What is Alzheimer's disease (AD). Know the Risk Factors and Stages.

INTRODUCTION:

Alzheimer's disease (AD) is a progressive degenerative disease that slowly and progressively destroys brain cells in all parts of the cortex of the brain.  It is neither infectious nor contagious, but is the single most common cause of dementia (the term used to describe a general decline in all areas of mental ability - symptoms involve a deterioration in cognitive processes - memory, language, thinking and so on – with important repercussions on behavior).  This condition affects about 10 per cent of those aged over 65 and about 20 per cent of those aged over 75.  The changes in the brain may begin to develop more than 20 years before symptoms develop.

RISK FACTORS:

  1. Although increasing age obviously plays a key role, it is not the cause - less than 1 person in 1000 under the age of 65 suffers from Alzheimer's, rising to about 1 person in 20 over 65 - most people over 80 stay mentally alert.
  2. Sex - Women seem to be more likely than are men to develop Alzheimer's disease, in part because they live longer.
  3. Family History and Genetic factors - Four genes have been identified so far that play a role in a proportion of cases.
  4. Trauma to the head has induced the disease. The risk appears to be greater if the person is over 50 at the time of the injury, has a specific gene (ApoE e4) and lost consciousness just after the injury.
  5. Down syndrome - Many people with Down syndrome develop Alzheimer's disease.
  6. Those with mild cognitive impairment (MCI) have an increased risk.
  7. Lifelong involvement in mentally and socially stimulating activities reduces the risk of Alzheimer's disease.
  8. Low education levels (less than a high school education) appear to be a risk factor for Alzheimer's disease.
  9. Lifestyle health (regular exercise; weight reduction; quitting smoking; controlling high blood pressure; reducing high blood cholesterol;  controlling type 2 diabetes; eating plenty of fruits and vegetables) reduces the risk of the disease.

STAGES OF ALZHEIMER'S:

Although the symptoms vary among individuals, there are 7 broad stages to the disease.

Stage 1:  No impairment

Alzheimer’s disease is not detectable and no memory problems or other symptoms of dementia are evident.

Stage 2:  Very mild decline

Minor memory problems exist, or the patient loses things around the house.  Memory tests are normal.  The disease is unlikely to be detected.

Stage 3:  Mild decline

Friends and family members begin to notice memory and cognitive problems.  The performance on memory and cognitive tests are affected.  Impaired cognitive function is detected.  Cannot find the right word during conversations or remember the names of new acquaintances; may also frequently lose personal possessions, including valuables, etc.

Stage 4:  Moderate decline

Clear cut symptoms of Alzheimer’s disease are apparent.  The patients have difficulty with simple arithmetic; may forget details about their life histories; have poor short term memory (may not recall what they ate for breakfast, for example; inability to manage finance and pay bills, etc.

Stage 5: Moderately severe decline

The patients need help with many day to day activities. There is significant confusion; inability to recall simple details about themselves such as their own phone number; difficulty dressing appropriately.  They typically can still bathe and toilet independently.  They also usually still know their family members and some detail about their personal histories, especially their childhood and youth.

Stage 6: Severe decline

The patients need constant supervision and frequently require professional care.  Symptoms include:  confusion or unawareness of environment and surroundings; major personality changes and potential behavior problems; the need for assistance with activities of daily living such as toileting and bathing; inability to recognize faces except  closest friends and relatives; inability to remember most details of personal history; loss of bowel and bladder control; and wandering.

Stage 7: Very severe decline

Because Alzheimer’s disease is a terminal illness, patients in this stage are nearing death.  The patients lose ability to respond to their environment or communicate.  While they may still be able to utter words and phrases, they have no insight into their condition and need assistance with all activities of daily living (ADLs).  In the final stages of the illness, patients may lose their ability to swallow.

DIAGNOSIS:

There is no single test that can definitively determine whether someone has Alzheimer's disease - as with many other medical conditions, diagnosis relies on a process of elimination.

The most important step in diagnosis is usually a discussion with the caretaker or the relative of the patient's symptoms and signs.

Tests of mental state can indicate decreased intellectual ability. 

Brain imaging - using computer tomography scanning or magnetic resonance imaging - can indicate a reduction in the size of the brain.

Yet the only way to diagnose Alzheimer's disease definitely is after death, as the hallmarks of the disease – plaques (these clumps of a protein called beta-amyloid may damage and destroy brain cells in several ways, including interfering with cell-to-cell communication) and tangles (threads of tau protein twist into abnormal tangles inside brain cells, leading to failure of the transport system) in the brain - can only be identified by autopsy.

TREATMENT:

There is no cure for Alzheimer’s disease.  Drug therapy aims to slow disease progression and treat symptoms associated with the disease. The benefit from drugs used to treat Alzheimer’s disease is typically small, so that the patients and their families may not notice any benefit.

The patients and their families need to discuss with their doctors whether drug therapy can help improve behavior or functional abilities. They also need to discuss whether or not drugs should be prescribed early in the course of the disease or delayed.

The following drugs are commonly prescribed for the treatment of Alzheimer’s disease:

  1. Donepezil (Aricept)
  2. Rivastigmine (Exelon)
  3. Galantamine (Razadyne)
  4. Memantine (Namenda)

Tags: Alzheimer’s , Disease , brain cells , brain cortex , dementia

 

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