What is Alzheimer’s dementia?
It was first described in 1906 by the German psychiatrist Alois Alzheimer who had seen a patient with dementia symptoms since 1901. The patient died of the disease in 1906.
In an autopsy of his patient, Alois Alzheimer found changes in the brain that are now acknowledged as typical for Alzheimer’s disease. He found deposits between the brain cells called plaque that consist of diseased deposits of a protein called beta-amyloid. Within the brain cells are tangles; tangled masses of a protein fiber called tau. Scientists believe that the plaques can kill nerve cells. The tangles might play a part in the death of the nerve cells or they might form as a consequence of the dying process.
Alzheimer’s dementia usually affects people age 65 or older, but there is a form of Alzheimer’s disease, called early onset or younger onset Alzheimer’s dementia, that can strike patients as early as in their thirties. A famous patient who died of early onset Alzheimer’s dementia at age 68, but showed signs of the disease in her early fifties, is the actress Rita Hayworth. Alzheimer’s is the more common the older a person gets: only about 10% of all Alzheimer’s cases are in their thirties with most people developing symptoms after the age of 65. About 50% of all people age 85 and older show signs of the disease.
Signs and Symptoms of Alzheimer’s dementia
Alzheimer’s dementia takes a different course for different people. While some patients might experience a certain symptom, others might not. One of the first signs of Alzheimer’s disease in many patients is memory loss. This memory loss affects mainly recently learned things rather than memories from the distant past. Since a limited amount of memory loss it to be expected with age, or can be caused by stress or other mental problems like for example depression, Alzheimer’s dementia is often not recognized at this early stage.
Some people experience difficulties with numbers like balancing check books or keeping track of monthly bills or they might have trouble following instructions like a recipe. Another early sign of Alzheimer’s dementia that is commonly seen is misplacing things and not being able to retrace what has happened since the item was last seen.
Some patients experience mood changes and may become depressed, paranoid (suspicicous), and anxious or fearful. It’s also possible that the patient becomes easily upset. Some patients show poor judgment or might have trouble with writing or don’t understand the rules of a familiar game anymore.
Social withdrawal or loosing the interest in activities that the patient used to enjoy can also be a sign of Alzheimer’s disease. Many of these symptoms like social withdrawal, loosing interest in activities enjoyed before, loss of concentration, and memory loss can also be sign of depression which makes it hard to diagnose Alzheimer’s disease correctly in the early stages.
In later stages, Alzheimer’s patients can show confusion about where they are, or how they got there. Patients might also get confused about the passage of time and for example think things that happened a week ago happened just yesterday. Some people loose the ability to judge spatial relationships or to correctly interpret visual images. They might think another person is in the room, when they see their image in the mirror, or might have difficulty in judging distance, like e.g. the distance of an approaching car. Patients might also develop trouble with spoken or written language. It is possible that the patients loose words, forget in the middle of a sentence what they were going to say or call things by the wrong name. Patients might also loose their judgment and might make poor decision e.g. about money. In later stages patients might forget things like their own address, the ability to count backwards and might need help in choosing the proper clothing for the season, or for a special occasion. At this mild to moderate stage, patients usually still retain a clear picture about who they are and know their own name and the ones of their loved ones and close friends. As the disease progresses to the moderate to severe stage, the patients might loose the understanding of their surroundings, and might forget a large part of their personal history. At this stage however, patients usually still recall their own name, but might occasionally forget the names of their loved ones. These patients require help getting dressed properly, and might need help with things like flushing the toilet. Paranoia especially about the caregiver stealing or being an impostor is common at this stage. Patients also might wander and become lost. In the late or final stage of Alzheimer’s dementia, patients might loose their ability to speak or understand language, need help with grooming and toiletry, and increasingly lose motor abilities like the ability to walk, to sit unassisted, and to smile. Reflexes will become affected and swallowing will also become hard. The disease will eventually lead to death.
Treatment Options for Alzheimer's Dementia
There is no cure for Alzheimer’s dementia. However, there are treatments available that lessen the symptoms or slow the progress of the disease. There are drugs available that alter the brain chemistry and can help with the cognitive changes (changes with the thinking ability) seen with Alzheimer’s dementia. These drugs are generally drugs that affect how chemical messengers in the brain are broken down. There are basically two classes of Alzheimer’s drugs that affect different chemical messenger molecules. Cholinesterase inhibitors inhibit the break down of the messenger molecule that is called acetylcholine, a molecule that is important for learning and memory. Three different drugs in this class are currently approved by the FDA as treatment of Alzheimer’s dementia. Another drug affects a different chemical messenger called glutamate that is also involved in learning and memory. Different other drugs can deal with the behavioral changes. Caregivers needs to check for the personal comfort of the patient and monitor things like food and water intake, constipation and personal hygiene.