Category: Alzheimer’s Disease

Is Alzheimer’s a Disease?

Dr. Holzmacher's Business LogoIs Alzheimer’s Disease truly a disease?  The word “disease” is defined as an “abnormal condition or illness” in the dictionary, and Wikipedia describes disease as “an abnormal condition affecting the body of an organism.”  The word shared in common between these definitions is “abnormal.”  What is labeled as “normal” or ” abnormal” is not a trivial distinction.  It encompasses much of the training I received towards becoming a clinical psychologist.  For something to be regarded as “normal” it must be observed to be the typical/common state of affairs.  This rests on the assumption that people are accurately and reliably able to distinguish between what is common and what is exceptional.  Where does one draw the line between the average and the exceptional?

Consider shoe sizes.  My feet are a size 12, and about 5% of males share this large size.  A size 12 foot is not the average for a male, but it is not uncommon.  The same size foot in a female is not average and it is fortunately uncommon.  What is considered or measured to be the average is highly dependent on the group being considered.  The deviation of my foot size from the human average increases when compared to females, Asians, and pygmy tribesmen-no relation is expressed or implied.  Though my feet are abnormal, they function quite well notwithstanding!  The notion of “normal” is an interval centered about the average of the population under consideration.  The notions of “normal” and “average” only have meaning in light of the specific population(s) being considered.  A statistical analysis may discover that male shoe sizes between 6 and 10 are within the “normal” range, whereas sizes less than 6 or over 10 are labeled “abnormal.”  The term “abnormal” should not be equated with the word “dysfunctional.”  An IQ of 130 is certainly abnormal, but definitely not dysfunctional.  These terms only have real meaning when nested within specific groups, defined by measurable functional outcomes that are evaluated over a finite period of time.

Most men are interested in enlarging their penis size Erectile dysfunction purchase female viagra affects one-third of men irrespective of age or race. Since different companies manufacture tadalafil best prices and cialis, these pills differ also in color, form and names. Decreased activity of mitochondria-specific proteins, including the transcription factor levitra free PGC1, a regulator of mitochondrial biogenesis, were also noted. One such issue which has bad effects later on is the dosage pattern which basically decides the after eating online viagra effects. So is a senile dementia of the Alzheimer’s type really a disease?  The quickest answer is that the biological process of Alzheimer’s is not a disease, but the end result of the process could be termed a disease.  All humans acquire neuritic plaques and neurofibrillary tangles as we cross the age 50 boundary.  Correspondingly, free verbal recall and naming decline with so-called normal aging.  The tangles and plaques are the organic hallmarks of Alzheimer’s Disease.  Less mentioned is that these tangles and plaques increasingly infest the brains of all middle-aged humans.  It is largely a question of degree.

Once the neurofibrillary tangles and neuritic plaques encompass about 30% of the cerebral cortex (brain’s outer coating of gray cells), the unfortunate person will exhibit the early symptoms of Alzheimer’s Disease.  Less than 30% of the cortical area manifests as “normal” cognitive decline, and over 30% of the cortex affected results in symptoms of early AD.  The organic pathology of AD is undifferentiated from normal aging until it is observed to cause functional impairment.  Even though the organic pathology is “normal,” the uncommon extent of the pathology and the unusual decline of mental skills could be termed a “disease.”  Similarly, all humans lose critical neurons that help us modulate and initiate motor movements as we age.  If more than 60% of these dopamine producing neurons are lost during our lifetime, we will exhibit the symptoms of Parkinson’s Disease.  Generally, under a 60% loss of the dopaminergic neurons will result in “normal” age-related tremors.  Once again the natural process of aging is labeled as a disease if its manifestation is unusually powerful and negative.  In the near future, I will address what people can do to minimize their chance of becoming “abnormal” in their old age.

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categories Alzheimer's Disease, Dementia, Neuropsychology | | datetime January 22, 2011 12:50 pm | comments Comments (1)

What’s Up with Mom?

Business Logo for Psychological and Neuropsychological IssuesWhat’s up with Mom?  We moved her into a new apartment over the weekend, and she is not like anything or anyone I’ve seen before.  She is so confused she has forgotten to eat; sitting and staring for hours, or up at night and wondering the hallways.  All the children take shifts supervising her, but the situation does not appear to be resolving.  It tears me up to see her like this.  What is worse, the our family is splitting down the middle; some favor keeping her in the apartment no matter what arises, and the rest believe she should be in a nursing home.  I don’t know where to turn.

This is a paraphrased narrative that I have heard literally hundreds of times.  Neurologists of old called this the “Monday Morning Disease.”  It refers to family that did not notice a loved one becoming senile until some change in their environment produced confusion.  Most families will report changes in the patient’s behavior over a one to two year period prior to an incident, only they did not ascribe them to a senile dementia of the Alzheimer’s type.

One of the earliest symptoms of Alzheimer’s to escape the notice of others is a deficit of planning.  It is not as noticeable as memory or attention deficits, yet it causes profound functional impairment.  As long as the dementia victim relies on old well-learned behavioral routines, there is minimal trouble living independently.  Once a person’s daily behaviors are upset by a move, they must develop new functional behaviors that accomplish goals necessary to live; for example, shopping for food.  In a new environment, the person lacks clues to their old behaviors, and so are at a complete loss for where to go and what to do.  Many cognitive scientists (fancy term for psychologist) conceptualize humans as planning machines.  As you read this post, you may also be thinking of what you are going to do next, and you may even formalize the steps to accomplish this goal.  Children burst with plans for what they will do after school.  Do not mistake deficient planning for a lack of energy or optimism.  Planning is a necessary cognitive skill for survival, and it is one of the earliest functions to decline in a senile dementia.
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Another early cognitive deficit is a decline of mental flexibility.  This is not to be confused with someone who is easygoing and complaint with the wishes of others.  Cognitive flexibility refers to a person’s ability to switch between mental sets; for example, glancing at a drawing and putting together a model.  It is a necessary skill we all employ every day to accomplish tasks with greater efficiency and accuracy.  It is evident while doing the dishes and answering the telephone, alternating between tasks at work, and making conversation while driving.  When this skill declines, the person is noticed to be performing behaviors that are out of character with the situation.  In my residency, the team was to discharge a patient to independent living when I noticed he had taken apart his shaver and laid it across his bed.  The patient missed several physical therapy sessions due to his insistence he had to fix the shaver.  The shaver was busted, but he could not conceive of working alternately on the shaver and his ambulation.  He became obsessed (stimulus bound) to the shaver; neglecting more important goals that he had to accomplish.  While it may appear as a failure to prioritize his goals, this unfortunate man could not accomplish the main goal because he was stimulus bound to an unimportant goal.

The early deficits of a senile dementia are subtle, yet as real and damaging to an independent existence as the deficits of verbal and visual memory.  The latter deficits are well known to the average person.  Memory skills are the main determinant of Alzheimer’s Disease in most people’s minds.  Actually, verbal and visual memory may be functional well into the disease, and these “executive” deficits of planning and flexibility may be crippling at an earlier stage of the disease.  In terms of planning the future for someone with a known or suspected senile dementia, the family should take these symptoms into account.  It reduces the probability of a Monday morning surprise.  Please leave comments regarding this post in the space provided below.

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categories Alzheimer's Disease, Dementia, Memory Disorders, Neuropsychology | | datetime January 7, 2011 4:38 pm | comments Comments Off on What’s Up with Mom?

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