Introduction
Alzheimer’s disease (AD) is considered the most general form of dementia, occurring mainly among older people. Dementia is a brain disorder, which affects a person’s capability to carry out simple everyday tasks. Alzheimer’s affects those parts of our brain which control our thoughts, language and memory. It causes nerve cells to die in the brain and the connection between them fails to make it impossible to send messages between them. The worst thing about this disease is that it has no cure. Alois Alzheimer, a German psychiatrist, first detected this terminal and extremely degenerative disease. Already more than 26 million people have Alzheimer’s worldwide and it has been estimated that by 2050 number of affected people will increase by four times. It is uncommon among younger people, although early-onset Alzheimer’s does occur a lot earlier and usually commences after 60. Its risk grows with age, although it is not an ordinary part of aging (Verhey, pp. 45-47).
History
According to ancient Roman and Greek physicians and philosophers, dementia was associated with old age. It was only in 1901 when Alois Alzheimer discovered the first case of Alzheimer’s disease. It was a 50-year-old woman and Alzheimer studied her until she died in 1906. He identified certain brain cell abnormalities and during a brain autopsy, he noticed dense deposits around nerve cells, called neurotic plaques, and found twisted bands of fibers, called neurofibrillary tangles in them. It was only then that he went public with his analysis and findings. Later, Emil Kraepelin was the first to describe Alzheimer’s like a disease, which he also named presenile dementia. He called it a subtype of senile dementia in his book, Textbook of Psychiatry. In the latter, half of the 20th century Alzheimer’s was only diagnosed for people aged 45 to 60 showing symptoms of dementia. Now its diagnosis is independent of age, as it has been found that both senile and presenile dementia is the same. Finally, Alzheimer’s disease was added to the medical classification for all people, disregarding their age, having common symptoms and patterns (Gelb, p. 12).
Causes
As scientists do not fully understand the causes of Alzheimer’s, several factors may be the reason for it. Age is considered the greatest risk factor for Alzheimer’s. The probability of catching Alzheimer’s almost doubles every 5 years after 60 and after 80, the risk factor reaches 50%. Another factor is genetics and family history. Studies show that people having relatives diagnosed with Alzheimer’s are more liable to catch the disease. Early-onset Alzheimer’s, which is a rare form of the disease, can occur after 30 and is inherited. Late-onset Alzheimer’s occurs late in life and shows no inheritance pattern. The gene, which causes late-onset Alzheimer’s, produces a protein, called ApoE or apolipoprotein E. Everyone has ApoE as it helps to carry cholesterol in the blood, but only 15% of people have the risk of Alzheimer’s. (Andin, p. 691).
There are also three major hypotheses, which try to explain the cause of Alzheimer’s. According to the cholinergic hypothesis, Alzheimer’s can occur due to the reduced synthesis of the neurotransmitter acetylcholine. The Amyloidal hypothesis holds amyloid-beta or Aβ deposits to be the main reason for the disease. This is a compelling theory as the gene for the amyloid-beta precursor (APP) which is located on Chromosome 21, and people having Down Syndrome (trisomy 21) have an extra gene copy usually show Alzheimer’s by 40. (Burns & Grover, 115) Finally, according to the tau hypothesis, tau protein abnormalities initiate Alzheimer’s. Here threads of tau start to pair with other hyperphosphorylated tau forming neurofibrillary tangles inside nerve cell bodies. Due to this, microtubules disintegrate and the neuron transport system collapses, finally causing the cells to die. Scientists are also studying diet, education, and environment to determine their role in the development of Alzheimer’s. They have also discovered that low levels of Vitamin folate, diabetes, high blood pressure, and cholesterol can also accelerate the risk of Alzheimer’s. Serious head injury tangles and plaques in the brain can also cause Alzheimer’s. (Livingston & Katona, p. 205).
Signs and Symptoms
There are two symptoms of Alzheimer’s disease, behavioral and cognitive. Cognitive symptoms generally affect the memory, verbal communication, thought and alertness of the patients. Patients become absentminded, which is generally mistaken to be related to strain or aging. People start to forget familiar names, places and events. On the other hand, behavioral symptoms cause character changes in patients. They become depressed, restless, and aggressive at times making it difficult to handle them. This also leads to mistrust and loneliness. (Mohs, 1406) They start to fantasize, feeling and seeing things that do not even exist.
Impacts
Alzheimer’s is a very slow disease and a single test cannot prove whether a person has it or not. It can last up to several years and finally even end in death. As the disease progresses, patients are unable to perform, daily activities, like writing, eating or dressing up, and become restless and aggressive. At times, they even stroll away from home and get lost. Alzheimer’s does not affect all memory activities. Old memories and embedded thoughts are less affected than new ones. Verbal communication becomes a problem as it affects fluency and pronunciation and people start to forget words. People appear to be clumsy as they are unable to coordinate their movements and actions and thus, require assistance performing certain demanding tasks. Finally, even long-term memory starts to get affected and a change in their behavior becomes evident. Some even become delusional and distrustful, which creates stress among family members. People become confused wondering where they are or which day of the week it is. As they suffer from memory lapses, their work is affected and often they lose their careers. (Youn, p. 679). In the last stages, patients become immobile and are bedridden being completely dependent on others. They lose the ability to sit or smile on their own. They can utter only single words or at the smallest phrases and fatigue sets in. They are unable to eat themselves and lose weight. Death is their final destination and is mainly caused by external factors like pneumonia or ulcers.
Myths and Facts
Some might say that Alzheimer’s is not fatal. However, it is as it might kill us. The reason is that it destroys brain cells and although sufferers may live from nine to 20 years, they finally die. It is also not true that Alzheimer’s is just a part of the natural aging process. People think that memory loss, associated with Alzheimer’s is due to old age, but it is not so. The mind gradually slows down causing memory failure. It is also a false belief that only old people can get Alzheimer’s. It is also believed that men are more susceptible to Alzheimer’s than women are. That is not the case. People only believe this since women live longer than men do and hence, are expected to develop the disease at some point or other (Livingston, p. 204). Eating food cooked in aluminum vessels or dinking in aluminum cans does not cause Alzheimer’s. Our contact with aluminum via the environment or soft drink cans is inescapable, but our intake of aluminum is low as it is insoluble and comes out of our bodies. Aspartame, an artificial sweetener used in drinks and food, also does not cause Alzheimer’s. Although aspartame is believed to be a neurotoxin, it does not cause memory failure. Alzheimer’s does not increase with flu shots; instead, studies have shown that flu shots and various vaccinations help reduce the risks of Alzheimer’s. No link has been found between silver fillings in the teeth and Alzheimer is, as it was believed that the amalgam in the filling, which contains tin, silver, and mercury, could be harmful to the brain (Gelb, p. 12).
Studies have shown that the disease is common among people who have suffered from head injuries, but a direct link has not been established between head injuries and Alzheimer’s. However, brain trauma is still considered a potential risk factor. Unfortunately, treatments cannot stop Alzheimer’s. It cannot be delayed or cured. People take drugs believing that they may be cured, but the drugs only slow down the symptoms for few months. Still, Alzheimer’s is not a death verdict as victims do live with their condition, with a lot of love and care (Aud, p. 17).
Diagnosis and Treatment
If Alzheimer’s is diagnosed accurately in its first stages, it helps the patients and their relatives to plan the treatment and helps them deal with the symptoms of the disease. The best way to diagnose Alzheimer’s is to find out whether there are tangles and plaques in the brain tissue. However, to find this, doctors need to perform an autopsy, which is usually done after a person dies. Thus, they can only inform us of probable or possible Alzheimer’s. This is done by questioning the patient about his past medical records, memory tests, overall health, and finally medical tests like brain scans and blood tests (Verhey, pp. 48-49). As already mentioned Alzheimer’s is a slow disease and it cannot be stopped by treatments. The drugs donepezil or Aricept, galantamine or Razadyne, tacrine or Cognex, and rivastigmine or Exelon may be of some help to the people in the early and middle stages of their disease. These are cholinesterase inhibitors, which help communication among the nerve cells and keeps acetylcholine levels high. Memantine or Namenda helps in the case of severe Alzheimer’s, with limited effects. It helps to regulate glutamate action which is a messenger chemical concerned with learning and memory. (Mohs, 1408) Medicines may also help monitor restlessness, insomnia, nervousness and dejection. When these symptoms are treated, patients become more comfortable and less agitated. However, these drugs have many side effects as they cause, vomiting and sometimes even liver injuries. No-drug treatments are also available to deal with the behavioral patterns of the patients. If thing as if excessive noise agitates the patient, a calm environment should be created to soothe his mind. The patients’ family should keep their cool and not get angry while dealing with him. We should try to indulge the patient in some pleasant activities like dancing or singing to keep his mind occupied and calm. Medicines can also be used to treat behavioral symptoms if the patients start to harm themselves. Antidepressant and antipsychotic drugs can be used in extreme cases, but should carefully be chosen and used along with no-drug treatments (Andin, pp. 691-693).
New Areas of Research
Researchers are always on the lookout for new ways to treat Alzheimer’s. A number of clinical trials are undertaken to determine which treatments are safe and useful for people suffering from Alzheimer’s. Scientists have found that damage to the part of the brain involving memory is clear on brain scans. AD Neuroimaging Initiative or ADNI is a study to determine whether PET and MRI scans can detect Alzheimer’s changes or at least measure its propagation. AD Genetics Study is also being used to learn about late-onset Alzheimer’s. Mild Cognitive Impairment or MCI has been the focus of many scientists and is a memory change different from Alzheimer’s. Researchers have also found that inflammation in the brain can cause Alzheimer’s. Non-steroidal and anti-inflammatory drugs or NSAIDs may help to slow the propagation of Alzheimer’s. Unfortunately, clinical trials have not shown any benefits from these drugs. It has been found that antioxidants as if Vitamin C and E can fairly slow the propagation of Alzheimer’s to some extent (Youn, pp. 686-689).
Conclusion
The best way to treat Alzheimer’s is to prevent it. Alzheimer’s is a devastating disease. Patients and their families should not lose hope and get tempted by unproven supplements and strategies. People should remain healthy and maintain an active social life to prevent the disease. We should control our blood pressure and cholesterol levels and exercise regularly. Those who already have the disease need a lot of care and patience from their family members. Thus, we should see to it that they are made as comfortable as possible and not discriminated against or neglected.
References
- Andin, Ulla. “Clinical manifestations in neuropathologically defined subgroups of vascular dementia”. International Journal of Geriatric Psychiatry 21.7 (2006): 688-697.
- Aud, M.A. & Rantz, M.J. “Admissions to Skilled Nursing Facilities From Assisted Living Facilities”. Journal of Nursing Quarterly 20.1 (2005):16-25.
- Burns, N., & Grove, S.K. Understanding nursing research. Ed: 3. New York: Elsevier Health Sciences, 2002.
- Gelb, Douglas J. “Measurement of progression in Alzheimer’s disease: a clinician’s perspective”. Statistics in Medicine 19.2 (2000): 11-12.
- Livingston, Gill & Cornelius Katona. “How useful are cholinesterase inhibitors in the treatment of Alzheimer’s disease? A number needed to treat analysis”. International Journal of Geriatric Psychiatry 15.3 (2007): 203-207.
- Mohs, Richard C. “Longitudinal studies of cognitive, functional and behavioural change in patients with Alzheimer’s disease”. Statistics in Medicine 19.11-12 (2006): 1401-1409.
- Verhey, Frans R. “Cross-national comparison and validation of the Alzheimer’s Disease Assessment Scale: results from the European Harmonization Project for Instruments in Dementia (EURO-HARPID)”. International Journal of Geriatric Psychiatry 19.1 (2004): 41-50.
- Youn, Jong Chul. “Development of a Korean version of the behavior rating scale for dementia (BRSD-K)”. International Journal of Geriatric Psychiatry; 23.7 (2008): 677-689.