Essay Instructions: I need the writer of this research paper to be familiar with Doing Literature ( Review ) Research Papers and also familiar with the topic -Alzheimer’s Disease-.
Below is a 7 page paper, I need this paper to be extended to 15 pages,( Additional 8 Pages.)
As you can see the topic Is very general.
So, I need the writer to come up with a Specific Hypothesis(Narrower Topic), BREAK it down to Narrower and more specific topic. The Hypothesis has to be something that hasn’t really been already proved and still under intensive research.
I need minimum of 33 Peer reviewed Articles. ( MAINLY FROM PUBMED.com) not from other online sources( unrelaiable sources..**** Prefer I need the PUBMED WEBSITE ******
here is how I want the paper to be set up:
This Literature Review should include
Intentative Title for paper.
Then the continuation of this paper needs to start with Hypothesis, Then 3 or 4 Specific Research Questions listing potential questions that could be studied. These questions should be as specific AS POSSIBLE and should be clearly related to the review of the literature.
Then Suggesting series of Data that those Questions can be Tested and studied.Also what would be the possible outcome and answers to those questions. This area could evaluated the published literature ( minimum of 33 should be included.)
Each topic area should be introduced with a general description of what will be covered, and will end with a similar paragraph that bridges from one division to another. Through , it is important to show the relatedness of the study to the topic. .
This major part of paper could be integrating ideas presented from literature , heavily relaying on writers ideas. Then theoretical research methods should be suggested , finding and implications of the reviewed literature could also be added.
LAST section (conclusion) should be analytical literature review should be a brief conclusion section where it takes all the information gathered and integrated and present the significance ( what does it all mean and why is this important.
In this section the information from those articles ( FROM PUBMED) Can be summarized and discussed.
The literature review paper should cover a specific area of research interest relating to topic.
Here is the original paper that can be used as introduction and first 7 page of this new paper.
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Abstract:
Alzheimer's disease is a unique incurable disease that affects the lives of many elderly people world- wide. This paper will examine Alzheimer’s in depth by looking at its definition, biological affects, facts, and drug treatments. Also, a look at new treatment drugs and whether they have a profound affect on the patient’s condition. The paper examines to see whether Aricept can deliver the needed drug therapy for Alzheimer patients.
Alzheimer’s disease is a progressive form of pre-senile dementia, which similar to senile dementia, except that it usually starts in the 40s or 50s, and with initial symptoms of impaired memory, then impaired thought and speech and finally complete helplessness (Lexico Publishing Group LLC 2006). It is a disease in the brain, which makes the sufferer forget how to use a key, walk, talk or eat (Liebman 2002).
Recent statistics showed that approximately a third of all people older than 85 have Alzheimer’s or another type of dementia. Around 1,000 are diagnosed with Alzheimer’s each day in the United States and records revealed that the number has been increasing each year. The projection is that there may be up to 14 million Americans with this disease by the year 2050, according to Neil Buckholtz, chief of the Dementias of Aging Branch at the National Institute on Aging. Recent research shows seventy percent of all cases of dementia are Alzheimer’s. Scientists are still in the dark as to what triggers Alzheimer’s and studies show that it is not part of normal aging process. Normal aging does not interfere with daily life, but Alzheimer’s disturbs the afflicted person entirely. In most cases, the disease first attacks those parts of the brain, which are involved in memory and visual-spatial thinking, such as where things fit in space. Symptoms can be difficulty in reading a map or in negotiating off a highway because the person cannot interpret road signs. His or her memory fails more than usual in remembering when he or she left the key, the birth date of someone, how to turn the computer off or the name of someone dear to him or her. Memory loss is greater and spreads more quickly over time. The change is visible in someone after six months with early Alzheimer’s and this is not the case with a normal person in that short span of time. In one out of ten cases, the disease begins with changes in behavior first. If it starts at the frontal lobe of the brain, that person may experience depression or psychosis. The disease then spreads to all parts of the brain (Liebman 2002).
Records attested that 70% of patients become depressed at some time during the disease but memory and visual-spatial impairment eventually occurs in all of them. Hallmarks of Alzheimer’s are plaques and tangles. It is, however, not clear that these cause Alzheimer’s (Delagarza 2003). The assumption was that inflammation around these plaques destroyed neighboring neurons. These plaques were composed of b-amyloid polypeptides, which formed as a result of disorders in processing b-amyloid and its precursor protein. The condition appeared to develop out of a genetic disposition and environmental influences. One of them may be sub-clinical ischemia, as patients with high blood pressure and high cholesterol levels tended to have increased risk for Alzheimer’s. On the other hand, neurofibrillary tangles are partly a protein, which links together to form filaments. These filaments within neurons in the brain are directly proportionate with the severity of dementia. It is not known why tangles form, but the alleles of a gene known to create them have been demonstrated as more likely to tangle. It is also unclear whether tangles are linked to plaque formation (Delagarza 2003).
Of the reported 4.5 million Americans afflicted with Alzheimer’s, African-Americans are two or three times more affected than Caucasians in the next 30 years (Ebony 2005). The estimate was that African-Americans beyond 65 years would be more likely to develop it at twice the rate up to 6.9 million. African-Americans would also tend to be diagnosed at the later stages, where the cognitive function has already significantly declined. Although, there has yet to be a specific cure for the disease, evidence showed that donepezil HCL, brand name Aricept, could benefit those with mild to moderate Alzheimer’s. This was the finding of a recent study conducted with 126 African-American patients who demonstrated significant improvement in their memory and learning. The prescribed dosage is once a day. Aricept has been shown to be well-tolerated, although some patients reported side effects, such as stomach problems and fainting (Ebony 2005). Four medications under the category of cholinesterase inhibitors have been approve as treatment of Alzheimer’s, one of them being donepezil, the generic for Aricept (Vickrey 2002). These medications are not considered cures, but they were found to improve cognition, behavior and functioning in some patients. The activity of acetylcholine as a brain neurotransmitter plays an important role in learning and memory and found to be significantly decreased in Alzheimer’s sufferers. Cholinesterase inhibitors appeared to break down acetylcholine and enhance cholinergic function (Vickrey 2002).
Aricept is marketed by Eisai America, Inc. and has the approval of the Food and Drug Administration for treating mild to moderate symptoms of Alzheimer’s disease (FDA Consumer 1997). Aricept increases the levels of a neurotransmitter, which is essential to memory, judgment, the ability to reason and other cognitive functions. Aricept became the second drug approved for the treatment of the disease, the first was Tacrine, brand name for Cognex, approved in 1993. A series of trials showed that most patients tolerated the drugs side effects, such as diarrhea and nausea, slowed heartbeat and fainting (FDA Consumer). This year, Aricept became the first and only treatment approved by the FDA for the full range of Alzheimer’s from mild to severe (PR Newswire 2006). A six-month, multi-center, randomized, double-bind, placebo-controlled clinical trial was conducted in March this year with 248 Swedish nursing home patients with the severe stage of the disease. It revealed that the patients received more significant benefit than those on placebo. This test confirmed that Aricept was generally well tolerated and that the most commonly experience side effects were diarrhea, anorexia, vomiting, nausea and bruising. Aricept is said to help slow down the progression of the symptoms of the disease. The approved dosage for mild and moderate stages was 5 and 10 mg. Aricept 10 mg is the approved dosage for the severe stage after four to six weeks on 5 mg. It is said to inhibit the breakdown of acetylcholine and thus increase the available levels of the chemical in the brain. A link between the loss of acetylcholine and Alzheimer’s was previously established (PR Newswire 2006).
Although well tolerated, Aricept did not appear to be the choice medication for everyone with Alzheimer’s (PR Newswire 2006). Those who suffer from stomach ulcers or stomach bleeding may be advised against its use. Some patients using Aricept were reported to have experienced nausea, vomiting, diarrhea, bruising, sleep problems, muscle cramps, loss of appetite or fatigue. Manufacturers, however, said that these side effects were mild and temporary. They explained that, in a progressively degenerative disease like Alzheimer’s, improvement, stabilization or a decline over time should be viewed as positive responses to treatment. These responses were observed in patients taking or treated with Aricept, according to clinical trials. It is the number one prescribed medication for Alzheimer’s worldwide and more than 3 billion patients have been on it. In the US alone, close to 2.3 million people were reported to taking Aricept (PR Newswire 2006).
Pfizer Inc and Eisai, marketing firms of Aricept, sponsored post-marketing studies to encourage its long-term use (Klotter 2002). However, some insurers and European government, which paid for medicines, opposed the long-term cost of the drug, which sold for $4 a day. These post-marketing studies were said to be often small and poorly designed and did not always reflect the actual results. A particular study of 208 nursing home patients, for example, had a sampling of only one-fourth with severe Alzheimer’s. They were given Aricept and their behavior problems were monitored. These behavior problems were delusions, anxiety, irritability, depression and night time wandering. The finding showed no significant difference between patients receiving the drug and those who did not. Yet the firms doctors published the study at the Journal of the American Geriatrics Society and claimed that it has a beneficial effect. Another study sponsored by these marketing firms was published in the August 2001 issue of the Neurology and claimed that it improved cognition, behavior and daily activity in 290 Alzheimer’s patients, only 80 of whom had a severe stage. The effect of the drug on the majority of the patients tested was, therefore, uncertain and inconclusive. The former head of the Alzheimer’s research for the National Institutes of Health, said that the modest effects of the drug on respondents fewer than several hundred to 1,000 people would be a problem. Exelon, a product of Novartis, and Reminy, a product of Johnson & Johnson and Janssen Pharmaceutica, were similar subjects of small, company-sponsored post-marketing studies. FDA rules say that companies cannot promote their drug products for off-label use or for purposes other than those approved by the FDA by providing doctors or researchers with scripts for their use at conferences and other professional gatherings. The companies were, however, allowed to sponsor conferences where their post-marketing and preliminary studies for off-label uses were discussed. Pfizer Inc and Eisai’s public relations firm, Hill & Knowlton, recruited doctors to speak to news media about Alzheimer’s and Aricept and also coached them on how to become effective spoke doctors for their product (Klotter 2002).
Although at present time here is no known cure for Alzheimer’s disease, numerous drug treatments and care strategies may increase or stabilize cognitive and behavioral symptoms, and improve the quality of life of patients and there families. Persistent treatment with Aricept may have delayed dementia-related nursing home placement for Alzheimer's patients for close to two years. Delaying nursing home placement for any reason may have benefits to families and society by lessening emotional and financial responsibility associated with caring for Alzheimer's disease patients. Therefore, the most effective treatment of a patient with Alzheimer's is good nursing care that provides both emotional and physical help.
Studies show that Alzheimer’s research is still in the dark ages. This simply means that Aricept is purely a symptomatic approach to the management of the disease. How do the side effects weigh against the benefits its marketers declare to doctors and patients? Have there been new findings, assumptions or speculations on its cause or causes? Has the efficacy of Aricept been subjected to further tests by the non-government sector? How does Aricept or its generic donepezil rate against the three other FDA-approved cholinesterase inhibitors
BIBLIOGRAPHY
1. PR Newswire. US Food and Drug Administration Approves ARICEPT for the Treatment of Severe Alzheimer’s Disease. PR Newswire Association LLC, 2006
2. Liebman, Bonnie. Tangled Memories. Nutrition Action Health letter: Center for Science in the Public Interest, 2002
3. Delagarza, Vincent W. Pharmacologic Treatment of Alzheimer’s Disease. American Family Physician, 2003
4. Ebony. Important News for African Americans in the Battle Against Alzheimer’s Disease. Johnson Publishing, 2005
5. Vickrey, Peg Gray-. Advances in Alzheimer’s Disease. Nursing: Springhouse Corporation, 2002
6. FDA Consumer. Second Alzheimer’s Drug Ok. Food and Drug Administration: US Government Printing Office, 1997
7. Klotter, Jule. Marketing Aricept for Alzheimer’s Disease. Townsend Letter for Doctors and Patients: The Townsend Letter Group, 2002
