Alzheimers Disease – 1st Important cause of Memory Loss

 

7 Interesting Facts of Alzheimers Disease

1. Alzheimers disease is a degenerative disease of the nervous system It is an irreversible condition.
2. Neurons present in the brain assist in the memory and normal functioning of the body.
3. Alzheimers disease will cause neurodegeneration which means the death of the neurons.
4. Death of neurons results in dementia, i.e., memory loss. Slowly and gradually as the disease progresses, the patient may lose the ability to perform basic tasks of everyday life.
5. Eventually, the patient will not be to able to carry out a normal living.
6. In older adults, the commonest cause of dementia is Alzheimer’s.
7. This is the most common degenerative central nervous system disease in the elderly. 
8. Symptoms of Alzheimers disease depend on the stage of the disease. Alzheimer’s disease is classified into preclinical or presymptomatic, mild, and dementia-stage depending on the degree of cognitive impairment. These stages are different from the DSM-5 classification of Alzheimer’s disease.

Top 10 early signs of Alzheimers Disease

 

1. Memory Loss
2. Social Withdrawal
3. Poor Judgement
4. Changes in Mood
5. Misplacing Belongings
6. Struggling to Communicate
7. Hard to complete familiar task
8. Confusion of Time and Place
9. Changes in Vision
10. Balance Difficulties

When was this disease identified?

Alzheimers disease (AD) was first described by German Bavarian psychiatrist and neurologist Alois Alzheimer in 1907. 

How common is this condition?

According to the Alzheimer’s Association, AD accounts for an estimated 60–80% of dementia cases.

At present, there are 50 million AD patients worldwide, and its incidence doubles every 5 years after the age of 65 years

What increases the risk of this condition?

• Usually, the symptoms of Alzheimers disease become evident only after the disease has progressed.
• There is approximately ten years time gap between the onset of illness and the development of visible symptoms.
• There is no evidence on the exact reasons for the development of the Alzheimer’s disease and the population at risk.
• From the research done by The Canadian Study of Health and Aging (CSHA), here are the risk factors which have been identified:

1. Age: Alzheimer’s usually associated with people of old age
2. Family History: The disease is hereditary and runs in families. People with a family history of dementia are more prone to Alzheimer’s disease
3. NSAIDS: Increased consumption of certain painkillers including Nonsteroidal Anti-inflammatory drugs like aspirin enhances the risk of getting Alzheimer’s disease.
4. Education: The association between the disease and education status has not been established. But, analysis from few surveys revealed a greater risk of this disease amongst the individuals with lower education.

What are the Symptoms Of Alzheimers Disease

Alzheimers disease deteriorates the patient’s condition with time as it is a progressive disease. Here is the detailed list of the symptoms:

1. Problems in remembering the names – Impaired memory; may not be obvious if casually observed
2. Subtle social withdrawal like Noticeable behavioral changes in social gatherings and events
3. Frequently repeating questions
4. Misplacing or losing objects and stuff
5. Finding problems in identifying the right word in conversations
6. Problems in planning and organizing daily tasks
7. Losses in more complicated activities (e.g., meal planning, finances)
8. Passive personality change
9. Difficulty in understanding language
10. Daydreaming and tendency to get lost in their thoughts.
11. Memory impairment leading to frequent forgetfulness of the events and one’s personal history
12. Unable to recall the daily activities
13. Unable to remember the names and numbers of even the close contacts
14. Disturbed sleeping patterns
15. Confused behavior
16. Increased episodes of aggressive outbreaks
17. Mood changes
18. Impairment in regular activities like using the stove, telephone etc
19. Self-care inability even bathing and grooming
20. Prominent Behavioural difficulties including sundowning and paranoia
21. Wandering behavior and getting lost
22. Unable to communicate properly as speech will become severely affected
23. Complete loss of memory
24. Reduced mobility including unable to walk and sit
25. Loss of awareness of the surroundings
26. Memory fragments only
27. May not recognize familiar people
28. Loss of all complex activities
29. Needs assistance with self-care

 

• The initial and most common presenting symptom of Alzheimers Disease is episodic short-term memory loss with relative sparing of long-term memory and can be elicited in most patients even when not the presenting symptom.
• Short-term memory impairment is followed by impairment in problem-solving, judgment, executive functioning, lack of motivation and disorganization, leading to problems with multitasking and abstract thinking. In the early stages, impairment in executive functioning ranges from subtle to significant.
• This is followed by language disorder and impairment of visuospatial skills.
• Neuropsychiatric symptoms like apathy, social withdrawal, disinhibition, agitation, psychosis, and wandering are also common in the mid to late stages.
• Difficulty performing learned motor tasks (dyspraxia), olfactory dysfunction, sleep disturbances, extrapyramidal motor signs like dystonia, akathisia, and parkinsonian symptoms occur late in the disease.
• This is followed by primitive reflexes, incontinence, and total dependence on caregivers

The 4 Warning Signs 4 As Of Alzheimers disease:

Amnesia: Amnesia refers to the loss of memory. Memory loss is the primary symptom in patients with Alzheimer’s disease. In the early stages of Alzheimers Disease, there may be partial amnesia. As the disease progresses, complete loss of memory develops.

Aphasia: Aphasia refers to impaired communication. In the initial stages, the patient may lose the ability to take part and converse. Gradually as the disease worsens, this will result in an inability to communicate.

Apraxia: Apraxia refers to the physical impairment of motor disability. This is seen in the later stages of the disease. Due to the neuronal damage, the patient may lose the ability to sit and move independently.

Agnosia: Agnosia refers to the impairment of senses like vision or smell. Neuronal damage results in this sensory impairment.

Alzheimers disease is best diagnosed by:

1. Medical History: To identify the genetic prevalence of disease in the family. The doctor may ask the patient and his family members, about the family history of the disease.
2. Mental Status Examination: A survey to assess the patient’s mental status and memory
3. Physical examination: This includes the complete assessment including the Liver, thyroid, kidney examination to identify the other existing diseases, which helps to analyze the health status of the patient. Muscle tone and brain- receptor coordination needs to be tested to identify any nervous system disorders.
4. Lab Work up: Here are the investigations which are confirmatory of the disease:

• CT Scan and MRI for brain imaging
• SPECT (Single photon emission computed tomography)  
• PET Scan: Records the brain responses to various activities like reading, sleeping, etc.

5. Psychiatric Evaluation: A psychiatric evaluation is mandatory to rule out other disorders like depression. Depression also mimics Alzheimer’s disease in symptoms.

Stages of Alzheimers Disease

Alzheimers disease deteriorates the patient’s condition with time as it is a progressive disease. Based on the severity of symptoms, the disease can be categorized into three stages.

Here are the three stages along with the noticeable symptoms of each stage listed:

Stage 1: Early stage or mild Alzheimers Disease:

This is the stage when the first symptoms begin to appear. The duration of the early stage of this disease is approximately 1 to 4 years.

The majority of Alzheimers disease patients are asymptomatic and the rest are with few symptoms which are very mild and may even go unnoticeable by the patients and even by their families.

The patient can work independently and self-care preserved, but still, behavioral changes may be seen which includes:

• Problems in remembering the names – Impaired memory; may not be obvious if casually observed
• Subtle social withdrawal like Noticeable behavioral changes in social gatherings and events
• Frequently repeating questions
• Misplacing or losing objects and stuff
• Finding problems in identifying the right word in conversations
• Problems in planning and organizing daily tasks
• Losses in more complicated activities (e.g., meal planning, finances)
• Passive personality change
• Difficulty in understanding language

Stage 2: Middle stage or moderate Alzheimers disease:

This stage of Alzheimers disease lasts the longest for many years ranging from 3 to 12 years. The brain function deteriorates in this stage, the symptoms worsen, and the condition of the patient deteriorates.

The patient becomes alarmingly dependent. The noticeable symptoms in patients with this stage are:

• Daydreaming and tendency to get lost in their thoughts.
• Memory impairment leading to frequent forgetfulness of the events and one’s personal history
• Unable to recall the daily activities
• Unable to remember the names and numbers of even the close contacts
• Disturbed sleeping patterns
• Confused behavior
• Increased episodes of aggressive outbreaks
• Mood changes
• Impairment in regular activities like using the stove, telephone etc
• Self-care inability even bathing and grooming
• Prominent Behavioural difficulties including sundowning and paranoia
• Wandering behavior and getting lost

Stage 3: Late stage or severe Alzheimers disease:

This is the most critical and final stage of Alzheimers disease lasting 1 to 2 years. The symptoms become easily distinguishable as the neurons in the brain are extensively damaged resulting in a loss of connectivity of the brain with the body parts.

The affected person becomes completely dependent on the caregiver and requires full-time assistance.

Some of the symptoms noticeable in this stage are:

• Unable to communicate properly as speech will become severely affected
• Complete loss of memory
• Reduced mobility including unable to walk and sit
• Loss of awareness of the surroundings
• Memory fragments only
• May not recognize familiar people
• Loss of all complex activities
• Needs assistance with self-care

Is there a cure for Alzheimers disease – Medications for Alzheimers?

How is this condition treated?

• Alzheimers disease is a complicated disease involving various stages of neurodegeneration. The treatment focuses on symptomatic control and relief. There is no permanent cure for the disease.
• Drugs that treat the symptoms and delay the progression of disease provide the patient with a better lifestyle. Most of these medications are effective only in the earlier stages of the disease. They might not work once the disease has progressed.
• The treatment approach also varies with the stage of the Alzheimers Disease.

Treatment for Mild to Moderate Alzheimers:

The medication used for the treatment of patients with Mild to moderate stage of Alzheimers is a class of drugs known as acetylcholinesterase inhibitors which include Rivastigmine, galantamine, etc.

• Acetylcholine is an important neurotransmitter in the brain. As Alzheimer’s disease progresses, the level of acetylcholine decreases in the brain. Due to this decline, the symptoms become severe.
• Acetylcholinesterase is the enzyme present in the body which breaks down acetylcholine.
• The drugs of the class acetylcholinesterase inhibitors inhibit the action of acetylcholinesterase, thereby increases the level of acetylcholine in the brain.

Treatment of Moderate to Severe Alzheimers disease:

The severe stage of Alzheimers disease is characterized by the death of brain cells, the neurons in the brain are extensively damaged resulting in loss of connectivity of the brain with the body parts.

The class of drugs used for the treatment of patients with Moderate to Severe Alzheimers disease is NMDA receptor antagonist which include memantine.

• Glutamate is a neurotransmitter in the brain that can cause cell death. This neurotransmitter exhibits its effect by binding to the NMDA receptor.
• The NMDA receptor antagonists do not allow binding of glutamate to the receptor. Hence prolong the lifespan of brain cells.

Recommended combination of the medications, acetylcholinesterase inhibitors, and NMDA receptor antagonists can provide better results in the later stages of the disease.

Behavioral Management of Alzheimers disease Patients:

Often the symptoms of the Alzheimers disease e are accompanied by other minor lifestyle problems. Depression, restlessness, sleep deprivation are commonly seen in patients with Alzheimer’s disease. These symptoms can be controlled by using the following medications:

1. Sleep Inducers: This class of medicines includes zolpidem and zaleplon are to be used under caution and must not be used regularly by the patients. These drugs can further aggravate confusion in the patients.
2. Anti-Anxiety medicines: This class of medicines includes lorazepam, clonazepam. These medications to be used cautiously due to their side effects.

Antipsychotics and anticonvulsant drugs are used for the symptomatic management of the disease.

Outcomes

• Alzheimers disease is initially associated only with impaired memory, but with time, the individual may develop severe cognitive and behavioral symptoms like depression, anxiety, anger, irritability, insomnia, and paranoia.
• As the disease progresses most of them will require assistance with daily living activities.
• Eventually, even walking becomes difficult and many may not be able to eat or develop swallowing difficulties that lead to aspiration pneumonia.
• The time from diagnosis to death is variable; some individuals may die within five years, and others may remain alive for ten years, but overall the quality of life is very poor.
• While an interprofessional approach to the management of Alzheimer patients is recommended, an analysis of several studies reveals that this approach has no impact on the care of his patients.
• However, because of the heterogeneity in the previous studies, more robust studies will be required to determine what type of approach works best for managing these patients.

Expected Questions For the Medical Examination:

To make the things easier for the Alzheimers disease patients and the treating doctor, the patient can prepare themselves for the medical examination. Steps involve making a note of the questions the doctor might ask. The questions generally asked are:

1. What symptoms have you observed?
2. Since when these symptoms started appearing?
3. Did you feel any progression in these symptoms over this period?
4. Do you have any other diseases?
5. Are you on any medication?
6. Do you have any family member who has had Alzheimer’s in the past?
7. What is the diet chart that you follow?

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Avoid taking medicines that can affect thinking, such as pain or sleeping medicines.

Lifestyle

• Make healthy lifestyle choices:
  • Be physically active as told by your health care provider.
  • Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your health care provider.
  • Eat a healthy diet.
  • Practice stress-management techniques when you get stressed.
  • Stay social.
• Drink enough fluid to keep your urine clear or pale yellow.
• Make sure to get quality sleep. These tips can help you get a good night’s rest:
  • Avoid napping during the day.
  • Keep your sleeping area dark and cool.
  • Avoid exercising during the few hours before you go to bed.
  • Avoid caffeine products in the evening.

General instructions

• Work with your health care provider to determine what you need help with and what your safety needs are.
• If you were given a bracelet that tracks your location, make sure to wear it.
• Keep all follow-up visits as told by your health care provider. This is important.
• If you have questions or would like additional support, you may contact The Alzheimer’s Association:
  • 24-hour helpline: 1-800-272-3900

Contact a health care provider if:

• You have nausea, vomiting, or trouble with eating.
• You have dizziness, or weakness.
• You have new or worsening trouble with sleeping.
• You or your family members become concerned for your safety.

Get help right away if:

• You develop chest pain or difficulty with breathing.
• You pass out.

Contact a doctor if:

• The person has a fever.
• The person has a sudden behavior change that does not get better with calming strategies.
• The person is not able to take care of himself or herself at home.
• The person threatens you or anyone else, including himself or herself.
• You are no longer able to care for the person.

Patient Care Guide For Alzheimer disease:

Taking care of a patient with Alzheimers disease is always a challenging task. The patient requires 24/7 monitoring and assistance with everyday activities. There can be episodes where the patient may deny recognizing you and other family members.

Thus, the caregivers need to be mentally prepared to face the worse and handle things with utmost care. Caregivers need to comfort the patient and assist them emotionally as well as physically.

Few basic instructions for the proper care of an Alzheimers disease patient

1. Ensure Personal Comfort:
   The patients might not be able to express their pain, hunger, thirst, etc. Make sure to assist these daily routine activities. You might need to feed the patient on time even though they may not express their hunger.

2. Do not Confront:
    The patient has dementia and thus may express unreasonable demands at many times.      Be patient and do not confront, rather provide them comfort and assurance.

Like they        might express the desire to meet some relative who is already dead. In such a case,          don’t tell them about death, rather comfort them by saying that the person is coming to      meet them tomorrow.

3. Allow Adequate Rest:
    The person may not realize, but they are suffering from the disease. Being the                    caregiver, you must ensure that the patient needs an adequate amount of sleep and rest

4. Medical Help:
    If you notice any sudden changes in the behavior and activities of the patient take              medical help from the patient’s physician.

Alzheimer disease causes a person to lose the ability to remember things and make decisions. A person who has Alzheimer disease may not be able to take care of himself or herself. He or she may need help with simple tasks. The tips below can help you care for the person.

What kind of changes does Alzheimers disease cause?

Alzheimers Disease makes a person:

• Forget things.
• Feel confused.
• Act differently.
• Have different moods.

These things get worse with time.

Tips to help with symptoms

• Be calm and patient.
• Respond with a simple, short answer.
• Avoid correcting the person in a negative way.
• Try not to take things personally, even if the person forgets your name.
• Do not argue with the person. This may make the person more upset.

Tips to lessen frustration

• Make appointments and do daily tasks when the person is at his or her best.
• Take your time. Simple tasks may take longer. Allow plenty of time to complete tasks.
• Limit choices for the person.
• Involve the person in what you are doing.
• Keep a daily routine.
• Avoid new or crowded places, if possible.
• Use simple words, short sentences, and a calm voice. Only give one direction at a time.
• Buy clothes and shoes that are easy to put on and take off.
• Organize medicines in a pillbox for each day of the week.
• Keep a calendar in a central location to remind the person of meetings or other activities.
• Let people help if they offer. Take a break when needed.

Tips to prevent injury

• Keep floors clear. Remove rugs, magazine racks, and floor lamps.
• Keep hallways well-lit.
• Put a handrail and non-slip mat in the bathtub or shower.
• Put childproof locks on cabinets that have dangerous items in them. These items include medicine, alcohol, guns, toxic cleaning items, sharp tools, matches, and lighters.
• Put locks on doors where the person cannot see or reach them. This helps the person to not wander out of the house and get lost.
• Be prepared for emergencies. Keep a list of emergency phone numbers and addresses close by.
• Bracelets may be worn that track location and identify the person as having memory problems. This should be worn at all times for safety.

Tips for the future

• Discuss financial and legal planning early. People with this disease have trouble managing their money as the disease gets worse. Get help from a professional.
• Talk about advance directives, safety, and daily care. Take these steps:
  • Create a living will and choose a power of attorney. This is someone who can make decisions for the person with Alzheimer disease when he or she can no longer do so.
  • Discuss driving safety and when to stop driving. The person’s doctor can help with this.
  • If the person lives alone, make sure he or she is safe. Some people need extra help at home. Other people need more care at a nursing home or care center.

Where to find support

You can find support by joining a support group near you. Some benefits of joining a support group include:

• Learning ways to manage stress.
• Sharing experiences with others.
• Getting emotional comfort and support.
• Learning about caregiving as the disease progresses.
• Knowing what community resources are available and making use of them.

Summary

• Alzheimers disease causes a person to forget things and to be confused.
• A person who has this condition may not be able to take care of himself or herself.
• Take steps to keep the person from getting hurt. Plan for future care.
• You can find support by joining a support group near you.