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The fifth-leading cause of death in the United States for people over the age of 65 is Alzheimer’s, with about 1 in a 100 people of that age affected (rising to 40 out of a 100 by 85). Alzheimer’s is commonly taken to be synonymous with dementia, but in fact, it is a specific type of dementia, which is an umbrella term for degeneration in mental ability.
Alzheimer’s is named after the doctor who helped in identifying the disease via its first published case. It is best described as a brain disorder of a progressive nature, meaning that symptoms worsen and grow over time.
Put simply, Alzheimer’s disease is the loss of communication between nerve cells in the brain, responsible for tasking and “electrifying” the rest of the cells, thus facilitating communication and coordination between the body and all the tasks it does.
As such, a gradual cognitive decline and a severe loss of memory come to characterize those with Alzheimer’s. Two of the key components of the disease, from a chemical standpoint, are the presence of abnormal protein clumps (called amyloid plaques) and tangled clusters of axons, both in the brain tissue.
The plaques build up over time, blocking communication between the nerve cells, eventually causing them to atrophy and brain tissue to die. This directly affects the aforementioned cognitive abilities such as thinking, recalling information, language skills, and reasoning.
Irritability also manifests alongside the patient’s inability to handle these otherwise “ordinary” tasks and functions and the gradual breakdown in communication between the “chemical messengers” in the brain.
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Recently, research has shown the possibility of another factor that causes Alzheimer’s: the Porphyromonas gingivalis gum disease (and the associated bacteria, specifically). It’s a relatively new hypothesis, but a plausible one with hope for treatment and many scientific and logical arguments in favor of it.
As established, there is no consensus on what causes Alzheimer’s, and yet there is a clear link with age (in particular, old age). The risk of developing Alzheimer’s doubles every five years after the age of 65, but early onset of Alzheimer’s has also been observed in the world in younger people aged 40 and above.
Unfortunately, the word best suited to describe the onset of Alzheimer’s is “sporadic”, meaning a complex mesh of age, lifestyle, and environmental factors go in to causing the disease, making it harder to pin down or avoid it altogether.
There is, however, a correlation between many lifestyle choices that can be linked to Alzheimer’s: smokers are 45% more likely, people with type 2 diabetes are twice as likely, and excessive drinkers are highly likely to develop dementia than those who do not fit these descriptions.
The first and most prominent factor associated with Alzheimer’s is memory loss, for example remembering recent conversations and events. This memory loss can be distinguished from a non-Alzheimer’s poor memory by recurring patterns such as repeating questions, failing to remember events, conversations and appointments even when prompted or reminded, getting lost in familiar places, losing items by placing them in unfamiliar or illogical places, and, ultimately, forgetting names of close relations such as family members.
Another way to assess the lapse in reasoning and thinking is a crippling inability to deal with numbers, making unexpected and uncharacteristic mistakes and choices in everyday situations (and failing to notice), and difficulty with language.
It is also helpful to know the symptoms of the advanced stage since many Alzheimer’s patients are only diagnosed postmortem: incontinence, loss of interest in food and drink (even regular meals), and even hallucinations and psychiatric delusions.
It is difficult to diagnose a patient with Alzheimer’s due to the various crisscrossing elements, risk factors, and symptoms that may develop.
While there is no single test, doctors will employ several methods concurrently, usually reliant on self-reporting or concerns from close family members or friends. Physical tests and cognitive tests are taken into consideration together, as well as the patient’s history.
Recent developments have been made (even if primarily just in the research stage) to employ positron emission tomography (PET) scans for the detection of amyloid plaques or nerve tangles. The abnormal protein concentration has also been measured using cerebrospinal fluid from a spinal tap (and namely, the presence of tau in it).
CT and MRI scans are also used to rule out or determine the presence of signs of a recent stroke, tumors, and recent changes to blood vessels in the brain, or vitamin deficiencies and thyroid gland diseases.
If any patient has unusual symptoms of dementia (particularly if these symptoms are early onset), amyloid PET imaging is used to measure the severity of the presence of amyloid deposits in the brain.
Additionally, Fluorodeoxyglucose (FDG) PET scans can be used to determine between Alzheimer’s and other forms of dementia (such as Lewy body dementia, dementia related to Parkinson’s disease, or temporary and reversible dementia).
While there is no cure for Alzheimer’s disease, medicine, and drugs are used to treat the symptoms and help patients manage their daily affairs better.
Cholinesterase inhibitors, particularly help with the neuropsychiatric symptoms such as anxiety, depression, agitation, and irritability by preserving the otherwise-depleting chemical messengers. The three most commonly prescribed of these are donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon).
The best treatment usually comes at a later stage that is combining one of these with an NDMA inhibitor called Memantine, resulting in the slowing of the progression of moderate to severe Alzheimer’s disease symptoms.
Ultimately, what matters most in Alzheimer’s is caregiving – both for the patient and the caregiver themselves.
Alzheimer’s disease results in a person losing what can be described colloquially as their “essence”, forgetting basic details about their life, lifestyle, and life partners. For this, the support of those around them is paramount. The need to monitor depression is also important, with two in 10 patients being diagnosed with severe depression.
However, anti-depressants bring a risk of being overprescribed in older patients, as do anti-psychotics, which have since long been discouraged and discontinued as common practice to prescribe to Alzheimer’s disease patients.
Caregivers should be expected to keep things organized for patients in the home so as to create a sense of familiarity and maintain links between memory lapses: keep their phone, wallet, keys, and similar items in the same place (as well as monitoring their presence at all times), reduce the number of mirrors in the house, and minimize clutter such as excess furniture.
Patients with Alzheimer’s disease should also be equipped with a medical alert bracelet and personally identifying information at all time, as well as good shoes that provide traction and a mobile phone that the caregiver can use to pinpoint their location from their own mobile.
Finally, to identify Alzheimer’s in its early stages is key: the MMSE test is one of the simplest for people to test whether they might be developing symptoms of Alzheimer’s.
Reaching out to a close relative or loved one for whom you might suspect the onset of Alzheimer’s is an important thing to do, as well as open and honest communication about their wishes for what they would like for you to do in a future where the situation grows more serious.
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