Alzheimer's disease

Symptoms: Early symptoms include memory problems, difficulty with familiar tasks, and changes in mood. As the disease progresses, symptoms can include confusion, trouble speaking, and disorientation.

Causes: The exact cause is unknown, but it involves a combination of genetic, lifestyle, and environmental factors that affect the brain over time.

Risk factors: Age, family history, genetic predisposition, head injuries, and cardiovascular disease.

Prevalence: Approximately 5 million new cases of dementia are diagnosed annually, affecting over 25 million people worldwide, the majority of whom have Alzheimer's disease (AD). Every 20 years, it's predicted that the number of dementia patients would be double.

Severity: Mild to severe

Which doctor to consult: Neurologist 

Overview: 

Alzheimer’s disease is a progressive neurological disorder that affects memory, thinking, and behaviour. It’s the most common cause of dementia, especially in older adults. The disorder worsens over time and is characterized by changes in the brain that lead to deposits of proteins such as beta-amyloid and tau. These deposits cause brain cells to degenerate and die, leading to a decline in cognitive functions.

Types of Alzheimer's Disease:

Alzheimer’s disease can be categorized into several types, each with its own characteristics:

Early-onset Alzheimer’s Disease: This rare form occurs in individuals usually younger than 65. It’s often more aggressive and may have a genetic component.
Late-onset Alzheimer’s Disease: The most common form, it typically affects people aged 65 and older. The causes may include a combination of genetic, environmental, and lifestyle factors.
Familial Alzheimer’s Disease (FAD) is a very rare form of inherited Alzheimer's disease that typically involves a mutation in one of several genes. Members of at least two generations in a family may have had the disease.
APOE e4 Alzheimer’s Disease: The APOE e4 gene variant increases the risk of Alzheimer’s, though not everyone with this variant will develop the disease.
These types share common symptoms but may differ in their onset, progression, and, in some cases, the genetic factors involved.

Symptoms: 

The symptoms of Alzheimer’s disease typically progress from mild to more severe and include:

Memory loss: Difficulty remembering recent conversations, names or events is often an early clinical symptom; apathy and depression are also often early symptoms. Later symptoms include impaired communication, poor judgment, disorientation, confusion, behaviour changes, difficulty speaking, swallowing, and walking.

Reasoning and handling of complex tasks: Struggling to manage finances or balance a checkbook, which were previously manageable tasks.

Language problems: Difficulty with vocabulary, such as struggling to find the right word or name.

Understanding visual images and spatial relationships: For some, vision problems are a sign of Alzheimer’s. These problems may lead to difficulty with balance or trouble reading.

Behaviour and personality changes: People may become confused, suspicious, depressed, fearful, or anxious. They may be easily upset at home, at work, with friends, or in places that are out of their comfort zone.

As Alzheimer’s advances, individuals may experience changes in their ability to develop and maintain social relationships and withdraw from social engagements and activities they once enjoyed.

Causes: 

The causes of Alzheimer’s disease are not fully understood, but they likely involve a combination of genetic, environmental, and lifestyle factors. Here’s a summary of the main factors:

Age-related changes in the brain: Aging is the most significant known risk factor for Alzheimer’s. The risk increases significantly as people age, especially after 65.

Genetic factors: Certain genes can increase the risk of developing Alzheimer’s. The most notable genetic risk factor is the presence of the apolipoprotein E (APOE) ε4 allele.

Environmental and lifestyle factors: These may include a history of head injuries, clinical depression, and high blood pressure. Additionally, factors like diet, exercise, and social engagement might influence the risk.

Brain changes: Alzheimer’s is characterized by the abnormal build-up of proteins in and around brain cells, leading to the formation of amyloid plaques and tau tangles, contributing to the death of neurons.

It’s important to note that having a risk factor does not mean that a person will definitely develop Alzheimer’s disease, and many people with risk factors never develop the disease. Conversely, some people with no apparent risk factors may still get Alzheimer’s.

Risk Factors:

The risk factors for Alzheimer’s disease are multifaceted and can be categorized into genetic and lifestyle/environmental factors. Here’s a brief overview:

• Genetic Elements:

Family History: The risk is increased if you have an Alzheimer's-affected first-degree relative.
Genetic Predisposition: One known genetic risk factor is the APOE e4 allele.

FAD is a rare type of Alzheimer's disease that typically manifests early and is caused by particular gene mutations.

• Environmental and lifestyle factors:

Age: As one age, especially after 65, the risk increases considerably.
Head Injury: A history of serious head injuries may make you more vulnerable.
Cardiovascular Health: Obesity, diabetes, and high blood pressure can increase risk.
Mental Health: There is a higher risk associated with depression and possibly other mental health conditions.

• Potentially Protective Measures:

Cognitive Reserve: Taking part in mentally demanding pursuits.
Exercise: Getting regular exercise can help reduce risk.
Diet: It is believed to be advantageous to follow a healthy diet, especially the Mediterranean diet.

It's crucial to remember that neither the presence nor absence of these variables ensures immunity from Alzheimer's disease. Research is still being done on the intricate interactions between these variables.

Complications: 

Numerous complications may arise from Alzheimer's disease, particularly as the illness worsens. The following are a few potential complexities:

Physical health problems: Pneumonia, fractures and falls, starvation, and dehydration.

Mental health issues include anxiety, restlessness, and depression.

Cognitive Decline: Continued deterioration of thinking, memory, and communication abilities.

Difficulties with Daily Life: Increasing reliance on others for eating, dressing, and bathing.

Behavior Modifications: This includes wandering, insomnia, and personality changes.

These complications may greatly impact the quality of life for Alzheimer's patients and their carers. A thorough care plan must be in place to effectively handle these challenges.

Prevention:

Preventing Alzheimer’s disease involves managing risk factors and adopting a healthy lifestyle. Here are some strategies that may help reduce the risk:

Manage Blood Pressure: High blood pressure, especially in midlife, is a risk factor for cognitive decline. Controlling it is crucial.

Increase Physical Activity: Regular exercise may help prevent Alzheimer’s or slow its progression. Aim for at least 30 minutes of moderate aerobic exercise three to four days weekly.

Cognitive Training: Engaging in activities that challenge your brain, like puzzles and learning new skills, might have a protective effect.

Healthy Diet: Eating a balanced diet, such as the Mediterranean diet, which is rich in fruits, vegetables, whole grains, and healthy fats, can contribute to brain health.

Quality Sleep: Aim for seven to eight hours of sleep per night to help clear amyloid proteins from the brain.

Social Engagement: Staying socially active can support brain health.

Stress Management: Effective stress management techniques can be beneficial.

Avoid Smoking: Smoking cessation is important for overall health and may reduce the risk of cognitive decline.

Healthy Weight: Maintaining a healthy weight through diet and exercise can help manage risk factors for Alzheimer’s.

While these measures are not guaranteed to prevent Alzheimer’s, they may contribute to overall brain health and reduce the risk of cognitive decline.

When to See a Doctor: 

It’s advisable to consult a doctor if there’s a noticeable change in memory or cognitive abilities.

Diagnosis:

When diagnosing Alzheimer's disease, a variety of techniques are usually used to rule out other illnesses that might be causing the same symptoms. An outline of the diagnosis procedure is provided below:

Medical History: The physician will review the patient's symptoms, family history, and any additional medical conditions.

Physical Exam: A check-up to determine general health.

Neurological Exam: To evaluate balance, coordination, reflexes, muscle tone, and eye movement.

Tests of Mental Status: One such test is the Mini-Mental State Examination (MMSE), which assesses cognitive functions such as memory.

Brain imaging: Exams such as MRIs and CT scans can identify abnormalities in the brain linked to Alzheimer's disease.

Tests in the lab: Blood tests to rule out other illnesses that might be causing symptoms.

Psychiatric evaluation: To ascertain whether the symptoms are being caused by depression or another mental illness.

It is important to remember that although these techniques can strongly suggest Alzheimer's, a post-mortem brain autopsy is the only method that can conclusively diagnose the illness. Nonetheless, a patient's lifetime treatment and management can benefit from a dependable diagnosis that is obtained through a combination of tests and evaluations.

Treatment: 

Alzheimer's disease is treated with a mix of medication, lifestyle modifications, and supportive care. Medications that are often taken include:

Donepezil: Often prescribed for Alzheimer's patients at all stages of the disease, donepezil functions by delaying the loss of acetylcholine, a neurotransmitter crucial to cognition and memory.

Galantamine: This medication helps maintain the brain's acetylcholine levels and treats mild to moderate Alzheimer's disease.

Rivastigmine: Prevents acetylcholine from being broken down, making it appropriate for mild to severe Alzheimer's disease.

Memantine: This drug controls glutamate, a neurotransmitter involved in memory and learning, and is used to treat moderate-to-severe Alzheimer's disease.
Furthermore, more recent drugs such as aducanumab and lecanemab target the brain's amyloid plaques, which are indicative of Alzheimer's disease.

In addition to medication, various non-drug interventions for Alzheimer’s disease focus on improving quality of life and cognitive function. These include:

Cognitive-oriented interventions: These aim to enhance cognitive and social functioning through cognitive training, stimulation, and individualized cognitive rehabilitation.

Physical exercise: Regular physical activity is associated with improved cardiovascular fitness, less brain atrophy, and reduced dementia risk.

Brain stimulation techniques: Methods like deep brain stimulation (DBS), transcranial direct current stimulation (tDCS), and repetitive transcranial magnetic stimulation (rTMS) have been explored for their potential benefits.

Nutrition supplementation: Certain dietary supplements may have a positive impact on cognitive health.

Art therapy, aromatherapy, and music therapy: These therapeutic approaches can help reduce stress and improve emotional well-being.

Contact with animals: Animal-assisted therapy can provide comfort and support.

Caregiver training: Educating family members and caregivers to support individuals with Alzheimer’s better.

It’s important to consult with healthcare professionals to determine the most suitable non-drug interventions based on the individual’s symptoms, disease progression, and personal preferences. These interventions should be tailored not to overburden the person and to allow for a sense of achievement and improvement in quality of life.

Additional information:

Supporting someone with late-stage Alzheimer’s requires patience, understanding, and a focus on comfort and quality of life. Here are some ways to provide support:

Maintain Interaction: Even if the person isn't responding very well, keep visiting and interacting with them. Speak quietly, smile, make eye contact, and say their name.

Physical Comfort: Move the person frequently to prevent stiffness and use special mattresses or cushions to prevent pressure sores.

Communication: Play soothing music or natural sounds for them to listen to, and use nonverbal cues like massages or soft touches.

Nutrition: Ensure the patient eats a healthy diet and seek medical assistance if they have trouble swallowing.

Medical Care: Look for any indications of infections or other health problems that might require medical intervention.

Emotional Support: Talk kindly and gently touch your loved one to comfort them. Promote social interaction and encourage them to participate in activities they enjoy, such as going for walks outdoors or listening to music.

Caregiver Support: Seek out assistance for yourself by connecting with a therapist or attending a support group for caregivers. Maintaining your own well-being is crucial for giving proper care, so practice self-care.

Recall that each person with Alzheimer's is unique, and their needs may vary. As they move through the later stages of the illness, it's critical to remain adaptable and responsive to their needs.