Alzheimer's erases a lifetime of memories
Alzheimer's disease is a progressive brain disorder that causes a gradual deterioration of the ability to reason, remember, imagine, and learn. Alzheimer's disease is distinguished from the mild forgetfulness, known as benign senescent forgetfulness, normally observed in older people. Over the course of the disease, victims may become unable to recognize themselves or much about the world around them. Depression, anxiety, and paranoia often accompany these symptoms. Although it cannot be cured, there are a number of new palliative treatments that help ameliorate Alzheimer's symptoms and slow its progression.
Alzheimer's disease is a degenerative neurological condition, and the most common form of dementia. It is characterized by "senile plaques" made of abnormal proteins and irregular tangles of abnormal brain cells. For reasons not well understood these neurofibrillary tangles and plaques take over healthy brain tissue, resulting in massive loss of function in the areas of the brain associated with intellectual function (thinking, reasoning, remembering, imagining, and learning).
While Alzheimer's disease usually affects those over age 65, a rare and rapidly progressive form of Alzheimer's can occur in some people in their 40s and 50s. Alzheimer's disease progresses slowly, taking between 3 to 18 years to advance from the earliest symptoms to death. The average duration of the disease is 8 years. Death results not from the disease itself but from some secondary illness such as pneumonia, urinary tract infection, or infected decubitus ulcers. At present, treatment of Alzheimer's disease focuses on slowing the progression of the disease and coping with its symptoms.
How Common Is Alzheimer's?
At the present time, over four million people are living with Alzheimer's disease. It is the most common form of dementia, and is the fourth leading cause of death in the United States. Experts predict that as baby boomers age, Alzheimer's may affect as many as 14 million people. Alzheimer's is widespread, affecting 5% or more of those over age 70 and up to 20% of those over age 80. Slightly more women than men have Alzheimer's disease. Its increasing prevalence has led epidemiologists to call Alzheimer's "the disease of the century."
Goals of Treatment
Treatment for Alzheimer's disease focuses on preserving an overall quality of life as long as possible. Treatment is limited to relief of some of the more adverse symptoms of the illness.
Medications can help improve alertness, clarity and memory, and regulate mood and behavioral disturbances.
Since there are so few clinical treatments for Alzheimer's disease, much of the available therapies attempt to improve the quality of patients' lives, keep them safe, and make caring for them easier. The primary care doctor will closely monitor the progress of the patient to check for medical complications, adjust medications to achieve the lowest effective dosage and assess any changes in drugs used. The doctor may do mental status tests routinely to chart the course of the illness. Support for the main caregiver is also a concern, and the doctor will help determine at what point the person with Alzheimer's disease may need professional nursing care outside the home.
|Drugs most commonly prescribed|
Antidepressants may be appropriate if depression is a problem. Antipsychotic drugs are used only if absolutely necessary, and sedative drugs are avoided.
Activity & Diet Recommendations
Physical activity should be continued as long as possible, both to prevent muscle atrophy and to stave off complications. Exercise also promotes a normal day and night routine, and may help to boost mood. Repetitive exercise such as walking, indoor bicycling or folding laundry may decrease patients' anxiety because they don't need to make a decision about what to do next.
In early stages, memory aids such as notebooks and posted daily reminders are helpful. Calm and repetitive reassurance is important. As the disease progresses, activities will need to be increasingly supervised. People with Alzheimer's disease must eventually stop driving, sometimes against their will. Loss of independence and the changes made to their daily routine may worsen their confusion and agitation.
No special diet is required, just well-balanced meals with adequate fiber. If the person with Alzheimer's disease is hyperactive, stimulants such as coffee, tea, cola, and chocolate should be avoided. Limiting the number of foods served to an Alzheimer's patient at any one time may reduce anxiety over decision making.
Some complications are also symptoms of the illness, ranging from agitation and belligerence to hostility and even violence. Complications such as increased disorientation after sundown and wandering may be observed. Falls may cause bruises and broken bones. Medical complications include drug toxicity. Malnutrition and dehydration may result from absentminded dietary patterns. In the early stages depression can manifest itself, possibly leading to suicidal tendencies. In the late, bedridden stage there is risk of pressure sores, contractures, pneumonia, and urinary tract infection.
Quality of Life
In the early and middle stages of Alzheimer's disease, victims may be painfully aware of their intellectual failings and what is yet to come. At this stage and throughout the course of the illness, it is vitally important to attend to victims' mental well-being with the help of their doctor, social worker, or psychological counselor.
The longer people with Alzheimer's can remain independent, the better, as long as they're safe. Maintaining a routine and keeping it simple will help the patient feel less stress about making decisions.
Self care & Prevention
Screening for Alzheimer's Disease
Family members who want to learn about their chances of getting Alzheimer's should consult their doctors. Genetic screening for the presence of the E4 allele of apolipoprotein E gene and other genetic traits may indicate a greater chance of the disease. Those who carry the allele may be at a greater risk to be diagnosed with Alzheimer's.
Self-Care Measures for Caregivers
Avoiding environmental and lifestyle triggers can help decrease the occurrence of seizures. Alcohol and drugs should be eliminated as they can effect medication and cause seizures. Vigorously treat infections anywhere in your body. Eat a consistent, healthy diet with regularly scheduled meals. In addition, the following tactics may help:
Alzheimer's affects not only the person with the disease, but their loved ones and caretakers. As the disease progresses, demands on family members will increase. Because caring for a person with Alzheimer's disease is so difficult, the well-being of the caregiver also needs much attention to make sure he or she has adequate help and support. The strategies below can help you and your loved ones cope with the changes to come.
- Don't expect to be perfect you won't be. Caring for a loved one with Alzheimer's is one of the hardest things you can do. Every caregiver makes mistakes. Forgive yourself.
- Get help. Recruit family members to help with caregiving. Consider hiring a house cleaner and a yard person to free you from those tasks. If possible, hire neighborhood teens or adults so they can get to know your loved one.
- Take time off. Caring for a loved one with Alzheimer's can be overwhelming. You can't do a good job unless you get your emotional batteries recharged regularly. Be sure to preserve some social activities, and work to maintain friendships and interests outside of caregiving. Get someone else to look after the person at least one night a week, preferably more.
- Get regular exercise. It will elevate your mood, give you energy, and relieve some of the stress of caregiving. Try taking a 40-minute walk every day ideally with the Alzheimer's patient.
- Join a support group. Your friends and relatives may not be able to fully understand what you're going through, but anyone caring for an Alzheimer's person will. Support groups help solve caregiving problems, point the way to good resources, and provide tremendous emotional support. To find one near you, contact your local Alzheimer's Association office or the national office in Chicago (www.alz.org).
- Personal counseling can help you deal with the feelings of loss you may experience as the person's condition progresses.
Last updated 23 May 2012
Despite extensive research, scientists do not yet know what causes the brain abnormalities that result in Alzheimer's disease. However, recent studies have revealed abnormal deposits of amyloid protein in the affected areas of the brain. Currently, scientists are trying to determine whether the deposits might be the result of an infection, a genetic trait, or an environmental toxin.
Other inquiries into the cause of Alzheimer's disease include the study of the following:
- The marked deficiency of the nerve transmitter acetylcholine in the brains of Alzheimer's victims
- Genetic basis of Alzheimer's disease
- Virus infection
- Accelerated aging
- Auto-immune attack
- Hormonal factors, especially that of estrogen
Much attention has been given to the notion that aluminum deposits in brain tissue may be a cause of Alzheimer's disease, but there is no scientific consensus to support such thinking.
The following factors are known to increase risk of Alzheimer's disease:
- Increasing age
- Family history
- Head trauma
- Down's syndrome
- Markers on chromosomes 1, 12, 14, 19, and 21
- Apolipoprotein E-4 gene on chromosome 19
Possible risk factors include:
- Personal history of heart disease, stroke, or high blood pressure
- Nutritional deficiency of antioxidants
- Little use of non-steroidal anti-inflammatory drugs (NSAIDs)
Symptoms & Diagnosis
Alzheimer's disease is usually marked by four fairly distinct stages. The symptoms depend upon the stage of the disease as follows:
- Simple forgetfulness. At its onset, Alzheimer's disease is characterized by simple forgetfulness, especially of recent events or directions to familiar places. Subjects may constantly misplace everyday objects, such as keys or glasses. This may be accompanied by personality changes such as poor impulse control and judgement, distrust, increased rigidity of views or belief, and restlessness. An increasingly narrow range of interests and a "flat" change of moods in response to situations are manifest. Such benign symptoms then progress to persistent confusion.
- Confusion. This second stage of the disease is marked by an increased difficulty in doing things that require planning, decision-making, and judgment such as might be encountered at work, in reconciling a checkbook, or driving a car. Everyday skills such as personal grooming are unaffected, but social withdrawal begins.
- Incompetence. Eventually, the people with Alzheimer's disease will be unable to accomplish the simple tasks of daily living such as eating, bathing, and using the toilet. There can be a lack of interest in personal hygiene and appearance, and a loss of usual sexual inhibitions. They may have difficulty recognizing all but their closest daily companions. In fact, a common symptom at this stage is "pseudohallucination, " in which victims mistake their own mirror images for a stranger. People with Alzheimer's may become frightened, reporting that there are "strange people in the house. " Communication of all kinds becomes difficult as written and spoken language ability declines. Withdrawal from family members begins and the patient may become agitated, displaying belligerence and a denial of the illness. Other symptoms include purposeless, repetitive activities, and nighttime awakening, pacing, and wandering.
- Complete deterioration. In the last stages of the disease, Alzheimer's victims will become bedridden, unable to recognize themselves or their closest family members. They may make small, purposeless movements and communicate only by screaming out occasionally. Essentially, the brain forgets how to live. Death often results from pneumonia and from complications of immobility.
Conditions That May Be Mistaken for Alzheimer's
Alzheimer's disease is one kind of progressive dementia, but it must be distinguished from other forms. Dementia is a sustained, severe decline in intellectual function. Since some types of dementia are treatable, an accurate diagnosis is critical. Other causes of progressive dementia include:
- Multiple strokes
- Communicating hydrocephalus
- Head trauma
- Alcoholic dementia
- Huntington's disease
- Tumors and masses
- Vitamin B-12 deficiency
- Thyroid disease
Pseudodementia refers to conditions that are reversible, such as dementia arising from drug interactions or depression. Drugs that can cause delirium include antidepressants, antipsychotics, antianxiety drugs, and sedatives.
How Alzheimer's Is Diagnosed
There is no diagnostic test for Alzheimer's disease. Diagnosis is protracted and difficult because it is based on the observations of the diagnostic medical team after ruling out other causes of dementia. Along with the many specific laboratories and imaging tests mentioned in this section, the patient's doctor will also do a complete physical exam and take a family history.
There are no lab studies that definitively diagnose Alzheimer's disease. Since it is critical to rule out other diseases that resemble Alzheimer's, many studies are used to exclude underlying conditions. Examples include:
- CBC (complete blood count)
- Thyroid function tests
- Folate and B-12 level tests
- Liver and renal panel studies
- HIV and syphilis tests
- Chemistry panel
Other tests may be done, mainly to exclude other possibilities:
- Cerebrospinal fluid analysis
- Neuropsychological testing
Some sophisticated imaging procedures may be used for diagnosis, including:
- Computed tomography (CT scan)
- Magnetic resonance imaging (MRI)
- Positron emission tomography (PET)
- Single photon emission computed tomography (SPECT)