A progressive neurodegenerative disease, Alzheimer's slowly destroys an individual's memory, judgment, cognition and eventually ability to function. It represents an enormous burden on victims of the disease and their family alike.
Alzheimer's disease (AD) is a progressive, neurodegenerative disease characterized by memory loss, language deterioration, impaired ability to mentally manipulate visual information, poor judgment, confusion, restlessness, and mood swings.
AD usually begins after age 65, but its onset may occur as early as age 40, appearing first as memory decline and, over several years, destroying cognition, personality, and ability to function. Confusion and restlessness may also occur. The type, severity, sequence, and progression of mental changes vary widely. However, there are some early-onset forms of the disease, usually linked to a specific gene defect, which may appear as early as age 30.
The early symptoms of AD, which include forgetfulness and loss of concentration, can be missed easily because they resemble signs of natural aging. Similar symptoms can also result from fatigue, grief, depression, illness, vision or hearing loss, the use of alcohol or certain medications, or simply an overwhelming burden of details to remember.
In the early stages (or mild AD) the changes may be very subtle and often include:
In moderate AD, the changes may include:
In a severe AD the deficits are more obvious. Some symptoms are:
As the disease progresses further, people with AD eventually forget how to do simple tasks like brushing their teeth or combing their hair. They begin to have problems speaking, understanding, reading, or writing. Some may wander away from home. Eventually, a patient may need total care.
The cause of Alzheimer's disease is not known, but it is not a part of normal aging and thought to include both genetic and environmental factors. By causing both structural and chemical problems in the brain, AD appears to disconnect areas of the brain that normally work together.
The most important risk factors are old age and a family history of dementia. In addition to age and family history, risk factors for AD may include longstanding high blood pressure, head trauma, and high levels of homocysteine (a body chemical that contributes to chronic illnesses such as heart disease, depression, and possibly AD). Because women usually live longer than men, they are more likely to develop AD.
Currently, the progression of AD can be slowed, but the disease cannot be cured, and impaired functions cannot be restored.
Treatment focuses on slowing the disease's progression; managing the patient's behavior problems, confusion, and agitation; modifying the home environment; and supporting the family. As symptoms worsen, the disease may take a greater toll on the family than on the patient.
Underlying disorders that contribute to confusion should be identified and treated. Behavior modification may be helpful for some patients in controlling unacceptable or dangerous activity.
For some people in the early or middle stages of the disease, medicines such as Cognex, Aricept, Exelon, or Reminyl may temporarily slow the progression of the disease. Memantine is sometimes used in moderate and severe stages to help patients maintain some daily functions for a little longer. Also, some medications may help control behavioral symptoms such as sleeplessness, agitation, wandering, anxiety, and depression. These treatments are aimed at making the patient more comfortable. It may be necessary to stop any medications that make confusion worse including painkillers, cimetidine, central nervous system depressants, antihistamines, sleeping pills, and others. Never change or stop taking any medicines without first talking to your doctor.
Research at the National Institute on Aging, the National Institute of Mental Health, and the National Institute of Neurological Disorders and Stroke is exploring possible new options for treating Alzheimer's. For example, a clinical trial is under way to see if anti-inflammatory drugs may ward off symptoms in at-risk people who are currently healthy. Another study is looking at whether statins, traditionally used to combat heart disease, may help Alzheimer's. Other studies are looking at the role of B and E vitamins, estrogen, and gingko biloba. Results are not yet available from these trials. Patients interested in participating in clinical trials should speak to their physicians.