Alzheimer’s disease is a neurodegenerative disease that affects the cognitive abilities of the patients. It causes degeneration and death of the brain cells, especially in the brain areas responsible for the cognitive, behavioral, and social skills, such as memory, thinking, language, and personality. Alzheimer’s disease is the most common cause of dementia; it accounts for about 60:80% of the cases of dementia. Dementia means loss of cognitive, behavioral, and social skills, such as thinking, reasoning, problem-solving, and memory. Dementia may occur due to other causes, such as vascular dementia, which occurs due to a problem in the blood supply of the brain. Dementia may be mild or severe to the degree that makes the patient full dependent on the others in his daily activities.
Alzheimer’s disease is the sixth leading cause of death in the united states, and recent estimates ranked it as the third leading cause of death. Alzheimer’s mostly affects people over 65 years old, but it also may affect younger people (early-onset Alzheimer). It affects 6% of those who are older than 60 years, and 5% of the cases are younger than this age.
Alzheimer’s disease is a chronic disease that starts mild and worsens over many years. The problem of Alzheimer’s in its early stages is that some patients consider the symptoms as a natural part of aging, which delays the search for medical aid and misses the chance to control the condition early. As the disease progresses, the patient starts to lose independence, become disoriented, and the quality of life declines. This nature of Alzheimer’s makes it a problem not only for the patient but also for his family and caregivers.
The exact cause of Alzheimer’s disease is unknown. Some risk factors may raise the risk of Alzheimer’s, such as old age, genetic mutations, positive family history, head injuries, untreated depression, and chronic diseases as hypertension and Diabetes Miletus. The researchers identified the deposition of two abnormal proteins in the brain tissue. These proteins accumulate with age, but, in Alzheimer’s, these proteins accumulate with a large amount and mainly in the brain areas that control cognition, behavior, and personality. These proteins interfere with normal brain functions by blockage of transmission of nerve signals among neurons. Also, these proteins destruct the brain cells, causing their death.
The early diagnosis of Alzheimer’s provides a chance to control the condition better, improve the quality of life, and slows the disease progression. But, the chronic nature of the disease makes the early diagnosis difficult; thus, the diagnosis of Alzheimer’s usually occurs later in the course of the disease. The doctor suspects Alzheimer’s through the history of symptoms, such as memory loss and behavioral changes. Then, the doctor will do some tests to exclude the other cause of dementia. Also, the doctor will ask about family history. After the exclusion of other causes of the symptoms, the doctor will test the mental and cognitive status of the patient to assess the disease severity and create the best management plan. The doctor may repeat the examination to evaluate disease progression.
We don’t know a current curative treatment, but the researchers do their best to find treatment for this disease that can cure it, delay its onset, and prevent its progression. The available treatment programs can temporarily relieve some of the symptoms, slow the disease progression, and improve the quality of life for the patient and the caregivers. Early diagnosis and treatment slow the decline in the mental functions and prolong the period of independence of the patient in his daily activities. Also, early diagnosis allows the family to put plans to deal with the patient, decrease the burden, and look for effective ways to support the patient’s life.
Learning about the symptoms of the disease allows you to suspect the cases of Alzheimer’s and seek medical aid early, which helps in disease control. Thus, we will discuss the clinical picture of Alzheimer’s in detail.
⇒ Now, let’s discuss the clinical picture & symptoms of Alzheimer’s disease.
The clinical picture of Alzheimer’s disease
As with everything in our body, the brain shows some weakness with age. This weakness appears in the form of slow thinking and temporary memory problems. But, severe memory problems and progressive deterioration in the mental function aren’t natural consequences of aging. In Alzheimer’s, we have the following symptoms:
1. Memory loss:
Memory affection is the main feature of Alzheimer’s. Natural people may have temporary lapses in memory, such as forgetting the place of keys. But, in Alzheimer’s, memory loss persists and worsens over time, which impairs the daily activities at work and home. Those patients:
- repeat questions and conversations over and over because they forget them
- get lost in familiar places
- forget appointments and events and don’t remember them later
- forget the names of family members and friends
- forget the names of everyday objects and their usual locations (he put them in unusual places)
- can’t find suitable words to express his thoughts, define the ordinary things, and can’t share in conversation
Memory problems start with difficulty remembering the newly learned information, then worsen over time.
2. Cognitive problems
Patients with Alzheimer’s have difficulties in thinking, reasoning, judgment, making reasonable decisions, planning, and multitasking. It is difficult for these patients to concentrate and think, especially with concepts, such as numbers. For example, they can’t easily manage financial issues, such as paying a bill. As the disease progresses, they may be unable to deal with numbers or recognize them.
Also, these patients face problems in making reasonable decisions and judgment in the situations of everyday life. For example, they may wear clothes unsuitable for the weather. They can’t respond to everyday problems, such as burning food or driving problems, because the disease impairs problem-solving skills.
Tasks that require successive steps represent a challenge for these patients, even familiar tasks. These can’t cook a meal, play a game, or open a computer. As the disease progresses, the patient may lose the ability to do basic tasks, such as bathing, dressing, and eating, which may affect the patient’s hygiene. Thus, the patient needs a caregiver who helps him in his daily and essential activities.
3. Personality and behavior problems
Patients with Alzheimer’s suffer from disturbances in their personality, mood, and behavior. They tend to withdraw from the community, family, and close friends. They may suffer from hallucinations (seeing and hearing things that don’t exist) and delusions (believing in untrue things). They may be uninterested in their usually enjoying activities. They may become depressed, apathetic, aggressive, irritable, and more worried than before. Also, they may be compulsive or obsessive. They may lose their trust in others. They also may have disturbances in their sleep habits.
4. Problems with the orientation to time and place
These patients have disturbances in balance, coordination, and orientation. For example, they may fall during walking or spill things. They don’t feel the clothes on their bodies during clothing. They become disoriented to time and place.
Later in the disease, patients with Alzheimer’s may have problems in reading, writing, speech, and recognition. They suffer during thinking in common words. They also make more errors during speaking and writing. Also, they experience difficulties during reading. The affection of these skills occurs later in the disease because Alzheimer’s affects the brain areas responsible for them later in the disease course.
With disease progression, Alzheimer’s represents another problem where the patient can’t communicate or express that he suffers from pain, such as dental pain. Also, he can’t complain if he has a symptom of other diseases. Also, it will be difficult for him to follow a management plan or notice or describe an adverse effect of a medication.
As we said before, Alzheimer’s disease is a chronic disease that starts gradually and worsens over a long period. Due to this chronic nature, the course of Alzheimer’s disease passes through four stages.
Alzheimer’s disease starts mild then becomes moderate, then progresses to the advanced or severe stage. Before these stages, there is a transition stage between natural aging changes and Alzheimer’s disease, and it is called pre-dementia or mild cognitive impairment (MCI).
⇒ Now, let’s discuss stages of Alzheimer’s disease.
Stages of Alzheimer’s disease
1) Pre-dementia
This stage is the prodromal or the preclinical stage of Alzheimer’s disease. It is a transition stage between the effect of aging and the dementia of Alzheimer’s. The most prominent features of this stage are problems in short memory, such as forgetting the recently learned information and difficulty in learning new information. The patient may be unaware of these early problems in memory.
Apathy may begin during this stage and persists through the course of the disease. Also, depression and irritability are common in this stage.
Problems in thinking, planning, and reasoning are usually asymptomatic in this stage.
This stage is also called mild cognitive impairment, which may occur with a lot of symptoms. When the memory problems are the predominant symptoms, it is called amnestic mild cognitive impairment, and it is usually a prodromal stage for Alzheimer’s.
The neuropsychiatric examination may reveal mild cognitive impairment even before the patient fulfills the diagnostic criteria of Alzheimer’s by years.
2) Mild (or Early) stage
In this stage, the doctor may be able to reach a definitive diagnosis. As the disease progresses, the problems in memory and learning increase, and the patient start to forget the names of his family and friends. The patient usually doesn’t remember the episodes of memory loss; thus, family and close people only can notice these changes. Alzheimer’s disease, in its early stage, affects the recent memory more than the older memory.
Also, during this stage, the patient may experience difficulty in financial issues, such as paying bills. He takes more than usual to do his daily tasks, and he may get lost in familiar places. He also may show some personality and behavior changes.
Some language problems may occur in this stage; the patient begins to lose the vocabulary and the word fluency, which leads to poor spoken and written language. During this stage, the patient is still able to deliver the basic ideas adequately. But, unnoticed problems in the more complex tasks may be present, such as writing, drawing, planning, balance, and coordination. Also, he may experience some unusual confusion.
With disease progression, the patient may start to need assistance in his daily activities.
In most cases, memory problems are more evident during this stage.
In this stage, the family and the close people around the patient has a vital role because they can notice the changes before the patient himself, which can help the early diagnosis and management of the case.
3) Moderate (or Middle) stage
In this stage, the disease progresses, the preexisting problems deteriorate, and the patient will lose new skills and abilities. Also, in this stage, the patient starts to lose his independence, which puts stress on the family and caregivers.
Memory problems deteriorate to the degree that involves the older memories and makes the patient unable to recognize his family, relatives, and friends. Language problems become more marked than in the previous stage. The patient forgets the essential words and replaces them with incorrect ones, which impairs the ability to communicate. Also, the patient loses the writing and reading skills progressively in this stage.
Behavior and personality problems increase and become more common. The patient may suffer from:
- Wandering: It represents the main problem for caregivers because they may lose the patient at night without appropriate clothes and because he can’t protect himself.
- Emotional incontinence: It is an emotional disturbance, which, during it, the patient shows sudden, unexpected, and uncontrolled emotions, such as laughing, crying, and aggression with resistance to the caregivers.
Also, the patients in this stage suffer from illusions and delusions, and they may show impulsive behavior. Multiple tasking (tasks that require sequential steps), such as clothing and bathing, becomes difficult for patients in this stage.
The patient also will be unaware of his disease and problems, which increases the stress on the caregiver.
4) Advanced (or Severe) stage
In this stage, the deposition of abnormal proteins involves nearly the whole brain, which may interfere with life. In this stage, the patient loses all of his independence and can’t do any of his daily activities alone. Apathy and exhaustion become the most common features of the patient. Language problems may reach complete speech loss, but the patient may understand the emotions and respond to them. The patient needs assistance in simple tasks, such as feeding; thus, he will be bedridden most or all of the time. The prolonged bedtime may result in bedsores and life-threatening infections, which may end in death.
Finally, Alzheimer’s disease needs good management and care to slow the progression. Thus, the knowledge about its manifestations and stages may enable you to suspect the cases around you early, and this gives the patient’s family a chance to plan and put a good management plan after looking for the best choices available for them.