Alzheimer's disease: pathology, diagnosis, and treatment approaches

Alzheimer's Disease has become a concern that is now more widely studied than it used to be. Typically seen in the elderly population, Alzheimer's disease is characterized by several factors, including forgetfulness and agitation (National, 2008). Currently, there is no cure for Alzheimer's disease, and it gets progressively worse as the patient continues to age (National, 2008). Despite the lack of a cure, however, there are some treatments that are just coming to light where Alzheimer's disease is concerned (Mace & Rabins, 2006). In other words, doctors and researchers are working on ways to be able to slow the progression of the disease and to ease the symptoms of the disease, and there are some medications that do show some promise at this point (Medina, 1999).

This is, naturally, very encouraging, but these medications also have some side effects, and many of them do not work well unless they are used in the very early stages, almost as a preventative measure rather than a type of maintenance or 'cure' (Dash & Villemarette-Pittman, 2005). Some people with certain other conditions also cannot take these medications because they are not able to withstand the side effects or because the medical condition that they have will not allow for the Alzheimer's disease medication to be mixed with the other medications that they already take (Dash & Villemarette-Pittman, 2005). Because of these concerns and others, alternative therapies are being discussed and studied as ways to provide help and relief for these individuals and their families without the medications and harmful side effects that they might otherwise endure (Alzheimer's, 2008).

These alternative therapies are worthy of discussion and consideration as ways of helping not only these people, but their families as well. It is for this reason that many are beginning to study this issue, in an effort to determine whether there is some truth to the idea that these therapies work and whether there are still more alternative therapies that should be considered and possibly used in the future.

Addressing the problem is very important here, as it must be understood what is being studied and examined. The main problem is that alternative therapies for Alzheimer's are very new to the medical field and therefore they are still largely suspect when it comes to whether they are safe and whether they are effective. Naturally, both of these things are important considerations, because the safety of a treatment should be one of the most important issues when it comes to patient care. If the treatment is not safe, essentially it does not matter how effective it actually is, since there is too much danger in it.

Likewise, the effectiveness of the treatment must also be considered, because no treatment, regardless of how safe it actually is, will be worthwhile if it does not work for the patient. This is part of the reason that there are different medications available that all treat the same thing, since not all patients respond in the same way to the same medication. The same is true of alternative therapies for Alzheimer's disease and the way that people with Alzheimer's are treated for pain and other issues that elderly people often develop in conjunction with the disease. Both safety and effectiveness have to be very strongly considered to find the right treatment for the patient in question, instead of treating everyone with Alzheimer's disease in the same way.

The purpose of this writing is to discuss therapies for Alzheimer's disease patients and determine whether they are valid and worthwhile, as well as safe, when it comes to Alzheimer's disease treatment. Also important is whether these treatments are affected by medications that these individuals might be taking. In other words, are the treatments better on their own, or are they better in conjunction with more traditional therapies that are more generally used in the treatment of Alzheimer's disease? Without knowing whether these therapies actually work and whether they are safe, it is difficult to determine whether they should be studied more and whether they should be used. Studies such as this one can work toward finding answers to these things and helping to determine whether alternative therapies and other methods of handling pain and mental confusion will actually be used for Alzheimer's disease patients as a more standard treatment.

Reviewing the literature is one of the most important areas of any work, as learning what has been done in the past can help paint a more accurate picture of the present and the future. One article by Tsai & Chang (2004) looked at the pain that elders with Alzheimer's disease often feel and the different ways that they use to express this pain. Also examined are the different methods that are used in order to determine whether an elder that is suffering from Alzheimer's disease is in pain and if treatment for that pain is necessary. The authors of the article indicate that determining whether an elder with Alzheimer's disease is actually experiencing pain is challenging, especially in late-stage Alzheimer's disease where the patient may have difficulty communicating (Tsai & Chang, 2004). This is of particular concern because many of these patients are in pain but their pain is not treated. Studies that were researched by the authors of this article indicate that pain in elders with Alzheimer's disease is very often overlooked (Tsai & Chang, 2004).

There are three ways, according to Tsai & Chang (2004) that pain assessments can be made in elderly people with Alzheimer's disease. For those that are in the early stages of the disease and still able to communicate, simply asking about pain and the rating of how severe the pain is often will tell the nurse or doctor enough to decide on what treatment should be used. For those that cannot communicate as easily, a proxy is often used. This is where a healthcare professional must attempt to determine whether the patient is in pain based on factors that generally do not include verbal, self-reporting responses. This can be done with both patients who can communicate verbally and those who cannot. The third and final way that is used to determine pain in elderly patients with Alzheimer's disease is through observation by a healthcare professional. This is done with patients that cannot communicate verbally. Unfortunately, the amount and frequency of pain in these individuals is often underestimated by healthcare professionals (Tsai & Chang, 2004).

Conclusions from the article indicate that more must be done in the field of research when it comes to assessing the pain for these patients, and that new and better methods of reporting and determination for pain should be looked at, since the rate of underestimation of pain in these patients is deemed to be rather high. Patients should always be asked about their pain, and those that are not able to communicate well or at all should also be analyzed based on the proxy and/or observation method. The instruments that are used to make these pain determinations should also be addressed, as many nurses reported that they often have trouble using the instruments that are currently available (Tsai & Chang, 2004).

The information in the article and others like it is very applicable to clinical practice, as many nurses do not rate pain as highly as the nursing home residents that actually experience the pain. This would indicate that, in a clinical setting, more knowledge is needed about instruments that measure pain and more observation by nurses is needed in order to determine what problems these elders might be experiencing. Since pain can cause many different behaviors in elders that are not able to express their pain verbally, there are various things that should be looked for such as restlessness, rubbing, shifting position, difficulty moving, and aggressive verbal behavior, among others (Tsai & Chang, 2004).

It is clear from this article and other similar information that not enough is being done to assess and treat pain in elders that have Alzheimer's disease, but it is often difficult for nurses and other staff members that often have large patient loads and are short on time. Despite this, however, the pain of these elders is real and should be treated. More nurses in the profession, especially those who are willing to work in and enjoy working in nursing homes, would help to ease some of the patient load and make the experiences of the elders in their care better and more pain-free. This does not mean that every little twinge of pain should be dealt with by providing medication, or that elders with Alzheimer's disease should be over-medicated so that they are not disruptive. However, given the information in many studies that pain in the elderly population with Alzheimer's disease is greatly underreported by survey instruments, it is clear that there are many implications for clinical practice and that the issue should be examined more closely.

The article and other information like it contributes to a body of nursing knowledge that is on the increase. More is learned every day in the field of medicine and nursing, and articles such as this one serve to point out that there is much more that needs to be learned. Serving the elderly population with Alzheimer's disease and treating them for their problems is often quite difficult, but the information in the article regarding what behaviors to look for in individuals that cannot express their pain verbally is very important for many that work in nursing homes, and for others that work with elderly Alzheimer's disease patients.

The article also helps to reinforce existing knowledge in that the instruments that are used to report pain in the elderly population have been seen for some time to be largely insufficient for many patients. For those that still communicate relatively well, this is not so much of a problem, but for patients that cannot verbally and correctly express where they hurt and how severe their pain is, the current instruments are not designed in such a way that they diagnose the problem well and provide the elderly patient with relief in most cases.

When information of this type is presented, it serves as a reminder of the problems that are being faced by the elderly, and as the elderly population grows with the longer life-spans seen by many and the aging of the baby-boomer population, the problem will only become more severe in the future. It is important, therefore, to address the problem now, before it becomes so overwhelming that many more elderly individuals with Alzheimer's disease must suffer with chronic pain because they are unable to verbally express themselves enough to receive treatment.

One of the alternative therapies that is being tried today is the combination of hand massage and calming music. A study that was conducted into this issue looked at the effect of calming music, the effect of hand massage, and the effect of both of these things together on a sample population of elderly nursing home residents (Remington, 2002). These individuals were chosen because aggressive behavior on the part of these individuals raises the cost of their healthcare, and stopping or lessening some of this behavior could keep these individuals from experiencing as many problems in the future, which will also help those that care for these Alzheimer's disease patients in their remaining years.

The method for the study exposed these individuals to either the music, the massage, or both for 10 minutes at a time in order to see whether it affected the Alzheimer's disease patients' behavior and whether the effect lasted after the treatment or therapy had ended (Remington, 2002). The results of the study indicated that nonphysical aggressiveness did decrease somewhat during and after the treatments, but that combining the music and the massage had no greater effect than simply using one or the other of the therapies (Remington, 2002). As for those patients that were involved in physically aggressive behavior, however, none of the therapies used appeared to have any significant impact on reducing this type of behavior (Remington, 2002). It seemed as though only the nonphysical behavior was helped by the music or the massage that these Alzheimer's disease patients were subjected to.

Other studies have also looked at the use of music to control fear, pain, nervousness, and other issues. Bally, Campbell, Chesnick, & Tranmer (2003) did a study that dealt with music when it came to older people undergoing frightening procedures such as those for heart problems and other troubling issues. They found that those who could listen to music (and control what they listened to) did better, had less discomfort and fear, and were not as worried when they were undergoing the procedure, showing that music therapy does work to reduce fear and agitation - something that is commonly experienced by patients with Alzheimer's disease, since they are often forgetful and uncertain about where they are, who other people around them are, and what's happening to them.

Music appears to be the most promising therapy for many people that are over the age of 65, as many of them have trouble sleeping, even if their problems are not related to Alzheimer's disease (Johnson, 2003).. A study that was conducted by Johnson (2003) was based on women that were over 70 years of age and met the criteria, both in the International Classification of Sleep Disorders and the Diagnostic and Statistical Manual of Mental Disorders, for a sleep disorder of some kind. In Johnson's (2003) study, fifty-two women made up the sample, and all of them had either trouble falling asleep, or problems with waking up frequently during the night. Some had both issues to deal with. The results of the study showed that women that were exposed to music at bedtime fell asleep faster and stayed asleep better than those that were not exposed to music, and the ability of these women to turn the music back on if they awoke during the night and it was not playing helped them to fall back into a good sleep pattern faster than they would have without the music (Johnson, 2003).