Alzheimer's disease is an incurable disease that affects the most severely elderly people over 65. It is a systematically worsening neurodegenerative disease, assuming in most cases the form of dementia or similar in its symptoms to senile dementia. It comes from a group of diseases whose pathogenesis is a consequence of damage to the nervous system as a result of pathological loss of nerve cells. For the first time, the disease was diagnosed and described by the German doctor, Alois Alzheimer, fascinated by its symptoms. It was from his name that the affliction gained its name later. The said neurologist and psychiatrist, according to written sources, studied the atypical case of a middle-aged woman named Auguste Deter. The woman was taken to a psychiatric hospital in Frankfurt in the fall of 1901. The observation of the ailments, not yet classified at that time, lasted a total of five years, until the patient's death in 1906. The results of the autopsy of patient Auguste Deter's brain were presented later that year at a conference of the Society of Southwest German Neuropsychiatry in Tübingen. According to the sources and notes of Dr. Alzheimer, the woman showed severe problems with long-term memory, amnesia of writing and difficulties with synthesized speech. She forgot basic information, such as her own surname or her husband's first name. She had trouble recognizing and defining objects or tastes. Numerous symptoms, including the area of psychosis and depression, could be better explained only after examining the patient's brain after her death.
The autopsy showed that pathological changes appeared in the structure of the brain, most likely responsible for neurological disorders manifested by problems with memory, thinking and recognition. The so-called neurofibrillary tangles - intracellular junctions of the hyperphosphorylated tau protein were formed between the dying and already dead brain cells. Alzheimer's disease has been researched to be one of the sub-types of senile dementia and classified as "pre-senile dementia" in the textbook of psychiatry by Emil Kraepelin. However, a few decades later, researcher John Hardy proposed the "amyloid hypothesis" that responsible for the development of Alzheimer's was the accumulation of plaques of sticky beta-amyloid protein between brain cells. Multi-protein deposits of this type most likely prevent proper communication between cell synapses, and the immune system concerned by the disturbances tries to eliminate the threat to the body by removing neurons damaged as a result of structural changes in the brain.
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Factors influencing the development of Alzheimer's disease
In fact, the causes of Alzheimer's disease in a patient are not known. The process that contributes to the progression of the disease is clear, but it is already a symptomatic stage of the disease. However, the very factors that are responsible for the development of the disease are undefined. Certain predispositions may only influence the conditions for the appearance of disturbances in the structure of the brain. Among the most frequently mentioned factors are:
- older age,
- female,
- diabetes,
- gene mutations,
- family genetic predisposition to Alzheimer's.
Alzheimer's disease symptoms and stages
Alzheimer's disease is a type of disease that progresses relatively slowly. It is a complex condition that develops different symptoms. The level of the disorder of the brain structures also increases. The most common classification of Alzheimer's stages is according to Barry Reisberg, which is described in detail below.
Stage I. No symptoms
The first symptoms of Alzheimer's may not attract much attention. In fact, the first phase of the disease is asymptomatic and this makes it difficult to detect it early and slow down the progression process.
Stage II. Slight cognitive impairment
The second phase of the disease is initially very subtle symptoms that can be associated with conditions other than Alzheimer's or be easily ignored. Especially in the elderly over 65, primary symptoms can be considered a natural part of the aging process. There may be periodic memory disturbances, manifested as slower association of facts, names or problems with concentration. At this stage of the disease, there may also be slight problems with speech in the form of difficulties in matching the appropriate terminology during the conversation. Older people will often find it difficult to lose small things. However, these are confusing symptoms, common in people in the second half of life, and do not clearly indicate Alzheimer's disease.
Stage III. Mild cognitive impairment
In the third stage of the disease development, the symptoms of Alzheimer's become much more pronounced, although they do not yet significantly affect the functioning of patients in everyday life. At this stage, mild cognitive impairment and problems with temporary memory lapses appear most often, which take the form of problems with remembering new information, difficulties with recalling recently learned content or problems with concentration. Planning and organization skills may be impaired. At this stage, performing new activities may prove problematic, and repeating learned tasks may come with a little more effort than usual. Sick people sometimes feel an increased sense of anxiety at this stage.
The symptoms of Alzheimer's disease at the third of the seven stages of the disease development can already be confirmed by clinical tests and a detailed medical history. They become visible to people around the patient. The appearance of symptoms of this stage is a kind of determinant on the basis of which the time of development of the next phase of the disease is predicted. In most cases, the disease progresses over a period of several years to a more advanced form.
Stage IV. Moderate cognitive impairment
The first more serious symptoms of Alzheimer's largely overlap with the signs of senile dementia. It was not for nothing that Alzheimer's disease was initially classified as a subcategory of senile dementia before it was described as a separate condition. In the stage of moderate cognitive impairment, not only do symptoms from the previous stages develop, but also problems with counting or planning simple activities. Sick people most often start to slowly confuse the events that have taken place in their lives. However, they remain aware of the problems they face, which causes irritability. There may be apathy and mood swings due to declining interest in others and increasing feelings of ineptitude and overwhelm with symptoms of the disease. It is estimated that the fourth phase of the disease remains at a similar level for about two years.
Stage V. Intermediate cognitive impairment
At this stage of the disease development, sick people require the assistance of another person so that their life can go on with the daily rhythm. They are unable to independently control matters such as paying bills or completing clothes. This is due to the progressive impairment of cognitive functions, which strongly affects the memory of patients. They have trouble remembering facts, often confuse important information and do not remember basic things such as their own telephone number or home address. There are serious problems with orientation in space and time, which manifests itself in difficulties with the correct determination of the date, time of year, day of the week or place.
Intermediate cognitive impairment results in symptoms that involve depressive or psychotic stages. Patients often show increased apathy and eating disorders. They also often do not pay attention to their own appearance and hygiene, which results in wearing clothes for several days and avoiding toilet activities. There are strong mood swings, and even states of anxiety and paranoia or aggression.
Stage VI. Advanced cognitive impairment
In the penultimate stage of the disease, constant care for the sick is necessary. Neurological disorders, resulting from profound damage to the brain structure at this stage, cause personality changes in ill people. Patients most often remember their names, but often forget other people's names. However, they are able to distinguish relatives from strangers, although they sometimes confuse people. Long-term memory problems make it impossible to fully remember the facts of your own life. Patients do not recognize their immediate surroundings and are unable to recall the latest events in the world around them.
A paranoid state develops, the symptoms of which are suspicion, delusions, and hallucinations. There may also be compulsive reflexes, such as twisting the arm. The sick are not able to function independently, therefore they need help with toilet and everyday activities, such as clothing. The regularity of bowel movements and the sleep-wake cycle are often disturbed.
VII - Very severe cognitive impairment
The last phase completely excludes the affected person from normal functioning. At this stage, they lose contact with their surroundings, both on the physical and mental levels. They are unable to function without the help of another person. They cannot eat, drink, take care of hygiene and toilet matters, walk or make any movements. All vital functions are slowly lost. Patients quickly lose their ability to speak, smile and keep their head upright. The symptoms of the final stage progress quickly and lead to the inevitable - death of the sick person.
Diagnosis and treatment of alzheimer's disease
The diagnosis of Alzheimer's disease is a complex and multifaceted process. It mainly consists in excluding other causes of dementia and finding the basis of potentially reversible cognitive impairment. These causes can be diagnosed by eliminating other diseases that give similar clinical symptoms, using laboratory tests for this purpose, such as anemia, thyroid diseases, electrolyte levels, metabolic disorders or diseases of the urinary system. Computed tomography and magnetic resonance imaging tests can help in the rejection of diseases that require neurosurgical treatment, e.g. hydrocephalus, brain tumors. In order to assess cognitive abilities, the patient is referred to a specialist neurologist.
A cure for Alzheimer's disease has not yet been discovered. Only methods are used that will delay the development of the next stages and symptoms of the ailment as far as possible. Palliative treatment in the case of alzheimer's disease, however, consists mainly in eliminating the effects and supervising the condition of patients. Unfortunately, this disease is incurable. The most frequently used methods of treating cognitive dysfunctions are pharmacotherapy and psychosocial influence.
Source:
- Alzheimer’s Association Official Website https://www.alz.org/alzheimer_s_dementia
- Barry Reisberg , Guide to Alzheimer's Disease, New York: The Free Press, 1981.
- Berchtold NC, Cotman CW, Evolution in the conceptualization of dementia and Alzheimer's disease: Greco-Roman period to the 1960s., „Neurobiol. Aging”, 19 (3), 1998, s. 173–189.
- Berrios G E, Alzheimer's disease: a conceptual history, „Int. J. Ger. Psychiatry”, 5 (6), 1990, s. 355–365.
- Bidzan L., Bidzan M., Łukaszewska B., Pąchalska M., Pufal A., Dynamika zmian zaburzeń zachowania w otępieniu typu Alzheimera, „Psychogeriatria Polska”, 6 (2), 2009, s. 43-58.
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- Brookmeyer R., Gray S., Kawas C., Projections of Alzheimer's disease in the United States and the public health impact of delaying disease onset, „American Journal of Public Health”, 88 (9), 1998, s. 1337–42, 09.
- Doody RS, Stevens JC, Beck C, RM Dubinsky i inni, Practice parameter: management of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology, „Neurology”, 56 (9), 2001, s. 1154–1166.
- Gaweł M., Potulska-Chromik A., Choroby neurodegeneracyjne: choroba Alzheimera i Parkinsona, „Postępy Nauk Medycznych”, t. XXVIII, nr 7, 2015, s. 468-476.
- Gerbaldo H., Maurer K., Volk S., Auguste D and Alzheimer's disease, „The Lancet”, 349 (9064), 1997, s. 1546–1549.
