Alzheimers

Alzheimers

Alzheimer’s Disease

Alzheimer’s disease is a degenerative illness of the old age resulting in dementia or amnesia causing loss of memory. Initially, the person starts to forget small everyday things like going to the supermarket, later he starts to forget the people around him and finally fails to recognize himself in the mirror. Approximately 10% of all persons over <  Read more...

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Alzheimer’s Disease

Alzheimer’s disease is a degenerative illness of the old age resulting in dementia or amnesia causing loss of memory. Initially, the person starts to forget small everyday things like going to the supermarket, later he starts to forget the people around him and finally fails to recognize himself in the mirror. Approximately 10% of all persons over  the age of 70 have significant memory loss, and in more than half the cause is AD. It is estimated that the annual total cost of caring for a single AD patient in an advanced stage of the disease is more than fifty thousand dollars. The disease also exacts a heavy emotional toll on family members and caregivers. Alzheimer’s disease can occur in any decade of adulthood, but it is the most common cause of dementia in the elderly.

Symptoms:

Early Stage:

The common presenting symptoms are the word-finding, organizational and navigational difficulty which is not directly related to the memory.

The memory symptoms are forgetting simple tasks which he would remember otherwise. This may go unnoticed initially because the person thinks of it as a simple forgetfulness worsening with age.

Later, cognitive symptoms start to develop like keeping track of finances, following instructions on the job, driving, shopping, and housekeeping.

People might grow acutely stressful to these symptoms which worsen their daily livelihood while some are ignorant of these because of another symptom of the disease called as Anosognosia.

Middle stage:

The patient is unable to work, is easily lost and confused, and requires daily supervision. Social graces, routine behavior, and superficial conversation may be surprisingly intact. Language becomes impaired—first naming, then comprehension, and finally fluency. In some patients, aphasia (inability to talk) is an early and prominent feature. Word-finding difficulties and circumlocution may be a problem even when formal testing demonstrates intact naming and fluency. Apraxia emerges, and patients have trouble performing learned sequential motor tasks. Visuospatial deficits begin to interfere with dressing, eating, or even walking, and patients fail to solve simple puzzles or copy geometric figures. Simple calculations and clock reading become difficult in parallel.

Late stage:

Some persons remain ambulatory but wander aimlessly. Loss of judgment and reasoning is inevitable. Delusions are common and usually simple, with common themes of theft, infidelity, or misidentification. Approximately 10% of Alzheimer patients develop Capgras’ syndrome, believing that a caregiver has been replaced by an impostor.Loss of inhibitions and aggression may occur and alternate with passivity and withdrawal. Sleep-wake patterns are disrupted, and nighttime wandering becomes disturbing to the household. Some patients develop a shuffling gait with generalized muscle rigidity associated with slowness and awkwardness of movement.

Diagnosis:

Ruling out other treatable causes of dementia should be ruled out using investigations like CT-Brain, MRI- Brain, Functional MRI and even biopsy.

Treatment:

The management of AD is challenging and gratifying, despite the absence of a cure or a robust pharmacologic treatment. The primary focus is on long-term amelioration of associated behavioral and neurologic problems, as well as providing caregiver support.

SUPPORTIVE MANAGEMENT:

  • Building rapport with the patient, family members, and other caregivers is essential to successful management.

  • In the early stages of Alzheimer’s, memory aids such as notebooks and posted daily reminders can be helpful.

  • Family members should emphasize activities that are pleasant and curtail those that are unpleasant.

  • In other words, practicing skills that have become difficult, such as through memory games and puzzles, will often frustrate and depress the patient without proven benefits.

  • Kitchens, bathrooms, stairways, and bedrooms need to be made safe, and eventually, patients must stop driving.

  • Loss of independence and change of environment may worsen confusion, agitation, and anger.

  • Communication and repeated calm reassurance are necessary.

  • Caregiver “burnout” is common, often resulting in nursing home placement of the patient or new health problems for the caregiver, and respite breaks for the caregiver help to maintain a successful long-term therapeutic milieu.

  • Use of adult day care centers can be helpful. Local and national support groups, such as the Alzheimer’s Association and the Family Caregiver Alliance, are valuable resources. Internet access to these resources has become available to clinicians and families in recent years.

PHARMACOLOGICAL MANAGEMENT:

  • Donepezil (target dose, 10 mg daily), rivastigmine (target dose, 6 mg twice daily or 9.5-mg patch daily), galantamine (target dose 24 mg daily, extended-release), memantine (target dose, 10 mg twice daily), and tacrine are the drugs presently approved by the Food and Drug Administration (FDA) for treatment of Alzheimer’s.

  • Mild to moderate depression is common in the early stages of AD and may respond to antidepressants or cholinesterase inhibitors. Selective serotonin reuptake inhibitors (SSRIs) are commonly used due to their low anticholinergic side effects (eg: citalopram 5–10 mg daily).

  • Generalized seizures should be treated with an appropriate anticonvulsant, such as phenytoin or carbamazepine.

  • Agitation, insomnia, hallucinations, and belligerence are especially troublesome characteristics of some AD patients, and these behaviors can lead to a nursing home placement.

  • The newer generation of atypical antipsychotics, such as risperidone, quetiapine, and olanzapine, are being used in low doses to treat these neuropsychiatric symptoms.

Prospective Measures:

In a prospective observational study, the use of estrogen replacement therapy appeared to protect—by about 50%—against the development of Alzheimer’s diseases in women. But it had other results which were not encouraging.

Vaccination against Aβ 42 has proved highly efficacious in mouse models of AD, helping clear brain amyloid and preventing further amyloid accumulation. In human trials, this approach led to life-threatening complications, including meningoencephalitis, but modifications of the vaccine approach using passive immunization with monoclonal antibodies are currently being evaluated in phase 3 trials.

Myths And Facts

  • Myth: Alzheimer’s is just an aging issue which doesn’t need any medical supervision.

  • Fact: Alzheimer’s is a degenerative disease, which could be very much controlled with care, support, and drugs. Some promising treatment modalities are under development.


  • Myth: Alzheimer’s runs in the family.

  • Fact: Alzheimer’s has a genetic pathophysiology which could be a predisposing factor but a clear cut autosomal dominant or recessive inheritance has never been established.


  • Myth: Alzheimer’s means the end of life to those patients.

  • Fact: In the early and middle stages of Alzheimer’s disease, the patients can very well take care of themselves with some support from the family.


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