Alzheimers Disease - Symptoms, Causes and Treatment
Alzheimer's disease, often described as the silent epidemic of the century is an important cause of morbidity and mortality. It is the most common cause of dementia in western countries. Alzheimer's disease most often presents with subtle onset of memory loss followed by a slowly progressive dementia that has a course of several years.
In medical terms, the most important implication is the diffuse atrophy of the cerebral cortex with secondary enlargement of ventrilcular system.
Symptoms of the Disease
The disease begins with memory loss that spreads to language and visuopatial deficits.
Memory loss -Alzheimer's begins to affect the day to day activities like keeping track of finances, following instructions on job,driving ,shopping and housekeeping. Some patients are unaware of these difficulties. In the middle stages, the patient is unable to work, is easily lost and confused and requires daily supervision. Social graces, routine behavior and superficial conversation maybe surprisingly retained.
Language- first there is impairment of naming, then comprehension and finally fluency. In some patients , aphasia-the inability to use language- is an early and prominent feature .
Visuopatial deficits begin to interfere with dressing ,eating ,solving simple puzzles and copying geometric figures. Patient maybe unable to perform simple calculations or tell time. In the late stages, some persons remain ambulatory,i.e they are not bedridden, but wander aimlessly. Delusions are common like those of theft, infidelity or misidentification. 10 percent of Alzheimer's patients develop Capgras Syndrome, i.e believes that a caregiver has been replaced by an impostor. Loss of inhibitions and aggression may occur.Sleep-wake patterns are prone to disruption and night time wandering becomes disturbing to the household. Some patients develop a shuffling gait(short uncertain steps) with generalized muscle rigidity associated with slowness and awkwardness of movement. In the end stages, Alzheimers patients become rigid, mute, incontinent and bedridden. Help may be needed with the simplest tasks like eating, dressing and going to the toilet. Myoclonic jerks or generalized seizures may occur.Often death results from malnutrition ,secondary infection or heart disease. The typical duration of Alzheimers disease is 8-10 years but the course can range from 1-25 years.Usually the disease starts at old age, but it has been observed as early as in the 40s.
Possible Causes of Alzheimers
The most important risk factors for Alzheimers disease are old age and a positive family history. Positive family history suggests a genetic cause. Some patients have a past history of head-trauma with concussion. Other causes like Aluminium, Mercury and virus have been proposed. Diabetis increases the risk of Alzheimers disease to three fold. Others like increased cholestrol, hypertension , decrease in serumfolic acid, low dietary intake of fruits,vegetables and redwine and lack of exercise - are proposed as potential risk factors.
Treatment - What the family needs to know.
Alzheimers disease cannot be cured and no higly effective drugs exist. The focus is on judicious use of muscle relaxant drugs,symptomatic management of behavioral problems and builing rapport with the patient and family members and other care givers.
New Findings - Role of genes
This information is a bit technical and is intended for those who wish to know more about the disease. Several genes have been found to play important roles in the pathogenesis of atleast some cases of Alzheimers. The first to be identified was the APP gene on chromosome 21. Two additional genes are presenilin-1 and 2. A discovery of great importance has implicated the apo-e gene on chromo 19 in the pathogenesis of late onset familial and sporadic forms of Alzheimers disease.
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