Alzheimer disease, each time I give this diagnosis to one of my patients, I feel like I am giving them a death sentence. I am sorry sir, you will progressively forget everything, everything you do, everything you have done, all the ones you have loved and this feels horrible.
Many people as they get older may notice several changes in memory and thinking abilities. At first these changes may be so subtle that they are easy to explain away as normal aging and they may be. However, it’s also possible they are the early symptoms of Alzheimer’s disease.
So, in this article I will try to cover up everything known till now about Alzheimer disease.
Over a century ago, in the year 1901 a woman called Auguste was taken to a medical asylum in Frankfurt. Auguste was delusional and couldn’t remember even the most basic details of her life. Her doctor called Alois. Alois didn’t know how to help Auguste but he watched over her until, sadly, she passed away in 1906. After she died Alois performed an autopsy and found strange plaques and tangles in Auguste’s brain, the types which he had never seen before.
Now here’s the even most striking thing, if Auguste had instead been alive today, even we could offer her no more help than Alois was able to 119 years ago. Alois was Dr. Alois Alzheimer and Auguste Deter was the first patient to be diagnosed with what we now call Alzheimer’s disease.
WHAT IS ALZHEIMER DISEASE?
Alzheimer’s disease is characterized by an episodic memory loss. It’s like forgetting episodes of your life, the recent events you just lived. Alzheimer’s disease is the most common form of dementia found among older people. Dementia is a brain disorder that seriously affects a person’s ability to carry out daily activities. Alzheimer’s disease begins slowly. It first involves the parts of the brain that can control thought, memory, and language.
People with Alzheimer’s may have trouble remembering things that happened recently or names of the people they know. Over time symptoms gets worse. People may not recognize their family members or may have trouble speaking, reading or writing. They may forget how to brush their teeth or comb their hair. Later on, they may become anxious, aggressive and wander away from home. Eventually they require total care. I hope you got an idea about Alzheimer’s now let’s see detail aspect of this condition.
CAUSES OF ALZHEIMER
We know that brain is made up of neurons and these are interconnected to form a vast network. These connections are known as synapses that enable the transmission of information from one neuron to another. In Alzheimer disease 10-15 years before the appearance of the symptoms two main lesions form in the brain senile plaques composed of amyloid beta protein and neurofibrillary tangles composed of tau protein.
Amyloid Precursor is a protein present in the fatty membrane surrounding nerve cells (Neurons). Amyloid precursor protein is just like any other protein it gets used, broken down and recycled. Normally it gets chopped out by an enzyme called alpha-secretase and gamma-secretase. This chopped up peptide is soluble and goes away and everything is normal. The problem arises when instead of alpha – secretase another enzyme which is beta – secretase accompanies gamma – secretase then the resulting sliced out is beta amyloid monomer.
Beta amyloid monomer is non soluble, sticky and have a tendency to clump together with another beta amyloid monomer. That clumping is what forms the things known as beta amyloid plaques or senile plaques. These plaques can potentially get between the neuron which can get in the way of neuron to neuron signaling. These clumps block signaling and therefore communication between cells are also seem to trigger immune response that causes the destruction of disabled nerve cells.
When a neuron communicates with another neuron, a signal goes from the body known as soma to the synapse to transfer the information. The signal passes through the skeleton of the neuron composed of microtubules. These microtubules are stabilized normally by tau protein. In Alzheimer disease tau protein becomes defective and detaches from the microtubules. Thus, the skeleton of the neurons dissociates as it is no longer maintained. Defective tau protein then assembles to form filaments in the neuron. Without the skeleton neurons degenerate and connection between the neurons are lost. The abnormal accumulation of tau filaments in the neuron create neurofibrillary tangles, obstructing nutrients from reaching the nerve cell and leading to death of neurons.
HOW DOES NEUROBRILLARY TANGLES AND SENILE PLAQUES SPREAD THROUGH OUT BRAIN?
Neurofibrillary tangles and senile plaques do not follow the same pathway in the brain overtime. Neurofibrillary tangles first developed in the region called hippocampus. The hippocampus controls memory and navigation. So, forgetfulness and getting lost are usually some of the first symptoms of Alzheimer disease and then reach the whole brain following a centrifugal movement. The process causes a trophy which engenders global dysfunction. Neurofibrillary tangles progression does correspond with the symptoms of the disease.
Senile plaques develop differently, they are initially observed in the cortex secondly in the hippocampus and then the senile plaques reach the whole brain following a centripetal movement. Their progression doesn’t correspond to the symptoms of the disease.
STAGES AND SYMPTOMS OF ALZHEIMER DISEASE
There are no clear cut or well-defined stages because it’s a gradual disease its actually difficult to classify the progression. Not all the patients may experience the same progression and some may deviate from the expected duration with each stage.
Your memory and cognitive abilities appear normal especially to everybody else. If there are any impairments, they might only be slightly apparent to the patient themselves.
You will notice very mild cognitive decline in this stage. So, maybe the patient may face trouble remembering recent events or information but it could be more subtle thing like forgetting a word or misplacing things. At this stage these lapses and changes in thinking aren’t usually detected by friends, family or even medical personnel, especially considering half of all people over 65 begin noticing problems with concentration and word recall just as normal consequence of aging.
At this stage there is a sign of early confusion and mild cognitive impairment. At this point, subtle difficulties can start to impact their daily life. The patient might consciously or even subconsciously try to hide these issues. They might have trouble retrying words, remembering what just said or read and planning and organizing. It could still be difficult to diagnose Alzheimer at this early stage.
This stage is known as mild Alzheimer disease. This stage lasts for about 2 years and during these 2 years, things like financials and math start to become very challenging. And ability to remember recent events and what was just learned becomes increasingly difficult. The patient might have trouble carrying out tasks like cooking or driving. But the patients are still usually unable to recognize. The diagnosis at this stage is usually accurate.
This stage is known as moderate Alzheimer or early stage of dementia. In this stage cognitive decline starts to become more drastic and the patient requires assistance. They might face problem remembering address, place, time. Decision and judgment skills are affected. This stage can last for about 1.5 years.
This stage is considered as moderately sever. In this stage there is a significantly lack of awareness of present events and the inability to remember the past. They will likely need help in doing basic things like eating or getting dressed. The patient will likely be unable to remember or recall names of their family members but will likely know that they are familiar. This stage lasts about 2.5 years.
In this final stage speech becomes severely limited and we see a serious decline in basic abilities. Even movement abilities begin to be affected. So, eating, walking, sitting or even standing up all starts to fade. At this stage they require a full-time assistance to carry out their daily care. At this stage they are more susceptible to diseases like pneumonia, death, etc. This stage may last for 1-2 years
Since 1901, medicine has advanced greatly we have discovered antibiotics and vaccines to protect us from infections, many treatments for cancer, antiretrovirals for HIV, statins for heart disease and much more. But we have made essentially no progress at all in treating Alzheimer disease. So, death is assured in Alzheimer disease. Researchers are still trying to understand what exactly triggers but it likely to be a mix of age, genetics and other factors.
Studies suggest that early diagnosis and intervention could potentially slow the course of Alzheimer’s disease and may help protect the brain from further injury.
One temporary treatment is help reduce the breakdown of acetylcholine an important chemical messenger in the brain, which is decreased in Alzheimer’s patient due to the death of the neurons which usually produce it.
More than 5.8 million Americans now have Alzheimer’s disease. By 2050, nearly 14 million (13.8 million) Americans over age 65 could be living with the disease, unless scientists develop new approaches to prevent or cure it. Worldwide, at least 50 million people are believed to be living with Alzheimer’s disease or other dementias. More than 1 million cases are found in India. Every 65 seconds, someone in America develops Alzheimer’s. By mid-century, someone in America will develop the disease every 33 seconds.
The future of Alzheimer disease is not only in the hands of doctors and scientist but it’s also determined by you. Maintain a healthy lifestyle, eat nutritious food, be active, try playing mind games like chess, exercise, include yoga and meditation in your day to day life. By doing these stuffs you can reduce your risk of getting Alzheimer disease. Pranayama – 8 Effective techniques for beginners
So, this was all about Alzheimer. For more such articles you can visit medicoved.com
Author : Dr. Easminara Shaikh