Since advances in medicine have allowed for humans to live well into their 80’s, it is only natural that age-related diseases are now among the most challenging topics in public health. With this article we’ll discuss some of the most basic and practical aspects of Alzheimer disease, one of the most feared and complex subjects associated with aging.
When we speak of Alzheimer’s Disease (AD), we are actually referring to a particular type of dementia, a loss of cognitive function (thinking, reasoning and remembering). Any form of dementia will cause the individual to become less capable of dealing with mundane tasks. In the particular case of AD, an individual will eventually become unable to manage even the simplest aspects of a normal life.
AD is the most common form of dementia in the world. It comprises 60 to 80% of the known cases. Nowadays we know that the most important risk factor for AD is age, with chances of developing this disease doubling every 5 years after the age of 65.
Early warning signs
Normally, diagnosis is based on medical history, lab tests confirmation by specialists and cognitive tests results (like the MMSE and Min-Cog tests), however, in those cases is very common for the patient to already have experienced advanced symptoms. Right now, there is no single test capable to accurately diagnose AD, this is always the result of a combination of different methods.
The early warning signs for AD can be subtle and often the early stages go unnoticed for a long time before diagnosis.
The earliest signs of AD are a topic that is still in development, however, in this article we’ll mention some of the most common. Interestingly, the earliest signs may not necessarily be related to memory.
Loss of social tact
Disorientation in time and place
Poor performance at work
Some researchers think that the earliest signs of AD are visual problems associated to retinal synaptic dysfunction. These results are still not considered as correct by the entire scientific community, but still are an interesting finding.
Stages of AD
After diagnosis, an individual may live anywhere from 8 to 20 years. The development of this condition varies a lot; however, there are some well recognized stages that most patients experience.
The individual retains independent function
Small memory lapses
Having problems remembering words
Difficulties remembering names
Challenges preforming casual tasks
Forgetting material that they just read
Loosing valuable objects
Ever-increasing problems when planning or organizing
This stage can last for many years, as it progresses, greater care will be required
Difficulty expressing thoughts
Forgetfulness about personal history
Moodiness or withdrawing in socially or mentally challenging situations
Confusion about the current date
Not knowing where they are
Difficulty controlling bowels or bladder
Changes sleep patterns
Increased chances of wandering
Personality and behavioral changes, including suspiciousness and delusions or compulsive, repetitive behavior like hand-wringing or tissue shredding
At this point individuals lose the ability to respond to their surroundings
They can no longer sustain conversations
They can’t control movements
Difficulties communicating pain
They will require help with daily activities and constant supervision
They don’t remember recent experiences
Difficulties with their motor skills
Difficulties with their communication
Prone to infections like pneumonia
There is no cure for AD, only treatments to slow down its progress. One of the main theories related to the progress of this disease is the “Cholinergic Hypothesis”, which attributes the initiation and evolution of AD to the activity of cholinesterases, a group of enzymes that consume acetylcholine (a very important neurotransmitter) therefore, the main pharmaceutical option consists of inhibitors for these enzymes.
There are 4 main options at the moment:
Donepezil: Cholinesterase inhibitor. Tablets. 10 mg. Possible side effects; Diarrhea, loss of appetite, muscle cramps, nausea, trouble sleeping, unusual tiredness or weakness and vomiting. Recommended for all stages of AD.
Galantamine: Cholinesterase inhibitor. Tablets. 4 mg. Possible side effects; Chest pain or discomfort, lightheadedness, dizziness, fainting, shakiness in the legs, arms, hands, or feet, shortness of breath, slow or irregular heartbeat, unusual tiredness. Recommended for mild to moderate AD.
Memantine: NMDA receptor antagonist (provides protection against nerve damage). Tablets. 10 mg. Possible side effects; most people get drowsy and dizzy, also, Bloating or swelling of the face, arms, hands, lower legs, or feet, blurred vision, dizziness, headaches, nervousness, pounding in the ears, rapid weight gain, slow or fast heartbeat, tingling of the hands or feet, unusual weight gain or loss. Recommended for moderate to severe AD.
Rivastigmine: Cholinesterase inhibitor. Capsules. 1,5 mg. Possible side effects; Diarrhea, indigestion, loss of appetite, loss of strength, nausea and vomiting, weight loss. Recommended for mild to moderate AD.
Treatment is not only drug-based. AD has a psychological element that needs to be addressed by a practitioner.
This type of treatment is not only directed towards the patients, but also the caretakers. Mainly it focuses on teaching the primary caretakers patience, how to monitor the patient, how to create a calm and relaxing environment and look for reasons behind their behaviors.
AD is a very challenging disease to have in the family, but you are not alone. There is a support system in place to help you and your loved ones. For more information and help you can visit this link: http://alz.org.pk/