Alzheimer's disease

Alzheimer's disease is named after Alois Alzheimer, a German neurologist who first discovered it. Alzheimer's disease is a brain disease which affects the behaviour, memory and cognitive ability of sufferers and is also considered to be a geriatric disease. It is the most common cause of dementia with over half a million people thought to have it.

Alzheimer's disease is a neurodegenerative disease. In its common form, it is usually found in patients over the age of 60 who manifest the symptoms.

Symptoms include problems with cognitive function from the lines of emotional behaviour, judgement, language and perception. The biochemistry of the disease shows that it is due to polypeptide accumulation in areas of the brain which in turn cause atrophy. Mutations in the gene APP cause an increased production of the insoluble polypeptide Beta-Amyloid. The mutation occurs when the amino acid valine is replaced with isoleucine at position 717.

Causes

There are no known causes of Alzheimer's. However, it is characterised by the following;

• Formation of Neurofibrillary tangles and Amyloid plaques (which are proteins) in the brain,
• Death of brain cells, possibly as a result of the aforementioned point.
• Abnormalities in the brain neurotransmitters. It is believed that Alzheimer's disease occurs due to irreversible damage to the brain neurones causing loss of function.
• Genetic factors; it has been found that mutations in certain genes are responsible for early-onset Alzheimer's. Polymorphisms in the apolipoprotein is a major risk factor in individuals with a family history of Alzheimer's.
• Recent studies have shown that Alzheimer's disease could have a microbial (fungal) aetiology.

Risk Factors

Scientists believe Alzheimer's is caused by a combination of factors, which include;

• Family History: it is suggested that people with family members who have had Alzheimer's have a higher risk of getting the disease themselves.
• Down's Syndrome: sufferer's from Down's syndrome have been noticed to have a higher risk of getting Alzheimer's disease also.
• Whiplash and Head Injury
• Aluminium: exposure to aluminium is suggested to increase one's risk of getting Alzheimer's disease.

Signs and Symptoms

The general signs and symptoms of Alzheimer's disease include:

• Memory loss; this is the major symptom of Alzheimer's; patients forget dates, events and even their location. This results in them having to ask the same questions repeatedly.
• Problems with speaking and writing; patients may lose their train of thought mid-conversation and not know how to continue speaking.
• Change in mood and personality; patients may become confused, aggressive, suspicious, depressed and irritated without provocation.
• Routinely placing objects in odd places, such as placing a phone in the fridge.
• Lack of concentration; patients have trouble understanding, may withdraw formwork and hobbies.

However, it must be noted that these signs and symptoms do not constitute conclusive evidence that one suffers from Alzheimer's disease. Anyone who has any of these symbols is strongly advised to see a doctor for proper diagnosis.

Stages

Alzheimer's disease is a progressive disease which means that the severity of the condition increases gradually up to the point where it severly intefers with daily life tasks^[2]. There are generally three stages of development of Alzheimer's disease; mild, moderate and severe. These can be subdivided into seven stages which range from :

Stage 2 : Very Mild Decline

This stage consists of minor problems in memory, however, not to the extent where it is noticeable by a physician or a loved one.

Stage 3 : Mild Decline

In this stage, physicians will now able to detect a problem in memory as performance on memory and cognitive tests is affected.

Stage 4 : Moderate Decline

In this stage, symptoms of Alzheimer's disease are very apparent. This will also start to affect short-term memory.

Stage 5 : Moderately Severe Decline

During the fifth stage, daily tasks become difficult, and patients will require an increasing amount of help, however, they are still able to maintain a modicum of functionality.

Stage 6 : Severe Decline

Constant supervision is required in the sixth stage. Loss of bladder and bowel movements, major personality changes and the inability of recognizing loved ones are common symptoms.

Stage 7 : Very Severe Decline

In the seventh stage of the disease, patients lose the ability to respond to their environment or communicate. As Alzheimer's is a terminal disease, this is the last stage of the disease.

Maintenance

As there is no known cure for Alzheimer's disease, however, sufferers can be managed in the following ways;

• Memory aids; large clocks and notice boards can be used to help patients remember what to do and when to do it.
• Utility equipment; such as compartmented pillboxes and non-spill cups can also be used.
• Mobility aids and safety devices are recommended.
• Nursing care is the most important way of maintaining Alzheimer's patients as constant supervision and assistance will be needed as the disease develops.

Treatment

At present, there are no known treatments for Alzheimer's. However, there are known methods used to help to delay the progression of symptoms into the later stages of the disease. This enables sufferers to maintain a more active, independent life for longer which will also benefit their family and friends. However, there are ethical concerns of whether prolonging the life of an Alzheimer's sufferer, especially in the later stages of the disease, is the right thing to do. The scientific evidence suggests that once diagnosed, sufferers usually only live for 8-10 years. Plus the knowledge that the patient is still suffering for longer periods of time leads us to wonder if it is the right thing to do to prolong the middle stages of the disease through preventative treatments, which do not in any way cure the disease but aim to manage it, preventing worsening of the amyloid plaques and neurofibrillary tangles in the brain.

• Antioxidant can be used for the treatment of Alzheimer since it produces free radicals.
• Cognitive stimulation is thought to delay the progression of the disease, through activities requiring mental activity. These will commonly include things like crosswords.