Alzheimer’s (AHLZ-high-merz) is a disease of the brain that causes problems with memory, thinking and behavior. It is not a normal part of aging. Alzheimer’s gets worse over time. Although symptoms can vary widely, the first problem many people notice is forgetfulness severe enough to affect their ability to function at home or at work, or to enjoy hobbies.
Dementia is a syndrome characterized by disturbance of multiple brain functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgment. Consciousness is not clouded. The impairments of cognitive function are commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behavior, or motivation.
The symptoms of Alzheimer’s disease are generally mild to start with, but they get worse over time and start to interfere with daily life. There are some common symptoms of Alzheimer’s disease, but it is important to remember that everyone is unique. Two people with Alzheimer’s are unlikely to experience the condition in exactly the same way.
Memory loss due to Alzheimer’s disease increasingly interferes with daily life as the condition progresses. The person may:
1. Lose items (for example, keys, and glasses) around the house
2. Struggle to find the right word in a conversation or forget someone’s name
3. Forget about recent conversations or events
4. get lost in a familiar place or on a familiar journey
5. Forget appointments or anniversaries.
Although memory difficulties are usually the earliest symptoms of Alzheimer’s, someone with the disease will also have or go on to develop problems with other aspects of thinking, reasoning, perception or communication. They might have difficulties with.
1. Language – struggling to follow a conversation or repeating themselves
2. visuospatial skills – problems judging distance or seeing objects in three dimensions; navigating stairs or parking the car become much harder
3. Concentrating, planning or organising – difficulties making decisions, solving problems or carrying out a sequence of tasks (such as cooking an meal)
4. Orientation – becoming confused or losing track of the day or date.
A person in the earlier stages of Alzheimer’s will often have changes in their mood. They may become anxious, irritable or depressed. Many people become withdrawn and lose interest in activities and hobbies.
The diagnostic criteria of the National Institute on Aging and the Alzheimer’s Association view AD as a spectrum beginning with an asymptomatic pre-clinical phase progressing to the symptomatic preclinical phase and then to the dementia phase. AD is a clinical diagnosis, based largely on identified symptoms and difficulty with activities of daily living revealed by patient and caregiver interviews.
In the future, improved brain imaging and validated biomarkers of disease will enablea more sophisticated diagnosis with identified cognitive strengths and weaknessesand neuroanatomic localization of deficits.
Patients with suspected AD should have a history and physical examination with appropriate laboratory tests (serum B12, folate, thyroid panel, blood cell counts, serum electrolytes, and liver function tests), and computed tomography or magnetic resonance imaging may aid diagnosis. To exclude other diagnoses, cerebrospinal fluid analysis or an electroencephalogram can occasionally be justified.
Obtain information on medication use; alcohol or other substance use; familymedical history; and history of trauma, depression, or head injury.
Rule out medicationuse (eg, anticholinergics, sedatives, hypnotics, opioids, antipsychotics, andanticonvulsants) as contributors to dementia symptoms.
Rule out medications thatcould contribute to delirium (eg, digoxin, nonsteroidal anti-inflammatory drugs[NSAIDs], histamine 2 [H2] receptor antagonists, amiodarone, antihypertensives,and corticosteroids).
The Folstein Mini-Mental State Examination (MMSE) can help establish a history of deficits in two or more areas of cognition at baseline against which to evaluate change in severity over time. The average expected decline in an untreated patient is2 to 4 points per year.
Age: The single greatest risk factor for developing Alzheimer’s disease is age, one of the non-modifiable risk factors. Most cases of Alzheimer’s disease are seen in older adults, ages 65 years or above. Between the ages of 65 and 74, approximately 5 percent of people have Alzheimer’s disease. For those over 85, the risk increases to 50 percent
Genetics of AD: The vast majority of Alzheimer disease is not genetically inherited although some genes may act as risk factors. Genetically identified forms of Alzheimer disease, which usually have an onset before the age of 65, have been identified and account for 0.1% of disease cases
Role of environment for AD: Several studies indicate a role for environmental effects on AD development. In a recent review Richard Mayeux and Yaakov Stern summarized the role of diet, activities, or diseases that potentially play a role in the onset of Alzheimer disease.
Diabetes, hypertension, smoking, obesity, and dyslipidemia have all been found to increase risk as well a history of brain trauma, cerebrovascular disease, and vasculopathies. A higher level of education, as well as Mediterranean diet were shown to decrease the risk of developing AD
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.
» Donepezil (Aricept®), approved in 1996 to treat mild-to-moderate Alzheimer’s and in 2006 for the severe stage.
» Rivastigmine (Exelon®), approved in 2000 for mild-to-moderate Alzheimer’s.
» Galantamine (Razadyne®), approved in 2001 for mild-to-moderate stages.
» Memantine (Namenda®), approved in 2003 for moderate-to-severe stages, is the only drug in this class currently available.
» Donepezil and memantine (Namzaric®), approved in 2014 for moderate-to-severe stages. The effectiveness of these treatments varies from person to person. While they may temporarily help symptoms, they do not slow or stop the brain changes that cause Alzheimer’s to become more severe over time.