Alzheimer’s disease is the most common form of dementia in which the disease starts mildly and gradually worsens. It is an irreversible, chronic neurodegenerative disorder that affects the brain cells and gradually destroys critical thinking, the capacity of carrying out easy everyday tasks and above all, it leads to memory impairment. In the past years, it was considered a rare brain disorder, but today it constitutes a major health problem that severely affects millions of elderly people and their families, it is also identified as one of the most common diseases amongst older people and the fourth cause of death. Estimates show that over 27 million people suffered from Alzheimer’s in 2006 and this figure is likely to increase over the years. Generally, this disease can be aggravated by age, but it isn’t a part of normal aging because it is caused by a fatal disease that affects the brain. According to studies, it affects people over the age of 65, although less frequently, premature Alzheimer can appear much earlier, perhaps even before the age of 50 but especially after the age of 85, every elderly person has 1 in 3 chances to suffer from it.
The disease was first presented in 1906 by Dr. Aloysius Alzheimer (1864-1915), a well-known psychiatrist and neurologist. After graduating with his medical degree in 1901 Alzheimer started working at an asylum in Frankfurt where he observed a patient named Auguste Deter. The 51-year-old woman who over the years became his obsession suffered from a rare brain disorder and developed unexplained behavioral symptoms, including memory loss, paranoid ideas, speech disorders and later severe dementia. Alzheimer treated her and documented her symptoms in depth, as well as his conversations with her. He noted that at one point when Auguste was unable to correctly write something, she stated, “I have lost myself.” After suffering for 4 years from the disease Deter died on 8 April 1906 at the age of 55 and Alzheimer had her medical records and brain brought to Munich for research. The post-mortem examination of her brain revealed cerebral cortex atrophy and a buildup of dense deposits, now called amyloid plaques, outside and around the nerve cells in her brain. These abnormalities are the main identifiers of what became known as Alzheimer disease. Because Alzheimer’s patient was relatively young, he believed that the disease he discovered only affected people under the age of 65. Today this view has been discarded because similar symptoms can be found in elderly people were simply regarded as a natural consequence of aging. Alzheimer’s notes allowed scientists to directly verify the brain changes he had described in his lecture in 1906 and also contributed to the understanding of other diseases such as vascular dementia and brain tumors. The disease became known as Alzheimer’s disease in 1910 when Alzheimer’s colleague Emil Kraepelin a German psychiatrist, honored Alzheimer in the 8th edition of his Handbook of Psychiatry for discovering the disease in 1906. Kraepelin’s book was based on the description of Alzheimer’s first case and three other cases from Alzheimer’s associates. Even though Alzheimer and Kraepelin had some different interpretations about the disease, they never had the chance to meet and discuss their ideas due to Alzheimer’s short life.
The ultimate cause of neuronal necrosis in Alzheimer’s is still unknown, many scientists believe that it occurs from an increase in the production of a particular protein called beta-amyloid. The brain of people suffering from this disease has an abundance of two abnormal structures. Beta-amyloid plaques which are dense deposits of protein and cellular material that accumulate outside and around nerve cells develop in the hippocampus, a structure deep in the brain that helps to encode memories, and in other areas of the cerebral cortex that are involved in thinking and making decisions. Scientists think that amyloid deposits form plaques between the neurons early in the course of the disease before the neurons start to die and before signs and symptoms occur. Neurofibrillary tangles which are twisted fibers that build up inside the nerve cell. The internal structural support of brain neurons depends on the normal functioning of a protein, called tau. In people with Alzheimer’s disease tau protein undergoes variations that cause it to rotate. There are also proteins in the brain that are linked to Alzheimer’s. Alzheimer’s number one indicator is a gene called apolipoprotein E. There are three forms of this gene. ApoE 4 is the one that is most closely related to Alzheimer’s sufferers. ApoE2 is another form of the gene but this one takes on the opposite path by decreasing one’s chances of getting affected by the disease. Lastly, because this disease is also genetic a person that has family members with the disease possesses an increased chance of being diagnosed with Alzheimer’s also.
Because Alzheimer is a progressive disorder, it gets worse and more functions are lost as time passes and the affected regions begin to shrink as nerve cells die. The stages of Alzheimer’s diseases are divided into four the preclinical, mild, moderate and the severe stage. In the early stages, patients deal with mild reduction in memory and other mental functions like the difficulty in recalling recent events. The symptoms are often overlooked and misidentified by doctors, relatives as an indication that occurs in the elderly age and because the progression of the disease is gradual, it is difficult to find the exact time that has begun to deteriorate but specific areas of the brain are likely to be affected decades before any signs or symptoms occur. Examples of this include getting lost on their way home or forgetting which medications need to be taken on a particular day. As the plaques and tangles spread to different areas of the brain, more severe symptoms occur and the activities of everyday life are strongly affected that it is starting to become difficult for the patient to be autonomous. This is usually followed by mild to severe aggressive behaviors like aggression, anxiety, mood swings, suspiciousness as well as illusions or hallucinations. When the disease enters the final stage, physical effects become more visible that individuals become very confused and disorientated. Memory disturbances are starting to become more serious that the patient cannot even recognize their own family or loved ones and are unable to communicate effectively as their senses are reduced. At this stage, the patient is completely dependent on others for care and every sense of self seems to disappear. The saddest part of the disease is that people live between 5-10 years after being diagnosed because of physical impairment due to diminished brain function but some patients today can live up to 14 years due to improvements in care and medical treatments.
There are no proven methods for preventing Alzheimer but evidence suggests that healthy lifestyles such as systemic physical but also mental exercise seem to protect against dementia. Ideal exercise seems to be about 160 minutes per week, combining aerobic exercises like walking, swimming with muscle strengthening exercises. A healthy diet is also recommended as a possible method of prevention, although no definitive nutritional recommendations can be made. It seems beneficial for the disease, to include fish, fruits, vegetables and legumes, two glasses of red wine a day and white meat in your diet. Therefore, performing activities that enhance memory such as reading, intellectual games or even simpler activities such as crosswords can keep the cognitive functions of the elderly alive and help preserve their memory. That is why educated people who systematically exercise their mind suffer from the disease in older age and in milder form than those who keep their minds idle. In addition, future studies may prove to be beneficial in preventing the occurrence of Alzheimer’s, or at least the severity of its progression.
A diagnosis of Alzheimer’s is said to be a “diagnosis by exclusion”. This means that there is no certain test just for Alzheimer’s, but today medical history, a physical exam, and mental status tests are used for diagnosis but they aren’t so accurate as an autopsy of brain tissue examined under a microscope. Unfortunately, there is also not a radical cure for Alzheimer because it is a complex disease and it is unlikely that any drug or other intervention can successfully treat it, so it cannot be halted or reversed. However, there are drugs that inhibit and significantly slow down its development, especially if given early. Their goal is to strengthen patient’s autonomy and daily functioning and significantly improve the lives of patients and their families. According to studies the condition of patients undergoing treatment is deteriorating much slower than those who are not treated. In addition, their quality of life is clearly better, making them easier to care for, and thus putting less weight on their families.