Dementia (Alzheimer's Disease)
There are several forms of dementia, but Alzheimer's Disease is the best known. Alzheimer's Disease is named after a German physician, Alois Alzheimer, who first described this condition in 1906. His original patient was a woman in her 40's, with memory loss, language problems, and unpredictable behavior.
The National Institutes of Health (NIH) has described the many molecular and cellular changes that take place in the brain of a person with Alzheimer's disease. [Referenced, infra.] These changes can be observed microsopically in brain tissue of affected individuals at post-mortem.
In Alzheimer's disease, there is an abnormal accumulation of beta-amyloid protein in the brain that comes in several different molecular forms. It collects between neurons and is formed from the breakdown of a larger protein, called amyloid precursor protein. One form, beta-amyloid 42, is thought to be especially toxic. In the Alzheimer's brain, abnormal levels of this naturally occurring protein clump together to form plaques that collect between neurons and disrupt cell function.
Neurofibrillary tangles also occur in the brain of Alzheimer's patients. They are abnormal accumulations of a protein called tau that collect inside neurons. Healthy neurons, in part, are supported internally by structures called microtubules, which help guide nutrients and molecules from the cell body to the axon and dendrites. In healthy neurons, tau normally binds to and stabilizes microtubules. In Alzheimer's disease, however, abnormal chemical changes cause tau to detach from microtubules and stick to other tau molecules, forming threads that eventually join to form tangles inside neurons. These tangles block the neuron's transport system, which harms the synaptic communication between neurons.
Doctors and scientists believe that the brain changes that occur in Alzheimer's may result from a complex interplay among abnormal tau and beta-amyloid proteins and several other factors. It appears that abnormal tau accumulates in specific brain regions involved in memory. Beta-amyloid clumps into plaques between neurons. As the level of beta-amyloid reaches a tipping point, there is a rapid spread of tau throughout the brain.
Chronic inflammation is associated with Alzheimer's and includes the buildup of glial cells normally meant to help keep the brain free of debris. One type of glial cell, microglia, engulfs and destroys waste and toxins in a healthy brain. In Alzheimer's, microglia fail to clear away waste, debris, and protein collections, including beta-amyloid plaques.
Vascular Contributions to Alzheimer's Disease
People with dementia seldom have only Alzheimer's-related changes in their brains. Any number of vascular issues, problems that affect blood vessels, such as beta-amyloid deposits in brain arteries, atherosclerosis (hardening of the arteries), and mini-strokes, may also contribute to the dementia that occurs in Alzheimer's patients.
Vascular problems may lead to reduced blood flow and oxygen to the brain, as well as a breakdown of the blood-brain barrier, which usually protects the brain from harmful agents while allowing in glucose and other necessary factors. In a person with Alzheimer's, a faulty blood-brain barrier prevents glucose from reaching the brain and prevents the clearing away of toxic beta-amyloid and tau proteins. This results in inflammation, which adds to vascular problems in the brain.
Loss of Neuronal Connections and Cell Death
In Alzheimer's disease, as neurons are injured and die throughout the brain, connections between networks of neurons break down, and many brain regions begin to shrink. By the final stages of Alzheimer's, the brain atrophy is widespread.
Genetic research has identified a gene called TREM2. Normally, TREM2 tells the microglia cells to clear beta-amyloid plaques from the brain and helps fight inflammation in the brain. In the brains of people where this gene does not function normally, plaques build up between neurons. Astrocytes, which are another type of glial cell, are signaled to help clear the buildup of plaques and other cellular debris left behind. These microglia and astrocytes collect around the neurons but fail to perform their debris-clearing function. In addition, they release chemicals that cause chronic inflammation and further damage the neurons they are meant to protect.
Disability Benefits for Early Alzheimer's Disease
While Alzheimer's disease typically strikes persons who are already beyond the retirement range (<65 years), there are unfortunately many instances of Alzheimer's causing significant cognitive dysfunction, dementia, and physical disability in the 40's, 50's and 60's. A famous example was Rita Hayworth, the movie actress, who developed symptoms of Alzheimer's in her 40's and wasn't diagnosed until she was 62 years of age. She died six years later. Her daughter recalled that “by the time she was diagnosed, she really wasn't totally aware ... She would look at me and say, ‘Who are you?' That was heartbreaking."
"The National Institute on Aging has put together a list of common symptoms at varying stages of Alzheimer's disease.
- Memory loss
- Poor judgment leading to bad decisions
- Loss of spontaneity and sense of initiative
- Taking longer to complete normal daily tasks
- Repeating questions
- Trouble handling money and paying bills.
- Wandering and getting lost.
- Losing things or misplacing them in odd places.
- Mood and personality changes.
- Increased anxiety and/or aggression.
- Increased memory loss and confusion
- Inability to learn new things
- Difficulty with language and problems with reading, writing, and working with numbers
- Difficulty organizing thoughts and thinking logically
- Shortened attention span
- Problems coping with new situations
- Difficulty carrying out multistep tasks, such as getting dressed
- Problems recognizing family and friends
- Hallucinations, delusions, and paranoia
- Impulsive behavior such as undressing at inappropriate times or places or using vulgar language
- Inappropriate outbursts of anger
- Restlessness, agitation, anxiety, tearfulness, wandering (especially in the late afternoon or evening)
- Repetitive statements or movement, occasional muscle twitches
- Inability to communicate
- Weight loss
- Skin infections
- Difficulty swallowing
- Groaning, moaning, or grunting
- Increased sleeping
- Loss of bowel and bladder controlage
Disability Benefits for Alzheimer's Disease (Dementia)
Essential Medical Documentation
SSA utilizes the term "Impairments" (and resulting "limitations" - why you cannot work) are the essential bits of information that must be clearly and consistently documented throughout your medical history by the treating sources (medical doctors, neurologists, psychologists, psychiatrists).
SSA additionally utilizes the term "Residual Functional Capacity" (RFC); this is a key concept related to the resulting physical and/or mental impairments from conditions for which the disability claim is based upon and the impact upon ability to work.
SSA has its own forms that are used for Physical RFC here and for Mental RFC here. These forms can be filled out by the treating source who has the opportunity to examine the patient and understand the limitations which result from his/her condition and thereby document with specificity in the language of SSA disability.
SSA has its own forms that are used for Physical RFC here. These forms can be filled out by the treating source who has the opportunity to examine the patient and understand the limitations which result from his/her condition and thereby document with specificity in the language of SSA disability.
SSA "Listing" or "Blue Book" description of Alzheimer's (dementia) for disability benefits can be found here. (see 11.00)
Your disablity lawyer must work closely with your treating physician to get the proper documentation of your specific findings and impairments into the medical records. At Law Med that's what we do.