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What is Alzheimer’s disease?
Alzheimer's Disease (AD) is a degenerative disorder of the brain which causes progressive memory disturbance, impaired thinking and problem solving deficits, behavioural and personality changes. This progressive cognitive impairment (dementia) leads to inability to care for oneself, and patient becomes completely dependent on others. AD is the most common cause of the dementia syndrome, representing 60% of all cases. Risk of AD definitely increases with age: whereas roughly 5% of individuals over the age of 65 years are affected, as many as 20-40% of persons over the age of 85 may have the disease. AD has been described the first time by Alois Alzheimer, a german neurologist who identified tipical lesions, senile plaques and neurofibrillary tangles, in a brain of a 51 years old female affected by progressive dementia.
What are the causes?
The causes of AD are still unknown: probably a variety of mechanisms may differentially contribute to develope AD. At the present reserch has devoted to evaluating different hypotheses: exogenous and endogenous toxins; heritable predisposition, etc. It appears that AD may result from complex interaction between variable genetic predisposition and environmental factors. In certain rare families AD shows an autosomal dominant pattern of trasmission (1%). In the most cases, genetic predisposition may exist, as shown by some affected relatives. A potential risk factor is the apolipoprotein 4 in the isoform E4.
How does Alzheimer’s manifest itself?
Alzheimer's disease has a progressive course of action ; its duration is 10 years on average, but it is widely changeable from case to case. The onset is shifty and first symptoms are often simply believed as consequence of aging process. Most of times slight loss of memory (84% of cases) and speech problems (76%) represent the initial symptoms, but also changes in behaviour and personality disorder, decreasing interest for hobbies and apathy may occur .Afterwards clinical picture gets clear with severe memory problems, loss of one's bearing in space and time, attention and concentration capability. Sometimes even in the early phase there may be hallucinations and agitation. At the end patients become unable in day to day chores ; by this time, they must be cared for constantly so that the whole of the family is struck by such event : the financial, affective and psychological burden is immense ; in fact the disease involves not only the patients but the whole family.
It's absolutely important that the person who shows signs of serious cognitive deterioration is submitted to complete medical tests, so as to detect any other different disease. The early diagnosis allows to plan the future life both of the patient and his family, the most suited therapy and the care organization. What is important is a careful anamnesis and medical examination , blood and neuroimaging exams ; the neuropsychological evalutation may help to distinguish demented from depressed patients . Brain CT or MRI allow to exclude other causes of cognitive impairment. Even if the undoubted diagnosis is based only on the post-mortem brain examination, very careful clinical criteria lead to diagnostic accuracy of 90%.
What can be done?
For the time being, there are no effective therapies ; some recently discovered drugs (cholinesterases inibitors, such as donepezil and rivastigmine) slow down ,for short periods of time, the advancing of simptoms . According to English studies, 75-80% of people affected by Alzheimer's lives with their families. Since caring for a person affected by Alzheimer's means being put to the test on a physical, economic, affective and psychological level, it is necessary that the family is supported through an efficient social assistance program. Moreover, the family should not be left alone. It's for this very purpose that A.I.M.A, the Italian Alzheimer's Disease Association, was constituted in 1985, in order to offer a meeting point for families, doctors, social and health workers.
The disease course can be divided into four stages:
Early stage
- decline of recent memory
- mild temporal disorientation
- difficulty in finding words properly
- anxiety/ depression - lack of initiative
- difficulty in tackling new situationIntermediate stage
- spatial and temporal disorientation
- severe loss of memory
- language and comprehension disturbances
- apraxia ( difficulties in dressing, handling tools etc)
- delusions, hallucination and wandering
- difficulty in recognizing objects and people
- psychomotor slowing
- Impairment in activities of daily livingAdvanced stage
- severe cognitive impairment
- complete loss of language abilities
- neurologic abnormalities (seizures, myoclonus)
- inability to care for oneself
- incontinence Late stage
- indifference, apathy
- complete loss of cognitive function
- incontinence
- walking and feeding disturbances
- weight loss
- complications (pneumonia, bedsores, phlebitis)Late stage
- indifference, apathy
- complete loss of cognitive function
- incontinence
- walking and feeding disturbances
- weight loss
- complications (pneumonia, bedsores, phlebitis)
