Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear in their mid-60s. Such people need our care and compassion. Rita tells us more about the dark and despondent world in which those affected are trapped, in the weekly column, exclusively for Different Truths.
Alzheimer’s disease is named after Dr. Alois Alzheimer. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman, who had died of an unusual mental illness. Her symptoms included memory loss, language problems, and unpredictable behaviour. After she died, he examined her brain and found many abnormal clumps (now called amyloid plaques) and tangled bundles of fibres (now called neurofibrillary, or tau, tangles). These plaques and tangles in the brain are still considered some of the main features of Alzheimer’s disease. Another feature is the loss of connections between nerve cells (neurons) in the brain. Neurons transmit messages between different parts of the brain, and from the brain to muscles and organs in the body.
Common Cause of Dementia
Alzheimer’s is the most common cause of dementia among older adults. Dementia is the loss of cognitive functioning — thinking, remembering, and reasoning — and behavioural abilities to such an extent that it interferes with a person’s daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living.
The causes of dementia can vary, depending on the types of brain changes that may be taking place. Other dementias include Lewy body dementia, frontotemporal disorders, and vascular dementia. It is common for people to have mixed dementia — a combination of two or more disorders, at least one of which is dementia. For example, some people have both Alzheimer’s disease and vascular dementia.
Signs and Symptoms
Memory problems are typically one of the first signs of cognitive impairment related to Alzheimer’s disease. Some people with memory problems have a condition called mild cognitive impairment (MCI). In MCI, people have more memory problems than normal for their age, but their symptoms do not interfere with their everyday lives. Movement difficulties and problems with the sense of smell have also been linked to MCI. Older people with MCI are at greater risk for developing Alzheimer's, but not all of them do. Some may even go back to normal cognition.
The first symptoms of Alzheimer’s vary from person to person. For many, decline in non-memory aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment, may signal the very early stages of Alzheimer’s disease. Researchers are studying biomarkers (biological signs of disease found in brain images, cerebrospinal fluid, and blood) to see if they can detect early changes in the brains of people with MCI and in cognitively normal people who may be at greater risk for Alzheimer’s. Studies indicate that such early detection may be possible, but more research is needed before these techniques can be relied upon to diagnose Alzheimer's disease in everyday medical practice.
Mild Alzheimer’s Disease
As Alzheimer’s disease progresses, people experience greater memory loss and other cognitive difficulties. Problems can include wandering and getting lost, trouble handling money and paying bills, repeating questions, taking longer to complete normal daily tasks, and personality and behaviour changes. People are often diagnosed in this stage.
Moderate Alzheimer’s Disease
In this stage, damage occurs in areas of the brain that control language, reasoning, sensory processing, and conscious thought. Memory loss and confusion grow worse, and people begin to have problems recognizing family and friends. They may be unable to learn new things, carry out multistep tasks such as getting dressed, or cope with new situations. In addition, people at this stage may have hallucinations, delusions, and paranoia and may behave impulsively.
Severe Alzheimer’s Disease
Ultimately, plaques and tangles spread throughout the brain, and brain tissue shrinks significantly. People with severe Alzheimer’s cannot communicate and are completely dependent on others for their care. Near the end, the person may be in bed most or all of the time as the body shuts down.
What Causes Alzheimer’s?
Scientists don’t yet fully understand what causes Alzheimer’s disease in most people. In people with early-onset Alzheimer’s, a genetic mutation is usually the cause. Late-onset Alzheimer’s arises from a complex series of brain changes that occur over decades. The causes probably include a combination of genetic, environmental, and lifestyle factors. The importance of any one of these factors in increasing or decreasing the risk of developing Alzheimer’s may differ from person to person.
Who gets Alzheimer’s Disease?
Most people who develop Alzheimer’s disease do so after the age of 65, but people under this age can also develop it. This is called early-onset Alzheimer’s disease, a type of young-onset dementia. Developing Alzheimer’s disease is linked to a combination of factors. Some of these risk factors, like lifestyle, can be controlled, but others, like age and genes, cannot.
Age is the greatest risk factor for Alzheimer’s. The disease mainly affects people over 65. Above this age, a person’s risk of developing Alzheimer’s disease doubles approximately every five years. One in six people over 80 have dementia.
For reasons that are not clear, there are about twice as many women as men over 65 with Alzheimer’s disease. This difference is not fully explained by the fact that women on average live longer than men. It may be that Alzheimer’s in women is linked to a lack of the hormone oestrogen after the menopause.
Many people fear that the disease may be passed down to them from a parent or grandparent. Scientists are investigating the genetic background to Alzheimer’s. There are a few families with a very clear inheritance of Alzheimer’s from one generation to the next. In such families, the dementia tends to develop well before age 65. However, Alzheimer’s disease that is so strongly inherited is extremely rare.
In the vast majority of people, the influence of genetics on risk of Alzheimer’s disease is much more subtle. A number of genes are known to increase or reduce a person’s chances of developing Alzheimer’s. For someone with a close relative (parent or sibling) who was diagnosed with Alzheimer’s when over 65, their own risk of developing the disease is increased. However, this does not mean that Alzheimer’s is inevitable, and everyone can reduce their risk by living a healthy lifestyle. People with Down’s syndrome are at particular risk of developing Alzheimer’s disease, because of a difference in their genetic makeup.
Health and Lifestyle
Medical conditions such as diabetes, stroke and heart problems, as well as high blood pressure, high cholesterol and obesity in mid-life, are all known to increase the risk of both Alzheimer’s disease and vascular dementia. Anyone can reduce their risk by keeping these under control. Depression is a probable risk factor for dementia; getting it treated early is important.
People who adopt a healthy lifestyle, especially from mid-life onwards, are less likely to develop Alzheimer’s disease. This means taking regular physical exercise and keeping to a healthy weight, not smoking, eating a healthy balanced diet and drinking only in moderation.
Leading an active lifestyle that combines regular physical, social and mental activity will help to lower risk.
Diagnosis of Alzheimer’s Disease
Doctors use several methods and tools to help determine whether a person who is having memory problems has ‘possible Alzheimer’s dementia’ (dementia may be due to another cause) or ‘probable Alzheimer’s dementia’ (no other cause for dementia can be found).
To diagnose Alzheimer’s, doctors may:
- Ask the person and a family member or friend questions about overall health, past medical problems, ability to carry out daily activities, and changes in behavior and personality.
- Conduct tests of memory, problem solving, attention, counting, and language
- Carry out standard medical tests, such as blood and urine tests, to identify other possible causes of the problem.
- Perform brain scans, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET), to rule out other possible causes for symptoms.
These tests may be repeated to give doctors information about how the person’s memory and other cognitive functions are changing over time.
People with memory and thinking concerns should talk to their doctor to find out whether their symptoms are due to Alzheimer’s or another cause, such as stroke, tumour, Parkinson’s disease, sleep disturbances, side effects of medication, an infection, or a non-Alzheimer’s dementia. Some of these conditions may be treatable and possibly reversible.
If the diagnosis is Alzheimer’s, beginning treatment early in the disease process may help preserve daily functioning for some time, even though the underlying disease process cannot be stopped or reversed. An early diagnosis also helps families plan for the future. They can take care of financial and legal matters, address potential safety issues, learn about living arrangements, and develop support networks.
Treatment and Support
There is currently no cure for Alzheimer’s disease, but there is a lot that can be done to enable someone to live well with the condition. This will involve drug and non-drug care, support and activities.
There are drug treatments for Alzheimer’s disease that can temporarily alleviate some symptoms or slow down their progression in some people.
A person in the mild or moderate stages of Alzheimer’s disease or mixed dementia will often be prescribed a drug such as donepezil, rivastigmine or galantamine. The drug may help with memory problems, improve concentration and motivation, and help with aspects of daily living such as cooking, shopping or hobbies. A person in the moderate or severe stages of Alzheimer’s disease or mixed dementia may be offered a different kind of drug: memantine.
This may help with mental abilities and daily living, and ease distressing or challenging behaviours such as agitation and delusions.
Coping with Alzheimer’s
If someone is depressed or anxious, talking therapies, such as cognitive behavioural therapy, or drug treatments, such as antidepressants, may also be tried. Counselling may help the person adjust to the diagnosis.
At Arogya HomeCare (www.arogyahomecare.in), we employ different ways to help an elderly person remain independent and cope with memory loss. These include practical things like developing a routine for them, educating the caregiver, and using a weekly pill box. For some patients, we call or send a text message as reminders for daily medication and diagnostic tests.
It is beneficial for a person with Alzheimer’s to keep up with activities that they enjoy. Many people benefit from exercising their mind with reading or puzzles. There is evidence that attending cognitive stimulation sessions to keep mentally active helps. Life story work, in which someone shares their life experiences and makes a personal record, may help with memory, mood, and wellbeing. As dementia worsens, many people enjoy more general reminiscence activities.
Over time, changes in the person’s behaviour such as agitation or aggression become more likely. These behaviours are often a sign that the person is in distress. This could be from a medical condition such as pain, because they misunderstood something or someone, or perhaps because they are frustrated or under-stimulated. Individualised approaches should look for, and try to address, the underlying cause. General non-drug approaches often also help. These include social interaction, music, reminiscence, exercise or other activities that are meaningful for the person. They are generally tried before additional drugs are considered, particularly antipsychotics.
Photos from the internet.
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