Alzheimer's disease treatment
Alzheimer's is the most common form of dementia faced by people after 65. The disease manifests with deterioration of short-term memory, impaired speech and cognitive functions, and a person loses the ability to navigate the environment and take care of himself. Drug therapy helps relieve symptoms and improve the quality of a patient's life.
Alzheimer's disease is a neurodegenerative disorder that progresses slowly and gradually destroys brain cells. It is the most common type of dementia and accounts for 60-65% of all cases. The disease was named after the German neurologist Alois Alzheimer, who in 1907 first described the symptoms and neuropathological signs of the disease. It affects the memory and cognitive skills, which leads to clouding of consciousness, changes in mood and disorientation in space and time.
The brain consists of many nerve cells that link. In Alzheimer's, the connections between these cells are lost. It is because proteins accumulate in brain tissues and form abnormal structures called "plaques" and "tangles". First, a particular part of the brain responsible for instant memory - the hippocampus - is affected. The brain also contains essential chemicals that help transmit impulses between cells. Ill people have fewer "chemical messengers" in their brains, so signals are not sent correctly.
In some individuals, memory problems are not the first symptoms of the disorder. It is atypical Alzheimer's disease because the first part of the brain to be affected is not the hippocampus. It is not typical for somebody diagnosed over 65 but for younger patients. Atypical forms of Alzheimer's include:
- Posterior cortical atrophy develops when areas in the back of the brain are affected. These areas process signals from the human eye and helps with spatial perception. It means that early symptoms are often problems recognising objects or reading, even if the person's eyes are healthy;
- Аphasia occurs when areas in the left part of the brain are affected, which are responsible for speech. A person may have problems finding the right word or long pauses during a conversation;
- A frontal variant develops when the area in the front part of the brain is affected. Symptoms include problems with planning and decision-making. A person may also behave in socially unacceptable ways.
Dementia occurs in 5% of the population over 60. In people aged 85 and over, the illness manifests in 30-40%. The frequency of Alzheimer's disease also depends on gender. Thus, among residents of European countries, this diagnosis is more common in women than in men.
Why does Alzheimer's occur?
Currently, the question remains open. Several theories try to explain the development of the disease. Possible reasons include:
- Hereditary predisposition;
- Oxygen deficiency;
- Deposition of beta-amyloid in brain cells;
- Decrease in the level of acetylcholine;
- Chromosomal disorders;
- Specific reactions of immunity;
- Exposure to toxic substances;
- Injuries (psychological, craniocerebral);
There is also a suggestion that the condition is contagious at the protein level. Many researchers include slow depression, high blood pressure, low intelligence, and diabetes as risk factors for the disorder.
Typical signs of Alzheimer's
Initial signs are usually mild, but as more brain cells are damaged over time, they become more severe and begin interfering with a person's daily life.
For most patients, the first symptoms of Alzheimer's are memory problems, particularly difficulty remembering recent events and learning new information. It is because the hippocampus is usually affected in the condition's early stages. It is essential for immediate memory. However, recollecting events that happened long ago usually does not change in the early stages. As brain damage progresses, memory problems affect daily life more and more:
- There is a loss of the location of objects at the place of residence;
- Forget the names of friends or the right word in a conversation;
- A person can get lost in a familiar place;
- Meetings and significant dates are forgotten.
In addition to memory problems, people may also develop other issues with thinking, language, and perception, such as:
- Repetition of the phrases and facts and increased attention to the conversation due to fear of not catching the meaning;
- Problems with estimating the distance to objects and recognising the shape of things;
- Going up or down stairs or parking a car also becomes much more difficult;
- Concentration, planning or organisation problems. It is hard for patients to make decisions, solve problems or complete a series of tasks (for example, preparing a meal);
- Disorientation in place or time.
As Alzheimer's disease progresses, memory loss, speech, thinking, and orientation troubles become more pronounced. Some people begin to believe facts that are not true, and sometimes hallucinations occur. In some cases, the patient has sleep disorders and aggressive behaviour. In the advanced stages of dementia, an individual becomes much less active and experiences difficulties in essential everyday activities (eating, cooking, and self-care).
What tests are carried out to diagnose Alzheimer's?
Only an experienced neurologist can properly diagnose Alzheimer's disease. Various tests and examinations must be carried out to ensure a reliable diagnosis. Family is often the first to notice cognitive changes in their loved ones, such as loss of memory, orientation and language. Relatives also recognize emerging deficits but repeatedly try to cover them up.
The first step includes consultation with the neurologist, blood tests, and taking stock of physical illnesses and medication history. The physical examination provides essential diagnostic information and paves the way for any follow-up tests that may be necessary. In laboratory diagnostics, blood and urine are examined for various values. It gives further indications of the physical state of health.
Diagnosis is followed by a psychological test, which provides information on memory performance and the degree of severity. Finally, a doctor uses memory tests (Mini-Mental Status Test - MMST, dementia watch test, and dementia detection test - DemTect) to determine whether and to what extent the ability to think and remember is already restricted.
Imaging procedures such as brain CT and MRI scans are primarily used to rule out other conditions or to identify changes typical of Alzheimer's. Other methods, such as positron emission tomography (PET) and single photon emission computed tomography (SPECT), establish metabolic or protein changes in the brain. However, these tests are usually only necessary in unique forms of dementia and are therefore not part of routine diagnostics.
A genetic test can be helpful if there are signs of hereditary Alzheimer's disease. Healthy relatives over 18 can be tested if a corresponding gene mutation has been detected in sick family members. The accuracy with which a physician can predict an illness is almost 100%.
The latest treatment for Alzheimer's patients
According to the current state of science, specialists cannot cure Alzheimer's completely. However, early therapy may help slow down the decline in mental performance and promote existing skills. The main treatment methods are medications. Drug therapy improves functional capabilities and alleviates cognitive and behavioural symptoms.
Glutamate is a messenger substance, and there is too much of it in the affected patients. As a result, it damages nerve cells and causes them to die. The medication memantine is intended to prevent this.
In the course of the disease, the nerve cells that work with the messenger substance acetylcholine die in particular. It is involved in learning processes and attention. If there is a lack of acetylcholine, electrical impulses between nerve cells are no longer appropriately transmitted. So-called acetylcholinesterase inhibitors ensure that the messenger substance in the brain is available again. It can also improve the forwarding of information.
Aduhelm is the first drug approved by the FDA in 18 years. However, according to published results, this medicine can slow the condition's progression rather than alleviate its symptoms. Aduhelm is currently available to residents of the United States - and there are regulations in place to allow drugs to be imported into countries where they are not now approved.
For the treatment of neurodegenerative diseases, doctors use multipotent stem cells. The main goal is to slow the progression of the illness. As a result, the neurologist can stabilise the condition and cognitive functions.
If Alzheimer's has already progressed significantly, the main concern is to treat typical symptoms with various psychotropic drugs:
- Antidepressants such as citalopram and sertraline have an activating effect, are well tolerated and have few interactions with other medications.
- Modern antipsychotics (neuroleptics) are used for behavioural disorders, restlessness, aggression and delusions.
In addition to drug therapy for Alzheimer's disease, intensive care by relatives or therapeutic facilities is essential. In addition to daycare, special facilities also offer individual and group therapies that promote remaining skills and even provide therapeutic support for relatives.
What is the prognosis for Alzheimer's?
Life expectancy depends on the stage of diagnosis and the treatment used in this case. For example, when the disease occurs before the age of 60, the patient can live from 15 to 20 years, but an older age leads to the fact that after the age of 70, the expected life expectancy is reduced to 10, and after 85 - to 5 years. Also, it is noted that life expectancy is higher in female patients.
Suppose Alzheimer's disease is detected at an early stage, the chances of successfully slowing the destruction of the brain increase. In this case, complex therapy and the attention of relatives will ensure a significant increase in life expectancy - up to 20 years or more. That is why it is so important not to ignore even minor deviations in behaviour.
How long do patients live with Alzheimer's?
The disease progression and life expectancy of someone with Alzheimer's disease vary. Still, patients live 8-10 years after the first symptoms appear. So it is also essential how old a person was when he got sick.
Does Alzheimer's run in families?
More than 99% of all Alzheimer's cases are age-related, and less than 1% are inherited. Three genes are responsible for the sporadic hereditary form. If one of these genes have got mutations, the disease will break out in any case.
What kind of doctor do you need for Alzheimer's?
To diagnose Alzheimer's dementia, a primary doctor or geriatrician (a doctor trained to treat older adults) will review symptoms and medical history. However, neurologists (doctors who specialise in disorders of the brain and nervous system) are often consulted to diagnose dementia.
What is the breakthrough for Alzheimer's?
There is no way to cure Alzheimer's dementia, but drug treatment significantly improves the condition of patients and extends their life expectancy. Aduhelm and stem cell therapy are currently the most advanced achievements in the search for effective treatment. They are already showing positive results.
Can Alzheimer's go away?
Alzheimer's disease is progressive. Doctors can slow down the progression or stop it in some cases. However, it means that gradually, over time, more and more brain areas are damaged. As this happens, more symptoms appear and become more intense.
Where can I get Alzheimer's disease treatment?
What are the best clinics for Alzheimer's disease treatment?
Who are the best doctors for Alzheimer's disease?
Prof. Dr. med. Christian E. Elger from Beta Clinic Bonn
Prof. Dr. med. Bernhard Hemmer from University Hospital rechts der Isar Munich
PD. Dr. med. Florian Masuhr from Academic Hospital Bundeswehr Berlin
PD. Dr. med. Axel Lipp from Park Clinic Weissensee Berlin
Dr. med. Gerhard Siebenhuner from Centre of Advanced Medicine Frankfurt am Main