Alzheimer’s Disease

First described by German psychiatrist and neuropathologist Alois Alzheimer in 1906

and was named after him. In 2006, there were 26.6 million sufferers worldwide.
Alzheimer's is predicted to affect 1 in 85 people globally by 2050.

AD is a progressive, irreversible, degenerative neurologic disease that begins

insidiously and is characterized by gradual losses of cognitive function and disturbances
in behaviour and affect. Although AD can occur in people as young as 40, it is
uncommon before age 65.

Although the greatest risk for AD is increasing age, many environmental, dietary and
inflammatory factors may affect whether a person suffers from this cognitive disease.
AD is a form of dementia, a complex brain disorder caused by a combination of various
factors. These factors may include genes, neurotransmitter changes, vascular
abnormalities, stress, hormones, circadian changes, head trauma and seizures.

AD can be classified into two types: familial or early onset and sporadic or late-onset.
Familial AD is rare. It is frequently associated with genetic mutations. It occurs in
middle-aged adults. If family members have at least one other relative with AD, then
there is a familial component, which non-specifically includes both environmental
triggers and genetic determinants. Sporadic AD generally occurs in people older than
65 years of age and it has no obvious pattern of inheritance.

Researchers are also beginning to discover the roles of inflammation and oxidative
stress and the contribution of brain infarctions to the disease.

Dementia is a degenerative disorder characterized by progressive memory loss,

confusion, and inability to think or communicate effectively. Consciousness and
perception are usually unaffected. Known causes of the dementia include multiple
cerebral infarcts, severe infections, and toxins.

CLINICAL MANIFESTATIONS

In the early stages of AD, forgetfulness and subtle memory loss occur. Patients may
experience small difficulties in work or social activities or social activities but have
adequate cognitive function to hide the loss and function independently. Depression
may occur.

With further progression of AD, deficits can no longer be concealed. Forgetfulness is

manifested in many daily actions. Patients may lose their ability to recognise familiar
faces, places and objects, and they may become lost in a familiar environment. They
may repeat the same stories because they forget that they have already told them.
Conversation becomes difficult, and word-finding difficulties occur. The ability to
formulate concepts and think abstractly disappears. Patients are often unable to
recognize consequences of their actions and will therefore exhibit impulsive behavior.
Patients have difficulty with everyday activities, such as operating simple appliances
and handling money.

Personality changes are also usually evident. Patients may become depressed,
suspicious, paranoid, hostile, and even combative.

Progression of this disease intensifies the symptoms: speaking skills deteriorate to

nonsense syllables, agitation and physical activities increase and patients may wander
at night. Eventually, assistance is needed for most ADLs, including eating and toileting,
because dysphagia and incontinence develop.

The terminal stage, in which patients are usually immobile and require total care, may
last months or years. Occasionally, patients may recognize family members or
caregivers. Death occurs as a result of complications such as pneumonia, malnutrition,
or dehydration.

Trying to reason with people with AD and using reality orientation only increases their
anxiety without increasing function.