New Directions in Understanding Dementia and Alzheimer’s Disease

164 Pages·1990·7.7 MB·English

by  Richard J. Ham M.D. (auth.)

NEW DIRECTIONS IN
UNDERSTANDING
DEMENTIA AND
ALZHEIMER'S DISEASE
ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY
Editorial Board:
NATHAN BACK, State University of New York at Buffalo
IRUN R. COHEN, The Weizmann Institute of Science
DAVID KRITCHEVSKY, Wistar Institute
ABEL LAJTHA, N.S. Kline Institute for Psychiatric Research
RODOLFO PAOLETTI, University of Milan
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NEW DIRECTIONS IN
UNDERSTANDING
DEMENTIA AND
ALZHEIMER'S DISEASE
Edited by
Taher Zandi
SUNY at Plattsburgh
Northeastern New York Alzheimer's Disease Assistance Center
Plattsburgh, New York
and
Richard J. Ham
SUNY Health Science Center at Syracuse
Central New York Alzheimer's Disease Assistance Center
Syracuse, New York
PLENUM PRESS • NEW YORK AND LONDON
Library of Congress Cataloging in Publication Data
New directions in understanding dementia and Alzheimer's disease / edited by Taher
Zandi and Richard J. Ham.
p. em. - (Advances in experimental medicine and biology; v. 28~)
Proceedings of a conference held May 25-26,1989, in Plattsburgh, N.Y., sponsored
by the Northeastern New York Alzheimer's Disease Assistance Center.
Includes bibliographical references and index.
ISBN-13: 978-1-4612-7917-4 e-ISBN-13: 978-1-4613-0665-8
DOl: 10.1007/978-1-4613-0665-8
I. Alzheimer's disease - Congresses. 2. Dementia - Congresses. 3. Alzheimer's
disease-Social aspects-Congresses. 4. Dementia-Social aspects-Congresses. I.
Zandi, Taher, 1952- . II. Ham, Richard J. III. Series.
[DNLM: I. Alzheimer's Disease-congresses. 2. Dementia-congresses. 3. Family
congresses. WI AD559 v. 282 / WM 220 N5324 1989]
RC523.N5 1990
616.8'31-dc20
DNLM/DLC 90-14297
for Library of Congress CIP
Although dosages of medications are quoted, physicians and others
must check the manufacturers' directions and/or package insert
before prescribing.
Proceedings of a conference on New Directions: Understanding
Dementia and Alzheimer's Disease, held May 25-26, 1989,
in Plattsburgh, New York
ISBN-13: 978-1-4612-7917-4
© 1990 Plenum Press, New York
Softcover reprint of the hardcover 1st edition 1990
A Division of Plenum Publishing Corporation
233 Spring Street, New York, N.Y. lOO13
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 our families, and to the families and individuals
whose lives are affected by dementia
Introduction
The management of Alzheimer's Disease and the related dementias is one of the
major challenges to health care professionals and American society-at-large for the
coming decade and the coming millennium. The rapid growth of the over-eighty-five
population, the group which, as recent studies have confirmed and as many of us
clinicians have long suspected, has an even higher prevalence than previously quoted
of dementing disorders, is the major cause of this. We are thus challenged by, as
Bernard Issacs used to call it, "the survival of the unfittest," as well as the oPtimistic
approach of "bringing life to years," as John F. Kennedy said.
The fact is that we, as a society, tend to confuse "treatment" and "cure" (and
"prevention"). As the proceedings of the conference which this book represents
emphasize, there is considerable work going on about the potential prevention of, or at
least the reduction of, symptomatology in these illnesses by interventions genetically,
chemIcally, and so forth. However, the more we find out, the more complicated it
becomes, and the more heterogeneous Alzheimer's and the related disorders appear to
be, not only in their manifestations (as clinicians have long recognized) but also in the
individual initiating and underlying processes. For these reasons, absolute preventive
techniques or the likelihood of an intervention which will reverse the process in a
high proportion of patients, do not appear to be just around the corner. This must not
in any way deter us from aggressively continuing to look at these factors. The
presenters at our conference stimulate one to realize how much we must concentrate
our efforts in research into all of these potential avenues.
However, the inability to prevent or cure should not deter us from "treating,"
and anyone who tells me that there is "no treatment" for Alzheimer's and the related
disorders has got it all wrong: there is a great deal we can do now, as health
professionals and informed caregivers, not only to relieve the suffering and burden of
Alzheimer's, but even to actively promote health and function, despite the inexorable
progression of the disease itself. Behavioral techniques, limited utilization of specific
medications, environmental considerations, methods for preventing and handling crises
and disturbances, for minimizing the disruption of the sleep disorders, catastrophic
reactions and wandering, to avert aggressive behaviors--these are but some of the
methods that we already have, but are as yet failing to implement for many patients
and families afflicted with these problems.
Hence the significance of this conference and our book. The conference
represented a coming together of scientists and researchers, clinicians of several health
disciplines, informed caregivers and those who seek to educate them, and other
interested individuals, including administrators and academicians, to focus on what we
know, and what we can do right now, about these illnesses and the impact they are
having. The conference represents a model of the ways in which, on a regional basis,
this rich mixture of individuals must unite in their efforts to find the resources and
the strengths, and to disseminate the necessary information, in order to make a real
impact on Alzheimer's and the other dementias in our immediate future, as well as in
the coming decades.
Richard J. Ham, M D.
March 1990 SUNY Distinguished Chair in Geriatric Medicine
vii
Preface
On May 25 and 26, 1989, a conference entitled New Directions: Understanding
Dementia and Alzheimer's Disease was held in Plattsburgh, New York. This
conference was sponsored by the Northeastern New York Alzheimer's Disease
Assistance Center at the State University of New York campus in Plattsburgh. The
conference brought together participants and presenters from across the State and
beyond, based around the network of Alzheimer's Disease Assistance Centers, founded
in 1988 by the New York State Legislature. It was Ii multi-disciplinary conference
with presentations by practitioners, clinicians, epidemiologists, scientists, social service
providers and caregivers.
This conference was organized in response to the abundance of recent demands
regarding the multi-faceted aspects of dementia and the paucity of multi-disciplinary
workshops and conferences.
At this conference, the presenters explored, synthesized, redefined and most
importantly, reiterated their commitment to meeting the challenges and obstacles that
are before them.
The conference addressed a variety of topics, including laboratory
investigations of chromosome 21, diagnostic procedures, etiology of Alzheimer's
Disease, reversible dementia, case management and the role of support groups for
dementia caregivers.
This book is a fully edited version of the proceedings of this conference and is
dedicated to dementia patients and their caregivers who suffer together in the
seemingly endless battle against this disorder. This book, like other contributions in
this field, reflects hope and optimism--hope for the day when we can conquer the
pain, agony and fear of this silent epidemic in human society; optimism in that we
have now a greater understanding of this disorder and current means to relieve some
of the problems and even improve some aspects by careful management and a well
informed, educated approach by all involved.
Our understanding of this disorder has greatly increased over the past decade.
We are far from a breakthrough in terms of prevention or cure of the disease itself,
but we now are better at differentiating the symptoms that are caused by this disease
itself, versus those that are induced by the nature of the environment that the disease
created, by concurrent disorders, and by the social isolation of the Alzheimer's patient
and the family caregiver. These distinctions enable us to implement treatment
procedures more effectively.
The treatment procedures range from a complete case management of both
patient and caregiver to drug treatment of the controllable symptoms. For example,
tetrahydroaminoacridine (THA) is one of several drugs being tested as treatment for
Alzheimer's patients. THA may help control memory loss in some patients with AD.
The preliminary results from this study will be available soon.
Another recent research approach concerning Alzheimer's patients' brain
functions has been geared towards brain-repair mechanism. Alzheimer's Disease
anatomically causes extensive brain injury. Scientists are looking at the brain-cell
ix
repair and its elasticity analogous to the brain repair that occurs after a trauma or
brain injury.
The research approach toward identifying the genetic markers in Alzheimer's
Disease has also progressed in the past decade. Studies have shown that a small
percentage of AD patients have shown an inherent pattern suggestive of autosomal
dominant transmissions. More recently, scientists have identified a particular locus on
chromosome 21 as being responsible for production of the abnormal amyloid protein.
Most significantly in terms of what we can do now, the scientific community
working with AD patients has fully realized that AD patients are not the only victims
of this disease. The caregiver's well being is being taken into consideration, and the
caregiver's burden is receiving national and international attention. During 1989,
nearly thirty-five percent of the articles appearing in gerontology related journals in
the United States involved caregiver issues.
This book, among other topics, addresses the above issues. The topics are
ordered in three sections of medical, cognitive, and social issues associated with
Alzheimer's Disease and other forms of dementia as well as the curegiver's issues and
problems.
Organization of the two-day conference that lead to the development of this
book was made possible through the dedicated efforts of the staff of the Northeastern
New York Alzheimer's Disease Assistance Center. We wish to express our thanks to all
the people who were involved in these efforts. Special thanks go to Gloria Bushey,
Linda Patnode and Martha Cashman for their enormous efforts in the technical
preparation of this manuscript.
Taher Zandi, Ph.D.
x
Contents
SECTION I
A MEDICAL AGENDA: ETIOLOGY, DIAGNOSIS AND
TREATMENT OF DEMENTIA ..................................................................................................................... 1
CHAPTER 1
Alzheimer's Disease and the Family: A
Challenge of the New Millenni um ............................................................................................................. 3
Richard J. Ham
CHAPTER 2
In Search of the Etiology of Alzheimer's Disease ........................................................................... 21
John A. Edwards
CHAPTER 3
Alzheimer's Disease: Theories of Causation ...................................................................................... 31
Walter G. Bradley
CHAPTER 4
The Reversible Dementias: Do They Reverse? ................................................................................ 39
A. Mark Clarfield
CHAPTER 5
The Diagnosis of Alzheimer's Disease .................................... ,. ............................................................. 59
Robert A. Murden
CHAPTER 6
Cholinergic Drug Studies in Dementia and Depression ............................................................... 65
Paul A. Newhouse
SECTION II
COGNITIVE AND LANGUAGE EVALUATIONS OF DEMENTIA
PATIENTS ........................................................................................................................................................... 77
CHAPTER 7
Verbal Communication Impairment in Dementia Research
Frontiers in Language and Cognition .................................................................................................... 79
Raymond A. Domenico
CHAPTER 8
Changes in Memory Processes of Dementia Patients ..................................................................... 89
Taher Zandi
xi
SECTION III
ALZHEIMER'S DISEASE: THE OTHER VICTIMS ....................................................... 101
CHAPTER 9
Understanding Placement of the Demented Elderly ................................................................... 103
Howard Bergman
CHAPTER 10
Psychological Difficulties of Caring for Dementia
Patients: The Role of Support Groups .............................................................................................. 113
Taher Zandi
CHAPTER 11
Easing the Burden of Caregiving for the Paraprofessionals .................................................. 121
Lory E. Bright-Long
CHAPTER 12
How to Care for Dementia Patients: Case Management
Models in Long-Term Home Health Care ......................................................................................... 127
Elizabeth Pohlmann, David Howells, Diane Buchanan
CHAPTER 13
Encounters of the Mobile Geriatric Team. ....................................................................................... 135
Suzanne Lavin
CHAPTER 14
Role of Support Group for the Family Caregiver of Dementia:
Recent Developments in the Structure of the Support System .............................................. 141
Alice Barbara Vickers
Contributors ..................................................................................................................................................... 149
Author Index ................................................................................................................................................... 151
Subject Index ................................................................................................................................................... 159
xii