Alzheimer's disease

Synonyms

Alzheimer's disease, "Alzheimer's", Alzheimer's disease, Alzheimer's dementia, Alzheimer's disease
English: Alzheimer's disease

Summary

Alzheimer's disease is a specific form of dementia, i.e. a reduction in intelligence acquired in the course of life. The basis of the disease are changes in the brain structure, the shrinking of the cerebral cortex and the extensive death of brain cells in certain regions. This is expressed u. a. in severe memory, behavior, thinking and personality disorders (see also personality disorder).

The disease progresses until the patient is completely in need of care, which can represent an immense psychological burden for those affected and their relatives. The exact mechanism of the disease is currently unclear, so a causal therapy is not possible. Nonetheless, there are ways of using medicinal and psychological-educational therapy to favorably influence and delay the course of the disease.

Read more on the subject under: Brain Atrophy

definition

Alzheimer's disease is one on the decline of Neurons and interconnections in brain sedentary form of dementia, which is associated with the excessive deposition of certain substances in the brain and cerebral vessel walls.

frequency

Alzheimer's disease is considered to be the leading cause of dementia in Western nations. Women are more often affected overall; the incidence in the population is given as around 5% of those over 65 and around 20% of those over 80. There is a genetic component to the disease, but other factors also play a role in its development. As part of a Trisomy 21 (See also Down syndrom) the risk of Alzheimer's dementia is increased many times over.

root cause

The exact cause of Alzheimer's disease is ultimately unclear. In autopsy specimens of the brains of deceased Alzheimer's patients, increased deposits of certain "protein lumps" ("plaques") and threads ("fibrils") can be seen under the microscope. These occur to a much lesser extent as part of the normal aging process or other diseases of the brain, but this is suspected to be a cause of the progressive breakdown processes in the brain of people with Alzheimer's disease.

In the course of the disease, brain cells die, which is expressed in a shrinkage of the affected brain regions, which can also be displayed in cross-sectional imaging methods such as computer or magnetic resonance tomography. The frontal, temporal and parietal lobes are particularly affected, although the clinical symptoms do not necessarily correspond to the extent of the discernible changes. Biochemically, several neurotransmitter systems are affected by the cell death, the influence of which with drugs is a mainstay of Alzheimer's therapy.

Read more on the topic: Alzheimer's Cause and What is Oxidative Stress?

The involvement of phospholipase D is also being discussed in Alzheimer's disease. For more information on each of the main forms of phospholipase, see: Phospholipase

Symptoms

In the early stages, Alzheimer's disease often manifests itself as a gradual increase in forgetfulness, and the short-term memory function in particular is affected relatively early in the course of the disease.The vocabulary of those affected is limited, word-finding disorders occur and patients find it difficult to orientate themselves in less familiar surroundings. It is not uncommon for the sick to appear mentally ill, impulsive and apathetic, so that it cannot always be easy to distinguish the clinical picture from depression.

In the further course the failure symptoms increase, the patients do not recognize familiar people and surroundings, language and arithmetic skills decrease and the patients forget simple skills, e.g. B. in the household.

Mentally a number of abnormalities can show up in an advanced stage, such as aggressiveness, hallucinations, delusions and general restlessness. Above all, this decline in personality is a great burden for relatives.

In later stages, the most severe disturbances in memory, language, recognition of people or objects and disorientation appear. There are also coordination disorders of the motor skills, frequent falls and u. U. Loss of control of urine and stool.
Read more about this under Memory loss.

In the final stage of the disease, the patients are bedridden, completely dependent on outside help and unable to communicate with those around them. Death usually occurs within 8-12 years of diagnosis, often due to secondary illnesses such as pneumonia, which result from the poor general condition of those affected.

Read more on the topic: Alzheimer's symptoms

Exclusion diseases (differential diagnoses)

It is important to differentiate Alzheimer's disease from other causes of dementia, which may be more easily treatable. These include, above all, circulatory disorders of the brain (second most common cause of dementia), infections, storage diseases (e.g. Wilson's disease), vitamin deficiencies, alcoholic-toxic dementia and other brain diseases such as Parkinson's disease or progressive supranuclear palsy. Sometimes there are also relatively large areas of overlap in the symptom patterns of Alzheimer's dementia and depression.

Read more about storage diseases in our article: Storage diseases - what are they?

Diagnosis

Ultimately, the diagnosis of Alzheimer's disease is a diagnosis of exclusion in the presence of the typical symptoms and evidence of shrinkage processes in the brain using sectional imaging methods in the absence of findings that suggest another cause of dementia. Therefore, in order to clarify dementia, extensive exclusion diagnostics have to be carried out.

This includes, first of all, the careful documentation of the patient's symptoms and medical history, as well as the question of similar clinical pictures in close relatives.

Note: Symptom picture

In doing so, it is particularly important to make statements from caregivers, as Alzheimer's patients often misjudge or downplay their own situation.

The neurological examination often shows no abnormalities in the early stages and serves to delimit other diseases of the brain and nervous system. A blood test can reveal the presence of metabolic disorders, vitamin deficiencies, infectious diseases and excessive alcohol consumption. The tomography examination using computer or magnetic resonance tomography (CT and MRT) shows a typical picture in Alzheimer's patients with shrinkage of the brain, especially in the area of ​​the frontal, temporal and parietal lobes. A relatively new procedure (PET = positron emission tomography) can show an altered energy metabolism in the affected areas of the brain.

Read more on the topic: Positron emission tomography

The focus of dementia diagnostics is the testing of intellectual performance with neuropsychological test procedures such as the mini-mental-state test. Such neuropsychological tests serve to uncover and document intellectual deficits in areas such as orientation to space, time and person, language, memory or even brain performance such as movement coordination.

Ultimately, the diagnosis of Alzheimer's disease can only be proven in an examination of brain specimens after the death of the person concerned, in which deposits of the relevant proteins can be detected far beyond a certain level.

therapy

There is currently no causal therapy for Alzheimer's disease. Nevertheless, a number of measures can slow the course of the disease, reduce symptoms and increase the quality of life of those affected. The symptomatic therapy of dementia is based on the medicinal effects on the neurotransmitter balance in the brain and on the training of the intellectual abilities of the patients, accompanying symptoms such as psychosis or depression can also be treated with medication.

Various medications are available to improve thinking and memory functions. In the case of mild to moderate dementia, preparations have proven to be effective that intervene in the metabolism of the messenger substance acetylcholine and increase its availability at the interconnection points in the brain. These active ingredients include u. a. Donepezil and Rivastigmine. In advanced dementia, therapeutic success can be achieved by influencing the glutamate metabolism in the brain. Medicines like Memantine the switching points between the brain cells from the harmful effects of the messenger substance, which is present in excess in Alzheimer's disease. According to studies, too, Gingko biloba supplements to have a small positive effect on thinking and memory performance.

The psychological symptoms such as aggressiveness or depression can be treated with common psychotropic drugs, but care must be taken that no drugs are administered that could affect the metabolic pathways of the above. Messenger substances intervene in order to avoid a worsening of the dementia symptoms.

The non-drug treatment of Alzheimer's disease includes B. Memory training and advice to relatives (e.g. care, supportright). The question of care, care and accommodation for the patient should best be clarified at an early stage.