Alzheimer’s disease

Alzheimer’s disease is a brain disorder that leads causes the brain to shrink and brain cells to eventually die. Dementia – a slow decline in memory, thinking, behavior and social skills is most commonly caused by Alzheimer’s disease.

The prevalence of Alziehmer’s AD and other dementias in India is low (0.84% for all dementias with a population aged 55 years and older), it is seen to increase with age.

What are the symptoms of Alzheimer’s disease?

The symptoms of Alzheimer’s disease often come on slowly. It might start when someone has trouble recalling things that just happened or putting thoughts into words. But memory gets worse and other symptoms develop as the disease progresses. The changes in brain associated with Alzheimer’s disease led to growing trouble with:

Memory

People with Alzheimer’s disease may:

• Repeat statements and questions over and over.
• Forget conversations, appointments or events.
• Misplace items, often putting them in places that don’t make sense.
• Get lost in places they used to know well.
• Eventually forget the names of family members and everyday objects.
• Have trouble finding the right words for objects, expressing thoughts or taking part in conversations.

Thinking and reasoning

• Difficulty in concentrating and thinking, especially about abstract concepts such as numbers.
• Multi-tasking becomes especially difficult.

Making judgments and decisions

• Hampers the ability to make sensible decisions and judgments in everyday situations.

Planning and performing familiar tasks

• Struggles in routine activities that include planning and cooking a meal or playing a favorite game.

Changes in personality and behavior

Problems affect the moods and may include the following:

• Depression.
• Loss of interest in activities.
• Social withdrawal.
• Mood swings.
• Distrust in others.
• Anger or aggression.
• Changes in sleeping habits.
• Wandering.
• Loss of inhibitions.
• Delusions, such as believing something has been stolen.

Preserved skills

People with Alzheimer’s disease maybe able to hold on to some skills even if other symptoms get worse. These preserved skills may include reading or listening to books, telling stories, sharing memories, singing, listening to music, dancing, drawing, or doing crafts and may be preserved as they are controlled by parts of brain that are affected at later stage of the disease.

There are three main phases of Alzheimer’s: mild, moderate, and severe. Each stage has its own set of symptoms.

Mild Alzheimer’s (Stage lasting from 2 to 4 years) symptoms

• Less energy and drive to do normal things
• Loss of interest in work and social activities and spending more time just sitting, watching TV, or sleeping
• Loss of recent memories, like forgetting conversations and events that just happened
• Language problems
• Mild coordination problems
• A hard time with everyday tasks, such as following a recipe
• Mood swings that involve depression or a lack of interest
• Trouble with driving, like getting lost on familiar routes

What the mild symptoms could also mean –

Having these symptoms may also mean are other medical conditions causing same problems, such as:

• Conditions that affect metabolism, such as a thyroid problem
• Drug abuse
• Taking multiple medications that do not work well
• Parkinson’s disease
• Stress
• Depression

Check with the doctor to assess these symptoms and understand if the disease is indeed Alzheimer’s or other condition.

Moderate Alzheimer’s (stage may last from 2 to 10 years)

Memory loss gets worse and causes problems in daily life.

Other symptoms at this stage can include:

• Rambling speech
• Trouble coming up with the right words
• A hard time planning or solving problems
• Confusion about time or place.
• Not dressing for the weather
• Getting angry or upset easily, sometimes lashing out at family or caregivers
• Trouble sleeping
• Wandering
• Delusions (thinking that caregiver is trying to hurt them)

Severe Alzheimer’s (The third stage that typically lasts 1 to 3 years)

People in this phase might have some or all these symptoms:

• Major confusion about what’s in the past and what’s happening now
• Trouble expressing themselves
• Problems with swallowing and control of their bladder and bowels
• Weight loss, seizures, skin infections, and other illnesses
• Extreme mood swings
• Hallucinating (Seeing, hearing, or feeling things that aren’t really there)
• Difficulty in movement

What are the causes and risk factors of Alzheimer’s disease?

In Alzheimer’s disease, the brain proteins fail to function normally, disrupting the work of brain cells (neurons), triggering a series of events leading to their death.

Alzheimer’s disease is caused by a combination of genetic, lifestyle and environmental factors that affect the brain over time and in rare cases, it is caused by specific genetic changes that guarantee the disease development. In these cases, the disease usually begins in middle age.

Most of the time, the brain cells also form two types of flaws, depending on 2 types of proteins: 

• Neurofibrillary tangles – twisted fibers inside the brain cells responsible for transporting nutrients from one part of the cell to another
• Beta-amyloid plaques – sticky clumps of proteins building up between nerve cells instead of breaking down like they do in healthy brains.

These plaques and tangles damage the healthy brain cells around them, causing the cells to die and the brain to shrink cause the symptoms of Alzheimer’s.

How is Alzheimer’s disease diagnosed?

Explaining the symptoms is an important part of diagnosing Alzheimer’s disease. The doctor would recommend testing immediately to diagnose an Alzheimer’s and by various ways. Testing may include:

• Medical history
• Mental status based on tests
• Physical exams
• Neurological exams
• Blood tests
• Tests of your cerebrospinal fluid (CSF)
• Images of your brain

What are the treatment options for Alzheimer’s disease?

Currently, there are lot of therapies and pharmacologic treatments under research that focus on stopping the brain cell death associated with Alzheimer’s.

The doctor draws up the best treatment regimen based on a person’s –

• Age, overall health, and medical history
• Disease severity
• Response of the person on a medicine or therapy
• Preferences of that person or family or caregivers

Medications

Alzheimer’s medicines help with memory symptoms and other cognitive changes by boosting levels of cell-to-cell communication, slowing the progression of symptoms with moderate to severe Alzheimer’s disease. The two types of drugs are Cholinesterase inhibitors and Memantine.

Alternative medicine

Herbal remedies, vitamins and other supplements are widely promoted for cognitive health or to prevent or delay Alzheimer’s. These are:

• Vitamin E
• Omega-3 fatty acids
• Curcumin
• Ginkgo
• Melatonin
• Vitamin D

Social engagement and activities

These may support preserved skills and abilities and also help with over-all well-being. Someone with dementia might:

• Listen to music or dance.
• Read or listen to books.
• Garden or do crafts.
• Go to social events at senior or memory care centers.
• Do activities with children.

Can Alzheimer’s disease be prevented?

Alzheimer’s disease is not a preventable condition, but a number of lifestyle risk factors can be modified such as, for example, it is said reducing the risk of heart disease may also lower your risk of developing dementia.

Heart-healthy lifestyle choices that may reduce the risk of dementia are as follows:

• Regular exercise
• Eating fresh produce, healthy oils and foods low in saturated fat (avoiding chips, packaged food products, etc.)
• Following treatment guidelines to manage high blood pressure, diabetes and high cholesterol.
• Quitting smoking and taking help if a person is unable to quit.

How do you if it is Alzheimer’s or Normal Aging?

Just about everyone has minor memory glitches as they get older. If someone forgets a name or why they walked into the kitchen, that doesn’t mean they have Alzheimer’s.

The main problem that defines the disease is trouble planning and handling day-to-day tasks, like paying bills, managing a checkbook, or using familiar appliances around the house.

What can be done by caregivers to make  living with Alzheimer’s disease easier in daily life?

Creating a safe and supportive environment is important part of any treatment plan. Following steps can make life much easier and support a person’s sense of well-being and continued ability to function:

• Keeping keys, wallets, mobile phones and other daily valuables at exact place so it is not lost.
• Medicines to be kept in a secure location and a tracker can be used to keep track of doses.
• Finances can be scheduled on automatic payment and automatic deposit.
• Patient should carry a mobile phone with location tracking and important phone numbers should be provided as emergency contact into the phone.
• Alarm sensors should be installed on doors and windows.
• Make regular appointments on the same day at the same time.
• A calendar or whiteboard can be kept to track daily schedules and completed items should be checked off.
• Sturdy handrails should be installed on stairs and in bathrooms.
• People with Alzheimer’s may find images in mirrors confusing or scary and hence, only necessary mirrors should be kept.
• A person with Alzheimer’s should carry an ID or wear a medical alert bracelet.
• Keep photos and other objects with meaning around the house.

1. Chandra V, Ganguli M, Pandav R, Johnston J, Belle S, DeKosky ST. Prevalence of Alzheimer’s disease and other dementias in rural India: the Indo-US study. Neurology. 1998 Oct;51(4):1000-8.
2. Alzheimer’s disease. Mayo Clinic. May 2024. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/diagnosis-treatment/drc-20350453
3. Understanding Alzheimer’s Disease: the Basics. WebMD. May 2024. https://www.webmd.com/alzheimers/understanding-alzheimers-disease-basics