What
is Alzheimer's Disease?Alzheimer's Disease (AD) is a neurodegenerative
disease, characterized by progressive mental deterioration, together with declining
activities of daily living. Often accompanied by psychiatric symptoms or behavioral
changes, it accounts for about 60% of all people living with dementia. Where
is Alzheimer's Disease usually found?Geographically, AD is found around
the world, and while a number of studies have suggested racial differences, when
other factors - such as weight, diabetes and higher mortality - have been removed,
there appears to be no staistical significance to the variation. How
common is Alzheimer's Disease?At age 65, 2-3% people show signs of AD,
but in 85 year olds, some 25–50% of people have symptoms, while still more
show signs without overt symptoms.. How is Alzheimer's
Disease transmitted?AD is not infectious or contagious. Is
there a genetic / familial / hereditary factor?There is a consensus
in the medical world that there is a dominant gene genetic component in some patience;
probably involving the early onset form of the disease. But familial links do
not account for every case, and there are many other factors that may have influence
on risk factors. Who is most at risk from Alzheimer's
Disease?AD is a disease of older people; usually over 65. the name was
initailly applied to younger people (but usually over 45) with presenile dementia;
senile dementia until recently being considered a 'normal' consequence of old
age. It is now accepted to be a disease that may or may not affect an individual,
most commonly - but by no means exclusively - in old age. Age is bar far
the biggest single risk factor; 2-3% people show signs of AD at age 65, but this
risk roughly doubles every five years; some 50% of people aged 90-95 show signs
of the disease. Familial incidence is a factor; having a parent or sibling
with AD more than doubles the risk. Cardiovascular factors, such as high
blood pressure, stroke, and diabetes, are all associated with increased risk. While
it is likely that thereare dietary factors that either increase or decrease risk,
there is currently no real consensus, beyond an acceptance that diet is already
associated with the risk of cardiovascular disease, and that, in turn, increases
the risk of AD. There is no direct link with intelligence, but a good education
and an mentally active life are thought to reduce risk (by people with a good
education and an active mental life!). the evidence is not overwhelming. Women
appear to be at slightly greater risk than men, even when studies are corrected
for the uneven longevity between the sexes. This may be a hormone-related matter.
or not. Environmental factors may well be involved; it used to be fashionable
to point the finger at aluminium, but as time passes, the case looks rather weaker.
No other single factor has been demonstrated. The real lack of clarity
about risk factors should be a source of shame to the scientific community; but
in fairness, there is considerable research going on now; including many long-term
studies. About time too. What are the symptoms of
Alzheimer's Disease?AD is a progressive disease, and it affects different
people in different way; this list is not exhaustive, and many peole may not exhibit
all or many of these symptoms. Memory loss - Some loss of short-term
(recent) memory is an early sign. The person progressively forgets more, and more
often, while often retaining a very clear long-term memory. Difficulty
with familiar tasks - AD often affects a person's ability to plan or complete
everyday tasks, such as playing a game, cooking a meal, or making a phone call. Problems
with language - People with AD may forget simple words or use inappropriate
words without seeming to realise. They may become frustrated when asking a question
that appears to make no sense, and so cannot be answered. Disorientation
- People with AD can easily get lost in a neighborhood they've known for years;
forgetting how they got there, and how to get home. Loss of judgment.
People with Alzheimer’s may dress inappropriately, unseasonally, or not at
all. They may show poor judgment with money. Difficulty with abstract
thinking - Fairly simple sums, that once they'd have done instantly, may become
impossible and frustrating. Losing things - A person with Alzheimer’s
disease may put things in inappropriate places: an iron in the freezer or a wristwatch
in the sugar bowl, without seeing any incongruity. Mood changes -
people with Alzheimer’s disease may show rapid and frequent mood swings for
no apparent reason. Personality changes - The personalities of people
with dementia can change totally, sometimes a complete reversal of their previous
personality, with rejection of close friends and family. 10. Loss of initiative.
A person with Alzheimer’s disease may become very passive, sitting in front
of the TV for hours, sleeping more than usual or not wanting to do usual activities.
What's normal? Sometimes feeling weary of work or social obligations. [based
on Sympoms
of Alzheimer's] What are the long term effects of
Alzheimer's Disease?As it is a progressive condition, symptoms will appear
with greater frequency and severity until the person is unable to care for themselves;
in many cases, an aged partner or companion will not be able to cope in the later
stages, and much support may be required. What
is the mortality rate for Alzheimer's Disease?While Alzheimers on death
certificates suggests that the disease is amjor cause of death, this is not a
reliable conclusion, for the simple reason that Alzheinmer's cannot even be diagnosed
with certainty pre-mortem, and many fewer patients have such a cause of death
confirmed at autopsy - the vast majority of people considered to have Alzheimer's
disease are not the subject of autopsy. This is not to cast doubt on diagnosis
of the disease; while only post mortem can provide 100% certainty, diagnosis in
life may be made with confidence. But diagnosis of Alzheimer's as a cause of death
is by no means as simple; the disease occurs in people, who by virtue of their
age, may have many co-existing conditions, often masked to some extent by AD.
While AD may well have been a cause of many of the most distressing symptoms,
that does not automatically link it directly to the patient's death. There
is, however, no doubt at all that AD contributes significantly to mortality; accidents
are more likely, self-neglect and inability to even eat properly all take their
toll, plus depression, and often total isolation, and sometimes an inability to
recognise or report severe pain. The stress of a few moments of lucidity in a
patient with advanced Alzheimers, who once had a full and active life, can never
be measured, but must rank among the worst experiences it is possible for a human
being to have. But death-certificated statistics on cause of death are not
to be relied on. [PLEASE NOTE: This is my interpretation of evidence
from many sources; I am not a doctor, and I must state that my views may be considered
controversial; equally, many may feel that the difference between 'cause of death'
and 'contributory factors' is moot] How is
Alzheimer's Disease diagnosed?Diagnosis is made based on disease history,
from a close relative or friend, together with an thorough physical and mental
examination. There is no laboratory test to provide a firm diagnosis, and even
scans cannot give a definitive diagnosis. AD can only be confirmed by post mortem
examination of the brain. Diagnosis requires the exclusion of other conditions
that may cause memory loss, such as depression, infection, vitamin deficiency
or brain tumour; all of which are amenable to treatment. An early diagnosis
can help carers and family to cope with disease progression, and may give the
patient an opportunity to make decisions about their financial and legal affairs
while they have the ability to do so. Early diagnosis may also provide an
opportunity to control conditions which may exacerbate symptoms and possibly accelerate
the disease progression, such as high blood pressure and diabetes.
Is
there a treatment for Alzheimer's Disease?No. Some measure of symptom
control may be achieved by better management of concurrent conditions, but AD
is irreversible, and no current treatment has a proven effect on disease progression,
though symptoms may be alleviated in some cases, at least for a while. Is
there a way to prevent the disease?There is no sure way to prevent the
disease. However, individuals may be able to reduce their risk factors:
Healthy ageing - Research suggests that people with better cardiovascular
health have a reduced risk of Alzheimer's disease; maintaining a healthy weight,
taking regular exercise and controlling high blood pressure and cholesterol may
help. Nonsteroidal anti-inflammatory drugs (NSAIDs) - research suggests
that NSAIDs may reduce the risk of developing Alzheimer's. however, NSAIDs carry
a risk of severe side effects which may undermine any benefit; it is not clear
that take NSAIDs solely to prevent Alzheimer's is either sensible or safe; more
research is needed. Statins - This class of drug lowers cholesterol
levels, and recent studies suggest they may reduce the risk of Alzheimer's disease.
It is not yet clear if a cholesterol reduction is having an effect, or whether
the drugs act directly on the disease, but it is likely that certain 'at risk'
groups may benefit. Vitamins have been linked to improvements in
cognitive abilities, and their potential effects on Alzheimer's are being studied.
results so far have been ambivalent at best. Mental fitness - Maintaining
mental fitness may delay the onset of dementia. There are serious questions still
to be answered; is there a better quality of life for longer, or merely an ability
to do well in tests for longer? Or is it that educated, 'mentally active' people
are more likely to come from a stable home with a good support network, and so
be better able to continue to function for longer?
What
is the Alzheimer's Disease vaccine?A few years ago, researchers developed
a vaccine against an amyloid peptide that is associated with AD; in mice, the
vaccine had led to a profound reduction in amyloid deposition. In the animal trials,
the vaccine was well tolerated. In early human trials, however, there were major
side effects that required the trials to be halted. More recently, another
vaccine has been developed. The new one is said to be capable of triggering the
body's immune system to produce antibodies which will reduced the build up of
amyloid-beta plaques in the brain, hopefully leading to improved learning and
memory. The new vaccine will be delivered via a nasal inhaler, thought to reduce
the risk of inflammatory reaction of the kind seen in the earlier study. Research
continues. Can Alzheimer's Disease be controlled
environmentally?ALzheimers is a complex disease that almost certainly
has some environmental influences. One study comparing residents of a Nigerian
village with urban African-Americans, found a significantly lower level of dementia
and AD (the cohorts were age-corrected). There was a proposed link with aluminium,
but this has failed to survive more recent research. The block-capital brigade
have suggested a connection with water fluoridation, but they blame that for everything
(except better dental health), without perceiving a need for what we human beings
call 'evidence'. Research continues. What can be learned
from history?Alzheimer did medical science a great service by his studies
of the barin of one patient with presenile dementia, and in relating the post
mortem studies to the disease process; he no more 'discovered' dementia than Columbus
'discovered America; it was already there, and had been described many times.
Indeed, he did not even cheekily apply his name to it; another doctor did that. Interestingly,
for 70 years, Alzheimer's disease was considered a form of presenile dementia;
it was only over the last 30 years, that it was recognised to be the same disease
process, and so the name spread to cover what had been 'senile dementia'; up to
that point, this had been seen as a 'normal' part of ageing. This change in understanding
coincided with journalists' disdain for disease names that were a little on the
blunt side, so Alzheimer's name now adorns a disease he never ever studied; he
thought he was studying an exceptional process, not the core process. Such is
the nature of medical research! Bibliography
and Further Information Sources If your question has not been
answered, email me at the address below, and I'll try to get the information you
seek.
I regret I cannot assist with individual cases or essays and school projects,
but if it's something I've missed, I'll be happy to try and help.
Article written by Andrew Heenan BA (Hons), RGN, RMN
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