Alzheimer’s disease (AD) is one of the most common neuro–degenerative diseases in the elderly. It is a form of dementia which causes cell changes in parts of the brain responsible for memory, language, perception and behaviour. This progressive decline in cognitive function often causes challenges with activities of everyday living. It is not a normal part of aging and not curable.
The actual cause of AD has however not been found yet. Current research indicates that a progressive loss of brain cells is related to the formation of abnormal insoluble protein fragments, in and around the brain cells – called “beta-amyloid plaques”. Another characteristic sign of AD is the presence of “tangles” within the brain cell itself. Abnormal twists of tau (a vital protein in healthy cells) within the cells causes cell death in the affected areas of the brain. Neuro/Nerve cell death in the brain results in brain shrinkage over time which affects nearly all its functions.
Aging appears to be the most decisive cause of AD, but other factors such as gender and genes also play a role. In the majority of cases (95%), the disease develops in older people aged 65 and older. AD is not caused by a single factor, but by a number of factors that affect people differently. Damage to the brain from physical trauma, metabolic disorders, lifestyle habits and toxins may also influence the development of the disease.
A small percentage of people develop the disease at an earlier age; between 35 and 60 years of age. This is known as “early-onset” AD where there is thought to be a link with genetics as cases tend to cluster within certain families.
Signs of Alzheimers Disease:
AD affects people in different ways at different stages. The first signs that are usually noticed are: short term memory loss and forgetfulness. As time passes, other abilities might also be affected which will vary from person to person.
AD signs & symptoms can be divided into three categories: Cognitive symptoms, Behavioural- and Functional symptoms.
Cognitive symptoms can be summarized as:
- Forgetfulness – losing keys, wallet or glasses. Forgetting food on the stove, forgetting of important appointments, recent conversations. Short term memory is usually affected.
- Indecisiveness- Difficulty in making decisions, coming to conclusions and rationalizing.
- Disorientation- Getting lost in familiar places.
- Language Difficulties- Difficulty in finding the right words, vague or incoherent speech.
- Lack of recognition- Reduced ability recognise familiar objects or even family members.
Functional symptoms include:
- Neglect personal hygiene- not brushing teeth or bathing.
- Difficulty grooming and dressing- not brushing hair, unable to button clothing or tie shoes.
- Difficulty handling money- shopping or doing hobbies. Inability to give correct change or pay bills.
- Loss of control of posture of walking- slumped stance, impaired walking, shuffling gait.
Behavioural symptoms include:
- Changes in mood – increased agitation, aggression and irritability.
- Socially Inappropriate behaviour- talking too loudly.
- Wandering- Pacing up and down in one area, repeated attempts to leave the house, roam around.
- Sleep disturbances- changes in sleep cycle, waking during night time.
- Delusions- unfounded belief that people are stealing belongings or that a spouse or carer is an imposter.
- Hallucinations- perceptions of intruders, misidentification of people, seeing objects or people that do not exist.
Many of these behavioural changes will appear to affect the person’s overall personality and can be particularly distressing to friends and family. Some people suffering from the disease might even become very aggressive and appear unkind and accusing. Often these symptoms can be relieved with treatment. It is important to remember that the disease is responsible for these changes and that the person is not behaving that way on purpose. Despite these complicated symptoms the person’s ability to express emotions and feelings will not be impaired.
Treatment
There is currently no cure for AD. There are several treatments that can ease or slow the development of certain symptoms. An early diagnosis means that treatment can be started as soon as possible, to help improve the quality of everyday life for both the individual with the disease as well as the family.
Medical treatment is divided into two main categories
- Acetylcholinesterase inhibitors (AChEI’s).
- N-methyl-D-aspartate (NMDA) receptor antagonists.
AChEI’s act to raise levels of chemicals in the brain (acetylcholine) that are abnormally low in early stages of AD. Generic names for these treatments are Donepezil (Aricept), Galantamine and Rivastigmine.
NMDA receptors antagonism act to protect the brain from overstimulation by a chemical (glutamate) that can damage and eventually kill brain cells. Memantine (Namenda) is the only drug in this class and has been shown to improve various symptoms of AD related to cognition, function and behaviour, even in the advanced stages of the disease.
Treatments are taken orally as tablets or liquids and can be administered at home. It is important that someone oversees that the person with AD sticks to the prescribed dose and keep contact with the doctor to get the best effects of treatment. It is normal for a person to start on a low dose of medication which is then gradually increased by their doctor until the required level or “maintenance dose” is reached. A minimum of 6 months should be allowed, during which cognitive, functional and behavioural status is monitored, before any definite decision regarding efficacy of the treatment is made. Response to the treatment should not be judged on the basis of monitoring change in only one of the above domains, as symptoms vary from person to person, so does the response to these treatments. It is advised to consult a health-care professional (GP, Geriatrician, Psychiatrist) to discuss the potential benefits and disadvantages of treatment.
To get hold of Alzheimer’s South Africa:
ASA Mpumalanga (based in Nelspruit)
Contact details: 013 752 3578
Email: adminmp@alzheimers.org.za
Website: www.alzheimers.org.za
Article supplied by: Alzheimer's SA NPC