Alzheimer’s: Symptoms & Treatment of the Disease

Alzheimer's: Symptoms & Treatment of the Disease

Did you forget to turn off the stove or miss an important appointment? Increasing forgetfulness can make everyday life much more difficult. It is entirely normal for people to lose memory as they get older. But when is forgetfulness pathological? And when does the dreaded Alzheimer’s disease lie behind it? In Germany, 1.2 million people are diagnosed with Alzheimer’s. The disease is an enormous burden for those affected and their families. Read here how you can recognize the symptoms of Alzheimer’s dementia, how the disease progresses and what treatment options are available.

Definition: What is Alzheimer’s?

Alzheimer’s disease is a form of dementia caused by deposits of age-related protein plaques and so-called “Alzheimer’s fibrils” in the brain. With increasing density of the deposits, slowly progressing memory disorders, cognitive decline and personality changes occur.

 

What is the difference between Alzheimer’s and Dementia?

Alzheimer’s is the most common cause of dementia worldwide. For this reason, dementia is often equated with Alzheimer’s in general usage. But in addition to Alzheimer’s, many other forms of dementia are associated with typical dementia symptoms such as impaired memory, reduced cognitive abilities and impairments in everyday life. However, individual dementia diseases differ in the cause, symptoms and course of the disease.

Causes: Is Alzheimer’s hereditary?

Research has now found that genetic factors are involved in the development of Alzheimer’s. Gene defects such as the presence of so-called apolipoprotein E type 4 alleles increase the risk of sporadic Alzheimer’s disease by a factor of two to ten. In the hereditary form, mutations in the presenilin 1 or 2 gene (PSEN1 or PSEN2) and in the amyloid precursor protein gene (APP gene) are responsible.

Alzheimer’s disease can, therefore, be inherited in the family. However, this accounts for only a tiny proportion of around five per cent of all cases. Most Alzheimer’s diseases occur sporadically and are associated with advancing age.

 

How does Alzheimer’s develop?

The exact cause of the disease is still unclear from the scientific point of view. Studies of brain tissue suggest that misfolded proteins (proteins) first lead to deposits on the nerve cells in the brain via immunological changes (i.e. reactions of the immune system) and then to the death of these cells.

The amyloid precursor protein is said to play an essential role in this. The amyloid precursor protein occurs naturally in the body and is broken down by enzymes, releasing the protein ß-amyloid. In healthy people, this protein is then broken down by the body. However, genetic changes can mean that this degradation can no longer take place sufficiently and the ß-amyloid is deposited as plaques (i.e. coverings) in the cerebral cortex or the brain’s vessels.

Too high amounts of ß-amyloid have a poisonous effect on the nervous system and can cause the formation of so-called Alzheimer’s fibrils in the nerve cells. Alzheimer’s fibrils are an assembly of another protein: the tau protein. It usually contributes to the stability of structures in the nervous system. As a result of misfolding, it clumps together into fibrils (i.e. bundles of proteins) and loses its function.

All these changes lead to the destruction of the synapses, i.e. the connections between the individual nerve cells in the brain, which are of essential importance for the flow of information in the brain. This happens in particular between the hippo- and parahippocampal cortex – these areas of the brain where critical processes for memory performance occur. In addition, the concentration of messenger substances, which are also responsible for transmitting information in the brain, is often reduced. Finally, at the level of the immune system, inflammatory substances are released, which can lead to the death of the nerve cells.

At what age does Alzheimer’s occur?

With a share of about 70 per cent, Alzheimer’s is the most common form of dementia in old age. Old age is one of the most critical risk factors for the disease. 30 to 40 per cent of people over 80 are affected by Alzheimer’s dementia.

By definition, the senile form of this dementia occurs after the age of 65 and is characterized by slow progression. However, Alzheimer’s can also occur in younger people. This is then referred to as presenile dementia. This is often accompanied by a rapidly increasing deterioration in cognition, i.e. the ability to perceive and think.

In people with trisomy 21 (Down syndrome), Alzheimer’s symptoms typically begin earlier, at around 40 years of age.

What are the first symptoms of Alzheimer’s?

Characteristically, the disease remains almost symptom-free for a long time. Only gradually does a creeping process begin, while the outer facade is often preserved for a long time.

The first signs are usually a reduced ability to concentrate and memory disorders. In the beginning, newly experienced things can no longer be remembered well and are quickly forgotten. Long-term memory, on the other hand, only shows gaps much later. First, there are difficulties with temporal and local orientation, and then there needs to be more memories about oneself or the current situation.

In addition to the impairment of memory and orientation, other characteristics that appear over the course are:

  • I frequently move things to inappropriate places, such as toilet paper in the fridge.
  • Limited judgment, for example, when choosing the right clothes in summer and winter
  • Decrease in the sense of smell.
  • Speech disorders: frequent repetitions, difficulty finding words or confusing similar terms such as dog instead of cat
  • Disturbances in the execution of purposeful movements
  • I do not recognize letters, words or sentences.
  • loss of the ability to write
  • Impairments in dealing with numbers, for example, when paying bills
  • Disturbance of sensory processing, for example, when recognizing images, familiar faces or when estimating spatial dimensions
  • Sleep and wakefulness disorders
  • urinary and faecal incontinence

Those affected often withdraw more and more from social life due to insecurity, give up hobbies and show less initiative than before. The personality remains unchanged for a long time. However, personality changes can then occur very distinctly and show themselves in various forms: from distrust and discomfort in a strange environment to aggressive behaviour, delusional theories as attempts at explanation and depressive moods due to the emotional stress of those affected.

 

The course of Alzheimer’s disease

A wave-like course often characterizes the disease. The beginning is usually insidious and suddenly increases speed in the middle phase. In the late stage, the progression of the disease slows down again.

Diagnosis of Alzheimer’s dementia

To diagnose Alzheimer’s disease with certainty, the doctor will first take a detailed anamnesis with the person concerned and, if possible, with a person close to them. Then, a physical examination with neurological examination and laboratory values ​​from blood and urine collection follow.

If Alzheimer’s is suspected, the focus is on neuropsychological testing, which can be used to record memory performance. This examination includes various tests:

  • DemTect:  Dementia screening test for early detection of suspected dementia
  • Mini-Mental Status Test (MMSE):  Assessment of orientation (year, date, season), memory (repeat words), concentration (spelling, arithmetic), language ability (naming objects, repeating, writing, drawing)
  • MoCA test for early stages and mild cognitive symptoms
  • Clock test  to test spatial and abstract thinking: A clock is to be drawn, and a given time marked on it

In addition, brain imaging takes place using CTMRT or SPECT (a unique computed tomography method). This is intended to provide information about the shrinkage of the cerebral cortex and other abnormalities, such as enlarged cerebrospinal fluid spaces. In PET (positron emission tomography), cerebral blood flow, oxygen content, and sugar metabolism in the bony areas of the brain can be shown.

With the help of a liquor puncture on the spinal cord, the brain fluid obtained, the so-called liquor, can be examined for increased tau protein. The ß-amyloid, on the other hand, is reduced in the liquor because it is increasingly deposited in the brain tissue.

Atrophied brain nerve cells and reduced synapses can be detected in histology (microscopic examination of tissue samples). Also visible under the microscope are amyloid plaques outside nerve cells, such as in blood vessels. In addition, tau proteins and Alzheimer’s fibrils can be detected.

With these diagnostic procedures, symptomatic forms of dementia can be specified, and other causes can be ruled out. Alzheimer’s or other types of dementia are not always the reason for forgetfulness: other diseases, such as depression or impaired consciousness, can also cause the typical memory disorders.

How is Alzheimer’s disease treated?

Although a lot of research is being done on Alzheimer’s, there is still no cure for the disease. The drugs for Alzheimer’s, so-called anti-dementia drugs, only have a short-term effect and cannot permanently stop the progression of the disease. Even if no cure can be brought about with the treatment at the current time of research, therapy should be started as early as possible to enable those affected to remain independent for as long as possible despite Alzheimer’s.

Two drugs are currently used:

  • Central acetylcholinesterase inhibitors such as donepezil, rivastigmine and galantamine lead to reduced breakdown of acetylcholine, a messenger substance that transmits information. The reduction in degradation is intended to counteract the decline in synapses. In the mild to medium stage, a positive effect on cognitive performance and an improvement in everyday situations can be achieved.
  • The NMD receptor antagonist memantine is said to protect nerve cells from glutamate. Glutamate is often found in excessive concentrations in Alzheimer’s. It has been proven that memantine can improve brain performance and the associated improvement in coping with everyday life and reduce the need for care. Memantine is recommended for moderate to severe forms.

The herbal preparation of Ginkgo biloba can also be used according to scientific guidelines to treat dementia.

 

Other forms of therapy

In addition to drug treatment, non-drug therapy, such as music and movement therapy, speech therapy, and occupational therapy, can also be used on an equal footing. The focus here is on improving those affected’s mood and helping them cope with everyday life with the disease independently.

Structuring the daily routine with fixed habits and rules, as well as memory aids and the resumption of social contacts and activities, can contribute to a sense of achievement and an increased quality of life. Adapting the home and other medical aids can also help people cope better with the problems that arise in everyday life.

Why is Alzheimer’s fatal?

In the final stages of dementia, those affected may find it difficult to eat and drink, and the need for care increases significantly. The most common cause of death in people with dementia is infections such as pneumonia. Life expectancy with Alzheimer’s is shorter, averaging about eight years after diagnosis.

How can you prevent Alzheimer’s?

People with a high level of education and social activities are often less affected by Alzheimer’s. It is assumed that, for example, intensive practice promotes neuronal plasticity (i.e. the ability of the brain to change through training) and increases nerve connections. Although this cannot stop the breakdown of nerve cells, it can compensate for it.

Learning a new language or doing arithmetic in your head instead of using a pocket calculator can help keep your brain fit for a long time. Regular exercise, a healthy diet and adequate sleep should also be ensured. Getting together with friends or relatives also ensures intellectual exchange.

 

 

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