Alzheimer’s disease (AD) is the most common cause of dementia in the world. It is a neurodegenerative disorder characterized by exacerbation of forgetting, lost children in familiar areas, difficulty in multitasking, and problem solving. Other symptoms include increased behavioral disorders (sensitivity, social withdrawal, etc.) and ultimately mobility problems.Read again- Australian researchers say Alzheimer’s disease is likely to be the identified cause
AD is usually found in the elderly (usually after age 65). However, in patients with hereditary AD (less than 1% of the population), dementia usually develops under the age of 60. Read again- Studies show that patients affected by COVID-19 may develop dementia in the future
What leads to AD?
There is progressive dysfunction in the anatomical area involved in AD memory and behavior. This is due to the deposition of amyloid plaque (SP), which consists of amyloid beta and neurofibrillary tangles. SP deposition begins in the hippocampus, the most important structure associated with recent memory, and spreads to other brain regions as the disease progresses. Read again- The FDA approves the first drug for Alzheimer’s disease in almost 20 years, everything you need to know
Clinical features / stages of AD
A central feature of Alzheimer’s disease is recent memory loss. As the disease progresses, various other cognitive areas are involved. The disease progresses in seven stages. However, there is some overlap between them.
Stage 1 (no clinical impairment): Like other neurodegenerative diseases, this stage can precede memory loss for years if the affected individual is clinically okay without memory abnormalities.
Stage 2 (very mild cognitive decline): This mimics normal aging-related forgetting, where individuals can misplace objects and eventually find them after a search period.Most of the patient’s relatives are unaware of even this mild forgetting
Stage 3 (mild cognitive impairment): Recent memories have deteriorated, which is now apparent to relatives. They suffer from day-to-day functions (banking, money problems, etc.) and can sometimes be confused.But they can still be independent in all daily activities
Stage 4 (moderate cognitive decline): Memory gets worse when it becomes difficult to perform tasks that require multitasking. They start roaming unfamiliar places and withdraw socially. At this stage, it is expected that they will deny their illness and become increasingly dependent on the caregiver’s simple tasks.
Stage 5 (moderately severe cognitive decline): They may forget their current environment, home address / phone number, and need help for a simple task like changing clothes.You may get lost in a familiar environment
Stage 6 (severe cognitive decline): There is aggravation of behavior with hypersensitivity and hallucinations.They also experience memory loss in past events and begin to lose control of bladder / bowel function
Stage 7 (very severe cognitive decline): At this stage, most of them now lose the ability to speak, communicate, and walk around (walk around and move).
How to diagnose AD?
The diagnosis of AD is clinical and excludes other treatable entities that can cause memory abnormalities (vitamin B12 deficiency, hypothyroidism, certain infections). In most patients, MRI of the brain is done to rule out other causes of dementia (such as stroke) and to show atrophy of the structures involved in memory.
What is the treatment for AD?
There is no specific treatment to reverse or stop the progression of AD. However, drugs that can improve cognition symptomatically are available. You need to take medicine in connection with:
- Correction of vascular risk factors (diabetes / hypertension)
- Smoking cessation / alcohol
- Indulge in cognitive tasks (solving sudoku puzzles, playing board games, etc.)
- Get enough sleep
- Balanced diet and regular physical activity
Contains some medicines used for treatment
Cholinesterase inhibitors such as donepezil, rivastigmine, and galantamine. These drugs improve memory from mild to moderate, especially in the early stages of illness.
Memantine: For people with moderate to severe AD in combination with any of the above medications.
Aducanumab: Intravenous treatment for amyloid beta is beneficial for patients with early or mild AD. The rapid approval of this drug has been controversial and its usefulness is currently limited for research until more data on its clinical efficacy and safety are available.
(In the opinion of Dr. Rajesh Benny, a neurologist consultant at Fortis Hospital Mulund)
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