Alzheimer - A Type of Dementia

About

It’s normal to forget things in normal day-to-day life. But as we grow older we take longer time to learn new skills or remember names or words or where we left our mobile. Of course, this doesn’t mean that an individual is suffering from Alzheimer’s. In fact, research has shown that only a very small percentage of older adults develop the form of dementia known as Alzheimer’s. However, there is a difference between occasional forgetfulness and behaviour that may cause for concern.

Alzheimer disease (AD) is a type of dementia, which is a progressive and irreversible brain disorder. AD slowly destroys and damages person’s memory and cognitive functions such as abstract thinking, planning, organizing and carrying the behaviours.

History

Alzheimer disease was first reported in 1907 by a German psychiatrist and neuropathologist, Alois Alzheimer who documented the case of a 51- year old woman complaining of poor memory and disorientation regarding time and place. He was unable to express this process of deterioration until after the women died, when an autopsy revealed that most of the tissue in the women’s cerebral cortex had degenerated. Ninety years later, a discovery of brain slides from this women confirmed that the changes seen in her brain were similar to current cases of disease.

Diagnostic Features:

The essential features of Alzheimer disease are as follows:

• Memory Loss

• Language Disturbances

•  Impaired ability to carry out coordinated bodily movements

•  Disturbance in executive Functioning.

• Spatial Disorientation

• Poor Judgement and Insight

•  Disinhibited Behaviour

•  Deterioration of social skills

•  Extreme Flatness or changeability of affect

These symptoms evolve over three stages: mild, moderate and severe. Their rate of progress varies from person to person and according to the stage of the disease, with the most rapid deterioration occurring during the middle phase

 Stages of Alzheimer Disease

 Diagnosis:

Earlier Alzheimer disease could only be confirmed after the patient’s died and autopsy was performed on the brain. Today, doctors can accurately diagnose Alzheimer in a living person by using following steps:

1) Patient’s Case History: A detailed information is gathered by the doctor which includes:

•  Description of how and when symptoms develop

•  Description of any medical condition in family history

•  Description of patient’s medical history

•  Description of patients emotional state and living environment

•  Interviewing patient’s family members and friends to gain insight into patient’s personality

2)      Physical Examination and Lab test: These test include evaluation of sight, hearing, heart, lungs,  temperature, urine, blood etc. to identify additional health problems such as diabetes or thyroid.

3)      Neuropsychological Testing: The most common neuropsychological test is Mini-Mental State Examination (MMSE). It is a screening tool which includes questions and tasks that helps to evaluate patient’s mental status. Patients respond in particular ways to several of the items on this instrument. They tend to be circumstantial, repeat themselves, and lack richness of detail when describing objects, people, and events.

4)      Brain Imaging:

•  MRI and CT scan are used to rule out other medical conditions such as brain injury, tumors, blood cloths.

•  PET scans are used to observe the brain activity from the use of glucose in specific areas of brain.

 Causes

1)      Biological Perspective: In People with Alzheimer’s disease  brain undergoes into two major types of changes:

•  One is the formation of neurofibrillary tangles, in which the cellular material within the cell bodies of neurons becomes replaced by densely packed, twisted micro fibrils or tiny strands of protein.

•  The other change that occurs is the development of amyloid plaques which are clusters of dead or dying neurons mixed with fragments of protein molecules.

2)  Genetics: Researchers have identified several genes that hold the key to understanding the cause of disease. They are as follows:

• The apoeE gene on chromosome 19 is unable to protect tau protein, leading to degeneration of microtubules, eventually leading to the destruction of the neuron.

•  Presenilin genes (PS1 and PS2) are involved in causing brain to age prematurely.

 Environmental Factors: Poor diet, Lack of Exercise and smoking are major reasons for development of Alzheimer’s disease.

Treatment

1) Medical Treatment: There is no cure for Alzheimer’s disease, however there are four medications approved by the U.S Food and Drug Administration are Donepezil (Aricept), Rivastigmine (Exelon), Galantamine (Remiryl) and Tacrine (Cognex). They improve memory and helps in goal-directed thought. These drugs are most useful for person with mild to moderate memory loss. Memantine is sometimes combined with donepezil to improve dementia.

Clinicians may also prescribe benzodiazepines for insomnia and anxiety, antidepressant for depression, and antipsychotic drugs for delusions and hallucinations.

Although the prospect of Alzheimer’s is frightening and painful for individuals involved, a number of medical interventions are available.