Alzheimer’s Disease (AD) is a progressive, eventually fatal disease of the brain that destroys brain cells and severely disrupts memory, thinking, reasoning, perception and behaviour. It generally affects people who are 65 and older. However, a small percentage of people under 65 may also suffer from Alzheimer’s disease. This is called early on-set Alzheimer’s and typically affects people in their 30’s, 40’s and 50’s.
History of Alzheimer’s Disease
The condition entered medical literature in 1907, when Dr. Alzheimer published his observations of a patient named Auguste D., a 51 year old woman brought to Dr. Alzheimer by her family 1901. She had developed problems with memory, and had difficulty speaking and understanding what was said to her. Her condition deteriorated rapidly and soon after she was bedridden. She died in 1906 and since Dr. Alzheimer had never seen such symptoms before, he took the family’s permission to conduct an autopsy. Dr. Alzheimer observed dramatic shrinkage in her brain especially in the cortex, dead and dying brain cells, abnormal clumps and irregular knots in and around cells, and fatty deposits in small blood vessels. In 1910, a psychiatrist noted for naming and classifying brain disorders, Dr. Emil Kraepelin, proposed that this disease be named after Dr. Alzheimer.
Causes of Alzheimer's
The causes of Alzheimer’s are still not well understood, however there are some clear observations of its effects on brain tissue. Our brains have roughly 100 billion nerve cells called neurons. These neurons form networks which have special jobs. Some networks help us see, smell and hear, while others are involved in thinking, learning and remembering. Yet others tell our muscles when to move.
To accomplish their work, neurons function like little factories, taking in supplies, generating energy and getting rid of waste. As a normal part of aging some of these brain cells fail causing some memory loss and confusion. In the case of Alzheimer’s, the little cell factories stop functioning well. These breakdowns in the cells cause problems in other areas and as damage spreads the brain cells die.
Scientists suspect that abnormal structures called plaques and tangles are responsible for killing nerve cells. First observed by Dr. Alzheimer as clumps and irregular knots, it is believed that plaques and tangles somehow block communication between nerve cells and disrupt their activities. These have been observed in other patients that died from Alzheimer’s disease and some of the theories around plaques and tangles are:
Plaques: Plaques develop between nerve cells. They are made up of a normally harmless protein called beta-amyloid. Evidence suggests that a form of beta-amyloid may be responsible for neuron death.
Tangles: Brain neurons contain a protein called tau. Fibres of this protein undergo a change that causes them to get twisted. These are called tangles. Though plaques and tangles are observed in people as they age, Alzheimer’s patients seem to develop much more.
Scientists have also observed inflammation in the brains of some Alzheimer’s patients but are yet unsure how this plays a role in the development of the disease.
Symptoms of Alzheimer's Disease
The early symptoms of Alzheimer’s are similar to the normal ageing process, which may start with simple forgetfulness and confusion. The disease progresses slowly leading to the point where the patient has severe mental impairment and dementia, leaving them unable to take care of themselves. Due to the slow progression of the disease, diagnosis is delayed until the symptoms are very severe and obvious. Also, many patients tend to hide early symptoms due to fear or embarrassment which is another cause for late diagnosis.
According Alzheimer’s Association, there are ten warning signs that may indicate Alzheimer’s disease. They are:
- Memory Loss: Forgetfulness and memory loss, particularly of short term memory is common in early stages of Alzheimer’s. This forgetfulness increases and becomes more persistent as the disease progresses. Patients frequently forget names, places and appointments and eventually may forget the names of family members.
- Difficulty performing familiar tasks: People with dementia associated with Alzheimer’s may find it difficult to plan or complete familiar tasks such as cooking or making a telephone call.
- Problems with language: People with Alzheimer’s have trouble finding the right word and often cannot express their thought or follow conversations. This makes their speech and eventually writing hard to understand.
- Disorientation to time and place: People with Alzheimer’s become confused about times, dates and places. Often they become lost in their own neighbourhood and cannot find their way home.
- Poor or decreased judgement: People with Alzheimer’s exhibit poor judgement, often dressing inappropriately, and being unable to solve problems like what to do when the food is bruning on the stove. Eventually it becomes difficult for patients to make decisions or plan.
- Problems with abstract thinking: Alzheimer’s causes patients to develop problems with abstract thinking and in other intellectual functions. They may have difficulties with numbers and may not be able to perform tasks such as balancing check books.
- Misplacing things: Alzheimer’s causes patients to frequently misplace things and put things in unusual places, for example, putting an iron in the freezer.
- Changes in mood and behaviour: People with Alzheimer’s exhibit mood swings for no apparent reason and may shift from being calm to extreme anger or tears.
- Changes in personality: Changes in personality are also seen in people with Alzheimer’s. They may become stubborn, restless, anxious or aggressive. They may become suspicious, fearful or dependent on family members.
- Loss of initiative: People with Alzheimer’s become passive, sleeping or watching TV for hours and not wanting to engage in activities.
Many of these symptoms occur occasionally as a normal part of the ageing process; however, in cases of Alzheimer’s disease, these symptoms are persistent and become progressively worse. If you suspect Alzheimer's disease based on the above warning signs, please contact a physician who can give a correct diagnosis.
Did You Know?
- If either of your parents had Alzheimer's at any age, your risk of getting the disease is twice as high as someone with no family history.
- A person's chances of developing Alzheimer's below age 65 are about one in fifty.
- Alzheimer's disease accounts for 60 to 70% of cases of dementia
- It is estimated that approximately 4.5 million people suffer from Alzheimer's Disease in America today. By 2050, this number may reach 16 million
Treatments for Alzheimer's Disease
There is no cure available for Alzheimer’s disease at this time. There are treatments that help with the cognitive and behavioural symptoms of the disease. For the cognitive symptoms, the treatments available are:
- Cholinesterase Inhibitors: This group of drugs works by preventing the breakdown (thus improving the levels) of acetylcholine. Acetylcholine is a neurotransmitter, a chemical messenger which is important for memory. Commonly prescribed cholinesterase inhibitors are Donepezil (for all stages of Alzheimer’s), Rivastigmine (for mild to moderate Alzheimer’s) and Galantamine (also for mild to moderate Alzheimer’s). These drugs do not work for everyone and they have side effects that include nausea, vomiting, cramping and diarrhea.
- Partial glutamate antagonists: The drug memantine (namenda) helps regulates a chemical messenger called glutamate also involved in memory and learning. It protects the brain cells from potential damage caused by glutamate. It is prescribed to people with moderate to severe Alzheimer’s and may be used in combination with cholinesterase inhibitors. A known side effect of memantine is dizziness.
Alzheimer’s disease causes a number of behavioural symptoms, and depending on the symptoms and their severity, doctors may choose to prescribe antidepressants. Anti-anxiety medication, drugs for restlessness, verbally disruptive behaviour and resistance. In some cases, mood stabilizers, seizure medications and even antipsychotic medications are also used.
All drugs taken to treat Alzheimer’s must be taken against a doctor's prescription and must be continually monitored by the doctor.
Non medical treatments for Alzheimer’s
Non medical treatments are also encouraged for people with Alzheimer’s. Patients should be encouraged to participate in social activities such as walking, dancing and singing that they can enjoy. Studies are underway to evaluate whether cognitive rehabilitation can benefit Alzheimer’s patients. Cognitive rehabilitation is where a patient practices on a computer program to improve and training memory.
Caring for Alzheimer’s
People suffering from and caring for family members with Alzheimer’s face frustration and distress. Both patients and family members need love, support and patience. Often Alzheimer’s treatments also put financial strain on the family. There are support groups and care and training programs available for patients, care givers and family members to help them cope. For more information please visit Alzheimer's Association
How to Reduce Your Risk
- Work out. Studies show that active people are less prone to develop Alzheimer's than couch potatoes.
- Challenge your brain regularly. People who play mental games, instruments or those who read and write regularly, significantly decrease their odds of developing Alzheimer's.
- Eat Almonds. The Vitamin E in almonds, flax seeds and other nuts prevent damage to neurons. Getting the recommended daily allowance of Vitamin E (15 mg), that too through food rather than nutritional supplements, may reduce your risk by nearly 70 per cent.
- See the world. Older people who travel have been found to be half as likely as their sedentary counterparts to develop Alzheimer's, according to a French study.