Disease, Illness and Condition Library
Alzheimer's Disease
characterized by degeneration of brain tissue, including loss of nerve cells and the development of senile plaques and neurofibrillary tangles. The most frequent cause of dementia is Alzheimer’s disease. In older people, it accounts for up to 65% of dementias. It is very uncommon among people younger than 60. It becomes more common with an increase in age. It affects only about 1% of people aged 60 to 64, but up to 30% of those seasoned citizens older than 85. In the United States, it is estimated that 4 million people have Alzheimer’s disease. Currently the cause of Alzheimer’s disease is unknown, but genetic factors play a role: The disease appears to run in some families and is caused or influenced by several specific gene abnormalities. One abnormality affects apolipoprotein E (apo E) – the protein part of certain lipoproteins, which transports cholesterol through the bloodstream. There are three types of apo E (2, 3, and 4). People with the 4 type develop Alzheimer’s disease more often and at an earlier age than other people. In contrast, people with the 2 type seem to be protected against Alzheimer’s disease. People with the 3 type are neither protected nor more prone to develop the disease. (These associations have been studies primarily in whites and may not apply to other races.) Genetic testing for apo E type cannot determine whether a person will develop Alzheimer’s disease. Therefore, this testing is not usually recommended. In Alzheimer’s disease, parts of the brain degenerate, destroying nerve cells and reducing the responsiveness of the remaining nerve cells to many of the chemical messengers that transmit signals in the brain (neurotransmitters). Abnormalities in brain tissue consist of senile or neuritic plaques (clumps of dead nerve cells containing an abnormal, insoluble protein called amyloid) and neurofibrillary tangles (twisted strands of insoluble proteins in the nerve cell). Such abnormalities develop to some degree in all people as they age but are much more numerous in people with Alzheimer’s disease. Symptoms Dementia resulting from Alzheimer’s disease typically begins subtly. People whose disease develops while they are still employed may not perform as well in their jobs. In those who are retired and not very active, the changes may not be as clear. The first sign may be forgetting recent events, although sometimes the disease begins with depression, fears, anxiety, decreased emotion, or other personality changes. In the early stages, judgment and abstract thinking may be impaired. Speech patterns may change slightly; the person may use similar words, use words incorrectly, or be unable to find the proper word. An inability to interpret visual cues may make driving a car challenging. People with Alzheimer’s disease may be able to function socially but may behave oddly. For example, they may forget the name of a recent visitor, and their emotions may change unpredictably and rapidly. They may get lost on their way to the store. As Alzheimer’s disease progresses, people have trouble remembering events in the past. They may require help with eating, dressing, bathing, or going to the toilet. Wandering, agitation, irritability, hostility, and physical aggression are common. All sense of time and place is lost: People with Alzheimer’s disease may even get lost on their way to the bathroom at home. Their increasing confusion puts them at risk of falling. Psychoses, with hallucinations, delusions, and paranoia, develop at some point in about 50% of people with Alzheimer’s disease. Eventually, people with Alzheimer’s disease will have difficulty walking or taking care of their personal needs. They may become incontinent and find it difficult to swallow, eat, or speak. These changes put them at risk of under nutrition, pneumonia, and bedsores (pressure sores). Memory is completely lost. Because these people become totally dependent on others, a nursing home may become necessary. Ultimately, coma and death, often due to infection, result. Progression is unpredictable. The expected survival from the time the disorder is diagnosed ranges from 2 to 10 years, but frequently it is from 3 to 5 years. On average, people with Alzheimer’s disease who can no longer walk live no more than 6 years. Diagnosis Doctors suspect Alzheimer’s disease as the most likely cause of dementia in older people whose memory gradually deteriorates. Although a diagnosis based on examination of the person can be correct most of the time, the diagnosis of Alzheimer’s disease is confirmed only by a microscopic examination of brain tissue obtained during an autopsy. When brain tissue is examined, the characteristic loss of nerve cells, neurfibrillary tangles, and senile plaques, containing amyloid can be seen throughout the brain but most notibly in the area of the temporal lobe that is involved in the formation of new memories. Analysis of spinal fluid and positron emission tomography (PET) have been suggested as ways to diagnose Alzheimer’s disease during life, but these procedures are not yet reliable in predicting who will develop Alzheimer’s disease or in identifying people who already have it. Treatment General measures for treatment of Alzheimer’s disease are the same as for all dementias. The use of certain drugs (such as nonsteroidal anti-inflammatory drugs [NSAIDs]) to prevent and slow the progression of Alzheimer’s disease is under study. Estrogen and vitamin E may help prevent and slow progression of the disease, although study results are inconsistent. Before any of these substances are taken, their risks and benefits should be discussed with a doctor. Donepezil, rivastigmine, tacrine, and galantamine increase the levels of the chemical messenger (neurotransmitter) acetylcholine, which may be low in many forms of dementia. These drugs may improve cognitive function for the short term but they do not slow the progression of the disease. About 50% of the people who have Alzheimer’s disease benefit from these drugs. For these people, the drugs effectively turn the clock back 6 to 9 months. These drugs are helpful for those with mild to moderate Alzheimer’s disease. Because the drugs are expensive and may have side effects, they should not be continued in people who do not benefit from them. The most common side effects include nausea, vomiting, weight loss, and abdominal pain or cramps. Side effects are usually mild and relatively uncommon with donepezil and galantamine. An extract of ginkgo biloba (called EGb) has been shown to have effects similar to those of the prescription drugs described above but additional research is needed to confirm these benefits. How Serious is Alzheimer’s Disease? Alzheimer’s disease isn’t an acute condition, and it seldom requires emergency treatment. Abrupt changes in mental status are usually due to other diseases, which may require an immediate evaluation. Alzheimer’s disease, however, is ultimately fatal. Individuals with the disease may become bedridden and unable to care for themselves. They often die of pneumonia or other infections because of the disability. People with Alzheimer’s may become disoriented, increasing their risk of falls, which can cause serious fractures or head injures. In the elderly, these types of serious falls have been shown to produce quality of life issues as well as reducing life expectancy in some cases. Alzheimer’s Warning Signs When people forget something they often joke that they’re developing Alzheimer’s disease. But having Alzheimer’s isn’t the same as having an occasional memory lapse. Alzheimer’s is a condition that becomes progressively worse. Most people with Alzheimer’s share certain characteristics. These may include: Increasing and persistent forgetfulness: At its onset, Alzheimer’s disease is characterized by periods of forgetfulness, especially of recent events or simple directions. But what begins as mild forgetfulness persists and increases. People with Alzheimer’s may repeat things and forget conversations or appointments. They regularly misplace things, often putting them in illogical locations. They frequently forget names, and eventually they may forget the names of family members and everyday objects. Difficulties with abstract thinking: People with Alzheimer’s disease may initially have trouble balancing their checkbook, a problem that progresses to trouble understanding and recognizing numbers. Difficulty finding the right word: It may be a challenge for individuals with Alzheimer’s to find the right words to express their thoughts or even to follow conversations. Eventually, reading and writing also are affected. Disorientation: People with Alzheimer’s disease may lose track of time and dates. They may find themselves lost in familiar surroundings. Eventually, they may even wander from home and get lost. Loss of judgment: Solving everyday problems, such as knowing what to do if food on the stove is burning, becomes increasingly difficult. Alzheimer’s is characterized by difficulty doing things that require planning, decision making and judgment. Difficulty performing familiar tasks: Once routine tasks that require sequential steps, such as cooking, become a struggle as the disease progresses. People with Alzheimer’s may forget how to do the most basic things, such as brushing their teeth. Personality changes: Those suffering with this condition may exhibit mood swings. They may express distrust in others, show increased stubbornness and withdraw socially. Early on, this may be a response to the frustration they feel as they notice uncontrollable changes in their memory. Depression often coexists with Alzheimer’s disease. Restlessness also is a common sign. As the disease progresses, individuals may become anxious or aggressive and behave inappropriately. General Recommendations (Smart Medicine for Healthier Living) * Whatever remedies you use, whither conventional or natural, they will be of the greatest benefit if started early, at the first indication of symptoms. * Avoid exposure to aluminum. Acid rain has contributed a lot of aluminum to tap water. Other everyday sources of aluminum include aluminum cookware, canned drinks, some antacids, and antiperspirants. * Audio presence intervention has proved helpful for end stage Alzheimer’s patients who become so severely agitated that they require tranquilizers or restraints to prevent them form hurting themselves. It has been found that hearing the recorded voice of a loved one can calm a frustrated and/or violent individual more effectively than medication. In this type of treatment, family members provide at least four tapes on which they reminisce about happy times, talking about the person’s favorite holidays, sing a familiar song, give news of the family’s doings, and so on. These one sided conversations are then played for the patient through headphones hooked up to a personal tape player. According to early reports, the tapes work so well that it has been possible to reduce the medication given some patients. * Chelation therapy has proven helpful in enhancing cognitive function in many Alzheimer’s patients. In chelation therapy, certain agents are administered to bind with toxins such as heavy metals and cause the body to excrete them. There are oral chelation formulas available over the counter. Intravenous chelation employs ethylenediaminetetraacetic acid (EDTA). Note: Intravenous chelation therapy must be administered and monitored by a qualified doctor. Laboratory rests are required before commencing treatment. Because chelation affects the kidneys, kidney function must be monitored during the course of the treatment. Prevention Unfortunately, there is no known way of preventing Alzheimer’s disease. Taking therapeutic doses of certain nutrients may help, however. Vitamins A, C, and E; the minerals zinc and selenium; the enzyme superoxide dismutase (SOD); plus pine bark or grape seed extract and bioflavonoids protect against the type of free radical damage that is associated with this disease. Magnesium protects against abnormal DNA production, which may be involved in the formation of the characteristic neurofibrillary tangles in the brain. Note: Excessive amounts of Vitamin A can produce serious side effects. Check with your doctor or medical professional for appropriate dosage guidelines.
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