Alzheimer’s Disease Introduction:
The most common form of dementia is Alzheimer’s disease. Although it is very uncommon before the age of 60, the incidence of Alzheimer’s disease becomes more common as an individual ages. Although it seems to effect only about 1% to 3% of people between the age of 60 to 64, the incidence of developing this dementia increases to approximately 30% for those over the age of 85. In the United States, as many is 4 million people may currently have the disease.
In Alzheimer’s disease, the brain deteriorates in a specific way resulting in the loss of nerve cells in the brain. Specific abnormalities develop in the brain cells referred to as tangles (neurofibrillary tangles) and plaques (senile or amyloid plaques) which then form between the nerve cells. It is also believed that there is disruption resulting in a reduction in the neurotransmitter (brain messenger between the cells) acetylcholine.
Some individuals may also have atherosclerosis, which then may lead to strokes. The strokes made then result in a vascular dementia, sometimes resulting in a mixed dementia. Mixed dementia is when an individual has both vascular dementia and Alzheimer’s disease or another form of dementia.
Cause of Alzheimer’s Disease:
At the present time, the cause of Alzheimer’s disease is unknown. The current belief in the medical community is that the development of Alzheimer’s disease may be as a result of some combination of genetics and the environment, although the environmental factors contributing to its development are not currently known. Although it is not known the relative contributions between genes and the environment, it is known to run in families and may possibly be more inheritable among individuals who develop it at an early age.
Alzheimer’s Disease Symptoms and Progression:
Alzheimer’s disease symptoms are very similar to the symptoms of other forms of dementia including a loss of memory, language problems, disorientation, behavioral problems and difficulties in activities of daily living. A person with Alzheimer’s disease is not required to have all of these symptoms however.
A couple of the more prominent changes in memory observed in people with Alzheimer’s disease is that changes are subtle and progressive. Some of the early changes may be almost unnoticeable at first but will progressively become worse over time, and will eventually get to the point of being totally disruptive in an individual’s activities of daily living.
The first change noticed in people with Alzheimer’s disease is a change in recent or short-term memory. Also, personality changes may be noticed as well. Some have been known to develop emotional changes such as depression, anxiety or an unusual level of fearfulness. There may be a higher level of fluctuation emotions noticed as well. Also, in the earlier stages, individuals may also notice minor changes in language abilities such as difficulty finding the correct words, misusing words or using general rather than specific language. Also, they quickly develop problems in judgment and the ability to think abstractly.
Unfortunately, some individuals may begin to develop behavioral problems. These problems result in their becoming irritable, agitated and sometimes physically aggressive. Also, they may begin to pace or even wander. Many Alzheimer’s patients develop insomnia, having trouble either initiating or maintaining sleep and sometimes may confuse night and daytime.
As the disease process continues, some individuals may even develop psychosis. Psychotic symptoms associated with Alzheimer’s disease are usually hallucinations, paranoia and/or delusions.
The progression of Alzheimer’s symptoms and ultimately the disease process is very unpredictable with people usually living approximately 8 to 10 years after the earliest signs of the disease. In the initial phases of the disease process, individuals experience things pretty much in the way they always have, enjoying the same activities and entertainment. However, as in all dementias, eventually memory problems become so pronounced that they can no longer participate in activities they have always enjoyed and will eventually become totally dependent on others. Once Alzheimer patients get to the stage of not been able to walk anymore, most individuals will only live an average of about six months. There is a lot of variation however with some individuals becoming bedbound and continue to live for several years.
Alzheimer’s disease diagnosis:
One of the first distinguishing characteristics in diagnosing an individual with Alzheimer’s is whether the individual develops a dementia that seems to have a progressive pattern. The Alzheimer’s disease diagnosis is initially based upon the pattern of symptoms, usually asking the individual and family members or other caregivers about memory problems and other symptoms of deterioration in activities of daily living. The diagnosis will later include a physical examination and other tests such as mental status exam, urine and blood tests, possibly computed tomography (CT) or magnetic resonance imaging (MRI). Some of these tests are used to exclude other possible diseases and conditions which could either cause or exacerbate underlying memory problems. After completing these tests, doctors are usually fairly accurate in their diagnosis of Alzheimer’s disease.
Confirmation of the diagnosis of Alzheimer’s disease can only be done upon death when a sample of the brain tissue is then examined under a microscope. At that time, the previously mentioned neurofibrillary tangles and senile plaques may then be seen throughout the brain. Newer tests such as positron emission tomography (PET) and analysis of spinal fluid are also believed to have possible utility in assisting with confirmation of Alzheimer’s disease. At the present time however, these tests are not believed to be very accurate and are not used very often.
Treatment of Alzheimer’s disease:
Similar to the treatment of other dementias, cholinesterase inhibitors seem to sometimes stabilize or mildly improve memory and mental functioning, but they cannot stop the progression of Alzheimer’s disease. Although inconclusive as to its effectiveness, ginkgo biloba has sometimes been used as an herbal treatment for Alzheimer’s disease.
New drugs continue to be researched constantly which may prevent or slow down the progression of Alzheimer’s disease. One recent example is the use of nonsteroidal anti-inflammatory drugs (NSAID’s) which are commonly used in the treatment of arthritis. Vitamin E is believed to possibly prevent or slow the progression of the disease process, although research is currently inconclusive related to the use of this vitamin. Obviously, risk and benefits of these and all treatments should be discussed with the patient’s physician.
Finally, individuals diagnosed with Alzheimer’s disease also have a high incidence of atherosclerosis or conditions which make it worse. This is of concern in that those individuals will then be at high risk for stroke, which is obviously a serious concern which needs to be eliminated to the best degree possible.
Some information adapted by Paul Susic Ph.D. Licensed Psychologist from the Merck Manual of Aging
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