Alzheimer’s Disease: Problems, Prospects, and Perspectives PDF
Preview Alzheimer’s Disease: Problems, Prospects, and Perspectives
ALZHEIMER'S DISEASE Problems, Prospects, and Perspectives ALZHEIMER'S DISEASE Problems, Prospects, and Perspectives Edited by J. Harvey Altman Director, Department of Behavioral Animal Research La/ayetle Clinic and Assist.:uJt Professor, Department of Psychiatry Wayne Slate University School of Medicine Detroit. Michigan SPRfNGER SCIENCE+BUSINESS MEDIA, LLC Library of Congress Cataloging in Publication Data National Conference on Alzheimer's Disease and Dementia: Problems, Pros pects, and Perspectives (1986: Detroit, Mich.) Alzheimer's disease. "Proceedings of a National Conference on Alzheimer's Disease and Demen tia: Problems, Prospects, and Perspectives, held April 10-12, 1986, in Detroit, Michigan" - T. p. verso. Includes bibliographies and index. 1. Alzheimer's disease-Congresses. I. Altman, Harvey, J. II. Title. [DNLM: 1. Alzheimer's Disease-congresses. WM 220 N2755a 1986] RC523.N38 1986 618.97/683 87-15374 ISBN 978-1-4615-6416-4 ISBN 978-1-4615-6414-0 (eBook) DOI 10.1007/978-1-4615-6414-0 Proceedings of a National Conference on Alzheimer's Disease and Dementia: Problems, Prospects, and Perspectives, held April 10-12, 1986, in Detroit, Michigan © 1987 Springer Science+Business Media New York Originally published by Plenum Press, New York in 1987 Softcover reprint of the hardcover 1s t edition 1987 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Dedicated to my wife Barbara and my three children, Jill, Paul, and Stefanie PREFACE Alzheimer's disease is a primary neurodegenerative disease whose incidence and prevalence is rapidly approaching epidemic proportions. A major reason for this is that man is living longer than he has ever lived before and the likelihood of contracting the disease is significantly greater within the elderly portion of the population. The problem becomes even more acute in the light of recent estimates which predict that the number of people living beyond the age of 65 is expected to continue to increase. The impact of these statistics on the family and the health care industry in terms of time, effort and cost are staggering. A recent report issued by the Michigan Task Force on Alzheimer's Disease and Related Conditions (1987) effectively underscores this last point. "Each person with a dementing disease requires an average of seven years of care, either at home or in a residential care facility. Care provided at home is estimated to cost about $12,000 annually, for a total of $84,000 per person. This is a conservative figure, however, because many persons with dementia spend their last few years in a nursing home at an average 'cost of $22,000 per year, and some spend from 10 to 15 years in a nursing home, for a total cost of $220,000 to $330,000. The human cost cannot be calculated so easily, because it includes exhausted caregivers and shattered families as well as depleted financial assets," Although there has been and continues to be a significant amount of research conducted with respect to this disease, no clear consensus as to the etiology, pathophysiology or means of treatment or prevention has yet to emerge. That is not to say that advances in our understanding of what this disease is and how it can be treated have not been forthcoming. To the contrary, a significant number of advances have been and continue to be made. However, much more needs to be accomplished and with great urgency. The hallmark of the disease is a progressive and insidious deterioration in recent memory and cognition. However, loss of memory and cognition are not the only functions to be affected by this disease. The disease also results in a significant deterioration in many aspects of normal daily functioning. Frequently, significant shifts in affect and/or personality are also reported; developing either as a result of the neurodegenerative process of the disease itself or independently as a consequence of other neurological or psychological problems. Eventually, the disease robs the individual of all conscious contact with the outside world; leaving the afflicted individual bed ridden and entirely dependent on those around him for all of his or her daily care and needs. Invariably, at some point during the course of the disease, the family or whoever it is that is left with the responsibility of caring for such an individual will be faced with the often times painful decision of whether or not it would be in the best interests of all involved (caregiver(s) and patient alike) to have such an individual institutionalized. This decision vii is further complicated by a whole gamut of financial, legal and ethical issues revolving around third party payments, patient's rights, competency, and the appropriateness of legal representation (both with respect to the patient and his personal property). At some point changes will have to be made at the State and Federal level. Some of these have already begun to emerge. Additional progress is clearly needed. The purpose of the conference and this book is to provide a comprehensive overview of the broad spectrum of issues and problems which will have to be addressed if this disease and the impact it is having on society is ever to be brought under control. Unlike most of the previous conferences and books on this subject, an attempt was made to foster the exchange and integration of ideas and view points across widely divergent areas and disciplines (e.g., research, professional health care and management, the family, legal and ethical issues and public policy). In so doing, it is hoped that the problems being faced by professionals and family members alike would better be appreciated and this would, in turn, foster the development of more effective methods of dealing with this disease. Harvey J. Altman, Ph.D. Director, Department of Behavioral Animal Research Lafayette Clinic and Assistant Professor, Department of Psychiatry Wayne State University School of Medicine Detroit, Michigan v~i ACKNOWLEDGEMENTS The editor of this book would like to take this opportunity to thank each member of the Conference Coordinating Committee for their help and input in organizing this year's conference. It was only through the concerted effort of all of the members of the Committee that this conference became such a success. The editor would also like to graciously acknowledge the generous contributions of the following institutions for their support of the conference on which this book is based: The Department of Psychiatry Wayne State University School of Medicine Alzheimer's Disease and Related Disorders Association Detroit Area Chapter The LeVine Institute on Aging of the Jewish Home For Age Astra Iiikemedel AB Ciba-Geigy Company Hoescht-Roussel Pharmaceutical, Inc. Janssen Pharmaceutica Company Lederle Laboratories The UpJohn Company Warner-Lambert Company Department of Family Medicine Wayne State University School of Medicine Neurosciences Program Wayne State University School of Medicine Stroh Brewing Company Perry Drugs, Inc. ix CONTENTS DIAGNOSIS AND EARLY DETECTION BEHAVE-AD: A Clinical Rating Scale for the Assessment of Pharmoco logically Remediable Behavioral Symptomatology in Alzheimer's Disease ............................................................ 1 B. Reisberg, J. Borenstein, E. Franssen, S. Salob, G. Steinberg, E. Shulman, S.H. Ferris and A. Georgotas Diagnosis of Alzheimer's Disease by Dermatoglyphic Discriminants •••••••• 17 H.J. Weinreb Dementia, Depression, and Pseudodementia •••••••••••••••••••••••••••••••• 29 B. Siegel and S. Gershon The Epidemiology of the Concurrence of Depression and Dementia •••••••••• 45 B. Gurland and J. Toner Cognitive Function and Brain-Adrenal Axis Activity in Aging, Depression and Dementia ....................................................... 59 G.F. Oxenkrug and S. Gershon ETIOLOGY AND PATHOPHYSIOLOGY From Family Studies to Molecular Hypothesis in Alzheimer's Dementia ••••• 67 M.L. Morris and L.L. Heston Scrapie Prions, Amyloid Placques, and a Possible Link With Alzheimer's Disease ..................•.•........•........•..•......•.......... 75 M.P. McKinley and S.B. Prusiner Alzheimer's Disease, Down Syndrome, and Parkinson's Disease: Selected Pathologic Features ••••••••••••••••••••••••••••••••••••••••••••••• 87 H.M. Wisniewski, P.E. Bendheim and D.C. Bolton Neurotransmitters in the Ageing Brain and Dementia •••••••••••••••••••••• 99 D.M. Bowen and A.N. Davison Sleep, EEG and Sleep Disorders in Alzheimer's Disease ••••••••••••••••• 113 P. Prinz and M. Vitiello TREATMENT STRATEGIES On Possible Relationships Between Alzheimer's Disease, Age-Related Memory Loss and the Development of Animal Models ••••••••••••••••• 129 R.T. Bartus and R.L. Dean xi Serotonin, Alzheimer's Disease and Learning and Memory in Animals •••••• 141 H.J. Normile and H.J. Altman Intracranial Cholinergic Drug Infusion in Patients with Alzheimer's Disease •••••••••••••••••••••••••••••••••••••••.•••••••••••••••••• 157 R.E. Harbough Neural Implants: A Strategy for the Treatment of Alzheimer's Disease •• 165 D.M. Gash Treatment of the Depressed Elderly Patient .••••.••..••••••••••••••.•••• 171 C. Salzman Status of Alzheimer Disease Research •..•..••.•.•••••••••..•.••••••••••• 183 z.s. Khachaturian PRIMARY CARE/PHYSICIANS Gatekeepers: Changing Roles and Responsibilities for Primary Care Physicians with Aging Family Systems •.••.•••••••••••••••••••••••• 191 R.L. Douglass ADRDA and the Physician .•..••••..•..••.••••••••.••••••••••••••••••••••• 197 M. Martinen Home Health Care for Victims of Alzheimer's Disease ••..•••..••...•••••• 201 S. Hicks, K. Linnell and M.J. Curle NURSING Understanding Progressive Dementia: Making a Case for the Case His tory •••••••••••••••••••••••.•••••...•.•......•.••••••••••••••. 209 D. Booth and A. Whall Exercise Treatment for Wandering Behavior •••••.•••••.•••.....•.••..•••• 213 S.S. Robb The Relationship Between Confusion and Abuse ..••••...•.•••••••••••••••• 219 L.R. Phillips A Systematic Approach to the Nursing Care of Acutely III Geriatric Patients with Cognitive Impairment •••••••••••••.•.••••••••••••••• 225 D.L. Wells Urine Control in Patients with Chronic Degenerative Brain Disease •••••• 235 M.M. Jirovec Cognitive Psychopathology and the Phenomenon of Wandering: Research and Clinical Nursing Approaches •••••...•.•••.•••••••••••••••••••• 249 P. Dawson Sleep and Dementia: Nursing Care Considerations ••••••••••••••••••••••• 259 J.A. Floyd Nursing Care of the Human with Cognitive Loss •••••••••••••••••••••••••• 265 M.O. Wolanin Patient Behavior, Care Needs, Personalized Community Resources of Both Institutionalized and Non-Institutionalized Alzheimer's Patients 271 C. Gmeiner xii THE FAMILY Creating Ties and Maintaining Support: Networking and Self Help ••••••• 279 L. Maguire The Family Caregiving Role: Stresses and Effective Coping ••••••••••••• 285 B.A. Baldwin Patterns of Functioning and Coping in Black Families: Caring for Physically Disabled Elders ••••••••••••••••••••••••••••••••••••••• 291 G. Walker-Burt and B.M. Morrison Designing Services for the Minority Aged ••••••••••••••••••••••••••••••• 301 H.R. Johnson Environmental Design and Mentally Impaired Older People •••••••••••••••• 309 L.G. Hiatt Overcoming Problems in Modifying the Environment ••••••••••••••••••••••• 321 D.H. Coons PUBLIC POLICY/LEGAL AND ETHICAL ISSUES When to Discontinue Home Care: The Caregiving Family's Dilemma •••••••• 329 V. Bell Developing Institutional Policies to Obviate Agonizing Over Complex Ethical Dilemmas ••••••••••••••••••••••••••••••••••••••••••••••••• 335 D.A. Robbins Alzheimer's Disease: Legal Issues ••••••••••••••••••••••••••••••••••••• 341 C.E. Klein Clarifying Who Decides ••••••••••••••••••••••••••••••••••••••••••••••••• 347 D.C. Hollister Legislative Advocacy and Alzheimer's Disease: The California Experience ••••••••••••••••••••••••••••••••••••••••••••••••••••••• 357 K.C. Rees A Public Policy Design Strategy for Alzheimer's Disease •••••••••••••••• 363 W. Bowman Public Policy and Long Term Care: Domestic and International Per- spectives •••••••••••••••••••••••••••••••••••••••••••••••••••••••• 371 Mary S. Harper Contributors ••••••••••••••••••••••••••••••••••••••.•••••••••••••••••••• 389 Index ••••••••••••••••••••••••••.•• ;.................................... 395 xiii
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