Alzheimer's Disease - Dementia

What is Dementia?

An acquired global impairment of personality, intellect and memory without any impairment in consciousness.

Dementia can either be progressive or non progressive depending upon the cause. It is noteworthy that Dementia is NOT a disease, it is simply a collective name given to a a group of disorders that may bring about the changes in memory, intellect and personality.

ALZHEIMER'S DISEASE

A TYPICAL CASE SCENARIO of Alzheimer's Disease:

"A woman in her early 50s was admitted to a hospital because of
increasingly odd behavior. Her family reported that she had been
showing memory problems and strong feelings of jealousy. She also
had become disoriented at home and was hiding objects. During a
doctor's examination, the woman was unable to remember her
husband's name, the year, or how long she had been at the hospital.
She could read but did not seem to understand what she read, and
she stressed the words in an unusual way. She sometimes became
agitated and seemed to have hallucinations and irrational fears."


Alzheimer's Disease is the leading cause of Dementia amongst the older people today.

According to the latest epidemiological survey, this progressively detoriating cause of dementia effects about four million people in the United States of America. 1 in every 10 people will suffer from Alzheimer's disease in the population of people greater than 65 years of age. This figure, however, becomes a staggering 1 in ever 2 persons for people over the age of 85 years. Approximately, fifty thousand deaths in the USA are directly caused by Alzheimer's disease. So yes, you are dealing with a big problem!

What causes Alzheimer's Disease?

Extensive research has been targetted at finding the basic cause of the development of this progressive dementia however, no single factor can yet be labelled as the soitary cause of Alzhiemer's Disease. Many pathology causing theories have been put forward amongst which the most widely accepted conclude the presence of :

*Neurofibrillary tangles in the Cortex of the Brain
*Amyloid or Senile Plaques
*Widespread loss of Acetylcholine in the CNS
*Selective neuron loss in the Hippocampus and Entorhinal areas the brain
*Decrease in the number of synapses in the CNS
*Tau protein abnormalities

Signs and Symptoms

The presence of signs and symptoms, in the early stages of the disease, are very much dependant on the pre-morbid personality of the individual. A shy, reserved and introvert type of a person will show more signs of the disease at an early stage whilst a socially skilled person can go on functioning adequately till much later stages of the disease.

*Memory Impairment --> This is the foremost sign of AD. Initially the short term memory is effected. The patients will have trouble understanding new concepts or new routines. They will forget their new neughbour's name however will not forget how to ride a bicycle, in the initial AD stages. In later stages the long term memory is also hampered.

*Mood Disturbances/Behavioural Changes --> Fluctations in the moods are present varying from depression to anger to aggressive behaviour. Many patients lose their social inhibitions and commit various embarassing actions like undressing in public etc.

*Catastrophic Reactions --> Patients, when moved from routine, can show signs of aggression

*Organic Orderliness --> A patient of Alzheimer's Disease likes to live by a very strict routine.

*Psychotic Symptoms --> Some of the patients may harbour Depression while some have been reported to have haluucinations. The most common Hallucinations known to occur in an Alzheimer's patient are Persecutory Hallucinations (patients complain of theft or robbery when nothing has happened in actuality).

Risk Factors

Genetics and Family History

Advancing Age

Smoking

Alcohol

Atherosclerosis

Increases plasma Homocysteine levels

Diabetes Mellitus

Down's Syndrome

Mild Congnitive Impairment (MCI) ---> One study claims that 40 percent of over 65 years inviduals who had MCI developed Alzheimer's Disease within the next three years!

Diagnosing Criteria

Comprehensive History and Examination to rule out any other problems
Mini Mental State Exam
MRI
EEG

According to DSM IV, the presence of the following features is necessary to label a person suffering from Alzheimer's Disease:
*Memory Impairment

*One or more of --> Aphasia,
Apraxia,
Agnosia,
Disturbance in Executive Functioning

*Exclusion of other organic disorders

Treating Alzheimer's Disease
Though there is no cure for Alzheimer's, the treatment aims to increase the quality of the life of the patients. A BioPsychoSocial standard plan for the treatment of Alzheimer's disease is given below.

Bio or Medical Therapy: Though there are devised medications for the treatment of Alzheimer's disease, it is important to remember that this a disease that runs on a one way road only, there is NO cure for Alzheimer's as yet. Medications will help the symptoms of the disease to get better but it cannot slow down or cure the disease.

*Choline esterase inhibitors (Tacrine, Donezapil, Rivastigmine, Galantimine) are the mainstray therapy. They work to increase the amount of Acetylcholine in the CNS, as these patients have increasingly low levels of AcH in their systems.

The following are given to the patients with specific symptoms:
*Anti Convulsants
*Sedatives
*Anti Depressants

Psychosocial Help
Secure Environment and Understanding:
The patients of Alzheimer's Disease require continous care by the ones looking after them. They need understanding and love. A normal routine life in a loving and caring environment is perhaps the answer to alot of poblems they face. These patients should be kept away from harm's way. All harmful objects in a household should be kept locked away from their way and they should not be allowed to drive themselves or go wandering about by themselves.
Care takers might feel burdened by the round the clock care needed by their loved ones suffering from Alzheimer's so it is necessary to take timely shifts in doing the duty.

Cognitive Therapy, Leisure activities and Exercise should be encouraged amongst these patients.
Support Groups help can seeked as needed.