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Alzheimer's Disease
Alzheimer's disease is the most prevalent type of dementia, and its underlying causes are not fully understood. Symptoms primarily involve a gradual memory decline. It typically starts with memory problems, like forgetting recent events or daily tasks, and can eventually lead to difficulties in decision-making and self-sufficiency. While there are medications and behavioral interventions for enhancing brain function, the disease continues to advance over time, necessitating diligent care due to the potential for severe complications, even death. Fortunately, there are several quick and precise neuroimaging and diagnostic methods available.
Symptoms
The primary and early symptom of Alzheimer’s disease is memory impairment, which will gradually progress. In the beginning, patients may be unaware of their difficulty remembering things. But, their families or those around them may notice the deteriorating memory of the patients.
- Memory impairment
In Alzheimer’s disease, memory impairment is severe, affecting the patient’s activities of daily living. Characteristic symptoms include repeating the same sentences or questions, forgetting the names of family members, misplacing things, and getting lost in familiar places. - Thinking and reasoning
Alzheimer’s disease patients lose decision-making skills, are unable to calculate, use items in the wrong way, and forget how to do or manage basic things in an orderly or logical way. - Personality and behavior
Patients become restless and isolated. Their sleep habits change. They may experience depression, mood swings, frustration, and aggression. They lose interest in routine daily activities such as taking a shower. - Preserved skills
Despite the neurodegenerative changes, some skills such as reading, telling stories, reminiscing, singing, dancing, or drawing are retained because they are under the control of the cortical parts of the brain that have not yet been affected.
When to see a doctor
When memory loss, slow decision-making, personality changes, or behavior develops, you should see a doctor for a thorough diagnosis.
Causes
Causes for Alzheimer's disease encompass factors such as advanced age, genetic predisposition, lifestyle choices, and environmental influences. The degenerative process originates in brain regions responsible for memory but eventually extends to other areas. The hallmark of Alzheimer's disease is widespread neuritic plaques formed by the accumulation of amyloid-beta and tau proteins. These changes contribute to neuronal deterioration, impaired cell-to-cell communication, and the eventual death of brain cells. Notably, neuropathologic changes in the brain can commence many years before noticeable symptoms emerge.
Risk factors
- Alzheimer’s disease commonly affects people over 65.
According to a study, there are increasing incidences of the disease per 1,000 people for every succeeding decade: two for the 65 to 74 years old, 11 patients for the 75 to 84 years old, and 37 patients for those 85 and older, confirming that aging is a dominant risk factor for the disease. - Family history of Alzheimer's disease and genetics
The genetic mechanism of the disease is still unexplainable. If you have a family history of the disease, you are at higher risk of developing the condition. The apolipoprotein E (APOE e4) gene variant can raise the disease risk. However, not everyone with this gene variant will develop the disease. - Down syndrome
Down syndrome persons develop Alzheimer’s disease at a younger age. They develop symptoms 10-20 years sooner than people without this condition due to the chromosome 21 trisomy, containing an extra dose of the amyloid precursor protein (APP) genes. - Gender
The gender-specific risk difference is minimal. - Vascular risk factors
Hypertension, diabetes, obesity, cerebrovascular disease, and other cardiometabolic disorders, such as insulin resistance, increase the risk of dementia and may link to Alzheimer’s disease. - Severe head injuries
People with severe head injuries are at risk of the disease. - Sleep disorders
According to studies, people with sleep disorders such as obstructive sleep apnea are at high risk of the disease. - Environmental risk factors
Several studies implicate occupational or environmental exposure to secondhand smoke, air pollution, and pesticides as raising the risk of Alzheimer's disease.
Diagnosis
- Alzheimer's disease diagnosis is often a complex process that involves ruling out other potential causes of cognitive decline. A definitive diagnosis may require multiple assessments and tests conducted over time. Symptom evaluation and observation of family members. Help diagnose psychological disorders such as depression or other physical conditions similar to Alzheimer's disease. Neuropsychological tests used to assess memory, language, problem-solving and other cognitive functions, and visual-spatial intelligence are The Thai Mental State Examination (TMSE) and the Montreal Cognitive Assessment (MoCA), which take about 15-20 minutes to complete.
- Laboratory tests
Laboratory tests can rule out other causes of memory loss, such as thyroid disorders or vitamin deficiency. Laboratory testing for amyloid-beta and tau proteins are common blood and cerebrospinal fluid biomarkers examined and specific gene variants or mutations testing. - Brain imaging test
Images from brain scans can provide a more accurate diagnosis of Alzheimer's disease at early stages and identify other brain degenerative diseases. Current diagnoses include magnetic resonance imaging (MRI) and Brain FDG PET Scan.
Treatment
There is no curative treatment for Alzheimer’s disease. The current treatment gears towards improving the memory and behaviors of patients. These include:
- Cholinesterase inhibitors block the action of enzymes breaking down neurotransmitters and improve the performance of cell-to-cell communication. They can improve the symptoms of patients with early-stage disease. This type of medication includes Galantamine and Rivastigmine, which are available as oral pills or patches.
- N-methyl-D-aspartate (NMDA) receptor antagonists are appropriate for patients with mild to moderate Alzheimer’s disease, usually prescribed with cholinesterase inhibitors.
- Lecanemab received approval from the US FDA in July 2023 to treat early Alzheimer’s disease. It binds to and helps remove amyloid-beta protein aggregates.
Behavioral and mood medications such as anti-anxiety drugs or sleeping pills
Dietary supplements such as vitamin E or ginkgo are used to prevent or slow the progression of the disease despite scant supporting clinical evidence.
Establishing a safe environment for Alzheimer’s disease patients and cooperative care from the family members play crucial roles in the successful management plan. These include putting things in the same place, which can help cope with memory impairment, and following the same daily routine. Moreover, family and relatives can help remind the patients to take medications or let them carry a communication device that can geolocate their whereabouts.
FAQ
- What is Alzheimer’s disease?
Alzheimer’s disease is a neurodegenerative disease of the brain due to genetic, lifestyle, or environmental factors. The disease begins in the parts of the brain that manage memory. Deposits of amyloid beta plaques and neurofibrillary tangles of tau proteins damage the neurons, causing neuronal cell death. The lesion can also develop in other parts of the brain. Usually, the neurodegenerative brain change is evident years before symptom manifestation. - What are the symptoms of Alzheimer's disease?
The primary and early sign and symptom is progressive memory loss, undiscerning to the patients but noticeable to families or persons close to them, such as repeating the same sentences or questions, forgetting the names of family members, misplacing things, using a familiar object in a wrong way, and getting lost in familiar surroundings. - What are diagnostic test modalities for Alzheimer’s disease?
The diagnostic test modalities for Alzheimer's disease typically involve a combination of clinical assessments, cognitive evaluations, laboratory and imaging studies. - How should we take care of Alzheimer's disease patients?
In managing Alzheimer's disease patients, beyond medical interventions, establishing a secure environment and receiving support from family members are vital components. These measures encompass organizing belongings consistently to aid with memory challenges and adhering to a regular daily schedule. Furthermore, family members and relatives can assist by ensuring medication adherence or providing patients with location-tracking communication devices.
