It is a neurological in which the brain cella become inactive and results in dementia and impaired cognitive functions. Alzheimer’s disease is named after Dr. Alois Alzheimer. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness.
It accounts for the 60-70 % of the dementia cases and it is uncommon under the age of 45 yrs.
It is caused by the abnormal build up of proteins in the brain.The buildup of protein called amyloid protein and tau protein leads to the death of the brain cells.Amyloid proteins build up in the surface of the brain forming larger masses of cells called plaques.Twisted protein of another protein which is termed as tau results in tangled structure of protein.These plaque and tangled blocks the synaptic communication between the nerve cells and results is loss of brain function and prevents the brain from carrying out its action.This leads to the programmed cell death in the indivduals with deposition of amyloid fibrils in their brain.The slow and ongoing death of the cells starting in one area of the brain eventually sprading to other areas usually starts in the area which controls the memory and leading to the cause of the Alzheimer’s disease.
ROUTES OF TRANSMISSION :
greater memory loss and impaired cognitive functions.Wandering and getting lost,repeating the questions,difficulty in paying bills and collecting money,feeling difficult to do day to day activities,personality and behavioural changes.patients are often diagnosed in this stage
In this stage the damage occurs to the brain cell that controls the language,reasoning,sensory processing and consciousness.Memory loss and confusion grows and the patients loss the ability to recognize the family and friends.The person find difficulty in dressing and to cope up with the new situations,inability to do multistep task.The patient might experience hallucinations,delusions and paranoia.
The amyloid and tau tangles covers the brain and leads to shrinkage of the brain.Loss of communication and the patient is completely depend on the other for their survival.the patient is mostly bed ridden at this stage and he/she is nearer to death.
COMMON CLINICAL SIGNS AND SYMPTOMS :
Inability to recall the past events
Difficulty to recognize the family members
Difficult in finding the words and reading
Spatial or vision issues
Impaired reasoning /judgement skills
Movement difficulties and problems linked to smell perception is also seen in some cases
It is usually diagnosed with the history of the patient and behavioural changes and impaired cognitive functions.
Magnetic resonance imaging-MRI
Single photon emission computed tomography
Electroencephalogram(EEG): the doctors might suggest EEG to detect any abnormalities in the brain.
Imaging tests: CT scan, MRI scan SPECTs and PET scans help doctors locate the tumor and determine if it is cancerous or benign.
Neurological exam: During a neurological exam, your doctor will look for changes in your balance, coordination, mental status, hearing, vision and reflexes. These changes can point to the part of your brain that may be affected by a tumor.
Spinal tap:A doctor uses a small needle to remove fluid from around the spine. A laboratory examines this fluid to look for cancer cells. It is also known as lumbar puncture.
Single photon emission computed tomography
Positron emission tomography :it is used in early diagnosis of Alzheimer disease.
Biomarker tests. A biomarker is a biological factor that can be measured to indicate the presence or absence of disease or the risk of developing a disease. The biomarker for Alzheimer disease is the beta amyloid,tau proteins and phsopho tau which are detected in the CSF
Neuropsychological test mainly to observe cognitive functions is done with MINI MENTAL STATE EXAMINATION
TREATMENT AND PROGNOSIS :
Drugs are the only choices of treatment.
Psychotherapy: Providing support to the patients verbally.
A patient with alzheimer disease tends to survive five to eight years after the diagnosis and this time period might increase depending upon the several factors.Patient with alzheiner tends to behave aggressive,paranoia and anxiety.
Create positive environment
Stay mentally active: play crossword,puzzle and other brain active games.
Get physically active:it increases the blood flow to the brain and keeps the brain active.
.Memantine is believed to work by regulating glutamate, an important brain chemical. When produced in excessive amounts, glutamate may lead to brain cell death. Because NMDA antagonists work differently from cholinesterase inhibitors, the two types of drugs can be prescribed in combination.
Donepezil:It prevents the breakdown of acetylcholine esterase.
Rivastigmine:It prevents the breakdown of butyrylcholinesterase and prevents the cell death.
Davidson principle and practice of general medicine-22nd edition