Chronic Diseases

Chronic Diseases

Chronic Diseases

Chronic Diseases


Although considerable progress has been made in the understanding and treatment of a range of medical disorders, it had recently been pointed out that 85 percent of the population will be stricken by chronic disorders which may be accompanied by many years of suffering.

This volume deals with issues of both cure and risk in chronic illnesses which are among the group of disorders associated with the leading causes of death in the United States at this time -- Alzheimer's disease, AIDS, and cancer. A consideration of the role of brain and behavior in relation to the cure and prevention of these disorders is the central focus of the various chapters in this book. Several chapters discuss the neuropsychological aspects of chronic illnesses including the underlying pathophysiology of changes in the brain which may be associated with both behavioral and physical signs and symptoms in these disorders. Considerable evidence suggests that a range of psychosocial or behavioral factors, such as stressful life events and depression, are associated with increased morbidity or mortality. Complex neurobiological pathways involving the brain, neurotransmitter, and neuroendocrine systems have been implicated. Other chapters consider some of the links among brain, behavior and chronic illnesses, as well as psychological factors such as coping and depression in relation to chronic disorders.

The three leading risk factors known to be associated with both chronic illnesses and death -- diet, tobacco, and alcohol -- are all related to behavioral choices. Sexual behavior can be added to the list in terms of HIV infection and acquired immunodeficiency disease (AIDS). Several chapters deal specifically with a consideration of sexual behavior and HIV infection which clearly highlight the need for scientific knowledge in human sexuality if effective long term preventive measures are to be developed while waiting for a vaccine or cure.

The search for cures must continue to have the highest priority in the scientific and clinical struggle against disease. Nonetheless, the value of psychosocial interventions on the quality of life and mental states of seriously ill persons should not be underestimated.


One major impetus for the development of behavioral medicine and the growth of the Academy of Behavioral Medicine Research has been the growing realization that the deadly and greatly feared diseases of our time have clear behavioral components. Where once the most serious diseases were caused by pathogens spread by casual contact, animals, or other largely uncontrollable agents, major diseases of our time, heart disease, HIV, and cancer, are often caused by or associated with the things we do, eat, smoke, drink, and how we cope with life's demands. In particular, two "new" diseases and one considerably older one promise to shape a good deal of biobehavioral research as we approach the millennium. AIDS (or HIV), Alzheimer's disease, and cancer constitute major public health problems in the world today. All three have important behavioral aspects, and all are debilitating, potentially deadly, and only partly understood. It is these chronic illnesses of the 1990s that are the focus of this book.

Many serious, life-threatening, and/or chronic diseases affect cognitive functioning, either because of damage to neural tissue, disruption of nervous system function, or mood and attention changes. Alzheimer's disease has become the primary source of intellectual impairment among older people and, in part because victims often must receive full-time care, constitutes a major social and economic problem as well as a health issue. Three chapters in the first section of the book address the impact of Alzheimer's disease. Pappolla and Robakis (chap. 1) address the neuropathology and molecular biology of Alzheimer's disease, describing the pathophysiology of senile and pre-senile dementia. Of particular importance for readers interested in biobehavioral determinants of disease course or outcome is the detailed discussion of the origin and development of amyloid . . .

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