Providing Counseling for Individuals with Alzheimer's Disease and Their Caregivers

Article excerpt

Alzheimer's disease is a progressive condition that results in brain wasting and eventual death. With its increasing diagnosis rate, counselors will likely acquire clients with Alzheimer's disease or their caregivers. Important background information and several practical counseling methods are provided that may assist counselors working with this population.

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Alzheimer's disease is a progressive, fatal condition that results in brain wasting and eventual death. Approximately 4.5 million Americans currently have Alzheimer's disease, and the likelihood of being diagnosed with Alzheimer's disease increases to nearly 50% by age 85 (Hodes, 2004). The annual economic cost of Alzheimer's disease on the American economy is estimated to be more than $100 billion. Furthermore, as the median age of the American population increases over the next several decades, the number of individuals diagnosed with Alzheimer's disease is projected by Hodes to increase to more than 13 million by 2050.

In the future, counselors will likely encounter clients who are diagnosed with Alzheimer's disease or who are caregivers of someone with the disease. The purpose of this article is to provide counselors with a summary of the implications of Alzheimer's disease and strategies for managing therapy with people whose lives are affected by Alzheimer's. By familiarizing themselves with information regarding the theories of etiology, behavioral effects, symptoms, diagnostic methods, current medical treatments, specific counseling considerations, and treatment interventions for those with Alzheimer's and for their caregivers, counselors can become better prepared to work with these clients.

ETIOLOGY OF ALZHEIMER'S DISEASE

A prominent manifestation of Alzheimer's is the formation of plaques and tangles of abnormal neurons in specific areas of the person's brain. The presence of plaques and tangles are characteristic of Alzheimer's disease, and the absence of one of these features means that Alzheimer's cannot be diagnosed. The plaques and neuron tangles found in the brain of an individual with Alzheimer's are indicative of a general wasting of the brain that leads to progressive cognitive impairment, which is characteristic of the disease. Cognitive impairment results in confusion during early stages of Alzheimer's disease. As the impairment worsens, the person with Alzheimer's disease gradually loses the ability to manage day-to-day activities such as dressing and hygiene. Eventually, those with Alzheimer's disease are unable to care for themselves and reside in a vegetative state until death.

The underlying cause of plaque formation is known to be related to harmful neurochemical processes (beta-amyloid peptides between cells and highly ordered aggregates of abnormal brain protein called tau within cells; Davies, 2000). Currently, experts in the field posit abnormal gene mutations as a potential basis for Alzheimer's disease (Davies, 2000). However, the three known genetic mutations related to the disease account for only about 0.5% of the cases of Alzheimer's disease, leaving the preponderance of cause still largely unknown.

Another hypothesis for Alzheimer's disease is impaired cerebromicrovascular perfusion (De La Torre, 2000). De La Torre proposed that, as part of the aging process, brain capillaries degenerate and fail to deliver adequate perfusion to brain cells to deliver glucose to neurons and remove waste products. De LaTorre provided a number of factors to support his particular theory for Alzheimer's disease, including findings that the majority of individuals with Alzheimer's exhibit microvascular abnormalities and drugs that improve cerebral perfusion lower the risk of Alzheimer's disease.

Persson and Skoog (1996) indicated that psychosocial risk factors may also contribute to the development of Alzheimer's disease. They identified major life stressors such as experiencing the death of a spouse, death of a child, death of a parent before reaching age 16. …