Navigating the Alzheimer's Challenge: A Holistic Perspective
Alzheimer's disease, an inexorable neurodegenerative force, not only presents a medical challenge but also raises profound ethical questions about maintaining dignity and quality of life amidst cognitive decline and the inexorable march towards death. This ethical conundrum is accentuated by the fact that those directly affected often struggle to express their preferences due to cognitive impairments. The failure of healthcare professionals to recognize and adapt to these impairments further exacerbates the suffering of patients1.
Research illuminates the prevalence of decisional impairments among cognitively impaired elderly individuals, emphasizing that those with dementia or cognitive impairment are more likely to exhibit decisional incompetence compared to their counterparts. It is crucial to recognize that a diagnosis of dementia does not equate to incapacity, as there is significant variability in decision-making abilities among individuals with mild-to-moderate Alzheimer's disease2.
Understanding the neuropsychological factors contributing to impaired decision-making is paramount for developing targeted interventions. Executive functions, which orchestrate complex, goal-directed behavior, emerge as pivotal in decisional abilities. This identification not only validates measures of decision-making but also opens avenues for enhancing decisional capacity through interventions2.
Expanding the scope beyond clinical realms, decision-making capacity extends to long-term care, legal matters, and financial decisions. Professionals in finance and banking, positioned at the frontlines of screening for cognitive impairment, require standardized guidelines and training to identify and address impaired decision-making capacity1.
The evolving landscape of Alzheimer's research calls for a reconsideration of how we define and address the disease. While endeavors to discover treatments for cognitive impairments progress, there is a call to expand the Alzheimer's label to encompass individuals who do not exhibit dementia but may still be at risk. Controversies are likely to arise concerning the value of early diagnosis and treatment, emphasizing the need for a nuanced approach1.
As we navigate these complexities, a fundamental question emerges: How are we to live with Alzheimer's disease? This query necessitates a multifaceted approach, integrating not only medical interventions but also ethical considerations, professional training, and societal attitudes. Living with Alzheimer's is not just an individual's struggle; it's a collective challenge that requires a comprehensive and compassionate response from healthcare systems, professionals, and society at large2, 3.
References
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[1] Kramer, P. L., Xu, H., Woltjer, R. L., Westaway, S. K., Clark, D., Erten-Lyons, D., Kaye, J. A., Welsh-Bohmer, K. A., Troncoso, J. C., Markesbery, W. R., Petersen, R. C., Turner, R. S., Kukull, W. A., Bennett, D. A., Galasko, D., Morris, J. C., & Ott, J. (2011). Alzheimer disease pathology in cognitively healthy elderly: a genome-wide study. Neurobiology of aging, 32(12), 2113–2122. https://doi.org/10.1016/j.neurobiolaging.2010.01.010
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[2] Kim, S. Y., Karlawish, J. H., & Caine, E. D. (2002). Current state of research on decision-making competence of cognitively impaired elderly persons. The American journal of geriatric psychiatry, 10(2), 151-165. https://www.sciencedirect.com/science/article/abs/pii/S1064748112613402
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[3] Karlawish, J. (2014). How are we going to live with Alzheimer’s disease? Health Affairs, 33(4), 541-546. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2014.0089