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Alzheimer disease: Consumer health article

Alzheimer disease: Definition


Alzheimer disease (AD) is a condition that may get worse over time, damaging the nervous system that causes memory loss (dementia), affects thinking and behavioral changes, usually in people older than 65 years.1


Causes and risk factors of AD includes:2

· Advancing age

· The Apolipoprotein gene is a primary genetic risk factor.

· Environmental factors like the injury to the brain, inadequate nutrition

· Genetic factors are known to cause early-onset Alzheimer disease.

· Immune system dysfunction

· Infectious agents

The possible pathophysiology of AD is as below:

Two proteins linked to AD are tau and β-amyloid, which causes brain cells' death; this happens due to advanced age and genetic factors. The Hallmark of AD is amyloid β accumulation.

Symptoms observed in AD:

· Memory loss for recent events is the most common symptom during the early stage of AD.

· Difficulty with words while speaking is an important symptom.

· The disease affects the ability to understand and interpret the size and location of the surroundings (Visuospatial skill)

· Lack of emotions, nervousness, worry, anger, and irritability may be seen.

· Sleep disturbance is a common behavioral symptom.

· You may experience disturbance of appetite, false belief (delusion); and may see, hear or feel things that don't exist (hallucination)

· Lack of awareness (insight)

If you need help to deal with anger, agitation, and fear, get in touch with counseling and support groups

Approach the health care workers and support groups for guidance to deal with the symptoms, tests, and treatment given to you.


Changes in personality and behavior observed in AD includes:

· Getting angry, upset, and agitated

· Increased restlessness and confusion during the evening (sundowning)

· Wandering away from home

· Hitting others

· Imagining things

· Low mood

· The person may stop caring about his looks, clothes, and hygiene


Diagnosis of AD:

· clinical symptoms

· positive biomarkers include

1. presence of amyloid-β and tau in fluid taken from the spine (cerebrospinal fluid)

2. the amyloid positive emission tomography scan shows a build-up of amyloid protein in the brain

3. Magnetic resonance imaging scan may show a decrease in size of the brain (atrophy)



Treatment of AD:2

Though this disease can't be cured, the medications can lessen your symptoms. Two classes of drugs are approved for the treatment of AD.

1. Acetylcholinesterase inhibitors

· Acetylcholine is a chemical needed for memory and thinking; as Alzheimer's progresses, the brain produces less of this chemical. The drugs used are donepezil, rivastigmine, and galantamine. The side effects of the medications include nausea, vomiting, diarrhea, and chest discomfort.

2. Glutamate receptor modulators:

· Used to treat mild to moderate Alzheimer disease

· Memantine is the medicine in this group

· The side effects include dizziness, headache, diarrhea, and constipation.


Anti-anxiety drugs are used to control agitation; but, always use them with caution as it may cause memory problems and falls.3

Anti-psychotic drugs are used to treat delusion and hallucination; however, you must be aware of its side effects and use them with caution.

Anti-convulsant may be used to treat severe agitation.

Sleep aids can be used to get sleep and avoid drugs that confuse the person and lead to falling.

Psychological and social measures like music, massage, caregiver education may work with medicines of AD.2

Exercise and pleasant experiences lessen depression.


A familiar environment with labels on the rooms, proper lighting will reduce the disorientation in the patient. Caretakers can reassure the patient with positive and clear language when the patient shows aggressive behavior.

Complications of AD:

· Falls and fractures may result due to drugs that cause drowsiness or due to advanced age,

· Chest infections (pneumonia)

· Bedsores in bedridden patients

· Harmful reduction of water from the body (Dehydration) and inadequate nutrition

· Urinary tract infection

· Difficulty in controlling bowel and bladder

· Incorrect swallowing of food and liquid may lead to choking; hence be cautious while taking food.


When to contact a medical professional?

· When the symptoms worsen

· When new symptoms start

· Side effects of medicine like drowsiness, chest discomfort

· Complications

· emergencies1

How can caregiver manage individuals with AD?

· Be friendly and make eye contact with the person.

· Being positive and cheerful may help the patient.

· Encourage a conversation and keep them engaged.

· Be patient when the person gets angry.

· Gentle touch and holding their hand are reassuring.

· Be aware of non-verbal communications.

· Giving medicine at the proper time as advised by the physician is essential.

· Recognize the changes in the behavior, side effects of drugs, and complication.

· Seek help from a health care professional during acute changes and emergencies.


References:


1. Briggs R, Kennelly SP, O'Neill D. Drug treatments in Alzheimer's disease. Clin Med. 2016;16(3):247-253. doi:10.7861/clinmedicine.16-3-247

2. Apostolova LG. Alzheimer Disease. Contin Lifelong Learn Neurol. 2016;22(2 Dementia):419-434. doi:10.1212/CON.0000000000000307

3 Lyketsos CG, Carrillo MC, Ryan JM, et al. Neuropsychiatric symptoms in Alzheimer's disease. Alzheimers Dement J Alzheimers Assoc. 2011;7(5):532-539. doi:10.1016/j.jalz.2011.05.2410




Word of caution: Do not use this information during acute emergencies and complications. Follow the guidance of a licensed medical practitioner for the diagnosis and treatments of the medical conditions.








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