Alzheimer
- Article
- 2021-03-02
Alzheimer's disease is an irreversible, progressive brain disease that slowly destroys memory and thinking, and ultimately the ability to perform the simplest tasks. It is the most common cause of dementia in older adults. Although dementia becomes more common as people age, it is not a normal part of aging.
Symptoms
Scientists continue to unravel the complex brain changes involved in the development and progression of Alzheimer's disease. It seems likely that brain damage begins a decade or more before memory and other cognitive problems arise. During this preclinical phase of Alzheimer's disease, people appear to be symptom-free, but toxic changes take place in the brain.
Damage that occurs in the brain of someone with Alzheimer's disease begins to manifest in very early clinical signs and symptoms. In most people with Alzheimer's disease - those with the late variant - symptoms first appear in their mid-60s. Signs of early-onset Alzheimer's begin between your 30s and mid-60s.
The first symptoms of Alzheimer's disease vary from person to person. Memory problems are typically one of the first signs of cognitive impairment related to Alzheimer's disease. Decreases in non-memory aspects of cognition, such as word finding, vision / spatial problems, and impaired reasoning or judgment, may also indicate the very early stages of Alzheimer's disease. And some people can be diagnosed with mild cognitive impairment. As the disease progresses, people experience more memory loss and other cognitive problems.
Alzheimer's disease has several stages: preclinical, mild (sometimes called early stage), moderate, and severe (sometimes called late stage).
Signs of mild Alzheimer's disease
With mild Alzheimer's, a person may appear healthy, but they have increasing difficulty understanding the world around them. The realization that something is wrong often comes gradually to the person and his or her family. Possible problems are:
- Amnesia
- Bad judgment leads to bad decisions
- Loss of spontaneity and sense of initiative
- It takes longer to perform normal daily tasks
- Repeating questions
- Problems handling money and paying bills
- Wandering and getting lost
- Losing things or losing them in strange places
- Mood and personality changes
- Increased anxiety and / or aggression
Alzheimer's disease is often diagnosed at this stage.
Signs of moderate Alzheimer's disease
At this stage, more intensive supervision and care become necessary, which can be difficult for many spouses and families. Symptoms can include:
- Increased memory loss and confusion
- Inability to learn new things
- Difficulties with language and problems with reading, writing and working with numbers
- Difficulty organizing thoughts and thinking logically
- Shortened attention span
- Problems dealing with new situations
- Difficulty in performing multi-step tasks, such as getting dressed
- Problems recognizing family and friends
- Hallucinations, delusions and paranoia
- Impulsive behavior, such as undressing at inappropriate times or places or using vulgar language
- Inappropriate outbursts of anger
- Restlessness, excitement, fear, tearfulness, wandering - especially in the late afternoon or evening
- Repetitive statements or movements, occasional twitching
Signs of severe Alzheimer's disease
People with severe Alzheimer's cannot communicate and are completely dependent on others for their care. By the end, the person may be in bed most or all of the time when the body is turned off. Their symptoms are often:
- Inability to communicate
- Weight loss
- Epileptic attacks
- Skin infections
- Difficulty swallowing
- Moan, moan or growl
- Sleep more
- Loss of bowel controland and the bladder
A common cause of death for people with Alzheimer's disease is aspiration pneumonia. This type of pneumonia develops when a person cannot swallow properly and takes food or liquids into the lungs instead of air.
There is currently no cure for Alzheimer's, although there are medications that can treat the symptoms of the disease.
Therapy
Alzheimer's disease is complex and it is unlikely that a drug or other intervention will treat it successfully. Current approaches aim to help people maintain their mental function, manage behavioral symptoms, and slow the symptoms of illness.
Several prescription drugs are currently approved by the United States Food and Drug Administration (FDA) to treat people diagnosed with Alzheimer's disease. Treating the symptoms of Alzheimer's can provide people with comfort, dignity and independence for a longer period of time and can also encourage and help their caregivers.
Most medications work best for people in early or mid-stage Alzheimer's disease. For example, they can delay certain symptoms, such as memory loss, for a time. It is important to understand that none of these drugs will stop the disease itself.
Treatment for mild to moderate Alzheimer's
Medicines called cholinesterase inhibitors are prescribed for mild to moderate Alzheimer's disease. These drugs can help reduce some symptoms and help manage some behavioral symptoms. The drugs are Razadyne® (galantamine), Exelon® (rivastigmine) and Aricept® (donepezil).
Scientists don't yet fully understand how cholinesterase inhibitors work in Alzheimer's disease, but research shows that they prevent the breakdown of acetylcholine, a chemical in the brain believed to be important for memory and thinking. As Alzheimer's progresses, the brain produces less and less acetylcholine; therefore, cholinesterase inhibitors can eventually lose their effect.
No published studies directly compare these drugs. Because they work in a similar way, switching from one of these drugs to another is unlikely to produce significantly different results. However, it is possible that an Alzheimer's patient will respond better to one drug than another.
Treatment for moderate to severe Alzheimer's
A drug known as Namenda® (memantine), an N-methyl D-aspartate (NMDA) antagonist, is prescribed to treat moderate to severe Alzheimer's disease. The main effect of this drug is to reduce symptoms, allowing some people to maintain certain daily functions for a little longer than without the medication. For example, Namenda® can help a person in the later stages of the disease maintain his or her ability to use the bathroom on their own for several months, benefiting both the person with Alzheimer's and caregivers.
The FDA has also approved Aricept®, the Exelon® patch, and Namzaric®, a combination of Namenda® and Aricept®, for the treatment of moderate to severe Alzheimer's disease.
Namenda® is believed to work by regulating glutamate, an important brain chemical. When glutamate is produced in excessive amounts, it can lead to brain cell death. Because NMDA antagonists work differently from cholinesterase inhibitors, the two types of drugs can be prescribed in combination.
