Alzheimer’s Disease

Alzheimer’s disease also known as "senile dementia" is the most common type of dementia. It is an incurable, degenerative, and terminal disease. Alzheimer’s disease affects about 5.3 million people in the US. It was the 5th leading cause of death in 2015.AD affects more of the African American population than the Whites. In India, around 4 million people have Alzheimer’s

Alzheimer’s disease is seen mostly in the age group of more than 65 years of age. Individuals mostly show memory loss, confusion, short attention span, personality changes, and loss of orientation. It was first described by German Physician Dr Alois Alzheimer in 1906. Few eminent personalities suffered from Tom Fears, Betty Robinson, Bill Quackenbush, and Ronald Reagan.

Alzheimer’s Disease: Causes

The exact cause of Alzheimer’s disease is not very specifically documented but these are associated with many risk factors.

Many genetic and environmental factors are found to be associated such as elderly age, trauma, family history, vascular disease like Stroke, etc.

Alzheimer’s Disease: Symptoms

Following are the five stages of Alzheimer’s disease −

• Pre-clinical AD

• Mild AD

• Moderate AD

• Severe AD

• End-stage AD

The following are the major symptoms of Alzheimer’s disease −

• AD patients will find difficulty in doing daily routine activities and tasks.

• Memory loss is the most significant associated feature.

• Difficult to find names of the things.

• Confusion about the time, place, and person.

• Changes in mood, personality, and judgment-making ability.

• Language problem.

• Wandering, Agitation, Aggression.

• Unstable gait

• Loss of talking skills.

• Loss of recognition of familiar people and places.

Alzheimer’s Disease: Risk Factor

The major risk factors include −

• Age − Higher the age more is the risk of developing AD.

• Gender − Females are affected more than males.

• Heredity − Early onset disease is caused by an alteration in the chromosomes 1, 4, 21. Late onset is caused by the apolipoprotein E gene (apo E). The degree of risk depends on the number of copies of genes, age, and ethnicity.

• Race and Ethnicity − African- American 2 times greater risk. Cardiovascular risk factors are common. The lower level of education and socioeconomic status are risk factors.

• Other factors are Smoking, Obesity, Head injury, and Environmental factors like Aluminium, Mercury, and Viruses.

• Vascular disease like Stroke

• Diabetes, Hypertension, Hypercholesterolemia, Downs syndrome.

Alzheimer’s Disease: Diagnosis

To diagnose Alzheimer’s disease, some of the prominent methods are −

• Blood studies − Circulatory miRNA, Inflammatory biomarkers

• Blood MRI/CT scan

• SPECT (Single Positron Emission Computerized Tomography)/ PET (Positron Emission Tomography)

• PiB PET

• Lumbar puncture; for Cerebro Spinal Fluid examination.

• Genotyping

• Electroencephalography

• Electromyography

Alzheimer’s Disease: Treatment

Goals of therapy

• To maintain the patient’s brain function as far as possible.

• To treat the patient’s psychiatric and behavioral sequelae.

• To decelerate the likelihood of progression into complications.

• To focus on emotional and supportive care for the concerned patient.

• To reduce morbidity and mortality as far as possible.

• To improve quality of life.

Pharmacological Treatment

Pharmacological Treatment includes Cholinesterase inhibitors. These medicines inhibit the acetylcholinesterase enzyme responsible for acetylcholine destruction. The adverse effects of these drugs include increased sweating, salivation, nausea, vomiting, abdominal cramps, bradycardia, tremors, and hypertension. Examples of such drugs are Donepezil, Rivastigmine, and Galantamine.

NMDA Receptor Antagonist can also be used. These medicines block the NMDA receptors during excessive stimulation. The adverse effect is Hypertension, Cataract, Cerebro Vascular Accidents, Thromboembolism, etc. An example of such a drug is Memantine.

Vitamin E also helps as an Add-On therapy along with the above-mentioned drugs. In addition, antidepressants, anxiolytics, antipsychotics, anticonvulsants can be used for the treatment.

Psychosocial Treatment

Psychosocial methods of treatment include −

• Behavioural approach

• Emotion-oriented approach − Reminiscence therapy, Validation therapy, supportive psychotherapy, sensory integration, stimulated presence therapy.

• Cognition-oriented approach

• Stimulation-oriented approach

• Acupuncture

• Aromatherapy

• Light therapy

• Massage and touch therapy

• Transcutaneous Electrical Nerve Stimulation (TENS)

Prognosis − The early stages of Alzheimer’s disease are difficult to diagnose. AD will from mild cognitive problems, such as memory loss through increasing stages of cognitive and non-cognitive disturbances, which reduces the chances of self-dependent living.

The life expectancy of the population having the disease decreases due to many factors such as falls and disturbances in the neurological examination.

Alzheimer’s Disease: Prevention

No such specific measures have been described in the literature, but the following methods have been tried to reduce the risk with limited benefit −

• Cessation of smoking

• Alcohol consumption should be kept at the minimum

• Healthy eating habits composed of a high protein and high vitamin diet especially Vitamin E and Vitamin D. High portions of fruit and vegetables should also be included in the diet.

• Exercise of any type should be included in the daily routine activity.

• Other associated risk factors if present should be taken care of.

• Blood pressure control

• Cognitive training

Conclusion

Alzheimer’s disease is the most debilitating disease affecting old age. Its pathology includes the formation of beta protein and Tau protein in the brain. As there is no specific and perfect cure, the level of action should be taken to delay the progression and prevent the disease. Approved medicine for the treatment with limited benefits is Acetyl Choline Esterase and NMDA receptor inhibitors.

World Alzheimer’s Day is on 21st September; let’s end the stigma of Alzheimer’s disease and help our respectful seniors to lead a life with dignity.

In addition to the financial burden of AD on the healthcare system, the disease has a powerful emotional impact on caregivers and families of those afflicted. Even though effective medicines are available, but still AD has no cure, so we need to continuously fight against the disease.