Alzheimer's disease is a brain disorder that worsens over time. It causes problems with memory and behavior, making it difficult for a person to manage everyday tasks, work, and social activities.
As the disease progresses, harmful proteins, mainly beta-amyloid and tau protein, build up in the brain. These proteins lead to the death of nerve cells. As nerve cells die, the amount of important chemicals they produce decreases, which is necessary for the brain to function properly.
The causes of Alzheimer's Disease are believed to be the abnormal accumulation of amyloid beta protein deposits in and around nerve cells and tau protein tangles, which occur almost exclusively in these cells.
Risk factors include:
From the point of view of prevention, modifiable factors that increase the risk of Alzheimer's disease are also important, including:
The initial symptoms of Alzheimer's disease are often underestimated, and a late diagnosis can increase the risk of depression for both the patient and their loved ones due to a lack of awareness about the disease's progression. Early-stage symptoms typically include, e.g., subtle memory problems and difficulties recalling specific words. As the condition advances, patients may experience impaired thinking and judgment, challenges in speaking, and trouble constructing sentences or selecting appropriate words. In the later stages, the disease progresses further, leading to additional complications that can destabilize the lives of both the patient and their family.
Other common symptoms include:
Contact your family doctor if you notice:
Often, those symptoms are interpreted as natural to the aging process. Still, they can be the cause of a serious disease, so it is worth consulting a doctor to diagnose and treat these troublesome symptoms. After a thorough interview and analysis of the course of the disease, the family doctor may decide to refer you to a neurologist for further diagnostics and treatment.
The disease has a progressive course and lasts for 8–20 years. The patient observes increasing symptoms in the following order: memory, mood, organization of daily life, behavioral disorders, and weight loss. The Global Deterioration Scale (GDS) describes the clinical symptoms and course of the disease and defines the stage of progression.
There are no subjective symptoms (reported by the patient) or objective symptoms (observed in a clinical examination) of memory impairment.
The patient reports experiencing memory impairment, often mentioning they forget where they have placed familiar objects or have trouble recalling well-known names.
Clinical examinations show no objective memory impairments. There are no objectively confirmed difficulties in work or social interactions. Moreover, the patient's anxiety is proportional to their reported memory issues.
This is the earliest stage where cognitive impairments become evident, with at least one of the following symptoms:
As a result, the patient experiences increasing difficulties in completing complex professional and social tasks. Disorders are repressed. Additionally, symptoms are accompanied by mild or moderate anxiety.
This type of impairment shows clear deficits that are evident upon close examination. The characteristics include:
Patients may also struggle with performing complex tasks. Furthermore, repression serves as the primary defense mechanism at this stage, often resulting in diminished effect and avoidance of challenges.
At this stage, the patient is unable to live independently and exhibits the following symptoms:
A clear deficit is visible on close examination. These disorders are manifested as follows:
The patient may sometimes forget the name of his spouse, on whom he is already fully dependent as a caregiver:
Additionally, personality changes and emotional disorders appear. They are quite variable and include:
The patient experiences a loss of all verbal abilities. Initially, they may retain a few words and simple sentences, but these will only have approximate meanings; later, they may only produce single sounds. Additionally, they exhibit complete urinary incontinence.
The patient requires assistance with washing and feeding tasks. There is a loss of motor abilities, and the patient may stop walking. They demonstrate severe disorders of executive functions. Moreover, neurological symptoms are present, indicating generalized damage to the cerebral cortex.
The diagnosis of the disease is most often made based on the symptoms of the disease. To exclude other diseases that can lead to dementia, the following are performed by the following.
This examination allows for obtaining layered images of the skull. Similar to X-ray, it uses X-ray radiation. The X-ray tube and the X-ray film cassette are in synchronized movement to obtain such images, while the patient remains motionless.
Computed tomography consists of a table on which the patient is placed, a hoop (in which the X-ray tube and radiation detectors are), and a console that programs the examination. The hoop is large in diameter and relatively small in width, so people who are afraid of small spaces should not feel worried.
The patient is asked to lie on a table, which will move towards the inside of the hoop during the examination. During the examination, the patient is instructed on how to behave. Before the examination, the following should be reported: recent X-rays and, in the case of women, pregnancy. Moreover, the test should not be performed in women in the second half of their menstrual cycle (after ovulation), in whom there is a possibility of fertilization. If the test requires it, the patient is given contrast – it can be administered intravenously or into a body cavity.
Magnetic resonance imaging (MRI) provides precise images of cross-sections of the human body, in this case, the patient's head.
The MRI test is safe; the patient is not exposed to harmful radiation. The device used for the test functions as a powerful magnet, utilizing a strong electromagnetic field. The visual appearance of an MRI machine resembles that of a computed tomography (CT) scanner. During the test, the patient lies on a moving table inserted into a cylindrical device where the imaging takes place.
The procedure lasts about an hour, and it's crucial for the patient to remain still during the entire duration. The machine can be quite loud, producing various sounds of different frequencies, but there is no need for concern. If necessary, a contrast agent may be administered intravenously or into a body cavity during the examination.
Before the MRI, patients are typically asked to undress to their underwear and remove all metal items, including jewelry and watches. Due to the magnetic field used in the procedure, the MRI cannot be performed on individuals with metal implants, such as intravascular stents, pacemakers, artificial heart valves, intramedullary bone fusions, or those who have had hip or knee joint replacements, or spine stabilizing implants from scoliosis surgeries.
Moreover, patients who suffer from claustrophobia should inform the medical staff prior to the examination, as the space inside the cylinder can feel quite tight. Before the MRI, patients will be required to fill out a card with relevant health information. However, it is best to discuss any past surgeries or concerns regarding small spaces with the doctor who ordered the examination.
There are a number of other tests that can be used to diagnose Alzheimer's disease. These include brain functionality imaging tests and tests of substances circulating in the cerebrospinal fluid. However, they have not been used in routine clinical diagnostics at present.
It is performed in the case of people whose disease symptoms appeared before the age of 65. The test aims to detect mutations in the APP, PSEN1, or PSEN2 genes – inherited in an autosomal dominant manner, responsible for the occurrence of the disease.
Alzheimer's disease is an incurable disease. We do not know the factors causing the disease, so we cannot treat it causally. Only symptomatic treatment is possible, aimed at improving the patient's quality of life and surviving for a long time in the best possible physical and mental condition.
It is based on activities aimed at improving the intellectual and physical fitness of the sick person. Memory exercises, e.g., solving crosswords, watching educational programs, reading books, and playing chess can be helpful. Physical exercises are helpful in maintaining independence and mobility. Moreover, it is recommended to follow a Mediterranean diet with a lot of vegetables and fruits. Such action can slow down the progression of the disease.
The patient should remain under the supervision of a neurologist or psychiatrist. Treatment should always be prescribed by a doctor of the above-mentioned specializations and continued by a family doctor. In the initial stage of the disease, medications are used that are intended to improve memory and other cognitive functions, such as counting, orientation, thinking, understanding, and learning.
This group of drugs includes:
Furthermore, drugs that slow down the progression of the disease include:
Moreover, in the treatment of depression and behavioral disorders, the following are used other medicines.
A complication of Alzheimer's disease may be mental disorders from the group of psychoses. Treatment of such symptoms involves the use of neuroleptics.
The methods of preventing the disease are not known. The progressive nature of the disease symptoms leads to severe dementia over time. This process can only be slowed down.
Helpful in maintaining intellectual fitness are also:
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