ALZHEIMER'S DISEASE

Alzheimer's is a type of dementia that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks.

In Alzheimer's disease, the connections between brain cells and the brain cells themselves degenerate and die, causing a steady decline in memory and mental function.

Current Alzheimer's disease medications and management strategies may temporarily improve symptoms. This can sometimes help people with Alzheimer's disease maximize function and maintain independence.

But because there's no cure for Alzheimer's disease, it's important to seek supportive services and tap into your support network as early as possible.

SYMPTOMS 

At first, increasing forgetfulness or mild confusion may be the only symptoms of Alzheimer's disease that you notice. But over time, the disease robs you of more of your memory, especially recent memories. The rate at which symptoms worsen varies from person to person. If you have Alzheimer's, you may be the first to notice that you're having unusual difficulty remembering things and organizing your thoughts. Or you may not recognize that anything is wrong, even when changes are noticeable to your family members, close friends or co-workers.

Brain changes associated with Alzheimer's disease lead to growing trouble with:

MemoryEveryone has occasional memory lapses. It's normal to lose track of where you put your keys or forget the name of an acquaintance. But the memory loss associated with Alzheimer's disease persists and worsens, affecting your ability to function at work and at home. People with Alzheimer's may:

• Repeat statements and questions over and over, not realizing that they've asked the question before
• Forget conversations, appointments or events, and not remember them later
• Routinely misplace possessions, often putting them in illogical locations
• Eventually forget the names of family members and everyday objects

Disorientation and misinterpreting spatial relationshipsPeople with Alzheimer's disease may lose their sense of what day it is, the season, where they are or even their current life circumstances. Alzheimer's may also disrupt your brain's ability to interpret what you see, making it difficult to understand your surroundings. Eventually, these problems may lead to getting lost in familiar places.

Speaking and writingThose with Alzheimer's may have trouble finding the right words to identify objects, express thoughts or take part in conversations. Over time, the ability to read and write also declines.

Thinking and reasoningAlzheimer's disease causes difficulty concentrating and thinking, especially about abstract concepts like numbers. It may be challenging to manage finances, balance checkbooks, and keep track of bills and pay them on time. These difficulties may progress to inability to recognize and deal with numbers.

Making judgments and decisionsResponding effectively to everyday problems, such as food burning on the stove or unexpected driving situations, becomes increasingly challenging.

Planning and performing familiar tasksOnce-routine activities that require sequential steps, such as planning and cooking a meal or playing a favorite game, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer's may forget how to perform basic tasks such as dressing and bathing.

Changes in personality and behaviorBrain changes that occur in Alzheimer's disease can affect the way you act and how you feel. People with Alzheimer's may experience:

• Depression
• Social withdrawal
• Mood swings
• Distrust in others
• Irritability and aggressiveness
• Changes in sleeping habits
• Wandering
• Loss of inhibitions
• Delusions, such as believing something has been stolen

CAUSES

Alzheimer's disease is caused by parts of the brain wasting away (atrophy), which damages the structure of the brain and how it works.

It is not known exactly what causes this process to begin, but people with Alzheimer's disease have been found to have abnormal amounts of protein (amyloid plaques) and fibres (tau tangles) in the brain.

These reduce the effectiveness of healthy neurons (nerve cells that carry messages to and from the brain), gradually destroying them.

Over time, this damage spreads to other areas of the brain, such as the grey matter (responsible for processing thoughts) and the hippocampus (responsible for memory).

Risk factors

Although it is still unknown what causes the deterioration of brain cells, there are several factors that are known to affect the development of Alzheimer's disease. These are described in more detail below.

Age

Age is the greatest factor in the development of Alzheimer's disease. The likelihood of developing the condition doubles every five years after you reach 65 years of age. However, it is not just older people who are at risk of developing Alzheimer's disease.

Family history

Genetic factors contribute to the risk of developing Alzheimer’s disease. Though in most cases, if you have a close family member with the condition, your risk of developing it is only slightly increased.

However, in a few families, Alzheimer’s disease is caused by the inheritance of a single gene, and the risks are much greater. If several of your family members over the generations have developed dementia, it may be appropriate to seek genetic advice and counselling.

The Alzheimer's Society website has more information about genetics and dementia.

Down's syndrome

People with Down's syndrome are at a higher risk of developing Alzheimer's disease.

This is because people with Down's syndrome have an extra copy of chromosome 21, which codes for a protein involved in the cause of Alzheimer's disease. Therefore, people with Down's syndrome produce more abnormal protein, which could contribute to developing Alzheimer's disease.

Whiplash and head injuries

People who have had a severe head injury, or severe whiplash, (a neck injury caused by a sudden movement of the head forwards, backwards or sideways) have been found to be at a higher risk of developing Alzheimer's disease.

Vascular disease

Research shows that several lifestyle factors and conditions associated with vascular disease can increase the risk of Alzheimer’s disease.

These include:

• smoking
• obesity 
• diabetes 
• high blood pressure
• high cholesterol

You can help reduce your risk by quitting smoking, eating a healthy balanced diet and having regular health tests as you get older. It is important to keep as active as possible both mentally and physically to help reduce the risk of Alzheimer’s disease.

TREATMENT 

There is currently no cure for Alzheimer's disease, but there are medications available on prescription that can help delay the condition’s development.

Treatment for Alzheimer’s disease also involves creating a care plan. This identifies the type of assistance that you might need, and focuses on ways of providing this support. 

Medication

Medications that may be prescribed for Alzheimer’s disease include:

• donepezil (brand name Aricept)
• galantamine (brand name Reminyl)
• rivastigmine (brand name Exelon)
• memantine (brand name Ebixa)

Whether these medications are used will depend on the severity of your Alzheimer’s disease.

Donepezil, galantamine and rivastigmine (AChE inhibitors) can be prescribed for people with mild to moderate Alzheimer's disease. Memantine may be prescribed for people with moderate Alzheimer's who cannot take AChE inhibitors or for those with severe Alzheimer's disease.

Medication should be prescribed by specialists such as:

• psychiatrists, including those specialising in learning disabilities
• neurologists
• physicians specialising in the care of older people

If you are caring for someone with Alzheimer's disease, your views should be taken into account when prescribing medication and also at regular assessments. These assessments take place to ensure the medication is having a worthwhile effect. 

Read the full NICE guidance on donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease (PDF: 665Kb).

Side effects

Donepezil, galantamine and rivastigmine (AChE inhibitors) can cause side effects including:

• nausea (feeling sick)
• vomiting
• diarrhoea 
• headache 
• fatigue (extreme tiredness)
• insomnia (difficulty getting to sleep or staying asleep)
• muscle cramps (when your muscles suddenly shorten and cause pain)

For more information about the possible side effects of a particular medication, refer to the patient information leaflet that comes with your medication, or see medicines information. 

Dementia

Alzheimer’s disease is the most common form of dementia. Dementia is a syndrome (a group of symptoms) that is associated with an ongoing decline in mental abilities. The treatment for Alzheimer’s disease will follow the same pattern as treatment for dementia.

If you have been diagnosed with any other conditions as well as Alzheimer’s disease, for example, depression or incontinence (when you unintentionally pass urine or stools), these may be treated separately.

Care assessment 

If you have been diagnosed with Alzheimer's disease, your future health and social care needs will be assessed and a care plan will be drawn up. This will be coordinated by:

• healthcare professionals, such as your GP or psychiatrist
• social care services, which is normally your local council working in conjunction with the NHS

As part of your care assessment your functional capacity will be assessed. This involves identifying areas where you may need some assistance with your day-to-day activities. For example, areas that may be assessed include:

• whether you can drive safely
• whether you can wash, dress and feed yourself
• whether you have a support network, such as family and friends
• whether you need any financial assistance

Following the care assessment, a care plan can be drawn up to arrange support for any areas where you may need to have some help. The kind of care that you will receive may depend on what is available from your local primary care trust (PCT).

Support

The healthcare professionals who are treating you will aim to keep you living as independently as possible. Support can be provided in many different ways. For example:

• grab bars and handrails can be added around your home, for example, to help you to get in and out of the bath
• an occupational therapist can identify problem areas in your everyday life, such as dressing yourself, and help you to work out practical solutions
• cognitive stimulation programmes can be arranged – these involve taking part in activities and exercises to improve your memory, problem-solving skills and language ability

Read more information about how dementia is treated.

You can find Alzheimer's support services in your area and, if necessary, choose a hospital for Alzheimer's disease.

PREVENTION 

As the exact cause of Alzheimer’s disease is still unknown, there is no way to prevent the condition. However, there are some steps that you can take which may help to delay the onset of dementia.

For example, you can help to prevent vascular dementia, as well as cardiovascular diseases such as stroke and heart attacks, by:

• quitting smoking 
• avoid drinking large amounts of alcohol
• eating a healthy balanced diet, including at least five portions of fruit and vegetables every day
• exercising for at least 150 minutes (2 hours and 30 minutes) every week, doing moderate-intensity aerobic activity (such as cycling or fast walking) as this will improve both your physical and mental health
• make sure your blood pressure is checked and controlled through regular health tests
• if you have diabetes, make sure you keep to the diet and take and medicines

Read more information about preventing dementia.

Staying mentally active

There is some evidence suggesting that rates of dementia are lower in people who remain as mentally, physically, and socially active as possible throughout their lives, and also among those who enjoy a wide range of different activities and hobbies.

Some activities that may reduce the risk of developing dementia include:

• reading
• writing for pleasure
• learning foreign languages
• playing musical instruments
• taking part in adult education courses
• playing tennis
• playing golf
• swimming
• group sports, such as bowling
• walking

There is no evidence that playing ‘brain training’ computer games reduces the risk of dementia.

Future research

Research into Alzheimer’s disease is continuing, and as more is revealed about the condition, other ways to treat or prevent it may be found. However, research does not always produce successful results.

You can read more information about ongoing dementia research on the Alzheimer's Research UK website.

The National Institute for Health and Clinical Excellence (NICE) has advised that there is no evidence yet to support the use of the following to prevent dementia:

• statins (cholesterol-lowering medicines)
• hormone replacement therapy (when powerful chemicals are taken to replace those that your body no longer produces)
• vitamin E (found in a variety of foods, such as olive oil, nuts and seeds)
• non-steroidal anti-inflammatory drugs (NSAIDs)

BY : NUR NADHIRAH NAJWA BINTI RUSLI 

MEJ 3 2013