Alzheimer’s disease is a neurological disorder in which the death of brain cells causes memory loss and cognitive decline. A neurodegenerative type of dementia, the disease starts mild and gets progressively worse. It is the most common type of dementia. The term “dementia” describes a loss of mental ability associated with gradual death of brain cells.
As the population ages, Alzheimer disease is becoms more of a medical, social and public health concern. It is a dementing disorder that causes severe and permanent loss of intellectual function. Patients with Alzheimer disease begin having forgetfulness, then progress to having irreversible loss of memory (including the memory of their own families) and other previously well-learned skills. Within a few years, some patients may be totally incapable of even the most basic self-care, imposing a great burden on their families and communities.
What happens in Alzheimer’s disease? Alzheimer’s disease often starts slowly. In fact, some people don’t know they have it. They blame their forgetfulness on old age. However, over time, their memory problems get more serious. People with Alzheimer’s disease have trouble doing everyday things like driving a car, cooking a meal, or paying bills. They may get lost easily and find even simple things confusing.
Some people become worried, angry, or violent. As the illness gets worse, most people with Alzheimer’s disease need someone to take care of all their needs, including feeding and bathing. Some people with Alzheimer’s live at home with a caregiver. Other people with the disease live in a nursing home.
Alzheimer’s is not a normal part of aging, although the greatest known risk factor is increasing age, and the majority of people with Alzheimer’s are 65 and older. But Alzheimer’s is not just a disease of old age. Up to 5 percent of people with the disease have early onset Alzheimer’s (also known as younger-onset), which often appears when someone is in their 40s or 50s. As many as 5 million Americans were living with Alzheimer’s disease. It is estimated that by 2050, this number is projected to rise to 14 million, a nearly three-fold increase.
Alzheimer’s disease is named after Dr. Alois Alzheimer. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. Her symptoms included memory loss, language problems, and unpredictable behavior. After she died, he examined her brain and found many abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary, or tau, tangles).
These plaques and tangles in the brain are still considered some of the main features of Alzheimer’s disease. Another feature is the loss of connections between nerve cells (neurons) in the brain. Neurons transmit messages between different parts of the brain, and from the brain to muscles and organs in the body.
Causes
In Alzheimer’s disease, brain cells start to deteriorate. The body attempts to stop this process by producing a protein called amyloid. However, amyloid deposits build up in the brain, leading to further deterioration. These deposits of amyloid are referred to as “plaques” and cause the brain cells to shrivel up and form “tangles”, which in turn lead to changes in the brain structure and cause the brain cells to die. The formation of plaques and tangles also prevents the production of some important brain chemicals, called neurotransmitters. Over time the loss of brain cells causes the brain to shrink.
There is no known cause for Alzheimer’s disease but some researchers now believe that a combination of environmental and genetic risk factors triggers an abnormal biological process in the brain that, over decades, results in Alzheimer-type dementia. Identified risk factors for developing the condition include –
- Age – The more individuals advance in age the higher is the risk they will develop Alzheimer disease. Most patients develop AD after the age of 65 years old. The risk of developing AD reaches 50% for individuals beyond age 85. Because more and more people live longer lives this disease is becoming a serious concern. The age-specific incidence rates for Alzheimer disease demonstrate a doubling of incidence for about every six years of added life, which indicates an exponential increasing risk with increasing age.
- Genetic Factors – The vast majority of Alzheimer disease is not genetically inherited although some genes may act as risk factors. Genetically identified forms of Alzheimer disease, which usually have an onset before the age of 65, have been identified and account for 0.1% of disease cases. The current thinking is that there are sporadic/late onset and familial/early onset cases of Alzheimer disease. When Alzheimer disease is caused by these deterministic variations, it is called “autosomal dominant Alzheimer disease (ADAD)” or “familial Alzheimer disease”. Many family members in multiple generations are affected. Symptoms develop before age 60, and may appear among persons between 30 and 40 years old. Most of autosomal dominant familial AD can be attributed to mutations in the amyloid precursor protein (APP) and/or presenilins 1 and 2 gene.
- Environmental Factors – Several studies indicate a role for environmental effects on AD development. Studies suggest that the role of diet, activities, or diseases that potentially play a role in the onset of Alzheimer disease. Diabetes, hypertension, smoking, obesity, and dyslipidemia have all been found to increase risk as well a history of brain trauma, cerebrovascular disease, and vasculopathies. A higher level of education, as well as Mediterranean diet was shown to decrease the risk of developing AD.
- Down’s syndrome – People with Down’s syndrome are at a higher risk of developing Alzheimer’s disease. This is because the genetic fault that causes Down’s syndrome can also cause amyloid plaques to build up in the brain over time, which can lead to Alzheimer’s disease in some people.
- Whiplash and head injuries – People who have had a severe head injury or severe whiplash (a neck injury caused by a sudden movement of the head) have been found to be at higher risk of developing Alzheimer’s disease.
Symptoms
The degenerative changes that occur with Alzheimer’s disease affect the areas of the brain that control thought, memory and language resulting in gradual signs and symptoms related to a person’s behaviour and mental function. Often, physical functions such as bowel and bladder control are also affected.
With Alzheimer’s disease there is great individual variability as to the nature of symptoms experienced and the speed at which deterioration occurs. The types of behaviour change and the length of time symptoms are present are different for each person. The symptoms of Alzheimer’s disease typically develop quite slowly. The time between the onset of the disease and death can range from five to 20 years.
Mild Alzheimer’s disease – Symptoms commonly experienced during the early stages of Alzheimer’s disease include –
- Mild forgetfulness – especially short-term memory loss
- Mood changes, including irritability and anxiety
- Difficulty processing new information and learning new things
- Loss of spontaneity and initiative
- Confusion about time and place
- Communication difficulties
- Decline in ability to perform routine tasks.
Moderate Alzheimer’s disease – As Alzheimer’s disease progresses the following symptoms may develop –
- Increasing short-term memory loss and confusion
- Difficulty recognising family and friends
- Shorter attention span and feelings of restlessness
- Difficulty with reading, writing and numbers
- Possibly neglectful of hygiene
- Loss of appetite
- Personality changes (eg: aggression, significant mood swings)
- Requires increasing assistance with daily tasks.
Severe Alzheimer’s disease – Towards the later stages of the disease the following symptoms may be experienced –
- Inability to understand or use speech
- Incontinence of urine / faeces
- Inability to recognise self or family
- Severe disorientation
- Increasing immobility and sleep time
The changes brought about by Alzheimer’s disease can be increasingly difficult for family members and friends. It is particularly difficult as the person’s condition deteriorates and they become unable to recognise loved ones.
Although a person loses many abilities as the disease progresses, it is often helpful to focus on the abilities that do remain, such as the senses of touch and hearing and the ability to respond to emotion.
Treatment
Alzheimer’s disease is complex, and it is unlikely that any one drug or other intervention can successfully treat it. Current approaches focus on helping people maintain mental function, manage behavioral symptoms, and slow or delay the symptoms of disease. Researchers hope to develop therapies targeting specific genetic, molecular, and cellular mechanisms so that the actual underlying cause of the disease can be stopped or prevented.
Medications such as sleeping tablets and tranquillisers may help to control symptoms such as sleeplessness and agitation. However they often cause increased confusion, so their use should be limited.
A group of medications called cholinesterase inhibitors have shown some effectiveness in slowing the progression of the condition in some people. These medications help prevent the breakdown of acetylcholine, a neurotransmitter responsible for memory. Cholinesterase inhibitor medications that are available include donepezil (Donepezil-Rex), rivastigmine (Exelon) and galantamine (Reminyl).
More recently, another drug – memantine (Ebixa) – has become available. Memantine works in a different way to the cholinesterase inhibitors, aiming to prevents the entry of an excess amount of calcium into brain cells. Higher than normal levels of calcium in the brain cells causes damange to them and also prevents them from receiving signals from other brain cells.
Currently, donepezil is the only drug that is government-subsidised for the treatment of Alzheimer’s disease.
Research continues into the development of other medications for the treatment of Alzheimer’s disease. Medications being investigated include those that prevent the build-up of amyloid deposits in the brain, as well as looking at the use of some anti-inflammatory and hormone medications
Alternative Treatment
Acetyl-L-carnitine (ALC) is the most common natural short-chain acetyl carnitine ester of L-carnitine. It plays roles in energy and lipid metabolism, membrane composition and transport, and may modulate enzyme and hormone activity. It is suggested that ALC may modulate the activity of neurotrophic factors and ameliorate the effects of a variety of toxins.
Lecithin, a choline-containing phospholipid, is the major dietary source of choline and has been shown to increase serum choline levels. It has been postulated that lecithin may accelerate acetylcholine synthesis in the brain through enhanced availability of the substrate choline in AD patients.
Huperzine A (HupA) is an extract of Huperzia serrata (Chinese club moss, Lycopodium serrata, Qian Ceng Ta, Shuangyiping), a hardy plant which grows in a variety of temperate habitats, preferring semi-to-full shade, and sandy, well-drained soil. It has been used for centuries in China to treat fever, swelling and blood disorders. HupA is a potent, reversible and selective inhibitor of acetylcholine esterase, with rapid absorption and penetration into the brain in AD patients.
Omega-3 fatty acids in fish oil may help prevent cognitive decline. Theories about why omega-3s might influence dementia risk include their benefit for the heart and blood vessels; anti-inflammatory effects; and support and protection of nerve cell membranes.
Coenzyme Q10, or CoQ10 – Alternative treatment advocates promote several vitamins and minerals as ways to treat AD. Supporters of these alternative treatments claim certain vitamins and minerals can prevent or stop AD. One such antioxidant is coenzyme Q10, or CoQ10. CoQ10 supplements are available in drug stores. This enzyme is important to normal healthy body functions, but it has never been studied as a way to treat AD.
Coral Calcium – Most people get enough calcium from their diet, but some people advocate coral calcium supplements as a treatment for AD. Coral calcium is typically derived from seashells and sea life, so the calcium supplement may contain trace amounts of other minerals. This supplement has not been shown to be beneficial in treating AD.
Ginko Biloba — An extract of this herb has long been used in Traditional Chinese Medicine (TCM) for its affect on memory, brain function and cognition. It may be one of the best known herbal treatments for Alzheimer’s disease
Turmeric — This is the one that is probably getting the most attention at the moment. It started when someone noticed that people who had a lot of curie in their diet seemed to be more resistant to Alzheimer’s. Curcumin, the active ingredient in turmeric, has anti-inflammatory and neuroprotective properties that show promise as a treatment for Alzheimer’s disease and other neuro-degenerative disorders.
Kami-Umtan-To (KUT) — A Japanese herbal concoction of 13 herbs has been used in Japan for centuries as a treatment for a variety of neuropsychiatric problems. It has been found to delay the progression of Alzheimer’s disease as compared to a control group.
Phosphatidylserine is a kind of lipid, or fat, that is the primary component of the membranes that surround nerve cells. In Alzheimer’s disease and similar disorders, nerve cells degenerate for reasons that are not yet understood. The theory behind treatment with phosphatidylserine is its use may shore up the cell membrane and possibly protect cells from degenerating.
Tramiprosate is a modified form of taurine, an amino acid found naturally in seaweed. Amino acids are the chemical building blocks of proteins. Tramiprosate was tested in a large Phase 3 clinical study as a possible Alzheimer’s treatment.
Caprylic acid is the active ingredient of Axona, which is marketed as a “medical food.” Caprylic acid is a medium-chain triglyceride (fat) produced by processing coconut oil or palm kernel oil. The body breaks down caprylic acid into substances called “ketone bodies.” The theory behind Axona is that the ketone bodies derived from caprylic acid may provide an alternative energy source for brain cells that have lost their ability to use glucose (sugar) as a result of Alzheimer’s.
Complementary Treatment
Art therapy is quickly becoming one of the most thoroughly documented alternative therapies for Alzheimer’s disease. Art therapists and activity professionals have long known that for people with Alzheimer’s, creating art as well as enjoying art opens up avenues of cognition and communication that were often thought to be lost forever.
Music therapy is really a sub-set of art therapy. Like the rest of that broader category, music therapy can involve both making music and enjoying music. Listening to (mostly familiar) songs and music is the ideal way to practice music therapy with people who have Alzheimer’s.
Reminiscence Therapy – Many people with progressive memory disorders, especially Alzheimer’s disease, are much more comfortable talking about memories of long ago than about more recent happenings and experiences. Because the area of the brain that stores memories long term is affected later in the disease’s progression than the area that forms new memories, the affected person will remember more about her life when she was 40 years younger than she knows about what has happened earlier in the week or at breakfast this morning. Old pictures provide a perfect vehicle for reminiscing.
Aroma Therapy – Several studies have found compelling evidence that certain aromatherapy oils have a positive effect on the mood, behavior, and even on the cognitive functioning of people with dementia. Aromatherapy is the use of volatile plant oils to improve psychological and physical health and prevent disease, and to affect mood. These “essential oils” are distilled from different parts of plants and contain the essence of the plant.
Reference –
http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp
http://www.everydayhealth.com/alzheimers-treatment.aspx
http://www.nhs.uk/conditions/alzheimers-disease/pages/introduction.aspx
http://nihseniorhealth.gov/alzheimersdisease/whatisalzheimersdisease/01.html
http://www.cdc.gov/aging/aginginfo/alzheimers.htm
https://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-fact-sheet
http://www.healthdirect.gov.au/alzheimers-disease
http://www.who.int/medicines/areas/priority_medicines/BP6_11Alzheimer.pdf
http://www.alzheimer.ca/en/About-dementia/Alzheimer-s-disease
http://www.medicalnewstoday.com/articles/159442.php?page=2#treatment_and_prevention
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2731997/