Alzheimer's is a progressive, neurodegenerative disease of the brain. It may develop slowly but affects memory and other cognitive skills irreversibly. Individuals with Alzheimer's have an impaired thinking capacity that day after day interferes with their daily life. Even the simplest tasks become difficult to perform, making these people dependent on others and their help. Scientists argue whether the disease is a type of dementia or a cause of it. It can be of early-onset or late-onset. The latter becomes symptomatic in the mid-sixties. If Alzheimer's is a cause of dementia, then it is the commonest one. The most significant risk factor of the disease is aging. Statistics suggest that an estimated 5.5 million people older than sixty-five years old live with Alzheimer's in the US. Current population trends and the general increase in life expectancy predicts a higher prevalence of the disease in the future unless treatment is available. Dr Alois Alzheimer was the first one to notice and study the disease.
Types of Dementia
As previously mentioned, scientists have not concluded yet whether Alzheimer's is a type of dementia or a factor leading to it. If we assume that dementia is a spectrum of disorders, then Alzheimer's is a type of it. Therefore, the following are the most well-known types of dementia:
- Mild cognitive impairment (MCI)
- Creutzfeldt-Jakob disease (CJD)
- Dementia with Lewy bodies (DLB)
- Vascular dementia
- Alcohol-related brain damage (ARBD)
- Young-onset dementia
- Frontotemporal dementia (FTD)
- HIV-related cognitive impairment
MCI might be an early indication of Alzheimer's. However, not everyone with MCI progresses into typical Alzheimer's. Some types of dementia have an apparent cause, such as ARBD and HIV-related cognitive impairment. Other examples have an unknown etiology. Vascular dementia is the result of a cerebrovascular accident, also called a stroke. Strokes may not only affect mobility but cognitive abilities, as well. Other dementias may profoundly affect the personality of an individual, as is the case with FTD, also called Pick's disease. Dementias present high variability regarding their clinical course and manifestations. Concerning Alzheimer's, we can classify the disease according to its severity, the onset timing, and the inflammatory response.
Pathophysiology of Alzheimer's disease
What happens in the brain of a person with Alzheimer's?
Healthy aging leads to the physiological loss of some neurons. Also, the brain shrinks to some degree, in people who get older. However, people with Alzheimer's disease experience a progressive loss of neurons. The widespread damage not only happens irreversibly, but it takes place in areas of the brain correlated with memory. Some neurons lose connection with others leading to an impaired and non-functional network. Although the damage is initially limited to the memory areas, it then involves parts of the brain that have to do with thinking, reasoning, and correctly using the language. Responsible for all these changes are two entities, the amyloid plaques, and neurofibrillary, or tau, tangles. Finally, the disease leaves the person unable to communicate or live independently. The final stage of the disease is usually fatal.
Classification based on the severity
The severity of Alzheimer's has to do with the intensity of its symptoms. A mild disease usually passes unnoticed. The individual starts forgetting things regarding their daily routine, such as paying the bills. These memory deficits form a pattern which the individual can initially handle, but with difficulties. Simple routine tasks become more and more challenging to perform, and they take more time than they used to. However, the patients fail to accept or notice the signs by trying to preserve their daily routines. Moderate Alzheimer's presents with more intense symptomatology. Patients forget a lot and find themselves confused. They are highly dependent on the others and find it hard to preserve their daily routine. Severe Alzheimer's leaves the person unable to communicate, think, or even walk. Patients with such an advanced stage are usually bedridden and have a decreased life expectancy.
Classification based on onset
We can classify Alzheimer's according to its onset or trigger type. The early-onset disease is rare and affects people younger than sixty-five years old. About only 5% of all individuals with Alzheimer's have an early-onset subtype. Scientists have correlated it with a defect in chromosome 14. The clinical manifestations usually commence between forty and fifty years old. Late-onset Alzheimer's is the most common subtype. It affects people older than sixty-five years old, but no genetic correlation exists at the moment. Familial Alzheimer's disease (FAD) is another very rare phenotype that accounts for about 1% of all cases. There are specific genotypic criteria to establish such a diagnosis.
Classification based on inflammatory response
The deposits of amyloid plaques and neurofibrillary, or tau, tangles in the brain of an individual with Alzheimer's disease allows us to classify the disease according to the inflammatory response. In some people, the disease presents with high serum albumin to globulin ratio and high levels of C-reactive protein. These markers of inflammation classify this subtype as the inflammatory one. The non-inflammatory type does not cause any elevations in these markers but affects other functions of the body. Finally, a widespread deficiency of zinc in the brain leads to the cortical subcategory of Alzheimer's disease. All these types cause abnormalities in the brain functioning and behavioural patterns of people with Alzheimer's disease. It is essential to know which subtype is responsible for the occurrence of the disease as treatment methods may vary.
Causes and risk factors of Alzheimer's disease
Triad of risk of Alzheimer's disease
Scientists don't know the exact cause of Alzheimer's disease. However, some risk factors increase an individual's chance of developing the disease. The most well-established risk factors for Alzheimer's disease are the following:
- Apolipoprotein E ε4 (APOE)
Getting old comes with losing cells, some of which are neurons. Alzheimer's disease is more common in people older than sixty-five years old. APOE-ε4 genotype also increases the likelihood of having the disease in the future. Finally, women have more chances of presenting with the condition than men. Other risk factors are some of the following:
- Physical inactivity
- Low educational levels
- Head injuries
- Familial Alzheimer’s disease
Symptoms and signs of Alzheimer's disease
One of the earliest and most common symptoms of Alzheimer's disease is memory loss. It starts by forgetting recent information, such as an appointment, or by asking the same question more than once. People with memory loss try to develop mechanisms to remember through memory aids, such as reminder notes. Others rely on a family member not to forget important information. Memory loss disrupts daily life and makes the individual dependent on others. However, physiological aging also leads to memory deficits. The difference is that people who usually forget because they are old, eventually recall the forgotten information.
Familiar tasks, dissociation, and visual problems
Another characteristic of Alzheimer's disease is the difficulty to complete familiar tasks, such as driving or going shopping. Dissociation regarding time and place also occurs. Individuals with the condition usually lose track of time and find it hard to remember how they ended up in a specific area. Also, people with Alzheimer's may have visual problems, making it hard to read. This sign, in conjunction with spatial relationships misinterpretation, leads to difficulties understanding or estimating distance.
Poor vocabulary, misplacement of things, and impaired decision-making
Vocabulary and speech difficulties are also common. People with Alzheimer's disease find it hard to follow a conversation. Sometimes, they interrupt you to ask the same question, or they repeat themselves. Other times they might ignore the theme of the conversation. Also, patients misplace things and put them in unusual places. For example, they might put the toothbrush in the fridge. Then, they find it hard to recall where they placed the missing object. Their judgment and decision-making capacity are also impaired. As a result, they might find it hard to keep themselves clean.
Mood and personality changes
Finally, patients with Alzheimer's disease, isolate themselves from social activities or hobbies they used to do, because of their inability to follow a conversation. All these symptoms and signs lead to mood and personality changes. Consequently, individuals with the disease may be suspicious, anxious, and with profound confusion and depressive signs.
The diagnosis of Alzheimer's disease is a procedure that has multiple steps. There is no single intervention that can diagnose the condition. Physicians usually use many approaches and collaborate with different medical specialities. History taking is the first step to diagnose the disease and aims to collect information regarding the individual's current and past medical conditions. It also includes a psychiatric history. The physical examination is a routine one, to search for other diseases that could be responsible for the symptoms and signs of Alzheimer's. It involves hearing the lungs and heart and measuring various parameters such as blood pressure.
A neurological exam might also be necessary. The neurologist will assess the reflexes, speech, and sensation, along with muscle tone and coordination. An eye exam is also necessary. Potentially, the physician may request some neurological imaging tests.
To asses an individual's mental function, your doctor will evaluate your thinking skills, such as memory and problem-solving capacity. The two most widely-used methods are the Mini-Mental State Exam (MMSE) and the Mini-Cog test. These interventions will show whether the individual is aware of the symptoms, has a sense of time and space, can perform simple calculations, and can remember some words sequences.
Mini-Mental State Exam (MMSE) and Mini-Cog tests assessments
MMSE is an assessment test that evaluates a person's cognitive skills. It includes simple questions about simple tasks and daily mental skills. The maximum score is thirty points. Less than twelve points indicate a severe stage of the disease. Moderate dementia is between thirteen and twenty points and mild one between twenty and twenty-four. MMSE is an initial test that shows if a person needs further evaluation. During the Mini-Cog test assessment, the individual has to remember three words and their sequence and recall it when the doctor asks them to. Afterward, he or she has to draw a clock pointing in an hour that the examiner indicates.
Except for the MMSE and Mini-Cog test, patients might require a mood assessment, as well. Some disorders, such as depression, have symptoms that might overlap with those of dementia. People with depression have low energy, decreased interest in life, and other cognitive disturbances that may mimic Alzheimer's disease and other forms of dementia.
Researchers identified some genes that called them deterministic, regarding Alzheimer's disease and the chance of its occurrence. Except for that, other well-established risk factors increase a person's chances of developing the disease. For example, APOE-e4 mutations lead to risk genes, whereas deterministic genes are those that cause Alzheimer's disease (ADAD) or familial Alzheimer's.
Brain imaging helps doctors, and especially neurologists, identify structural changes in the brain of those assessed for Alzheimer's disease. Magnetic resonance imaging (MRI) and computed tomography (CT) are the most widely-used methods of imaging. Another reason why you may need to undergo such a test is to exclude other possible causes of your symptoms, such as brain tumours or cerebral edema. Doctors may also visualize the amount of beta-amyloid in your brain.
Can you treat Alzheimer's disease?
Current therapeutic interventions regarding Alzheimer's disease focus on minimising its symptoms and signs and slow down the progression of the disease. Most commonly, pharmacological therapies treat cognitive symptoms. Two well-known drugs used to control Alzheimer's disease are cholinesterase inhibitors and memantine. The former class of drugs also targets the neuropsychiatric symptoms. Memantine can work alone or in combination with cholinesterase inhibitors. They both may have side effects that may interfere with the person's daily life.
Herbal remedies and various vitamins may also slow down the progression of Alzheimer's disease. Examples of such substances include the following:
- Omega-3 fatty acids
- Vitamin E
A strongly correlated intervention against Alzheimer's disease and its progression is regular exercise. People with a family history of the disease or with risk factors for it should exercise regularly and eat a healthy diet. Another very significant factor in the life of a person with Alzheimer's disease is social interaction. Having hobbies and practicing activities with others could help individuals with the disease integrate themselves again back in society and fight against Alzheimer's signs.
Another essential approach to Alzheimer's disease is creating a supportive environment. Keep in mind that patients with dementia can occasionally be dangerous toward themselves and others. They might forget the kitchen on or place objects at unusual places. Also, they might go for a walk and get lost or confused. Therefore, family members and close friends should create a safe and supportive environment for those living with Alzheimer's disease. They can do so by keeping objects that can become dangerous if used carelessly, away from individuals with the disease. Also, it would be wise for the patients to carry with them mobile phones or devices able to locate them. Finally, keeping objects that create memories in the house and common places is important in stimulating the brain of people with Alzheimer's disease.
Sleep and Alzheimer's disease
Alzheimer's disease severely affects the sleep quality and quantity of those who live with it. It is not clear why this happens. People with the disease have sleep difficulties that make them wake up often and spend less time sleeping during the night. Sundowning effect refers to the agitation patients feel in the early afternoon, after a whole day of sleepiness and drowsiness. During the night, people with Alzheimer's disease spend 40% of their time awake, resulting in day-time tiredness and agitation. The complete reversal of the sleep cycle is rare but possible. During this phenomenon, patients sleep during the day and stay awake during the night. Complete reversal is dangerous as patients may act alone during the night and while everyone else is sleeping. Also, it further isolates the patient with Alzheimer's disease.
Weighted blankets and Alzheimer's disease
Weighted blankets reduce Alzheimer's-related anxiety and insomnia by providing deep pressure stimulation while sleeping. They are a non-drug intervention that improves sleep and decreases daily sleepiness, agitation, and drowsiness. Deep pressure therapy is an evidence-based intervention that improves sleep, provides relaxation, and helps you release substances that make you feel better. You can use a weighted blanket at any time during the day, every time you want to take a nap or a good night's sleep.
When it comes to individuals with Alzheimer's disease, rest is a very important aspect of their lives. It relaxes and restarts their brains, improving memory and cell regeneration. Keep in mind that anxiety and depressive symptoms may worsen even more the mental and cognitive abilities of a person with Alzheimer's disease. Getting rid of the extra stress, and feeling rested and happier during the day is essential for those living with dementia. Besides, an agitated or anxious patient is even harder to manage and live with, for both family members and caregivers. Consult your healthcare giver and buy a weighted blanket today.
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