not recall what they did or where they put it.
There's also a decline in the
ability to solve a problem,
something that perhaps they were able to do
prior to the dementia starting to take hold.
They now, the idea of how to turn on a stove
might become something that is very upsetting
because they can't recall how to do it.
They also may have some mood and personality changes.
So you may see someone who is suddenly
becoming quite depressed or elated,
which is not with what their
routine behaviors and emotions are.
And finally, because of this confluence, this
whole spectrum of different characteristics,
the person might not be so eager
to get together with other people.
They can't remember who the people are.
They may not be able to remember how to get home
from a place that they have traveled to many times.
So what are some of the signs that
we see with Alzheimer's disease?
We see some biological factors like cerebral atrophy.
We see the neurofibrillary tangles,
and then we see those amyloid plaques
that are just a hallmark of Alzheimer's,
which are also called 'neuritic plaques.'
We want to think also genetics.
Genetics lets us know that if a
person has Alzheimer's in the family,
it is an inheritable disease,
especially with early onset Alzheimer's.
And there are tests that can be
done when we have somebody who is
Alzheimer's in their 40s or even 30s.
It's really important for them to
understand that that is something that
they can pass on to their children.
There are also environmental factors that we want
to have in our mind with Alzheimer's disease.
Most evidence is suggesting that genetics are really
the primary predisposition to Alzheimer's disease.
So there are different stages in Alzheimer's disease.
So we have stage 1, this is the most
mild stage of Alzheimer's disease.
And this is where we see that
forgetfulness, that amnesia change.
And if the person is still functioning
normally, though, there are just time and again
little things that they can't seem
to remember where they place them
or perhaps they find themselves driving and
they're not sure what street they're on,
even though it is a way that they
have gotten home time and again.
We normally see their functioning continuing
and not really making a big difference.
But we might find that they are
aware of these slight changes
and we might see that they start socially
withdrawing because they're getting a little nervous.
In stage 2, this deterioration of their
cognitive functioning becomes far more evident.
We see memory loss where now they
can't remember their own address.
If you are saying to them and
you're taking a history and you say,
"So, Mr. Jai, can you tell me your home address?
"On the tip of my tongue, I can't
believe I've forgotten this."
This is usually stage 2.
"A date, do you know what today's date
is? Do you remember what year it is?"
These are very important questions that
we're asking as we're assessing a person
for their neurocognitive status.
Their mood might be fluctuating - happy, sad.
It's very labile, it's not necessarily
connected to what's going on around them.
And it's important to remember if you
can't remember where you're going,
if you can't remember how to get
to where you're supposed to be,
If sometimes there's intermittent
forgetfulness, even how to drive the car,
activities like driving can be very hazardous, and
taking away driving is also a great frustration.
Because now, this person who
has already started to withdraw
can't drive because it's too
dangerous and now they can't connect.
We also might see a deterioration in self care.
They may not care so much to take care of themselves.
And when we ask them, "aren't you going to
take a shower?", they might confabulate.
So what does that mean, confabulation?
Confabulation is when you realize
that you can't remember something.
And so you come up with a fairly plausible story
to cover the fact that you don't really know why.
And so you might say, "I thought you were going
to shower this morning, you didn't shower.
Why didn't you shower?"
And you don't know why you didn't
shower in the morning, and you say,
"Oh, because I got a phone call
and it really threw my morning off,
and so rather than to take an extra half
hour, I just decided to get dressed".
When in fact, that that's not the truth.
When that person, remember, this is a
progressive or chronic progressive disease,
when they get into stage 3 now, the
person is really having difficulty
even identifying familiar objects and people.
They may not recognize their daughter, their son.
They might not know what a plate is.
They might look at the plate and
you say, "what is this called?"
And they cannot tell you.
The mini mental exam is really important
because it will show you this progression
as the person is unable to remember
short sentences or maybe a word,
be able to identify an object that is fairly common.
This person in stage 3 needs a lot of
directions, even for the most simple task.
We want to be able to say, "okay", rather than say,
"please go in your room", "take off your shoes".
"I put out your your pajamas on
the bed, so put your pants on first
and then put on your shirt and
then come on back to the table".
That person lost you at, "please go into the room".
So you want to keep all
directions as simple as possible.
when you go into stage 4, when the person
is now beginning to experience stage 4,
now their actual ability to talk
and walk have become jeopardized,
being able to form words, to be able to talk.
They have lost their memory and they
may be in sort of a stupefied situation
where you try to talk to them,
they're not answering you.
They're there, but they're not there.
Also, it's really important to know
that they may have hypermetamorphosis,
and so keeping that in mind, we want
to start thinking about how do we treat
a person who has Alzheimer's disease?