Alzheimer’s: causes, symptoms, treatment and prevention

Cancer, HIV / AIDS and dementia are among the most disturbing disorders in the Western population today, among the most common disorders that do not yet have a solution or effective treatment.

Within the dementia group, the best known is dementia caused by Alzheimer’s disease.

Alzheimer’s: general definition

Alzheimer’s disease is one of the most common and well-known neurodegenerative diseases. It is a chronic and currently irreversible disorder of unknown causes which it works by producing a progressive deterioration of the mental faculties of the patient. Initially, it acts only at the level of the cortex, but as the deterioration progresses, it ends up affecting the subcortical level as well. Initially insidious, the first lesions appear in the temporal lobe and later spread to other lobes such as the parietal and frontal.

Currently, his diagnosis is only considered fully definitive after the patient’s death and analysis of his tissues (before death his diagnosis is considered only probable) although, according to advances in neuroimaging techniques, a more precise diagnosis is possible. The course of Alzheimer’s disease leads to homogeneous and continuous cognitive disorders, On average between eight and ten years.

typical symptoms

  • To learn more about the symptoms: “The 11 first symptoms of Alzheimer’s disease (and its explanation)”

One of the most characteristic and well-known symptoms is memory loss, which usually occurs gradually.. The recent memory is lost in the first place, because according to the disease, it continues its course to forget aspects and elements more and more distant in time. It also decreases the ability to pay attention, the ability to judge, and the ability to learn new things.

Like most cortical dementias, Alzheimer’s disease is characterized by a progressive loss of function that occurs mainly in three areas, shaping what has been called aphasic-apraxo-agnostic syndrome. In other words, throughout its deterioration, the patient loses the ability to speak (the presence of anomie or difficulty remembering the names of things is very typical), to perform sequenced actions or even to recognize stimuli. Coming from outside, resulting in a state of silence and stillness. The presence of falls, sleep and eating disorders, emotional and personality disorders and loss of smell are also common in people with Alzheimer’s disease.

Over time, the subject tends to become disoriented and lost, to have recklessness and strange and carefree behaviors, to forget the value of things, and even end up being unable to recognize those close to them. As the disease progresses, the subject gradually loses his autonomy, depending over time on the care and management of external agents.

Statistically, the average age at which Alzheimer’s disease begins to appear is around 65, increasing its prevalence as age increases. It is considered precocious or presenile if it begins before age 65, and senile or late if it occurs after this age. At a younger age of onset with poor prognosis, symptoms progress more quickly.

Deterioration process: stages of the disease

As we have said, Alzheimer’s disease leads to a gradual deterioration in the mental functions of the patient. This progressivity can be observed throughout the three phases in which the degeneration process has been differentiated.

In addition to these phases, it should be noted that there may sometimes be a period of time before the onset of the disorder in which the individual suffers from mild cognitive impairment (generally of the amnesic type).

First phase: beginning of the problems

In the early stages of the disease, the patient begins to have small memory deficits. He has trouble remembering what he just did or ate, as well as withholding new information (in other words, he has anterograde amnesia). Another particularly typical symptom is anomie or difficulty remembering the names of things even though they know what they are.

Judgment and problem-solving skills are also compromised, Less efficient at work and in daily activities. At first, the patient is aware of the onset of limitations, and depressive and anxious symptoms such as apathy, irritability and social withdrawal often appear. This first phase of Alzheimer’s disease can last up to four years.

Second phase: gradual loss of skills

The second phase of Alzheimer’s disease is characterized by the appearance of an aphasic-apraxo-agnostic syndrome, With the onset of retrograde amnesia. In other words, the subject begins to have difficulty understanding and delivering language beyond anomie, as well as having severe difficulty performing sequenced activities and recognizing objects, people and stimuli, as well as having trouble remembering. loss refers mainly to events that had just occurred and that were not retained).

The patient needs supervision and is not able to perform instrumental activities, but may be able to perform basic activities such as dressing or eating alone. There is usually temporal and spatial disorientation, and it is not uncommon to get lost.

Third phase: the advanced phase of Alzheimer’s disease

During the third and final phase of the disease, the deterioration of the individual is particularly intense and evident. Episodic memory loss dates back to childhood. There is also a loss of semantic memory. The subject ceases to recognize his relatives and relatives and he is even unable to recognize himself in an image or a mirror.

They usually have extremely severe aphasia which can end in complete silence as well as difficulty in coordination and walking. There is a total or almost total loss of autonomy, depending on external caregivers to survive and not being able to alone and the basic skills of daily life are lost, having a total dependence on external caregivers. Episodes of restlessness and personality disorders often occur.

Binge eating and / or hypersexuality, lack of fear of aversive stimulation and episodes of anger may also occur.

Neuropsychological features

The dementia caused by Alzheimer’s disease has a number of effects on the brain that end up causing the symptoms.

In this way shows the gradual reduction of acetylcholine levels in the brain, One of the main brain neurotransmitters involved in neural communication and influencing aspects such as memory and learning. This decrease in acetylcholine levels results in a gradual degradation of brain structures.

In Alzheimer’s disease, the breakdown of structures begins in the temporal and parietal lobes, to follow the course of the disorder by advancing forward and gradually towards the rest of the brain. Over time, neuronal density and mass are reduced, dilating the ventricles to occupy the space left by neuronal loss.

Another aspect of great relevance is the presence in the neuronal cytoplasm of neurofibrillary tangles and beta-amyloid plaques, which hamper synaptic processes and cause weakening of synapses.

unknown causes

Research on this type of dementia has attempted to explain how and why Alzheimer’s disease occurs.. However, there is still no proof of why it appears.

At the genetic level, the participation of mutations in the APP gene, the amyloid precursor protein, as well as in the ApoE gene, linked to the production of cholesterol regulatory proteins, is suspected.

The decrease in the level of cerebral acetylcholine leads to the degradation of the various structures, pharmacological treatments based on the fight against this reduction. A cortical atrophy with temporo-parietal onset appears and eventually becomes general – over time to the rest of the nervous system.

Risk factors

The causes of Alzheimer’s disease are still unknown today. However, there are many risk factors that need to be taken into account when performing prevention tasks.

One of the factors to consider is age. Like most dementias, Alzheimer’s disease tends to appear after 65 years of age, although there are cases of onset even earlier.

The level of education or, rather, the mental activity of the individual is also involved. And is that the greater mental exercise greater resistance and strength of neural connections. However, this effect, while positive because it slows the progression of the disease, can make it difficult to identify the problem and treat it.

Another is the history of the family. Although Alzheimer’s disease is not usually transmitted genetically (except in some specific variants), it is true that almost half of people with this problem have a relative with the disorder.

Finally, the patient’s life cycle must also be taken into account: it seems that tobacco consumption and high fat diets can promote its onset. Likewise, a sedentary lifestyle with high levels of stress increases the likelihood of occurrence. The presence of certain metabolic diseases such as diabetes or hypertension are facilitators of Alzheimer’s disease.

treatments

To this day, Alzheimer’s disease remains incurable, the treatment being based on the prevention and delay of cognitive disorders.

pharmacological treatment

Pharmacologically, they tend to use different acetylcholinesterase inhibitors, An enzyme that breaks down acetylcholine in the brain. In this way, acetylcholine is present in the brain for longer, prolonging its optimal functioning.

Specifically, donepezil is used as a treatment in all stages of Alzheimer’s disease, while in the early stages it usually prescribes rivastigmine and galantamine. These drugs have been shown to slow the progression of the disease by about six months.

psychological treatment

At the psychological level, he generally uses occupational therapy and cognitive stimulation. as key strategies to slow the rate of deterioration. Likewise, psychoeducation is essential in the early stages of the disease, when the patient is still aware of the loss of faculties.

It is not uncommon for people with dementia to experience episodes of depression or anxiety. In this way, the clinician must assess the effect of the notification of the problem on the subject.

We must also work with the family environment, advise on the process of deterioration that the patient will follow, his loss of autonomy and indicate valid strategies to cope with the situation.

Prevention

Since the causes of Alzheimer’s disease are still unknown and their treatment is based on slowing or reducing symptoms, it is necessary to take into account the factors related to the disease in order to carry out preventive tasks.

As we said, a sedentary lifestyle is a risk factor for developing this disease. Exercise has been shown to be an excellent preventive mechanism, as it helps strengthen both body and mind, being useful in a large number of disorders.

As other risk factors include high cholesterol, diabetes, and high blood pressure, food control becomes an important preventive element. It is very useful to have a rich and varied diet with little saturated fat.

Another aspect to be addressed is the level of mental activity. Brain exercise involves strengthening the learning capacity and neural connections, so that reading or learning new things (not necessarily theoretical and technical knowledge) can help curb symptoms or prevent them. to appear.

Finally, one of the key elements of prevention is the early detection of symptoms. Since age-related memory loss without the need to involve dementia is common, it is not uncommon for the early signs of Alzheimer’s disease to be overlooked. If memory problems are very common and are accompanied by other behavioral problems and / or other faculties, it would be advisable to go to a medical center where you can assess the patient’s condition. Precautions should also be taken in case of mild cognitive impairment, which can sometimes progress to different dementias (including Alzheimer’s disease).

Bibliographical references:

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.

  • Förstl, H. and Kurz, A, (1999). Clinical features of Alzheimer’s disease. European Archives of Psychiatry and Clinical Neuroscience 249 (6): 288-290.

  • Sants, JL; Garcia, LI; Calderon, MA; Sanz, LJ; of rivers, P .; Left, S .; Román, P .; Hernangómez, L .; Navas, E .; Lladre, A and Álvarez-Cienfuegos, L. (2012). Clinical Psychology. CEDE PIR preparation manual, 02. CEDE. Madrid.

  • Waring, SC and Rosenberg, RN (2008). Genome-wide association studies in Alzheimer’s disease. Bow. Neurol. 65 (3): 329-34.

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