Alzheimer’s Disease is one of the most common forms of dementia, comprising 50-75% of all cases. Dementia is a general term for impairment, or loss of intellectual capacity or memory, due to the loss/damage to neurons in the brain. The greatest known risk factor for Alzheimer’s dementia is increasing age. Patients rarely show symptoms before the age of 50, but risk for the disease quickly doubles every 5 years, starting from a level of 1% for the 60 to 64-year-old population and reaching 40% or more for the 85 to 89-year-old cohort. These symptoms are thought to be due to the progressive loss of neurons in the cerebral cortex of the brain, usually involving the frontal lobe. This degeneration usually results in progressive loss of mental function, which worsens over time. Dementia, in the case of Alzheimer’s Disease, can advance to be serious enough to interfere with daily life.
Scientists think that Alzheimer’s dementia results from the accumulation of proteins on neurons, which develop into what is termed plaques and tangles. These plaques are deposits of a protein fragment called beta-amyloid, and the tangles are composed of twisted fibers from the protein called tau. These proteins disrupt the communication between neurons in the brain and cause their degeneration. The reason these plaques and tangles develop in Alzheimer’s Disease is being heavily researched. Scientists are trying to better understand the pathogenesis of this disease to ultimately develop more effective diagnostic tools and treatments.
The first symptom a patient may notice is an increase in forgetfulness and moderate confusion. The brain may no longer be able to interpret what the patient is seeing so they may frequently get lost in familiar places. Over time these symptoms may worsen. Patients may have difficulty organizing their thoughts and emotions. They may become easily agitated and their conversational skills may dramatically decrease. Alzheimer's patients may develop spatial and orientation problems. They may become disoriented and lose their sense of time. These patients may develop problems with routine daily activities and tasks. Thinking and reasoning is often impaired which results in poor judgment. Family and friends are usually the first to note a change in personality and behavior; thus, they are vital to the patient’s diagnosis and care.
Currently there is no specific test that can confirm a patient has Alzheimer’s Disease. This disease can only be diagnosed with complete accuracy after death by microscopic examination of brain tissue. To help the physician distinguish the symptoms of Alzheimer’s disease from other dementia-like disorders, a series of tests may be suggested. The physician will usually begin with a physical exam focusing mostly on neurologic health. A brief mental status test will allow for the physician to gauge your memory and thinking skills. This test usually includes a series of common questions and simple tasks such as, writing down a complete sentence, remembering three words, and following a three-step command. Further Neuropsychological testing and brain imaging may be needed to rule out all other possible dementias. The physician may even refer the patient to an Alzheimer’s specialist, a special type of neurologist, for a more complete diagnosis. Together, all this information can help the healthcare team make a diagnosis that a patient’s symptoms and signs are Alzheimer's.
Unfortunately, there is no available cure for Alzheimer’s Disease. However, many treatments have minimized the disease progression and symptoms. There are many medications for memory such as cholinesterase inhibitors, which help maintain levels of certain neurotransmitters in the brain. This helps with brain function and memory loss. Other medications can be prescribed for sleep problems and behavioral symptoms. In addition to prescribed medication, patients may take dietary supplements. Most of these supplements, however, are not rigorously scientifically researched; thus, their use is not recommended by the FDA for treatment of Alzheimer's.
Beyond medication and supplements, an important part of an Alzheimer’s treatment is creating a safe and supportive living environment. Simple gestures such as removing excess furniture and applying handrails in the patient’s living space can reduce the risk of falls. It is also suggested to reduce the number of mirrors in the home. People with Alzheimer’s may find the images confusing or frightening. Keeping a daily routine can help a patient feel relaxed and unsurprised. Regular exercise, good nutrition, and good hygiene are an important part of the patient’s wellness plan. Exercise can promote a restful sleep and prevent constipation. Alzheimer’s patients may develop trouble walking, thus they may require daily assistance. Supportive care is vital in a successful Alzheimer’s patient treatment, thus healthcare professionals and family/friends must work together to obtain an optimal treatment plan.
Ashley Loan and Justin F. Fraser, MD