Alzheimer's Disease - Causes, Symptoms And Treatment
Also known as primary degenerative dementia, Alzheimer's disease accounts for over half of all dementia's. An estimated 5% of people over age 65 have a severe form of this disease, and 12% suffer from mild to moderate dementia. Because this is a primary progressive dementia, the prognosis for a patient with this disease is poor.
CausesAlzheimer's disease is thought to be related to several causal factors. They include neurochemical factors, such as deficiencies in acetylcholine (a neurotransmitter), somatostatin, substance P, and norepinephrine; environmental factors, such as aluminum and manganese; viral factors, such as slow-growing central nervous system viruses; trauma; and genetic immunologic factors. The brain tissue of patients with Alzheimer's disease has three hallmark features: neurofibrillary tangles, neuritic plaques, and granulovascular degeneration.
Signs and symptomsOnset is insidious. Initially, the patient experiences almost imperceptible changes, such as forgetfulness, recent memory loss, difficulty learning and remembering new information, deterioration in personal hygiene and appearance, and an inability to concentrate. Gradually, tasks that require abstract thinking and activities that require judgment become more difficult. Progressive and severe deterioration in memory, language, and motor function results in a loss of coordination and an inability to write or speak. Personality changes (restlessness, irritability) and nocturnal awakenings are common. Eventually, the patient becomes disoriented, and emotional liability and physical and intellectual disability progress. The patient becomes very susceptible to infection and accidents. Secondary to loss of the cough reflex, pulmonary diseases such as pneumonia may result in death.
Early diagnosis of Alzheimer's disease is difficult because the patient's signs and symptoms are subtle. A positive diagnosis is based on an accurate history from a reliable family member, mental status and neurologic examinations, and psychometric testing.
A positron emission tomography scan measures the metabolic activity of the cerebral cortex and may help in reaching an early diagnosis. An EEG and a computed tomography scan may help in later diagnosis. Currently, the disease is diagnosed by exclusion: Various tests are performed to rule out other disorders. It can't be confirmed until death, when an autopsy reveals pathologic findings.
CLINICAL TIP Many researchers believe that the aluminum and silicon found in neurofibrillary tangles and neuritic plaques occurs as a result of damage and isn't a cause.
TreatmentCerebral vasodilators, such as ergoloid mesylates, isoxsuprine, and cyclandelate, are prescribed to enhance the brain's circulation; hyperbaric oxygen, to increase oxygenation to the brain; psychostimulators such as methylphenidate, to enhance the patient's mood; and antidepressants, if depression seems to exacerbate the patient's dementia. Tacrine, a centrally acting anticholinesterase agent, is given to treat memory deficits. Most drug therapies currently being used are experimental. These include choline salts, lecithin, physostigmine, deanol, enkephalins, and naloxone, which may slow the disease process. Another approach to treatment includes avoiding the use of antacids containing aluminum, aluminum cooking utensils, and aluminum-containing deodorants to help decrease aluminum intake.
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