Alzheimer's disease

Alzheimer's disease is a complex and progressive brain disorder that affects millions of people worldwide. It is a neurodegenerative condition that causes the brain to shrink and brain cells to die, leading to a gradual decline in cognitive function. As the disease progresses, it can have a profound impact on an individual's ability to carry out daily activities and maintain their independence. In this article, we will explore the nature of Alzheimer's disease, its effects on individuals, and the current understanding of its causes and risk factors.

What is Alzheimer's disease?

Alzheimer's disease is a type of dementia that is characterised by the accumulation of abnormal proteins in the brain, including amyloid plaques and tau tangles. These abnormal proteins disrupt communication between brain cells, leading to the death of brain cells and a decline in cognitive function. The disease typically progresses slowly, with symptoms worsening over time. Common symptoms of Alzheimer's disease include memory loss, difficulty with language and communication, disorientation, and changes in mood and behaviour. As the disease advances, it can affect a person's ability to carry out basic daily activities, such as dressing, eating, and personal hygiene.

The symptoms of Alzheimer's disease can vary from person to person but typically develop slowly and gradually worsen over time. Some common symptoms include:

• Memory loss, particularly forgetting recently learned information

• Difficulty completing familiar tasks

• Confusion with time or place

• Trouble understanding visual images and spatial relationships

• Problems with speaking or writing

• Misplacing things and losing the ability to retrace steps

• Decreased or poor judgement

• Withdrawal from work or social activities

• Changes in mood and personality, such as apathy, depression, or anxiety

Alzheimer's disease progresses through several stages, each with its own set of symptoms and challenges:

• Preclinical stage: Brain changes occur before any noticeable symptoms appear. This stage can last for a decade or more.

• Mild (early-stage): Symptoms include memory loss, poor judgement, difficulty completing normal daily tasks, and loss of spontaneity.

• Moderate stage: Symptoms worsen and may include increased confusion, withdrawal from social activities, difficulty with language, and problems recognising family and friends.

• Severe (late-stage): Individuals lose the ability to communicate and become completely dependent on others for care. Physical symptoms may include difficulty swallowing, weight loss, and loss of bladder and bowel control.

The exact cause of Alzheimer's disease is not fully understood, but several factors are believed to play a role in its development:

• Age: The risk of developing Alzheimer's increases significantly after the age of 65.

• Family history and genetics: Having a first-degree relative with Alzheimer's increases your risk of developing the disease. Certain genes, such as APOE ε4, have been linked to a higher risk of Alzheimer's.

• Head trauma: Repeated head injuries or traumatic brain injury (TBI) may increase the risk of developing Alzheimer's.

• Cardiovascular disease: Conditions that damage the heart and blood vessels, such as high blood pressure, high cholesterol, and diabetes, may increase the risk of Alzheimer's.

• Lifestyle factors: Lack of exercise, smoking, and an unhealthy diet may contribute to the development of Alzheimer's disease.

Alzheimer's disease can affect people of all ages, but it is most commonly diagnosed in individuals over the age of 65. According to the Mayo Clinic, more than 6.5 million people in the United States aged 65 and older live with Alzheimer's disease, with the majority being 75 years old and older. However, the disease can also affect younger people, with early-onset Alzheimer's disease accounting for about 1 in 20 cases. Individuals with a family history of Alzheimer's disease, those with Down syndrome, and people with certain genetic mutations are at higher risk of developing the disease. It is important to note that while age is the greatest known risk factor for Alzheimer's disease, it is not a normal part of ageing, and the disease can have a significant impact on an individual's quality of life and independence.

Although there is no guaranteed way to prevent Alzheimer's disease, adopting a healthy lifestyle may help reduce the risk or delay the onset of the condition. Some preventive measures include:

• Engaging in regular physical exercise, which can improve cardiovascular health and maintain cognitive function.

• Maintaining a healthy diet rich in fruits, vegetables, whole grains, and lean proteins, while limiting the intake of saturated fats and processed foods.

• Staying mentally active by engaging in stimulating activities such as reading, solving puzzles, learning new skills, or playing musical instruments.

• Socialising regularly and maintaining strong social connections, which can help reduce stress and keep the mind engaged.

• Managing chronic conditions such as diabetes, hypertension, and high cholesterol, which are risk factors for Alzheimer's disease.

• Avoiding smoking and excessive alcohol consumption, as these habits can negatively impact brain health.

Diagnosing Alzheimer's disease involves a comprehensive evaluation by a doctor, which may include a combination of medical history, physical and neurological examinations, cognitive assessments, and brain imaging tests. The process typically involves ruling out other potential causes of cognitive decline, such as vitamin deficiencies, depression, or side effects from medications.

Doctors may use various cognitive tests to assess memory, language, problem-solving, and other mental skills. Brain imaging tests, such as magnetic resonance imaging (MRI) or positron emission tomography (PET) scans, can help identify changes in the brain associated with Alzheimer's disease. In some cases, cerebrospinal fluid (CSF) tests may be used to measure levels of certain proteins that are indicative of Alzheimer's.

While there is no single definitive test for Alzheimer's disease, a combination of these diagnostic tools can help doctors make an accurate diagnosis and develop an appropriate treatment plan.

While there is currently no cure for Alzheimer's disease, several treatment options are available to manage its symptoms and, in some cases, slow its progression.

Disease-modifying treatments

The FDA has approved several disease-modifying treatments aimed at slowing the progression of Alzheimer's disease, particularly in its early stages:

• Lecanemab: An anti-amyloid antibody that has been shown to slow down memory and thinking decline in early Alzheimer's disease.

• Donanemab: Another anti-amyloid antibody administered via intravenous infusion every four weeks, which has demonstrated a statistically significant reduction in clinical decline compared to placebo.

Symptomatic treatments

For managing the symptoms of Alzheimer's disease, several medications are available:

• Cholinesterase inhibitors: Drugs like donepezil and rivastigmine work by blocking the action of acetylcholinesterase, the enzyme responsible for destroying acetylcholine, a chemical that helps nerve cells communicate. These medications can improve some memory problems and reduce behavioural symptoms.

• NMDA Antagonists: Memantine is FDA-approved for treating moderate to severe Alzheimer's disease. It helps keep certain brain cells healthier and improves performance in daily activities such as eating, walking, and dressing.

In addition to medications, lifestyle changes and supportive interventions can help manage Alzheimer's disease symptoms:

• Engaging in regular physical exercise and social activities

• Maintaining a healthy diet and managing other health conditions

• Creating a safe and structured environment

• Participating in cognitive stimulation activities

• Seeking support from family, friends, and support groups

While these interventions cannot stop the progression of Alzheimer's disease, they can improve the quality of life for both the person with Alzheimer's and their caregivers.

If you or a loved one are experiencing symptoms of Alzheimer's disease, it is crucial to consult a doctor for a proper diagnosis. Early detection and intervention can improve the quality of life for people with Alzheimer's dementia. Some key situations that warrant a visit to the doctor include:

• Persistent memory loss that disrupts daily life, such as forgetting important dates, events, or recently learned information.

• Difficulty completing familiar tasks at home, work, or during leisure activities.

• Confusion with time or place, such as losing track of dates or forgetting where they are.

• Trouble understanding visual images and spatial relationships, which may lead to difficulties with balance or reading.

• New problems with words in speaking or writing, such as struggling to find the right words or calling things by the wrong name.

• Misplacing things and being unable to retrace steps to find them.

• Decreased or poor judgment, such as giving large amounts of money to telemarketers or paying less attention to personal grooming.

• Withdrawal from work or social activities due to changes in memory or behaviour.

Your doctor may conduct a thorough medical evaluation, including a physical exam, neurological tests, and brain imaging scans to determine the cause of the symptoms and rule out other potential conditions. They may also refer you to a specialist, such as a neurologist or geriatrician, for further assessment and management of Alzheimer's disease.

• Alzheimer's disease is a progressive neurological disorder that causes memory loss, cognitive decline, and changes in behaviour.

• Early symptoms of Alzheimer's dementia include persistent memory loss, difficulty completing familiar tasks, confusion with time or place, and problems with speaking or writing.

• Risk factors for Alzheimer's disease include age, family history, genetics, and lifestyle factors such as lack of exercise and poor diet.

• There is no cure for Alzheimer's disease, but treatments are available to manage symptoms and improve quality of life.

• If you or a loved one are experiencing symptoms of Alzheimer's disease, it is essential to consult a doctor for a proper diagnosis and management plan.