Alzheimer’s disease is a progressive and irreversible brain disease that causes loss of cognitive abilities such as memory and thinking skills, and in its advanced stages, the person becomes unable to perform even simple daily tasks. Symptoms of the disease usually appear in the mid-60s. Millions of people live with dementia caused by Alzheimer’s disease and need ongoing care.
It is a disease that entered the medical literature with the Auguste Deter case presented by the German physician Alois Alzheimer in 1906. Auguste Deter’s complaints started a little earlier than the classical disease, at the age of 50. After his death at the age of 55, Dr. Alzheimer examined the patient’s brain and revealed the classic histopathological features of the disease.
Alzheimer’s disease is among the most common causes of death in the United States. In fact, estimates in recent years suggest that it is the third most common cause of death in the elderly, after heart disease and cancer. It is the most common cause of dementia in the elderly. Dementia is the loss of cognitive functions such as thinking, remembering, logic, and behavioral skills needed to continue daily life. While it affects the life of the person in its mild form, it can cause complete dependence on others in advanced stages. Dementia or dementia is not a natural part of aging, but its incidence increases with age.
Although the most common cause of dementia is Alzheimer’s disease, it can also occur for different reasons such as dementia with Lewy bodies, frontotemporal disorders and vascular dementia (dementia due to vascular problems). The two problems can coexist, for example a person may have both Alzheimer’s disease and vascular dementia.
Although there is no cure for Alzheimer’s disease yet, scientific research continues. There are treatments available that temporarily slow the progression of dementia symptoms and improve a person’s quality of life.
One of the most common symptoms seen in the early stages of the disease is difficulty in remembering newly learned information. Changes in Alzheimer’s disease affect the part of the brain involved in learning. As the disease progresses, symptoms of disorientation, changes in emotion and behavior, difficulty in understanding what is happening, unfounded suspicions about relatives, more severe memory loss, difficulty in speaking, swallowing, and walking are added.
The memory loss and other symptoms caused by the disease may go unnoticed by the affected person. His family and friends can see the change more clearly. For people whose dementia symptoms are noticed, it is necessary to be examined by a neurologist without delay. Starting treatment early can make a difference. Although Alzheimer’s disease is the cause of dementia in the elderly in 60-80%, other possible causes should also be investigated. The average life expectancy after diagnosis is 4-8 years, but this time may vary depending on other factors; There have been patients who have lived for 20 years with a diagnosis of Alzheimer’s.
What Happens in the Brain?
In Alzheimer’s disease, some microscopic changes occur in the brain almost ten years before the clinical manifestations. Beta-amyloid plaques and tau protein tangles are the main abnormal structures observed in the brain. These abnormal structures begin to form in memory-related regions first and then spread to other regions in a disease-specific pattern over time. Plaques and tangles prevent nerve cells from functioning normally. Eventually, nerve cells die and the brain shrinks.
Alzheimer’s disease affects one out of every 14 people after the age of 65, and one in six after the age of 80. 1 in 20 of all cases occur between the ages of 40-65; This is called early-onset Alzheimer’s disease. Genetic causes were found in a small number of patients, but no cause could be identified in the majority of them.
There is no single test that definitively diagnoses it. People with symptoms of the disease are evaluated by taking a medical history and physical examination. Special clinical tests that evaluate cognitive functions can be used. Blood tests and imaging methods such as CT and MRI can be used to distinguish other possible problems such as vitamin B12 deficiency, tumor, vascular causes.
Since the cause of the disease is not known exactly, there is no preventive or curative method yet.
To reduce the risk of developing dementia, it is recommended not to smoke, not to consume excessive alcohol, to eat a healthy and balanced diet, to be physically active and fit, and to stay mentally active.
Acetylcholine is a molecule (neurotransmitter) in the brain that has important roles in learning and memory. In Alzheimer’s disease, a decrease in neurons containing intense acetylcholine is observed. Drugs that increase acetylcholine levels (acetylcholinesterase inhibitors) can provide moderate improvement in memory. They are ineffective in late-stage disease and cannot stop the progression of the disease.
In moderate-to-severe disease, the NMDA antagonist memantine can be used. This medication can reduce symptoms and allow the person to do their daily work for a little longer.
NMDA antagonists and cholinesterase inhibitors can also be used in combination. Drugs are usually started with a low dose and the doses can be increased according to the patient’s tolerance. The frequency of side effects increases with higher doses. Side effects such as nausea, vomiting, diarrhea, loss of appetite can be seen.
Various drug treatments may be beneficial for psychiatric symptoms such as depression, anxiety, and irritability. This requires the evaluation of a psychiatrist.
Studies for Alzheimer’s disease have shown that physical activity improves memory. Regular exercise can also make it easier for a person to do their daily work. Occupational therapy provides exercises for the independent realization of daily living activities. Alzheimer’s patients have an increased risk of falling . Balance and coordination exercises are beneficial in this respect. Ensuring that daily work is done step by step by breaking it down into small pieces can increase functional capacity.