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Alzheimer's: causes, symptoms, treatment and prevention

Alzheimer's: causes, symptoms, treatment and prevention

February 29, 2024

Cancer, HIV / AIDS and dementias are some of the most worrisome disorders in the western population today, being some of the most frequent disorders that still do not have an effective solution or treatment.

Within the group of dementias, the best known is the dementia produced by Alzheimer's disease .

Alzheimer's: general definition

Alzheimer's disease is one of the most frequent and known neurodegenerative diseases. It is a chronic and currently irreversible disorder of unknown causes that acts producing a progressive deterioration in the mental faculties of the sufferer . Initially, it acts only at the level of the cortex, but as the deterioration progresses, it also ends up affecting the subcortical level. Insidious onset, the first lesions appear in the temporal lobe to later expand to other lobes, such as the parietal and frontal lobes.


At present, its diagnosis is considered to be totally definitive after the death of the patient and the analysis of its tissues (before the death it is considered its diagnosis is only probable), although as the neuroimaging techniques advance, a more accurate diagnosis becomes possible. The course of Alzheimer's disease causes homogenous and continuous cognitive deterioration , having an average duration of between eight and ten years.

Typical symptoms

  • To delve into the symptoms: "The first 11 symptoms of Alzheimer's disease (and its explanation)"

One of the most characteristic and known symptoms is the loss of memory, which usually occurs gradually . First of all, the recent memory is lost, so that according to the disease, it continues its course, forgetting aspects and elements that are increasingly distant in time. It also decreases the attention capacity, the judgment capacity 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 afaso-apraxo-agnósico syndrome. Said in another way throughout its deterioration the patient loses the ability to speak (it is very typical the presence of anomie or difficulty to remember the name of things), perform sequenced actions or even recognize the stimuli coming from the outside, culminating in a state of silence and immobility. The presence of falls, alterations of sleep and feeding, emotional and personality alterations 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 careless and strange behaviors and carelessness, to forget the value of things and even ends up being unable to recognize their loved ones. As the disease progresses, the subject loses its autonomy little by little, depending on the time of care and the management of external agents.


Statistically, the average age at which Alzheimer's disease begins to appear is around 65 years old, increasing its prevalence as age increases. It is considered to start early or presenile if it starts before 65, and senile or late start if it occurs after that age. The younger the age, the worse the prognosis, the faster the symptoms progress.

Deterioration process: phases of the disease

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

In addition to these phases, it should be taken into account that there may be a period of time prior to the beginning of the disorder in which the individual suffers a mild cognitive impairment (generally of amnestic type).

First phase: Start of problems

In the first moments of the disease, the patient begins to experience small memory deficits. He has difficulty remembering what he has just done or eating, as well as retaining new information (in other words, he suffers from anterograde amnesia). Another particularly typical symptom is anomie or difficulty remembering the name of things despite knowing what they are.

Judgment and the ability to solve problems are also compromised , yielding less in work and daily activities. Initially, the patient is aware of the appearance of limitations, with frequent depressive and anxious symptoms such as apathy, irritability and social withdrawal. 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 the aphaso-apraxo-agnosic syndrome , next to the appearance of retrograde amnesia.That is, the subject begins to have problems of understanding and issuing language beyond the anomie, as well as having severe difficulties to perform sequenced activities and to recognize objects, people and stimuli, as well as having problems remembering past events ( until now the memory losses refer mainly 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 get to perform basic activities such as dressing or eating on his own. There is usually a temporo-spatial disorientation, it is not strange that it is 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. The loss of episodic memory can go back to childhood. There is also loss of semantic memory. The subject stops recognizing their relatives and loved ones and it is even incapable of recognizing itself in an image or a mirror.

They usually have an extremely severe aphasia that can end in total silence, as well as incoordination and changes in gait. There is a loss of total or almost total autonomy, depending on external caregivers to survive and not being able by themselves and the basic skills of daily life are lost, having total dependence on external caregivers. Episodes of restlessness and personality alterations frequently appear.

They may also appear hyperphagia and / or hypersexuality, lack of fear of aversive stimulation and episodes of anger.

Neuropsychological characteristics

The dementia produced by Alzheimer's disease causes a series of effects in the brain that eventually cause the symptoms.

In this sense highlights the progressive reduction of acetylcholine level 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 a progressive degradation in brain structures.

In Alzheimer's disease the degradation of structures begins in the temporal and parietal lobes, to go along the course of the disorder advancing towards the frontal and little by little towards the rest of the brain. With time the density and neuronal mass is reduced, dilating the ventricles to occupy the space left by the neuronal loss.

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

Unknown causes

The investigation of this type of dementia has tried to give an explanation to how and why Alzheimer's disease arises . However, there is still no evidence of why it appears.

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

The decrease in the level of cerebral acetylcholine causes the degradation of the various structures, pharmacological treatments being based on combating said reduction. A cortical atrophy of temporoparietal onset that ends up generalizing over time to the rest of the nervous system appears.

Risk factor's

The causes of Alzheimer's disease are still unknown today. However, there are a large number of risk factors that must be taken into account when performing prevention tasks.

One of the factors to take into account is the age . Like most dementias, the one produced by Alzheimer's disease tends to appear after 65 years, although there are cases of onset even earlier.

The educational level or, better said, the mental activity of the individual also intervenes. And it is that to greater mental exercise greater resistance and strength of the neural connections. However, this effect, although it is positive given that it delays the progress of the disease, can make it difficult to identify the problem and its treatment.

Another one is the family history . Although Alzheimer's disease is not usually transmitted genetically (except for some specific variant), it is true that almost half of individuals with this problem have a family member with this disorder.

Finally, the vital history of the patient should also be taken into account: It seems that the consumption of tobacco and high-fat diets may favor their appearance. Similarly, a sedentary life with high levels of stress enhances the likelihood of occurrence. The presence of some metabolic diseases such as diabetes or hypertension are facilitating elements of Alzheimer's disease.

Treatments

Today, Alzheimer's disease remains incurable, based on the prevention and delay of cognitive decline.

Pharmacotherapy

At the pharmacological level, different inhibitors of acetylcholinesterase tend to be used , an enzyme that degrades cerebral acetylcholine.In this way, it is achieved that acetylcholine is found for a longer time in the brain, 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 around 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 fundamental 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 indicated to have dementia to experience depressive or anxious episodes. In this way, the clinician should evaluate the effect of the problem on the subject.

We must also work with the family environment, advising them in the face of the process of deterioration that the patient is going to 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 their treatment is based on slowing or reducing 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 said, 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 body and mind, being useful in a large number of disorders.

Taking into account that another of the risk factors include high cholesterol, diabetes and hypertension, the control of food becomes a preventative element of great importance. It is very useful to have a rich and varied diet with few saturated fats .

Another aspect to deal with is the level of mental activity. Exercising the brain supposes to strengthen the learning capacity and neuronal connections, so that reading or learning new things (not necessarily theoretical technical knowledge) can help to curb the symptomatology or that it does not appear.

Finally, one of the fundamental elements of prevention is the early detection of symptoms. Since memory loss is common with age without the implication of dementia, 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 alterations and / or other faculties, 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 become different dementias (including the one derived from Alzheimer's disease).

Bibliographic references:

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • Förstl, H. & Kurz, A, (1999). Clinical features of Alzheimer's disease. European Archives of Psychiatry and Clinical Neuroscience 249 (6): 288-290.
  • Santos, J.L. ; García, L.I. ; Calderón, M.A. ; Sanz, L.J .; de los Ríos, P .; Left, S .; Román, P .; Hernangómez, L .; Navas, E .; Thief, A and Álvarez-Cienfuegos, L. (2012). Clinical psychology. CEDE Preparation Manual PIR, 02. CEDE. Madrid.
  • Waring, S.C. & Rosenberg, R.N. (2008). Genome-wide association studies in Alzheimer's disease. Arch. Neurol. 65 (3): 329-34.

Early Detection and Prevention of Alzheimer's Disease Video - Brigham and Women's Hospital (February 2024).


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