Alzheimer's disease (AD), also known as Alzheimer disease, Senile Dementia of the Alzheimer Type (SDAT) or simply Alzheimer's, is a very specific and the most common form of dementia. Dementia can be caused by several other factors, many of which can be controlled, at times even reversed.
Contents: Alzheimer's vs Dementia
edit What is Alzheimer's?
Alzheimer's is a degenerative brain process that gradually leads to dementia or senility. It is also known as senile dementia. In an Alzheimer's patient, the brain develops plaques and tangles, and loses neurons. Tangles consist of a protein called tau and plaques are a result of another protein—amyloid beta—folding upon itself and forming long fibers that accumulate. Many scientists believe that an increase in the production or accumulation of beta–amyloid protein in the brain leads to nerve cell death and is largely responsible for the development of Alzheimer's disease.
The brain is disrupted from its normal function; mental abilities become impaired, and the patient's memory, ability to think clearly and at times even language is impaired. The disease produces physical change in the brain. There is shrinking in some areas and widening in the others. When the brain shrinks or widens, connections inside the brain are broken, causing disruption of the electrical signals in the brain.
edit What is Dementia?
In Latin 'dementia' means irrationality. Contrary to popular belief, dementia is not a specific disease as such, but a progressive brain dysfunction with several symptoms which results in limitation in performance of daily activities, and in most cases leads to the long term need for care. There is a significant loss of intellectual abilities such as memory and reasoning, which can interfere with social or occupational functioning.
Dementia is not temporary confusion or forgetfulness that might result from a self-limited infection, underlying illness, or side effects of medication. Dementia typically worsens with time. Many different diseases can cause dementia, but Alzheimer's disease is by far the most common cause for dementia in most countries in the world.
The biggest risk factor for Alzheimer's disease is aging. The likelihood of developing Alzheimer's disease doubles every 5.5 years from 65 to 85 years of age. On an average, this disease lasts 8 -12 years, and while the chance of acquiring it increases with age (usually 65+), Alzheimer's in a more rapidly progressing form can also affect adults in their late 30s and early 40s. This disease is thought to be hereditary in most cases, but not necessarily passed on to the next generation.
Studies have found that Alzheimer's disease occurs more often among people who suffered significant traumatic head injuries earlier in life, particularly among those with the apoE 4 gene. (The apoE (apolipoprotein E) gene has three different forms (alleles) –– apoE2, apoE3, and apoE4. The apoE4 form of the gene has been associated with increased risk of Alzheimer's disease in most populations studied.)
In addition, studies have demonstrated that people with limited formal education – usually less than eight years – are at increased risk for Alzheimer's disease. It is not known whether this reflects a decreased "cognitive reserve" or other factors associated with a lower educational level.
Dementia increases with advancing age. Dementia predominantly occurs in the second half of life, usually after 65. Some experts think it is the 'price society has to pay' for our higher life expectancy and therefore the term 'dementia' activates similar fears and repression mechanisms as 'cancer' or 'AIDS'. The frequency of dementia increases with increase in age from less than 2 % for the 65-69-year-olds, to 5 % for the 75-79 year-olds and to more than 20 % for the 85-89 year-olds. Every third person over 90 years of age suffers from moderate or severe dementia
The "amyloid cascade hypothesis" is the most widely discussed and researched hypothesis regarding the cause of Alzheimer's. The strongest data supporting the amyloid cascade hypothesis comes from the study of early–onset inherited (genetic) Alzheimer's disease. Mutations associated with Alzheimer's disease have been found in about half of the patients with early–onset disease. In all of these patients, the mutation leads to excess production in the brain of a specific form of a small protein fragment called ABeta (Aβ). Many scientists believe that in the majority of sporadic (i.e. non–inherited) cases of Alzheimer's, there is too little removal of the Aβ protein rather than too much production. Much of the research in finding ways to prevent or slow down Alzheimer's disease has focused on ways to decrease the amount of Aβ in the brain.
A smaller camp in Alzheimer's research focuses on tau, the protein that forms tangles in the brain. Tangles are formed in all brains as they age, not just patients who get Alzheimer's. From The Alzheimer's Enigma, a recently published article in Mosaic:
The spread of tangles [the protein tau] in the brain is much more closely related than plaques [the protein amyloid beta] to the progress of dementia in Alzheimer’s disease. When it was discovered that tau could cause damage, the amyloid hypothesis was updated to accommodate the idea that it might be tau, not amyloid beta, that actually kills nerve cells and causes dementia. “You could call the APP [amyloid] dysfunction the initiator of the whole thing but the tau dysfunction is the executioner,” says Goedert. There are some who go further, however, saying that tau is the real driving force behind Alzheimer’s disease. According to them, the reason the tau gene has not been linked to the disease is that tangles are a natural phenomenon of ageing in the brain. For most of us, this only becomes a problem in old age when the tangles have blocked lots of pathways, similar to the way our muscles become weak in old age. In Alzheimer’s disease, some other factor – maybe faulty or excessive amyloid beta – causes problems to occur earlier and progress faster.
In rare cases, the disease is caused by mutations (genetic changes) in the family. In these cases, symptoms usually occur before the age of 60 and progress rapidly. All currently known mutations result in an overproduction of a protein which destroys the nerve cells. In most cases the exact cause remains largely unexplained; interaction of several factors probably leads to the onset. Everybody is at risk of developing this disease. Several genetic factors are known to increase the risk without being the cause themselves. These include a (normal) variant of the gene apolipoprotein E which encourages the deposition of the harmful protein.
There are some conditions of dementia which only mimic serious disorders and are actually reversible. These are called "pseudodementias," and are treatable. Examples of conditions causing reversible symptoms of dementia are:
- Reactions to Medication—Older persons taking prescription drugs may suffer adverse reactions, including confusion. Sedatives, hypnotics, neuroleptics, antihypertensives and antiarthritic medication are among the most common drugs.
- Emotional Distress—Depression or major life changes such as retirement, divorce or loss of a loved one can affect one's physical and mental health.
- Metabolic Disturbances—Problems including renal failure, liver failure, electrolyte imbalances, hypoglycemia, hypercalcemia, hepatic diseases or pancreatic disorders can provoke a confusional state, changes in sleep, appetite or emotions.
- Vision and Hearing—Undetected problems with vision or hearing may result in inappropriate responses. This could be misinterpreted as dementia because an individual is unable to perceive surroundings or understand conversations.
- Nutritional Deficiencies—Deficiencies of B vitamins (folate, niacin, riboflavin and thiamine) can produce cognitive impairment. Loss of taste and smell, loss of appetite, poorly fitting dentures or even difficulty shopping or preparing food may lead to nutritional deficiencies.
- Endocrine Abnormalities—Hypothyroidism, hyperthyroidism, parathyroid disturbances or adrenal abnormalities can cause confusion which mimics dementia.
- Subdural Hematoma (blood clot on the surface of the brain)—Clots can form which create collections of fluid that exert pressure on the brain. These clots can be treated by draining the fluid before it has caused permanent damage.
- Normal Pressure Hydrocephalus—The flow and absorption of spinal fluid, which is manufactured inside the brain, is interrupted. When the fluid is not absorbed properly, it builds up inside the brain and creates pressure.
- Brain Tumors—Tumors in the brain can cause mental deterioration. Benign tumors can be surgically removed. For other tumors, a combination of surgery and radiation/chemotherapy can help the patient.
- Atherosclerosis (hardening of the arteries)—Intellectual impairment can result when a series of small strokes occurs (multi-infarct dementia). Although damage from small strokes is typically irreversible, built-up atherosclerotic plaques can be surgically removed or medically treated in order to prevent future strokes from occurring. If action is taken early enough, the person can be helped.
Certain conditions cause irreversible cognitive impairment. These include:
- Traumatic Brain Injury—Traumatic brain injury can occur at any age. Trauma from a fall or an accident can precipitate personality, cognitive or behavior changes.
- Cerebral Degenerative Diseases—If dementia is caused by a degenerative disease, progressive cognitive deterioration cannot be reversed. The most common irreversible dementia is Alzheimer's disease.
edit Alzheimer's Disease
The onset of Alzheimer's is usually gradual, and the disease progresses slowly. Memory problems that are dismissed as "a normal part of aging" are in retrospect noted by the family to be the first stages of Alzheimer's disease. Alzheimer’s Disease progresses in three stages, namely Early stage, Middle stage and Late stage.
edit Early Stage Symptoms
- Trouble remembering recent events and conversations
- Difficulty remembering the month or day of the week
- Loss of ability to manage finances
- Withdrawal from social situations and general apathy
- Cooking and shopping become more difficult
- Poor judgment - difficulty making wise decisions
- Tendency to lose things
- May become disoriented in familiar surroundings
edit Middle Stage Symptoms
- Difficult behaviors emerge
- Anger, suspiciousness, overreacting and paranoia
- Repeating questions or statements
- Fear of bathing, hallucinations, eating problems
- Hoarding belongings
- Inappropriate sexual behavior
- Violent behavior
- Help in choosing clothes ,remembering to change clothes, help getting dressed.
- Will progress from needing reminders regarding personal care to needing help bathing, taking medication, brushing teeth, toileting, etc.
- Increased difficulty in verbal expression and comprehension
- Spatial problems (e.g., having trouble setting the table or going to the right room)
- Loss of reading, writing and arithmetic abilities
- Loss of coordination
- Will need care or supervision 24 hours a day, seven days a week
- May not recognize family and friends at times
edit Late Stage Symptoms
- Inability to communicate
- Inability to recognize people, places and objects
- Loses ability to walk
- Loses ability to smile
- Muscles may become contracted
- May lose ability to swallow
- Seizures may occur
- Weight loss
- Majority of time spent sleeping
- May exhibit a need to suck on items
Death can then follow, perhaps from pneumonia or some other problem that occurs in severely deteriorated states of health. Those who develop the disorder later in life more often die from other illnesses (such as heart disease) rather than as a consequence of Alzheimer's disease.
edit Dementia Symptoms
Some of the common symptoms in Dementia are:
- Forgetfulness with effects at work: Most people sometimes forget names or appointments. If this happens more frequently along with inexplicable states of confusion, it might be an indication for a decline in memory function.
- Difficulties with familiar activities: People who are very busy are sometimes absent-minded and for example forget the pot on the stove. People with dementia possibly not only forget the pot on the stove but also that they have cooked at all.
- Language problems: Most people sometimes experience difficulties in finding the right words. Dementia sufferers often cannot remember simple words and instead they use inappropriate fillers which makes it difficult to understand the sentences.
- Problems with spatial and temporal orientation: A lot of people sometimes forget e.g. the day of the week or they get lost in unfamiliar surroundings. Dementia sufferers might be in their own street and no longer know where they are, how they got there and how to get home again.
- Impaired capacity of judgement: People not always choose clothes suitable for the weather. Dementia sufferers sometimes wear totally inappropriate clothes. For example, they wear a bathrobe while shopping or several blouses on top of each other on a hot summer day.
- Problems with abstract thinking: For many people running a bank account is a challenge. Often dementia patients can neither recognize numbers, nor carry out simple calculations. However, mild dementia patients will often demonstrate strong capacity to deal with numbers such as counting backwards from 100 in 7's, multiplication, addition, division and subtraction and understand income and expense outcomes. These kind of dementia patients are not necessarily classified as disabled, and can be of sound mind in the management of finances and their day to day affairs. These dementia patients will often fail mini-mental tests, but can recall elements of the test outside the testing period. Medical practitioners must be cautioned about drawing conclusions about mild dementia cases, as misdiagnosis can lead to inappropriate outcomes for the patient.
- Leaving things behind: While it's not unheard of for anybody to leave their keys or a wallet behind, dementia sufferers might put things in completely inappropriate places, say the iron in the fridge or a watch in the sugar bowl. Afterwards, they do not remember where they put them.
- Mood swings and behavioral changes: Everybody has mood swings. People with dementia may have very sudden mood swings, often without discernible cause.
- Personality changes: With advancing age the personality of most people changes a little. People affected by dementia may experience a very pronounced personality change suddenly or over a longer period of time. Somebody who is generally friendly, for example, becomes unexpectedly angry, jealous or timid.
- Loss of initiative: Nobody continuously works with the same motivation. Dementia patients sometimes lose the zest in their work and the interest in their hobbies completely without enjoying new activities.
Dementia-like symptoms can also develop as a result of other lifestyle condition, such as alcohol or substance abuse, vitamin deficiency and certain infectious diseases. Although Alzheimer's Disease accounts for nearly 60 percent of all dementia cases; all cases of dementia are not Alzheimer’s.
edit Alzheimer's treatment
The best way to treat Alzheimer's is to take active steps to not develop it. No cure exists for Alzheimer's disease today, although new advances in medicine show some promise in treatment such as reversible cholinesterase inhibitors, which improve the patient's function level. Treatment today focuses on contributing problems -- creating a consistency in the daily routine and living environment. This consistency, combining emotional support with logistic support, is best implemented by primary care givers. Alzheimer's patients will need assistance in maintaining the highest level of functioning in day-to-day living routines. Safety concerns are a priority -- some patients are not steady on their feet; they may benefit from the assistance of a walker or having the home or living quarters equipped with handrails. Studies show that routine visits to an adult day care center are beneficial to the patient.
edit Alzheimer's Drugs
The pharmaceutical industry has tried various drugs over the last 15 years to treat or slow down the progression of Alzheimer's disease. These drugs have focused on beta-amyloid protein. But these drugs have failed to be effective. Some have been withdrawn because their side-effects were too detrimental, others did not show enough of an effect slowing patients’ mental decline. Solanezumab is one of the most recent drugs undergoing testing; it has shown some promise in early stages when the severity of the disease is mild. But the drug needs further testing.
There is one drug that approaches Alzheimer's treatment by dissolving the tau protein instead of focusing on amyloid beta. This drug — called LMTX and manufactured by TauRx Therapeutics — showed promise in a 2008 trial of 321 patients and is currently under another phase of testing, results for which will be reported in 2015. However, critics and skeptics have asked for results from the 2008 study to be published so they can be peer-reviewed by the scientific community. Until that happens, we only have the manufacturer's word that the drug works.
edit Treatment for Dementia
There are a number of favorable conditions which can ease the situation of a dementia patient. In the early stage, training of thinking and memory functions should only be carried out carefully, else there is the danger that the patient is always reminded of his/her diminishing mental abilities. As with numerous other diseases, there is no cure for the illness but medication can improve disease symptoms and can slow down the progression which can be considered a positive response to treatment.
The more recent antidementia agents belong to the so-called acetylcholinesterase inhibitors Reminyl (galantamine), Exelon (rivastigmine) and Aricept (donepezil). Research suggests that the neurotransmitter acetylcholine is reduced in the brain of dementia patients; acetylcholinesterase inhibitors prevent acetylcholine being eliminated too quickly by a substance responsible for its breakdown. With these drugs the deterioration of the symptoms can be delayed. Psychotropic drugs can be used as a supportive therapy in the treatment of behavioural problems in dementia. There is often criticism particularly of these agents that they are only used to quieten patients down so that they only behave in an apathetic manner and cannot take part in daily events.
Apart from treating the specific symptoms of Alzheimer' or dementia, it is important to observe the general state of health because a good general condition improves the feeling of well-being.
According to the NIH, Alzheimer's disease has no cure as of today - Alzheimer's has without exception resulted in a slow, suffering death. And while there is no evidence that points to an absolute prevention of the disease, doctors do believe that the right nutritional and lifestyle choices, including nurturing brain health may delay, slow or possibly even prevent Alzheimer's. The following steps are the best regimen one can follow to prevent Alzheimer's and dementia in general:
Exercise: Maintaining an active lifestyle and exercising for at least 3-4 hours a week, preferably outdoors. Even going for a walk everyday makes a difference.
Brain health: Staying mentally active; doing math or calculations in the head instead of using calculators, solving puzzles and brain-teasers, reading, listening to music. There are, however, no studies showing a direct co-relation between keeping the brain active and prevention of Alzheimer's or dementia.
Reading and formal education: Although it is difficult to make an assertive claim, studies with large samples have shown Alzheimer's prevailed more in people with fewer than eight years of formal education.