Alzheimer’s disease

Definition

Alzheimer’s disease is a progressive form of dementia (from the Latin ‘demens’, meaning ‘mad, deluded’) that mainly appears in old age and involves a decrease in brain power and memory. It was first diagnosed by the Tübingen-based doctor Alois Alzheimer at the start of the 20th century. Alzheimer’s disease is our most common cause of dementia.

Protein deposits (so-called amyloid plaques) disrupt speech, thought and memory in people with the disease. Moreover, key neurotransmitters (substances that transmit information between nerve cells), such as acetylcholine, are no longer produced in sufficient quantity, which leads to more general mental retardation.

With growing life expectancy, the disease is being diagnosed in more and more people, mainly in industrialised countries. The risk of Alzheimer’s disease increases with age. In rare hereditary forms of the condition, the disease can appear as early as in your thirties.

Causes

The actual causes are still not known and there is much to suggest that there are several different triggers. Deposits of protein fragments in the brain lead to necrosis (dying off) of nerve cells. The brain cells that manage memory, speech and thought are particularly affected.

Symptoms

Alzheimer’s is first and foremost linked to forgetfulness. In fact, short-term memory loss is generally the first sign of Alzheimer’s onset that the sufferer or their relatives notice. Admittedly, memory declines in most people as they age. However, age-related mental decline does not affect independence. Things are different for people with Alzheimer’s.

Typical signs of Alzheimer’s are:

·         Short-term memory loss (forgetfulness) and difficulty thinking

·         Speech impairment (an early sign is difficulty in finding words) and impaired judgement

·         Depression, anxiety (which frequently appear as Alzheimer’s progresses)

·         Temporal, geographical and situational disorientation

·         Warped perception, delusions and hallucinations

·         Personality and behavioural changes

·         Problems with eating and drinking, difficulty swallowing (with advanced Alzheimer’s, automatic bodily functions are also disturbed)

·         Double incontinence

Diagnosis (tests)

The medical history must be established with the help of relatives, because at the time of diagnosis, short-term memory and thought are generally already significantly disturbed. Patients often live in the past and struggle to recognise everyday people and things; above all, daily living is increasingly difficult to manage (getting dressed, eating, shopping, incontinence). Patients can no longer live alone and become a mental strain on their relatives.

Special memory function tests can establish whether a patient has Alzheimer’s. There are also short tests (10–15 minutes) that use questions and small tasks to check memory, observation, speech and judgement. Current tests are the mini mental state examination, clock test and dementia detection test.

However, a final diagnosis can only be made with additional tests, e.g. magnetic resonance imaging (MRI) or positron emission tomography (PET).

Treatment

Medication, physiotherapy and memory training can also help maintain the sufferer’s day-to-day capabilities for as long as possible. However, there is no cure for the disease.

Medication can improve signalling between the surviving nerve cells but cannot prevent nerve-cell necrosis. Prescription drugs can be used for accompanying symptoms, such as anxiety, sleep or movement disturbances, or depression. It is important to encourage but not overwhelm the person affected.

Regular visits to the family doctor are very important throughout the course of the disease. A GP can identify whether there are additional conditions and whether specialist help is needed.

Drug therapies

Two groups of medication are available to treat Alzheimer’s disease. Memantine and acetylcholinesterase inhibitors. These are also known as antidementives. Moreover, ginkgo extract is proven to have a positive effect on memory and everyday capabilities in the case of Alzheimer’s disease.

Memantine protects the nerve cells from cell death. Patients remain active for longer and care activity around the patient can be reduced.

The acetylcholinesterase inhibitors (galantamine, donepezil, rivastigmine) prevent acetylcholine that has already formed in the brain from being broken down again. This therefore ensures better transmission of information. These drugs have a positive effect on cognitive functions (e.g. memory and thought disturbances, “loss of reality”), on everyday activities and on the general picture of health.

Drugs in this substance class cannot cure the disease but only delay its course. The earlier they are used, the greater their impact.

Non-drug treatment

·         Memory training, functional training

·         Psychotherapy, couples’ therapy

·         Occupational therapies (painting, cooking, music, inclusion in a healthy household, etc.)

·         Movement, sociability, games

 

Preventative measures

There are no scientifically proven preventative measures. Initial research into a vaccine, designed to prevent protein deposits in the brain (the primary cause of Alzheimer’s), is currently underway. There are studies that suggest people who remain mentally active can delay the impact for longer than other sufferers. Regular exercise may also have a positive effect on brain functioning.

The preventative effect of various drugs is also being discussed. However, it is not currently recommended to take any medication pre-emptively.