Alzheimer's Disease

Alzheimer's Disease

What is Alzheimer’s Disease?

Alzheimer’s, pronounced ahlts-hahy-merzis the most common form of dementia amongst elderly people. Dementia describes a specific set of symptoms that include having trouble thinking, suffering from memory loss and having issues with problem solving and basic communication. Dementia is the result of brain damage from certain diseases such as Alzheimer’s.

Alzheimer’s disease is named after the first doctor to describe it, Alois Alzheimer. He discovered it in 1906. Simply put, the disease affects the brain from functioning properly, its biggest risk factor is age. It is not a normal part of the aging process but the majority of people with the condition are over the age of 65 however, there are cases where younger people have started to show symptoms of the disease.

Being a progressive disease, meaning that the disease worsens over time, it causes the sufferer to experience memory loss, difficulties in thinking, problem solving, communicating or even reasoning with other people.

As the disease progresses, basic functions such as brushing teeth or having a shower become unfamiliar to the patient, they may even become aggressive due to the frustration of memory loss, or they may run away from home. Forgetting who they are or who a family member is, no matter how close they may have been to them, is one of the hardest and most common symptoms later on in the disease.

The condition normally requires a full-time carer for the patient as it can be draining for loved ones.

Life expectancy varies from one Alzheimer’s patient to another.  After diagnosis, the average lifespan is normally between eight and ten years, however, there have been cases where patients have lived for as little as three years, with others living up to 20 years, dependent on their health conditions.

The truth is, there is no cure for Alzheimer’s at this time, but there are treatments that can slow down the progression of the disease and help to improve the quality of life for the sufferer and their loved ones.

The following article takes a look at Alzheimer’s disease, it’s causes, treatments, risks and more. Please note that this article is intended to be used only as a guideline and not as a professional opinion. It is always best to consult with a doctor or health care professional for that. 

What is the cause of Alzheimer’s?

As Alzheimer’s disease develops, being a physical disease that affects the brain, protein structures build up in the brain that are referred to as ‘plaques’ and ‘tangles’ – these are types of abnormalities. These cause the nerve cells to lose connection to one another, hampering the transmission of signals around the brain, eventually leading to the death of the nerve cells and brain tissue being lost, as a result, the brain shrinks.

The exact cause of the disease is still unclear, however there are genetic, lifestyle and environmental factors that may contribute.

It is known, as stated above, that the basis of the disease is the destruction of the nerve cells in the brain leading to brain damage. The two types of abnormalities responsible for cell destruction in Alzheimer’s are explained below:

  • Plaques, called amyloid plaques, are groups of protein that disrupt the communication between the nerve cells of the brain. This disruption can lead to damage and eventually death of the brain cells.
  • Neurofibrillary tangles are abnormal threads of tau proteins that have collected in the brain cells of someone with Alzheimer’s. Tau proteins help to make up the structure of a microtubule within nerve cells, which transports various nutrients and chemicals from one part of the cell to another. In Alzheimer’s the abnormal tau proteins cause the microtubules to collapse, preventing these essential nutrients and chemicals from being carried through the brain.

Genetics is also known to play a role in the cause of Alzheimer’s. The apolipoprotein E gene (APOE), is known for playing a part in the late-onset of the disease. If you have the gene, it does not mean you will definitely develop Alzheimer’s, it is merely a factor that may increase your risk of doing so.

Another cause can be changes in certain genes, for example, people with Down Syndrome have an increased risk of developing Alzheimer’s in later life, which is thought to be the result of their extra copy of chromosome 21.

Health, environmental and lifestyle causes

This is another entity that is thought to play a role in the development of Alzheimer’s disease. This is seen in the cognitive deterioration of patients with vascular conditions such as strokes, heart disease, high blood pressure or metabolic conditions such as diabetes.

What are the symptoms of Alzheimer’s?

What are the early signs of Alzheimer’s?

The symptoms of Alzheimer’s are generally mild in the beginning and progress over time, however rapid progression can be lessened through early detection.

Alzheimer's Brain

Everyone who develops the disease has common symptoms, but, keep in mind that no one person is the same and a certain person or loved one may display unlikely or unusual symptoms given the health and history of the patient. If you or a loved one start to develop any of the early symptoms of Alzheimer’s, it is best that you consult with your doctor.

Early signs normally start with lapses in memory. The person may have a difficulty remembering something new or trying to remember recent occurrences. The part of the brain that is responsible for recalling day-to-day events is called the hippocampus, failing to recall recent events may be the result of damage to this area of the brain.  

In early stages of the disease, patients can still remember events that took place on a long-term basis, but battle with recent events.

Day-to-day memory loss can include:

  • Losing everyday items around the house such as keys
  • Having trouble to find the right word to say in conversation
  • Getting lost in familiar places
  • Forgetting recent events and conversations
  • Forgetting special dates or appointments
  • Irritability and anxiousness

It is important to note that some of the instances above like misplacing keys or grasping for a word in a conversation are often normal for healthy people when they occur as isolated events, and may often be symptomatic of stress and/or fatigue.  Lapses in memory, however, become of concern when they are regular, chronic occurrences that affect one’s life significantly.

Follow-on stages of Alzheimer’s

Alzheimer patients may go on to develop any of the following issues after they have already experienced the above memory loss symptoms:

  • Struggling to talk easily in conversation, losing their train of thought and word-usage.
  • Visuospatial issues resulting in having trouble seeing things in three dimensions, such as walking up or down stairs or navigating parking lots.
  • Having trouble in following a sequence of events such as playing a board game or cooking a meal.
  • Losing track of day-to-day activities or dates.
  • Withdrawing from loved ones and losing interest in activities and hobbies they once enjoyed.

More severe symptoms

These commonly occur in the final stages of Alzheimer’s. The disease has usually been diagnosed before these symptoms become prominent.

  • Loss of response in conversation, completely unaware of their surroundings.
  • Needing assistance in all daily activities, they may even lose their ability to swallow.

If you or your loved one starts to exhibit any of the above symptoms, it is best to seek help from a medical professional for an accurate diagnosis.

The typical progression of the disease is as follows:

  • Mild symptoms, early stage – two to four-years’ time frame.
  • Moderate symptoms, middle stage – two to 10 years’ time frame.
  • Severe symptoms, late stage – one to three years’ time frame.

How is Alzheimer’s diagnosed?

There is no specific way to diagnose the disease, typically, a series of tests are conducted by a doctor in order to make a judgement about the diagnosis of Alzheimer’s. Some of the tests may include:

  • Memory tests, problem solving, counting and language.
  • Testing the blood and urine so as to rule other conditions out.
  • CT (computerised tomography) scan, MRI (magnetic resonance imaging) or PET (positron emission tomography) scans – these help to rule out possible conditions such as a stroke, fluid build-up in the brain or a tumour. They may also be able to clarify the type of dementia the patient has. In early stages of Alzheimer’s, a brain scan (PET) may also be able to show the shrinking in the hippocampus and brain tissue surrounding it.
  • Neuropsychological testing is conducted, one such test is the SAGE memory test, this can be done at home. This stands for Self-Administered Geocognitive Examination. It is a 15-minute written exam detecting memory loss in four out of five people who take this test, should they suffer from it.
  • Questioning the patient and loved ones regarding behavioural changes, ability to complete everyday tasks and medical history.

Alzheimer’s treatment

The disease itself is complex, therefore there is not a specific type of medication that is prescribed for Alzheimer’s patients. The patient’s doctor will treat according to the progression and symptoms of the disease. The goal is to slow the progression of the condition. To date, there is no cure for Alzheimer’s.

Medication

The two types of medications used to treat mental functionalities are:

  • Cholinesterase inhibitors aid in communication of cells in the brain. The drugs in this category are used to help with depression and agitation which are common occurrences with the disease. Drugs include, donepezil (Aricept), rivastigmine and galantamine.
  • Memantine (Namenda) also assists in the communication between cells in the brain. It is used for moderate and severe cases of Alzheimer’s and can be used in conjunction with a cholinesterase inhibitor.

Some doctors may use a drug which is a combination of both cholinesterase inhibitors (dopanzil) and memantine called Namzaric, this helps to slow the progression of memory loss.

Anti-depressants may also be prescribed should the patient symptoms of depression.

Lifestyle

Lifestyle changes are important to adapt to when dealing with someone suffering from Alzheimer’s. These changes can help the patient not to suffer from anxiety in feeling as though they are overly forgetful or mentally challenged.

Making the home and other surroundings as accommodating as possible are the main changes to be made.

A few things that can be done to make this happen are:

  • Keeping common belongings in the same place.
  • Ensuring good traction on shoes to prevent slipping and falling.
  • Keeping meaningful belongings and photos in easily seen places as this provides a degree of familiarity for the patient in a seemingly unfamiliar world.
  • Keeping a mobile phone with a GPS in the patient’s pocket to find them if they wander from home and get lost.
  • Sticking to routine as strictly as possible.

Further lifestyle habits should be adopted if they haven’t been already. These include:

  • Regular walking and exercise
  • Healthy diet and eating plan
  • Lots of fluid to avoid constipation or dehydration

Elderly Women

What are the risk factors associated with Alzheimer’s?

As discussed, the biggest risk factor for Alzheimer’s is age, those being most at risk are over the age of 65 There are a variety of factors that may increase a person’s risk of developing the disease, these include:

Age

One in six people over the age of 80 years old have dementia, one of the main causes is Alzheimer’s. Above the age of 65 a person’s risk of developing the disease doubles every five years.

Genes

Scientists are investigating the finding that Alzheimer’s is passed down through generations, some families show clear signs of this whilst others do not. In families who have had Alzheimer’s, they tend to show clear signs of dementia well before the age of 65. However, inheriting the disease is not common.

As previously mentioned, Down Syndrome sufferers also have a higher risk of developing the condition. 

Lifestyle and health

There are a variety of medical conditions and lifestyle factors that are known to increase the risk of developing Alzheimer’s. These include:

  • Heart disease
  • Diabetes
  • High blood pressure
  • Poor diet
  • Smoking
  • Obesity

Keeping these under control will help to reduce the risk of Alzheimer’s or dementia, it is also important to get treated as early as possible.

People who follow a healthy lifestyle and diet, exercising regularly and eating a balanced diet tend to help lower the risk of development. Speak to your health care professional about healthy lifestyle changes. 

Gender

Twice as many women over the age of 65 have Alzheimer’s – the reasons are still unclear as to why. It is thought to be because women tend to live longer than men, it may also be that the disease is linked to the decline of the hormone oestrogen, which depletes after menopause.

The seven stages of Alzheimer’s and how to deal with them

The seven stages of Alzheimer's disease were developed by Doctor Barry Reisberg, a doctor from New York. The symptoms mentioned earlier give a brief outlook on the typical symptoms of Alzheimer’s, however, there are a series of stages that the patient typically follows as the disease progresses:

Stage One - No Impairment 

In the early stages of Alzheimer’s, it might be difficult to detect the symptoms of the disease, your doctor will conduct a PET scan if he/she suspects it. The scan will help to detect grey areas of low brain activity. The stages following on from here will start to affect reason and thinking more severely.

Stage Two - Very Mild Decline

Small changes such as recurrently misplacing objects or forgetting recent memories may start to develop in this stage. These changes may just be a result of stress and aging, but they could also be the early onset of Alzheimer’s. These include having less energy to do things, coordination issues, difficulty in following recipes or even playing a board game. 

Stage Three - Mild Decline

At this stage, changes to thinking and reasoning become prominent:

  • Forgetting what one has just read
  • Repeatedly asking the same question
  • Difficulty making plans and organising
  • Forgetting names of people one has just met

You can help a person affected by Alzheimer’s by organising their things for them, reminding them of everyday tasks and being patient when they ask the same question or get confused.

Stage Four - Moderate Decline

During this stage, the thinking and reasoning issues of stage three become more prominent and new issues start to emerge, such as:

  • Forgetting personal details about themselves
  • Having issues with numbers and dates
  • Having trouble cooking or even ordering from a menu

It is best to help an Alzheimer’s sufferer with everyday chores, ensuring he/she doesn’t hurt themselves and ensuring that someone is not financially taking advantage of their condition.

Stage Five - Moderately Severe Decline

The patient may have issues remembering where they are and what the time is. Other issues may arise such as forgetting where they went to school, their address or even phone number. They may have issues matching their outfits to the weather.

You can help them by laying their clothes out for them, and trying to help them in conversation to remember facts or names but do so gently and with patience to avoid embarrassing them and increasing their frustration and anger.  

Stage Six - Severe Decline

Mistaking someone for someone else is common during this stage, for example thinking that a sister is one’s mother. Delusions will start to set in, one might think they have to go to work even when they have retired.

The patient may need assistance in going to the bathroom as remembering how to execute everyday activities is often a struggle.

Conversation will be difficult at this stage, you can ty to connect through music and possibly looking through old photo albums as they may still be able to remember some things from their past.

Stage Seven - Very Severe Decline 

Basic abilities take a toll in this stage, such as walking, eating, sitting up and bathing. It may help to feed the patient with healthy smoothies and other soft foods, making sure they eat and drink according to a nutritional and balanced diet, your doctor or dietician may set one up for you. It is very important to ensure that they drink during this stage as they may forget or not be able to tell when they are thirsty which may result in dehydration.

Outlook

After being diagnosed with the condition, the best thing to do is to ensure that the patient follows treatment to slow down the progression of the symptoms. Being patient, supportive and understanding are keys factors in dealing with a person with Alzheimer’s as it will be a confusing and difficult time for them.

Some further questions you may have …

What is the difference between Alzheimer’s and Dementia?

Dementia refers to a set of symptoms that can include having troubles with thinking, memory loss, problem solving and issues with language. Therefore, dementia is not a disease, but a series of symptoms that lead to mental diseases. It is caused by the destruction and damage of brain cells. Alzheimer’s is the most common cause of dementia, being a disease that destroys the brain.

How do people die from Alzheimer’s?

Due to the fact that many Alzheimer’s patients develop the disease at an advanced age, many sufferers die from old age rather than the disease itself.

There are however a variety of complications that can be the result of Alzheimer’s, the most common being an intercurrent infection, such as aspiration pneumonia which is a cause of death in some patients. It is the result of advanced Alzheimer’s where the immune system has weakened and the patient may have difficulty with normal functions such as moving and eating. When food or liquid accidently go down the windpipe instead of the oesophagus, this can cause damage and infection to the lungs resulting in aspiration pneumonia.

What are the most important signs for early Alzheimer’s?

There are 10 important signs to detect the early onset of Alzheimer’s, these are:

  • Having trouble in completing everyday tasks at home, leisure or work.
  • Memory loss disrupting daily life.
  • Experiencing difficulty in problem solving and working with numbers.
  • Having trouble remembering where they are and what day it is.
  • Not being able to translate visual images and judging spatial objects.
  • Not being able to talk naturally in a conversation due to stopping and forgetting what they were saying or not being able to find the right word.
  • Forgetting where things were placed and not being able to retrace steps.
  • Poor judgment in decision making.
  • Isolating and withdrawing themselves from work and social gatherings.
  • Changing their moods and personality in becoming confused and possibly suspicious.

Is there a cure for Alzheimer’s?

There is no sure for Alzheimer’s. It is therefore important that early detection of the above symptoms is identified and treated in order to slow down the progression of the disease.

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