World Alzheimer's Day - 21st September, 2015

Prof N Heramani & Dr S Gojendra *

Combination of two brain diagrams in one for comparison. In the left normal brain, in the right brain of a person with Alzheimer's disease
Pix - wikipedia/Garrondo

Alzheimer's disease:

Every year since 1994, Alzheimer organisations have observed World Alzheimer's Day on 21 September and the day will continue to play an important and key role during the World Alzheimer's Month events. The theme this year is 'Remember Me'.

The disease was named after neurologist Alois Alzheimer, a German Psychiatrist who first described the disease in a 51 year old woman who suffers from progressive course of dementia.

Alzheimer's disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks.

Alzheimer's disease is currently ranked as the sixth leading cause of death in the United States, but recent estimates indicate that the disorder may rank third, just behind heart disease and cancer, as a cause of death for older people.

Risk factors

Risk factors associated with Alzheimer's disease include

* Age - the disorder is more likely in older people, and a greater proportion of over-85-year-olds have it than of over-65s.

* Family history (inheritance of genes) - having Alzheimer's in the family is associated with higher risk. This is the second biggest risk factor after age.

* Having a certain gene (the apolipoprotein E or APOE gene) puts a person, depending on their specific genetics, at three to eight times more risk than a person without the gene. Some studies have indicated that as many as 40 per cent of patients have a family history dementia of Alzheimer's type and it has shown linkage to chromosomes 1,14 and 21

* Being female (more women than men are affected).

* Factors that increase blood vessel (vascular) risk - including diabetes, high cholesterol and high blood pressure. (These also increase the risk of stroke, which itself can lead to another type of dementia.)

* Low educational and occupational attainment.

Prior head injury

Neuropathology in Alzheimer's disease

In Alzheimer's, there are microscopic ' senile plaques' and 'neurofibrillary tangles' between and within brain cells. The damage initially appears to take place in the hippocampus, the part of the brain essential in forming memories. As more neurons die, additional parts of the brain are affected, and they begin to shrink. By the final stage of Alzheimer's, damage is widespread, and brain tissue has shrunk significantly.

The classic observation of a brain from a patient with Alzheimer's disease shows diffuse atrophy and enlarged cerebral ventricles.

Common Symptoms of Alzheimer's disease

Worsened ability to take in and remember new information, for example:
* "Repetitive questions or conversations, Misplacing personal belongings, Forgetting events or appointments, Getting lost on a familiar route.

Impairments to reasoning, complex tasking, exercising judgment:
* Poor understanding of safety risks , Inability to manage finances, Poor decision-making ability, Inability to plan complex or sequential activities."

Impaired visuospatial abilities (but not, for example, due to eye sight problems):
* Inability to recognize faces or common objects or to find objects in direct view, Inability to operate simple implements, or orient clothing to the body.

Impaired speaking, reading and writing:
* Difficulty thinking of common words while speaking, hesitations, Speech, spelling, and writing errors.

Changes in personality and behavior, for example:
* Out-of-character mood changes, including agitation; less interest, motivation or initiative; apathy; social withdrawal, Loss of empathy, Compulsive, obsessive or socially unacceptable behavior.

Stages of Alzheimer's disease

Mild Alzheimer's Disease

As Alzheimer's disease progresses, people experience greater memory loss and other cognitive difficulties. Problems can include wandering and getting lost, trouble handling money and paying bills, repeating questions, taking longer to complete normal daily tasks, and personality and behavior changes. People are often diagnosed in this stage.

Moderate Alzheimer's Disease

Memory loss and confusion grow worse, and people begin to have problems recognizing family and friends. They may be unable to learn new things, carry out multistep tasks such as getting dressed, or cope with new situations. In addition, people at this stage may have hallucinations, delusions, and paranoia and may behave impulsively.

Severe Alzheimer's Disease

People with severe Alzheimer's cannot communicate and are completely dependent on others for their care. Near the end, the person may be in bed most or all of the time as the body shuts down.

Tests and diagnosis for Alzheimer's disease

Alzheimer's disease is not simple to diagnose - there is no single test for it.
* Proper history (asking about symptoms and daily activities)
* Detailed physical examination to find any signs of a stroke, heart condition or kidney disease
* Detailed Neurological function, e.g. by testing balance, senses and reflexes.
* Blood and urine samples testing
* Arranging brain scans (possibly including CT, MRI and EEG).
* Cognitive/Psychological test

1. The "abbreviated mental test score" (AMTS)
2. The general practitioner assessment of cognition (GPCOG) test
3. The mini mental state examination (MMSE) is a fuller cognitive test to help diagnose Alzheimer's disease.

Treatment:
* Psychosocial therapy:
1. Patents often benefit from a supportive and educational psychotherapy in which the nature and course of their illness are clearly explained
2. Psychodynamic interventions with family members of patients with the illness
* Pharmacotherapy: Cholinesterase inhibitors are useful in treating mild to moderate cognitive impairment
* The most important step in the management is to identify a continuous care giver and to give nursing care till the fullest life span and to listen to "Remember Me".