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Alzheimer's disease is a degenerative neurologic ailment that causes brain cells to die and the brain to shrink (atrophy). Alzheimer's disease is the most prevalent form of dementia, which is defined as a progressive deterioration in cognitive, behavioral, and social skills that impairs a person's capacity to operate independently.
Alzheimer's disease affects around 5.8 million people in the United States aged 65 and up. Eighty percent of those are 75 or older. Alzheimer's disease is believed to affect 60-70 percent of the approximately 50 million people globally who have dementia.
The disease's early symptoms include forgetting recent events or discussions. A person with Alzheimer's disease will develop severe memory impairment and lose the capacity to do daily chores as the disease develops.
Medications may improve or reduce the course of symptoms temporarily. These medicines can sometimes assist patients with Alzheimer's disease keep function and independence for a short period of time. Various programs and services are available to help people with Alzheimer's disease and their caretakers.
There is no cure for Alzheimer's disease or medication that affects the disease process in the brain. Complications from significant loss of brain function, such as dehydration, starvation, or infection, result in mortality in advanced stages of the condition.
WHAT ARE THE SYMPTOMS OF ALZHEIMER'S DISEASE?
Alzheimer's disease is characterized by memory loss. The inability to recall recent events or discussions is one of the early warning indicators. Memory difficulties worsen as the disease advances, and new symptoms emerge.
At initially, a person suffering from Alzheimer's disease may be aware that they are having difficulties remembering things and organizing their thoughts. A family member or a close friend may be more likely to notice as the symptoms intensify.
Alzheimer's disease-related brain alterations cause increasing difficulty with:
- Memory: Everyone experiences periodic memory lapses, but Alzheimer's disease memory loss persists and increases, impairing capacity to perform at work or at home.
Alzheimer's patients may:
- Repeat remarks and questions several times.
- Forget about discussions, appointments, and events, and probably won't recall them later.
- Misplace possessions on a regular basis, frequently putting them in odd areas
- Get lost in familiar surroundings.
- Eventually forget the names of family members and ordinary items
- Have difficulty identifying items, expressing thoughts, or participating in conversations?
- Making decisions and judgments: Alzheimer's disease impairs one's capacity to make sound decisions and judgments in everyday situations. For example, a person may make bad or unusual decisions in social situations or dress inappropriately for the weather. It may be more difficult to successfully respond to routine concerns, such as food burning on the stove or unexpected driving scenarios.
- Reasoning and thinking: Alzheimer's disease impairs concentration and thinking, particularly when it comes to abstract notions like numbers.
Multitasking is extremely tough, and managing finances, balancing checkbooks, and paying payments on time may be difficult. A person suffering from Alzheimer's disease may eventually be unable to recognize and cope with numbers.
- Planning and carrying out routine duties: Activities that used to be regular, such as planning and making a meal or playing a favorite game, become difficult as the condition progresses. People with advanced Alzheimer's disease frequently lose the ability to do basic actions such as dressing and bathing.
- Personality and behavioral changes: Alzheimer's disease-related brain alterations can have an impact on moods and behaviour. The following are examples of potential issues:
- Depression
- Apathy
- Withdrawal from social activities
- Mood swings
- Lack of trust in others
- Irritability and aggression
- Sleeping habits are changing.
- Wandering
- Loss of inhibitions
- Delusions, such as believing that something was stolen
- Preserved skills: Many critical skills are retained for longer periods of time even when symptoms increase. Reading or listening to books, sharing stories and reminiscing, singing, listening to music, dancing, sketching, or creating crafts are all examples of talents that can be preserved.
These abilities may be kept for a longer period of time since they are controlled by areas of the brain that are impacted later in the disease's progression.
WHAT ARE THE CAUSES OF ALZHEIMER'S DISEASE?
The precise causes of Alzheimer's disease are unknown. However, on a fundamental level, brain proteins fail to function appropriately, which disturbs the work of brain cells (neurons) and sets off a chain of harmful events. Neurons are injured, lose their connections, and eventually die.
Alzheimer's disease, according to scientists, is caused by a mix of hereditary, lifestyle, and environmental factors that damage the brain over time.
Alzheimer's disease is caused by certain genetic abnormalities that nearly guarantee a person will develop the condition less than 1% of the time. These uncommon circumstances almost always result in illness development in middle age.
The damage usually begins in the part of the brain that governs memory, although the process begins years before the first symptoms appear. The loss of neurons spreads to other areas of the brain in a rather predictable fashion. The brain has shrunk greatly by the late stage of the disease.
Researchers attempting to discover the etiology of Alzheimer's disease are concentrating on the roles of two proteins:
- Plaques: The protein beta-amyloid is a fragment of a bigger protein. When these pieces congregate, it appears that they have a harmful effect on neurons and disrupt cell-to-cell transmission. These clusters combine to produce bigger deposits known as amyloid plaques, which also contain other cellular detritus.
- Tangles: Tau proteins contribute to a neuron's internal support and transport system, which transports nutrition and other important components. Tau proteins change shape and assemble themselves into aggregates known as neurofibrillary tangles in Alzheimer's disease. The tangles are harmful to cells and impair the transport mechanism.
WHAT ARE THE RISK FACTORS OF ALZHEIMER'S DISEASE?
Age: The most significant known risk factor for Alzheimer's disease is advancing age. Alzheimer's disease is not a normal part of aging, but as you become older, your chances of having it rise.
According to one study, there are four new illnesses per 1,000 persons aged 65 to 74, 32 new diagnoses per 1,000 people aged 75 to 84, and 76 new diagnoses per 1,000 people aged 85 and older each year.
Down syndrome: Alzheimer's disease affects a large number of persons with Down syndrome. This is most likely due to having three copies of chromosome 21 — and so three copies of the gene for the protein that causes beta-amyloid to form. Alzheimer's disease symptoms appear 10 to 20 years earlier in people with Down syndrome than in the general population.
Sex: There appears to be minimal difference in risk between men and women, but women are more likely to get the condition since they live longer than males.
Genetics and family history: If a first-degree family, your parent or sibling, has the disease, your chances of having it are slightly higher. Most genetic pathways of Alzheimer's disease in families remain largely unknown, and genetic variables are likely to be complicated.
One other well-known genetic component is a variant of the apolipoprotein E gene (APOE). The gene variant APOE e4 raises the risk of Alzheimer's disease. An APOE e4 allele is carried by around 25% to 30% of the population, however not everyone with this variant of the gene develops the disease.
Scientists have discovered unusual alterations (mutations) in three genes that nearly ensure a person inheriting one of them would acquire Alzheimer's. However, these mutations account for less than 1% of Alzheimer's patients.
Mild cognitive impairment: Mild cognitive impairment (MCI) is defined as a deterioration in memory or other thinking skills that is greater than usual for a person's age but does not preclude a person from functioning in social or work settings.
People with MCI are at a high risk of getting dementia. When memory is the predominant MCI deficit, the condition is more likely to proceed to dementia as a result of Alzheimer's disease. A diagnosis of MCI requires a greater emphasis on healthy lifestyle modifications, the development of techniques to compensate for memory loss, and the scheduling of regular doctor consultations to check symptoms.
Air pollution: Air pollution particulates have been shown in animal studies to hasten the deterioration of the neurological system. In addition, human studies have revealed that exposure to air pollution, notably from car exhaust and wood burning, is connected with an increased risk of dementia.
Overindulgence in alcoholic drinks: It has long been known that excessive alcohol use causes brain alterations. Several big research and reviews discovered a link between alcohol use problems and an increased risk of dementia, particularly early-onset dementia.
Head injury: People who have had a severe head injury are more likely to develop Alzheimer's disease. Several big studies indicated that patients aged 50 and up who had a traumatic brain injury (TBI) had an elevated risk of dementia and Alzheimer's disease. People with more severe and multiple TBIs are at a higher risk. According to some research, the risk is greatest between the first six months to two years after a TBI.
Inadequate sleeping patterns: Poor sleep patterns, such as trouble getting or staying asleep, have been linked to an increased risk of Alzheimer's disease, according to research.
Lifelong learning and social participation: Several studies have established a link between lifetime participation in mentally and socially stimulating activities and a lower risk of Alzheimer's disease. Low education levels, defined as less than a high school diploma, appear to be a risk factor for Alzheimer's disease.
Heart health and lifestyle: According to research, the same risk factors that are related with heart disease may also raise the chance of Alzheimer's disease. These are some examples:
- Lack of exercise
- Obesity
- Smoking or being exposed to secondhand smoke
- Hypertension
- High levels of cholesterol
- Type 2 diabetes that is poorly managed
All of these variables are modifiable. As a result, modifying your living behaviors can reduce your risk to some extent. Regular exercise and a healthy low-fat diet rich in fruits and vegetables, for example, are linked to a lower chance of acquiring Alzheimer's disease.
HOW IS ALZHEIMER'S DISEASE DIAGNOSED?
Being able to articulate your symptoms, as well as the opinion of a close family member or friend on symptoms and their impact on everyday life, is a significant aspect of diagnosing Alzheimer's disease. Furthermore, a diagnosis of Alzheimer's disease is based on memory and thinking abilities tests administered by your doctor.
Laboratory and imaging tests can rule out other possible causes or assist the doctor in identifying the condition causing dementia symptoms.
Traditionally, Alzheimer's disease was only identified with certainty after death, when a microscope examination of the brain revealed the distinctive plaques and tangles. Clinicians and researchers can now more confidently diagnose Alzheimer's disease during the course of a patient's life. Biomarkers, such as specific types of PET scans or quantifying amyloid and tau proteins in plasma and cerebral spinal fluid, can detect the existence of plaques and tangles.
Physical and neurological examinations
Your doctor will do a physical exam and will most likely evaluate your general neurological health by testing the following:
- Reflexes
- Muscle tone and power
- The ability to get out of a chair and stroll across the room
- Visual and auditory perception
- Coordination
- Balance
Testing for mental state and neuropsychological disorders
Your doctor may do a brief mental status examination to examine your memory and other cognitive abilities. Longer forms of neuropsychological testing may reveal more information about mental function when compared to others of a similar age and education level. These tests can aid in the establishment of a diagnosis as well as act as a starting point for tracking the evolution of symptoms in the future.
Laboratory tests
Blood tests may assist your doctor in ruling out other possible reasons of memory loss and disorientation, such as a thyroid disease or vitamin shortages.
Brain imaging
Images of the brain are currently mostly used to identify visual abnormalities associated with illnesses other than Alzheimer's disease that may induce cognitive decline, such as strokes, trauma, or tumors. New imaging applications, which are now utilized primarily at major medical centers or clinical trials, may allow clinicians to detect particular brain changes caused by Alzheimer's disease.
Imaging of brain structures includes the following:
- Magnetic resonance imaging (MRI): MRI creates comprehensive images of the brain by using radio waves and a strong magnetic field. While MRI scans may reveal brain shrinkage in areas associated with Alzheimer's disease, they also rule out other illnesses. For the examination of dementia, an MRI is often chosen over a CT scan.
- Computerized tomography (CT): A CT scan, a type of X-ray technology, creates cross-sectional images (slices) of your brain. It is most commonly used to rule out malignancies, strokes, and head traumas.
Positron emission tomography (PET) can be used to image disease processes. A low-level radioactive tracer is injected into the blood during a PET scan to reveal a specific feature in the brain. PET imaging may comprise the following procedures:
- PET scans of fluorodeoxyglucose (FDG): reveal areas of the brain where nutrients are poorly digested. Identifying degeneration patterns — areas of low metabolism — can aid in distinguishing Alzheimer's disease from other types of dementia.
- Amyloid PET imaging: can assess the extent of amyloid plaques in the brain This imaging is primarily utilized for research purposes, however it may be employed if a person exhibits uncommon or very early beginning of dementia symptoms.
- Tau PET imaging: which assesses the load of neurofibrillary tangles in the brain, is commonly employed in studies.
Other tests may be used to evaluate aberrant beta-amyloid and tau in the cerebrospinal fluid in some cases, such as fast advancing dementia, dementia with unusual characteristics, or early-onset dementia.
Future diagnostic tests
Researchers are striving to create tests that can detect biological markers of illness processes in the brain.
These diagnostics, particularly blood testing, may increase diagnostic accuracy and allow for earlier diagnosis before symptoms appear. A blood test for Plasma A is currently available, and the Centers for Medicare & Medicaid Services recently certified it for commercial distribution in the United States.
A routine Alzheimer's disease evaluation should not include genetic testing. People with a family history of early-onset Alzheimer's disease are an exception. Before undergoing any tests, it is recommended that you consult with a genetic counselor about the risks and advantages of genetic testing.
WHAT ARE THE TREATMENTS FOR ALZHEIMER'S DISEASE?
Drugs
Current Alzheimer's medications can help with memory symptoms and other cognitive changes for a short time. To treat cognitive problems, two types of medicines are now used:
- Cholinesterase inhibitors: These drugs work by restoring levels of cell-to-cell communication in the brain, which has been depleted by Alzheimer's disease. These are usually the first medications tried, and most people see modest improvements in symptoms.
Cholinesterase inhibitors may also help with neuropsychiatric symptoms including agitation or sadness. Donepezil (Aricept), galantamine (Razadyne ER), and rivastigmine are examples of commonly prescribed cholinesterase inhibitors (Exelon).
These medications' most common side effects are diarrhea, nausea, loss of appetite, and sleep difficulties. Serious side effects in patients with certain heart diseases may include cardiac arrhythmia.
- Memantine (Namenda):
This medication affects another brain cell communication network, slowing the progression of symptoms in those with moderate to severe Alzheimer's disease. It is occasionally used with a cholinesterase inhibitor. Dizziness and disorientation are rather uncommon adverse effects.
The Food and Drug Administration (FDA) approved aducanumab (Aduhelm) for the treatment of certain types of Alzheimer's disease in June 2021. This is the first medicine approved in the United States to target and remove amyloid plaques in the brain, which is the underlying cause of Alzheimer's disease. The FDA approved the medicine on the condition that additional research be undertaken to confirm the treatment's efficacy. Experts must also determine which patients will benefit from the medicine.
Other drugs, such as antidepressants, are sometimes recommended to assist control the behavioral signs of Alzheimer's disease.
CREATING A SECURE AND ENCOURAGING ATMOSPHERE
Adapting a person's living surroundings to their Alzheimer's disease needs is a crucial aspect of any treatment plan. Establishing and maintaining habitual behaviors, as well as avoiding memory-demanding chores, can make life considerably easier for someone with Alzheimer's.
You can help a person's sense of well-being and ability to operate by taking the following steps:
- Keep keys, wallets, mobile phones, and other valuables in the same place at home to avoid losing them.
- Keep drugs in a safe place. To keep track of dosages, create a daily checklist.
- Set up your funds to be paid and deposited automatically.
- Allow the Alzheimer's patient to carry a mobile phone with location capabilities so that a caregiver may track its location. Important phone numbers should be programmed into the phone.
- Sturdy railings should be installed on stairwells and in bathrooms.
- Check that your shoes and slippers are comfortable and have sufficient traction.
- Limit the number of mirrors. Images in mirrors might be misleading or scary for those with Alzheimer's.
- Check to see if the individual with Alzheimer's has identification or wears a medical alert bracelet.
- Keep pictures and other sentimental items about the house.
- Install alarm sensors on all of your doors and windows.
- As much as feasible, schedule regular appointments on the same day and at the same time.
- To keep track of everyday schedules, use a calendar or a whiteboard at home. Make it a habit to cross off finished items.
- Get rid of any unnecessary furniture, clutter, and throw rugs.
WHAT ARE THE COMPLICATIONS OF ALZHEIMER'S DISEASE?
Alzheimer's disease can complicate therapy for other health disorders by causing memory and language loss, decreased judgment, and other cognitive impairments. A person suffering from Alzheimer's disease may be unable to:
- Inform him or her that he or she is in agony.
- Describe the symptoms of another sickness.
- Follow the treatment plan that has been prescribed to you.
- Describe the side effects of medications.
As Alzheimer's disease advances, abnormalities in the brain begin to impact bodily processes such as swallowing, balance, and bowel and bladder control. These side effects can make you more vulnerable to other health issues, such as:
- Food or liquid inhalation into the lungs (aspiration)
- Infections such as the flu, pneumonia, and others
- Falls
- Fractures
- Bedsores
- Malnourishment or dehydration
- Diarrhea or constipation
- Problems with the teeth, such as mouth sores or tooth decay
HOW CAN ALZHEMIER'S DISEASE BE PREVENTED?
Alzheimer's disease is not a disease that can be avoided. A variety of lifestyle risk factors for Alzheimer's can, however, be reduced. Changes in food, exercise, and routines, efforts to reduce your risk of cardiovascular disease, may also lessen your risk of acquiring Alzheimer's disease and other dementia-causing diseases, according to research. The following are examples of heart-healthy lifestyle behaviors that may minimize the risk of Alzheimer's:
- Regular exercise
- Eating a diet rich in fresh vegetables, healthy oils, and low-fat meals, such as the Mediterranean diet
- Following treatment recommendations for high blood pressure, diabetes, and high cholesterol
- If you smoke, seek help from your doctor to quit.
Participating in social events, reading, dancing, playing board games, producing art, playing an instrument, and other activities that demand mental and social engagement have been linked to maintained thinking skills later in life and a lower risk of Alzheimer's disease.
CONCLUSION
Alzheimer's is a complex disease, and scientists are attempting to uncover its mysteries. A healthy lifestyle may assist to prevent it. If you have a family history of Alzheimer's disease, you should talk to your doctor about it.
The course of Alzheimer's disease is irreversible by the time it is diagnosed. However, medication can help to postpone symptoms and enhance your quality of life.
Consult a doctor if you suspect you or a loved one has Alzheimer's disease. They can assist in making a diagnosis, discussing what to expect, and connecting you with services and support. If you are interested, they can also provide you with information on how to participate in clinical trials.