ALZHEIMER’S DISEASE-EARLY WARNING SIGNS AND TREATMENT

Updated 5 March 2024

Millions of families face challenges due to Alzheimer’s disease. World Alzheimer’s Day is observed on the 21st of September every year when the world wears purple to raise awareness about Alzheimer’s and Dementia.

What is Alzheimer's disease?

Alzheimer's disease is a progressive disorder that leads to the degeneration and eventual destruction of brain cells. As it worsens, thinking abilities and memory are impacted. Although it has occasionally taken longer than eight years, the complete process can take anywhere from four to eight years on average. Complications in the later stages of the disease might include significant loss of brain function from infections, starvation, or dehydration, eventually leading to death.

Worldwide Statistics

As of 2017, Alzheimer's disease affected over 40 million people worldwide. Cases are most prevalent in Western Europe and North America but most scarce in Sub-Saharan Africa. Most people with this disease do not even realize they have it, as only one in every four patients is actually diagnosed. Within the United States alone, Alzheimer's has become the sixth leading cause of death, and the country is expected to see a steady rise in Alzheimer's patients by the year 2025.

The cost of care for an Alzheimer’s patient is estimated to be around $230 billion dollars worldwide. This cost is projected to rise close to $605 billion worldwide over the next fifteen to twenty years. This sum equates to approximately 1% of the world's gross domestic product.

There are almost sixteen billion people around the world caring for Alzheimer's patients. This caregiving role includes doctors and nurses as well as private home health aides and family or friends participating in the care of these people. In 2016, over eighteen billion hours were devoted to the supervision and caregiving of Alzheimer's patients.

Different Stages of Alzheimer's Disease

Alzheimer's disease progression can be broadly categorized into three stages: early (mild), middle (moderate), and late (severe). Understanding these stages helps in providing the appropriate care and support for those affected.

• Early-Stage Alzheimer's: In the initial phase, a person may still function independently, engaging in daily activities and maintaining social relationships. However, they may start to lose their memory, forgetting the location of everyday objects or words they know. It is during this stage that symptoms are first noticeable to close family members or friends, including difficulty in planning or organizing and challenges in managing tasks at work or leisure activities.
• Middle-Stage Alzheimer's: This period can extend for several years and is usually the longest. The individual suffering from Alzheimer's will need more care as the disease progresses. During this phase, people may experience increased confusion or trouble understanding their environment, difficulty with language (such as struggling to follow a conversation or repetitive conversations), and significant changes in behavior and personality (such as withdrawal from social situations, moody or withdrawn behavior, especially in socially or mentally challenging situations). They might also encounter difficulties recognizing friends and family members, have trouble dressing appropriately, and show significant disruptions in sleep patterns.
• Late-Stage Alzheimer's: A person with Alzheimer's disease progressively loses the capacity to walk independently, respond to their surroundings, and carry on a conversation. Communication of suffering becomes harder, even if they may still express words or phrases. As memory and cognitive skills further decline, significant personality changes may take place, and people need extensive help with daily personal care. This stage includes loss of awareness of recent experiences and surroundings, changes in physical abilities (including the ability to sit, walk, and, eventually, swallow), difficulty communicating, and vulnerability to infections, especially pneumonia.

Different Types of Alzheimer's Dementia

Alzheimer's disease is not a one-size-fits-all condition. The two primary types of Alzheimer's are early-onset and late-onset, each presenting unique characteristics:

• Early-Onset Alzheimer's: This type affects people younger than 65, often appearing as early as one's 40s or 50s. It is less common, accounting for a small percentage of all Alzheimer's cases. Early-onset Alzheimer's can be particularly challenging, as it may impact people in the prime of their work life or as they are raising families. Some cases of early-onset Alzheimer's have a genetic component known as familial Alzheimer's disease (FAD), linked to mutations in specific genes.
• Late-Onset Alzheimer's: This is the most common form of Alzheimer's, typically occurring in people aged 65 and older. The risk increases with age, but it is not considered a normal part of aging. The exact cause of late-onset Alzheimer's is not fully understood, though a combination of genetic, environmental, and lifestyle factors is believed to influence its development. Unlike early-onset Alzheimer's, late-onset does not usually have a clear-cut pattern of inheritance, though having a family history of the disease can increase one's risk.

Early Warning Symptoms and Signs

Alzheimer's disease symptoms encompass a wide range of cognitive, functional, and behavioral changes, evolving from mild to severe as the disease progresses. Here is a detailed overview:

• Memory Loss Affecting Daily Activities: One of the most recognizable symptoms, including forgetting recently learned information, important dates or events, and increasingly needing to rely on memory aids.
• Challenges in Planning or Solving Problems: Difficulties may be seen in following a familiar recipe, keeping track of monthly bills, or difficulty concentrating on complex tasks.
• Difficulty Completing Familiar Tasks: This could range from having problems remembering the rules of a favorite game to managing a budget or traveling to a familiar place.
• Confusion with Time or Place: Losing track of dates, seasons, and the passage of time. Individuals may forget where they are or how they got there.
• Trouble Understanding Visual Images and Spatial Relationships: This can lead to issues when driving because it involves difficulties with reading, assessing distance, and ascertaining color or contrast.
• Issues with Speaking or Writing: Repeating oneself, finding it difficult to follow or join a conversation, or halting in the middle of one without knowing how to go on.
• Losing Things and the Inability to Retrace Steps: Placing items in unusual places, losing things, and being unable to go back over their steps to find them. This may lead to accusations of stealing.
• Decreased or Poor Judgment: Alterations in judgment or decision-making, such as in managing finances or how little care one pays to personal hygiene or grooming.
• Withdrawal from Work or Social Activities: Withdrawal from hobbies, social activities, work projects, or sports.
• Changes in Mood and Personality: Exhibiting signs of confusion, suspicion, depression, fear, or anxiety. They could get agitated easily at home or with friends.

Risk Factors for Alzheimer's Disease

The development of Alzheimer's disease is influenced by multiple factors, including genetic, environmental, and lifestyle aspects. Key risk factors include:

• Age: The biggest recognized risk factor for Alzheimer's, which primarily affects those over 65, is advanced age.
• Genetics (Family History): Having a parent, brother, sister, or child with Alzheimer’s increases the likelihood of developing the disease. If more than one family member is affected, the risk goes up.
• Genetic Mutations: Certain genetic mutations lead to Alzheimer’s. These mutations, however, only make up a small portion of cases and typically cause early-onset Alzheimer's.
• Down Syndrome: Alzheimer's disease is more common in people with Down syndrome, likely related to having three copies of chromosome 21.
• Gender: Women are more likely than men to develop Alzheimer's disease, possibly due to living longer.
• Mild Cognitive Impairment (MCI): Alzheimer's disease is more common in those with MCI, particularly in those with memory impairments.
• Cardiovascular Risk Factors: These include heart disease, stroke, high blood pressure, and high cholesterol. The relationship between brain and heart health highlights the importance of managing cardiovascular risk factors.
• Head Injury: There is a link between the future risk of Alzheimer’s and serious head trauma, especially when there is a loss of consciousness.
• Lifestyle and Heart Health: Lifestyle factors that increase cardiovascular risk, such as obesity, smoking, lack of exercise, poor diet, and alcohol consumption, may also increase the risk of developing Alzheimer's disease.
• Social and Cognitive Engagement: The risk of Alzheimer's may be raised by limited social engagement and lack of mental stimulation. Engaging in social activities, continuous learning, and mental exercises are thought to have a protective effect.

Diagnosing Alzheimer's Disease

In order to rule out other potential causes of symptoms and determine the rate at which cognitive impairment is progressing, a thorough evaluation is necessary to diagnose Alzheimer's disease. Here is an overview of the different methods used in the diagnosis:

• Medical History and Physical Examination: An initial step involves discussing the patient's medical history, including symptoms, past health conditions, family health, medications, diet, alcohol consumption, and lifestyle. A physical examination might assist in identifying other illnesses that might be causing similar symptoms.
• Neurological Assessment: This includes testing reflexes, muscular tone, strength, and coordination, as well as balance, touch, and vision.
• Cognitive and Neuropsychological Tests: These tests assess memory, problem-solving, attention, counting, and language skills. They can help determine if the individual has Alzheimer's or another kind of dementia.
• Brain Imaging: Technologies like magnetic resonance imaging (MRI) and computed tomography (CT) scans are used to rule out other conditions that may cause symptoms, such as tumors, stroke, or build-up of fluid. They can also identify brain shrinkage associated with Alzheimer's. Positron emission tomography (PET) scans can detect plaques in the brain, a hallmark of Alzheimer's disease.
• Biomarker Tests: Biomarkers in cerebrospinal fluid (CSF) and imaging that identify changes in the brain can help in the diagnosis. For example, levels of beta-amyloid and tau proteins in CSF can support a diagnosis of Alzheimer's. New imaging techniques and blood tests that detect beta-amyloid and tau are being developed and may aid in earlier detection and confirmation of the disease.
• Genetic Testing: Although routine genetic testing is not currently recommended for Alzheimer's disease, it can be considered in certain cases, especially for early-onset Alzheimer's, where specific genetic mutations are known to be a factor.

Current Treatment Options for Alzheimer's Disease

Alzheimer's disease currently has no known cure, although therapies aim to manage symptoms and enhance quality of life. Treatment plans are often tailored to the individual and can include:

Medications

By improving neurotransmitter levels in the brain, Cholinesterase inhibitors treat mild to moderate Alzheimer's disease. Some other drugs might be prescribed to manage symptoms such as depression, agitation, and aggression. However, these medications are used cautiously due to potential side effects and risks, particularly in older adults.

Supportive Therapies

• Cognitive stimulation and rehabilitation therapies can help maintain cognition and function.
• Occupational therapy can assist in adapting living spaces and routines to improve safety and independence.
• Physical activity and exercise may help maintain muscle strength, mobility, and overall health.

Caregiver Support and Education

It is essential to offer caregivers resources and assistance. This includes education on the disease, managing daily care, and coping strategies for the emotional and physical stress of caregiving.

Lifestyle Modifications

Encouraging a healthy diet, regular physical activity, social engagement, and mentally stimulating activities can help improve overall well-being and may slow the progression of symptoms.

Emerging Treatments and Clinical Trials

Ongoing research into new treatments includes studying drugs that target amyloid and tau, the proteins that accumulate in the brains of people with Alzheimer's. Participation in clinical trials is also an option for some patients, offering access to experimental treatments.

Treatment strategies for Alzheimer's disease are evolving, and ongoing research continues to seek more effective ways to treat and eventually cure this complex condition.

Preventing Alzheimer's Disease

While there is no certain way to prevent Alzheimer's disease, evidence suggests that the same strategies that support heart health may also reduce the risk of developing Alzheimer's and other forms of dementia. These strategies include:

• Regular Physical Activity: Engaging in regular exercise helps reduce the chance of heart disease and preserve blood supply to the brain.
• Healthy Diet: Following a diet rich in whole grains, vegetables, fruits, and lean protein, particularly foods that contribute to heart health, can potentially lower the risk of Alzheimer's. The Mediterranean and MIND diets are often recommended.
• Mental Stimulation: Building cognitive reserve can be facilitated by mentally challenging pursuits like solving puzzles, reading, picking up a new skill, or practicing an instrument.
• Quality Sleep: Maintaining good sleep habits can support brain health. Sleep disturbances should be addressed and treated.
• Social Engagement: Staying socially active can support brain health. Engage in community activities, maintain friendships, and pursue hobbies that involve social interaction.
• Manage Stress: Techniques such as meditation, yoga, and deep breathing can reduce stress and its negative impact on cognitive health.
• Avoid Smoking and Limit Alcohol Consumption: These lifestyle factors can contribute to cardiovascular disease and cognitive decline.
• Regular Health Check-ups: One way to help protect against Alzheimer's disease is to manage cardiovascular risk factors such as high blood pressure, diabetes, obesity, and high cholesterol with regular health check-ups.

Tips for Caregivers of People with Alzheimer's Disease

There are techniques to help manage the caregiving journey, even if caring for someone with Alzheimer's can be difficult:

• Educate Yourself: Learn as much as you can about Alzheimer's disease to understand what your loved one is experiencing.
• Establish a Routine: Predictable routines can help reduce confusion and anxiety for someone with Alzheimer's.
• Foster a Safe Environment: Make necessary adjustments to the living space to prevent falls and injuries.
• Simplify Communication: Use simple words and sentences. Be patient and offer reassurance.
• Encourage Independence: Allow the person with Alzheimer's to do as much as possible with the least amount of assistance.
• Plan for the Future: Discuss care preferences early and make legal and financial plans.
• Take Care of Yourself: Caregiver burnout is common. Seek support from family, friends, or caregiver support groups. Make time for your own health and well-being.
• Join a Support Group: Connecting with others who are in similar situations can provide emotional support and practical advice.

Latest Research on Alzheimer's Disease

Recent research in Alzheimer's disease focuses on understanding the disease's causes, developing effective treatments, and finding potential preventive strategies. Key areas include:

• Targeting Amyloid and Tau Proteins: The new medications are designed to lessen the build-up of tau tangles and amyloid plaques in the brain, which are characteristics of Alzheimer's disease.
• Immunotherapy: Several clinical trials are exploring the use of antibodies to help the immune system clear amyloid plaques from the brain.
• Lifestyle Interventions: Studies on the impact of diet, exercise, and cognitive training on cognitive decline are ongoing.
• Genetic Research: Identifying genes associated with Alzheimer's can provide insights into the disease's mechanisms and potential targets for treatment.
• Biomarkers for Early Detection: Research is focused on finding biomarkers in blood and cerebrospinal fluid that can detect Alzheimer's before symptoms appear.

Resources for People with Alzheimer's and Their Families

Numerous resources are available to support people with Alzheimer's and their caregivers:

• Alzheimer's Association: Offers educational materials, a 24/7 helpline, and links to local support groups and services.
• Alzheimer's Foundation of America: Provides information on care strategies, support groups, and free memory screenings.
• National Institute on Aging: Offers comprehensive guides and the latest research updates.
• Online Communities: Patients and caregivers can exchange experiences and guidance in forums.
• Local Community Resources: Adult daycare programs, respite care, and community support services can offer practical assistance and relief for caregivers.

Utilizing these resources can help manage the challenges of Alzheimer's, offering support, guidance, and community for both people with the disease and their caregivers.

Conclusion

Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out everyday activities. At this time, there is no treatment that cures Alzheimer's disease or alters the disease process in the brain, but there are treatments that can help manage symptoms.

There are various studies being conducted around the world in the hope of finally finding a cure for Alzheimer's Disease, and some clinical trials have shown positive results. While much work still needs to be done, raising awareness and supporting patients and their families will hopefully lead to the ultimate goal of a cure for Alzheimer's Disease.

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