An overview of Alzheimer’s disease by Dr Atta Alkaznaji

 

You don’t recognize your daughter, you have forgotten how to tie your shoelaces, you find yourself in the middle of the street and you don’t know how you got there – for most of us all of this seems surreal and far removed from our daily lives. These are the effects of a neurological disorder called Alzheimer’s disease in which the death of brain cells causes memory loss and cognitive decline. A fast growing condition, Alzheimer’s affected 26.6 million people in 2006 and by 2050 its prevalence is set to quadruple by which time 1 in 85 persons worldwide will be living with the disease.

Dr. Atta G.A. Alkaznaji, neurology specialist at Burjeel Hospital, Abu Dhabi, sheds light on the disease.

Alzheimer’s Overview:

• Alzheimer’s is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. The disease accounts for 60 to 80 percent of dementia cases.
• Alzheimer’s is not a normal form of aging – the greatest risk factor is increasing age and the majority of those stricken with the disease is 65 years or above. However, it is not a disease of old age alone as up to 5 percent of those stricken with the illness have early onset Alzheimer’s and appears in someone in their 40s or 50s.
• As Alzheimer’s is a progressive disease, the dementia worsens over time with individuals losing their ability to carry on a conversation and respond to their environment.

Causes

Like all forms of dementia, Alzheimer’s is caused by brain cell death. The total brain size shrinks with the disease and the tissue has progressively fewer nerve cells and connections.

Postmortems and autopsies of affected brains also show tiny inclusions in the nerve tissue called plaques and tangles and these are believed to be the prime suspects in damaging and killing nerve cells.

• Plaques are founds between the dying cells of the brain and are formed from the buildup of a protein called beta-amyloid. These block cell to cell signaling at synapses which activates immune system cells that trigger inflammation and devour disabled cells.
• Tangles are twisted fibers of another protein called tau that builds up inside the brain cells. This affects the supply of nutrients and other essentials through the cells which eventually dies.
• The brain regions most important to memory, thinking and planning develop more plaques and tangles than were present in the early stages. This results in individuals developing serious problems in memory and thinking that interferes with work or social life. They get confused, have trouble handling money, expressing themselves and organizing their thoughts.
• Plaques and tangles next spread to the areas involved in speaking and understanding speech and the sense of where your body is in relation to objects around you. Individuals experience personality and behavioral changes in this stage and have trouble recognizing friends and family members.

Risk Factors

• Age: The disorder is more likely to affect older people – a greater proportion of 85 year olds have it than over 65 year olds.
• Family history – Having a family member affected by Alzheimer’s puts you at a risk for the disease.
• The female gender is more likely to be inflicted with the disease than a male.

Signs and Symptoms

For a doctor to make a diagnosis of Alzheimer, he must confirm a dementia. “Dementia involves cognitive or behavioral symptoms that show a decline from previous levels of functioning and performing and interferes with the ability to function at work or at usual activities.”

Some of the more common symptoms include:

• Worsened ability to take in and remember new information. For example, misplaced personal belongings or getting lost on a familiar route.
• Impairments to reasoning, complex tasking and exercising judgment. For example, poor understanding of safety risks and inability to plan complex or sequential activities.
• Impaired visuospatial abilities (but not from for example eye sight problems).  For example the inabilities to operate simple implements or orient clothing to the body.
• Impaired speaking, reading and writing. For example difficulty thinking of common words while speaking.
• Changes in personality or behavior: For example out of character mood changes and loss of empathy.

Tests and Diagnosis

Alzheimer’s disease is not simple to diagnose as there is no single test to diagnose it. First doctors rule out other problems by asking for a detailed history of the patient, family members should be involved for accurate details, do physical examinations for signs of other problems like a stroke, heart and/or metabolic dysfunction conditions and by checking for neurological function.

Depending on this comprehensive analysis, a doctor may order blood and urine tests and brain scans.

If there is no evidence of another issue a doctor will then carry out cognitive tests. Some of these are the abbreviated mental test score, the general practitioner assessment of cognition and the mini mental state examination.

Treatment  

There is no known treatment of Alzheimer’s disease; however advancements have been made in the management of the disease. Medications used to support the patient either to modulate the disease or to control agitation and behavioral changes. Activities and programs for adult day care have been developed and support groups and services formed. Support groups are key for not only patients but also their families and caregivers.