Alzheimer's disease is the most common form of dementia. Usually, it develops very insidiously - the patient first develops a slight memory impairment that gradually builds up. What problems can be symptoms of Alzheimer's and how to treat it? Check

Alzheimer's disease( alzheimer , Alzheimer's disease, abbreviated as AD) belongs to the group of dementia disorders (dementia). for the majority of cases of these individuals - it turns out thatamong patients with dementia disorders, as many as 60 to even 70% of them suffer from Alzheimer's.

The relationship between advanced age and memory impairment was noticed by ancient people - the ancient Greeks and Romans associated old age, among others with memory loss.

Alzheimer's disease - one of the causes of memory disorders - was first described, however, only in 1901. It was then that a psychiatrist of German origin, Alois Alzheimer, was treating a 50-year-old patient with symptoms of dementia, and eventually the name of the disease was derived from his name.

Typically Alzheimer's disease develops after the age of 65 , but it may also appear earlier - in a situation where a patient under 65 develops Alzheimer's disease, the disease is defined by then as early-onset Alzheimer's.

The majority of elderly people suffer from this problem, but it also happens that early-onset Alzheimer's disease begins in a person in their 30s. Luckily, this form of the disease accounts for only about 5% of all cases.

Alzheimer's disease is diagnosed more often in women.According to European statistics, 5% of people 65 or older struggle with this disease. In Poland, according to estimates, the number of people suffering from Alzheimer's already exceeds 300,000.

Causes of Alzheimer's disease

Doctors have already managed to find out some things about the causes of Alzheimer's disease, but one thing can be said for sure: the exact pathogenesis of this disease has not yet been known.

Generally, genes are suspected of a significant share in the development of the disease, in practice, however, the relationship of genetic mutations with the development of Alzheimer'scan be clearly identified in only 1-5% of all cases of this disease.

In approximately 0.1% of cases, Alzheimer's occurs as an autosomal dominant disease, which is then referred to as early-onset familial Alzheimer's disease.

Most of all cases of this form of Alzheimer's are due to mutations in the presenilin 1 and 2 genes (PS-1 and PS-2 genes) and the amyloid precursor protein (APP gene) gene.

However, the vast majority, exceeding 90%, are sporadic cases of Alzheimer's disease, i.e. those where specific genetic mutations cannot be directly related to the disease.

In this case, however, it is also believed thatmay be related to the onset of the disease by thegenes (but it is impossible to determine which ones exactly).

Apart from them, various environmental factors can also influence the development of the disease. Overall, however, much more than the causes of Alzheimer's disease, the mechanism by which pathological changes in the central nervous system occur.

Alzheimer's disease: pathomechanism

Alzheimer is a neurodegenerative disease - it is associated with a progressive loss of nerve cells, which is irreversible and is responsible for the symptoms of Alzheimer's that appear in patients.

It has already been observed thatin the course of Alzheimer's disease there is a decrease in the number of neurons in patients(especially the structures of the limbic system, temporal and frontal cortex) and to reduce the number of synaptic connections between individual nerve cells.

Disturbances in cholinergic transmission are also characteristic of the disease - patients develop deficits of this neurotransmitter and the effect on its levels is one of the basic therapeutic methods offered to people suffering from Alzheimer's.

In Alzheimer's disease, nerve cells die - the problem is related to the deposition of pathological substances in the nervous system.

We are talking primarily about the tau protein (which accumulates inside nerve cells) and about beta-amyloid deposits (which, in turn, is deposited between neurons).

Both of these substances are toxic to the structures of the nervous system and ultimately lead to both dysfunction of neurons and their gradual dying off.

Risk factors influencing the occurrence of Alzheimer's disease

Some problems can be listed that increase the possibility of occurrence to varying degreesAlzheimer's. The risk factors for this disease include:

  • age(the older the patient is, the greater the possibility of getting sick)
  • occurrence of Alzheimer's disease in family members of the patient
  • genetic burden(the best known gene that increases the risk of Alzheimer's disease is the ε4 allele of the apolipoprotein E gene - having one such allele increases the risk of the disease threefold, while the patient has two alleles ε4, then the risk of Alzheimer's disease is increased up to fifteen times)
  • head injuries(Alzheimer's has been seen to be more common among people who have experienced severe head injuries in their lifetime)
  • certain diseases(Alzheimer's is associated with diabetes, hypertension and obesity, among others)
  • exposure to toxic substances(e.g. to pesticides or heavy metals)

Symptoms of Alzheimer's Disease - Early, Moderate and Advanced Stage

There are usually three stages of Alzheimer's disease:

  • Initial Alzheimer's Stage
  • moderate stage of Alzheimer's
  • advanced stage of Alzheimer's

Initial Alzheimer's Stage

The onset of Alzheimer's is usually difficult to spot- this is due to the fact that the least pronounced disorders appear at this stage. Among them, memory problems dominate (first of all, the so-called fresh memory is disturbed).

During this period of illness, the patient may ask for the same questions several times during one conversation. Sometimes he forgets where he put some things (e.g. keys or glasses), he often does not remember whether he has performed any activity (e.g. a sick person may wonder if he has eaten breakfast).

The first spatial orientation difficulties appear in the initial stages of Alzheimer's(sometimes it may be more difficult for the patient to find his way home).

Memory disorders are not the only manifestation of the disease - apart from them, behavior changes begin to appear in the patient. He becomes lethargic and often falls into a depressed mood. He may be much less willing to perform activities that he has enjoyed so far, and may also lead to a general decline in his activity.

The first problems related to speech may also appear - the patient's statements may become more and more impoverished, he may lack words during conversations.

Moderate Alzheimer's Stage

As the disease begins to progress, Alzheimer's symptoms are usually much more soclear to the patient's surroundings. Memory disorders worsen -the patient may slowly stop recognizing their loved ones .

However, behavioral disorders that develop are usually much more difficult for the caregivers of the patient. Compared to the initial stage, behavioral disturbances are much more pronounced in moderate Alzheimer's.

The patient has a very irritable mood, he may often experience outbursts of aggression (usually directed at his loved ones).

There may be other problems, such as voraciousness, attempts to chew inedible objects or sexual disinhibition.

There may also be a reversal of the rhythm of sleep and wakefulness (usually leading to considerable difficulties in caring for a loved one).

The patient may be most active at night and only sleep during the day.In the moderate stage of the disease, patients also develop psychotic symptoms such as hallucinations and delusions quite frequently.

Advanced Alzheimer's Stage

In the most advanced stage, the patient completely loses the ability to function independently - he or she requires constant care from his loved ones.

It is difficult to talk about problems with memory in this case - usually at this stage of Alzheimer's disease, the patient is basically no longer in contact (if he says anything, they are usually single, rather incomprehensible words).

There are also other difficulties, such as movement disorders (e.g. increased muscle tone), urinary incontinence or faecal incontinence.

Alzheimer's disease or age-related memory impairment?

People who have elderly people in their families often panic when they notice that they sometimes forget something.

It is perfectly normal for cognitive function to decline to some extent with age. If a person occasionally forgets where an object is lying or does not remember any details from a few moments ago, and at the same time nothing else is bothering him - there are probably no reasons for concern.

In a situation where there are more serious episodes of memory disorders, and what is worse - with time they get worse - then there is a possibility that the patient's problems are caused by dementia disorders and it is most advisable to consult a doctor.

Diagnosis of Alzheimer's disease

When Alzheimer's disease is suspected, many different tests are performed, such as :

  • neurological examination(it allows to determine the presence of any deviations in the patient that could suggest what is the cause of his dementia)
  • screening tests for the initial diagnosis of dementia(such as e.g. clock drawing test or MMSE test)
  • neuropsychological tests(it is possible to precisely determine the degree of the patient's cognitive deficits)
  • head imaging(e.g. computed tomography or magnetic resonance imaging)

Carrying out a thorough diagnosis in a patient suspected of having Alzheimer's disease is absolutely crucial - just as it is quite easy to diagnose dementia, it is much more difficult to determine what type of dementia has occurred in the patient.

Alzheimer's disease must in fact be differentiated from other types of dementia (e.g. with frontotemporal dementia or dementia with Lewy bodies), but also with the causes of reversible dementia, which may include:

  • depression
  • vitamin B12 deficiency
  • anemia
  • hypothyroidism

At the same time, it should be emphasized here that a certain diagnosis of Alzheimer's disease can only be made by examining the nervous tissue and detecting the deposits characteristic of this entity - for this reason, the final diagnosis is made only after the patient's death.

Alzheimer's disease treatment

Currently, there is no causal treatment for Alzheimer's disease - only therapeutic methods that slow down the pace of the disease are available.

Neurological deficits that will appear in a patient cannot be reversed - this is why the necessity to treat people with Alzheimer's as early as possible is emphasized so much.

In the treatment of Alzheimer's disease, drugs from the group of cholinesterase inhibitors are used primarily. This enzyme breaks down the neurotransmitter that may be missing in patients, i.e. acetylcholine, and its blockage leads to an increase in its amount in patients using the drug.

Examples of agents from this group are rivastigmine, donepezil. A drug with a different mechanism of action, also used in the treatment of Alzheimer's disease, is galantamine.

The above-mentioned measures are the basic ones used in the treatment of Alzheimer's disease.

Sometimes, however, patients are recommended completely different preparations - as an example, we can mention antipsychotic drugs, which are used in patients who frequently experience, for example, agitation andaggression.

Pharmacological treatment is certainly treated as a specific basis of therapy in patients with Alzheimer's , but it is certainly not the only method that can positively affect the condition of patients.

We are talking here about various interactions aimed at improving memory in patients, such as, for example, special memory exercises (during which, for example, photos belonging to the patient's collection may be used).

Alzheimer's disease: prognosis

Alzheimer's disease, unfortunately, shortens the lives of patients suffering from it.This disease can take many different forms, but it is generally estimated that the time from diagnosis to death of the patient is 3 to 10 years.

The causes of death of a person suffering from Alzheimer's disease can be different, but in general, due to the fact that eventually patients become completely unable to get out of bed, they most often die from dehydration and pneumonia with complications.

Prevention of Alzheimer's disease

Due to the fact that the causes of Alzheimer's disease have not been fully understood, it is impossible to say exactly how to prevent this disease.

As a prophylaxis, a he althy lifestyle is primarily recommended - maintaining a proper body weight, using a varied, nutrient-rich diet and exercising regularly.

Avoiding stimulants (e.g. smoking) can also reduce the risk of falling ill, as well as preventing head injuries - e.g. by wearing a helmet every time you go on a bicycle or rollerblades.

The relationship between the course of Alzheimer's disease and human education is quite interesting - it turns out thatpeople with higher education usually get sick at a later age , and additionally Alzheimer's is milder in them.

It is worth describing here one of the Alzheimer's risk factors, which was mentioned earlier, i.e. the burden of the ε4 allele.

Some people might think that it is worth using research that gives an answer to the question of whether you are a carrier of this gene. In practice, however, the performance of such analyzes is quite controversial. Well, burdening this allele does increase the risk of the disease, although it does not necessarily mean that you will actually get sick.

Additionally, if you even have two ε4 alleles and know them, all you can do is maintain a he althy lifestyle - they don't get treatment to prevent Alzheimer's disease.

It is these aspects that make manydoctors emphasize that the research on the carrier of the ε4 allele brings in fact little benefit, and in fact they lead to the emergence of anxiety in patients.

Alzheimer's disease is a disease of celebrities

Alzheimer's disease has affected many famous people, incl. former US President Ronald Reagan, French actress Annie Girardot, American actress Rita Hayworth, and American singer and actor Dean Martin.

About the authorBow. Tomasz NęckiA graduate of medicine at the Medical University of Poznań. An admirer of the Polish sea (most willingly strolling along its shores with headphones in his ears), cats and books. In working with patients, he focuses on always listening to them and spending as much time as they need.

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Neurology