Alzheimer's disease

Alzheimer's disease (AD) is an acquired disorder of the intellect. The disease is accompanied by a gradual and persistent decrease in intellectual brain activity. A person loses previously learned skills and knowledge and is unable to learn new ones. Patients with asthma cannot lead a full-fledged lifestyle and perform even elementary household tasks.

The first mention of this disease is found in ancient sources. But Alois Alzheimer gave her a detailed definition on the example of his ward only in 1907. This form of dementia is called senile dementia of the Alzheimer's type or Alzheimer's disease. It is still being studied in an attempt to reduce the likelihood of new diseases and improve the lives of patients.

Epidemiology

According to the World Health Organization for 2015, 0.441% of the world's population lives with dementia. According to WHO forecasts, by 2030 this figure will increase to 0.556%. According to research, Alzheimer's disease is the most common cause of dementia in the elderly. And the number of patients will double every 20 years. An analysis of groups of patients shows that 60% of them live in countries with low and middle living standards.

The main reason for the spread of the disease on a global scale is the increase in the number of elderly people. AD most often affects people over 65 years of age, up to 65 years of age it is rare, and up to 45 years of age it almost never occurs. Although over the past decade, the disease is increasingly affecting people at a younger age - up to 60 years. An exception in the statistics falls on patients with Down syndrome; in this group of patients, the first signs of the disease occur more often by the age of 30. Men get BA 2-3 times less often than women. Children and adolescents do not have AD.

Modern classification

In simple words, Alzheimer's disease is a slow degradation of a person in all aspects of life. It is divided into two forms: senile and presenile. The first is said when the disease begins after 65 years, and the latter - when it is detected before this age. This classification reflects the old ideas about dementia, when it was believed that intellectual disorders at an early and late age are different pathologies. Then Alzheimer's disease was called the presenile form, and the senile form was simply called senile dementia.

Studies in the etiology and pathogenesis of the disease have shown that both forms have the same stages and mechanisms of development. Based on this, both presenile and senile were combined into one disease and are referred to as "Alzheimer's disease." According to ICD 10, this type of dementia received the code G30. Despite the common essence, scientists do not deny the differences in clinical indicators in senile and presenile dementia.

Presenile

Rapid form. It occurs between 45 and 65 years of age, except in rare cases when it affects people over 65 years of age. It differs from senile by a faster rate of development and a family history. Distinctive characteristics of the presenile form:

Most often, the onset of the disease occurs at 55-60 years of age. The first stages develop slowly and can last for a period of several months to 2-4 years. The decay of the intellect begins with forgetfulness of current events: the patient remembers well past events, but forgets recent ones. Unlike senile dementia, the patient does not plunge into the past. In the initial stages of the disease, criticism of one's own state remains.

The patient, aware of what is happening, may try to hide the disease. When talking, a person often tries to get away from the topic, because he cannot remember the right words or events. Over time, attempts to maintain the "facade of personality" weaken, criticism decreases. The patient quickly loses reading, counting, writing skills. The perception of the environment is also blurred.

Sensory and amnestic disturbances are accompanied by disorientation. With the progression of the disease, a person gradually forgets how to use household items. In the future, senseless movements and gestures are observed. In the last stages, the patient's set of skills and knowledge is completely exhausted. Speech is limited to incoherent sounds, the patient forgets even automated actions, such as walking or sitting on his own.

The full cycle of the disease takes from 1 to 10 years. The rate of progress depends on factors such as heredity, type of activity, standard of living, and the presence of other diseases.

At the end of the pathology, patients are not able to do something themselves, to ask for something. Death in most cases occurs from the addition of infections.

Senile

A form of later manifestation, more often occurs after 65 years. Senile dementia is called the first type of Alzheimer's disease. It is distinguished from presenile by slow progress and the absence of a family history. Distinctive characteristics:

  • occurs after 65 years;
  • no family history;
  • progress is slow with temporary plateaus;
  • the clinical picture is dominated by memory disorders.

Clinical features also distinguish type I AD from presenile form I. In the first case, the patient quickly develops speech, awareness, movement, and gnosis disorders. With senile dementia, the personality and mental activity gradually disintegrate. The first stages of pathology are hardly noticeable. Over time, the constitution of the individual changes, a person can become gloomy, suspicious, grouchy.

Of the symptoms of senile dementia, a “shift into the past” is distinguished. In the early stages, a person does not perceive new knowledge, judgments, skills. The past is perceived by them as an example. As patients progress, false memories or recognitions come, people from the current moment are associated with people from the past. Also, patients can invent events related to the past.

From the early stages to the last, egocentrism and egoism progresses. The patient's priorities narrow around his personality, health and safety. Emotional memory to relatives is broken, former attachments to people disappear. In behavior, the lower drives progress: gluttony, inappropriate sexualization, the accumulation of rubbish, etc.

In contrast to the presenile form, in this case there is no complete disintegration of speech and motor function. Patients up to the last stage can maintain a rich vocabulary and liveliness of speech. However, logical connections suffer greatly due to insanity. Amnesia progresses slowly and affects from the most complex skills to the simplest.

In the last stages, patients, just as in presenile form, cannot take care of themselves. The full cycle of pathology takes from 4 to 15 or more years.

Causes

Alzheimer's disease is not contagious and is recognized as a multifactorial disease. The exact cause of the development of degenerative processes in the brain remains unclear. The main cause of pathological anatomy is called gene defects that can be inherited. Familial dementia occupies only 10% of the total number of patients, but most of the studies of pathology are devoted to it.

Four genes have been identified that lead to the development of Alzheimer's in old age. These genes lead to metabolic disorders at the cellular level. A key role in predisposition is attributed to defects in the gene encoding the amyloid precursor protein (APP). Normally, it breaks down into identical polypeptides. During mutations, APP is divided into fragments of different sizes, while long ones do not break down and form plaques.

Accumulations of APP are deposited in the brain parenchyma and damage neurons. Due to broken neural connections, the brain does not fully perform its function. A deviation in the structure of the tau protein also leads to a similar result. Its threads combine and create "balls". Such compounds interfere with biochemical signaling between cells. Over time, the cells die completely.

It has not yet been possible to establish the exact cause of mutations in genes, in addition to heredity. Scientists have compiled a list of factors that increase the risk and can serve as triggers for the onset of the disease.

These include:

  • head injuries;
  • episodes of depression and psychological upheaval;
  • lack of intellectual activity;
  • diabetes mellitus;
  • diseases of the respiratory and cardiovascular systems;
  • sedentary lifestyle and sedentary work;
  • addiction to sugar and coffee ;
  • weight gain ;
  • alcohol and nicotine addiction.

Almost all factors can be classified as both controlled and conditionally correctable. At particular risk are people aged 65 years and older, older women. Also, the likelihood of encountering dementia is higher in people who are overweight, have heart and vascular diseases, and have low intellectual activity.

Localization of lesions

After the death of his patient, Alois Alzheimer examined parts of her brain where he found senile plaques. Modern post-mortem studies confirm that protein accumulations are found in patients. In APP disorders, insoluble fragments are deposited in the brain parenchyma and the walls of cerebral vessels. Tau protein is part of the inner membranes of neurons. Violations in this protein damage the membranes, which in turn leads to the death of brain cells.

Lesions are localized in the cortex and brain cells. The effects extend to the nervous system and all brain functions. The hippocampus, the region of the brain responsible for memory and learning, suffers the most.

Symptoms of the disease

Establishing the exact time of onset of asthma is very difficult. The debut of the pathology is hardly noticeable, and neither the patients themselves nor their relatives can determine when the first stage began. The first manifestations include a narrowing of the circle of interests, instability of mood, suspiciousness, lack of concentration. Teaching patients is very difficult, new material is absorbed worse and worse.

Also among the symptoms in the first stages:

  • difficulty in performing difficult household tasks;
  • interrupted sleep at night and sleepiness during the day;
  • gradual loss of professional skills;
  • "loss" of individual words from memory, an attempt to replace them with synonyms;
  • frequent mood and behavior changes;
  • periodic disorientation in space, cases of topographic cretinism;
  • lethargy and weakening of thought processes.

During the first three years of the disease, dysfunctions of counting, vision, self-awareness and perception of the environment are added to the progressive amnesia. With progress, gnosis is increasingly violated - orientation in space, events, dates. A person is lost in the area familiar to him, confused in dates and numbers, in a senile form, reality is replaced by the events of the past. In the last stages, the patient does not recognize relatives, is not able to perform elementary actions: dress, eat independently, communicate, etc.

Stages

The full cycle of the disease can take from 3 to 15 or more years. Life expectancy depends on external factors and physiological. So far, AD is an irreversible pathology; it is impossible to completely stop or reverse the degradation process. Depending on the symptoms and condition of the patient, 4 stages of BA are distinguished.

Predementia

This is the first stage of the disease and most often goes unnoticed. It is also called mild cognitive decline. This phase lasts from several months to several years. During this period, there are already the first symptoms. The patient cannot plan his activities, sometimes forgets the meaning of some words, cannot concentrate for a long time, does not keep his attention on one thing, it is difficult to learn new information.

Pre-dementia has mild short-term memory impairment. A person more and more often forgets why he entered the room, loses the logical chain in the conversation, often gets lost in dates.

At this stage, apathy appears and gradually intensifies and interest in the outside world decreases. Also, the environment can replace minor changes in behavior, the patient may become more suggestible and trusting, or, conversely, suspicious and grouchy.

Early

With the progress of degradation, predementia is replaced by an early phase of asthma. Already at this stage, the patient himself and his relatives may suspect serious problems. Absent-mindedness and forgetfulness are aggravated, while episodes from the distant past are not erased, short-term memory suffers. Dates and days of the week are confused, cases of disorientation in place and time are becoming more frequent. A person perceives new information worse and more difficult to learn.

At an early stage, agnosia is added to progressive amnesia - a disorder of tactile, visual, auditory perception. Vivacity of speech and vocabulary slowly decrease, although in the senile form they may remain practically unchanged. There are also violations in the coordination of movements and the first cases of forgetfulness of the functions of objects. However, consciousness still remains. In the presenile form, the patient is aware of what is happening to him and may try to hide his condition.

Moderate

The third stage of the disease occurs gradually, passing from the early one. At this stage, all of the above symptoms intensify, the person needs the help of the environment more and more. The loss of short-term memory is aggravated, there may be "failures" when a person does not recognize loved ones. There are deviations in the behavior and character of the patient, there may be a craving for overeating, vagrancy, the accumulation of rubbish.

Gradually increasing symptoms such as:

  • disorientation;
  • counting and reading skills worsen;
  • orientation in days and numbers is almost completely erased;
  • more and more people forget the name and purpose of objects;
  • Speech is disturbed, there are more and more nouns, incorrect pronunciation and long pauses.

But in moderate dementia, the patient can still dress himself, take care of hygiene, and eat. Over time, these skills disappear, and the sick need more care and attention.

In the evenings, there is often a change of mood: tearfulness, inappropriate talkativeness or sullenness, businesslike or grouchy. At night, sleep is interrupted; during the day, drowsiness sets in. Nocturnal enuresis is on the rise.

Severe

At this stage, it is very difficult to care for a patient without specialized care. The patient cannot take care of himself on his own. Vocabulary is almost completely exhausted, with the exception of senile dementia. The patient no longer recognizes relatives and friends, does not remember the purpose and names of objects. Apathy reaches its peak, weight decreases. The patient cannot stand up and walk, eat, perform household functions on his own.

In the presenile form, a person lies silently most of the time, in the senile form he takes a fetal position. Also in the first case, speech consists of separate passages and syllables; in the senile form, the liveliness of speech can be preserved, but it is meaningless. Together with objects, a person forgets the meaning of words, so he does not understand those around him. Due to a sedentary lifestyle, infections, pressure ulcers, and pneumonia are often added.

Diagnosis

Recognizing the disease in the pre-dementia stage is quite difficult. Most often, the diagnosis is made at an early stage, when the relatives of the patient or he himself understands what is happening. Senile plaques and tau tangles in the brain are deposited from the very beginning of the disease. However, they can be detected only under the conditions of a pathoanatomical autopsy. The diagnosis of AD is a laborious process that includes neuropsychological evaluation, imaging tests, and clinical tests.

Diagnosis begins with an examination by a neurologist, communication with the patient and his relatives. To get the most complete clinical picture, the patient passes tests: remembers images and words, reads, counts in his mind, etc. Imaging methods such as MRI, PET, CT are necessarily added to the tests.

MRI

Evaluation and screening of the patient may be consistent with many types of dementia. To establish an accurate diagnosis, studies of the brain are needed, since it is in it that the main changes occur. Magnetic resonance imaging shows the most characteristic changes in the structure of the brain. These include:

  1. Disturbed metabolism in cells.
  2. Cerebral atrophy. Due to disruption in neuronal connections and cell death, the brain shrinks, decreases in size and changes its original shape.
  3. Expansion of the ventricles and sulci.

In combination with the results of other studies and MRI, the chance of establishing an accurate diagnosis and choosing the right therapy increases.

CT

Sometimes the readings of one of the studies are sufficient if they are exhaustive. But for better visualization, the doctor can combine CT and MRI data. The doctor can see the x-ray density of a substance that changes with illness. For the patient, the examination process for MRI and CT is almost identical.

PET

A relatively new scheme for examining the brain is positron emission tomography (PET). It is considered the most effective method of research in the first stages of AD. The principle of PET is to visualize the molecular structure of the brain. This makes it possible to establish a diagnosis with maximum accuracy at any stage of the disease. The test subject is injected with a contrast agent and placed in a tomography machine.

The examination process is painless and safe, since the level of radiation is equal to the usual x-ray. Based on the readings of the device, the doctor can consider not the anatomical structure, but the functioning of the brain. This method of analysis registers the smallest deviations in the work of individual systems and organs. PET may be complemented by CT or MRI.

Treatment

The text is provided for informational purposes only. We urge you not to self-medicate. When the first symptoms appear, consult a doctor. Recommended reading: " Why can't you self-medicate?". There is no cure for AD. Unfortunately, the process of brain degradation in patients is irreversible. But timely examination, good care and symptomatic treatment improve the patient's quality of life. The earlier the disease is detected, the greater the chance of effective therapy. Drug candidates are already in clinical trials, and a new blood test has been discovered in Japan.

In the treatment of asthma, palliative measures are used that alleviate the disease and improve the patient's life. These include:

  1. Drugs that optimize synaptic transmission are acetylcholine esterases and memantine. They reduce and slow down the severity of cognitive disorders, support adaptation in everyday life. Drugs can be prescribed at the same time, as they affect different processes in the brain.
  2. Diet. The patient is given a menu based on concomitant diseases, the diet includes foods that contribute to the proper functioning of the brain.
  3. Therapeutic exercise (exercise therapy). Physical activity is just as necessary as mental activity. Patients are shown walking, yoga, light gymnastics, running, swimming.
  4. Supportive psychotherapy. The course of treatment includes work with a psychologist, a psychotherapist - a specialist prevents the development of depression and apathy, conducts cognitive retraining and orientation in reality. This point of treatment is especially important and effective in the initial stages of the disease.

In addition to medications, other preventive and curative procedures may be used. Also important for the patient is the support and help of loved ones, sensory exercises and memory therapy. To slow down the degradation process, hobbies, physical activity, intellectual games and tests are shown.

In most cases, in the last stages of the disease, patients are admitted to medical facilities where they can receive professional care. At this point, complex therapy narrows down to medication and symptomatic. Treatment methods in the last stages are designed to prevent the addition of infections and bedsores. Psychotherapy is no longer effective in this case. With proper treatment from the first stages, it is possible to prolong the life of the patient and maintain normal life for decades.

How to prevent disease

Asthma prevention is an active and interesting life. When a person's brain works constantly, new connections are formed in it between neurons. These connections replace other brain cells that have died for some reason. Since the root cause of the formation of plaques and protein tangles is still being studied, prevention methods are aimed at increasing the resilience of the brain.

To prevent Alzheimer's disease, it is recommended to constantly learn something new. This could be learning languages ​​or new hobbies, learning to play musical instruments, or driving a vehicle.

It is very useful to keep up with the times, master computers and the capabilities of telephones, electronic payment systems, etc.

Physical activity is good for both muscles and brain function. When playing sports, the blood is saturated with oxygen, which also reduces the risk of dementia. Treatment of diseases of the respiratory and cardiovascular systems - refers to both the prevention and treatment of asthma. The normal functioning of the respiratory system, blood vessels and heart reduces the risk of any type of dementia.

A study and analysis of the epidemiology of AD showed that Indians suffer from dementia 5 times less often than other races. Studies have shown that this situation may be caused by a large consumption of curry. This seasoning contains curcumin which reduces changes in the brain. If we talk about nutrition, it should be complete and varied, contain cereals and greens. Also, vitamins A, E, C, B12 ​​are also useful for the brain. They can be taken with food or as individual vitamins.

Consequences

The main danger of the disease is the disintegration of the personality. A person cannot fully live the entire period of illness, so a whole decade can “fall out” of his life. Dementia violates the attachment of patients to relatives and friends, in the stage of insanity a person is practically “absent”. Irreversible changes in the structure of the brain lead to actual paralysis, the patient is unable to help himself.

In the last stages of the disease, control over physiological processes is lost. Alzheimer's disease is a test for both the patient and the family. Due to a sedentary lifestyle that progresses to the stage of moderate dementia and worsens over the years, infections join.

Life expectancy

It is very difficult to give an individual prognosis, life expectancy in AD depends on many factors. First of all, it depends on the characteristics of the patient's body. The average prognosis from the moment of diagnosis is 7-10 years. Moreover, more often patients under 60 years old can live with the disease for 15 years or more. The older the patient, the shorter the life expectancy. Early diagnosis, complex therapy and quality care help prolong the life of the patient.

Causes of death

The disease itself does not cause death. From the decreased standard of living and activity, body weight falls, immunity decreases, other diseases are added. In asthma, death most often occurs from infections of the skin, urinary tract, and respiratory system. Cases of tragedies are not ruled out if a person is alone at home or on the street.

Sources
  1. Alzheimer's Association volunteer organization. – Alzheimer's disease and dementia in Russia.
  2. MSD MANUAL Professional edition. – Alzheimer's disease.
  3. Ravijuhend Portal. – Information about Alzheimer's disease (for patients and their loved ones) (PJ-G/24.1-2018).