What is worth noting here is the fact that behavior disturbances, ranging in severity from repeated questioning to physical violence, are common (National Institute of Mental Health, 1989). It is unclear whether Alzheimer's disease represents a single entity or several variants. Some experts believe that there are distinct subtypes of Alzheimer's disease, such as Lewy body disease (in which the signs of Parkinson's disease, visual hallucinations or alterations in alertness or attention, or all of these symptoms, are conspicuous) and frontotemporal dementia (in which disinhibition, misconduct or apathy, or all of these signs, are prominent). The well-established risk factors for Alzheimer's disease are age, a family history of the disease and Down syndrome (National Institute of Mental Health, 1989).

Confusions about Alzheimer's Disease and the Need for Alternative Actions

There have been numerous studies conducted in relation to Alzheimer's disease. At the same time, there are a number of reports which revealed about the symptoms, treatments and/or prevention approaches that can be done for the disease. but, it cannot be denied that there are also a number of different disorders and illnesses which are closely related or are significantly similar to the qualities and symptoms of Alzheimer's disease. This is the very reason why it is perceived that Alzheimer's can normally be confused with other related diseases (Advisory Panel, 1992).

Because of the rising number of confusions, there is a call to have more and comprehensive clinical examinations to clearly differentiate Alzheimer's disease from the others. The three major components of the clinical evaluations must include at least (Advisory Panel, 1992):

thorough general medical workup neurological examination psychiatric evaluation that may include psychological or psychometric testing

Although the exact causes of Alzheimer's are not yet known, new diagnostic tools and criteria make it possible to obtain a diagnosis of probable Alzheimer's with an accuracy of 85 to 90%. Scientists are continuously researching new, more effective diagnostic tests in an effort to make it easier to diagnose Alzheimer's disease in the early stages. Being able to recognize symptoms early and obtain an accurate diagnosis gives affected individuals a greater chance of benefiting from existing treatments and preparing for the future (Alzheimer's Association, 1994).

While there is no direct medicine to cure the disease, there are several approaches suggesting how people can handle and/or take care of the people suffering from Alzheimer's disease. Progressively more, social and behavioral scientists are nowadays turning their attention to discovering the most effective methods of providing dementia-capable care, and family care research is becoming more rigorous and focused (Alzheimer's Association, 1994).

The Alzheimer's Association has developed training opportunities for care professionals, including nurses and activity directors due to the increasing research on the benefits of care-giving,. The Association has also developed a unique document called Key Elements of Dementia Care, which defines, describes and illustrates dementia-capable care throughout the range of residential care settings (Alzheimer's Association, 1994).

Caregivers who understand these behaviors and who receive appropriate training in Alzheimer's care are better able to effectively respond and redirect the resident in a compassionate and respectful manner. Communication skills become increasingly important as the disease progresses and residents resort to physical behaviors rather than words to express themselves (AM J. Psychiatry, 1997).

Basic to training is a clear understanding of the effect of Alzheimer's disease on communication. Imagine living in a strange land where you do not speak the language, people don't understand what you are saying and you don't understand what they are saying. Would you perhaps feel frustrated, sad or lonely? A resident with Alzheimer's disease lives in a land like this. It falls to the caregiver to find ways to improve communication verbally and nonverbally (AM J. Psychiatry, 1997).

When a resident's behavior becomes challenging, it could be a result of declining brain function, or it could be an expression of a need or feeling. The challenge to caregivers is to "enter the resident's world," by trying to understand the situation from the patient's point-of-view and figure out what he/she is attempting to communicate (AM J. Psychiatry, 1997).

Skill-based training for managing these behaviors allows the caregiver to minimize residents' discomfort and make their challenging behaviors less of a problem. This then implies that caregivers should be given strategies that help them cope effectively with such behaviors as wandering, agitation, aggression, paranoia and repetitive actions (AM J. Psychiatry, 1997).

References

Advisory Panel on Alzheimer's Disease. Advisory Panel on Alzheimer's Disease. DHHS Pub. No. (ADM) 89-1644, Washington, DC: Supt. Of Docs., U.S. Govt. Print. Off. 1989. (Available from the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325, GPO S/N -1, $2.25.)

Advisory Panel on Alzheimer's Disease. Second Report of the Advisory Panel on Alzheimer's Disease, 1990. DHHS Pub. No. (ADM) 91-1791, Washington, DC: Supt. Of Docs., U.S. Govt. Print....

Off., 1991. (Available from the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325, GPO S/N -7, $3.00.)
Advisory Panel on Alzheimer's Disease. Third Report of the Advisory Panel in Alzheimer's Disease, 1991. DHHS Pub. No. (ADM) 92-1917, Washington, DC: Supt. Of Docs., U.S. Govt. Print. Off., 1992. (Available from the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325, GPO S/N -4, $3.50.)

Advisory Panel on Alzheimer's Disease. Fourth Report of the Advisory Panel on Alzheimer's Disease, 1992. NIH Pub. No. (NIH) 93-3520, Washington, DC: Supt. Of Docs., U.S. Govt. Print. Off., 1993. (Available from the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325, GPO S/N -3, $3.75.)

Agency for Health Care Policy and Research. Recognition and initial assessment of Alzheimer's disease and related dementias. Clinical practice guideline no. 19. Rockville, Md.: Dept. Of Health and Human Services, Public Health Services, 1996; AHCPR publication no. 97-0702.

Alzheimer's Association. Care for advanced Alzheimer's disease. Chicago: Alzheimer's Association, 1994.

Apolipoprotein E. genotyping in Alzheimer's disease. Lancet 1996;347:1091-5.

Besdine RW, Jarvik LF, Tangalos EG. Managing advanced Alzheimer's disease. Patient Care 1991; 25:75-100.

Burns a, Murphy D. Protection against Alzheimer's disease? Lancet 1996;348:420-1.

Cummings JL, Cyrus PA, Bieber F, Mas J, Orazem J, Gulanski B. Metrifonate treatment of the cognitive deficits of Alzheimer's disease. Neurology 1998;50: 1214-21.

Delagarza, Vincent W. Pharmacologic Treatment of Alzheimer's Disease. American Family Physician, 2003

Ebony. Important News for African-Americans in the Battle Against Alzheimer's Disease. Johnson Publishing, 2005

FDA Consumer. Second Alzheimer's Drug Ok. Food and Drug Administration: U.S. Government Printing Office, 1997

Ferrell BA, Ferrell BR, Rivera L. Pain in cognitively impaired nursing home patients. J Pain Symptom Manage 1995;10:591-8.

Filley CM. Alzheimer's disease: it's irreversible but not untreatable. Geriatrics 1995;50:18-23.

Folstein MF, Folstein SE, McHugh PR. "Mini-mental state." A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-98.

Hall GR. Examining the end stage: what can we do when we can't do any more? [Editorial] J. Gerontol Nurs 1991;17:3-4.

Kawas C, Resnick S, Morrison a, Brookmeyer R, Corrada M, Zonderman a, et al. A prospective study of estrogen replacement therapy and the risk of developing Alzheimer's disease: the Baltimore Longitudinal Study on Aging. Neurology 1997;48:1517-21.

Klotter, Jule. Marketing Aricept for Alzheimer's Disease. Townsend Letter for Doctors and Patients: The Townsend Letter Group, 2002

Le Bars PL, Katz MM, Berman N, Itil TM, Freedman AM, Schatzberg AF, et al. A placebo-controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. JAMA 1997;278:1327-32.

Liebman, Bonnie. Tangled Memories. Nutrition Action Health letter: Center for Science in the Public Interest, 2002

Light, E., and Lebowitz, B.D. Alzheimer's Disease Treatment and Family Stress: Directions for Research. DHHS Pub. No. (ADM) 89-1569, Washington, DC: Supt. Of Docs., U.S. Govt. Print. Off., 1989. (Available from the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325, GPO S/N -0, $14.00.)

Lovestone S, Graham N, Howard R. Guidelines on drug treatments for Alzheimer's disease. Lancet 1997:350:232-3.

McCann RM, Hall WJ, Groth-Juncker a. Comfort care for terminally ill patients. The appropriate use of nutrition and hydration. JAMA 1994;272:1263-6.

Mitchell SL, Kiely DK, Lipsitz LA. The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment. Arch Intern Med 1997;157:327-32.

Mor V, Banaszak-Holl J, Zinn J. The trend toward specialization in nursing care facilities. Generations 1996;19:24-9.

National Institute of Mental Health. If You're Over 65 and Feeling Depressed... Treatment Brings New Hope, DHHS Pub. No. (ADM) 90-1653, 1990. (Single copies available from Public Inquiries, NIMH, 5600 Fishers Lane, Room 7C-02, Rockville, MD 20857. Available in packages of 50 from the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325, GPO S/N -5, $23.00 per package of 50.)

National Institute of Mental Health. Plain Talk About Mutual Help Groups DHHS Pub. No. (ADM) 89-1138, 1989. (Single copies available from Public Inquiries, NIMH, 5600 Fishers Lane, Room 7C-02, Rockville, MD 20857.)

Paganini-Hill a, Henderson VW. Estrogen replacement therapy and risk of Alzheimer's disease. Arch Intern Meal 1996;156:2213-7.

Phillips CD, Sloane PD, Hawes C, Koch G, Han J, Spry K, et al. Effects of residence in Alzheimer disease special care units on functional outcomes. JAMA 1997;278:1340-4 [Published erratum appears in JAMA 1998;279:1376-7].

PR Newswire. U.S. Food and Drug Administration Approves ARICEPT for the Treatment of Severe Alzheimer's Disease. PR Newswire Association LLC, 2006

Practice guideline for the treatment of patients with Alzheimer's disease and other dementias of…