Advancing age may be associated with difficulty in delayed recall, decreased cognitive flexibility and deterioration in memory and some visuospatial skills (Weintroub, 2000). Normally; Such mental changes that occur with advancing age can be compensated for by using some clues and ways to facilitate remembering. In this case, if the mental functions of the elderly person were to be tested, they would be expected to be within normal limits but slower (Morris and Peterson). However, the emergence of a disease that causes deterioration in mental activities and daily living activities with advancing age may be a sign of a neurological disease that manifests itself primarily with the complaint of forgetfulness.
The most common of these, Alzheimer's Disease (AD), is a progressive neurological disease. . When examined clinically, AD appears as a progressive deterioration in cognitive and functional levels and a significant impairment in memory and other intellectual activities (Scinto & Daffner, 2000). These are:
- Impairment in the ability to learn new information or remember previously learned information
- Speech disorder
- Inability to perform motor activities although motor functions are preserved
- Impairment of sensory functions Inability to recognize objects even though they are protected It is not caused by a temporary deterioration that occurs with another disease. Alzheimer's Disease is expected to occur in 50% of the population over the age of 85. It has been revealed that 25% of Alzheimer's cases are related to genetic inheritance. Although the disease is irreversible, its process can be slowed down. The key to this is early diagnosis. The prognosis of the disease may consist of slowly progressive periods or acute phases depending on the patient's physiological condition and genetic mutation. The earliest symptom of Alzheimer's Disease is loss of short-term memory. It may be quite mild at first and may be hidden by the patient. Patients' relatives also see this as a normal symptom of the aging process, rather than seeing it as a symptom of disease. They tend to interpret it as an afterthought (Cohen, 1999). It can be considered as the reversal of the developmental stage of AD, which lasts an average of 8 to 10 years and results in mortality.
Alois Alzheimer, who gave his name to the disease, was a psychiatrist who lived between 1864 and 1915. Alzheimer, a father of three children, spent his entire life in Germany. He tended to attribute behavioral disorders in his patients to organic causes. At the clinic where he is the chief, the symptoms of a female patient named Auguste D., born in 1850, attract his attention and he begins to examine them in detail. During the time she watches her patient, whose speech has been impaired since her arrival, Mrs. August gradually becomes unable to name objects, remember her place of birth, perform simple mathematical operations, loses her ability to write and read, becomes increasingly anxious, anxious and even angry, and says she hears voices that no one else can hear. He no longer recognizes his doctor, who visits him every other day (Maurer & Maurer, 2001). Illness; It is named after Alois Alzheimer, who thought that these symptoms were different from other known diseases.
Causes
Decreased acetylcholine in the brain is considered as a cause of Alzheimer's Disease. is known. Studies have shown that AD patients have abnormal protein accumulation on the outer surface of their brains, the cause of which is unknown, and cell loss and loss of intercellular connections, which are thought to be related to this (Giacobini, 2000). Although having a family member with this disease is seen as a risk factor, it is known to be a genetic disease.
Symptoms
1. Forgetfulness: He forgets places (such as glasses, wallet), names or faces of people he knows, whether he has done a job or not. These seem like forgetfulness that we all experience in the fast flow of daily life, but Alzheimer's patients can never find their belongings by putting them in inappropriate places or by not looking for them in the appropriate place. Cannot remember the names of people and objects. He cannot remember people he has just met, asks questions over and over again, forgetting that he got the answers, or repeats the same sentence forgetting what he said. 2. Memory loss that affects daily life activities: Self-care, There may be a loss of basic skills such as eating habits and manners, toilet control.
3. Loss of acquired skills: Frequently forgetting to burn food on the stove, loss of skills that may pose a danger while driving, not being able to count change in the market, etc. Loss of skills may not be explained solely by 'forgetfulness'. In addition, the patient becomes unable to learn new skills; For example, not learning how to use a mobile phone or an ATM. In this case, a housewife may no longer be able to cook, a tailor may no longer be able to sew.
4.Communication: Sometimes it may be considered natural to not be able to remember the name of an acquaintance at the moment and remember it after a while. Difficulties arise in finding words; This may be a person's name, or it may be finding object names in a way that interrupts fluent speech. A person may ask a question over and over again, forgetting both the answer and the fact that he asked it, even though he has received the answer, or he may end up expressing himself with a limited number of words and a weaker grammatical structure than before. It may be difficult to follow long conversations.
5. Disorientation: We may not know what day of the week or month it is, but then we adapt to the calendar information. AD patients, on the other hand, lose temporal information such as year, month and day. In this case, the diary becomes unsuccessful in keeping track of current events. The person may become confused or not know where he is. The person may also experience loss of information about himself. For example, he may not know his date of birth or his age.
6. Difficulty in reasoning: He may not be able to judge any situation he encounters within the framework of logic. May have difficulty making decisions.
7. Difficulty in comprehending what lies beneath the visible (abstract thinking)
8. Behavioral changes: AD patients may show sudden behavioral changes, which may be inappropriate for the situation; such as sudden anger without cause. He may become frightened and agitated due to daytime dreams or voices he hears (Stur, Smith, Rummans, 2002).
9. Personality changes: He may become suspicious, angry, restless or completely uninterested.
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Diagnosis
Many disciplines are used to diagnose AD. It requires the examination of the most clinicians and the use of many examination methods. In this way, physiological, psychological and neurological evaluations are made. Radiological imaging, neuropsychological tests and all these examination results work together with the neurologist who will perform the examination. Even though the patient seems to have lost his initiative and cannot express himself, it is natural for him to be disturbed by the situation he is in. He/she may experience emotional collapse due to feelings of inadequacy. In order not to aggravate the course of the disease and to improve the patient's quality of life, he/she should be examined by a psychiatrist (neuropsychiatrist or old-age psychiatrist) who is an expert in this field for personality changes and behavioral disorders.
To reveal the losses in the person's mental functions in detail and to make a differential diagnosis. A neuropsychological evaluation should be performed by a psychologist who is an expert in the field to assist the neurologist. Again, neuroradiological imaging examinations guide the neurologist to detect the damage caused by the disease and for differential diagnosis.
Treatment
Forgetfulness and related skill losses that reduce the quality of daily life. A treatment approach aimed at stopping the disease is followed. In addition, psychiatric help is added to the treatment to control problems such as behavioral changes, sleep and eating disorders that accompany the disease, and thus to make the patient and the disease more stable. Regular nutrition and regular sleep, which are known to contribute significantly to the stabilization of the disease and the comfort of the patient, are very helpful in the treatment.
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