What is Alzheimer'sAlzheimer's disease is a neurodegenerative brain, progressive and irreversible pathology. It affects of diffusely to the neurons of the cerebral cortex and other adjacent structures, and leads to a degeneration of cognitive and behavioral disorders.
It is characterized by a deterioration in the ability of the subject to control their emotions, develop in its surroundings according to normal behavior patterns, and properly coordinating their movements and memory, among other disorders.
It is the most common form of dementia (represents 60% of all cases of dementia), and affects nearly 36 million people around the world. Prevalence reaches at least 30% of the population that exceeds 85 years. Still women about 70 per cent of those affected between 65 and 90 years old.
In addition, due to the increase in life expectancy, estimated the number of people with Alzheimer's is expected to triple in the next 40 years, coming to get it some 113 million people, of them 1.5 in Spain, according to data from the Spanish Neurology Society (SEN).
Causes of Alzheimer's diseaseIdentified several biological factors which interact with different mechanisms of genetic or environmental type, and which result in lesions that cause progressive nerve cell degeneration and the onset of Alzheimer's disease.
We have identified two characteristic signs of the disease as a cause of Alzheimer's that are: the emergence of the so-called senile plaques, plaques amyloid, or neuritic plaques, and the presence of tangles of neurofibrils:
Senile plaques are extracellular deposits of the protein beta-amyloid in the brain's gray matter, and are associated with degeneration and neuronal death. This beta amyloid protein is derived from the degradation of a larger protein called amyloid precursor protein, which is found in the membrane of many cells and whose mission is not fully clarified. The accumulation of beta-amyloid is due to an increase in its production or to a reduction in their elimination.
On the other hand, the formation of tangles of neurofibrils is the result of abnormal protein polymerization tau (a protein that is in neurons), and starts in the region of the hippocampus, where memory management function. These two processes involved in Alzheimer's disease may be interrelated and, in any case, cause a degeneration and neuronal dysfunction.
Risk factors for developing Alzheimer'sThe main factors related to the development of the disease are age and family history of Alzheimer's disease. Exposure to certain substances, such as tobacco, also seems to favor his appearance.
On the contrary, a moderate intake of alcohol, the Mediterranean diet, physical exercise in the middle ages and an active social life, been associated with a lower risk of developing the disease in different studies. Also they have related to the years of education a lower risk of the disease.
Types of Alzheimer's diseaseIt is a disorder that can come associated with different causes; Thus, we can differentiate three types of Alzheimer's:
- Family Alzheimer: are known to persons in whose family cases of Alzheimer's disease have been more likely to suffer from the disease. There is also a type of Alzheimer's specifically called familial Alzheimer's disease, characterized by starting so early, i.e. before the age of 60. This type of Alzheimer's disease is given by mutations in genes such as the gene for the amyloid precursor protein, the gene of the presenilin I or II presenilin gene. Mutations in these genes lead to an abnormal accumulation of the protein beta amyloid, a main component of senile plaques. This type of familial Alzheimer's disease is rare.
- Associated with Down syndrome Alzheimer: due to Trisomy in chromosome 21, people with this syndrome present excess of amyloid precursor protein, which favors that your metabolism will lead to an accumulation of senile plaque causing fragments. In individuals with Down syndrome, we found cases of Alzheimer's from the age of 12.
- Age-associated Alzheimer: although this disease is not a consequence of ageing, affects 5-7% of people over 65 years. There are more than 70 genes whose presence in the organism can favour the onset of Alzheimer's disease associated with age. These include ubiquitin gene, the gene for the protein tau, or the gene for apolipoprotein E.
Symptoms of Alzheimer's diseaseThe first symptoms of Alzheimer's include a wide range of cognitive and behavioural. Many of the signs that can be seen in the earlier stages of the disease can be easily confused with the typical signs of aging, so it is good to know them and know to differentiate them.
One of the lighter which usually associated to Alzheimer's but also with old age could be starting to forget things, activities that would make, or names of people. This can be normal at a certain age, for example forgetting the name of a co-worker, a neighbor or Baker, and yet remember that working with you or living in the fifth. While a person with symptoms of Alzheimer's disease also forget the context, i.e., probably you don't even remember its name, but that is not your neighbor or your grocer.
Early symptoms of Alzheimer's
Memory and concentration
- Change of place or loss of important objects.
- Confusion about how to carry out everyday tasks.
- Difficulty to solve simple arithmetic problems.
- Difficulty to make routine decisions.
- Confusion about the month or the season of the year.
- Difficulty to perform drawings (test clock), buildings in three dimensions, or to orient themselves in open spaces. The patient gradually loses the ability to recognize objects, persons, or places.
- Unpredictable mood swings.
- Progressive loss of interest by the environment, or in their tastes or hobbies.
- Depression, anxiety, or confusion in response to changes.
- Denial of the symptoms.
- It may present irritability, aggressiveness, agitation and social disinhibition.
Language and speech
- Difficulty completing sentences or find the right words.
- Inability to understand the meaning of the words.
- Reduced or irrelevant conversation.
- Markedly deteriorated, including slowed movements, ailing March and sense of balance decreased movement and coordination.
Diagnosis of Alzheimer's diseaseCurrently there is no diagnostic test specific or reliable to diagnose Alzheimer's, so it is necessary to resort to an array of tests of different types that allow, firstly, rule out other types of dementia and, secondly, assess the degree of the same.
- The first step that will give the physician that is evaluating the patient will be the study of family history, personal history and symptoms that the patient presents. It will also perform a general physical examination and neurologic examination.
- Neuropsychological testwill be held. Some of the most commonly used are called mini–mental test and the test of the clock. The Mini–mental test consists of questions that explore the orientation, the ability to repeat a few words, concentration, calculation, memory and the language of the patient. It can be in 5-10 minutes. The patient gets a score that should be low, suggests a diagnosis of dementia. Watch test consists of making the patient draw a clock with the hands pointing out eleven and ten. This way we will be able to assess activity in the temporal lobes of the brain where they reside, among others, the functions related to memory and the development of complex Visual activities. It will be evaluated if the patient manages to write all the numbers, doing so in the right place, and if it is capable of situating the hands marking time which instructed. Each of these steps is assigned a score; from 7, it is considered that the patient is not suffering from the disease.
- Neuroimaging studies are techniques used to confirm a suspected diagnosis in patients who present other signs of the disease.
- By CT (computed Axial Tomography) and MRI be ruled out structural injury as a cause of dementia. In addition, in the case of Alzheimer's disease, is usually appreciate atrophy of certain brain structures.
- The computed tomography by emission of Simple photon (SPECT) and Positron Emission Tomography (PET) allow to perform a functional analysis, i.e., provide information about metabolic changes related to Alzheimer's disease. A decrease in metabolism in some brain regions is characteristic.
- Recent studies of the University of Pennsylvania are running a new method which consists in analyzing images obtained by magnetic resonance imaging (MRI) employing an algorithm allows to detect Alzheimer's disease and its progression with a 75% effective.
- It is possible to use the detection of biomarkers as an additional method to the above. Pay special attention if you notice a decrease in the cerebrospinal fluid of the protein beta-amyloid and tau protein increased.
Treatment of Alzheimer's diseaseAlzheimer's is a disease for which currently cure is not known. It is not possible to halt its advance or restore the damaged functions. The drugs that are on the market today are intended to slow the progression of the disease, reduce symptoms (depression, psychotic symptoms, sleep disorders...), improve cognitive function and slow down certain metabolic processes, which is believed to accelerate the degenerative process.
- Drugs that protect the cholinergic system: system, that modulates information processing in different parts of the brain, is affected so early in the disease. These drugs Act on the enzyme that degrades acetylcholine (a neurotransmitter), increasing their levels in the brain. Some of the most commonly prescribed are Donepezil, rivastigmine and galantamine. They produce a slight improvement in the cognitive abilities of the sick. They all have side effects on the digestive tract, such as nausea and vomiting. They can also cause dizziness and decreased heart rate. All these side effects decrease if the administration of the drug at low doses and climb the dose gradually.
- The NMDA receptor antagonists (N-methil-D-aspartate): the main component of this group is a drug called memantine, which inhibits the toxic action on an amino acid called glutamate neurons. Used in moderate to severe Alzheimer's disease. It can be used in combination with drugs in the former group. Its most common side effects are dizziness, headache and confusion.
- Nonsteroidal anti-inflammatory drugs: are indicated both in prevention and in the treatment of Alzheimer's disease. Among them are the type drugs aspirin and ibuprofen, which act by blocking prostaglandins, the inflammatory response factors that seem to play an important role in Alzheimer's. Not recommended for long-term use.
- Antioxidants: several studies have shown that antioxidants may slightly delay the progression of the disease or its symptoms. High doses of vitamin E, or the consumption of Ginkgo biloba - a medicinal plant that has antioxidant properties - contribute to a slight improvement in comparable to that experienced memory after the consumption of certain drugs, but without its side effects. It is necessary to take care and manage Ginkgo always under medical supervision, as there exist contraindications in use with certain medications.
Recommendations for living with Alzheimer'sOnce you have been diagnosed Alzheimer's disease will begin a very difficult process, both for the sick and for the people that surround him (more if fit for the latter). The entire environment of the patient, the House and the family, should be reorganized to avoid any type of injury, to facilitate the management of complicated situations, and to ensure a quality of life appropriate to the patient and their carers.
A: should be taken measures
- Preventing falls: be sure to remove all with whatever it is easy to slide, remove obstacles that hinder movement, to avoid cables to drag along the ground, ensure a good birth of stays, etc. Where necessary, there are adapted walkers which are available at orthopedic centers.
- Accidents: is important to withdraw from circulation all sharp, flammable and toxic materials. It is advisable to equip the tub with bars that facilitate the entry and exit of the same, and non-slip bands. Install insurance in windows and doors, and not only never let the patient in places such as terraces, stairs, and other places that might be dangerous for him. It is highly recommended to always have the phone number for the emergency department or nearest health center.
- Organize the environment: in general you should try to simplify the layout of the House and objects, not to let anything fall easily or with what is tripping. In addition, it should not change site things to not mislead the sick. It is good to indicate the path from the bedroom to the bathroom and the kitchen, and posters with the name (and preferably a simple drawing) can be placed from these stays at the door.
- Activities of daily living: since the early stages of the disease are must create a routine and follow it more faithfully possible; What will help the patient to orient themselves in space and in time. This can also be achieved facilitating patient access to a calendar where this can go by day, drawing up a list of activities, or placing a watch that the patient understand view (usually find it easier to interpret the digital watches).
Tips for families of patients with Alzheimer's diseaseThe family will live and suffer all the progress of his illness with the Alzheimer's patient. Changes that are going to happen from now on will be in many cases the appearance of certain negative feelings (depression, fear, anxiety, guilt...), and a level of stress and wear, both physical and psychological, that will result in what has been called "the caregiver syndrome".
To avoid that the person that takes the main role of caregiver suffer this disorder must, first, be informed and receive some type of training to orient it in the development of its function. Second, you should know that you have help whenever you need it, psychological, social and family support.
Last, but not least, the caregiver must have time to rest and carry out activities outside the environment of the patient. In short, don't forget that the maintenance of the quality of life of the people that surround you is as important as the well-being of the patient.