Alzheimer's disease (AD), also called Alzheimer disease, Senile Dementia of the Alzheimer Type (SDAT) or simply Alzheimer's, is the most common cause of dementia. Dementia can also be caused by a variety of other factors, many of which can be controlled and some can even be reversed.
This is a degenerative brain process that produces, usually slowly over time, dementia or senility. It is also known as senile dementia. Many scientists believe that Alzheimer's disease results from an increase in the production or accumulation of a specific protein (beta–amyloid protein) in the brain that leads to nerve cell death. The brain is disrupted from the way it normally works -- mental function becomes impaired -- and the patient's memory, ability to think clearly and sometimes the patient's 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.
This is a progressive brain dysfunction (in Latin 'dementia' means irrationality), which results in a restriction of daily activities and in most cases leads in the long term to the need for care. It involves significant loss of intellectual abilities such as memory capacity, severe enough to 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 medications. Dementia typically progresses to become worse over 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.
Alzheimer’s Disease: The biggest risk factor for Alzheimer's disease is increased age. The likelihood of developing Alzheimer's disease doubles every 5.5 years from 65 to 85 years of age. The average duration of this disease is 8--12 years and while the incidence of getting it increases with age, usually affecting those over 65, Alzheimer's in a more rapidly progressing form can affect adults in their late 30s and early 40s as well. This disease is thought to be inherited in the majority of cases, though it does not mean that because either a mother or father has it that the child will automatically develop it. Some 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 (but not all) populations studied.) In addition studies have demonstrated that persons 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: This increases with advancing age. Dementia predominantly occurs in the second half of our life, often after the age of 65 - some experts think that this 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 rising 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
Alzheimer’s disease: The "amyloid cascade hypothesis" is the most widely discussed and researched hypothesis about the cause of Alzheimer's disease. 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 (for example, non–inherited) cases of Alzheimer's disease (these make up the vast majority of all cases of Alzheimer's disease) there is too little removal of this Aβ protein rather than too much production. In any case, 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. In rare cases, the disease is caused by genetic changes (mutations) 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 themselves being the cause. These include a (normal) variant of the gene apolipoprotein E which encourages the deposition of the harmful protein.
Dementia: There are some conditions which only mimic serious disorders and are actually reversible. These are sometimes called "pseudodementias," and are treatable. Examples of conditions causing reversible symptoms of dementia are:
- Reactions to Medications—Older persons taking prescription drugs may suffer adverse reactions, including confusion. Sedatives, hypnotics, neuroleptics, antihypertensives and antiarthritic medications are among the most common.
- 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 of 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.
edit Certain conditions cause cognitive impairment which is not reversible
- 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 disease is usually gradual, and it is slowly progressive. 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)
- 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.
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 and inexplicable states of confusion also occur, this 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. Dementia patients can often neither recognise 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 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: From time to time almost everybody leaves their keys or a wallet behind. Dementia sufferers however might put things in completely inappropriate places, such as for example the iron in the fridge or a watch in the sugar bowl. Afterwards they do not remember where they put them.
- Mood swings and behavioural 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 loose 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.
Alzheimer’s Disease: No cure exists for Alzheimer's disease today, though new medications show some promise in treatment such as reversible cholinesterase inhibitors which improve a 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. Some may benefit from the assistance of a walker or having the home or living quarters equipped with handrails. It has been found that routine visits to an adult day care center are beneficial to the patient.
Dementia: There are a number of favourable conditions which can ease the situation of the patient In the early stage, training of thinking and memory functions should only be carried out carefully, otherwise 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' disease, it is important to observe the general state of health because a good general condition improves the feeling of well-being.