Alzheimer’s – The Disease
Named after a German neuropathologist Dr Alois Alzheimer in 1906, Alzheimer’s disease is a common form of dementia mostly affecting older people. While it develops slowly, it is terminal and many of the aspects surrounding it are unknown. What is known however is that brain function is reduced until nothing is left and eventually the patient will die. Some scientists have come to the conclusion that with the increase in the beta-amyloid protein, the nerve cells start to die and there goes the brain.
While it is more common among people of ages 70 and above, for those with the genetic risk factor it may come earlier on at 40 or 50 years. These are the children of people with early onset of the disease and are more likely to get it too with a more than 50% chance. A mutation of the chromosome 19 will result in a risk factor for late onset of the disease, but scientist are yet to find a genetic link with most Alzheimer’s cases.
Causes and Risk Factors
As already stated, the actual cause of the disease is largely unknown, though majority of the patients with early onset of the disease have shown it to be genetic while the rest have shown increase in the levels of the beta-amyloid protein. As a result, in an effort to find appropriate treatment and maybe a cure, scientists are focusing on trying to reduce the level of the fatal protein in the brain so as to reduce its destructive effect. There are however some risk factors that may increase an individual’s chances of getting the disease and these include:
- High blood pressure
- Coronary artery disease
- High blood cholesterol
- Low education levels (said to be at less than 8 years)
- Sufferers of Down syndrome
- Substance and drug abuse
These factors increase the risk for getting affected by the disease but do not guarantee a person getting it. Some people will suffer from it due to these factors but others most likely will not, with the exception of ‘Down syndrome’. In this case, all sufferers will develop the Alzheimer’s disease by the age of 40-50.
Signs, Symptoms and Diagnosis of Alzheimer’s disease
It should be noted that long before any physical evidence can be seen, the disease has already caused some amount of damage to the brain. And for those who have a parent with the disease, having frequent check ups may be helpful. Below we discuss the more visible signs and symptoms of the disease to get a feel of what it is like:
- The most noticeable is memory loss. The patient is unable to remember various aspects of their everyday life, even major events such as what they were doing at the store. Failure to account for large lapses in time should be checked out. Also, there maybe trouble trying to figure out where things were put as misplacement of stuff becomes more common.
- Problems with language and speaking. At this point, the language centre of the brain has been affected and it is difficult for the person to speak. It is like they never knew the language in the first place.
- Disorientation of time and place. Failure to tell where they are and or how they got there. You may have a patient waking up in the middle of the night thinking they fell asleep at work.
- Changes in personality, mood, and loss of initiative. For someone who was very proactive and a go getter, the patient will become more laid back and not willing to initiate anything whatsoever. Somehow their power of innovation seems to have disappeared.
- Trouble performing familiar everyday tasks along with decreased and poor judgment. It may result into the patient doing something that is clearly dangerous or foolish and thinking it to be fine and normal. For example, the need to take off one’s pants in public simply because they feel hot. This can also be worsened by decrease in cognitive function with more complex problems becoming an issue for a formerly brilliant mind.
With these signs, you should have the person see a doctor to determine what is wrong, and if it is Alzheimer’s, the necessary treatment and preparation is made to deal with it.
There are some techniques that have been advanced to help diagnose the disease. However, there is no particular test that can be performed directly to determine whether a person suffers from the disease or not. The diagnosis for Alzheimer’s is offered:
- After all the tests have been carried out and these will include advanced medical imaging such as CT scans, MRI scans, SPECT, and PET scans, plus the assessment of intellectual functioning.
- With checking of patient and relative history, both medical and otherwise.
- Evidence of neurological and neuropsychological factors associated with Alzheimer’s.
- The absence of any other medical ailment that could explain the cause of the dementia.
- Finally, after the assessment of areas most affected by the disease which are: memory, attention, perpetual skills, orientation, language, problem solving, constructive and functional abilities.
Stages of the disease
The stages of Alzheimer’s disease are dependent on the progression of the disease, and for most people the first stage goes by unnoticed as there is no physical or psychological impairment yet. For purposes of identification then, we shall begin with when evidence has started to show up and it is certain that something is wrong.
- Ordinary forgetfulness with age: At this point, the person is at an average age of 65 and may complain of forgetting names, where they placed things or some words. But this they will usually put down as the decline of one’s mind that comes with age and it may be difficult to tell that it is Alzheimer’s.
- Mild cognitive impairment: At this point, the forgetfulness is increasingly noticeable to those close to the person but nothing will seem out of the ordinary to an outsider. For example, one’s competence at their job may reduce while another may continuously ask the same question over and over again even when they have already received an answer. This stage may last for up to 7 years before it gets worse.
- Mild Alzheimer’s disease: Here memory loss becomes more obvious. There is confusion about where one has been, finances become harder to handle, and so do other daily activities such as cooking or reading a book. Major events will not be remembered by the victim and they may require some form of supervision. This is estimated to last an average of 2 years.
- Moderate Alzheimer’s disease: At this point, the person will need to live in a community setting where a routine is emphasized as they forget more often. They may still be able to perform ordinary functions by themselves with minimum supervision. This may go on for 1 and a half years, then it is likely to get worse. Then they will need continuous attendance and help to perform their daily mundane acts such as eating, bathing, or even putting on their clothes. This will last for another 2-3 years.
- Severe Alzheimer’s disease: Here round the clock supervision and help is required. Soon all motor function will cease, they will not be able to even lift their own heads or feed themselves. Smiling and facial movement will become limited and they may develop various deformities from the immobility of their muscles and bones, speech and feeling will also be lost. It is unfortunate that this stage can go on for a long time before the patient finally passes on.
Treatment and Management
As with cause, there is no known treatment for the disease and it is terminal. However, there are ways to make the lives of the sufferers easier and give them a chance at a better quality life in there last years.
- Medication includes Cholinesterase inhibitors and partial glutamate antagonists, none of which have showed to slow down the advancement of the disease though some scientists claim that they help with some of the symptoms. The drugs also have some side effects such as nausea, vomiting, and diarrhea, while glutamate may actually make the destruction of the nerve cells worse.
- Non-medication treatment options include social interaction, walking, singing, playing games, exercise, cognitive rehabilitation programs on the computer or on paper. It will become harder for these to work though as the disease advances and medication for particular ailments will have to be administered. These will include insomnia, depression, and anxiety. It may need to be kept in mind that the drugs given to treat these ailments have severe side effects for the patient, especially the newer drugs. It is best to stick to the older anti-depressants and anti-psychotics as the new ones are said to cause strokes and lead to death instead of making the patient better.
Scientists are working hard to try and find a cure or at least a way to slow down the destruction caused by the disease and there are over 800 clinical trials going on around the world. For those in nursing homes or those with a relative who needs care, it is essential to remember the 3Rs – Repeat, Reassure and Redirect as the pillars by which you offer care.
As an ever growing disease, it is time for people to start acknowledging what it can do and find ways of making the lives of those affected better. Just like when the brain develops when we are babies, in the case of Alzheimer’s disease, it slowly dissolves or grows backwards. Think of the victims as just big babies who need care as well and give it willingly, because 40 years down the road this could be you.