Help And Guidance For Alzheimer's Disease


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Alzheimer's disease occurs as a result of changes in the human brain. Although the causes are unclear as of today the levels of chemical messengers decreasing can bring on the signs of Alzheimer's disease. Over time this can deteriorate the person's way of thinking and lead to all the stages of dementia.

Alzheimer's disease is a very destructive disease that not only affects the patient but also the family of the patient.

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Help And Guidance For Alzheimer's Disease

  1. 1. ==== ====Learn more information about Alzheimers disease, signs and symptoms, diagnosis and treatmentat: ====Alzheimers disease is the most common type of dementia. The disease was first observed by aGerman psychiatrist and neuropathologist Alois Alzheimer in 1906 and is named after him.Alzheimers disease is an incorrigible neurodegenerative disorder generally occurring inindividuals above 65 years of age but cases with early onset of the disease are not uncommon. Areport presented in 2006 specified that about 26.6 million individuals suffer from thisneurodegenerative disease. The symptoms of this disorder are although inimitable for everyindividual but there are many symptoms that are common. The initial symptoms of the disease areloss of the capability to form new memories and inability to recall current events. Diagnosis ofAlzheimers disease is based on cognitive tests and brain scan. As the disease advances theindividual shows the symptoms of confusion, irritability, aggression, mood fluctuations, languageproblems and finally long-term memory loss. The vivacious functions of body fail to operate anddeath is the decisive fate. Less than 3% percent live for about fourteen years after the diagnosis ofthe disease.The precise cause of Alzheimers disease is still not understood. Researches carried out all overthe world designate that the disease is caused due to the accretion of plaques and tangles in thebrain. Although treatment for this disorder is available but the chances of complete recovery isless. More than 500 clinical trials have been carried out but meticulous reason for the occurrenceof this disorder is yet not available. Mental stimulation, balanced diet and exercise arerecommended for the patients of this disorder. As Alzheimers disease is degenerative andincurable disease proper management of the patient is essential. Family support is sturdilyrequired.Who are at risk?The prime factor blamable for Alzheimers disease is increased age and as the age of theindividual increases the risk of this disease also increases. According to a report about 10% of theindividuals belonging to the age group of 65 and 50% of the individuals of the age group of 85suffer from Alzheimers disease. According to a guesstimate the number of patients of this diseasewill increase to 14 million by 2050. Genetic factors are also thought to be responsible for thisdisease and most of the individuals develop this disorder after the age of 70.However, about 2-5% of the individuals develop the symptoms in their early forties and fifties. Thechildren of a person with early onset of the symptoms of Alzheimers disease are at 50% risk ofdeveloping this disorder. The gene located on chromosome 19 is believed to be responsible forthis disease. However, in majority of cases specific genetic risks have not been identified yet.Other risk factors associated are high blood pressure, coronary artery disease, high bloodcholesterol and diabetes. All the patients of Down syndrome develop this disorder in their forties.
  2. 2. SymptomsThe onset of the disease is gradual but the symptoms become more penetrating as the diseaseadvances. Problems associated with short-term memory normally arise in the earlier phase of thedisease. Mild personality changes also occur in the preliminary phase of the disorder. With theadvancement of the disease the patient develops symptoms of difficulty in abstract thinking andother intellectual impairments. The patient feels difficulty in carrying out the office work also.Behavioral changes also take place. In later cases the person becomes confused and disorientedin relation to month, time, people and places. The person is also at the jeopardy of getting infectedwith pneumonia and the condition become worse before the death of the patient.Ten warning signs of Alzheimers disease and mild cognitive impairmentThe Alzheimers Association has developed a list of warning signs that can help the medicalexpert to ascertain whether a person is suffering from Alzheimers disease or not. These signs arememory loss, difficulty if performing duties coupled with family. Problems with language,disorientation in relation to time and place, decreased judgment ability and difficulty in abstractthinking. Misplacing things, mood fluctuations, behavioral changes and loss of ability to takeinitiative for any task are also common. The advancement of this disorder is precarious andsluggish and the memory status of the patient becomes inferior day by day but he or she may notdevelop dementia as there are convinced criteria that form the baseline of dementia. Thissyndrome is recognized as Mild Cognitive Impairment (MCI) and can be analyzed only afterneurophysiological testing. There are numerous forms of MCI but the most common one isassociated with memory impairment. The aptitude to plan a work and the cognitive ability of theindividual are not affected in this syndrome. Individuals with this type of MCI are known asamnestic MCI and have a high risk of getting affected with Alzheimers disease. Individuals withincapability of decision making are at low risk of developing Alzheimers disease.Causes and risk factorsThe rigorous cause of the disease is still vague but the amyloid cascade hypothesis is mostextensively discussed and agreed in this context. The data that supports this hypothesis actuallycomes from the early onset of Alzheimers disease that had a genetic basis. In about half of thepatients with early onset of symptoms of Alzheimers disease, mutations play a key role. In allthese patients mutations result in the disproportionate production of a protein fragment known asABeta in brain. In the present scenario much of the research is focused on finding out the ways toslow down the extreme production of this protein in Alzheimers disease. The biggest and theprincipal significant factor of this disorder is the increased age. The individuals belonging to theage group of 65-85 are at the double risk of developing this disease. Only 1-2% of individuals of70 years of age develop Alzheimers disease however, about 40% individuals of 85 years of agedevelop this disorder. The individuals that lived in the past for about 95 years were not thesufferers of this disease.There are many genes that can be considered responsible for the development of this disease butthey may not develop the disorder every time. The major risky gene that is generally consideredresponsible for AD is apoE that encodes for apolipoprotein E. This gene apoE occurs in threealleles namely apoE2, apoE3 and apoE4. The allele apoE4 is believed to upsurge the risk of the
  3. 3. disease and the frequency lies below 30%. The individuals with one copy of apoE4 have two-threetimes increased risk of developing Alzheimers disease and those with two copies of this allelehave nine-fold increased risk. Generally individuals with two copies may not suffer from thedisease always but only one copy of E4 is generally found in individuals with late onset of thedisorder. We can predict here that genetic basis does not form a strong baseline for Alzheimersdisease. Genetic tests also do not forecast that the children of the patients of this disease are atthe risk of developing this disorder in their lifetime. Majority of the studies carried out havesignposted that females are at a superior risk of developing Alzheimers disease in comparison tomales. It is clear that the lifespan of females is longer than males but this criterion cannot becorrelated with the occurrence of AD. Scientists believe that the estrogen level can be comparedwith the risk of developing the disease, so much research is now focused on this issue. Evenstudies have indicated that the individuals who have received traumatic head injuries are at anelevated risk of developing Alzheimers disease.Diagnosis and importance of clinical evaluationNo specific blood test and imaging technique can predict that whether a person is suffering fromAlzheimers disease. For the diagnosis of this disorder a person must fulfill the criteria that formthe baseline for dementia. A number of factors can be considered responsible for the developmentof dementia. Neurological disorders namely Parkinsons disease, brain tumors, blood clots,cerebrovascular disease and strokes can be sometimes associated with dementia. Chronicsyphilis, chronic HIV can also sometimes develop the symptoms of dementia. Many medicationsnamely those used for the control of bladder urgency and incontinence can also cause cognitiveimpairment. Psychiatric and neurological medications are also responsible for cognitiveimpairment. If the medical expert finds these medication problems in the patient he sturdilyrecommends halting the usage of these drugs. In older individuals that usually suffer fromdepression also develop the problems associated with memory and concentration loss and such acondition can be specified as pseudodementia. Excessive use of alcohol and illegal drugs can besometimes responsible for the symptoms of dementia. Thyroid dysfunction, thiamine deficiencyand steroid disorders can also lead to cognitive impairment. Blood clots outside the brain regioncan also cause symptoms of dementia. Carbon monoxide poisoning leads to encephalopathy thatdevelops symptoms of dementia. Sometimes heavy metal poisoning is also consideredresponsible for dementia.Since a number of disorders are often confused with Alzheimers disease a comprehensive clinicalevaluation is very important for the accurate diagnosis of the disease. Three procedures aregenerally followed while diagnosing the disorder and these are a complete medical workup,neurological examination and psychiatric evaluation. These evaluations usually continue for atleast an hour. In the United States healthcare system a combined help of neurologists,psychiatrics and geriatrics is taken. Even a single physician can also perform the evaluation well.The American Academy of Neurology has given some guidelines that include brain imaging whileworking with the patients of dementia. These imaging techniques comprise non-contrast CT scanor MRI scan. SPECT, fMRI, PET can also be of help but are not used. In areas outside the UnitedStates brain imaging is considered an important part while diagnosing Alzheimers disease. Thesearch for an efficient blood test for the perfect diagnosis of Alzheimers disease is still going on.Prognosis
  4. 4. Alzheimers disease is customarily a progressive disorder that reaches its peak within the intervalof 8-15 years. The patients generally do not die with the disorder alone but they also suffer from anumber of others problems also like they feel difficulty in swallowing, walking and are at anelevated risk of getting infected with pneumonia. In the later courses of the disease strongly familyassistance is required. A patient of Alzheimers disease is however unable to solve numericalproblems but can feel interest in reading a magazine. Playing of piano may be too difficult for thepatient as he commits many mistakes but the ability of singing and listening to music remainsunaffected. Playing chess may be too difficult for the patient but he or she may feel pleasure whileplaying tennis.TreatmentThe treatment of Alzheimers disease can be placed under medication based and non-medicationbased categories. FDA has classified two groups of pharmaceuticals for the treatment of thisdisease and these are cholinesterase inhibitors and partial glutamate antagonists. But none of thedrugs can perfectly slowdown the rate of progression of Alzheimers disease. In patients sufferingfrom this disorder the process of formation of the brain neurotransmitter especially theacetylcholine stops and research has indicated that this chemical plays a crucial role in memoryformation. The cholinesterase inhibitors (ChEIs) participate in blocking the breakdown of thisneurotransmitter and therefore, help in memory formation. FDA has approved four cholinesteraseinhibitors namely donepezil hydrochloride, rivastigmine, galantamine and tacrine for the treatmentof Alzheimers disease but only first three are used by the medical experts as the fourth one isrisky and causes severe side effects. Studies have clearly indicated that these drugs slowdownthe rate of disease progression only for about 6-12 months and then the disease starts advancingagain.FDA has approved the use of rivastigmine and galantamine for the treatment of mild and moderatesymptoms of Alzheimers disease but donepezil can be used for the treatment of mild, moderateand severe symptoms. The exact reason why these two drugs are not used against the severesymptoms of the disease is not clear. The major side effects of ChIEs are associated with thegastrointestinal system and they include nausea, cramping, diarrhea and vomiting. Thesesymptoms can be controlled by changing the timing of medication as well as intake of smallamount of food and about 75-90% of the patients bear the potential of tolerating the therapeuticdoses of cholinesterase inhibitors. Glutamate is the chief excitatory neurotransmitter of brain. Onehypothesis suggests that excessive secretion of glutamate is harmful for brain as it damagesnerve cells. Memantine is a drug that slows down the rate of activation of nerve cells by glutamateand is therefore, reducing the progression of this disorder. This drug can be used for treating bothmild and severe disease. The patient recovers faster if a dose of cholinesterase inhibitors andmemantine are given together.Non-medication based treatments include orientation of the patient towards social activities likesinging, dancing, walking etc. Cognitive rehabilitation may be helpful in this regard. The chiefpsychiatric symptoms associated with Alzheimers disease are irritation, depression,hallucinations, anxiety and sleep disorders. Standard psychiatric drugs are although used for thetreatment of these symptoms but none of the drugs have been approved by the FDA. Thesesymptoms become as intense as disease advances that treatment with medication becomesnecessary. Agitation becomes very much severe in the later stages of the disease. Agitation iscontrolled by a number of agents for example, beta-blockers, anxiolytics, antipsychotics and mood
  5. 5. stabilizing anticonvulsants. Newer antipsychotic drugs have taken the place of the older drugs andare giving fruitful results for example, risperidone, clozapine and olanzapine.Depression is another very common symptom of Alzheimers disease and the patients can betreated with antidepressants namely sertraline and citalopram. Anxiety in this disorder can betreated with benzodiazepines for example, diazepam. Non-benzodiazepines anxiolytics likebuspirone are generally preferred for the treatment. Insomnia is another symptom that can crop upin patients of Alzheimers disease at any part of their life. Trazodone is a promising drug used forovercoming this symptom. A number of clinical research trials have been carried with increasing ordecreasing the amount of Aβ1-42 but no successful result has been achieved.Caring for the caregiver is an essential aspect while dealing with the patient of Alzheimersdisease. Caregiving is a distressing experience and proper education of the caregiver is essential.The 3Rs namely repeat, reassure and redirect can help a caregiver in reducing the troublesomebehavior as well as limiting the use of medication in the patients. The short-term training programscan help a caregiver to increase his or her confidence while dealing with the patients. Love, careand support can however, help the patient to enjoy life.-RANJEET-==== ====Learn more information about Alzheimers disease, signs and symptoms, diagnosis and treatmentat: ====