Alzheimer's disease

What is Alzheimer's disease?

Alzheimer's disease is a progressive dementia or decline in intellectual and social abilities that affect daily activities. It is characterized by disturbances in problem-solving abilities, personality alterations, forgetfulness, emotional instability, apathy, and loss of recent and remote memory. Alzheimer's disease, the most common form of dementia, is due to a degeneration of brain cells. The cause of this degeneration is unknown, and no effective treatment exists. The symptoms of the disease are progressive, but the rate of degeneration varies from person to person. Individuals may eventually die of pneumonia or other infection.

Alzheimer's disease occurs in approximately four percent of persons 65 to 74 years old, ten percent of those 75 to 84 years, and up to twenty percent or more of those 85 years or older. It affects both men and women. The disease is extremely rare in young people and uncommon in middle age. Individuals with Down's syndrome have a higher incidence of Alzheimer's disease.

How is Alzheimer's disease diagnosed?

• History: Progressive memory loss is usually the initial symptom reported. Speech becomes halting with groping for words. Comprehension is less quick, errors in calculation become frequent, and the individual may become easily disoriented or lost. The individual exhibits a slow disintegration of personality, judgment, and social graces. Other symptoms usually include increasing irritability, anxiety, depression, confusion, and restlessness. Because an individual is often unaware of the disability, the individual's history, as told by family and friends, becomes a key factor in the diagnostic process.
• Physical exam: Depending upon how advanced the disease is, physical examination can confirm some of the reported symptoms. Gait is usually normal until late in the course of the disease. Testing of reflexes, sensation, hearing, visual fields, and ocular movements also reveal normal responses in the early stages of disease.
• Tests: There is no single test that can be used to diagnose this disease. CT and MRI scans reveal a greater degree of brain cell degeneration (cerebral atrophy) than expected for age. An electro-encephalogram (EEG), measuring the electrical activity of the brain, shows a diffuse slowing. Cerebrospinal fluid is sometimes collected by lumbar puncture but testing of the fluid generally shows no abnormalities. Neuropsychological testing is performed to determine the scope of the cognitive dysfunction. Hearing is often evaluated. Other laboratory tests are often utilized in the effort to assess other possible causes for the changes in mental status.

How is Alzheimer's disease treated?

There is no specific treatment for Alzheimer's disease. Medical counseling and the use of Alzheimer's drugs to counteract certain troublesome symptoms such as insomnia, agitation, and paranoia can be helpful to the individual and his/her family. There are new drugs that have improved symptoms in about one-third of individuals with Alzheimer's disease. These drugs appear to be useful, however, only in the healthy individual with mild to moderate cognitive impairment who is able to comply with close monitoring. This medication probably does not alter the overall course of the disease.

Medications

Information	Brand	Generic	Label	Rating
	Zoloft	Sertraline
	Paxil	Paroxetine
	Lipitor	Atorvastatin
	Lexapro	Escitalopram

Celexa (Citalopram), Desyrel (Trazodone), Prozac (Fluoxetine), Zyprexa (Olanzapine), Tegretol (Carbamazepine), Seroquel (Quetiapine), BuSpar (Buspirone), Aricept (Donepezil)

What might complicate it?

Complications of Alzheimer's disease include decreased resistance to infections, especially pneumonia and meningitis, and seizures. Recurrent falls are commonly seen in later stages.

Predicted outcome

Early diagnosis affords individuals with an opportunity to plan retirement from work, arrange for management of their finances, and discuss the management of future medical problems. Skilled, supportive care can improve the quality of the individual's life. Affected persons eventually may become bedridden and unable to care for themselves and, in advanced stages of the disease, may require care in a nursing facility. In the final stages, individuals with Alzheimer's disease may be unable to communicate or feed themselves and have bowel and bladder incontinence. Alzheimer's disease is ultimately fatal.

Alternatives

Differential diagnoses may include vitamin B12 deficiency, hypothyroidism, depression, delirium, an adverse reaction to prescribed medications, chronic subdural hematoma, Pick's disease, Creutzfeldt-Jakob disease, tumors, hydrocephalus, or multiple strokes.

Appropriate specialists

Neurologist, neuropsychologist, audiologist and radiologist.

Last updated 20 May 2015