Alzheimer’s: Causes, Symptoms, Treatment And Prevention
Cancer, HIV/AIDS and dementia are some of the disorders that are of most concern today in the Western population, being some of the most common disorders that still do not have an effective solution or treatment.
Within the group of dementias, The best known is the dementia caused by Alzheimer’s disease.
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 that It acts by producing a progressive deterioration in the mental faculties of the person who suffers from it. Initially it acts only at the cortex level, but as the deterioration progresses it ends up also affecting the subcortical level. Insidious in onset, the first lesions appear in the temporal lobe and subsequently expand to other lobes such as the parietal and frontal.
Currently, its diagnosis is only considered totally definitive after the death of the patient and the analysis of his tissues (before death his diagnosis is considered only probable), although as neuroimaging techniques advance, a more exact diagnosis becomes possible. The course of Alzheimer’s disease causes homogeneous and continuous cognitive impairment having an average duration of between eight and ten years.
Typical symptoms
One of the most characteristic and well-known symptoms is memory loss, which usually occurs gradually. Firstly, recent memory is lost, and as the disease continues its course, aspects and elements increasingly distant in time are forgotten. It also decreases attention span, judgment ability, and the ability to learn new things.
Like most cortical dementias, Alzheimer’s disease is characterized by a progressive loss of functions that occur especially in three areas, configuring what has been called aphaso-apraxo-agnosic syndrome. In other words, throughout his deterioration, the patient loses the ability to speak (the presence of anomia or difficulty remembering the names of things is very typical), perform sequenced actions or even recognize stimuli coming from the outside, culminating in a state of muteness and immobility. The presence of falls, sleep and eating disorders, emotional and personality disorders and loss of smell are also common in those with Alzheimer’s.
Over time, the subject tends to become disoriented and lost, have strange and careless behaviors and carelessness, forget the value of things and even ends up being unable to recognize their loved ones. As the disease progresses, the subject gradually loses its 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 years, with its prevalence increasing as age increases. It is considered early-onset or presenile if it begins before age 65, and senile or late-onset if it occurs after that age. The younger the age of onset, the worse the prognosis, with the symptoms progressing more rapidly.
As we have said, Alzheimer’s disease causes a progressive deterioration of the patient’s mental functions. This progressivity can be observed throughout the three phases in which the degeneration process has been differentiated.
In addition to these phases, It must be taken into account that sometimes there may be a period of time prior to the onset of the disorder. in which the individual suffers from mild cognitive impairment (generally amnestic type).
First phase: Beginning of problems
In the early stages of the disease, the patient begins to experience small memory deficits. He has trouble remembering what he just did or ate, as well as retaining new information (in other words, he suffers from anterograde amnesia). Another especially typical symptom is anomia or difficulty remembering the names of things despite knowing what they are.
Judgment and problem-solving abilities are also compromised. performing less in work and daily activities. Initially the patient is aware of the appearance of limitations, and depressive and anxious symptoms such as apathy, irritability and social withdrawal are common. This first phase of Alzheimer’s disease can last up to four years.
Second phase: Progressive loss of capabilities
The second phase of Alzheimer’s disease is characterized by the appearance of aphaso-apraxo-agnosic syndrome. along with the appearance of retrograde amnesia. That is, the subject begins to have problems understanding and emitting language beyond anomie, as well as having severe difficulties in carrying out sequenced activities and recognizing objects, people and stimuli, in addition to beginning to have problems remembering past events ( Until now memory losses mainly refer to events that had just happened and were not retained).
The patient needs supervision and is not able to carry out instrumental activities, but can perform basic activities such as dressing or eating on his or her own. There is usually temporal-spatial disorientation, and it is not unusual for people 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 especially intense and evident. Episodic memory loss can date back to childhood. There is also semantic memory loss. The subject stops recognizing his family and loved ones and is even unable to recognize himself in an image or a mirror.
They usually have extremely severe aphasia that can end in total mutism, as well as incoordination and gait disturbances. There is a total or almost total loss of autonomy, depending on external caregivers to survive and not being capable on their own and the basic skills of daily living are lost, having total dependence on external caregivers. It is common for episodes of restlessness and personality alterations to appear.
Hyperphagia and/or hypersexuality, lack of fear in the face of aversive stimulation and episodes of anger may also appear.
Neuropsychological characteristics
The dementia caused by Alzheimer’s disease causes a series of effects on the brain that end up causing the symptoms.
In this sense highlights the progressive reduction in the level of acetylcholine in the brain one of the main brain neurotransmitters involved in neuronal communication and that influences aspects such as memory and learning. This decrease in acetylcholine levels causes progressive degradation in brain structures.
In Alzheimer’s disease, the degradation of structures begins in the temporal and parietal lobes, progressing throughout the course of the disorder towards the frontal and little by little towards the rest of the brain. Over time, neuronal density and mass are reduced, and the ventricles dilate 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 hinder synaptic processes and cause a weakening of the synapses.
Unknown causes
Research into this type of dementia has attempted to explain how and why Alzheimer’s disease arises. However, there is still no evidence as to why it appears.
At the genetic level, the participation of mutations in the APP gene, the amyloid precursor protein, is suspected, as well as in the ApoE gene, linked to the production of proteins that regulate cholesterol.
The decrease in the level of cerebral acetylcholine causes the degradation of the various structures, and pharmacological treatments are based on combating this reduction. A cortical atrophy appears that begins temporoparietally and ends up generalizing over time to the rest of the nervous system.
Risk factors
The causes of Alzheimer’s disease remain unknown to this day. However, there are a large number of risk factors that must be taken into account when carrying out prevention tasks.
One of the factors to take into account is age. Like most dementias, that caused by Alzheimer’s disease tends to appear after the age of 65, although there are cases of even earlier onset.
The educational level or, rather, the mental activity of the individual also intervenes. And the more mental exercise, the greater the resistance and strength of neuronal connections. However, this effect, although positive since it delays the progression of the disease, can make it difficult to identify the problem and its treatment.
Another of them is family history. Although Alzheimer’s disease is not usually transmitted genetically (except for a specific variant), it is true that almost half of individuals with this problem have a family member with this disorder.
Finally, the patient’s life history must also be taken into account: Apparently tobacco consumption and high-fat diets can favor its appearance. Likewise, a sedentary life with high levels of stress increases the probability of its appearance. The presence of some metabolic diseases such as diabetes or hypertension are facilitating elements of Alzheimer’s disease.
To this day, Alzheimer’s disease remains incurable, with treatment based on the prevention and delay of cognitive deterioration.
Pharmacological treatment
At a pharmacological level, different acetylcholinesterase inhibitors tend to be used. an enzyme that breaks down brain acetylcholine. In this way, acetylcholine is present in the brain for longer, prolonging its optimal functioning.
Specifically, donepezil is used as a treatment in all phases of Alzheimer’s disease, while rivastigmine and galantamine are usually prescribed in the initial stages. These medications have been shown to be able to delay the progression of the disease for about half a year.
Psychological treatment
On a psychological level, occupational therapy and cognitive stimulation are usually used. as main strategies to slow the pace 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 individuals who are diagnosed with dementia to suffer from depressive or anxious episodes. Thus, the clinician should evaluate the effect that reporting the problem has on the subject.
We must also work with the family environment, advising them regarding the process of deterioration that the patient will follow, their loss of autonomy and indicating valid strategies to face the situation.
Prevention
Taking into account that the causes of Alzheimer’s disease are still unknown and that its treatment is based on stopping or reducing the symptoms, it is necessary to take into account factors linked to the disorder in order to be able to carry out prevention tasks.
As we have said, A sedentary life is a risk factor for developing this disease. Physical exercise has been shown to be an excellent prevention mechanism, since it helps strengthen both the body and the mind, being useful in a large number of disorders.
Taking into account that other risk factors include high cholesterol, diabetes and hypertension, dietary control becomes a preventive element of great importance. It is very useful to have a rich and varied diet with little saturated fat.
Another aspect to address is the level of mental activity. Exercising the brain means strengthening the learning capacity and neural connections, so reading or learning new things (not necessarily technical theoretical knowledge) can help stop symptoms or prevent them from appearing.
Finally, one of the fundamental elements of prevention is the early detection of symptoms. Given that memory loss without the involvement of dementia is common with age, it is not uncommon for the first signs of Alzheimer’s disease to be ignored. If memory complaints are very frequent and are accompanied by other behavioral and/or other faculties alterations, it would be advisable to go to a medical center where the patient’s condition could be evaluated. We must also pay attention in cases of mild cognitive impairment, which can sometimes progress to different dementias (including that derived from Alzheimer’s disease).
