Alzheimer’s Disease (AD), a common cause of dementia, is a condition that affects the brain by attacking the connective tissues, resulting in tissue death and consequentially affecting brain functions. Naturally, the brain shrinks with age without losing too many neurons. However, with Alzheimer’s, the connections between neurons are severed. The destruction of these connections usually occurs in brain centers responsible for memory functions including the hippocampus and the entorhinal cortex. Formation of neurofibrillary tangles amyloid plaques causes neuron degeneration. The disease then affects the cerebral cortex which is responsible for reasoning, learning, social behavior and speech. This robs the patient of the ability to live independently and since the disease is incurable, a huge burden is placed on the family and caretakers of a person with Alzheimer’s disease.

AD occurs in the central nervous system (CNS), made up of the spinal cord, neurons and the brain. The brain is in charge of complex actions such as feeling, thinking, coordination and sensory processing. White brain matter consists of mostly of axons while grey brain cells is made up of axons, dendrites and nerve cell bodies. The cerebrum’s role is to process conscious sensations, voluntary movements, emotion, learning and problem solving. This is why the symptoms of AD affect cognition and memory. Aging is a biological process that has significant impact on the brain causing social impairments, cognitive decline, memory consolidation decline, and issues in mood and behavior regulation. Neuroinflammation, oxidative stress and transformed cellular signaling are some of the processes involved in the aging brain(Bettio et al., 2017). The part of the brain responsible for memory, the hippocampus, varies in size in a person with AD compared to people with no symptoms of the disease. The hippocampus, which is the part of the brain responsible for formation of new memories and retrieval of old ones, is the first centers impacted by AD. The hippocampus atrophies and decreases in size impairing memory formation and recollection. Professionals can analyze images of the hippocampus through an MRI as one of the ways to diagnose the disease. Volumetric differences is a major factor in telling apart a healthy brain from a diseased one (Suksuphew&Horkaew, 2017).

Aging is a random natural process that every person goes through involving time-based degenerative factors and regulated by environmental and genetic factors. During this process, the capacity of cellular regeneration reduces significantly. Physiological aging results in some alterations in the mental and organic functions of a person, reducing their ability to maintain regular organic functions, some of which are precursors to AD (Xia et al., 2018). There are mainly two main theories on aging. Stochastic theories are bases on loss of functions due to the buildup of aleatory lesions during aging, brought about by environmental factors. These theories are based on a reduction in sublethal radiation over time resulting in the increased probability of getting sick. In summary, exposure to different regular life factors in an individual’s lifetime reduces their life expectancy because of biomolecular degradation. In non-stochastic theory, genetics and the environment work in tandem on aging. The CDC estimates that Alzheimer’s diseases resulted to about 84,000 deaths in the US. This number was as a result of Aalzheimer’s being listed as the cause of death in death certificates in 2010. However, a new study suggests that the disease may account for more that half a million deaths in the same year, resulting from complications attributed to complications of the disease such as pneumonia(NYTimes, 2014). This would mean that AD is now the third leading cause of death behind cancer and heart complications in the US.

The disease has proved to be a unique challenge for patients, their families, healthcare providers and researchers. Alzheimer’s disease and dementia has been a huge burden for patients and their loved ones. In addition to functional and cognitive deterioration, patients experience psychological and behavioral issues, increased use of social and health services, complex healthcare management and increased risk for complications such as falls, crashes, infections and fractures. For family members and caregiver, dementia can result to anxiety, depression, chronic fatigue and sleep problems. The numbers and rates of dementia have been steadily ascending, increasing the disease’s devastation. One huge challenge on patients and family caregivers involves end-of-life strategies for patients with dementia(Span, 2015).

Through a terminal diagnosis of dementia, patients encounter a unique obstacle in controlling how they die. Dementia is often a slow death often with no “plug” to pull. There exists no technically advanced, life sustaining intervention to be withheld or withdrawn.Even in states where it is legal for lethal medication to be prescribed to terminally ill patients, the patients must be mentally capable to take the medication themselves by law. Often, dementia patients don’t meet the requirements for death with dignity. (VSED), Voluntarily stopping eating and drinking, is a method, lawfully accepted, to quicken the death for terminally ill patients who find the suffering unendurable. Supporters have called this a comfortable death with proper palliative and oral care. The dilemma that presents with VSED is whether patients with such a directive is still feasible for patients who later don’t remember requesting it or why they chose it. Cutting off water and food for dementia patients by their family members of healthcare providers is always a controversial decision and may lead to elder abuse charges and other criminal prosecutions. However, if a patient prefers withholding of basic care if they get dementia, no legal measure is efficient in dealing with the dilemma. Additionally, the ethical and moral factors are even more complicated. Is a competent person, currently able to make decisions for their future self if they get diagnosed with dementia?

The financial burden associated with dementia and Alzheimer’s disease is not only on the patient and their family but also on healthcare providers. Researchers have found that the costs associated with taking care of dementia patients is almost similar or higher to that of cancer and heart disease. This is more worrying especially considering that both the number of people with dementia and the costs of taking care of patients will double in about 30 years. This trend suggests that the country is ill prepared for the surge in cases and cost of dementia, especially as the baby boom generation grows old. Studies have revealed that by 2040, 9.1 million individuals will have dementia, up from 3.8 million people currently, constituting 15% of individuals aged 71 and above. The problem will be more intensified by the maturing of the baby boomer generation and lesser children acting as informal caregivers.
For researchers, finding participants to test promising AD treatments on is proving a persistent obstacle despite what the trials promise. One pharmaceutical company, Eli Lilly has been struggling to find 375 participants with early onset AD for an approved clinical trial hoping to stop or slow memory loss(Kolata, 2018). Even with 5.4 million AD patients in the US, it has not been easy. The company estimates that for this to happen, about 18,000 people in the relevant age groups will need to be informed about the trials. Out of this number, 2000 must pass a screening test in order to be included. They must be between 60 to 89 years old, must have experienced acute progressive memory degradation over a period of 6 months at least and must present with Alzheimer’s. The fact that no treatment has been found to lessen the effects of AD continues to discourage people from participating in such trials. The patients are old and getting to these trials may be difficult. AD patients are mainly seen by private physicians who may not be aware of clinical trials. The stigma associated with the disease also contributes towards patients and family members to hide or deny the early memory loss signs of AD. Furthermore, AD is often misdiagnosed leading to errors in studies where participants did not have AD.

One study revealed that direct healthcare costs associated with dementia were about 109 billion dollars in 2010 compared to 102 billion dollars for heart disease and 77 billion dollars for cancer. The amount associated with informal care for dementia patients was also quantified at between 50 billion to 106 billion dollars. With no preventative or curative interventions to manage these conditions, the majority of the costs go towards assisting patients to manage basic day-to-day activities as their cognitive and physical abilities deteriorate with time. Eventually, patients of dementia are unable to care for themselves and in most cases, their family members too are overcome with the burden making long-term care of patients highly costly. Researchers estimate that the average total cost associated with dementia care will increase by more than 100% by 2040 from 215 billion to 511 billion dollars(Belluck, 2013). Since the population is also expected to increase, the dementia financial burden per capita will be nearly 80% more.

Despite researchers learning more about dementia, no conclusive literature or pharmaceutical trials have come up with efficient preventative or treatment measures. However, there are some ways to reduce the probability of getting dementia or Alzheimer’s. One study relying mainly on randomized clinical trials endorsed three recommendations to delay or prevent cognitive decline, supported by inconclusive but encouraging evidence. The interventions include, participating in regular physical activity, managing blood pressure for individuals with hypertension and finally, cognitive training(Span, 2019). One study on the management of blood pressure recommendation found intensive hypertension treatment to reduce heart conditions and deaths. The study found that participants in the intensive hypertension treatment were less likely to develop dementia in contrast participants of the standard interventions. The treatment reduced the participant’s likelihood to develop acute cognitive impairment, a common dementia precursor. This was the first study to report an effective intervention for preventing against cognitive impairment associated with aging. Other recommendations also encourage hypertension treatment combined with exercise, social interaction, management of diabetes, depression and obesity as ways to prevent nearly 30% of all dementia cases.

Works Cited

Belluck, Pam. “Dementia Care Cost Is Projected To Double By 2040 (Published 2013)”. Nytimes.Com, 2013, https://www.nytimes.com/2013/04/04/health/dementia-care-costs-are-soaring-study-finds.html?pagewanted=all. Accessed 17 June 2021.

Bettio, Luis E.B. et al. “The Effects Of Aging In The Hippocampus And Cognitive Decline”. Neuroscience & Biobehavioral Reviews, vol 79, 2017, pp. 66-86. Elsevier BV, doi:10.1016/j.neubiorev.2017.04.030. Accessed 17 June 2021.

Kolata, Gina. “For Scientists Racing To Cure Alzheimer’S, The Math Is Getting Ugly (Published 2018)”. Nytimes.Com, 2018, https://www.nytimes.com/2018/07/23/health/alzheimers-treatments-trials.html. Accessed 17 June 2021.

NYTimes. “Opinion | High Mortality FromAlzheimer’S Disease (Published 2014)”. Nytimes.Com, 2014, https://www.nytimes.com/2014/03/13/opinion/high-mortality-from-alzheimers-disease.html. Accessed 17 June 2021.

Span, Paula. “Complexities Of Choosing An End Game For Dementia (Published 2015)”. Nytimes.Com, 2015, https://www.nytimes.com/2015/01/20/health/complexities-of-choosing-an-end-game-for-dementia.html. Accessed 17 June 2021.

Span, Paula. “Supplements Won’T Prevent Dementia. But These Steps Might. (Published 2019)”. Nytimes.Com, 2019, https://www.nytimes.com/2019/03/01/health/dementia-prevention-supplements.html. Accessed 17 June 2021.

Suksuphew, Sarawut, and ParamateHorkaew. “Hyperplanar Morphological Clustering Of A Hippocampus By Using Volumetric Computerized Tomography In Early Alzheimer’S Disease”. Brain Sciences, vol 7, no. 12, 2017, p. 155. MDPI AG, doi:10.3390/brainsci7110155. Accessed 17 June 2021.

Xia, Xian et al. “Aging AndAlzheimer’S Disease: Comparison And Associations From Molecular To System Level”. Aging Cell, vol 17, no. 5, 2018, p. e12802. Wiley, doi:10.1111/acel.12802. Accessed 17 June 2021.