Alzheimer’s Disease

Alzheimer's disease is a disease that leads to the destruction of brain cells and the shrinking of one's brain size. The symptoms of the disease worsen as time goes on. It is one of the most common contributors of dementia, characterised by a steady deterioration in mental, behavioural, and social abilities and degrades a person's capacity to do things independently. Alzheimer’s is a disease that has no cure or ways to reverse it, even with the many ongoing studies on it. Many people may not realise that it is not a normal aspect of ageing and needs urgent attention if symptoms are noticed. The signs and symptoms of Alzheimer's get worse with time. In fact, according to doctors, the illness process could last up to 10 years before Alzheimer's disease symptoms start to show.

When memory issues become apparent, they are frequently classified as mild cognitive impairment (MCI). At this point, the brain adjusts to the effects of the disease, affecting intellectual function but leaving the ability to operate and lead a normal life.

MCI may not continue to progress in some persons at this point. However, dementia is most likely to progress in MCI patients. The chief type of dementia is Alzheimer's disease. Daily function is compromised with dementia, as opposed to MCI.

Now that you have understood what Alzheimer’s disease is and what the differences between Alzheimer’s and Dementia are, let us look into the types of Alzheimer’s disease.

There are two basic types of Alzheimer’s disease based on the time they start showing symptoms in patients. The two types of Alzheimer’s disease are late onset and early onset Alzheimers.

• Late-Onset Alzheimer’s- Most Alzheimer's patients have the late-onset variety, whose signs first appear in their mid-60s. According to research, the late-onset type of the disease is not directly caused by any one gene. The apolipoprotein E (APOE) gene is located on chromosome 19, and having one variant, or allele, increases an individual's chances of developing the disease. Because it raises an individual's chances of contracting the disease, APOE 4 is a risk-factor gene. However, having the APOE 4 allele does not guarantee that a person would develop Alzheimer's. It is also possible that a person can develop Alzheimer's without having the APOE 4 allele.
• Early-Onset Alzheimer’s- Less than 10% of patients with Alzheimer's have the early-onset form of the disease, which usually manifests between the ages of 30 and 60. One among the three genes can change due to heredity in some situations. According to studies, some genetic factors appear to be involved in some cases. Researchers are currently seeking other genetic risk variations for Alzheimer's disease with early onset.

Many people can mistake Alzheimer’s disease for simple signs of ageing. However, keeping a keen eye, you can distinguish the various Alzheimer’s disease stages. A person's symptoms will worsen as the stages progress. Recognising these Alzheimer’s disease stages is important as they can help you aid the patient and even yourself in battling the disease.

The different Alzheimer’s disease stages are;

• Stage 1- Alzheimer's disease typically develops slowly over years before anyone detects any changes in their mental state. Your loved one won't exhibit any symptoms during this early stage, so you won't be able to identify that they have Alzheimer's.

• Stage 2- The patient may detect subtle variances in behaviour that even a physician would miss, even though you may not yet notice anything unusual about their behaviour. This could involve losing track of items or forgetting words. They can still work and normally live despite mild Alzheimer's disease symptoms.

• Stage 3- At this time, you start to see alterations in the patient's reasoning and thought processes. You will notice symptoms such as repetitiveness, forgetting information they've recently read, or having difficulties organising themself.

• Stage 4- In this stage, the cognitive and reasoning challenges you encounter in - **Stage 3 become more pronounced, and new problems emerge. The patient will become aware of any memory or cognitive gaps on their own.

• Stage 5- The patient may become disoriented about their whereabouts and the time. They can have problems recalling their home address, contact information, or former school. They could become perplexed about the appropriate attire for the time of year or day.

• Stage 6- The patient may recognise faces as the disease worsens but lose names. Additionally, they could confuse a person for someone else, such as believing their wife to be their mother. This is also the - **Stage where the patient becomes delusional and possibly violent.

Protein accumulation that is out of the ordinary in the brain leads to Alzheimer's disease. These proteins, known as tau protein and amyloid protein, accumulate and cause cell death.

More than 100 billion neurons and other types of cells make up the human brain. The nerve cells carry out all the activities required to carry out tasks like thinking, memorising, remembering, and organising. Scientists suspect that the accumulation of amyloid protein leads to the formation of bigger aggregates known as plaques in the neurons. Tau tangles are made of twisted tau protein fibres. Such plaques and tangles obstruct nerve cell connection, which stops nerve cells from performing their functions. The symptoms experienced by people with Alzheimer's disease are caused by the slow and continuous destruction of the nerve fibres, which begins in one of the brain's regions (often in the part of the brain that governs memory) before progressing to other places.

Having looked at some of the causes of Alzheimer’s lets us also understand some of the risk factors that could lead to the onset of the disease.

• Older people (over 65) face a greater risk of Alzheimer’s disease.

• If someone in your family has been diagnosed with Alzheimer’s, you may get it too.

• There have been some genes that have been identified as a cause of Alzheimer’s. If you carry those genes, your chances of developing Alzheimer's increase significantly

• Those who suffer from severe depression for long periods are more susceptible to developing Alzheimer’s.

• Smoking has been recognised as one of the triggers of Alzheimer’s.

• Some heart diseases have been known to increase the risk of Alzheimer’s.

• If you have ever sustained a traumatic injury to your brain, you could be more susceptible to Alzheimer’s.

Remember that these risk factors do not necessarily mean you will have Alzheimer’s disease. It just means you are at a higher risk of developing the disease.

Because Alzheimer's is a degenerative illness, the signs and symptoms appear progressively over a long period and then worsen. Numerous brain functions are impacted. In most cases, mild memory issues are the initial indication of Alzheimer's disease. For instance, this can include not remembering the names of individuals and things and recent discussions or incidents. Memory issues get more severe as the illness worsens, and additional symptoms may crop up, such as:

• Getting confused about where to go and whom to meet

• Forgetting names and faces

• Missing appointments

• Becoming repetitive

• Getting out of home and then forgetting where you need to be

• Insomnia

• Not remembering where you have kept certain things

• Difficulty in expressing thoughts and feelings

• Difficulty managing finances

• Being anxious or afraid all the time

• Being impulsive

• Trouble with numbers

• Difficulty in driving and cooking

• Having short-term recall

These are some of the most common symptoms you may notice in people in the first few stages of Alzheimer’s disease. As the disease progresses, you may see symptoms like;

• Losing patience very fast

• Increased fear

• Going into a shell

• Trouble swallowing

• Losing motor functions like walking

• Severe depression

• Extreme mood swings

• Aggression

• Losing trust in close people

• Forgetting loved ones

• Delusions

• Paranoia that can lead to the patient becoming increasingly violent

As the symptoms of Alzheimer’s progress, a person loses their sense of self. They may need help in the smallest of tasks. It is important to remember to be kind to the patient, even when they are being difficult. The patient may sometimes act out just to see if you will support them at their worst. Knowing they have people they can depend on makes bearing the disease much easier. Also, caring for a patient with Alzheimer’s is a full-time job. Remember to be kind to yourself if you care for someone with Alzheimer’s.

Since Alzheimer's disease indicators develop gradually, it might be challenging to spot a problem. Many people believe that memory issues are just a natural part of ageing. Additionally, people might not necessarily be able to recognise memory changes due to the illness itself. However, Alzheimer's disease is never a "natural" aspect of ageing. Fast and precise identification of Alzheimer's disease may offer you the best opportunity to make plans and preparations and obtain any necessary treatment or assistance.

Some ways your doctor might make an Alzheimer’s diagnosis include;

• Routine Blood and Urine Cultures- Standard laboratory tests such as blood levels, liver and kidney performance, vitamin counts, thyroid hormone function and mineral balance tests are done to exclude other potential causes of symptoms.

• Patient History- The doctor will inquire about the patient's present and previous illnesses, the drugs they are currently taking, and any history of Alzheimer's disease, as well as other memory impairments in the patient's family. Additionally, they will perform a neurologic exam and assess all existing vital signs, including blood pressure, heartbeat, fever, and pulse.

• Neurological Tests- Tests for attention, recollection, language, planning and thinking, reasoning ability, ability to alter behaviour, temperament, and mental stability are all part of this exam. Testing of this kind can also track the development of Alzheimer's disease.

• Test of Mental Status- Tests of recollection, problem-solving, concentration, calculating, and language proficiency are among these. Testing of this kind can also track the development of Alzheimer's disease.

• Lumbar Puncture- This procedure, also known as a spinal tap, looks for the tau and amyloid proteins that build the plaques and tangles characteristic of Alzheimer's disease in the brains of patients.

• MRI- Brain deterioration can be visibly seen on this scan. It can also detect other structural abnormalities, including strokes, tumours, fluid accumulation in the brain, and other conditions that can manifest symptoms resembling Alzheimer's disease.

• CT Scan- In the later stages of Alzheimer's disease, tangible alterations in the morphology of brain cells can be detected. These changes include a reduction in brain size (brain atrophy), extension of the fluid-filled regions in the brain, and a broadening of the creases in the brain tissues.

• Amyloid PET Scan- This test checks for Amyloid protein accumulation in the brain, which is a determiner of Alzheimer’s disease.

Alzheimer's disease currently has no known treatment. To help you manage your symptoms and slow the spread of the illness, your doctor may suggest drugs and other therapies.

Your doctor might suggest drugs like donepezil or rivastigmine for mild to early-stage Alzheimer's treatment. The high quantities of acetylcholine these medications can keep in your brain. Your brain's nerve cells may be able to send and receive impulses more effectively. As a result, some Alzheimer's symptoms might be lessened.

Only patients with early Alzheimer's are advised to take the more recent medicine, aducanumab. It is believed to lessen the accumulation of protein plaques in the brain associated with Alzheimer's. However, since this medicine is still fairly new in the market, many doctors and scientists are still wary of prescribing it as an Alzheimer's treatment.

In Alzheimer's disease, glutamate, a brain neurotransmitter, is produced in larger amounts and kills brain cells. Your medical professional might suggest memantine or donepezil to treat mild to advanced Alzheimer's. Memantine can aid in preventing the ill effects of the over-accumulation of glutamate in your brain.

Some of the frequent behavioural signs of Alzheimer's disease can be managed with medication. Antidepressant medications, for instance, can be employed to relieve depression, anxiousness, hyperactivity, and violence. Agitation can be managed using anti-anxiety medications. Aggressiveness is occasionally treated with anticonvulsants. Hallucinations, restlessness, and psychosis can all be treated with antipsychotic medications. These medicines may lead to confusion and disorientation, which might raise the risk of collapsing. Because of this, these medications are normally only used briefly when severe behavioural issues occur.

It is very difficult to make certain comments about Alzheimer’s disease. There have been various studies on the disease, and studies are still going on in the field, yet doctors and scientists have not been able to draw many conclusive results from their studies. However, a few factors could help keep Alzheimer’s at bay, even if we cannot prevent its onset completely.

These factors include:

• Diseases like diabetes, high cholesterol, hypertension, obesity, and smoking can directly connect to the development of Alzheimer’s disease. According to research, these five indicators may hinder the brain's ability to eliminate amyloid protein, increasing the likelihood of Alzheimer's disease. A person is more likely to develop Alzheimer's if most of these health conditions exist simultaneously and are present in their 50s. If you can avoid these diseases, your likelihood of avoiding Alzheimer’s increases.

• There might be some strategies to lessen the likelihood of mental decline. A healthy lifestyle generally guards against heart attacks and strokes and is thought to shield the brain against cognitive deterioration. The causes and effects of the following elements cannot be shown with certainty, although research has revealed a "positive correlation."

• Keep your mind engaged. Enjoy board games, read, solve crossword puzzles, play an instrument, take community college classes on the side, or engage in other activities that call for "brain power."

• Take up some exercise. Exercise improves oxygen and blood supply towards the brain, and this may have a direct impact on the health of brain cells.

• If partaking in tasks that enhance the potential of head trauma, wear proper safety gear.

• Maintain your social life. Regular communication with family and friends and participation in group tasks can positively decrease your chances of developing Alzheimer's.

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