Alzheimer - Causes, Stages, Diagnosis, Treatment and Prevention


Instead of becoming emotional about me and this brain disease, if my friends thought Alzheimer’s could be a liberating event, freeing me to float through life and stand it on its head. And say Come fly with me.” Then things would be so easy - Thomas DeBaggio offer

( last stage of Alzheimer )




Alzheimer’s disease is named after German physician Alois Alzheimer, who first described the disorder as "a peculiar disease" in 1906. He noticed changes in the brain tissue of a woman who had died of an unusual mental illness and had symptoms that include memory loss, language problems, and unpredictable behavior.


After she died, he examined her brain and found many abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary, or tau, tangles).

These plaques and tangles in the brain are still considered some of the main features of Alzheimer’s disease. Another feature is the loss of connections between nerve cells (neurons) in the brain.


Furthermore, Dr. Alzheimer described the symptoms of alzheimer's patient known as “Auguste D.” in 1906. The symptoms included:

  • memory loss

  • abnormal behavior

  • shrinkage of the patient’s brain


Psychiatrist Emil Kraepelin, Dr. Alzheimer’s colleague, coined the name “Alzheimer’s disease” in a 1910 medical book.


Today, Alzheimer's is at the forefront of biomedical research. And researchers are working to uncover as many aspects of Alzheimer's disease and other dementias as possible.

And more than five million people in the United States are living with Alzheimer’s disease. That number has doubled since 1980 and is expected to be as high as sixteen million by 2050.


Introduction


Alzheimer's disease is the most common cause of dementia a general term for memory loss and other cognitive abilities.

It is a degenerative brain disease that is caused by complex brain changes following cell damage and is not a normal part of aging. Besides,it also affects the ability to communicate, thinking, behavior and feelings.


The most common early symptom of Alzheimer’s is trouble remembering new information because the disease typically impacts the part of the brain associated with learning first.


Alzheimer's worsens over time. Alzheimer is the sixth leading cause of death in the United States. On average, a person with Alzheimer's lives four to eight years after diagnosis, but can live as long as 20 years, depending on other factors.    



Causes

  • Abnormal build-up of proteins in and around brain cells. There are two types of proteins that are involved one is called amyloid, deposits of which form plaques around brain cells. The other protein is called tau, deposits of which form tangles within brain cells.

  • Decrease in chemical messengers (called neurotransmitters) involved in sending messages, or signals, between brain cells. Due to which levels of neurotransmitter, acetylcholine, are particularly low in the brains of people with Alzheimer's disease.

  • Age is the single most significant factor. The likelihood of developing Alzheimer's disease doubles every 5 years after you reach 65.

  • The genes inherited from parents can contribute to risk of developing Alzheimer's disease, although the actual increase in risk is small. But in a few families, Alzheimer's disease is caused by the inheritance of a single gene and the risks of the condition being passed on are much higher.

  • People with down's syndrome are at a higher risk of developing Alzheimer's disease. This is because the genetic fault that causes down's syndrome can also cause amyloid plaques to build up in the brain over time, which can lead to Alzheimer's disease in some people.

  • People who have had a severe head injury may be at higher risk of developing Alzheimer's disease, but much research is still needed in this area.

  • Research shows that several lifestyle factors like smoking, bad food habits,sedentary lifestyle, loneliness or social isolation,untreated depression and conditions like diabetes, high blood pressure, high cholesterol, obesity and diabetes which are associated with cardiovascular disease can increase the risk of Alzheimer's disease.


Stages


1. Early-stage Alzheimer's (mild) 


In the early stage of Alzheimer, symptoms may not be widely apparent and it’s possible to live well by taking control of their health and wellness as a person may function independently i.e he or she may still drive, work and be part of social activities.


Despite this, the person may feel as if he or she is having memory lapses, such as forgetting familiar words or the location of everyday objects. This stage is called preclinical Alzheimer's disease and is often mistaken for normal aging. 

Common difficulties in the early stage of Alzheimer include:

  • Difficulty in spelling or using out right word or name.

  • Difficulty in remembering names when introduced to new people.

  • Forgetting information that was just read.

  • Losing or misplacing a valuable object

  • Trouble with complex tasks, and they may lose interest in hobbies

  • Asking the same question over and over


2. Middle-stage Alzheimer's (moderate)


It is typically the longest stage and can last for many years and will require a greater level of care. During the middle stage of Alzheimer, the dementia symptoms are more pronounced. the person may forget details about their own histories, confuse words, get frustrated or angry, and act in unexpected ways, such as refusing to bath.


Besides,they need more help with the basic activities of daily living, such as dressing properly and maintaining good personal hygiene. Their personalities may show disturbing changes such as more anxiety, suspiciousness, or irritability and all these symptoms are mainly due to damage to nerve cells in the brain which can also make it difficult for the person to express thoughts and perform routine tasks without assistance. In simple words in this stage the ability to make sound decisions can become harder for people with MCI.


Symptoms, which vary from person to person, but common symptoms usually may include:


  • Being forgetful of past events or personal history like their address or telephone number, and the high school or college they attended.

  • ​Feeling moody, withdrawn, irritated especially in socially or mentally challenging situations and prefer to be self isolated

  • Lack of ability to take sound decisions in every routine habit like choosing clothes etc

  • Experiencing changes in sleep patterns, such as sleeping during the day and becoming restless at night.

  • Showing an increased tendency to wander and become lost in their own world i.e overthinking about everything.

  • Demonstrating personality and behavioral changes, including suspiciousness and delusions or compulsive, repetitive behavior like hand-wringing or tissue shredding.

  • Problems with reading, writing, and working with numbers

  • Be restless, agitated, anxious, or tearful, especially in the late afternoon or at night

  • Repeating stories or favorite foods, places, songs, etc

  • Trouble recognizing family and friends

In this middle stage, to help person living with Alzheimer’s in daily activities it’s important to find out what the person can still do or find ways to simplify tasks. And try to engage them in meditation,yoga or few breathing exercises. Besides, if we are well versed with their hobbies then try to drag them in those activities and keeping them busy whole day.

3. Late-stage Alzheimer's (severe)


In the final stage of the disease, dementia symptoms are severe due to loss of normal brain cell connection, combined with the death of nerve cells from amyloid plaques, becomes vulnerable to infections especially pneumonia and other factors. Individuals lose the ability to respond to their environment. to carry on a conversation.


Also the person is totally dependent on others for basic functions such as feeding, toileting, memory and cognitive skills continue to worsen and significant personality changes may take place and individuals need 24 hour extensive care. Although Alzheimer’s may not be able to initiate engagement in the last stage, but he or she can still benefit from interaction in ways like listening to relaxing music or receiving reassurance through gentle touch.


Care Strategies for Those with Severe Alzheimer’s

  1. The focus is more on preserving quality of life and dignity by connecting to your loved one during this phase.

  2. The most difficult part for the family is often when names and moments are forgotten, the impact of connection remains so loss of name is not a loss of a relationship.

  3. Practice self-care and accept offers of help from friends, neighbors, and family members. Reach out when you need more support.

  4. During this stage, the best way to support your loved one is to stripping away of the noise of everyday life and focusing on decreasing frustration and increasing joy.


Diagnosis


.The early signs of Alzheimer disease may not be obvious to anyone except the person with the disease and the people closest to them. So healthcare providers usually do an physical and neurological exam to find out how well the person’s brain is working. The tests may seem like puzzles or word games or ask questions like what day it is, who the president is, to remember and recall a short list of words.


Furthermore, the healthcare provider might also take a health history and order some tests to check for other possible causes of memory loss or confusion. These tests may include brain scans such as -


  • Computed tomography (CT) scan - This scan detects proportion of plaque protein buildup in the brain.


  • Magnetic resonance imaging (MRI) - This scan helps to understand inflammation, bleeding, and structural issues if any in the brain

. Besides, doctor may also conduct a neurological exam again to check your reflexes, muscle tone, and speech and also include blood tests to check for genes that may indicate you have a higher risk of Alzheimer’s disease.



Treatment


Alzheimer disease is so complex that it is unlikely that any one drug or other intervention will successfully treat it. As treatments or medications maintain mental functions, manage behavioral symptoms and might slow down the symptoms of disease to some extent but will not stop the disease itself.


Several prescription drugs are currently approved by the U.S. Food and Drug Administration (FDA) to treat people who have been diagnosed with Alzheimer’s disease.


For mild to moderate Alzheimer’s disease - Medications called cholinesterase inhibitors are prescribed to prevent the breakdown of acetylcholine which is a brain chemical believed to be important for memory and thinking.


The medications are Razadyne® (galantamine), Exelon® (rivastigmine), and Aricept® (donepezil) but its recommended to consume these medicines only after consulting doctor.


For moderate to severe Alzheimer’s disease - A medication known as Namenda® (memantine), an N-methyl D-aspartate (NMDA) antagonist, is prescribed by the medical practitioner.

This drug's main effect is to decrease symptoms, which could allow some people to maintain certain daily functions a little longer than they would without the medication.


The FDA has also approved Aricept®, the Exelon® patch, and Namzaric®, a combination of Namenda® and Aricept®, for the treatment of moderate to severe Alzheimer’s disease.

as it is believed to work by regulating glutamate, an important brain chemical to prevent brain cell death. Besides, NMDA antagonists work differently from cholinesterase inhibitors and these two types of drugs can be prescribed in combination.



Prevention

Just as there’s no known cure for Alzheimer’s, there are no foolproof preventive measures. So its mandatory to focus on overall healthy lifestyle habits as way of preventing cognitive and immunity decline.

The following measures are -


1. Quit smoking as it increases risk of vascular problems or smaller bleeds in the brain which is dangerous for Alzheimer. Besides, smoke also increase oxidative stress and inflammation which have been linked to develop Alzheimer disease.


2. Exercise regularly to increase blood flow to the brain to drastically improve memory,reasoning, judgment etc for people with mild Alzeimer disease or mild cognitive impairment but with severe Alzheimer disease its better to be active rather than sedentary lifestyle to live for longer period.


3. Try cognitive training exercises like

  • Puzzles

  • Remembering sequence of numbers in the same order and in inverse order.

  • An image is shown and then questions are asked to confirm some details of the image

  • Online memory games or video games

  • Learning something new,such as second language or musical instrument

4. Eat a more plant-based diet and low animal products to prevent onset and delay of cognitive impairment.


5. Consume more antioxidants that include vitamins and minerals rich food, dietary or supplements to atleast get benefits of reducing mild effects of Alzheimer.



6. Manage your numbers of blood pressure, blood sugar, and cholesterol as research shows strong connections between Alzheimer’s and conditions like high blood pressure, high cholesterol, type 2 diabetes, and heart disease.




  • According to the Centers for Disease Control and Prevention (CDC), Alzheimer’s is the sixth most common cause of death among U.S. adults. It ranks fifth among causes of death for people 65 years and older.

  • A study found that 4.7 million Americans over the age of 65 years had Alzheimer’s disease in 2010. Those researchers projected that by 2050, there will be 13.8 million Americans with Alzheimer’s.

  • The CDC estimates that over 90 percent of people with Alzheimer’s don’t see any symptoms until they’re over 60 years old.

  • Alzheimer’s is an expensive disease. According to the CDC, about $259 billion was spent on Alzheimer’s and dementia care costs in the United States in 2017.

  • Every 65 seconds, someone in America develops Alzheimer's. By mid-century, someone in America will develop the disease every 33 seconds.2 It is estimated that nearly 500,000 new cases of Alzheimer's disease will be diagnosed this year.

  • Obesity has been linked to Alzheimer’s disease, but losing just 5 to 10% of your body weight can help to lower your risk of chronic disease. “More than two-thirds of Americans are overweight or obese. There is clear evidence linked excess weight to Alzheimer's, cardiovascular disease and diabetes, which are also considered risk factors for dementia.

  • Eighty percent (80%) of the 15 million unpaid caregivers providing care for someone with Alzheimer’s disease in North America are family members.


Conclusion


Indeed! People often exclaim " Oh god! Alzeimer ? Then i am not going to survive for long. This small negative thought even in first stage makes things worse. So its always advisable to the Alzheimer community to stay positive throughout the treatment. And you may never know positive thoughts can make big difference in reducing Alzeimer to some extent giving the patient opportunity to live longer.


You can still maintain a productive, meaningful, and enjoyable life by eating a healthy diet, exercising regularly, staying socially connected, and trying to manage stress levels. If you think you or a loved one may have Alzheimer’s, your first step is to talk with your doctor. They can help make a diagnosis, discuss what you can expect, and help connect you with services and support.


Sources


Maintain your brain


Mayoclinic


Very well health


alz.org


Moma,org


nhs UK