Microsoft word - waw 8.doc
Alzheimer’s Disease: A Psychological Perspective
Alzheimer’s disease (AD) affects older adults and is characterized by memory loss and
dementia. It is a progressive disease and the effects are irreversible. Alzheimer’s disease
affects a person’s life both psychologically and physically. The disease causes much
anxiety and sometimes depression. A person with Alzheimer’s disease can also become
violent towards loved ones and caregivers. There is no definite way to diagnose
Alzheimer’s disease until an autopsy can be performed at the death of the afflicted
person. Specialists can correctly diagnose the disease up to 90% of the time. There is no
cure for the disease, but with early diagnosis the progression can be slowed by drugs. The
drugs (Cognex®), donepezil (Aricept®), rivastigmine (Exelon®), or galantamine
(Razadyne®, formerly known as Reminyl®) may help in the early to middle stages of
Alzheimer’s disease. Sever Alzheimer’s may be treated by the drug memantine
(Namenda®) or donepezil. Researchers are constantly trying to find new methods for
Course: PSYC 2000: Research Psychological Methods
“Alzheimer’s disease is a disease of older adults that causes dementia as well as
progressive memory loss” (Sternberg, 2006, p. 185). This paper will further discuss what
the symptoms of Alzheimer’s disease are and how they affect a person’s life both
physically and psychologically, how is Alzheimer’s disease diagnosed, and what drug
options are available to help slow the progression of Alzheimer’s disease.
A case report in the Journal of Psychiatry in Clinical Practice
, Jainer, Onalaja,
and Noushad (2005) describe a specific case of Alzheimer’s disease affecting Mrs. X, a
58-year-old woman. In April of 2002, she was referred to the psychiatric services by her
general practitioner for her 2 ½ year history of anxiety symptoms. She was accompanied
by her husband. Her symptoms of anxiety included shakes, palpitations, and sweating,
which lasted from 45 minutes to an hour. She reported that her father and sibling had
anxiety problems as well. The case report goes on to describe her:
She had a normal childhood. She had been treated with the serotonin
reuptake inhibitor citalopram, 20 mg once a day, 2 months prior to the
clinic visit. Her Mental State Examination was normal except for
occasional restlessness. She was continued on citalopram. Four weeks
later, she reported that her anxiety attacks had reduced to one in 10 days.
Her husband died few months later. During subsequent visits, she started
complaining of memory problems. She was finding it difficult to cope
Mrs. X’s family began to raise concerns about her forgetfulness. The family also
mentioned that they believed her memory lapses had began long before the death of her
husband. This suggests he may have covered up her lapses in memory during the
previous meetings with the psychiatrist. Her memory problems were now quite clear.
“Her short-term memory was impaired. She scored 16/30 on the Mini Mental State
Examination (MMSE). It was reported that she was unable to cook, shop, and find her
way back home. She was suspected to have early onset dementia was urgently referred to
The Young Onset Dementia Team revealed that she was “forgetting events,
becoming repetitive, misplacing valuable possessions like her purse, mismanaging
finances, and burning food.” On top of this, she had also lost weight due to her scattered
eating habits. They reported that she was also disoriented in time, place, and person. The
functions of her language had also declined. She had mood swings and could become
aggressive towards her loved ones. Her score on the MMSE was a 10/30. After doing
brain MRI scans they reported “sever atrophy affecting the supratentorial brain. The
atrophy was global but with more involvement of the temporal lobe and hippocampus.
There were hardly any ischaemic changes. The overall appearance was consistent with a
fairly advanced Alzheimer’s type neurodegenerative disorder” (Jainer et al., 2005).
This is a fairly typical case of Alzheimer’s disease. As you can see, the onset of
the disease brings great anxiety to the afflicted person. The problem with diagnosing
Alzheimer’s disease is that a loved one can cover up the memory lapses making it
The National Institute on Aging (2006) gives seven warning signs of Alzheimer’s
disease in a publication titled Understanding Stages and Symptoms of Alzheimer’s
. The seven warning signs of Alzheimer’s disease are:
1. Asking the same question over and over again.
2. Repeating the same story, word for word, again and again.
3. Forgetting how to cook, or how to make repairs, or how to play cards –
activities that were previously done with ease and regularity.
4. Losing one’s ability to pay bills or balance one’s checkbook.
5. Getting lost in familiar surroundings, or misplacing household objects.
6. Neglecting to bathe, or wearing the same clothes over and over again, while
insisting that they have taken a bath or that their clothes are still clean.
7. Relying on someone else, such as a spouse, to make decisions or answer
questions they previously would have handled themselves.
In a meta-analysis study done by Swedish neuropsychologists (American
Psychological Association, 2005) they found the following results, “people can show
early warning signs across several cognitive domains years before they are officially
diagnosed, confirming that Alzheimer’s causes general deterioration and tends to follow a
stable preclinical stage with a sharp drop in function.” Lead author Lars Backman, PhD
explains, “There are no clear qualitative differences in patterns of cognitive impairment
between the normal 75-year old and the preclinical AD counterpart. Rather, we think of
the normal elderly person, the preclinical AD person, and the early clinical AD patient as
representing three instances on a continuum of cognitive capabilities. This presents an
obvious challenge for accurate early diagnosis.”
Early diagnosis of Alzheimer’s disease is important. From a therapeutic point of
view it is extremely important because most cognitive enhancers are only beneficial in
patients with mild to moderate Alzheimer’s disease.
There is only one definite way to diagnose Alzheimer’s disease and that is to find
whether there are plaques and tangles in the brain tissue. The downfall to this approach is
that in order for scientists to look at the brain tissue they must wait until the person dies
and they can do an autopsy (National Institute on Aging, Diagnosis)
. This presents an
obvious problem to the persons living with Alzheimer’s disease.
There are specialized centers where doctors can correctly diagnose Alzheimer’s
Doctors use several tools to diagnose ‘probable’ Alzheimer’s disease
including: (a) questions about the person’s general health, past medical
problems, and ability to carry out daily activities; (b) tests to measure
memory, problem solving, attention, counting, and language; (c) medical
tests – such as tests of blood, urine, or spinal fluid; and (d) brain scans
(National Institute on Aging, Diagnosis
After a diagnosis is made, treatment options can be discussed. Currently, there is
no treatment that has been proven to cure Alzheimer’s disease. The Alzheimer’s disease
education department in the National Institute of Aging (Treatment
, 2006) says:
For some people in the early and middle stages of the disease, the drugs
tacrine (Cognex®), donepezil (Aricept®), rivastigmine (Exelon®), or
galantamine (Razadyne®, formerly known as Reminyl®) may help
prevent some symptoms from becoming worse for a limited time in some
patients. Another drug, memantine (Namenda®) has been approved to
treat moderate to severe AD, although it also is limited in its effects. And
the FDA recently approved the use of donepezil to treat moderate to
There are other strategies that are being researched to determine if they are safe
for treatment on Alzheimer’s disease. They are anti-inflammation medication,
antioxidants, ginkgo biloba or estrogen treatments.
There is some evidence that suggest that inflammation of the brain may attribute
to Alzheimer’s disease damage. Clinical trials have been examining whether or not
nonsteroidal anti-inflammatory drugs (NSAIDs) help to slow the progression of
Alzheimer’s. So far, research has not yet confirmed a benefit from these drugs.
“Several years ago, a clinical trial showed that vitamin E slowed the progress of
some consequences of AD by about 7 months” (National Institute on Aging, Treatment,
2006). Researchers are now studying whether antioxidants such as vitamin E, vitamin C,
and selenium can prevent Alzheimer’s disease or cognitive decline or slow the
There is no concrete support that leaves from the ginkgo biloba tree may help
treat Alzheimer’s disease symptoms, but earlier studies did suggest this. Scientists are
now trying to find evidence in clinical trials to show that ginkgo biloba can delay
cognitive decline or prevent dementia in older persons (National Institute on Aging,
A handful of studies have revealed that when women use estrogen to treat
menopausal symptoms, the estrogen may also protect the brain. Some experts wonder
whether estrogen may have positive effects for preventing Alzheimer’s disease. So far
there is no proof, and some research actually shows adverse effects.
There are also medicines that do not directly treat Alzheimer’s disease, but they
do help the afflicted person feel more at ease (Alzheimer’s Disease Education and
Referral Center, 2006). These medicines include anti-anxiety medication, anti-
depressants, or pills to aid your sleeping. These medications do not slow the progression
of the disease, but they help the person be more comfortable and ultimately have a better
A person with Alzheimer’s disease has both psychological and physical
symptoms. The dementia associated with Alzheimer’s disease can cause a lot of anxiety
and/or depression. Diagnosis can be tricky, and there is no way to make a definite
diagnosis until an autopsy can be performed after the person dies. The progression of the
disease is irreversible, but it can be slowed somewhat by certain drug treatments.
Researchers are constantly trying to find other ways to help those afflicted with
Alzheimer’s disease. We can only hope that someday soon we will find a cure to this
Alzheimer’s Disease Education and Referral Center. (2006). Understanding Alzheimer’s
American Psychological Association. (2005, March 13). Brain imaging suggests how
higher education helps to buffer older adults from cognitive declines.
American Psychological Association. (2005, July 31). Early warning signs of
Alzheimer’s show up across cognitive areas years before official diagnosis
Retrieved Monday, February 26, 2007 from
American Psychological Association. (2005, September 25). Psychologists find more
sensitive tests for predicting Alzheimer’s as well as subtle changes in cognition.
Retrieved Monday, February 26, 2007 from
Bowirrate, A., Marlene, O., & Logroscino, G. (2006). Association of depression with
Alzheimer’s disease and vascular dementia in an elderly Arab population of
Wadi-Ara, Israel [Electronic version]. International Journal of Geriatric
Cotrell, V., & Hooker, K. (2005). Possible Selves of Individuals with Alzheimer’s
disease. Psychology and Aging
, 20(2), 285-294. Retrieved Wednesday, February
07, 2007 from the PsycARTICLES database.
Gallo, D., Shahid, K., Olson, M., Solomon T., Schacter, D., & Budson, A. (2006).
Overdependence on degraded memory in Alzheimer’s disease. Neuropsychology
20(6), 625-632. Retrieved Wednesday, February 07, 2007 from the
Jones, S., Livner, A., & Backman, L. (2006). Patterns of prospective and retrospective
memory impairment in preclinical Alzheimer’s disease. Neuropsychology
144-152. Retrieved Wednesday, February 07, 2007 from the PsycARTICLES
Lesser, J., & Hughes, S. (2006). Psychosis, agitation, and disinhibition in Alzheimer’s
disease: Definitions and treatment options [Electronic version]. Geriatrics
Loneliness associated with increased risk of Alzheimer’s disease
. (2007, February 07).
Retrieved Monday, February 26, 2007 from Science Daily website
McFarlane, J., Welch, J., & Rodgers, J. (2006). Severity of Alzheimer’s disease and
effect on premorbid measures of intelligence [Electronic version]. British Journal
of Clinical Psychology
, 45, 453-463.
The National Cell Repository for Alzheimer’s Disease. (2003). The genetics of
. Retrieved Monday, January 29, 2007 from
National Institute on Aging. (2006, August 29). Alzheimer’s information. Causes
National Institute on Aging. (2006, August 29). Alzheimer’s Information. Diagnosis.
National Institute on Aging. (2007, January 14). Research information. Scientists find
new genetic clue to cause of Alzheimer’s disease.
Retrieved Monday, January 29,
National Institute on Aging. (2007, January 17). Publications. Understanding stages and
symptoms of Alzheimer’s disease
. Retrieved Monday, January 29, 2007 from
National Institute of Health. (2006). Genes, lifestyles, and crossword puzzles: Can
Alzheimer’s disease be prevented?
Rascovsky, K., Salmon, D., Hansen, L., Thal, L., & Galasko, D. (2007). Disparate letter
and semantic category fluency deficits in autopsy-confirmed frontotemporal
dementia and Alzheimer’s disease. Neurpsychology
, 21(1), 20-30. Retrieved
Wednesday, February 07, 2007 from the PsycARTICLES database.
Robinson, L., Clare, L., & Evans, K. (2005). Making sense of dementia and adjusting to
loss: Psychological reactions to a diagnosis of dementia in couples [Electronic
version]. Aging & Mental Health
, 9(4), 337-347.
Selwood, A., Thorgrimsen, L., & Orrell, M. (2005). Quality of life in dementia – a one-
year follow-up study [Electronic version]. International Journal of Geriatric
Shimabukukoro, J., Awata, S., & Matsuoka, H. (2005). Behavioral and psychological
symptoms of dementia characteristic of mild Alzheimer patients [Electronic
version]. Psychiatry and Clinical Neurosciences
, 59, 274-279.
Sternberg, R. (2006). Alzheimer’s disease. In M. Taflinger (Ed.), Cognitive psychology
(pp. 185-186). Belmont, CA: Thomson Wadsworth.
Strategies for optimizing functionality in patients with psychotic disorders: An evidence-
based approach [Electronic version]. American Journal of Health-System
Tales, A., Snowden, R., Brown, M., & Wilcock, G. (2006). Alerting and orienting in
Alzheimer’s disease. Neuropsychology
, 20(6), 752-756. Retrieved Wednesday,
February 07, 2007 from the PsycARTICLES database.
White, A., & Bush, A. (2006).The metallobiology of Alzheimer’s disease: From bench
to clinic [Electronic version]. Current Medical Literature: Neurology
Zacks, J., Speer, N., Vettel, J., & Jacoby, L. (2006). Event understanding and memory in
healthy aging and dementia of the Alzheimer type. Psychology and Aging
466-482. Retrieved Wednesday, February 07, 2007 from the PsycARTICLES
Mail Service Pharmacy Tips Walgreens Mail Service Illinois Comprehensive Health • Complete attached registration form. You may also register yourself (and dependents, if applicable) at Insurance Plan REGISTRATION & PRESCRIPTION ORDER FORM • New prescriptions must be mailed to the mail Use black ink only. Enclose form with prescription(s) and payment. PARTICIPANT
14 Conclusions The Kyushu Case Study has helped to extend and test the ITM Methodology further, from the basis developed in the Tohoku Case Study. However, it is emphasised at the start of these conclusions that both Case Studies were intended to be development tools, rather than demonstrations of a completed, mature and systematic technical methodology that was already available and widely te