Document 1439932

Alzheimer’s disease
Also called: SDAT, Senile Dementia Alzheimer’s
Alzheimer’s disease is a progressive neurological disease, and the
most common cause of dementia among aged people. Five percent
of people aged 65 to 74 and roughly 35 to 50 percent of people aged
over 85 have the disorder. Alzheimer’s disease is a progressive,
degenerative neurological disorder, meaning that the disorder gets
worse over time.
There is no cure for Alzheimer’s disease, although there are medications that can
be prescribed to ease or stabilize the symptoms.
Age is by far the most significant risk factor for Alzheimer’s disease.
Despite the high prevalence of Alzheimer’s disease among elderly
people, Alzheimer’s disease is not a normal part of aging.
Other risk factors include a family history of the disease and a history
of severe head trauma.
It little is understood about what causes Alzheimer’s disease and what
can be done to prevent or cure it. The best known aspects of the
disease are the symptoms of dementia it produces and the
characteristic changes seen in the brains of patients after death.
The symptoms of Alzheimer’s disease occur when neurons (nerve
cells) in the brain die or break connections with other neurons. Also,
people with Alzheimer’s disease have protein deposits in and around
the neurons called beta-amyloid plaques and neurofibrillary tangles, which
are thought to disrupt the function of the neurons. However, these
plaques and tangles can only be identified during an autopsy and their
role in the development of the disease or its symptoms is not
understood.
The signs and symptoms of Alzheimer’s disease are usually divided
into two categories:
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• cognitive (intellectual)
• Psychiatric.
Cognitive signs and symptoms of Alzheimer’s disease include:
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Loss of memory
Loss of language skills
Loss of motor function
Loss of ability to recognize familiar things
Psychiatric symptoms, which are not necessary for diagnosis of
Alzheimer’s disease, include:
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Personality changes
Depression
Hallucinations
Delusions
Alzheimer’s disease is usually diagnosed by a physician observing
patients’ symptoms and ruling out other possible causes of dementia.
In many cases, a mental status examination may be conducted. There
is no single diagnostic test for Alzheimer’s disease.
Alzheimer’s disease occurs when neurons in the brain die or break
their connections with other neurons. This occurs because people
with Alzheimer’s disease experience atrophy of a part of the brain
called the hippocampus.
The hippocampus produces a neurotransmitter called acetylcholine.
This chemical carries electrical signals from one neuron to another
and is essential for memory, judgment and learning.
In people with Alzheimer’s disease, the cells that produce
acetylcholine are damaged or killed and levels of the chemical
gradually decline in the brain. This means that the electrical signals
are not transmitted effectively from one neuron to another, causing
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the breakdown of neuron connections and the gradual atrophy of
other parts of the brain.
The symptoms of Alzheimer’s disease reflect where neuron
connections are broken. For example, memory loss, a common early
stage symptom, is caused by the disruption of neurons in the
temporal and parietal lobes, which are associated with memory.
Language problems, on the other hand, are thought to be caused by
the disruption of the large networks of neurons that are associated
with understanding and producing language.
People with Alzheimer’s disease also have abnormal lesions called
beta-amyloid plaques and neurofibrillary tangles. Beta-amyloid plaques are
sticky pieces of protein and other matter than surround the neurons.
Neurofibrillary tangles are twisted fibers also made from protein that
builds up inside the neurons. These plaques and tangles work
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together to disrupt brain function and are known to increase in
quantity as the Alzheimer’s disease progresses.
Certain factors of brain dysfunction in Alzheimer’s disease are
known, but much about the disease is unknown. The known factors
include the onset and progress of dementia in patients and the
presence of the plaques and tangles in their brains, which may be
detected at autopsy.
But specific causes remain unknown and the role of plaques and
tangles, as either cause or result, are not well understood. It is
thought that these amyloid plaques form very early in the disease
stage and set of a cascade of inflammation and cell death throughout
the affected portions of the brain. However, no one knows why the
amyloid plaques form. Similarly, very little is understood about the
tangles in the brain, or how they relate to the plaques.
The symptoms of Alzheimer’s disease usually begin to appear around
the age of 60. However, some people develop a condition called
early-onset Alzheimer’s disease as early as their 20s. Early-onset
Alzheimer’s disease is thought to be caused by a genetic disorder.
Alzheimer’s disease can progress slowly or rapidly, depending on the
individual. Patients generally live for an average of eight years after
they are diagnosed with Alzheimer’s disease, although they may live
for up to 20 years. During the final stages of the disease, most
patients require constant supervision and help performing basic selfcare tasks such as bathing and feeding.
Most people do not die as a direct result of Alzheimer’s disease.
Instead, people with Alzheimer’s disease are more likely to contract
other medical conditions that can be fatal.
Many people with Alzheimer’s disease die from aspiration pneumonia
(pneumonia caused by breathing in vomit or other fluids) because of
the reduced ability to swallow in the later stages of the disease. In
2004, the most recent year for which figures are available,
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Alzheimer’s disease was the fifth leading cause of death among
people over 65 and the seventh leading cause of death overall,
according to the Centers for Disease Control and Prevention (CDC).
Women are more commonly diagnosed with Alzheimer’s disease
than men.
Although Alzheimer's disease is the leading cause of dementia, other conditions
may cause dementia, including stroke, brain tumors and infections.
Stages of Alzheimer’s disease
Alzheimer’s disease is caused by the progressive destruction of
neurons in the brain. However, physicians may refer to ‘stages’ of
Alzheimer’s disease when diagnosing or monitoring the progress of
the disease in a patient.
These stages are commonly accepted patterns of progression that
physicians have witnessed in people with the disease. However, it is
important to remember that the stages are used as a rough
approximation of the progress of the disease and that different
staging frameworks may be used by different physicians.
An example of a staging framework may be:
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Early-stage Alzheimer’s disease. At this stage, the symptoms of
Alzheimer’s disease are mild and may include problems
remembering recent events and a tendency to be more
withdrawn than usual. These symptoms may be noticeable by
friends and family. At this stage, patients are usually able to live
independently and compensate for many of the symptoms they
may be experiencing.
Mid-stage Alzheimer’s disease. By this stage, the symptoms of
Alzheimer’s disease may become more pronounced and the
patient may require assistance with some activities of daily
living, such as dressing, eating and using the bathroom. Patients
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may be unable to remember essential information about
themselves such as their current address or telephone number.
They may also be confused about where they are and what day,
month or year it is. At this stage, patients may or may not have
a problem remembering their own name or the names of their
family members. The patient may begin to experience signs of
personality and behavioral changes.
• Late-stage Alzheimer’s disease. At this stage of the disease,
symptoms become severe and the patient usually requires
constant assistance for the majority of daily functions. Patients
may have lost the ability to use or understand language. They
may also be unable to recognize members of their family or
remember their own name. They may have lost many aspects of
motor function, requiring assistance to sit, walk and support
their head. Swallowing may become impaired, increasing the
risk of choking or developing pneumonia.
Risk factors and causes of Alzheimer’s disease
Although scientists are unsure of the initial cause of Alzheimer’s
disease, it is known that the symptoms of Alzheimer’s disease are
caused by the disconnection and death of neurons in the brain.
Based on what scientists understand about Alzheimer’s disease, the
following have been established as risk factors for the disease:
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Age. By far the greatest risk factor for developing Alzheimer’s
disease is age. The number of people with Alzheimer’s disease
doubles every five years after the age of 65, according to the
National Institute of Neurological Disorders and Stroke
(NINDS).
Family history. People who have a sibling or parent with
Alzheimer’s disease are more likely to develop the disease
themselves. This risk is greater if more than one member of the
family has been diagnosed with Alzheimer’s disease. Although
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the phenomenon is still being studied, it is thought to be related
to a slight variation in the genes of certain people that makes
them especially susceptible to the disease.
• Head injury. There is strong evidence that suggests that people
who sustain serious head injury are more likely to develop
Alzheimer’s disease later in life. However, this link has not been
firmly substantiated by medical research and is more commonly
linked to other forms of dementia.
•
Lifestyle factors. Although this is somewhat controversial, a
number of lifestyle factors might play a role in the development
of Alzheimer’s. These include
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Lack of exercise,
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Lack of access to a social network, and
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Lack of mentally stimulating activities.
For example, numerous studies have shown that people with
advanced degrees are less likely to develop Alzheimer’s,
possibly due to increased brain elasticity. In addition, there may
be a link between obesity and the metabolic syndrome and
Alzheimer’s disease.
• Environmental factors. There have been some reports linking
aluminum to an increased risk of developing Alzheimer’s
disease. Aluminum is a common element that is found naturally
in the environment as well as in various household products.
Although toxic levels of exposure to aluminum are known to
cause some neurological symptoms, the role of aluminum in the
development of Alzheimer’s disease is not fully understood.
Many experts believe that the risks associated with normal
aluminum exposure are low.
Signs and symptoms of Alzheimer’s disease
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Symptoms of Alzheimer’s disease usually begin to appear around the
age of 60. Alzheimer’s disease is primarily marked by the onset and
progression of dementia, a decline in mental function that may
interfere with the ability to perform daily functions.
Dementia involves both cognitive (intellectual) and psychiatric
symptoms. Cognitive symptoms of Alzheimer’s disease may include:
•
Memory loss. Memory can be categorized in two ways:
• Short-term memory
Short-term memory is the ability to remember events that
has occurred a short time ago or to recall things that were
recently learned (such as a person’s telephone number or
the name of a restaurant). Short-term memory is stored in
the temporal lobe in the brain. This is often the first part
of the brain to be affected by Alzheimer’s disease.
• Long-term memory.
Long-term memory is the ability to remember events that
happened in the distant past or recall things that were
learned earlier in life. Long-term memory is stored in
both the temporal and parietal lobes of the brain. It is
usually lost during later stages of the disease.
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Aphasia. Loss of the ability to use and understand language.
This is usually the result of neuron damage to the left side of
the brain, which is associated with language. People with
Alzheimer’s disease may forget words and have difficulty
communicating with others (extensive aphasia). They may also
have problems understanding spoken or written words (receptive
aphasia).
Agnosia. Loss of ability to recognize familiar people, places or
things. It is usually the result of neuron damage in the occipital
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or parietal lobes. Agnosia also involves an inability to interpret
signals from the body, such as when the bladder is full or pain
signals that imply serious conditions (e.g., chest pain).
•
Apraxia. An impaired ability to carry out motor activities, even
when motor functioning remains intact.
The psychiatric symptoms of dementia are most likely caused by
imbalances in brain chemistry and are often the most distressing for
the patient and the patient’s family and friends. Some people with
Alzheimer’s disease do not experience all or any of these symptoms.
Psychiatric symptoms may be treated using antipsychotic, anti-anxiety
or anti-depressant medication. They may include:
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Personality changes. This is often a marker of the early stages
of Alzheimer’s disease. Changes in personality may include
irritability, apathy and a tendency to withdraw from the
company of friends and relatives.
Depression. Most people with Alzheimer’s disease show some
signs of depression throughout the progression of the disease.
This may be mistaken as a reflection of recent events, especially
if the person has recently lost a loved one. The development of
depression is a risk factor for further psychiatric symptoms,
including hallucinations and delusions.
Hallucinations and delusions. These usually occur during the
middle stage of Alzheimer’s disease. Hallucinations may be
visual or aural and may be exacerbated by loss of hearing or
sight. Although people with Alzheimer’s disease may
sometimes be aware that the hallucination is false, in later stages
of the disease they may have a strongly held belief in things that
are not real. This is called delusion. A significant percentage of
Alzheimer’s patients suffer from paranoid delusions, in which
they imagine their home has been invaded, that personal items
have been stolen, or that loved ones have been replaced by
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impostors. These can be extremely upsetting to both caregivers and Alzheimer’s patients.
People with Alzheimer’s disease may also experience apraxia, which
is an inability to perform tasks on demand. This symptom occurs
when the neuron connections in the parietal lobe of the brain are
affected. The first element that is affected by Alzheimer’s disease is
usually complex motor skills such as those required to perform most
daily tasks (e.g., writing, brushing hair). Next, a person may be unable
to complete tasks that were learned during childhood, such as tying a
shoelace or brushing teeth. The last element of motor function to be
lost is instinctive motor function such as chewing, swallowing or
walking.
Certain symptoms of Alzheimer’s disease may be mistaken for the
changes in memory function and mild confusion that people may
experience as they get older. Older people occasionally misplace
items or forget the exact details of something that happened in the
past. These minor changes are different from Alzheimer’s disease
because Alzheimer’s disease progressively gets worse until the person
is unable to function without a permanent caregiver.
Diagnosis methods for Alzheimer’s disease
There is no definitive diagnostic test for Alzheimer’s disease and
diagnosis can often be delayed because the early symptoms (e.g.,
forgetfulness, mild confusion) may be similar to some of the signs of
normal aging. It may be especially difficult to obtain a diagnosis if the
patient is under 65 and experiencing early-onset Alzheimer’s disease
because early symptoms may be similar to those experienced by
people under extreme stress or people who are depressed.
An important aspect for physicians is to assess whether the
symptoms the patient is experiencing could be due to another cause,
such as vitamin deficiency, dehydration or a side effect of medication
the patient is taking. Patients may be referred to a neurologist,
psychiatrist or psychologist following the presentation of symptoms.
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If a physician suspects Alzheimer’s disease, diagnosis will begin with
a physical examination and a medical history. Patients or their
caregivers are encouraged to keep a log of symptoms to report to the
physician. A physician may also ask family members or close friends
about the nature of the patient’s symptoms. During the medical
history, the physician may ask questions related to the patient’s
dietary habits and use of alcohol and/or drugs in order to rule out
other potential causes of dementia. During the physical examination,
the physician may assess neurological function by testing the patient’s
reflexes, balance and coordination.
A physician may also use an electroencephalogram (EEG). An EEG
is a test in which electrodes are placed on a patient’s head and
information about the brain’s electrical activity is recorded as a series
of brain waves. This type of test can be used to rule out other causes
of dementia, such as infections or metabolic problems.
A physician may conduct a mental status examination to assess the
stage of dementia that a patient may have reached. During the exam,
the physician may ask the patient a variety of questions aimed at
testing the patient’s awareness of surroundings, problem solving skills
and memory skills. Examples of these questions may include:
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Situational questions such as “What year is it?” or “What is the
address of this office?”
Remembering and recalling a short list of items (e.g., a ball, a
pencil, a dog)
Counting backward or spelling a word backward
Naming familiar objects in the room as the physician points to
them
Following simple instructions or writing a simple sentence
This test can also be used after diagnosis to evaluate the progression
of Alzheimer’s disease in the patient.
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In diagnosing Alzheimer’s disease, a physician may also recommend
imaging tests, such as magnetic resonance imaging (MRI), computed
tomography (CT) and positron emission tomography (PET) scans.
Imaging tests can be used to identify other potential causes of
dementia such as tumors, evidence of strokes or damage from head
trauma. Imaging tests can also be used to measure the brain, which
shrinks over time in people with Alzheimer’s disease as parts of the
brain atrophy. However, imaging tests cannot identify the
microscopic ‘plaques’ and ‘tangles’ in the brain characteristic of
Alzheimer’s disease because of their small size.
In some cases, blood tests, urine tests and spinal taps may be
performed to rule out other conditions that may have symptoms
similar to Alzheimer’s disease.
Treatment options for Alzheimer's disease
At this time, there is no cure for Alzheimer’s disease, nor is there any
way of slowing the progress of the disease. However, there are
treatment options available that can minimize or stabilize patients’
symptoms, and in some cases delay the necessity of nursing home
care.
A physician may prescribe medication for cognitive symptoms (e.g.,
memory loss, loss of language function). Some Alzheimer’s
medications are designed to maintain the levels of a brain chemical
called acetylcholine.
Acetylcholine is a neurotransmitter, which means that it carries
electrical signals from one neuron to another. This chemical is
essential for memory, judgment and learning.
Medications that delay the breakdown of acetylcholine are called
cholinesterase inhibitors. These medications may not be as effective
among patients with advanced disease. Other Alzheimer’s
medications regulate the function of another neurotransmitter,
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glutamate, which is important for learning and memory. Studies have
shown that these two medications — the cholinesterase inhibitors
combined with glutamate receptor blockers — may be more effective
than either medication used alone with severe disease.
It is thought that Alzheimer’s disease may be caused or exacerbated
by the presence of free radicals, a type of molecule that can damage
cells and has been known to cause cancer and other medical
conditions. Some physicians might recommend vitamin E, an
antioxidant, used in combination with other antioxidants to reduce
oxidative damage to the brain.
Behavioral or psychiatric symptoms may first be treated with
methods other than medications. This usually includes identifying the
potential trigger for the symptoms and attempting to resolve it. Many
times this involves making adjustments to the environment that the
patient lives in, for example simplifying the environment or
increasing the time between stimulating events (e.g., bath-time,
getting dressed). A few studies have also examined the use of
aromatherapy to reduce agitation and dementia. Other possible
interventions include massage therapy, exercise, and even pet therapy.
In addition to non-drug methods, a physician may recommend
certain medications to control behavioral or psychiatric symptoms. It
is important that these medications be used with caution because
people with dementia are more likely to experience severe side effects
than most people. Medications that may be prescribed for patients
with behavioral or psychiatric symptoms include:
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Antidepressant medications to treat depression and low moods
Anti-anxiety medications to treat anxiety or verbally disruptive
behavior
Antipsychotic medication to treat hallucinations, delusions or
aggression
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•
Medications to treat sleep problems
In recent years, numerous complementary and alternative therapies
and supplements have been promoted for Alzheimer’s disease and its
symptoms. However, in most cases, these treatments have not been
studied in clinical trials and have not been approved by the Food and
Drug Administration (FDA) for use by Alzheimer’s patients.
Many alternative treatments are marketed as dietary supplements,
which only prove they are safe. They are not tested for effectiveness
in treating a disorder. Some alternative treatments include:
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Coenzyme Q10. Antioxidants that occur naturally in the body
and may help reduce the presence of free radicals.
Ginkgo balboa or Brahmi. An herb that is claimed by some to
improve memory. The National Center for Complementary and
Alternative Medicine (NCCAM) is conducting a long-term
study on the use of ginkgo balboa in healthy elderly people to
prevent the onset of dementia. Ayurveda has been using
Brahmi for thousands of years for mental improvement.
Huperzine A. An herbal supplement that may function in a
similar way as cholinesterase inhibitors.
Phosphatidylserine. A type of lipid (fat) that may protect nerve
cells from degenerating.
Omega-3 fatty acids. These fatty acids are already known to be
protective of the heart, and populations that consume large
amounts of omega-3 fatty acids such as those found in fish oil
appear to have a reduced incidence of Alzheimer’s disease.
However, clinical trials have not shown any affect on the
course of the disease once symptoms have begun to show.
Rather, it appears that omega-3 fatty acids might have a
protective, long-term effect.
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It is important to discuss the use of alternative treatment methods
with a physician before they are started. Some alternative remedies
could interact with prescribed medication or lead to more serious
health complaints.
Prevention methods for Alzheimer's disease
There is much that is unknown about Alzheimer’s disease, including
the cause or causes and how to slow or stop its progress. Because of
this, Alzheimer’s disease is a difficult disease to prevent.
There is some evidence that indicates that people who sustain severe
head injuries are more likely to develop Alzheimer’s disease later in
life. For this reason, it is important to always wear a seatbelt while
traveling in a car and to wear protective headgear while operating a
motorcycle or bicycle, or while playing contact sports.
Other studies have shown that oxidative stress, the process of cell
damage by free radicals, contributes to the risk of developing
Alzheimer’s disease.
Oxidative stress can be prevented by consuming foods that are high
in antioxidants, such as olive oil, fish and fresh fruit and vegetables. It
can also be prevented by taking supplements of vitamin A, C and E,
although a physician should always be consulted before starting any
supplements.
It is also becoming clear that maintaining brain health by remaining
physically and mentally active throughout life, especially in later life,
is important. This includes controlling weight, blood pressure and
cholesterol levels. It is not known whether physical and mental
activity directly reduce the risk of developing Alzheimer’s disease, but
scientists agree that it appears reasonable that keeping the body and
mind healthy is beneficial on many levels.
Lifestyle considerations for Alzheimer’s disease
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Alzheimer’s disease can be overwhelming for both the patient and
the patient’s loved ones. In the early stages of Alzheimer’s disease,
patients and their loved ones may become frustrated with memory
loss or the inability to complete simple tasks. This may result in
depression or anger. As the disease progresses, patients usually
experience more substantial dementia that may affect their ability to
perform self-care tasks such as bathing and dressing and may require
professional care in a nursing home.
Alzheimer’s disease also presents certain safety issues. For example,
people with Alzheimer’s disease are more likely to be injured around
the home. Injuries may be caused by falls that occur when the parts
of the brain responsible for balance and coordination are affected.
Additionally, the memory loss that is associated with Alzheimer’s
disease may make it unsafe for patients to cook (especially over a
direct heat source), drive and otherwise live independently. It may be
necessary to take certain safety precautions in the home, such as
installing railings around the bath or shower and setting the water
temperature to a lower level to avoid scalding.
Family support is an essential aspect of Alzheimer’s care and
treatment. It is important that loved ones understand the patient’s
limitations and adjust their behavior and communication strategies
accordingly.
As the disease progresses, patients may exhibit strange behavior such
as aggression or forgetting the names of immediate relatives. This can
be a traumatic experience for close friends and family. In some cases,
individual or group therapy is beneficial for those coping with the
consequences of Alzheimer’s disease in a close friend or family
member.
Ongoing research for Alzheimer’s disease
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There are many avenues of continuing research for Alzheimer’s
disease, only some of which are progressing through medical clinical
trials. Some areas of research include:
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Genetics. Scientists believe that they may have discovered genes
linked to the development of Alzheimer’s disease. The genes,
ApoE4 and SORL1, appear to be more common in people with
Alzheimer’s disease. However, not all people with the gene
develop Alzheimer’s disease and some people without the gene
may also develop the disease. Therefore, it is thought that these
genes may make carriers more susceptible to Alzheimer’s
disease, although other factors may also be involved in its
development.
Inflammation. Some studies have indicated that inflammation
around the brain may contribute to the progression of
Alzheimer’s disease. This has lead to the belief that medications
such as nonsteroidal anti-inflammatory drugs may be beneficial
as both a preventive measure and as a means of slowing disease
progression. However, clinical trials have shown negative
results. Moreover, some types of NSAIDs such as aspirin or
ibuprofen may interact poorly with Alzheimer’s medications.
Chemicals called cytokines are produced during inflammation
and may be detectable in blood tests to make it possible to
diagnose Alzheimer’s disease earlier.
Antibiotics. A few studies have found the presence of bacteria
including Chlamydophila in the brains of Alzheimer’s patients,
and lab studies have shown that some antibiotics can interfere
with the accumulation of dangerous proteins in the brain.
However, more study is needed before antibiotics become part
of standard Alzheimer’s care.
Vaccine. Although there is no cure for Alzheimer’s disease,
scientists have been working on various types of vaccines that
may be able to prevent the development of the plaques and
tangles that seem to be closely connected with Alzheimer’s
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disease. One attempt was the AN-1792 vaccine, which was
designed to enable the immune system to recognize and attack
amyloid plaques. However, despite promising results, clinical
trials of the vaccine were stopped when it was discovered that
the vaccine may have contributed to inflammation of the brain
and spinal cord experienced by some of the participants.
•
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Estrogen. Some studies have indicated that estrogen may be
linked to the development of Alzheimer’s disease, although the
precise relationship is unknown. It appears that estrogen used
by menopausal women may protect the brain and slow the
progression of Alzheimer’s disease. However, in clinical trials,
this link was not confirmed and evidence showed that the use
of estrogen with progestin (a common combination in the
contraceptive pill) may increase the risk of developing
Alzheimer’s disease. In addition, use of hormone replacement
therapy has been linked to increased risks of breast cancer in
women.
Testosterone. Older men with lower testosterone levels appear to
be a greater risk of developing Alzheimer’s disease or cognitive
impairment. Only a few studies have been conducted so far on
the value of testosterone supplementation among older men to
enhance cognitive function. Results have been mixed.
Insulin. One early study showed that insulin therapy reduced the
level of beta amyloid protein in the blood (the protein that
causes the plaques associated with Alzheimer’s disease). It
appears that insulin is somehow related to the protein’s
metabolism, and that people with higher levels of insulin have
fewer symptoms of dementia.
Scientists are working on a number of ways to confidently detect and
thus treat Alzheimer’s disease earlier than what is currently possible.
Methods under investigation include blood tests, modified imaging
tests, genetic tests and improved risk factor calculations.
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