What is Alzheimer’s Disease?
Alzheimer’s is late-onset dementia, usually occurring in individuals above sixty-five years of age, where the shrinkage of cortical matter in the brain results in memory, cognition, and behavior being affected. Although the majority of the affected individuals are above sixty-five years of age, a newly-diagnosed variant is now affecting the younger population as well. The disease remains insidious in its initial phase and the symptoms manifest slowly and gradually over time until they become severe enough to interfere with normal activities.
Understanding The Risk Factors
Aging seems to be the greatest risk factor in the development of Alzheimer’s. Although cases of early-onset Alzheimer’s are now being diagnosed in significant numbers, ninety percent of the patients still fall into the category of sixty-five years and older. Other minor risk factors include smoking, excessive alcohol consumption, high cholesterol, hypertension, depression, and diabetes. However, it’s important to understand that not all aged people develop Alzheimer’s and environmental factors play an important role in the pathogenesis of the disease.
Progression Of The Disease
The nature of the disease is progressive which means that the symptoms of dementia worsen with time. In fact, it has been announced as the sixth leading cause of death in America. The progression of the disease might be slow but an average individual survives for four to twenty years after diagnosis of Alzheimer’s.
Staging The Disease
Alzheimer’s disease progresses in a streamlined fashion. Once past the preclinical stage, the patient enters the phase of clinical disease where the magnitude of symptoms is mild and limited to cognitive impairment only. As the disease progresses, other aspects of cognition like spatial abilities, vision, reasoning, and judgment are also affected. The most severe form of the disease is characterized by a complete dependency on others.
Alzheimer’s Disease Symptoms
The signs and symptoms depend on the clinical stage of the disease.
A person suffering from an initial stage of the disease is otherwise healthy but experiences difficulty in remembering things and making decisions. He takes longer than usual to execute daily activities of living, experience anxiety or aggression, finds trouble in handling money and misplaces items. Mood and personality changes are quite evident at this stage. This is usually the time when the disease can be diagnosed by physical and clinical examination.
The patient experiences a significant loss of memory and function and supervision by a caretaker becomes necessary. Language difficulties are quite evident at this stage and he may experience hallucinations, delusions, paranoia, outbursts of anger, impulsive behavior, restlessness, limited attention span, muscle twitching and difficulty in reading and writing. Recognition of friends and family becomes a difficult task and the patient remains confused most of the time.
Individuals suffering from severe Alzheimer’s constantly need a guardian for care and support. Patient’s communication skills are severely affected and the body shuts down at the end stage. Weight loss, infections, seizures, swallowing difficulty, constant discomfort, and grunting, loss of bowel control and increased sleeping hours are few of the common symptoms. The most common cause of death in these patients is aspiration pneumonia and superimposed infections.
The diagnosis of Alzheimer’s requires a proper assessment of memory impairment, judgmental abilities, and behavioral changes. Laboratory tests are encouraged to rule out other causes of dementia. Proper diagnosis is essential for providing accurate treatment and counseling.
History and Examination:
A proper insight into the medical history of the patient gives a clear cut idea about his family history and other co-morbidities. Furthermore, a clinical examination will help diagnose memory impairment and cognitive disabilities. Physical evaluation of the patient helps rule out other causes of dementia and gives knowledge about the overall health of the patient.
Mental Status Testing:
Medical history and examination are followed by a couple of tests that score a person’s memory and cognitive skills. Such neuropsychological tests help evaluate the patient’s current condition and staging of the disease becomes convenient.
Interviewing The Closed Ones:
A specialized doctor often believes that speaking to the close ones of the patient can give clues about the disease. Family and friends may reveal noticeable changes in the patient and how his functioning has declined over time. Such knowledge is always helpful to figure out the progression of the disease.
Blood tests are conducted to rule out similar medical disorders like thyroid dysfunction and vitamin B12 deficiency.
Brain Imaging Scans:
Degeneration of cortical matter is the characteristic feature of Alzheimer’s. This loss of neurons can be seen in a variety of imaging techniques like CT scan, MRI and PET scan. Not only do these scans show signs of dementia but they also help rule out other causes like tumors and hemorrhages. PET scan is evolving as the latest technology because it shows amyloid deposits in the core of neurons – a pathological change that is a hallmark of Alzheimer’s.
Researchers are ongoing to develop tests that can scan the genetic material of susceptible individuals and detect Alzheimer’s even before the initiation of symptoms. Many disease markers and diagnostic tests are under trial and may be able to provide mind-blowing information about the disease’s progression in near future.
Why is early diagnosis essential?
It’s absolutely normal for affected individuals to feel embarrassed about their disease and be reluctant to consult a doctor from the fear of bringing their disease into the limelight. However, it is imperative to counsel the patient about the benefits of early diagnosis.
Alzheimer’s is not a fatal disease but it affects the quality of life to a significant magnitude. Delay in diagnosis will only make the pathology worsen with time. An early diagnosis means that effective treatment can be started immediately and the disease can be halted in its path.
Obviously, being diagnosed at a late stage only makes the reversal of symptoms more complicated and sometimes impossible. Timely therapeutic intervention can do wonders to ease the burden of the disease. Besides, counseling and strategic planning can encourage the patient to enhance his living environment and not let the disease hinder the activities of his daily life.
Weighing The Treatment Options
All therapeutic options available today are effective in halting the symptoms of the disease but none of them can reverse the cortical damage or prevent the occurrence of disease in a susceptible individual. Ongoing research is targeting to formulate drugs that not only stop the progression of the disease but also delay onset.
Although not effective in reversing the brain damage but Alzheimer medications are very beneficial in providing symptomatic relief. Two classes of drugs that are currently employed in clinical practice are cholinesterase inhibitors and memantine. Cholinesterase inhibitors like Donepezil and Rivastigmine work by elevating the levels of acetylcholine – a neurotransmitter that’s important for neuronal communication. Elevated levels, in turn, improve memory and cognition. The other drug, Memantine, blocks the effect of excess glutamate on the brain. Glutamate is another neurotransmitter that is released in toxic levels in an Alzheimer’s patient. These two drugs can also be taken in conjunction with better results.
Few drugs are only used to provide symptomatic relief. Antidepressants and anti-anxiety drugs, for instance, can help combat behavioral changes.
Customizing The Lifestyle:
The lifestyle of an Alzheimer’s patient should be modified in order to strengthen his routine habits and minimize the effect of the disease on his activities. Memory demanding tasks such as calculations should be omitted from his daily routine. Other activities like driving and going alone for a walk should be minimized to prevent accidents. Important items like wallets and keys should be kept in one place so they’re not lost. Medication should be taken on time and an alarm can be set on the phone as a reminder.
Regular exercise helps improve mood by releasing the happy hormone serotonin. Physical activity not only maintains the health of the nervous system but also ensures the smooth functioning of other organs.
Loss of appetite is a characteristic feature of this disease. Individuals with Alzheimer’s should make sure to consume high calorie, healthy diet in order to prevent starvation and dehydration. Milkshakes and healthy beverages should be a part of every meal. Caffeine consumption should be limited to prevent anxiety attacks. Supplementation in form of tablets and syrups can also be taken to avoid deficiencies. Fruits and vegetables should be incorporated into the diet plan.
Engaging with other people and maintaining a social circle stimulates intellect and helps preserve mental function.