Page 2
www.alzheimerscharity.org
About Alzheimers
(To help others, please send us useful information for this page.
E Mail info@compassvision.co.uk)
Alzheimer's disease (AD) is a progressive, neurodegenerative disease characterized by memory loss, language deterioration, impaired visuospatial skills, poor judgment, indifferent attitude, but preserved motor function. Mild and moderate forms of the disease 450,000 in the UK. By 2025 it is estimated that 22 million people worldwide will be affected. Alzheimer's disease usually begins after age 65, however, its onset may occur as early as age 40, appearing first as memory decline and, over several years, destroying cognition, personality, and ability to function. Confusion and restlessness may also occur. The type, severity, sequence, and progression of mental changes vary widely. Areas of the brain that influence short term memory tend to be affected first. The early symptoms of AD, which include forgetfulness and loss of concentration, can be missed easily because they resemble natural signs of aging. Similar symptoms can also result from fatigue, grief, depression, illness, vision or hearing loss, the use of alcohol or certain medications, or simply the burden of too many details to remember at once. There is no cure for AD and no way to slow the progression of the disease. For some people in the early or middle stages of the disease, medication such as donepezil, tacrine and rivastigamine may alleviate some cognitive symptoms. A new drug called Reminyl, based on an extract from the daffodil called galantamine. Trials indicate a step forward in effectiveness over existing drugs. Also, some medications may help control behavioral symptoms such as sleeplessness, agitation, wandering, anxiety, and depression. These treatments are aimed at making the patient more comfortable. AD is a progressive disease. The course of the disease varies from person to person. Some people have the disease only for the last 5 years of life, while others may have it for as many as 20 years. The most common cause of death in AD patients is infection. The NINDS conducts and supports research on neurodegenerative and dementing disorders, including AD. The goals of this research are to improve the diagnosis of AD and to find ways to treat and prevent the disorder. The National Institute on Aging and the National Institute of Mental Health also support research related to AD. WHAT IS A DEMENTIA? The term dementia (sometimes referred to as senility) is used to describe a gradual deterioration of cognition (thinking abilities) and behaviour to a point that interferes with customary daily living activities. "Customary daily living activities" could include working at one's usual occupation, balancing the chequebook, keeping house, driving the car, and participating in social activities. Contrary to popular belief, dementia is not a normal outcome of ageing, but is caused by diseases that affect the brain. Dementia can influence all aspects of mind and behaviour, including memory, judgement, language, concentration, visual perception, temperament, and social interactions. SYMPTOMS OF DEMENTIA Symptoms that signal the onset of dementia are usually subtle and may not be noticeable for a number of years. In fact, earlier signs usually are identified in retrospect, and often by someone other than the patient. Most people think of memory loss as the central symptom in dementia. While most dementias affect memory, some forms of dementia do not initially involve memory loss. Other areas that may be affected include language, perceptual skills, reasoning, and personality. This is especially true in individuals whose symptoms begin before age 65. TEN WARNING SYMPTOMS of Alzheimer's disease or dementia. Memory Loss That Affects Job Skills It's normal to occasionally forget assignments, colleagues' names, or a business associate's telephone number and remember them later. Those with a dementia, such as Alzheimer's disease, may forget things more often and not remember them later. Difficulty Performing Familiar Tasks Busy people can be so distracted from time to time that they may leave the carrots on the stove and only remember to serve them at the end of the meal. People with Alzheimer's disease could prepare a meal and not only forget to serve it but also forget they made it. Problems with Language Everyone has trouble finding the right word sometimes, but a person with Alzheimer's disease may forget simple words or substitute inappropriate words, making his or her sentence incomprehensible. Disorientation of Time and Place It's normal to forget the day of the week or your destination for a moment. But people with Alzheimer's disease can become lost on their own street, not knowing where they are, how they got there or how to get back home. Poor or Impaired Judgement People can become so immersed in an activity that they temporarily forget the child they're watching. People with Alzheimer's disease could forget entirely the child under their care. They also may dress inappropriately, wearing several shirts or blouses. Problems with Abstract Thinking Balancing a chequebook may be disconcerting when the task is more complicated than usual. Someone with Alzheimer's disease could forget completely what the numbers are and what needs to be done with them. Misplacing Things Anyone can temporarily misplace a wallet or keys. A person with Alzheimer's disease may put things in inappropriate places: an iron in the freezer, or a wristwatch in the sugar bowl. Changes in Mood or Behaviour Everyone becomes sad or moody occasionally. Someone with Alzheimer's disease can exhibit rapid mood swings (from calm to tears to anger) for no apparent reason. Changes in Personality People's personalities ordinarily change somewhat with age. But a person with Alzheimer's disease can show drastic personality changes, becoming extremely confused, suspicious, or fearful. Loss of Initiative It's normal to tire of housework, business activities, or social obligations, but most people regain their initiative. The person with Alzheimer's disease may become very passive and require cues and prompting to become involved. MAKING A DIAGNOSIS The absolute diagnosis of Alzheimer's disease can only be made at autopsy. However, physicians at specialised centres can diagnose Alzheimer's disease with 90 percent certainty based on clinical information. To make the diagnosis the following may need to be conducted: A medical history and neurological exam Neuropsychological testing Neuropsychological testing involves a careful analysis of a person's memory, problem solving, language, attention, and visuospatial ability. Basic blood tests Blood tests may be used to help exclude other causes of memory difficulties. For example, a person with a thyroid disorder or a vitamin deficiency may have problems with his or her memory. Brain scans A brain scan such as an MRI or a CT scan may need to be done in certain patients to detect brain tumours or strokes. These disorders may cause memory problems. WHO GETS ALZHEIMER'S DISEASE? The two main categories of Alzheimer's disease are familial and sporadic. Familial Alzheimer's disease refers to a genetic form of the disease that is transmitted from one generation to the next. Only 5 percent of all cases of Alzheimer's disease have been associated with a genetic component. These individuals come from families in which as many as half of the members develop Alzheimer's disease. Fortunately, this form of the disorder is rare. The remaining 95 percent of Alzheimer's disease cases are sporadic, or randomly occurring in the population. Particular dietary habits, professional occupations, or personality types do not seem to lead to the development of Alzheimer's disease. A variety of "risk factors" have been identified in individuals diagnosed with probable AD (PRAD). In fact, it is quite common to pick up a newspaper or to turn on the TV and hear about the newest "risk factor" that has been identified. While some of these factors may turn out to be useful, it is important to remember that much of the research that has been done in this area is retrospective research. This means that the research is conducted by comparing a group of patients diagnosed with PRAD with a group of healthy age-matched adults. These types of analyses provide information about the number of individuals diagnosed with PRAD who have a certain characteristic compared with the healthy individuals. While these results are useful in directing future research studies, they do not provide information about cause and effect. What is needed is a prospective study in which large numbers of individuals are followed from an early age to the age at which PRAD develops. TREATMENTS FOR ALZHEIMER'S DISEASE Many treatments are being evaluated, but as yet, there is no cure. Some research is focused on attempts to increase the levels of certain brain chemicals thought to be disrupted in Alzheimer's disease. Cognex (generic name, tacrine) and Aricept (generic name, donepezil) are the only approved medications at present. A variety of other medications are being tested nation-wide. Medications are available to help control the behavioural symptoms that are associated with Alzheimer's disease such as aggression, sleeplessness, wandering, and anxiety. Treating these behavioural symptoms makes it easier to care for the patient at home. Terminology One of the things you may find confusing is staying current with new medical "language." Listed below are some common terms you may hear. Behavioural Neurologist Neuropsychologist Psychiatrist Clinical Psychologist Geriatrician Clinical Social Worker Brain CT (Computed Tomography) Scan Brain MRI (Magnetic Resonance Imaging) Scan EEG (Electroencephalogram) PET (Positron Emission Tomography) Scan SPECT (Single Photon Emission Computed Tomography) Scan Blood Tests Behavioural Neurologist--A physician (MD) who specialises in the diagnosis and treatment of behavioural and memory disorders that are due to brain disease. A typical neurological evaluation takes about 1 to 2 hours and involves testing for sensory and motor abnormalities as well as a brief review of mental functions (referred to as a "mental status" examination). The neurologist may prescribe medications to treat the memory disorder and/or troublesome behavioural symptoms. Neuropsychologist-- An individual who holds a PhD in clinical psychology or a related discipline and specialises in the evaluation and management of brain dysfunction. A typical neuropsychological evaluation takes between 3 to 6 hours and consists of various types of tests that assess language, visual-perceptual skills, memory, attention, problem solving, and reasoning. In-patients with dementia, especially in the early stages, the neuropsychological tests may be the only means of detecting abnormalities and making a diagnosis. Psychiatrist-- A physician (MD) who specialises in the diagnosis and medical treatment of psychiatric disorders such as depression, anxiety, and schizophrenia. Psychiatrists decide whether medications (such as antidepressant, antianxiety) would be helpful. They regularly monitor patients to ensure that the medications are working properly. Psychiatrists may also provide psychotherapy or work concurrently with a psychologist who is responsible for providing therapy or counselling to the patient. Clinical Psychologist-- A psychologist (PhD) who provides individual or group therapy to people suffering from psychiatric disorders. Psychologists are not medical doctors and do not prescribe medication. They see patients in therapy and provide assistance with coping and adjustment. Depending on the individual and the issues being addressed in therapy, the amount of time a person spends in therapy could be as short as one or two sessions or as long as several years. It is not uncommon for caregivers to talk with a psychologist or social worker about the difficulties involved in coping with a family member who has dementia. Caregivers may themselves require psychiatric intervention if they develop depression in response to their burdens. Geriatrician-- A physician (MD) who specialises in the medical care and treatment of older adult patients. A Geriatrician has additional training in disorders and conditions prevalent in older adults. Clinical Social Worker-- An individual who has specialised training in identifying and accessing community resources. This may include assisting the family with adult day-care placement or arranging for in-home caregiving help. Some social workers also provide individual and/or group counselling sessions to assist patients and family members in managing and coping with the dementia. Brain CT (Computed Tomography) Scan-- This is a 3-dimensional picture of the anatomy of the brain that is obtained by taking multiple X rays through the head and reconstructing the image of the brain using a computer. CT scans are used in-patients with dementia to make sure that stroke, tumour, or hydrocephalus are not causing the dementia. In the early stages of Alzheimer's disease, the CT scan may look normal because the changes occur at a microscopic level. However, in later stages, one of the memory centres of the brain (known as the "hippocampus") may show atrophy. Sometimes a contrast agent or dye is injected into a vein in the arm before the CT scan to obtain a more detailed picture of the brain's anatomy. Brain MRI (Magnetic Resonance Imaging) Scan-- This method uses a strong magnetic field and radio frequency waves, rather than X rays, to provide pictures of the structure of the brain. MRI offers the advantage of a lack of exposure to radiation, and provides a more detailed picture of brain structures than does CT. MRI is superior to CT for diagnosing some conditions (such as multiple sclerosis). However, like the CT scan, the MRI may look completely normal in the early stages of a dementia. In-patients with Probable Alzheimer's disease (PRAD) and other dementias, especially in the early stages, the CT or MRI may be normal. This only means that there is no evidence of a tumour, stroke, or other structural abnormality that could cause the dementia. It does not mean that the brain is normal. The abnormalities of Alzheimer's disease are mostly at the microscopic level and are not detectable by these tests in the initial stages of the disease. A "NORMAL" CT OR MRI DOES NOT MEAN THAT THE BRAIN IS NORMAL IN THE PATIENT WITH DEMENTIA. EEG (Electroencephalogram)-- A procedure that measures the amount and type of electrical activity in the brain from the surface of the scalp. EEG is used in the evaluation of suspected seizure disorders or altered states of consciousness (such as coma). In PRAD, the EEG is usually normal, especially in the early stages. PET (Positron Emission Tomography) Scan-- A technique used to provide quantitative information about brain function rather than structure. Measurements of glucose metabolism or blood flow reflect physiological activity in the brain. PET is not widely used in clinical practice because of the high cost and lack of availability (See Figure 4). However, research studies have shown that Alzheimer's disease is associated with hypometabolism (reduced activity) in some regions of the brain. SPECT (Single Photon Emission Computed Tomography) Scan-- A procedure that measures blood flow in different areas of the brain. SPECT is less expensive and more widely available than PET and is used more often in clinical settings. SPECT studies have also shown blood flow abnormalities in parts of the brains of patients with Alzheimer's disease. Neither PET nor SPECT is a routine diagnostic test for the evaluation of Alzheimer's disease. Blood Tests-- A series of blood tests is routinely done to look for abnormalities associated with causes of dementia other than Alzheimer's disease. Tests of electrolyte balance, thyroid function, liver function, syphilis, vitamin deficiencies, and auto-immune disorders may be ordered by the physician since some causes of dementia may be treatable or reversible. |