| Alzheimer's disease | |||||
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- What is alzheimer's disease?
- Symptoms of alzheimer's disease
- Causes of alzheimer's disease
- Treatment of alzheimer's disease
- Important alzheimer's disease facts
Alzheimer's disease (AD) is a degenerative disease of the brain, which is the most common form of dementia. Alzheimer's disease is a serious brain disorder which seriously affects a person's ability to have a normal life and their ability to carry out their activities each day.
Alzheimer's disease normally starts after after age 65, but the symptoms normally start slowly and can often be disregarded as a normal part of ageing (slowed thinking, confusion and forgetting things).
Alzheimer's disease is characterised by the increased amounts of abnormal clumps (amyloid plaques) and tangled fibres of proteins (neurofibrillary tangles) - basically abnormal deposits of substances in and around the neurons. Some of these changes normally occur with ageing, but not anywhere near the level that they do in a person with Alzheimer's disease.
Scientists believe that the communication between the nerons (nerve cells) becomes disconnected, especially in the parts of the brain which rule memory and learning. Some of the nerve cells die. In addition to this, levels of some of the neurotransmitters in the brain appear to be low, which may also play a role in this disease.
It is known that Alzheimer's affects brain cells by progressively making them fail to work properly, but scientists do not yet know what causes the brain cells to fail in such a way.
Symptoms of Alzheimer's disease
Alzheimer's disease starts slowly and progresses in a deteriorating manner.
Early symptoms (mild to moderate)
- Dicfficulty in calculating
- Difficulty in retaining information
- Inability to recall people's names or familiar words
- Inability to perform complicated mathematical calculations (or do any analytical or critical thinking)
- Less ability to organise or carry out complicated plans
- Mild to moderate memory lapses
- Performance difficulties at work
- Socially withdrawn
Theearly symptoms are normally not noticed at first, as they can be quite mild and signal a normal part of ageing (occasionally forgetting some things). Once the symptoms increase and worsen, they are noticed by other people.
Later symptoms (severe)
- Assistance required for many daily activities (dressing, washing, eating, cooking) - this will deteriorate until assistance is necessary for all daily activities
- Inability to remember address, phone number, date - will progress until there is an in ability to remember anything
- Incontinence
- Insomnia
- Major decline in cognition
- Major gaps in memory
- Personal history will still be recalled, but symptoms will progress until this is also forgotten
- Personality changes - depression, anxiety, anger, hallucinations, suspicious and paranoid
Late-stage symptoms (very severe)
- Difficulty swallowing
- Inability to cook and eat - feeding is achieved through tubes
- Inability to go to the toilet - require assistance
- Inability to speak
- Inability to walk without assistance - then inability to sit or hold the head up without assistance (can only lie down)
- Incontinence
- Loss of control of body movement
- Loss of control of reflexes
This is the final stage of Alzheimer's disease, where the disease progresses until the person loses all body movement and finally dies.
Scientists have not yet discovered what causes Alzheimer's disease, although they do have a list of risk factors, which means people in these groups are at higher risk for this disease:
- Age - people over 65 have a higher risk of developing Alzheimer's disease with people over 85 having a 50% chance of getting the disease
- Family history - research shows that people who have a close family relative have a higher risk of developing Alzheimer's disease
- Genetics - research has shown that genes play a definite role in the development of this disease:
- Risky genes - apoliprotein E-e4 (APOE-e4) gene provides the mechanism that allows proteins to carry cholesterol in the blood (lipoproteins); inheriting this gene (1 or more copies of it) increases the likelihood of developing Alzheimer's disease but does not guarantee it
- Deterministic genes - inheriting some very rare genes are known to directly cause Alzheimer's disease, this type of the disease is called familial Alzheimer's disease and is responsible for less then about 5% of all cases of Alzheimer's disease
There are also the following risk factors which can be reduced:
- Aluminium - current research has shown that aluminium could be a risk factor for developing Alzheimer's disease
- Head injury - research shows that people who sustain serious head injury are at higher risk for developing Alzheimer's disease; always wear protective head gear when cycling, riding etc
- Healthy ageing - research suggests that overall health as people age has some implications on the risks of developing Alzheimer's disease; recomendations - stay within a healthy weight, perform mental calculations every day (crosswords, maths etc), socialise, exercise and eat nutritious food
- Heart health - much research shows that an unhealthy vascular system (heart and blood vessels) is a definite risk factor for Alzheimer's disease; the brain is the body's most important organ and requires about 25% of the blood pumped from the heart; if it is not getting the correct nutrients (oxygent, vitamins, minerals, glucose etc), then it may be more vulnerable to Alzheimer's disease
Treatment of Alzheimer's disease
People with Alzheimer's disease are treated for the type of symptoms they have (symptoms are treated as the disease itself cannot be cured as yet). The treatments for the specific symptoms are a way to try to alleviate the symptoms temporarily, as the progression of the disease cannot be halted once it starts.
Conventional treatments
- Memory and cognition symptoms - there are a few drugs which are approved to help with the memory problems
- Acetylcholinesterase inhibitors - these drugs block the activity of acetylcholinesterase, which is an enzyme that destroys acetylcholine, a very important neurotransmitter involved in memory; these drugs are used for people with mild to moderate Alzheimer's disease (these drugs are available on the PBS in Australia for a small fee, but to continue being prescribed the drugs after 6 months of treatment, the patient must show some improvement in symptoms)
- Memantine - this drug blocks the neurotransmitter glutamate and prevents too much calcium moving into the brain cells causing damage; this drug is used for people with moderate to severe Alzheimer's disease (this drug is not available on the PBS in Australia and must be privately prescribed)
- Behavioural and psychological symptoms - there are a variety of different classes of drugs used to treat the behavioural and pscyhological symptoms that start to appear once the disease progresses
- Anti-psychotics - these drugs are used to treat symptoms such as delusion, aggression, hallucination and agitation; some of these drugs can cause some side effects which some people cannot tolerate well
- Anti-depressants - these drugs are used to treat depression symptoms
- Anti-anxiety medications - benzodiazepine drugs are used as a short-term treatment for anxiety, fear and agitation; the effect of these drugs may lessen over time
- Sedating medications - these drugs are used to help with the sleeping problems experienced; care needs to be taken with sedating medications as the person using them can become addicted to these drugs
Alternative / complementary treatments
Before trying any type of alternative / complementary treatments, you must advise your doctor, as they may cause serious complications or side effects with any other medications you are taking, including death. You should determine your risks with advice from medical specialists.
- Choline (or phosphatidylcholine) - this B vitamin co-factor is used by the body to make the fatty substance in the membranes of healthy cells and to ensure the membranes of cells can be repaired when necessary; one study showed that increased plasma levels of phosphatidylcholine were associated with a reduction of the risk of Alzheimer's disease by almost 50%; other studies have shown that people with Alzheimer's disease have a deficit of phosphatidylcholine in cerebral-spinal fluid
- Ginkgo biloba - this is a herb used in traditional Chinese medicine (and also Western herbal medicine) which is known to have beneficial effects on circulation of the blood; it is also used to improve memory and other cognitive functions which means it could be especially beneficial for people with Alzheimer's disease; one trial showed no improvement in cognitive function, while other trials have shown some improvement; to determine if ginkgo biloba has any ability to slow or prevent the onset of dementia (specifically Alzheimer's disease), the National Centre for Complementary and Alternative Medicine (NCCAM) USA is conducting a large trial to test this theory
- Huperzine A - this is a type of moss used in Traditional Chinese medicine, which has a potent alkaloid substance that is the active component; the active component in the moss is thought to provide the beneficial memory and learning benefits, especially in people with Azheimer's disease; studies show that this herb has has neuroprotective effects that are even more beneficial than the acetylcholinesterase inhibitor type drugs; in April 2004, the National Institute of Ageing (USA) launched a clinical trial to determine the effect of Huperzine A on improving cognitive function in people with Alzheimer's disease - this trial was completed in December 2006 and the results are yet to be released (as at September 2007); this study is being conducted to confirm (or reject) previous research which showed the benefits of Huperzine A on cognitive functions
- Omega 3 fatty acids - these essential nutrients could be a key nutrient to stop the development of Alzheimer's disease in the first place; one of the omega 3 essential fatty acids (docosahexaenoic acid or DHA) exists in the membranes of healthy cells; promising research shows that having enough omega 3 fatty acids (especially of the DHA type) prevents dementia and decline in cognition (memory); other research recommends eating at least 2 servings of omega 3 rich salmon, mackerel or turn each week to get the benefits of these essential fatty acids in the most natural way possible
- Phosphatidylserine - this is a type of fatty substance which is found in the membranes of healthy cells; research has shown that it helps with preventing further decline in symptoms by preventing deteriorating of the brain cells; more research is needed to confirm these preliminary results
- Vitamins - the antioxidants (vitamin A, vitamin C, vitamin E, selenium, zinc, alpha-lipoic acid) may protect cell membranes from damage caused by Alzheimer's disease; several studies suggest that there appears to be a relationship between higher antioxidant use with lower risk for developing Alzheimer's disease; one study showed there was no reduced risk of developing Alzheimer's disease with higher blood plasma levels of antioxidant vitamins (but these studies only looked at some of the antioxidants such as vitamin A and vitamin D, not all the antioxidants)
Important Alzheimer's disease facts
- Alzheimer's disease is not a normal part of the ageing process
- Scientisits still do not know exactly what causes Alzheimer's disease, but have a few theories which are currently being investigated (including researching specific genes which seem to be associated with Alzheimer's disease)
- Alzheimer's disease will progress over time in the individual, with a deterioration of their condition in the long term
- Since Alzheimer's is a progressive disease, this means it will continue to cause deterioration for anywhere from 5-20 years
- The most common cause of death in people with Alzheimer's disease is serious infection
- Alzheimer's disease is named after Dr. Alois Alzheimer, a German doctor who first diagnosed this disease in a patient in 1906
- Age is the most common risk factor for Alzheimer's disease, with most people diagnosed being over 65
- There is currently no cure for Alzheimer's disease (as at 2007), but some drugs (or alternative treatments) may help keep symptoms from getting worse for a short time
references
- Bai DL, Tang XC, He XC. Huperzine A, a potential therapeutic agent for treatment of Alzheimer's disease. Curr Med Chem. 2000 Mar;7(3):355-74
- Dos Santos-Neto LL, de Vilhena Toledo MA, Medeiros-Souza P, de Souza GA. The use of herbal medicine in Alzheimer's disease. Evid Based Complement Alternat Med. 2006 Dec;3(4):441-5. Epub 2006 Oct 23
- Engelhart MJ, et al. Plasma Levels of Antioxidants Are Not Associated with Alzheimer's Disease or Cognitive Decline. Dementia 2005; 19: 2-3
- Mulder C, Wahlund LO, Teerlink T, Blomberg M, Veerhuis R, van Kamp GJ, Scheltens P, Scheffer PG. Decreased lysophosphatidylcholine/phosphatidylcholine ratio in cerebrospinal fluid in Alzheimer's disease. J Neural Transm. 2003 Aug;110(8):949-55
- Schaefer EJ, Bongard V, Beiser AS, Lamon-Fava S, Robins SJ, Au R, Tucker KL, Kyle DJ, Wilson PW, Wolf PA. Plasma phosphatidylcholine docosahexaenoic acid content and risk of dementia and Alzheimer disease: the Framingham Heart Study. Arch Neurol. 2006 Nov;63(11):1545-50
- Solomon PR, Adams F, Silver A, Zimmer J, DeVeaux R. Ginkgo for memory enhancement: a randomized controlled trial. Journal of the American Medical Association. 2002;288(7):835-840
- Ved HS, Koenig ML, Dave JR, Doctor BP. Huperzine A, a potential therapeutic agent for dementia, reduces neuronal cell death caused by glutamate. Neuroreport. 1997 Mar 3;8(4):963-8
- Zandi PP, et. al. Reduced Risk of Alzheimer Disease in Users of Antioxidant Vitamin Supplements (Arch Neurol 2004; 61:82-88)
- Zhang HY, Tang XC. Neuroprotective effects of huperzine A: new therapeutic targets for neurodegenerative disease. Trends Pharmacol Sci. 2006 Dec;27(12):619-25. Epub 2006 Oct 23
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