ALZHEIMER’S DISEASE:

Alzheimer's disease (AD) is a neurodegenerative disease that usually starts slowly and
progressively worsens.]It is the cause of 60–70% of cases of dementia. The most common early
symptom is difficulty in remembering recent events. As the disease advances, symptoms can
include problems with language, disorientation (including easily getting lost), mood swings, loss
of motivation, self-neglect, and behavioral issues. As a person's condition declines, they
often withdraw from family and society. Gradually, bodily functions are lost, ultimately leading
to death. Although the speed of progression can vary, the typical life expectancy following
diagnosis is three to nine years.

SIGNS AND SYMPTOMS

First symptoms
The first symptoms are often mistakenly attributed to aging or stress. These early symptoms can
affect the most complex activities of daily living. The most noticeable deficit is short term
memory loss, which shows up as difficulty in remembering recently learned facts and inability to
acquire new information. Subtle problems with the executive functions of attentiveness,
planning, flexibility, and abstract thinking, or impairments in semantic memory (memory of
meanings, and concept relationships) can also be symptomatic of the early stages of Alzheimer's
disease. Apathy and depression can be seen at this stage. Mild cognitive impairment (MCI) is
often found to be a transitional stage between normal aging and dementia.

Early stage
Alzheimer's disease does not affect all memory capacities equally. Older memories of the
person's life (episodic memory), facts learned (semantic memory), and implicit memory are
affected to a lesser degree than new facts or memories. In this stage, the person with Alzheimer's
is usually capable of communicating basic ideas adequately. While performing fine motor
tasks such as writing, drawing, or dressing, certain movement coordination and planning
difficulties (apraxia) may be present, but they are commonly unnoticed.

Middle stage
Behavioral and neuropsychiatric changes become more prevalent. Common manifestations
are wandering, irritability and emotional liability, leading to crying, outbursts of
unpremeditated aggression, or resistance to care giving. Sun downing can also
appear. Approximately 30% of people with Alzheimer's disease develop illusionary
misidentifications and other delusional symptoms. Subjects also lose insight of their disease
process and limitations (anosognosia).
Late stage
During the final stage, there is complete dependence on caregivers. Language is reduced to to
complete loss of speech, loss of verbal language abilities. People with Alzheimer's disease will
ultimately not be able to perform even the simplest tasks independently. The cause of death is
usually an external factor, such as infection of pressure ulcers or pneumonia, not the disease
itself.

WHAT CAUSES ALZHEIMER’S?

Alzheimer's disease is a progressive brain disease. It is thought to be caused by the abnormal
build-up of proteins in and around brain cells. It is characterized by changes in the brain—
including amyloid plaques and neurofibrillary, or tau — tangles that result in loss of neurons
and their connections. These and other changes affect a person’s ability to remember and think
and, eventually, to live independently. Levels of one neurotransmitter, acetylcholine, are
particularly low in the brains of people with Alzheimer's disease. Over time, different areas of
the brain shrink.

GENETICS OF ALZHEIMER’S DISEASE

People’s genes, which are inherited from their biological parents, can affect how likely they are
to develop Alzheimer’s disease. There are two types of Alzheimer's—early-onset and late-onset.
Both types have a genetic component.

 Late-onset Alzheimer's disease

Most people with Alzheimer's have late-onset Alzheimer's disease, in which symptoms become
apparent in their mid-60s. One genetic risk factor—having one form, or allele, of the
apolipoprotein E (APOE) gene on chromosome 19—does increase a person's risk. APOE ɛ4 is
called a risk-factor gene because it increases a person's risk of developing the disease. However,
inheriting an APOE ɛ4 allele does not mean that a person will definitely develop Alzheimer's.
Some people with an APOE ɛ4 allele never get the disease, and others who develop Alzheimer's
do not have any APOE ɛ4 alleles.

 Early-onset Alzheimer's disease

Early-onset Alzheimer's disease occurs between a person's 30s to mid-60s and represents less
than 10 percent of all people with Alzheimer's. Some cases are caused by an inherited change in
one of three genes. For other cases, research shows that other genetic components are involved.
Researchers are working to identify additional genetic risk variants for early-onset Alzheimer's
disease.
DIAGNOSIS

Blood and imaging tests can rule out other potential causes of the symptoms. Or they may help
your health care provider better identify the disease causing dementia symptoms. In the past,
Alzheimer's disease was diagnosed for certain only after death when looking at the brain with a
microscope revealed plaques and tangles. Biomarkers can detect the presence of plaques and
tangles. Biomarker tests include specific types of PET scans and tests that measure amyloid and
tau proteins in the fluid part of blood and cerebral spinal fluid.

Tests

Diagnosing Alzheimer's disease would likely include the following tests:

1. Physical and neurological exam

A health care provider will perform a physical exam. A neurological exam may include testing:

 Reflexes.

 Muscle tone and strength.

 Ability to get up from a chair and walk across the room.

 Sense of sight and hearing.

 Coordination.

 Balance.

2. Lab tests

Blood tests may help rule out other potential causes of memory loss and confusion, such as a
thyroid disorder or vitamin levels that are too low. Blood tests also can measure levels of beta-
amyloid protein and tau protein, but these tests aren't widely available and coverage may be
limited.

3. Mental status and neuropsychological testing

Your provider may give you a brief mental status test to assess memory and other thinking skills.
Longer forms of this type of test may provide more details about mental function that can be
compared with people of a similar age and education level. These tests can help establish a
diagnosis and serve as a starting point to track symptoms in the future.

4. Brain imaging

Brain scan images for diagnosis of Alzheimer's disease- Open pop-up dialog box

 Magnetic resonance imaging (MRI). MRI uses radio waves and a strong magnetic field
to produce detailed images of the brain. While they may show shrinkage of some brain
regions associated with Alzheimer's disease, MRI scans also rule out other conditions.
An MRI is generally preferred to a CT scan to evaluate dementia.

 Computerized tomography (CT). A CT scan, a specialized X-ray technology, produces

cross-sectional images of your brain. It's usually used to rule out tumors, strokes and head
injuries.

Positron emission tomography (PET) can capture images of the disease process. During
a PET scan, a low-level radioactive tracer is injected into the blood to reveal a particular feature
in the brain. PET imaging may include:

 Fluorodeoxyglucose (FDG) PET imaging scans show areas of the brain in which
nutrients are poorly metabolized.

 Amyloid PET imaging can measure the burden of amyloid deposits in the brain.

 Tau PET imaging, which measures the tangles in the brain, is generally used in the
research setting.

TREATMENT FOR ALZHEIMER’S

 Medications

 Cholinesterase inhibitors. This may improve symptoms related to behavior, such as

agitation or depression. The medicines are taken orally or delivered through a patch on the
skin. Commonly prescribed cholinesterase inhibitors include donepezil (Aricept, Adlarity),
galantamine (Razadyne) and rivastigmine transdermal patch (Exelon).

 Memantine (Namenda). This medicine works in another brain cell communication

network and slows the progression of symptoms with moderate to severe Alzheimer's
disease. It's sometimes used in combination with a cholinesterase inhibitor. Relatively rare
side effects include dizziness and confusion.
  Creating a safe and supportive environment

These are some ways to support a person's sense of well-being and continued ability to function:

 Keep keys, wallets, mobile phones and other valuables in the same place at home so they
don't become lost.

 Keep medicines in a secure location. Use a daily checklist to keep track of doses.

 Arrange for finances to be on automatic payment and automatic deposit.

 Have the person with Alzheimer's carry a mobile phone with location tracking. Program
important phone numbers into the phone.

 Alternative medicine

 Vitamin E. Although vitamin E doesn't prevent Alzheimer's, taking 2,000 international

units daily may help delay symptoms getting worse in people who already have mild to
moderate disease. However, study results have been mixed, with only some showing
modest benefits.

 Omega-3 fatty acids. Omega-3 fatty acids in fish or from supplements may lower the risk
of developing dementia. But clinical studies have shown no benefit for treating Alzheimer's
disease symptoms.

 Curcumin. This herb comes from turmeric and has anti-inflammatory and antioxidant
properties that might affect chemical processes in the brain. So far, clinical trials have
found no benefit for treating Alzheimer's disease.

 Ginkgo. Ginkgo is a plant extract. A large study funded by the National Institutes of Health
found no effect in preventing or delaying Alzheimer's disease.

 Melatonin. This supplement helps regulate sleep. It's being studied to see if it can help
people with dementia manage sleep problems. But some research has indicated that
melatonin may worsen mood in some people with dementia.

 Lifestyle and home remedies

 Exercise
Regular exercise is an important part of a treatment plan. Activities such as a daily walk can help
improve mood and maintain the health of joints, muscles and the heart. Exercise also promotes
restful sleep and prevents constipation. People with Alzheimer's who have trouble walking may
still be able to use a stationary bike, stretch with elastic bands or participate in chair exercises.

 Nutrition

People with Alzheimer's may forget to eat, lose interest in meals or may not eat healthy foods.
They may also forget to drink enough, leading to dehydration and constipation. Offer the
following:

 Healthy options.

 Water and other healthy beverages.

 High-calorie, healthy shakes and smoothies (milkshakes with protein powders).

 Social engagement and activities

Social activities can support preserved skills and abilities. They also help with over-all well-
being. Do things that are meaningful and enjoyable. Someone with dementia might:

 Listen to music or dance.

 Read or listen to books.

 Garden or do crafts.

 Go to social events at senior or memory care centers.