Communication Skills: Explaining Alzheimer's Disease
Alzheimer's disease is a very prevalent and distressing condition, and you are bound to come across its effects in almost all of your placements both in medical school and as a junior doctor. Make sure you have an understanding of its core features - both to help in 'explaining stations' in OSCEs, and when you encounter it on the wards.
- Alzheimer's disease is a degenerative disease of the brain. It is a type of 'dementia' (a condition that causes persistent and progressive decline in cognitive function). It is caused by a loss of nerve cells (neurones), and deposition of 'neurofibrillary tangles' and 'tau plaques'. These collect in and around the nerve cells and stop them working properly. It is thought that certain nerves which produce a chemical called acetylcholine are affected more than others, and this causes loss of cognitive ability
- AD is a progressive and irreversible condition, leading to a variety of symptoms, which vary from individual to individual. These symptoms include; loss of memory (short term memory first usually), loss of intellectual ability, changes in personality, and loss of ability to perform normal day to day tasks. It normally occurs in the elderly, and is more common in women
- The cause of AD is largely unknown. There is a familial type of AD, but this occurs in very young people and is very rare. Some genes have also been linked to AD. It is thought to occur due to ageing, and a mixture of genetic and environmental factors
- It is important to note that this is an irreversible process, and no treatment will stop it occurring. (Note: if explaining this to family members, this needs to be explained clearly but with tact and empathy for the impact that this information might have)
- There are both drug and non drug treatments available for AD
- The main drug treatment for AD is anticholinesterase inhibitors, for example Donepezil. These work to increase acetylcholine in the brain. This chemical is thought to be in lower levels in patients with AD as the nerve cells which produce it are damaged. Acetylcholine is important in allowing the brain to process information. These drugs specifically works for patients with mild to moderate AD (with an Mini-Mental State Examination/MMSE between 10-20), and is not effective in every patient. Only a select group of patients who fit certain criteria are able to take this drug. It is also important to note that the drug does not stop the underlying disease process
- Another drug which is being used in patients with AD is Memantine. This drug works to try to stop the toxic build up of another chemical that is produced by the brain, glutamate
- There are many non drug treatments available. This includes therapy, such as counselling, in order to help the person and their family to come to terms with their diagnosis. Other therapies can be used to improve cognition, and health professionals such as occupational therapists are vital in order to help a patient adapt to increasing cognitive difficulties in their home. Day centres and respite care can provide support for patients and their carers
- There are many other ways that the NHS can help to support a person with AD. This includes providing support with housing, finances and care, in order to improve the person's quality of life. Caring for a patient with AD requires a multidisciplinary approach, where many different health care workers are involved in their care. Important members of the team include: social workers, community psychiatric nurses, occupational therapists, psychiatrists, general practitioners, and geriatricians
- There is also a variety of support available for carers of patients with AD - more information can be found at www.alzheimers.org.uk, a support charity for AD
- AD is a progressive condition. Currently there is no cure for the disease, and there is only very limited treatment to attempt to slow its progression. Symptoms in some people in the early and middle stages of the disease may be lessened by medication. Medications may also help control behavioural symptoms, such as the use of antidepressants to help elevate the patient's mood. The course of AD varies from person to person, with some people having the disease for 5 years, and others for up to 20 years. Although not a direct cause of death, AD can indirectly cause death by predisposing the patient to infections.