What Is Alzheimer’s Disease?
Alzheimer’s disease is a brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. It is a common condition. There are more than 10 lakh cases per year in India. That are more people living with Alzheimer’s disease in India than the total population of medium-sized cities in India like Sangli-Miraj and Kolhapur!
It must be understood that Alzheimer’s disease is not the suffering of only one person, who is the patient. The family of the Alzheimer’s patient and friends and neighbours of the Alzheimer’s patient also experience Alzheimer’s disease because of the patient. The reason is the behaviour of the patient has to be tolerated and people around a patient have to make adjustments. Because Alzheimer’s disease is not like fever, pain, cancer or a broken bone. It is a disease in which the mental capacity and behaviour of the patient change. Many Alzheimer’s patients are 65 years or older.
The symptoms of Alzheimer’s disease are changes in thinking, remembering, reasoning, and behaviour. All the symptoms together are known as dementia. That’s why Alzheimer’s is sometimes referred to as ‘dementia’. While other diseases and conditions also cause dementia, Alzheimer’s is the most common cause of dementia in older adults.
Alzheimer’s disease is not a normal part of ageing. It’s the result of complex changes in the brain that start years before symptoms appear and lead to the loss of brain cells and their connections.
The doctor who first described this disease was Alois Alzheimer [1864-1915] a German psychiatrist and neuropathologist and a colleague of Emil Kraepelin. Alzheimer’s is credited with identifying the first published case of ‘presenile dementia. Later Kraepelin the disease with dementia as the major symptom of Alzheimer’s disease after Alois Alzheimer.
Understanding Different Types of Dementia
Alzheimer’s disease
Alzheimer’s disease is the most common form of dementia. Around 60% of people suffering from dementia have Alzheimer’s disease.
However, there are other types of dementias. They have to be excluded before firmly labeling a patient as an Alzheimer’s disease patient.
Vascular dementia
Around 17% of people diagnosed with dementia will have vascular dementia. It is the second most common form of dementia in the over 65 age group.
Frontotemporal dementia
Frontotemporal dementia is the third most common dementia in people under the age of 65, but it occurs less in the over 65 age group.
Mixed dementia
At least one in every ten people with dementia is diagnosed as having more than one type, or mixed dementia.
Alcohol related brain damage
Alcohol related brain damage is caused by drinking alcohol excessively over a prolonged period of time.
Posterior cortical atrophy
Posterior cortical atrophy is a rare form of dementia which people usually develop between the ages of 50 and 65 and often affects their sight.
Huntington’s disease
Huntington’s disease is a genetic disorder caused by a faulty gene on chromosome 4. A protein called Huntingtin usually helps nerve cells develop but when faulty it can damage them instead and this mainly occurs in the areas of the brain responsible for movement, learning, cognition, and emotions (basal ganglia and cerebral cortex). Huntington’s Disease is primarily thought of as a condition of motor function – that is, it affects the person’s movement. But there can be damage to the brain which can develop into dementia.
The first signs of Huntington’s disease are more commonly seen in the 30–50-year age group but current research indicates that about 10% of cases can appear after the age of 60 years and 5-10% of cases under the age of 18 years (known as juvenile Huntington’s disease).
Parkinson’s disease
It is estimated that Parkinson’s disease affects about 1 in 500 people, most commonly in those over 50. Parkinson’s disease is a condition in which a part of the brain called the substantia nigra loses nerve cells. This loss of nerve cells results in a reduction of a substance called dopamine which is important for the regulation of movement of the body. As the dopamine levels decrease the person’s movements become slower. Most people with a diagnosis of Parkinson’s do not go on to develop dementia – although one-third of Parkinson’s disease patients will suffer dementia, usually in the later stages. This is known as ‘Parkinson’s disease with dementia and may also be referred to as Lewy body dementia. About one-fifth of people diagnosed with Parkinson’s disease are under 40 years old but it is more common in the over 50s.
Lewy body dementia
Lewy body dementia is a progressive condition that affects movement and motor control. It may be associated with Parkinson’s disease.
What Causes Alzheimer’s?
A small number of people have an inherited form called Familial Alzheimer’s disease (FAD) which is caused by a faulty gene that runs within families. People with FAD typically first develop symptoms before the age of 65, most commonly in their 40s or 50s.
People with Down’s syndrome and other learning disabilities can also develop dementia at an early age. If people with Down’s syndrome develop dementia, it is usually Alzheimer’s disease.
The exact cause of Alzheimer’s disease is unknown but we do know that ‘plaques’ and ‘tangles’ form in the brain due to two proteins called amyloid (plaques) and tau (tangles).
Amyloid is a naturally occurring protein that for a reason that is not yet understood begins to malfunction, creating beta-amyloid which is toxic to the brain cells. Plaques form in the brain and they consist of dead cells and amyloid protein.
Tau protein naturally occurs in the brain and helps brain cells communicate with each other but for a reason that is not yet understood it can become abnormal and it ‘clumps together’ leading to the death of the brain cells affected.
People diagnosed with Alzheimer’s may additionally have a reduction of a chemical in the brain called acetylcholine. Acetylcholine functions as a chemical messenger to take information to and from brain cells (called neurons), so a reduction in this chemical leads to information not being transmitted effectively.
How does Alzheimer’s develop?
Alzheimer’s develops very gradually. Research suggests that changes in the brain can occur up to ten years before a person starts to show symptoms of Alzheimer’s disease. The symptoms are usually mild at the beginning and gradually worsen over time. These may include:
- Memory problems are often one of the first signs of Alzheimer’s. Symptoms vary from person to person.
- Difficulty recognizing people or objects.
- Difficulty remembering recent events while having a good memory for past events
- Impaired reasoning or judgment, which can impact decisions.
- Increased anxiety and/or aggression.
- Losing things or misplacing them in odd places.
- Mood and personality changes.
- Changes in the person’s behavior.
- Poor concentration.
- Poor organization skills.
- Problems with decision-making, problem-solving, planning, and sequencing tasks.
- Repeating questions.
- Slow, muddled or repetitive speech.
- Taking longer to complete normal daily tasks.
- Trouble handling money and paying bills.
- Vision and spatial issues, like awareness of the space around them.
- Wandering and getting lost.
- Withdrawal from family and friends
- Word-finding, or having more trouble coming up with words than other people the same age.
How Is Alzheimer’s Diagnosed?
Doctors may ask questions about health, conduct cognitive tests, and carry out standard medical tests to determine whether to diagnose a person with Alzheimer’s disease. If a doctor thinks a person may have Alzheimer’s, they may refer the person to a specialist, such as a neurologist, for further assessment. Specialists may conduct additional tests, such as brain scans or lab tests of spinal fluid, to help make a diagnosis. These tests measure signs of the disease, such as changes in brain size or levels of certain proteins.
Treatment: Managing the effects of Alzheimer’s disease
There is currently no cure for Alzheimer’s disease.
However, there are some medications that may help with some of the symptoms and make life a little easier. These medications may also slow the progression of Alzheimer’s disease for a short while in some people, but it does not prevent or cure the condition.
People with Alzheimer’s may be prescribed a type of medication called cholinesterase inhibitors. There are three options: Donepezil, Rivastigmine or Galantamine
These medications may improve concentration, which helps with memory, thinking and language. These effects may last for approximately six to 12 months, although there is now some evidence showing the benefits may last a lot longer. They support the communication between the nerve cells in the brain by preventing the breakdown of the neurotransmitter chemical called acetylcholine
Another medication called memantine may also be prescribed in the moderate to severe stage of Alzheimer’s disease alongside one of the above medications. This medication blocks the effects of excess glutamate in the brain. Memantine may help with memory, reasoning, language and attention.
There are several more medicines approved by the U.S. Food and Drug Administration (FDA) that can help manage some symptoms of the disease along with coping strategies to manage behavioural symptoms. In 2021, FDA provided accelerated approval for a new medication, aducanumab, that targets the protein beta-amyloid, which accumulates abnormally in the brains of people with Alzheimer’s. The new medication helps to reduce amyloid deposits, but has not yet been shown to improve clinical symptoms or outcomes, such as progression of cognitive decline or dementia.
Most medicines work best for people in the early or middle stages of Alzheimer’s. Researchers are exploring other drug therapies and nondrug interventions to delay or prevent the disease as well as treat its symptoms.
What Are the Stages of Alzheimer’s?
Alzheimer’s disease slowly gets worse over time. People with this disease progress at different rates and in several stages. Symptoms may get worse and then improve, but https://ucbs.com.uahttps://ucbs.com.ua until an effective treatment for the disease itself is found, the person’s ability will continue to decline over the course of the disease.
Early-stage Alzheimer’s is when a person begins to experience memory loss and other cognitive difficulties, though the symptoms appear gradual to the person and their family. Alzheimer’s disease is often diagnosed at this stage.
During middle-stage Alzheimer’s, damage occurs in areas of the brain that control language, reasoning, sensory processing, and conscious thought. People at this stage may have more confusion and trouble recognizing family and friends.
In late-stage Alzheimer’s, a person cannot communicate, is completely dependent on others for care, and may be in bed most or all the time as the body shuts down.
How long a person can live with Alzheimer’s disease varies. A person may live as few as three or four years if he or she is older than 80 when diagnosed, to as long as 10 or more years if the person is younger. Older adults with Alzheimer’s disease need to know their end-of-life care options and express their wishes to caregivers as early as possible after a diagnosis, before their thinking and speaking abilities fail.
What Is Mild Cognitive Impairment?
Mild cognitive impairment, or MCI, is a condition in which people have more memory problems than normal for their age but are still able to carry out their normal daily activities. A doctor can do thinking, memory, and language tests to see if a person has MCI. People with MCI are at a greater risk for developing Alzheimer’s disease, so it’s important to see a doctor or specialist regularly if you have this condition.
What Can You Do if you have MCI?
If you are concerned about memory problems or other symptoms, call your doctor. If you or someone you know has recently been diagnosed, consult a well-known neuro-physician or a neurosurgeon as soon as possible.
