Alzheimer's is a progressive neurologic disorder that causes the brain to shrink (atrophy) and brain cells to die. It is the most common cause of dementia — a continuous decline in thinking, behavioral and social skills that disrupts a person's ability to function independently.
There is currently no cure, but medications and management strategies may temporarily improve symptoms and help people maximize function for as long as possible.
Symptoms
Memory loss is the key symptom. Early signs may include difficulty remembering recent events or conversations. As the disease progresses, memory impairments worsen and other symptoms develop.
1. Cognitive Changes
- Memory Loss: Repeating statements, forgetting conversations, getting lost in familiar places, and forgetting the names of family members.
- Thinking & Reasoning: Difficulty concentrating, especially with numbers (finances, bills).
- Making Judgments: Poor decision-making, such as wearing incorrect clothes for the weather or poor driving.
- Planning Tasks: Struggling with sequential steps, like cooking a meal or playing a game.
2. Behavioral & Personality Changes
Brain changes can affect moods and behaviors. Patients may experience:
- Depression and social withdrawal.
- Mood swings and irritability.
- Distrust in others (delusions that things have been stolen).
- Wandering or getting lost.
- Changes in sleeping habits.
- Loss of inhibitions.
Causes: Inside the Brain
Scientists believe Alzheimer's is caused by a combination of genetic, lifestyle, and environmental factors. The exact cause isn't fully understood, but the effect on the brain is clear: Brain cells are damaged and killed.
The Hallmarks of Alzheimer's
When doctors examine Alzheimer's brain tissue under a microscope, they see two types of abnormalities:
- Plaques (Beta-amyloid): These are clumps of protein that build up between nerve cells. They may damage and destroy brain cells by interfering with cell-to-cell communication.
- Tangles (Tau protein): Threads of protein that twist inside brain cells. These disrupt the transport system that carries nutrients to the brain cells, leading to cell death.
Risk Factors
- Age: Risk increases greatly after age 65.
- Family History: Risk is higher if a parent or sibling has the disease.
- Genetics: The APOE e4 gene increases risk, though not everyone with the gene gets the disease.
- Head Trauma: Past severe head injuries may increase future risk.
- Heart Health: Poor heart health (high blood pressure, high cholesterol, diabetes) is linked to a higher risk of dementia.
Diagnosis
There is no single test for Alzheimer's. Diagnosis involves a comprehensive assessment:
- Neurological Exam: Testing reflexes, muscle tone, sight, hearing, coordination, and balance.
- Mental Status Testing: Short tests to assess memory and thinking skills.
- Brain Imaging (MRI/CT): Used to rule out other causes (like tumors or strokes) and to check for brain shrinkage.
- PET Scans: Advanced scans can now detect the level of plaques and tangles in the brain.
Treatment & Management
While there is no cure, treatments can help manage symptoms.
1. Medications
- Cholinesterase inhibitors (Aricept, Exelon): These boost cell-to-cell communication.
- Memantine (Namenda): Slows the progression of symptoms in moderate to severe cases.
2. Creating a Safe Environment (Caregiver Tips)
Adapting the home environment is a crucial part of treatment. It allows the patient to maintain independence for longer.
- Keep keys, wallets, and phones in the same place every day.
- Remove excess furniture and throw rugs to prevent falls.
- Install sturdy handrails in bathrooms and stairways.
- Reduce the number of mirrors (images can be confusing or frightening).
- Use a whiteboard or calendar to track daily schedules.
- Program important numbers into a simple mobile phone.
3. Lifestyle
- Exercise: Regular walking can improve mood and maintain joint health.
- Nutrition: Patients may forget to eat or drink. Offer high-calorie smoothies and water frequently to prevent dehydration.
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