ALZHEIMER'S DISEASE

ALZHEIMER'S DISEASE

What is Alzheimer' s disease ?

Alzheimer's disease (AD),also known in medical literature as Alzheimer disease, is a type of dementia that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks. There is no cure for the disease, which worsens as it progresses, and eventually leads to death .It was first described by German psychiatrist and neuropathologist Alois Alzheimer in 1906 and was named after him. Most often, AD is diagnosed in people over 65 years of age, although the less-prevalent early-onset Alzheimer's can occur much earlier. Alzheimer's is predicted to affect 1 in 85 people globally by 2050.

AD develops for an unknown and variable amount of time before becoming fully apparent, and it can progress undiagnosed for years. On average, the life expectancy following diagnosis is approximately seven years. Fewer than three percent of individuals live more than fourteen years after diagnosis.

The cause and progression of Alzheimer's disease are not well understood. Research indicates that the disease is associated with plaques and tangles in the brain. Current treatments only help with the symptoms of the disease. There are no available treatments that stop or reverse the progression of the disease.

Because AD cannot be cured and is degenerative, the sufferer relies on others for assistance.

AD is one of the most costly diseases to society .

 History

It was 1901 that German psychiatrist Alois Alzheimer identified the first case of what became known as Alzheimer's disease in a fifty-year-old woman he called Auguste D. He followed her case until she died in 1906, when he first reported publicly on it.

During the next five years, eleven similar cases were reported in the medical, some of them already using the term Alzheimer's disease. The disease was first described as a distinctive disease by Emil Kraepelin after suppressing some of the clinical (delusions and hallucinations) and pathological features (arteriosclerotic changes) contained in the original report of Auguste D

About Alzheimer's Disease

Alzheimer's Disease & the Brain

• Alzheimer's changes the whole brain
• Neurons are the chief type of cell destroyed by Alzheimer's disease.
• Alzheimer's disease leads to nerve cell death and tissue loss throughout the brain.
• Over time, the brain shrinks dramatically, affecting nearly all its functions.

These images show:

A brain without the disease A brain with advanced Alzheimer's How the two brains compare

In the Alzheimer's brain:

• The cortex shrivels up, damaging areas involved in thinking, planning and remembering.
• Shrinkage is especially severe in the hippocampus, an area of the cortex that plays a key role in formation of new memories.
  
  
  
  
• Ventricles (fluid-filled spaces within the brain) grow larger.
  
  
• The damage disrupts communication between brain cells, crippling memory, speech, and comprehension.

Under the microscope

Alzheimer's tissue has many fewer nerve cells and synapses than a healthy brain.

• Plaques, abnormal clusters of protein fragments, build up between nerve cells.
• Dead and dying nerve cells contain tangles,which are made up of twisted strands of another protein.

Scientists are not absolutely sure what causes cell death and tissue loss in the Alzheimer's brain, but plaques and tangles are prime suspects.

Plaques & Beta-amyloid

Plaques form when protein pieces called beta-amyloid (BAY-tuh AM-uh-loyd) clump together. Beta-amyloid comes from a larger protein found in the fatty membrane surrounding nerve cells.

Beta-amyloid is chemically "sticky" and gradually builds up into plaques.

The most damaging form of beta-amyloid may be groups of a few pieces rather than the plaques themselves. The small clumps may block cell-to-cell signaling at synapses. They may also activate immune system cells that trigger inflammation and devour disabled cells.

Causes

• The cause(s) of Alzheimer's disease is (are) not known.
• The "amyloid cascade hypothesis" is the most widely discussed and researched hypothesis about the cause of Alzheimer's disease.
• The strongest data supporting the amyloid cascade hypothesis comes from the study of early-onset inherited (genetic) Alzheimer's disease.
• Mutations associated with Alzheimer's disease have been found in about half of the patients with early-onset disease.
• In all of these patients, the mutation leads to excess production in the brain of a specific form of a small protein fragment called ABeta (Aβ).
• Many scientists believe that in the majority of sporadic (for example, non-inherited) cases of Alzheimer's disease (these make up the vast majority of all cases of Alzheimer's disease) there is too little removal of this Aβ protein rather than too much production.
• In any case, much of the research in finding ways to prevent or slow down Alzheimer's disease has focused on ways to decrease the amount of Aβ in the brain.
• Many, but not all, studies have found that women have a higher risk for Alzheimer's disease than men. It is certainly true that women live longer than men, but age alone does not seem to explain the increased frequency in women. The apparent increased frequency of Alzheimer's disease in women has led to considerable research about the role of estrogen in Alzheimer's disease. Recent studies suggest that estrogen should not be prescribed to post-menopausal women for the purpose of decreasing the risk of Alzheimer's disease.
• Some studies have found that Alzheimer's disease occurs more often among people who suffered significant traumatic head injuries earlier in life, particularly among those with the apoE 4 gene.
• In addition, many, but not all studies, have demonstrated that persons with limited formal education - usually less than eight years - are at increased risk for Alzheimer's disease. It is not known whether this reflects a decreased "cognitive reserve" or other factors associated with a lower educational level.
  
  

 Stages

Early - Stage Alzheimer's

• In early Alzheimer's, long-term memories usually remain intact while short-term memories become sketchy.
• Patients may forget conversations they had.
• He or she may repeat questions that were already answered.
• The disease also disrupts speech, so patients may struggle to remember common words.
• In addition to memory loss, Alzheimer's can cause confusion and behavior changes.
• Patients may get lost in familiar places.
• Mood swings and poor judgment are also common, as is poor hygiene.
• People who once dressed with style may resort to wearing stained clothes and unwashed hair.

End-Stage Alzheimer's

• People with advanced Alzheimer's may lose the ability to walk, talk, or respond to others.

• Eventually, the disease can hinder vital functions, such as the ability to swallow.

• Patients in this stage may benefit from hospice care, which provides pain relief and comfort for the terminally ill.

How Alzheimer's Affects Daily Life

• Because Alzheimer's affects concentration, patients may lose the ability to manage ordinary tasks like cooking or paying the bills.

• A study suggests difficulty balancing a checkbook is often one of the first effects of Alzheimer's.

• As the symptoms worsen, patients may not recognize familiar people or places.

• He or she may get lost easily, or use utensils improperly, such as combing hair with a fork.

• Incontinence, balance problems, and loss of language are common in the advanced stages.

  
  

 Diagnosing Alzheimer's

• There is no simple test for Alzheimer's, so the doctor will rely on you to describe the changes in your patient.

• A mental status test, sometimes called a "mini-cog," or other screening tests can help evaluate the patient's mental function and short-term memory.

• In addition, neurological exams and brain scans may be used to rule out other problems, such as a stroke or tumor -- and they can help provide other information about the brain.

  PET scan of the brain of a person with AD showing a loss of function in the temporal lobe

   The Caregiver's Role

• As the caregiver of someone with Alzheimer's, you will probably wear many hats -- cook, chauffeur, accountant.

• While you may have to handle the meal planning and finances, encourage the patient to do some activities independently.

• It may help to label cabinets with their contents and put up sticky notes with reminders of daily tasks.

• Be sure to buy a weekly pill box for medications.

• In the early stages of Alzheimer's, patients often understand what is happening and may be ashamed or anxious.

• Watch for signs of depression because this can often be managed with medication.

• In the more advanced stages, patients may become paranoid or violent and could even turn on you. Remember that the disease is responsible for this change.

• Alert the doctor about violent behavior promptly.