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Alzheimer’s Disease

Alzheimer’s Disease is a very difficult disease that is commonly noted as a form of Dementia.  An important thing to remember is that Alzheimer’s itself, is a disease that is considered terminal and not curable.

Classified as degenerative and progressive with a large majority of patients diagnosed in an elderly stage – typically over the age of 65

The diagnosis of Alzheimer’s disease, in the initial stages, can be difficult because symptoms often reflect “expected” mental changes as age progresses.

The average length of survival following diagnosis is 7 years and less than 3% of patients survive longer than 14-15 years

As age progresses the number of cases of Alzheimer’s increased dramatically.

Brain scans may show “plaques” and “tangles” which refer to Senile plaques which are deposits of amyloid into the gray matter of the Brain.

Tangles are proteins that group and gather within neurons.

Management is often very difficult for spouse and/or family members

Often patients may find themselves in nursing homes to be cared for by caregivers.

Early-onset Alzheimer’s

This is a similar disease but age of onset, as the title suggests, is often much earlier.  Early-onset – has changes in 3 genes but its causes are unknown. Early-onset is seen in less than 10% of cases.

Symptoms

–  Memory loss
–  Loss of part or majority of “daily living activities”
–  Confusion
–  Fatigue
–  Change in thinking
–  Apathy
–  Language changes or difficulties
–  Loss of body function

Classifications

1.)  Pre-Dementia

–  Initial stage
–  Often this stage is undiagnosed or in early diagnosis
–  Mistaken for age-related changes

2.)  Early Dementia

–  Increase difficulty and impairment of daily living
–  Affects some memories
–  Change in language abilities

3.) Moderate Dementia

–  Independence is loss or greatly difficult
–  Large changes in speech
–  Large changes in behavior
–  Large changes in memory
–  Diagnosis becomes quite taxing on family

4.)  Advanced Dementia

–  Last stage of dementia
–  Complete loss of speech may be seen
–  Some response from individuals may indicate some understanding
–  Loss of muscle mass
–  Decrease movement
–  Increased problems with ulcers and other illnesses

Causes

–  Largely unknown
–  Reduced amounts of neurotransmitter acetylcholine [Large prevailing theory]
–  Amyloid hypothesis – Amyloid beta as the cause  [Theory]
–  Other degenerative disorders [Theory]
–  Genetics may be a factor

Diagnosis

–  CT
–  MRI
–  SPECT
–  PET scan
–  Evaluation of mental status

Prevention

–  No specific evidence points to a manner to completely prevent this disease
–  Several possible associated factors may prevent this disease

Prevention [Theory based]

1.)  Fish
2.)  Bread
3.)  Red wine
4.)  Vitamins
5.)  Coffee
6.)  Mental games [cross word puzzles, board games, etc]

–  Several possible associated risk factors may be present

Increased risk [Theory based]

1.)  Hypertension
2.)  Diabetes
3.)  Medications  [long term use of statins and NSAIDs] – Again a theory

Treatment

–  There is no cure for this disease

Management

Acetylcholinesterase inhibitors

  –  Donepezil (Aricept)  –  only approved for advanced AD dementia
  –  Rivastigmine (Exelon)
  –  Galantamine (Razadyne)

NMDA receptor

–  Memantine (Namenda)

–  these 4 medications are approved by the FDA and its European counterpart

Other drugs are for symptoms such as:

–  Antipsychotic drugs