RxMed: Illness Information - ALZHEIMER'S DISEASE

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General Illness Information

Common Name:

ALZHEIMER'S DISEASE

Medical Term:

Pre-senile dementia

Description:

A brain disorder characterized by a gradual and progressive mental deterioration. A rapidly progressive form begins in adults around the ages of 36 to 45. A more gradual form, with slower development of symptoms, begins around ages 65 to 70. An estimated 5 to 10 percent of persons over 65 show some form of dementia. Dementia is a permanent or progressive decline in mental function in which memory, thinking, judgment, ability to pay attention and learn are impaired and deterioration of personality occurs. Alzheimer’s disease is the commonest cause of dementia. It affects 3 to 4 million people in the U.S.

Causes:

Damage to or loss of brain cells for unknown reasons. Genetic factors may play a role- the disease seems to run in some families and is associated with some specific gene abnormalities. Research into the genetic factors has implicated chromosome 21 as the gene responsible for the development of familial Alzheimer’s disease. Abnormality of Chromosome 21 (trisomy 21) is also responsible for Down’s syndrome. In fact patients with Down’s syndrome have a higher risk for developing Alzheimer’s disease by age 50.

Prevention:

There has been much interest recently in a herbal supplement, Ginkgo Biloba in the prevention and treatment of progression of Alzheimer's disease, and some studies appear to support this.

Signs & Symptoms

Early Stages:

Forgetfulness of recent events (loss of short-term memory)-- this is the most prominent early symptom

Increasing difficulty performing common tasks, such as accustomed work, balancing a checkbook, or maintaining a household

Personality changes, including poor judgment

Later Stages:

Difficulty performing simple tasks such as choosing clothing, problem solving
Failure to recognize familiar persons
Disinterest in personal hygiene or appearance
Difficulty feeding self
Belligerence and denial that anything is wrong
Loss of sexual and social inhibitions
Wandering away
Anxiety and insomnia

Advanced Stages:

Complete loss of memory, speech and muscle function (including bladder and bowel control), necessitating total care and supervision
Extreme belligerence and hostility, or complete docility

Risk Factors

	Family history of Alzheimer's disease
	Aging

Diagnosis & Treatment

General Measures:
Diagnosis is a matter of clinical judgment. Forgetfulness is usually the first apparent sign which, is noted by the family members or the doctor. Mental status testing is usually performed in the doctor’s office and more sophisticated neuro-psychological testing may help in making the diagnosis and help determine the degree of impairment. Because dementia may sometimes be due to a treatable cause such as thyroid disease, abnormal blood levels of electrolytes, infections, vitamin deficiencies, medication toxicity and HIV, blood work and other laboratory investigations such as CT scan, MRI, EEG and a lumbar puncture must be done. At present there are no reliable tests available to make a definite diagnosis of Alzheimer’s disease. Therefore, examining the brain at autopsy can only prove it.
	Caregivers are most important. Some of the patient's problem behavior can be reduced by repetition. Patient with memory problem may benefit from frequent, simple reminders.
	Reassurance; A brief firm chat with a family member may help quell anxiety, verbal outbursts or agitation.
	Redirection; Distract the patient who is frustrated or agitated. A short walk or other diversion can be helpful.
	If a family member has this disease, don't take their hostility personally.
	Modify the home environment for safety.
	Have the patient wear an identification bracelet or neck tag, or clip identification onto clothing.
	If you care for a family member with this disease, try to obtain help so you can get away often. Don't feel guilty about needing a respite even if the patient resents it.
	Join a support group for families of Alzheimer's victims. Use adult day care where available.
	Beware of persons offering treatments for large sums of money. No legitimate treatment currently exists.
	Psychotherapy or counseling for family members.
	Nursing home care when home care becomes impossible.

Medications:
	There is no definitive treatment for Alzheimer’s disease. However it is essential to treat the neurologic and behavioral symptoms such as agitation, insomnia and depression with appropriate medication.
	At present drug therapy is limited to two drugs which have been approved by F.D.A. They are cholinesterase inhibitors-and they presumably function by increasing the level of acetylcholine in the brain. The two drugs are Tetrahydroaminoacridine (Tacrine) and the newer agent donazepril (Aricept).
	Estrogen may be helpful in post-menopausal women. The value of vitamin E in prevention is still uncertain.
	A follow-up with your family physician is very important.

Activity:
As much as possible. As the condition progresses, all activity will eventually require supervision.

Diet:
	Studies appear to indicate that certain dietary supplements may help to improve memory and mental function. These include Ginkgo biloba, Ginseng, and gotu kola.
	Phosphatidylserine has been used in conjunction with these supplements to facilitate entry through the blood brain barrier. Feeding assistance will eventually become necessary.
	Choline and lecithin supplements are under study.

Possible Complications :
	Decreased resistance to infections, especially pneumonia and meningitis.
	Seizures and coma (rare).

Prognosis

This condition is currently considered incurable and untreatable. However, the newer medications do help in slowing down the progression of the disease in the early stages. It is usually fatal within an average of 7 to 10 years. Research into causes and treatment continues, so there is hope for eventual treatment and cure.