Alzheimer’s disease (AD) is the most common cause of dementia among older people. It is an irreversible brain disease that destroys brain cells and slowly causes decline in cognitive function like thinking, memory and reasoning as well as behavioural activities. Patients are unable to carry out even the simplest tasks or activities of daily living. Symptoms first appear after 60 years of age but can happen much earlier in some genetically predisposed individuals. According to latest literature, there are 5.3 million Americans suffering with this disease. Frequency of AD reaches 20-40 per cent of the population over the age of 85. Estimated annual cost of treating advance cases of AD can be more than $50,000.
At very early stages, the patient experiences problems with memory, word finding, visual/spatial and impaired reasoning. Later they will start getting lost, trouble handling money, paying bills, repeating questions, taking longer to complete daily tasks, using poor judgment, having mood and personality changes. In moderate cases, memories and confusion grows worse. They begin to have trouble recognising family and friends. In severe cases, they will become completely dependent on others for their care. At the end, they become bedridden as their body shuts down.
Causes of AD are a complex series of events, including genetic, environmental and lifestyle factors. Risk factors for AD include old age, positive family history, heart disease, stroke, high blood pressure, diabetes and obesity. Nutritional diet, physical activity, social engagement and mentally stimulating pursuits can all help people stay healthy as they age. New research is underway to test if they will also reduce the risk of cognitive decline of AD.
Definite diagnosis of AD is made on autopsy after death. Diagnosis is also based on symptoms including problem with memory, problem solving, and writing, language test along with CT scan or MRI of brain. Thyroid disease, vitamin deficiencies, brain tumour, drug, medication effect, infection and depression must be ruled out before making definite diagnosis. A neurologist can be consulted for proper testing before making the diagnosis.
AD is a very complex entity for which there is no cure. The main goal of treatment is to improve the patient’s quality of life. There are medications available to delay the onset of cognitive decline. The family must understand what treatment can do and be realistic about what to expect. The demand of the day to day care, changing family roles, and a difficult discussion about nursing home placement can be hard to handle. It takes heavy emotional toll on family members and care givers. There is worldwide effort underway to find better ways to treat the disease, delay its onset and prevent it from developing into full blown disease.
[Anis Ansari, MD, FASN, is Board Certified in Internal Medicine and Nephrology, and is based in Clinton, Iowa, USA]