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Making Sense Of ... Health Issues of the 21st Century

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Making Sense of ... Alzheimer's Disease

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Alzheimer's

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 growing evidence of genetic components in some patients1. But familial links do not account for every case, and there are many other factors

Does depression affect susceptability to Alzheimer's Disease?

There is clear evidence of an association between past and present depression and Alzheimer's disease, but it is not yet clear whether Alzheimer's is caused by depression, or there is

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

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

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

Disorientation - People with AD can easily get lost in a neighborhood they've known for years; forgetting how they got there, and how

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

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,

Mood changes - people with Alzheimer’s disease may show rapid and frequent mood swings for

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.

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.

Personal Neglect - A person with Alzheimer’s disease is likely to neglect things we all take for granted; hair, nail, personal hygiene; possibly other health needs, such as oral care2.

[based on Sympoms ]

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

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

Is there a way to prevent Alzheimer's 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

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

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

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

Alzheimer's 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 brain 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!

With an ageing population in much of the developed world, there has been an increase in research into Alzheimer's disease; sadly, of the hundreds of papers published each year, few - if any - have any impact on the management of thedisease, or increase our understanding. Hopefully, however, the vast amount of data being accumulated will eventually yield

It is, perhaps, a shame that so much intellectual effort is going into the esoteric edges, and so little on the day-to-day care of those living with the disease.

References

1. Lambert, J-C; Ibrahim-Verbaas, C. A.; Harold, D. Meta-analysis of 74,046 individuals identifies 11 new susceptibility loci for Alzheimer's disease Nature Genetics ng.2802 (2013) abstract

2.

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.

If this article hasn't answered your question, 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

First Published: 20 February 2012
Last updated: 27 February 2017
© Andrew Heenan 2012 et seq
 

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