Alzheimer’s disease: Who am I?
The winter years of one’s life comes with its own set of challenges and acceptance. India is greying rapidly with the geriatric population of about 8.5 percent that is 103.9 million people, according to the 2016 report documented by the Ministry for Statistics and Programme Implementation. The common adversities faced by the elderly are Depression, Dementia, Alzheimer, motor and cognitive impairments. According to the report submitted by Alzheimer’s and Related Disorders Society of India, India houses 4.1 million people suffering from Dementia. Dementia is a clinical syndrome that characterizes a group of symptoms linked with a decline in memory and other cognitive abilities thus interfering with the smooth functioning of daily life. Alzheimer’s disease is one of the most common causes of Dementia. Alzheimer is a progressive disease that leads to memory loss as well as the continuous decline in social, behavioral and thinking skills thus affecting the smooth functioning of daily living.
Alzheimer’s disease is demonstrated and closely associated with the geriatric population, however, anyone can fall prey to the disease. Dr. Alois Alzheimer, a German psychiatrist, is credited for his extensive research and for the first time description of the dementing condition called Alzheimer’s disease. He presented his case study of a 51-year-old-woman, suffering from the symptoms of this condition in the landmark conference during 1906. After this, many researchers and clinicians dwelled deep into the symptomology and interventions for this disease.
What Causes Alzheimer’s?
Over the past century, researchers have made great strides in building a strong understanding of the causes of the disease. Alzheimer’s disease is not characterized by just one cause, however, several causes build the repertoire of the disease.
Genetics– Genes have been found to play a major role in the development of the disease. Although there exist controversies for the certainty of the role of genetics, researchers have found that when the brain proteins fail to function normally, it leads to disruption of the neurons further damaging the brain cells and causing them to lose connections and eventually die. Two major brain proteins have been identified as the root cause of the disease, namely, Beta-amyloid and Tau proteins.
Beta-amyloid clusters disrupt cell-to-cell communication leading to the loss of the memory. Tau proteins referred to as neurons internal support system. However, during Alzheimer’s disease, they changed their shape and form, leading to the disruption in the transportation of proteins and other materials, thus causing this degenerative disease.
The early onset and the late-onset forms of Alzheimer’s disease have been speculated to have genetic bases. The late-onset Alzheimer’s disease is characterized by the gene called apolipoprotein E on chromosome 19. The inheritance of this gene has been hypothesized to cause Alzheimer. However, debates on it have pronounced that mere inheritance of this gene does not necessarily lead to the disease and even the fact that people can develop Alzheimer’s disease despite the absence of this gene. The early onset of Alzheimer’s disease can be determined by a change in the gene structure passed down by parents to the child. This change in the gene structure causes the formation of abnormal proteins which generates harmful forms of amyloid proteins are known as the hallmark indicator of Alzheimer’s disease.
Aging – Aging is one of the primary risk factors of Alzheimer’s disease. Age is proportionally related to the development of the disease. In one of the studies, it was found that annually there were two diagnoses of Alzheimer’s disease of people belonging to the age bracket of 65-74, however, the numbers increased drastically to thirty-seven new diagnoses of the people belonging to the age bracket of 85 years and older.
Lifestyle and social engagement– Research has indicated that individuals that develop a healthy life pattern are at lower risk of facing any medical conditions. Studies have also shown that individuals who are mentally and emotionally stable as well as engage themselves in social interactions are less likely to develop Alzheimer’s disease. However, lack of exercise, obesity, poor lifestyle management, high blood pressure, and high cholesterol are several other risk factors that might indicate the onset of the disease.
Symptoms of Alzheimer’s disease:
As we age, our mind and body undergo severe changes. These changes are accompanied by alterations in our physical, mental and social functioning. One of the most common symptoms of the disease is difficulty in remembering the newly acquired information. Normal aging causes forgetfulness and reduction in thinking abilities, however, in Alzheimer’s disease, it leads to serious memory loss thus interfering with daily life functioning. The group of symptoms that symbolizes Alzheimer’s disease includes:
The decline in personal hygiene, problem-solving abilities, and judgment abilities.
Difficulty in the completion of familiar tasks.
Disorientation from time to time.
Withdrawal from friends and family.
Increase in mood swings and personality changes.
Profound confusion in terms of events, people, and time.
Reduction in the abilities to speak, swallowing, and walking
The emergence of apathy, aggressiveness, depressive symptoms, and irritability.
Decreased cognitive abilities and motor movements.
Dependency on caregivers.
Reduced visuospatial abilities.
The severity of these symptoms depends upon whether the person is diagnosed with a mild, moderate or severe form of Alzheimer’s disease.
What are the Stages of Alzheimer’s disease:
Alzheimer’s disease is marked and broken down into seven stages as the condition worsens with time. These seven stages are characterized by its gradual nature and severity of the symptoms. Stage 1 to Stage 3 refers to a mild display of the symptoms of the disease. The individuals at this stage can work independently, experience mild physical symptoms and memory loss, however, not much visible upfront.
Stages 4 and 5 are marked by a moderate display of symptoms wherein the individuals would need assistance from their caregivers for demanding cognitive tasks. Moderate impairments in their speech, motor movements, and cognitive abilities would be visible. Feelings of apathy, depressive symptoms and irritability would be detachable.
Lastly, Stages 6 and 7 are described as a severe case of Alzheimer’s disease. Individuals at this Stage are completing dependent on their caregivers even for menial tasks. They withdraw themselves from others and are in dissociated states almost all the time.
Diagnosing Alzheimer’s disease:
One of the most primitive methods for diagnosing this disease was autopsy-based pathological evaluation. With the advent of technology and literature on the subject matter, several other techniques have been brought into the picture in order to identify the severity and the stage of the disease. However, examining one cause for the disease can be challenging as the common presence of comorbidity exist. Also, the distinction between pseudo-dementia and true dementia can be another challenge that needs to be carefully examined by the clinician.
In clinical settings, Alzheimer’s disease is diagnosed with the help of medical history, physical and neurological examinations and ancillary testing in order to exclude other conditions. The National Institute of Aging- Alzheimer Association (NIA-AA) has prepared a set of criteria for the diagnoses of probable Alzheimer’s disease Dementia. NIA-AA based clinical criteria for Alzheimer’s disease includes the presence of dementia, gradual onset of symptoms over months to years, history of progressive cognitive decline, initial presentation may be amnestic (typical) or non-amnestic (atypical), no evidence for another cause of cognitive impairment: cerebrovascular disease, other dementia syndromes, or neurological/medical disease. (Adapted from NIA-AA guidelines)
Several other neurological pieces of evidence are used as an adjunct with the clinical evaluation that helps in understanding brain lesions and in order to identify reversible causes of the disease. Magnetic Resonance Imaging and Functional Magnetic Resonance Imaging are different ways through which the brain structure can be visualized and targets can be identified.
In order to assess the cognitive impairments, several diagnostic tests are conducted on the individual. The Mini-Mental State Examination is one of the most widely used instrument to assess cognitive impairments in an individual. Along with that Montreal Cognitive Assessment, a recently developed technique is also used to detect subtle cognitive deficits. A battery of tests should be utilized in order to understand the advancement of the disease.
Treatment of Alzheimer’s Disease:
The treatment of the disease is still in its infancy stage as there are no certain remedial measures to combat the disease. Drug therapy is paving its way to medicate the disease. Its current status includes helping in ease of symptoms as well as to prolong the advancement of the symptoms. The practitioner opts for Donepezil or Rivastigime for individuals suffering from the early stages of the disease as these rugs help in the maintenance of high levels of acetylcholine which aids in memory. For those at the later stages of the disease, Memantine is prescribed as it helps to block access glutamate in the brain, because of the increase in glutamate damages the brain cells causing them to die.
Along with medications, several other remedial measures are available in order to prolong the rapid advancement of the symptoms. Lifestyle management is one such way. The need for quality life management becomes imperative as an individual slowly loses his/her ability to work independently. Individuals suffering from the disease along with their caregivers and the clinicians should sit together and chalk out an effective plan for better adaptation to the life changes. Certainly, behavior management is a subset of managing the symptoms of the disease. Research has revealed that managing behavioral symptoms not only aids in the upliftment of people suffering from the hardship of the disease, but it also makes things easier for the caregivers.
Recently, with research and literature, the development of medical food in order to treat symptoms of the diseases are at a rise. Even for Alzheimer’s disease, certain medical food has made promising statements of improving the mental status of the brain which includes Axona, Cerefolin NAC and Souveniad. Lately, researchers are working on building a model in order to successfully treat the symptoms of the disease which would include early detection of diabetes, hypertension, and hyperlipidemia followed by modified intervention strategies that would combat the loss of neurons and reduction of toxins in the brain cells.
The caregiver is one of the primary modules of the treatment. Individuals suffering from moderate to severe stages of the disease would require constant assistance from their caregivers. Thus, caregivers should be alerted about the advancement of the symptoms as well as the consequences of the same. Caregivers should be well educated about the disease in order to make informed decisions. Furthermore, training should be provided to them in order to combat the unforeseen situations.
Home remedies for Alzheimer’s disease:
Although there is no certain cure that has worked wonders in the treatment of the symptoms of the disease, however, along with drug and behavioral therapy, certain alternative remedial forms have emerged. However, researchers and clinicians should operate with caution as these alternative treatments have claimed a very little body of research and validity of its effectiveness have not been established yet.
Coconut oil contains Caprylic acid which can be broken down into protein ketone by the human body. This protein has been found to reduce cognitive decline and increase memory performance.
Omega-3 fatty acids have been established as a source that reduces cognitive impairment. In the human diet, these acids are obtained from fish, nuts, and oils. Thus, the consumption of these food substances in a certain amount can help in the reduction of cognitive impairment.
Medicinal herbs such as Ginkgo biloba, Choto-san, and Kami-utan have shown medicinal properties in order to aid the symptoms of the disease. These herbs have anti-inflammatory and antioxidant properties as well as may benefit the functioning of cognitive abilities. Very few studies have been conducted to prove its effectiveness.
Mental Exercise is yet another method to tone and nourish one’s memory. Individuals suffering from Alzheimer’s should be encouraged to solve exercise that enhances their cognitive abilities, like, sudoku, puzzles, crosswords, reading, and writing. These exercises help in the formation of neural pathways and prevent a sedentary state of mind.
Alzheimer’s disease is becoming an increasingly common condition among the masses, with no cure entitled to it. Although much progress has been made in understanding its physical, behavioral and clinical stance, much more research needs to be undertaken in order to unveil its treatment plans. Clinicians, researchers, as well as caregivers, need to remain abreast of the current ventures in the field of Alzheimer’s disease.