Written By :Wafaa Shwaiky. RPH
What is Alzheimer’s Disease?
Alzheimer’s disease (AD) is the most common type of dementia (To know about the other types of dementia check reference # 7). Dimentia is a general term for loss of memory and other mental abilities severe enough to interfere with daily life.
AD occurs among older people, accounting for 50 to 70 % of cases. It involvesneurodegenerative changes of parts of the brain that control thought, memory, and language.
Emil Kraepelin first identified the symptoms of the disease, and a German psychiatrist called Alois Alzheimer, after whom the disease is named in 1906, first observed the characteristic neuropathology. He noticed changes in the brain tissue of a patient who had died of an unusual mental illness (plaques and tangles). Today these plaques and tangles in the brain are considered signs of AD.
Thereafter, other brain changes have been noticed by Scientists in AD patients, as death of Nerve cells in areas of the brain that are vital to memory and other mental abilities, disruption of the connections between nerve cells, and decrease in the level of some brain chemicals that transport messages between nerve cells which lead to thinking and memory impairment.
Who is at risk for Alzheimer's disease?
AD is not caused by any single factor, but by a combination of factors that can affect each person differently. Some of proven AD risk factors are:
Advancing Age: The most important known risk factor for AD. The number of affected persons doubles every 5 years beyond age 65. Although Alzheimer's typically affects people older than 65, it can also affect much younger people. It is important to note, however, that AD is not a normal part of agingSex: Women are more likely to develop the disease than men, because women live longer.Heredity: Genetics may play a role in many AD cases. However, several risk factor genes may interact with each other and with non-genetic factors to cause the disease. Only 3% of AD cases are linked to heredity, and 40% of Early-onset AD is linked to family history. Late-onset form of AD is linked to risk factor gene identified so far, that makes one form of a protein called Apolipoprotein E (ApoE). If the person carries a particular variation of this gene, he will be at higher risk of AD but not certain to develop it. Only about 15 % of people have the ApoE form that increases the risk of AD.
However, other genes may also increase the risk of AD or protect against it, but they remain to be discovered.
Researchers believe that other factors may play a role in the risk of the disease, but the link between them and AD is not proven yet, they include:
Environment: Researchers are studying a variety of environmental factors as possible causes of and ways to prevent AD. For example, the brain tissue of people with AD often shows traces of Aluminum and Zinc. Researchers are trying to determine if exposure to these and other types of metals are a cause or an effect of the disease.Diet: may play an important role in the development of this disease or the protection against it. Some recent studies report that Mediterranean diet “rich in fruits, vegetables, olive oil, legumes, cereals.”, and Omega-3 fatty acid supplements might help lowering risk of developing AD. For more information check references # 4 and 5. Risk factors for heart disease and stroke: Scientists are finding increasing evidence that high blood pressure, high cholesterol, and low levels of Folic acid, may also increase the risk of ADMental fitness: Doctors agree that maintaining good mental and physical health can enhance your quality of life. However, no research has proven that staying mentally or physically fit will prevent or alter your risk of AD.Education.
Other risk factors for which there is conflicting evidence and need for additional research include severe head trauma, certain viral infections, family history of Down syndrome, thyroid disease, and smoking.
What Are the Symptoms of AD?
This disease begins slowly and progresses differently in each person who has it. Not everyone will have every symptom. The symptoms may occur at various times in different individuals. Since AD can last as long as 20 years, it can be helpful to look at it in terms ofstages. Knowing the stages can help give you a general idea of what to expect and how to provide care.
Each of AD stage may bring about changes in everyday activities, behavior, mood, and cognition.
Generally, AD stages are classified into 3 main stages:
Early stage Symptoms: At this stage, patient has trouble remembering recent events, activities, or the names of familiar people or things; he may not be able to solve simple math problems; he can manage many of his daily activities by himself but may need some assistance or support.Mild or moderate stage Symptoms: At this stage, Forgetfulness begins to interfere with daily activities. Patient may forget how to do simple tasks like brushing his teeth or combing his hair, he can no longer think clearly, can’t recognize familiar people and places, and begin to have problems speaking, understanding, reading, or writing. At this stage, medical help becomes a must.Late or severe stage Symptoms: Patient at this stage often require total care, hemay become anxious or aggressive, or wander away from home.
To know more about AD stages check references # 8 and 11.
Why early diagnosis is important?
The early and accurate diagnosis is very important to:
Help patients and their families plan for the future.Give them time to discuss care while the patient can still take part in making decisions.Offer the best chance to treat the symptoms of the disease.
How is AD Diagnosed?
Physicians can only make a diagnosis of possible*, or probable** AD, while the person is still alive. The only definite way to diagnose AD is to find whether there are areas of plaques and tangles in brain tissue. Such diagnosis requires an autopsy where brain tissue is then examined directly under a microscope.
AD could be diagnosed correctly up to 90% of time. Physicians use several tools to diagnose “probable” AD, including:
Personal medical history.Neurological examinationMedical and Laboratory tests.Brain imaging scans: such as MRI or CT, to look for brain changes (look at the picture) .Psychiatric evaluations,
The test results may help the doctor to find other possible causes of the person’s symptoms. Memory loss isn't always due to Alzheimer's. It's estimated that 5-10% of people showing memory loss, confusion and other signs of dementia have a potentially reversible illness, such as metabolic problems, depression, drug intoxication, thyroid problems, blood vessel disease, brain tumors, or vitamin deficiencies. The earlier the diagnosis, generally the easier it is to treat one of these conditions.
*AD is suspected, but other causes cannot be ruled out.
** This means that all other disorders that may cause dementia have been ruled out.
How is AD Treated?
No treatment can stop Alzheimer’s. But current medications may slow it down, lessen signs and symptoms, and help prevent some symptoms from becoming worse for a limited time in patients who are in the early and middle stages of the disease. The recommended medications include:
Cholinesterase inhibitors: This group of medications which include, donepezil (AriceptÒ), rivastigmine (ExelonÒ), and galantamine (RazadyneÒ) works by improving the levels of neurotransmitters in the brain. Research published in April 2005 in the New England Journal of Medicine indicates that donepezil (Aricept) additionally can delay, although not prevent, the onset of Alzheimer's disease. Recently, Aricept becomes the first product approved by FDA for the treatment of late stage of AD. Researchers believe that delaying or slowing Alzheimer's is an important step in fighting the disease. About half of people taking cholinesterase inhibitors have some improvement in their signs and symptoms.Memantine: The FDA approved the drug Memantine (NamendaÒ) in October 2003, the only medication specifically indicated for treatment of moderate to severe stages of Alzheimer's. Memantine seems to slow the loss of daily living skills. It works by protecting brain cells from damage caused by the chemical messenger glutamate.Behavioral Symptoms Control Medications: Some medicines may help control behavioral symptoms of AD such as sleeplessness, agitation, wandering, anxiety, and depression. Treating these symptoms often makes patients more comfortable and makes their care easier for caregivers.
What about alternative treatments?
Several herbal remedies and other dietary supplements are promoted as effective treatments for AD, such as Coenzyme Q10 or Ubiquinone, Ginkgo biloba, Huperzine A (a chineese moss extract), Omega-3 fatty acids, Phosphatidylserine, Coral calcium. Although many of these remedies may be valid candidates for treatments, there are many reasonable concerns about using them as an alternative or in addition to physician-prescribed therapy. Because of their unidentified effectiveness, safety and purity, their unknown side effects, and interactions with prescribed medications.
For more information about the remedies mentioned above check reference #9.
Are there ways to prevent AD onset?
Right now, there's no way to delay the onset of AD. Researchers are looking to develop a vaccine against AD, and they continue to look for ways to reduce the risk of this disease. Several leads are hopeful, but preliminary. They include:
Healthy aging: improving your cardiovascular health, and eating a low-fat diet, as well as consuming foods rich in omega-3s, may be helpful.Nonsteroidal anti-inflammatory drugs (NSAIDs): Several studies have shown that theNSAIDs may reduce the risk of developing Alzheimer's. This may be because inflammation appears to play a role in AD. Clinical trials need to be completed before it's clear whether people should take NSAIDs solely to prevent this disease.Antioxidants: Several studies are investigating whether antioxidants as vitamins E and C, Selenium, and alpha-lipoic acid, can slow AD. However, research published in April 2005 in the New England Journal of Medicine indicates no benefit from taking vitamin E.Selegiline: Researchers have been studying whether selegiline (EldeprylÒ), a drug used to treat Parkinson's disease, may protect against the progression of Alzheimer's.Statins: These drugs are normally used to lower cholesterol levels, but recent studies have shown that they may also reduce the risk of Alzheimer's disease. More studies are being done to determine exactly what role statins may have in Alzheimer's prevention.Estrogen: Early studies suggested that estrogen might provide a protective effect against Alzheimer's, but more recent studies have failed to confirm a positive effect from estrogen in women who already had Alzheimer's. Research is under way, however, to see if taking estrogen supplements can prevent, or at least delay, Alzheimer's in women with a family history of the diseaseMental fitness: Some researchers believe that lifelong mental exercise and learning may promote the growth of additional connections between neurons, and delay the onset of dementia. Others think that the advanced level of education simply may help some people “cover up” their condition until later.
Can AD interfere with car driving?
Driving is a complex activity that requires the ability to do a number of things at once. A diagnosis of AD does not necessarily mean loss of the ability to drive. However, AD can interfere with a number of abilities that are required to drive safely. Studies have shown that people with Alzheimer's disease and similar conditions have more car accidents than other people of the same age. Unsafe driving threatens not only your own safety but the safety of others.
To know more check reference # 12.
Can AD interfere with working?
If you are still employed when you are diagnosed with Alzheimer's disease, you will need to decide whether you want to continue to work and for how long.
Depending on the kind of activity your job requires, you may be able to continue to work during the early stages of the disease, and you can continue to do so as long as you and your healthcare provider believe that you are still able. But if your job is the kind in which errors could endanger your safety or that of others, then you will need to seriously consider leaving or changing to another kind of work.
To know more check reference # 13.
What is the role of the caregiver?
Caregivers are playing an important role in the lives of AD patient. As a caregiver, you should know that there is no one approach to caregiving. Your caregiving responsibilities can range from making financial decisions, managing changes in behavior, and to help a loved one get dressed in the morning. Handling these duties is a hard work. But by learning caregiving skills, you can make sure that your loved one feels supported and is living a full life. You can also ensure that you are taking steps to preserve your own well-being.
To know more about caregiving skills check references #14 and 15.
References:
1- http://www.nia.nih.gov/Alzheimers/Publications/adfact.htm
2- http://en.wikipedia.org/wiki/Neurodegenerative_disease
3- http://www.mayoclinic.com/health/alzheimers-disease/DS00161/DSECTION=7
4- http://www.healthscout.com/news/1/535411/main.html
5 -http://www.medscape.com/viewarticle/546356?sssdmh=dm1.220416&src=nldne
6 - http://www.alz.org
7- http://www.alz.org/AboutAD/relateddiseases.asp
8- http://www.alz.org/AboutAD/stages.asp
9- http://www.alz.org/AboutAD/Treatment/Alternative.asp
10- https://www.alzheimersdisease.com
11- http://www.alzheimersdisease.com/info/about/stages-alzheimers.jsp
12- http://www.alzheimersdisease.com/info/living/driving-alzheimers.jsp
13- http://www.alzheimersdisease.com/info/living/working-alzheimers.jsp
14- http://www.alz.org/Care/overview.asp
15- http://www.alzheimersdisease.com/info/caring/alzheimers-care.jsp
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