We all have a fair, working knowledge of Alzheimer’s Disease, thanks to movies like The Notebook. (Personally, I prefer the novel, though!) The disease has been vilified, and has been shown in the right light that it takes away the life of a person, and is like a slow, agonizing death that not the patients nor their loved ones can bear.
Alzheimer’s is a neurodegenerative disorder. Neurodegenerative disorders are disorders that characteristically show the ongoing loss of neurons (the basic unit of our brain). The main pathology behind them is accumulation of abnormal, weird proteins that drive the brain crazy.
Alzheimer’s disease is a form of dementia. Since we start losing nerve cells, our brain shrinks in size. Its folds start to widen, leaving clear messages that the brain parenchyma mass is decreasing. The sulci widen and the gyri thin out. When we compare a normal brain with an Alzheimer Disease’s patient’s brain, it is really small. They say that the brain has atrophied.
Then holes begin to appear in the brain. Plaques and weird protein aggregates called neurofibrillary tangles (such a mouthful, right!) begin to spread all over the brain substance. They undermine the brain substance.
Holes and plaques are prominent in areas of Hippocampus, Amygdala and Neo cortex (these are just complicated terms for memory and emotion centers).
These plaques and tangles are highly associated with severe cognitive dysfunction of the patient.
The egregious causes of Alzheimer’s are not very clearly elucidated, but roughly, it is an interplay between genetics, environment and lifestyle. The pure genetic form has a lower prevalence (Thank God!) but spontaneous ones are common (not really a bright fact, right?)
Symptomatology of The Disease
The disease is the most common cause of old age dementia (mind you, that does not confirm that it cannot occur at a younger age). Its increasing incidence is a function of age, though (meaning it increases as you grow older).
Alzheimer’s disease becomes clinically apparent when insidious impairment of judgement and loss of higher cognitive functions becomes manifest. It then marches forward in the brain, and also the life of the patient, leading to a progressive deficit in memory, spatial orientation, judgement, personality and language.
Over a period of a decade or so, the poor patient becomes profoundly incapacitated, unable to speak and express self, and eventually becomes immobile.
Here is what we should look for in the elderly for Alzheimer’s symptoms
Since Alzheimer’s primarily affects the hippocampus, patients tend to have memory loss. Initially, the memory loss is subtle. They might forget what they have done recently, like a recent conversation, or the fact that they have met someone, or any subtle thing that might be pointing towards memory loss.
Inability to do something they know very well:
Acquired habits, first the complex ones, like baking, or cooking a dish in a characteristic manner, may be lost in a little later stages. You might begin to appreciate the change in taste of the dishes, or changes in signature pattern. Oftentimes, patients receive letters from bank for bounced cheques, and this is an important clue in understanding that Alzheimer’s is setting in or progressing. Patients might find it difficult to do basic things, like wearing shoes, or buttoning up shirts, and this is a grave sign of advancement of Alzheimer’s disease.
Visuospatial orientation loss:
To say that elderly women have loss of spatial sense anyway is a gross wrongdoing (pun intended). Women, on an evolutionary basis, don’t have a very good map reading sense, but that is not a reason why you should ignore new symptoms in an elderly lady. Both men and women with Alzheimer’s Disease tend to lose their way, and may even reach a place in neighbourhood that they have no idea of (remember, their memory is impaired), neither do they have any idea how they reached the place.
Families of such patients often receive calls from kind neighbours that their grandpa or grandma has drifted unknowingly into the neighbourhood. If this is happening to you, it is a sign and should be taken seriously.
Judgment and Personality:
As Alzheimer’s progresses, the patient becomes a different person. Their judgement is, hampered; their personality develops stark changes, and they sometimes become jittery and irritable. Patients may even become violent at times.
Significant disability sets in the late stages of Alzheimer’s, where patients are unable to do basic chores of life to sustain themselves. They are unable to speak (partly because they don’t remember the words, and partly due to the inability to coordinate their tongue and laryngeal muscles to articulate the words). Then comes the stage of immobility. This is a dreadful stage. An immobile patient cannot carry out the basic functions, like going to the toilet for passing urine or stool.
These patients need a constant assistant to help them feed, bathe and carry out basic human activities. These problems are only the beginning. Patients in bed for long periods of time are highly susceptible to bed sores, which can easily complicate themselves by getting, infected. Also, they are at grave risk of Deep Venous Thrombosis. In DVT, clot forms in the deep veins, which travel to the heart and lungs, and cause Pulmonary Embolism, which is fatal.
Chest infections are pretty common and recurrent issue with Alzheimer’s patients. Due to hampered mobility of the chest wall, the lungs become a nidus of infection. Impaired immune system of the elderly also plays a big role in making them susceptible to pneumonias. Patients eventually succumb to these fatal attacks.
Alzheimer’s Disease is an inevitable end once it has occurred, and it slowly eats away the brain. Though it is true that we have no cure for this, or even agents to significantly decrease its progression; we do have possibilities cropping up in research.
People who ultimately go on to have Alzheimer’s need medical and family support; but more than that, they need a family that can catch the symptoms early. Catching this gruesome disease early makes all the difference in the patient’s life. The family is ready, the patient also knows what is coming up; but most of all, it is the fact that drugs work best when given in early phase. Hence, we must learn the basics and be vigilant, for the love of our family!