Select one movie to watch in the list below. Using DSM 5 criteria, you are required to diagnose one of the characters in the chosen movie. Include the diagnostic criteria for the diagnosis. Describe the symptoms, incidence, prevalence, etiology, prognosis, and treatment of the diagnosis. Support your arguments with relevant literature.
Alzheimer Disease is a mental problems suffered by some people at certain ages of their life. A type of dementia, the disease causes partial to complete loss of memory. Previously known as Alzheimer’s disease, it causes changes in behavior and thinking as well. The symptoms like forgetting words, routes and such are observed at the initial stages of the disease. One of the most common forms of dementia, Alzheimer’s has received great attention from the filmmakers as well. Several movies have been produced where one or two characters suffered from this disease. Films like The Notebook (2004), Away from Her (2007), On Golden Pond (1981), Iris (2001) and A Moment to Remember (2001) amongst others are some fine examples of movies that are based on Alzheimer’s disease. while most of the films in the list have focused largely on the emotional content, Still Alice focuses on the emotional trauma faced by the lead character herself while she passes through the stages of the disease.
In this essay, the lead character from the film Still Alice shall be discussed. While doing so, the essay will use the DSM 5 Diagnostic Criteria to diagnose the lead character. Health care professionals use the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders) Diagnostic Criteria as the reliable guide to the analysis of mental disorders. Further, the essay will shed light on the symptoms and incidences, the prevalence, etiology and prognosis of the disease as seen in the lead character. In addition, it will also include discussion on the treatment of the disease. The lead character in the chosen film passes through the different stages of Alzheimer’s and at the end of the movie, she is seen struggling to even speak. Using the DSM 5 criteria, the essay will analyze the disease that the lead character suffers from in the movie elaborately.
The reason for choosing this movie is because Alzheimer’s is one of the most common forms of dementia and yet people are ignorant of its symptoms. This movie demonstrates clearly, the three stages of this disease and the feelings the patient goes through during these phases. According to Ken Hepburn, the Education Core Director at the Alzheimer’s disease Research Center, Alice in the film beautifully portrays the subtle signs of the disease (Youtube.com, 2018). He further states that the “authenticity of the progression of the disease” is believable as it is what one sees when one suffers from this disease. However, many have argued regarding the depiction of the Late Stage that is the third stage of the disease in the movie. According to them, the movie wrongly depicted a rapid deterioration of the patient. Apart from that, people have accepted the film warmly across the globe and especially those associated with the disease directly or indirectly.
Released in 2014, the film portrays the life of Dr. Alice Howland (played by Julianne Moore), who gradually discovers that she is losing her memory (Imdb.com, 2018). In one of the beginning scenes, Alice is seen delivering a lecture on English grammar and linguistics but suddenly she forgets a particular word. The film is succinct in its depiction of the disease from the early onset Alzheimer until the final stages. Julianne Moore also does a commendable job in portraying the role of Alice, as she is able to present the trouble, anguish, pain and frustration of a person suffering from Alzheimer’s disease. The directors Richard Glatzer and Wash Westmoreland succeed in brining the minute aspects of the disease on the big picture with ease. Richard Glatzer being a patient of ALS (Amyotrophic Lateral Sclerosis) has speech impairment and hence, he was able to create the lead character with technicality and emotions as well.
Prior to proceeding with the use of DSM 5 to diagnose the disease in the lead character of the film, it is important to provide an explanation. The DSM 5, as discussed earlier in the essay, is the handbook that healthcare professionals use to diagnose mental disorders. The first DSM was introduced in the year 1984 and it was amended in 2013 when its fifth edition was launched. In the previous version of the DSM, Alzheimer’s and other related diseases were named differently (Delirium, Dementia and Other Cognitive Disorders). In the newest version, however these are collectively termed as “Neurocognitive Disorders”. The amendments were minor but significant and relevant to the new age occurrence and practice of such diseases. The updated classification of such diseases was done to demarcate Alzheimer from psychiatric disorder because an AD (Alzheimer Disease) patient shows symptoms of cognitive impairment, which is different from schizophrenia, depression or other forms of mental illness.
In the movie, Alice discovers first symptoms of AD when she forgets a particular word, which would have been easier to remember if she was not suffering from the disease. As per the DSM 5 criteria, anyone who shows symptoms of Mild Cognitive Impairment (MCI) is taken under AD. In addition, the DSM 5 criteria recognize other symptoms like attention, confusion, being lost cognitively and so on as signs of AD and not just the memory loss. The requirement of the DSM 5 criteria involves history-based estimation of cognitive decline in addition to positive testing of cognitive shortage. In the movie, when Alice visits the doctor for the first time and the doctor engages her in memory exercises asking basic questions like the name of her parents. She passes all the tests but mistakes AD as brain tumor and goes through an MRI.
As discussed earlier, the beginning of the movie shows Alice trying hard to remember a word while lecturing in a university classroom and later, she struggles to remember the route to her home while jogging. As the movie progresses, Alice start forgetting small things like names of kitchen utensils or the time of her younger daughter Lydia’ (played by Kirsten Stewart) play. She also forgets about occurrences of the immediate past, which is evident in the scene where she reintroduces herself to her son’s girlfriend. Gradually, Alice starts to forget simple yet significant things like going for dinner with her husband. Later, she even forgets the location of the bathroom of her house and pees in her pants. Through the end of the movie, Alice fails to recognize her own daughter. In the final scene, the audiences see Alice even struggling to speak and understand the things going around her.
As per the DSM 5 Diagnostic Criteria, Alice struggling to remember words and routes to her own home are the mild symptoms of the neurocognitive disorder and indentified as the early onset AD (Yang Cece, 2018). Further, as the disease enters the second stage that is the middle stage, Alice begins to feel lost and forgets things like the way to her own home. Symptoms like these in addition to forgetting important events, repeating questions r conversations fall under the broader symptom of reduced ability to take in new information. In the last stage of AD, the patient shows symptoms like incapability of recognizing faces (Lydia’s after play scene when Alice fails to recognize Lydia). In addition, other symptoms such as impaired speaking, hesitations, and loss of empathy and so on are also start to appear in this stage as happened to Alice.
The Alzheimer’s disease occurs more in low-income countries and each year, more than 10 million people are affected by it. In the 2015 World Dementia Report, it was found that over 47 million people across the globe had dementia and in 2017, the number rose to 50 million approximately (Alz.co.uk., 2018). Further research into the disorder shows that the number will double in every 20 years, which means 75 million people in 2030 and 131.5 million people in 20150 will be diagnosed with Alzheimer disease. As Grant (2014) observes, “Alzheimer’s disease rates in Japan and developing countries have risen rapidly in recent years”. The author further observes that the chief reason for this s attributed to factors like obesity, alcohol consumption, Western diet and smoking. Around 58% of the population in low and middle-income countries suffers from AD and the figures are expected to increase up to 68% by 2050 (Alz.co.uk, 2018). India, China and other Pacific and South Asian nations are witnessing the fastest rise of AD.
Neurocognitive disorders occur usually in people over the age of 60 years and tend to increase, as the individuals get older. However, experts around the globe are of the opinion that no real cause of the Alzheimer disease has yet been identified. Although no real etiology is identifiable, it is often attributed to genetic and environmental factors. In less than 5% of people suffering from AD, genetic causes have been found as the cause. Environmental factors rarely cause Alzheimer’s in individuals. In the views of Nicolia, Lucarelli and Fuso (2015), environmental factors do not directly cause Alzheimer’s but these can “induce epigenetic modifications in the individual”. In addition, it is caused by brain cell death, as is the case with other forms of dementia. Alzheimer’s is also caused by the gradual degeneration of the brain cells that result in less and less nerve cells and associations. It has been found that people with AD have in their brains, tiny deposits called plaques and tangles that form on the brain tissue. A protein named beta-amyloid makes up the plaques found in the dying brain cells. Tangles on the other hand, are caused from another protein known as ‘tau’ Chin-Chan, Navarro-Yepes and Quintanilla-Vega (2015). Nonetheless, researchers are yet to find the actual cause behind the formation of these proteins. The makers of Still Alice have thus apparently refrained themselves from showing the actual cause of Alzheimer’s in Alice although they do depict the genetic connection of the disease. Anna (played by Kate Bosworth), Alice’s oldest daughter is tested positive which meant that she will eventually develop Alzheimer’s later in her life.
When it comes to prognosis, Alzheimer’s has little medications with which it could be cured. In addition, the medications that are available do not cure or reverse the disease but prolongs the deterioration. The disorder has been observed to last between 1.5 years to 15 years with symptoms gradually worsening. Individuals suffering from AD have a life expectancy of around one to twenty years post diagnosis. The average life span is however eight years to the maximum. Variations are there in terms of the lifespan of AD detected individuals. Very often, people diagnosed with Alzheimer’s pass away due to other medical conditions that result from complications of the disease. These complications include pneumonia and heart disease amongst others. In a study conducted by (Drachman DA, 2018), it was found that AD patients were examined for prognostic assessment at succeeding follow-up of 54 in more or less 25 months. The prognostics were of three types in particular – severity features degree, inconsistent clinical features and individual unique features. The authors made use of the Kaplan-Meier life-tables to predict the power of the prognostic features as mentioned. The results revealed that the severity features displayed patient’s dependence in daily activities, incontinence and institutionalization. Further, the results also revealed that age, gender, historical duration of the disease and familial dementia history had little effect in prognosis.
As mentioned in the previous sections, there is no known, possible cure for Alzheimer, as brain cells death cannot be reversed. Nonetheless, with therapeutic interventions, people with dementia like AD could be empowered to survive with the disease more easily. In the movie as well, Alice receives care and love of her relatives and loved ones but does not seem to recover rather, her condition worsens. In the end as well, the audiences see Alice speaking with difficulty and as the credits roll, it is implied that her condition deteriorated.
It is but important to note that proper care could lead to an increased lifespan of AD patients, as per the claims of Alzheimer’s Association (Medicalnewstoday.com, 2018). According to the association, certain significant elements of care could help AD patients. These elements include efficient management of other conditions resulting from Alzheimer’s, daycare programs and other activities and engagement with support services and groups. Apart from that, certain drugs are there that help reduce the symptoms of the disease. In the United States, cholinesterase inhibitors are approved for suggestive relief. In addition, the Memantine, also known as Namenda drug has been found effective in slowing the progression of the symptoms of Alzheimer disease from moderate to severe. However, it has certain side effects as well which include dizziness, constipation and headache. Other treatment for Alzheimer disease includes constant care for the patient and show of love and positivity.
To conclude, it can be stated that motion pictures in recent decades have succeeded in portraying the issue of Alzheimer disease. The essay tried to provide as much information as it could to analyze and diagnose the condition of the lead character in the movie Still Alice. In attempting so, the essay at first explained the DSM 5 Diagnostic Criteria and tried to diagnose Alice’s condition using this criteria. She was diagnosed with early onset-Alzheimer’s, which later deteriorates as the film progresses. Then, the symptoms and incidences of the diagnosed diseases have been presented in the essay. The essay also explained how the film has demonstrated an authentic progression of AD through its lead character. After that, the prevalence of the disease was also discussed revealing that low and middle-income countries mostly are influenced from this disorder. In addition, the figures indicating the future occurrence of Alzheimer’s across the globe has been provided as well. The paper has also discussed the etiology and prognosis of the disorder in which it found that there is no tangible cause of the disease. in terms of prognosis, Alzheimer’s duration is between 1 to 15 years and the average life expectancy of the patient is one to twenty years after diagnosis. The essay also revealed that degrees of severity features, family history, age and gender do not influence prognosis. Limitations in treatment have been discussed as well.
References:
Alz.co.uk. (2018). Dementia statistics | Alzheimer’s Disease International. Retrieved from https://www.alz.co.uk/research/statistics
https://www.alz.co.uk/research/statistics
Chin-Chan, M., Navarro-Yepes, J., & Quintanilla-Vega, B. (2015). Environmental pollutants as risk factors for neurodegenerative disorders: Alzheimer and Parkinson diseases. Frontiers in cellular neuroscience, 9, 124.
https://www.ncbi.nlm.nih.gov/pubmed/25914621
Drachman DA, (2018). The prognosis in Alzheimer’s disease. ‘How far’ rather than ‘how fast’ best predicts the course. – PubMed – NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/2375690
https://www.ncbi.nlm.nih.gov/pubmed/2375690
Grant, W. B. (2014). Trends in diet and Alzheimer’s disease during the nutrition transition in Japan and developing countries. Journal of Alzheimer’s Disease, 38(3), 611-620.
https://www.ncbi.nlm.nih.gov/pubmed/24037034
Imdb.com (2018). Still Alice (2014). [online] IMDb. Available at: https://www.imdb.com/title/tt3316960/plotsummary?ref_=tt_stry_pl#synopsis [Accessed 25 Jul. 2018].
https://www.imdb.com/title/tt3316960/plotsummary?ref_=tt_stry_pl#synopsis
Medicalnewstoday.com. (2018). Alzheimer’s disease: Symptoms, stages, causes, and treatment. Retrieved from https://www.medicalnewstoday.com/articles/159442.php
https://www.medicalnewstoday.com/articles/159442.php
Nicolia, V., Lucarelli, M., & Fuso, A. (2015). Environment, epigenetics and neurodegeneration: Focus on nutrition in Alzheimer’s disease. Experimental Gerontology, 68, 8-12. doi: 10.1016/j.exger.2014.10.006
https://www.ncbi.nlm.nih.gov/pubmed/25456841
YANG Cece, X. (2018). Are the revised diagnostic criteria for Alzheimer’s disease useful in low- and middle-income countries?. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4466853/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4466853/
Youtube.com. (2018). Still Alice: An accurate look at Alzheimer’s?. Retrieved from https://www.youtube.com/watch?v=20Sn0qz8L_M&t=89s
https://www.youtube.com/watch?v=20Sn0qz8L_M&t=89
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