On Alert: What All Doctors Need to Know About Alzheimer’s Disease

Alzheimer’s disease is the sixth leading cause of death in the United States and is the only disease in the list of top 10 diseases that cannot be prevented, slowed, or cured.1 Reports indicate deaths related to Alzheimer’s have increased more dramatically than those related to other diseases. From 2000 to 2013, deaths attributed to Alzheimer’s increased 71 percent, while those attributed to the number-one cause of death—heart disease—decreased 14 percent.1

Alzheimer's disease is the leading cause of dementia, accounting for about 65 percent of dementia cases in individuals over age 60. Early diagnosis of dementia, requiring the expertise of a neuropsychiatric physician who specializes in it, is essential to allow for maximum quality of life.2,3 Physicians of all specialties should become familiar with the early signs of this disease in order to refer patients with symptoms to a specialist for further testing.

Typically, Alzheimer's progresses slowly in three stages—mild (early-stage), moderate (middle-stage), and severe (late-stage), with symptoms worsening over time. On average, a person with Alzheimer's lives four to eight years after diagnosis, but can live as long as 20 years, depending on other factors.3

The early signs of Alzheimer’s are:

  • Memory loss that disrupts daily life (e.g., forgetting important dates or events).
  • Difficulty completing familiar tasks at home, work, or leisure (e.g., trouble driving to a familiar location or remembering the rules of a favorite game).
  • Confusion with time or place.
  • New problems with words in speaking or writing.
  • Decreased or poor judgment.
  • Changes in mood and personality.

Physicians should also assess for other conditions that may mimic or exacerbate dementia, such as vitamin deficiencies, heart conditions, or sleep apnea.

Only 45 percent of people with Alzheimer’s disease or their caregivers report being told of the diagnosis, whereas 90 percent of people with the most common types of cancer have been told of their diagnosis.1 Studies have revealed that physicians and other healthcare providers recognize the benefits of disclosing Alzheimer’s, but despite this, there is a reluctance to do so.

The benefits of clearly explaining the Alzheimer’s diagnosis include:

  • Improved decision making. When patients are fully aware of their diagnosis in the early stages of the disease, they are more likely to be competent to understand options and provide informed consent for current and future treatment options. When patients are actively involved in decision making about their care, they are more likely to be compliant.
  • Access to services. Knowing the diagnosis allows caregivers to obtain information about support services and plan ahead.
  • Safety. Awareness of the diagnosis allows caregivers to take steps to ensure the patient is in a safe environment and identify certain activities that may need to be curtailed, such as driving.
  • Social support. Knowing the diagnosis helps affected people focus on spending quality time with loved ones.

Once a patient has learned of his or her illness, physicians should:

  • Educate caregivers and patients on ways to promote activity. As the disease progresses and cognitive and functional abilities decline, patients have difficulty moving and, therefore, are more vulnerable to infection. Pneumonia is often a contributing factor to the death of patients with Alzheimer’s disease.
  • Facilitate consults and have a system in place to track and recall patients to ensure there is appropriate follow-up.
  • Consider referring patients to a mental health professional. Depression occurs in 40 percent of Alzheimer’s patients and a mental health professional can help provide treatment. Other team members may include home healthcare workers, social workers, and psychologists.

There is hope for brain disorders like Alzheimer’s, with recent focus from a government initiative to improve scientific understanding of the human brain. In April 2013, President Obama announced the BRAIN Initiative to uncover new ways to treat and cure brain disorders like Alzheimer’s and other neurological disorders. Over $300 million in public and private investments are supporting this initiative. Since the announcement of the BRAIN Initiative, dozens of leading technology firms, academic institutions, scientists, and other key neuroscience contributors have made significant commitments to advancing the initiative.4


References

  1. Alzheimer’s News: New Alzheimer’s Association report finds less than half of people with Alzheimer’s disease say they were told the diagnosis. Alzheimer’s Association website. http://www.alz.org/news_and_events_facts_figs_told_diagnosis.asp. Published March 24, 2015. Accessed June 8, 2015.
  2. Dementia Advocacy and Support Network. http://www.dasninternational.org.  Accessed June 11, 2015.
  3. 2015 Alzheimer’s Disease Facts and Figures. Alzheimer’s Association. http://www.alz.org/facts/downloads/facts_figures_2015.pdf. April 2015. Accessed June 10, 2015.
  4. BRAIN Initiative. White House website. https://www.whitehouse.gov/share/brain-initiative. Published September 30, 2014. Accessed June 11, 2015.

 By Cynthia Morrison, RN, ARM, CPHRM, Patient Safety Risk Manager, The Doctors Company

 


The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

8/15

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