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Old age is marked by multiple changes which are multidirectional. Some changes include lowered physical activity, slower cognitive processes, forgetfulness, lack of social support etc. One of the unavoidable conditions experienced by older adults is Alzheimer's disease, a common cause of dementia.
What is Dementia?
The Diagnostic and Statistical Manual of Mental Health, 5th edition (DSM-5), categorizes dementia into two classifications, i.e., mild neurocognitive disorder and major neurocognitive disorder. Dementia is also divided based on the probable cause of dementia. For example, two of the commonly known degenerative dementias are Alzheimer's dementia and Parkinson's dementia. Alzheimer's disease can occur in people as young as 40, but it is commonly known to occur in the elderly.
What is Alzheimer's Dementia?
Alzheimer's dementia is a fatal and progressive neurocognitive dementia that has an impact on memory functions. It is separate from forgetfulness and is not a part of the natural aging process. Alzheimer's disease has its name after Alois Alzheimer (1864-1915), who was the first to detect pathological signs and brain changes associated with Alzheimer's dementia.
Stages of Alzheimer's Dementia
Alzheimer's is a progressive and terminal disease, and the changes in the brain occur much before the symptoms are seen. The presentation of the disease and its progression differ amongst varied people, but it generally progresses gradually with three stages- early, intermediate (middle) stage, and late stage. It can be said that Alzheimer's has a slow onset but steady progress.
The early stage is characterized by forgetfulness of common names and places, a decline in selective attention, and slight disorientation, but the individual is capable of functioning independently. Some personality changes can also be seen during the beginning of the presentation of symptoms.
The middle stage is marked by changes in mood like frustration, irritability, aggression, confusion, disorientation, and anxiety. Another symptom seen during the middle stage is deterioration in speech.
In the late stage, the patient's ability to respond to the environment declines along with their ability to adapt to the surrounding. Gradually, memory and cognitive abilities decline to a level that affects their ability to communicate pain and use words and phrases improperly. They lack awareness at this stage.
Clinical Picture of Alzheimer’s Dementia
Its symptoms include:
Risk Factors for Alzheimer’s Dementia
Some of the common risk factors for developing Alzheimer's Dementia are as follows-
Age: The risk of Alzheimer's disease increases as age increases. Although Alzheimer's is not a consequence of aging, it is one of the biggest risk factors. The majority of the people with this disease are 60 years and older.
Female: There are some sex differences seen in developing Alzheimer's. There is an increased prevalence of women with Alzheimer's, although subjective interpretations are attached. Some suggest that women tend to live longer than men and feel lonelier than their counterparts which may create a link between gender and the development of Alzheimer's disease.
Family history and genetics: Similar to other diseases, the risk of Alzheimer's disease increases if one of the family members has the illness. Therefore, genes increase the risk of developing the disease.
Low educational level: In addition to being women and escalating age, low educational level adds to the vulnerability.
Other risk factors: In addition to the factors mentioned above, being a current smoker, accidental head injury or trauma, and lack of brain exercise make a person vulnerable.
Neural Correlates of Alzheimer
The key features of Alzheimer's that confirm the diagnosis of the disease apart from the behavioral changes are brain abnormalities. Three important neural correlates identified in Alzheimer's disease are neurofibrillary tangles, amyloid plagues, and neuronal loss. Neurofibrillary tangles are thin proteins that are threadlike, suspended in the neural cytoplasm, and amyloid plagues are scar tissues clumped together that consist of protein, amyloid, and degenerating neurons.
In healthy people, amyloid is present in small quantities, whereas, in patients with Alzheimer's, this protein is available in a large amount. Lastly, substantial neuronal loss affects the functioning of the brain and, thereby, the behavior. These changes occur in the entire brain but are prominent in specific brain areas like the hippocampus, amygdala, and entorhinal cortex, all involved in memory functions and a part of the medial temporal lobe.
Management of symptoms
Alzheimer's diagnosis can only be confirmed after the patient's death through biopsy. This disease has no cure, and only the symptoms can be managed. A holistic management strategy works best in such cases. Global management strategy includes multiple methods like pharmacological, counseling, and psycho-education for the patient, family, and caregivers. The decision for the management strategy is based on multiple factors like cost, time, willingness, etc.
The initial efforts to treat Alzheimer's disease were based on the neurotransmitter acetylcholine, which was supposedly thought to be causing some symptoms. Therefore, cholinergic agonists are the first line of treatment for Alzheimer's. Focusing on similar roots, nerve growth factor (NGF) affects the cholinergic neurons, which help manage some symptoms of Alzheimer's disease.
Alzheimer's disease is a dilapidating neurodegenerative disease that has no cure. The characteristic feature of Alzheimer's disease is deterioration in memory along with other symptoms like behavioral and personality changes, lack of concern for personal hygiene, forgetfulness, irritability, etc. More work needs to be done to find better ways to diagnose and treat Alzheimer's dementia.
Ciccarelli S., White J.N. Introduction to Psychology.
Grossberg G.T., Desai A.K. Management of Alzheimer’s disease. (URL: https://academic.oup.com/biomedgerontology/article/58/4/M331/605023?login=false)
Scott S.A., Crutcher K.A. Nerve Growth Factor and Alzheimer’s disease. (URL: https://pubmed.ncbi.nlm.nih.gov)
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