Alzheimer's Disease - Symptoms, Causes and Treatment
Alzheimer's disease is a degenerative and progressive disease that causes brain atrophy, leading to dementia in elderly patients.
We know that Alzheimer's disease attacks older patients preferentially, above 65 years, but their causes have not yet been elucidated. Currently, there is an association between genetic propensity and exposure to environmental factors not yet recognized.
Alzheimer's disease is a disease of slow and progressive evolution, which destroys important mental functions, leading the patient to dementia, a term used to indicate that the individual has lost his / her thinking, judgment and memory capacities, making him dependent on support in your daily activities. Alzheimer's disease is the most common cause of dementia, accounting for more than 60% of cases.
In Alzheimer's disease, neurons and their connections degenerate and die, causing brain atrophy and overall decline in mental function.
Although we have recognized several risk factors, the exact cause of Alzheimer's disease is still a mystery. It is believed that the accumulation in neurons of a protein called amyloid beta and another called tau is the factor responsible for triggering the disease. The reason why these substances accumulate in some people and not in others still needs to be elucidated.
Because there is no cure for Alzheimer's disease, early diagnosis is important to try to preserve the intellectual capacities to the maximum and to prolong the quality of life of the patient and his / her caregivers.
The greatest risk factor for Alzheimer's disease is old age. After age 65, the chance of developing Alzheimer's doubles every five years, causing 40% of people over age 85 to have the disease. Rarely, Alzheimer's disease occurs before 60 years of age.
Interestingly, patients who reached the age of 90 without signs of the disease have a low risk of developing it later.
In addition to age, another important risk factor is family history. People with first-degree relatives with Alzheimer's are at higher risk of having Alzheimer's disease, evidence of an important genetic load.
Alzheimer's disease is 2 times more common in blacks than in whites; are also more common in women than in men.
Some other factors also appear to increase the risks of developing Alzheimer's, including:
As Alzheimer's disease is the leading cause of dementia in the world, and dementia is the main clinical feature of Alzheimer's disease, it is worth spending a few lines explaining the concept of dementia.
Dementia is a syndrome, that is, a set of signs and symptoms related to the deterioration of the patient's intellectual abilities. In addition to Alzheimer's disease, dementia is also common in patients with multiple strokes, Parkinson's disease, chronic alcoholism, cranial trauma, vitamin deficiency, severe hypothyroidism, brain tumor, and some other neurological diseases.
The demential syndrome has three basic characteristics:
Memory changes.
Changes in intellectual capacity, including difficulties with logical reasoning, language, writing, thinking organization, interpretations of visual stimuli, planning and performing complex tasks, etc.
Behavior changes such as loss of inhibition, agitation and hallucinations, etc.
Dementia is a slowly progressive progressive syndrome that often goes unnoticed in the early stages. It is common for the elderly patient with dementia in the early stages to have their changes treated as "normal things of age".
It is important to note that minor forgetfulness is common and occurs with all people, especially in times of increased stress or fatigue. However, when memory lapses begin to occur frequently and are important, such as forgetting one's address, leaving home and losing oneself, forgetting the names of familiar people, etc., we should raise a warning signal. If along with frequent and progressive loss of memory for recent events, the elderly also exhibit changes in social behavior, such as apathy and tendency to isolate, as well as periods of confusion, such as storing salt in the refrigerator or the house keys in the closet of foods, dementia must be a hypothesis to be considered.
Forgetfulness of dementia is different from the common forgetfulness of everyday life. A person may forget about a scheduled meeting, but when someone tells you, she remembers to have her dialed. The Alzheimer's patient forgets the meeting and does not even remember to have it checked out, even if he sees it written with his handwriting on an agenda.
In the early stages of Alzheimer's disease, the patient himself can not recognize these neurological deficits, always arranging an excuse to justify these failures. As the patient is not aware of the disease, the family members often also take time to appreciate the changes. As dementia progresses, the family begins to notice that the signs and symptoms begin to become very evident and no longer fit into what people consider natural for age.
Patients with Alzheimer's disease in more advanced stages may be apathetic, depressed or aggressive, reads things and can not interpret them, is unable to make calculations, can not name objects and does not recognize familiar people. Over time, he becomes unable to perform basic tasks such as dressing and showering. The patient becomes disoriented in time and space, not knowing to indicate the current date nor to identify geographically where it is.
Loss of inhibitions is another common symptom of Alzheimer's. The patient can show his genitalia in public, accuse people of stealing his objects, swearing profanity or profanity indiscriminately, or insulting others for no apparent reason.
Alzheimer's disease is a disease that inexorably progresses. There are cases of Alzheimer's for more than two decades and cases of patients with rapid evolution in just two or three years.
It is often difficult to establish retrospectively a date for the onset of symptoms, which hinders the timing of disease progression. It is known, however, that once the diagnosis of Alzheimer's disease has been established, the patient's life expectancy is usually around three to eight years.
What leads the patient to death is not the disease itself, but its complications, such as accidents and falls with cranial trauma, difficulty in swallowing, which causes bronchoaspiration and malnutrition, and restriction to the bed, which favors the onset of infections and bedsores. The pneumonia and urinary tract infection are often the main types of infection of the patient with Alzheimer's.
The greater the care provided by the family, often with the help of nursing and physiotherapy, the higher the quality and the survival time of these patients.
The definitive diagnosis of Alzheimer's disease is made by biopsy of brain tissue, which, for obvious reasons, is rarely performed in clinical practice. In more than 90% of cases, the diagnosis is based on clinical data; blood tests and imaging tests help rule out other causes of dementia but do not make the diagnosis of Alzheimer's disease. Similarly, imaging tests such as MRI or CT scans of the skull also do not help close the diagnosis.
There are simple tests to document and monitor changes in patients' mental capacity. The most famous and used is the mini-mental, which is a questionnaire of 30 questions grouped into 10 sections, in which the following characteristics are evaluated:
Spatio-temporal orientation (ability to recognize where and when we are)
Ability of attention, concentration and memory
Ability to abstract and perform simple calculations
Language and visual-spatial perception
Ability to follow basic instructions
Criteria for the clinical diagnosis of Alzheimer's disease are:
Dementia attested by clinical examination and by standardized tests, such as mini-mental tests
Deficit in two or more cognitive areas (memory, language, reasoning, concentration, judgment, thought, etc.)
Progressive worsening of cognitive deficits
Beginning after 40 years and before 90 years
Absence of another neurological or systemic disease that causes cognitive deficits
The above criteria can correctly identify Alzheimer's disease in up to 90% of cases.
Biomarkers for Alzheimer's disease
Recently some biomarkers have been discovered that indicate the accumulation of beta-amyloid protein and tau protein in the nervous system of Alzheimer's patients. These markers can be identified by examination of the cerebrospinal fluid or by an imaging test called PET (Positron Emission Tomography).
The biomarkers are still under study and alone are not used to establish the diagnosis. Its presence in patients with a clinical picture suggestive of Alzheimer's, however, is another factor that speaks in favor of the diagnosis.
An important issue for family members or caregivers of Alzheimer's patients is to keep them away from unsafe acts and situations. As many people with dementia do not realize that their mental functioning is affected, they try to maintain their daily routines. Trivial situations for most of us can be very dangerous for patients with Alzheimer's disease, such as driving cars, cooking, walking alone on the street or going to the beach alone.
Falls are very common, so the home should be prepared so as not to create "traps" for the patient, such as floor wires, uneven floor, slippery floor, excess furniture along the way, etc.
Cigarette and alcohol should be avoided. Supervised physical activities should be encouraged.
b) Remedies for Alzheimer's disease
Although knowledge about Alzheimer's disease is rapidly evolving, there is currently no cure for it. There are, however, some medications that may help alleviate some of the symptoms of Alzheimer's disease.
Medications like Donepezil, Rivastigmine and Galantamine are called cholinesterase inhibitors and work by increasing the levels of a neurotransmitter called acetylcholine, which helps in communication between neurons. Unfortunately, not all patients show any improvement with these medications.
Memantine is a drug other than cholinesterase inhibitors. This drug is more effective and can protect the brain from damage caused by Alzheimer's, slowing the progression of the disease symptoms. It is sometimes used in combination with a cholinesterase inhibitor to optimize its effects.
It is important to have realistic expectations about the potential benefits of these medications. Neither of these remedies cure Alzheimer's disease or definitely prevent it from advancing. When drugs work, their great merit is to delay the course of the disease, prolonging the quality of life and cognitive abilities of the patient. However, sooner or later, the disease will cause severe dementia to the patient.
