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...social integration, depression, holistic wellness.
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The life experiences of women, their educational and vocational opportunities, their access to health care, medications, and disease exposures may affect their risks of Alzheimer's Disease in ways that current research is only beginning to comprehend.
--Lerner, 1999, p. 1831
Among the many challenges encountered in late life, a diagnosis of dementia is particularly devastating. Not only does the diagnosis represent a personal tragedy for those with dementia, it portends a harrowing experience for families and other caregivers. One of the best known forms of dementia, dementia of the Alzheimer's type (DAT), is a disorder that, as its name indicates, is an outcome of the Alzheimer's disease (AD) process. As is the case for all dementias, DAT presents affected individuals with an array of cognitive deficits and emotional struggles. Unlike most other forms of dementia, however, the impact of DAT is greater on women than it is on men (Baum, 2005).
Although DAT remains an incurable, dreaded disorder, contemporary research in the biomedical sciences suggests that there is some hope that the disease can be averted. There are, in fact, a host of strategies, many falling within the purview of counseling practice, which may be able to alter the progression of the AD process. This article explores the role of counseling in averting the devastating effects of DAT, giving particular attention to how counselors can help women in the fight against AD. It begins with an overview of the statistics, symptoms, etiology, pathology, and risk factors related to the disorder. Strategies for controlling the symptoms of DAT are then considered and are followed by a discussion of how counselors are uniquely positioned to assist in initiatives targeting control of women's brain health in late life. Finally, the role of holistic wellness counseling as a lifelong prevention strategy is considered.
AN OVERVIEW OF DAT
Statistics
Data provided by the Alzheimer's Association (2006a) on late-onset AD indicate that the disorder doubles every 5 years in individuals over 65 years of age and that "by age 85, the risk reaches nearly 50 percent" (p. 1). Late-onset AD is the most common form of the disorder and by definition includes cases that begin after age 65. The incidence of AD developing before age 65, a form of the disease termed early onset, is more rare, tends to run in families, and accounts for less than 5% of all AD cases (Alzheimer's Disease Education and Referral Center, 2004).
A report commissioned by the Alzheimer's Association estimates that AD costs businesses in the United States $61 billion per year. This figure includes $36.5 billion to cover productivity loss, absenteeism, and worker replacement for caregivers and $24.6 billion to provide health care to AD patients (Kopel, as cited in Alzheimer's Association, 2006b). The estimated average lifetime cost to care for an individual with AD ranges from $200,000 to $400,000 (Shankle & Amen, 2004).
The Symptoms of DAT
The Diagnostic and Statistical Manual of Mental Disorder (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association [APA], 2000) states that "the essential feature of a dementia is the development of multiple cognitive deficits that include memory impairment and at least one of the following cognitive disturbances: aphasia, apraxia, agnosia, or a disturbance in executive functioning" (p. 147). To meet the criteria for a diagnosis of dementia, cognitive deficits must be severe enough to cause problems in occupational or social activities and "must represent a decline from a previous level of functioning" (p. 147). It is noteworthy that deficits may appear to be more severe in work situations that involve complex cognitive skills than in occupations that are less cognitively demanding (APA, 2000). For example, the cognitive deficits endured by someone who is employed in a job that involves routine physical labor, such as house cleaning or stocking shelves at a grocery store, may be less noticeable than a similar deficit level in someone, such as a chemical engineer, who regularly negotiates abstract mathematical concepts, structural chemistry, and the verbal skills necessary to organize and compose reports. The principal components of dementia, namely, memory loss, aphasia, apraxia, agnosia, and disturbed executive functioning, are elaborated in the DSM-IV-TR text. A summary of that text is provided in the following paragraphs.
The most salient feature of early dementia is memory loss. Without a memory deficit, a diagnosis of dementia cannot be made. Two types of memory impairment may be present: The first type of impairment is characterized by an inability to remember new information, and the second destroys the client's capacity to recall information that was previously learned. These two forms of memory impairment can occur either individually or simultaneously.
Aphasia includes a range of symptoms that are manifestations of deterioration in language function. In the early stages of dementia, when cognitive impairment is less severe, the client's spoken or written language comprehension may be compromised. At this time, individuals with AD may not be able to recall names of objects, or their speech may become vague and filled with indefinite references such as "it" or "thing." In the advanced stages, aphasia may include mutism (an inability to speak), echolalia (speech echoing), or persistent repetition of sounds.
Apraxia refers to the inability to perform routine motor functions in spite of the fact that motor abilities, sensory functions, and the ability to understand commands are intact. For example, although individuals diagnosed with dementia may demonstrate an ability to move their arms, they may not be able to perform essential daily activities such as cooking or personal hygiene. Simple tasks such as hair combing or tooth brushing may become impossible.
Agnosia is defined as an inability to recognize otherwise familiar objects in spite of having intact sensory function. Although it may be evident that a client with AD is able to see, he or she may not be able to name a common inanimate object such as a table or a book. Tragically, and particularly burdensome to loved ones, agnosia may render individuals with dementia unable to recognize family, friends, neighbors, or other familiar persons.
Finally, executive functioning includes a number of important activities essential to daily living, including planning, sequencing, initiation or cessation of complex behavior, and the ability to think abstractly. The loss of executive function can cause problems, such as being unable to carry out the steps needed to complete a simple project or losing the ability to make sound judgments about the consequences of one's behavior.
Etiology of DAT
Dementia is a general term that refers to the cognitive deficits caused by a number of conditions including AD, HIV/AIDS, Parkinson's disease, stroke, and longterm abuse of alcohol...
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