The Effect That Alzheimer's Has On A Person's Personality

Alzheimer is the neurodegenerative brain disorder which develops mainly in the mid-old adulthood and is characterized by neuropsychological, neuropsychiatric and neurologic manifestations. Alzheimer disease and senile dementia of the Alzheimer type (SDAT) are characterized by gradual loss of memory(most common is damage in short-term memory) and worsening of cognitive functions. The disease progresses very slow and conditions of the patient become worse over time. This disease cause irreversible damage to the memory function of the brain as well as the other cognitive ability of the brain.

Evidence shows that the nucleus basalis of Meynert is the main source of cholinergic inputs.The nucleus basalis of Meynert, contains diffuse cholinergic neurons, provides diffuse cholinergic input to the neocortex. It was found that few patients with AL have less functioning choline acetyltransferase in the neocortex. When AL (Alzheimer) diseasepatients are compared with controls, both groups having same gender and age, it was found that AL patients have less neurons compared to healthy controls.

The characteristic features of AL disease also consist of senile plaques, neurofibrillary tangles, granulovacuolar neuronal degeneration. Granulovacuolar neuronal degeneration starts in the early stages of AL disease but it is only rarely found in the brains of nondemented subjects or in old persons below the age of 60 years. AL patients suffer from memory deficits, having difficulty with both short- and long-term memory. As the disease progresses few symptoms such as the person gets confused and behaves aggressively are seen in AL patients. The neurological disorder progressed inexorably at the last stage of disease where the affected person become completely demented, unable to raise from bed, unable to feed or dress himself, and nearly mute. The disease might pass from other family members. Behavioral and psychological symptoms of dementia (BPSD) consist of three main syndromes, such as agitation, psychosis, and mood disorders, and these syndromes frequently co¬exist. All BPSD become more severe and frequent as disease progresses. Agitation, for example restlessness, pacing,always following a carer, is also seen in AL patients.

A drug named Scopolamine causes amnesia and is given to patients before surgery. Experiment was done on healthy people using scopolamine and the amnesia effect of this drug is confirmed. Drowsiness and amnesia, caused by this drug, are not correlated.A research was conducted in healthy people,where some volunteers were given scopolamine, to see the amnesia effect of Scopolamine. The “retrieval by category” test was conducted in the research where volunteers were given the name of a familiar category of nouns were told to list as many words as they could which fitted into the category. The retrieval scores of volunteers having amnesia were less than volunteers who don’t have amnesia. The “false-positive retrievals” that happens after scopolamine treatment is similar to errors found in AL patients. AL patients have difficulties in recalling lists of names,for example naming trees.

AL disease causes brain damage which has a great impact on a person’s behaviour such as physical violence, hitting, incontinence, catastrophic reactions, suspiciousness, and accusatory behaviour and these acts impose a huge burden on carers and may result in patients being admitted in nursing home.Recent studies have shown statistics of behavioural disturbances in detail. Swearer et al (1988) evaluated 126 demented patients (57 with AD) who attended an AD research centre. Angry outbursts occurred about 50% of patients and 21% patients behaved violently. 46% ofpatients are accounted for Dietary change' (not further specified. Ten et al (1988) found wandering in 26% of 127 patients with AD.

Consequently, the same group gave more detailed results: 20% of patients have increased appetite, 5% of patients are found to be wandering, and no patient showed behaviour aimed at “attempting to hurt others”. In a community study of aggression (Ryden, 1988) 65% of the 183 subjects behaved aggressively. However, dementias of any aetiology were included in this sample. In further studies, Reisberg et al (1987) found that 19% of patients in the experiment behaved violently and Ryden (1988) found that 65% of patients (in a sample of 183 subjects) have at least one form of aggression (most commonly verbal aggression). Ryden’s result showed the following aggressive behavior: pushing/shoving (21%), pinching/squeezing (15%), and hitting/punching (14%).

Other aggressive behaviours seen in AL patients are shouting, throwing objects etc.. Studies on animals and humans confirmed the involvement of the medial nuclei of the hypothalamus, the amygdala, and hippocampus.

Two conclusions are found which shows a relation between aggression and neurochemical changes in AD. It was found that the circuits causing aggression are cholinergic and the cholinergic is depleted in AL patients. Seroton metabolites are depleted in aggressive patients with depression, schizophrenia, AL. Wandering is also seen in AL patients. Researches found that 26% of the 127 subjects had wandering behavior.

Pharmacological treatments for aggression such as antipsychotics have huge benefit in short-term treatment (over 6–12 weeks) of aggression but it doesnot work well in longer term therapy. This treatment might lead to stroke and death. Antipsychotic drugs are used as a treatment for agitation, aggression and BPSD. Memantine, carbamazepine, and citalopram are found to be effective in treating aggression in AL patients.

The reduction of neurons in nucleus basalis affects mental function. It was found, from behavioral and pharmacological studies, that storing and gaining of new information,attention,motivation and learning depend partly on cholinergic activities. It has been found that the destruction in cholinergic hippocampal circuits in the septum and basal areas may cause a large memory loss in patients suffering from AL disease. BPSD are frequent in AL patients which present a significant management challenge for clinicians.