Alzheimer’s is a progressive disease which destroys memory & many other important functions of the mind. While mild confusion & difficulty in remembering is noticed by people as the first sign of symptoms, Alzheimer’s eventually leads patients to even forget important people & undergo dramatic changes in personality. Alzheimer’s is one of the most common causes of dementia, which is broadly a group of brain related disorders which cause loss of social & intellectual skills. Brain cells are usually found to degenerate & die in Alzheimer’s & which cause a steady decline in mental function including memory loss. Medications & management strategies currently applied for treating Alzheimer’s disease only temporarily help improve symptoms so as to help these people maintain independence & maximize function for a little longer period of time. It is however important to seek supportive services & tap into a support network as soon as possible since there in fact is no cure for Alzheimer’s disease.
Causes of Alzheimer’s Disease
It is largely believed that Alzheimer’s disease is caused by a combination of environmental, lifestyle & genetic factors which affect the functioning of brain over time. Only in less than 5% of the cases Alzheimer’s is caused due to specific genetic changes which guarantee that certain people will eventually develop this disease. However, specific causes of Alzheimer’s are not yet fully understood but their effect on brain is clear. While Alzheimer’s damages & kills brain cells whereby brain affected by this disease is left with fewer cells & fewer connections among surviving cells when compared to a healthy functioning brain. As more of these brain cells die, Alzheimer’s will eventually lead to significant shrinkage of brain. The following 2 types of hallmark abnormalities are observed by doctors when they examine Alzheimer’s brain tissue under microscope.
- Plaques – These are clumps of protein called beta-amyloid which are found to damage & destroy brain cells in several ways including interference with cell-to-cell communication functionality. Even though the ultimate cause of death of brain cells is unknown, collection of beta-amyloid outside of brain cells is prime suspect.
- Tangles – Brain cells are dependent on internal support & transport system so as to carry nutrients & essential materials throughout lengthy extensions of the mind which in turn requires normal structure alongside functioning of a protein known as tau. Threads of this protein are found to twist into abnormal tangles inside brain cells of Alzheimer’s patients leading to failure of the transporting system & which is also strongly implicated by decline & death of brain cells.
Signs & Symptoms of Alzheimer’s Disease
First & foremost symptoms of Alzheimer’s disease noticed by patients include mild confusion & increased forgetfulness. This condition over time robs more of memory & more particularly the recent memories. Rate at which this symptom worsens generally varies from one person to another. Patients having Alzheimer’s could be the first to notice unusual difficulty in remembering things & organizing thoughts. Or sometimes, they may not be able to recognize that anything is wrong even when these changes are easily noticeable to close friends & family members.
Brain Changes Associated with Alzheimer’s Disease
- Memory – Occasional lapses in memory are experienced by everyone. Losing track of where we put keys or forgetting name of an acquaintance is normal. However, memory loss associated with Alzheimer’s will persist & worsen & affect functioning ability at home & at work. People with Alzheimer’s will face the following difficulties.
- Repeating questions & statements over & over again without realizing that they have asked this question earlier.
- Forgetting events, appointments or conversations & not be able to remember them later.
- Getting lost in familiar places.
- Routinely misplace possessions by putting them in illogical locations.
- Forgetting names of everyday objects & family members.
- Trouble expressing thoughts or indulge in conversations including finding the right words to identify objects.
- Thinking & Reasoning – Alzheimer’s causes difficulty in thinking & concentrating especially about abstract subjects & numbers. Multitasking will also be difficult & patients may find it challenging to balance checkbooks, manage finances & pay bills on time. Moreover, these difficulties will progress to inability &Alzheimer’s patients may not be able to recognize & deal with numbers.
- Decisions & Judgments – Proper response to everyday situations burning food on stove or unexpected driving problems becomes increasingly difficult for Alzheimer’s patients.
- Planning & Performing Tasks – Activities which require sequential steps & were routine at one time like playing a game or cooking meals now become a struggling task as Alzheimer’s disease progresses. Advanced Alzheimer’spatients may eventually also forget to perform basic tasks like bathing & dressing.
- Changes in Behavior & Personality – Brain changes which occur due to Alzheimer’s disease can affect how patients feel & act. Alzheimer’s patients may also experience the following.
- Mood Swings
- Social Withdrawal
- Distrust in Others
- Loss of Inhibitions
- Changes in Sleeping Habits
- Irritability & Aggressiveness
- Delusions like believing that something has been stolen
However, many important skills are not lost until very late in Alzheimer’s disease including the ability to reminisce, tell stories, engaging in hobbies & crafts, enjoying old music, sing & dance & the ability to read.This is mainly because habits & skills are learnt early in life & are among the last of abilities which are lost due to progression of Alzheimer’s disease as part of the brain which stores this information tends to be affected in the future course of this disease. Making use of these abilities can help foster success while maintaining quality of life even in moderate phase of Alzheimer’s disease.
Diagnosing Alzheimer’s Disease
As of now, there is no specific test which can confirm that a person has got Alzheimer’s disease. Doctors usually make a judgment about Alzheimer’s on the most likely cause of symptoms based on information provided by patients & results of various tests which will help clarify diagnosis. Most often doctors determine patients with these symptoms having dementia & can in cases identify Alzheimer’s disease as the reason for dementia. Alzheimer’s disease can only be diagnosed with complete accuracy after death when a microscopic probe of brain can reveal characteristic presence of plaques & tangles. Doctors generally rely on the following tests so as to distinguish Alzheimer’s disease from various other causes of memory loss.
- Physical & Neurological Examination – Doctors will perform a physical examination & will most likely check overall neurological health of patients.
- Muscle tone & strength
- Sense of hearing & sight
- Ability to rise from chair & walk around the room
- Laboratory Tests – Doctors make use of blood tests to rule out any other potential causes of confusion & memory loss like vitamin deficiencies or thyroid disorders.
- Neuropsychological Testing & Mental Status – Doctors may also conduct brief mental status tests in order to assess patient’s memory & other mental thinking skills. Additionally, they may suggest extensive assessment of memory & thinking. Longer formats of neuropsychological testing may also provide details about mental function compared with other people of similar age & level of education.
- Brain Imaging – Images of brain are nowadays used to identify & pinpoint abnormalities which are related to conditions other than Alzheimer’s. These include tumors, trauma or strokes which can cause cognitive changes in patients. New imaging techniques which are primarily in major medical use enable doctors detect specific changes in brain caused by Alzheimer’s disease. Some of these brain imaging technologies include the following.
- MRI / Magnetic Resonance Imaging – MRI utilizes strong magnetic fields along with radio waves so as to produce detailed images of brain. These are normally used to rule out other conditions which may account for or add to cognitive symptoms of Alzheimer’s patients. Additionally, MRI may also be used to assess if shrinkage in brain regions as implicated in Alzheimer’s has occurred.
- CT Scan / Computerized Tomography – CT scans produce slices or cross-section images of brain. This technique is currently useful in ruling out strokes, brain tumors & head injuries among Alzheimer’s disease suspects.
- PET / Positron Emission Tomography – Low-level radioactive tracer is usually injected in a vein during PET scan. This tracer can be a special form of glucose which can show overall activity in various regions of the brain so as to show which parts of the brain are not functioning properly. Newer PET techniques are also able to detect level of tau tangles &amyloid plaques which are the 2 hallmark abnormalities closely linked to Alzheimer’s disease.
- Cerebrospinal Fluid – This is employed in special circumstances where dementia is rapidly progressing or in very young onset of dementia. Spinal fluid is tested for biomarkers indicating likelihood of Alzheimer’s disease through a cerebrospinal fluid examination.
Future Diagnostic Tests
New diagnostic tools are being developed by researchers in collaboration with doctors in order to definitely diagnose Alzheimer’s. Another important factor under consideration is to detect Alzheimer’s disease before it can cause any symptoms. Genetic testing is usually not recommended for routine evaluation of Alzheimer’s disease, except for people who are having a history of early onset of the disease. Moreover, people with family history of early Alzheimer’s will require meeting genetic counselors so as to discuss risks & benefits involved with genetic testing.
New tools under Alzheimer’s investigation include the following.
- Additional approaches in brain imaging procedures.
- More sensitive tests so as to evaluate mental abilities in dementia patients.
- Measurement of protein patterns or key proteins in spinal fluid or blood as biomarkers.
Treatment for Alzheimer’s Disease
Alzheimer’s medications which are presently in the market can only help for a time with memory symptoms & associated cognitive changes. The following two types of drugs are presently used in treating cognitive symptoms.
- Cholinesterase Inhibitors – These medications generally work by providing depleted neurotransmitter (acetylcholine) in brain of Alzheimer’s patients which boost cell-to-cell communication levels. Modest in effect, cholinesterase inhibitors are found to improve neuropsychiatric symptoms like depression or agitation. Main side effects of these drugs include sleep disturbances, nausea, loss of appetite & diarrhea. Serious side effects of cholinesterase inhibitors include heart block & slow heart rate in Alzheimer’s patients with cardiac conduction disorders.
- Memantine (Nameda) – While slowing progression of symptoms in moderate to severe among Alzheimer’s disease cases, Memantine also works in brain cell communication network. Memantine is also sometimes used in combination with cholinesterase inhibitors. General side effects of this drug include headache, dizziness & constipation.
Quite often, other medications like antidepressants are also used so as to help control behavioral symptoms which are associated with Alzheimer’s. But these medications should be used with utmost caution as they can increase risks of falls & confusion. Therefore, always check with the doctor before taking them.
Create a Safe & Supportive Environment
Adaptable living situations needed by Alzheimer’s patients are important part of treatment plan. Establishing & strengthening routine habits while minimizing demanding tasks involving memory will go a long way & make living much easier for Alzheimer’s patients. Following steps will therefore be immensely helpful in restoring sense of well-being & continue ability to function among Alzheimer’s patients.
- Keep mobile phones, wallets, keys & other valuables in same place so they do not get lost.
- Simplify medication regimen in consultation with doctors to once-a-day dose& arrange finances on automatic payment & deposit mode.
- Carry mobile phone with location capability so that Alzheimer’s patients can call in case they are confused or lost & can also be easily tracked via location of phone. It would also be ideal to program important phone numbers into phone.
- Ensure regular appointments are on the same day at the same time as far as possible.
- Utilize a whiteboard or calendar at home in order to track daily schedules. Develop a habit of checking off completed items.
- Remove clutter, throw rugs & excessive furniture from living areas.
- Install stairways with sturdy handrails & inside bathrooms.
- Ensure slippers & shoes are comfortable & provide good traction as well.
- Reduce number of mirrors in the area as Alzheimer’s patients can find reflected images to be frightening or confusing.
- It would be sensible to keep photographs & other meaningful objects around the Alzheimer’s patients living area.
Wellness Plan for Alzheimer’s Disease Patient
- Exercise – Regular exercise is a vital part of any wellness plan & more so with Alzheimer’s patients. Activities like regular daily walks can improve mood alongside maintaining health of muscles, joints & heart. Exercise also helps prevent constipation & promotes restful sleep. Make sure that Alzheimer’s patients carry identification or wear a medical alert bracelet in case they are walking unaccompanied. Alzheimer’s patients with trouble in walking may use stationary bike or participate in chair exercises. Exercise programs geared for older Alzheimer’s patients are also available.
- Nutrition – Alzheimer’s patients may lose interest in preparing meals, forget to eat or not be able to arrive at a healthy combination of foods. They may also forget to consume enough fluids & which will lead them to constipation & dehydration.
- High Calorie Smoothies & Healthy Shakes – Alzheimer’s patients can supplement milkshakes with protein powders which are available at drugstores or grocery stores. A blender can be used in order to make smoothies with favorite ingredients.
- Water, Juice & Healthy Beverages – Ensure that Alzheimer’s patients drink several full glasses of liquids at least every day. Avoid caffeinated beverages since they interfere with sleep, increase restlessness & trigger frequent urge to urinate.
Risk Factors for Alzheimer’s Disease
- Age – Old age is one of the greatest known risk factors for Alzheimer’s. Not a part of the normal aging process, but old age greatly increases risk of Alzheimer’s especially when people reach age 65. Rate of dementia is found to double every decade after people reach age 60. Linked to early onset of Alzheimer’s, people with rare genetic changes experience symptoms as early as they are 30 years of age.
- Genetics & Family History – Risk of developing Alzheimer’s appears to be higher in case if a first-degree relative, like a parent or sibling is having this disease. Scientists have identified mutations in 3 genes which virtually guarantee people who inherit them will develop Alzheimer’s disease. These mutations however only account for less than 5% of Alzheimer’s disease. Even then most genetic mechanisms of Alzheimer’s disease among families largely remain unexplained. Strongest risk gene found so far is APoE4 or apolipoprotein e4, but all researchers do not agree with this factor. Some other genes have also been identified but have not been conclusively confirmed.
- Down Syndrome – People with Down syndrome are often found to develop Alzheimer’s. Symptoms of Alzheimer’s tend to appear 10 – 20 years earlier among people with Down syndrome than they do in general population. Gene contained in extra chromosome which causes Down syndrome significantly increases risk of developing Alzheimer’s disease.
- Gender – Women are more likely to develop Alzheimer’s disease than men, simply because they live longer.
- Past Head Trauma – People who have had severe head trauma in the past also seem to have greater risk of developing Alzheimer’s disease.
- Mild Cognitive Impairment – People with MCI or Mild Cognitive Impairment generally have problems with memory or other symptoms showing cognitive decline which are worse than what is expected of their age. However, MCI is not severe enough so as to be diagnosed as dementia. Nevertheless, people with MCI have increased risk, but is not a certainty of developing dementia later on in life. These patients should take positive action in order to develop a healthy lifestyle & strategize to compensate for memory loss at this stage which may eventually help delay or even prevent MCI progression to dementia.
- Lifestyle & Heart Health – However, no lifestyle factors have definitely proved to reduce risk of Alzheimer’s disease. Although, some evidence suggests that same factors which put people at risk of heart disease may also increase chances of them developing Alzheimer’s disease. Some of these factors increasing risk include the following.
- Lack of Exercise
- Smoking or Even Exposure to Secondhand Smoke
- Poorly Controlled Type 2 Diabetes
- High Blood Cholesterol
- High Blood Pressure
- Diet Lacking Vegetable & Fruits
These risk factors for Alzheimer’s are also linked to vascular dementia which is a type of dementia generally caused by damaged blood vessels in brain. Working closely with a healthcare team, prepare a plan so as to control these risk factors which will help protect heart & will also help reduce risk of vascular dementia &Alzheimer’s disease.
- Social Engagement & Learning – Research has revealed a close association between life-long involvements in socially & mentally stimulating activities to a reduced risk of Alzheimer’s disease. Therefore, lower education level like less than high school education can appear to be a risk factor for developing Alzheimer’s disease.
Complications of Alzheimer’s Disease
Impaired judgment, language & memory loss & other forms of cognitive changes caused by Alzheimer’s disease complicate treatment for many other related health conditions. People with Alzheimer’s therefore may not be able to perform the following tasks.
- Communicate experience of pain – like for example dental pain
- Report symptoms of any other illnesses
- Follow prescribed treatment plans
- Notice or describe side effects of medications
Brain changes start affecting physical functions like bowel & bladder control, balance & swallowing when Alzheimer’s progresses to last stages. These effects can complicate & increase vulnerability to additional health issues like the following.
- Aspiration – inhaling liquid or food into lungs
- Other Infections
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