Alzheimer's disease is a disease that leads to the death of brain cells. It is accompanied by severe mental and functional disorders. One of the diseases of the central nervous system, the mechanisms of occurrence of which are still not fully understood.
Diagnostic Methods
The main tool in research on the development of dementia is neuroimaging. To do this, use CT, MRI, PET of the brain. The doctor considers the degree of damage to individual lobes, and also assesses the possible causes and associated diseases.
Using the EEG procedure allows you to observe brain activity and the degree of disturbance of neural connections. Laboratory tests confirming Alzheimer's show a sharp decrease in α-β-42 and a simultaneous increase in tau protein.
Causes of Alzheimer's
The essence of Alzheimer's disease has not yet been disclosed by scientists to the end. Today, there are only a few theories about the causes of the onset and development of the disease, but not one of them has yet received worldwide recognition. The leading place among the hypotheses put forward is the genetic factor.
Among other things, there are 3 groups of risk of morbidity:
- uncorrectable;
- partially correctable;
- correctable.
Alzheimer's disease, the causes and treatment of this disease - all these issues with uncorrectable factors are quite complex and unresolved at the moment.
Genetic Development Factor
Hereditary pathology accounts for up to 10% of all recorded cases of the disease. The development of Alzheimer's disease by the genetic mechanism begins earlier than 65 years. The gene is transmitted in an autosomal dominant manner: even if the second parent is not a carrier, the healthy gene transferred to them is replaced by a pathological one. The probability of transmission to a child usually occurs in half the cases.
Despite the proven genetic factor, scientists are convinced that different types of chromosomes contribute to the development of the disease. More recently, in the course of research, a defect in the gene of the 14th chromosome was discovered, which in 70% of cases leads to the development of the disease.
Violations of the 21st chromosome that cause Down's disease in 5% of cases lead to the early development of Alzheimer's disease. The rarest pathology - a gene defect of the 1st chromosome - has a low probability of a "family" disease.
High Risk Factors
Non-correctable causes are a congenital or acquired anatomical or physiological pathology that can no longer be cured or altered. These factors include:
- senile age (over 80 years);
- gender affiliation;
- skull injuries;
- severe depression, stress;
- lack of “training” for intelligence.
Partially correctable factors make up a group of diseases that cause acute or chronic lack of oxygen in the cells of the cerebral cortex:
- hypertension;
- atherosclerosis of the vessels of the neck, head, brain;
- violation of lipid metabolism;
- diabetes;
- heart disease.
Eliminating diseases reduces the risk of Alzheimer's.
Correctable - completely eliminated - factors include:
- reduced physical activity;
- lack of intellectual development, limited;
- non-compliance with the basic principles of healthy lifestyle.
Pathologies are not a 100% guarantee of the development of the disease, but often precede it, which allows us to conclude about possible risk factors and prevention.
Developmental stages
Scientists have found that Alzheimer's disease (initial symptoms) appears 15-20 years before the pronounced clinical picture, which greatly complicates the prevention of the development of the disease. To date, 3 stages of the pathological process have been distinguished:
- Preclinical - pathology is in its infancy, CNS disorders are not observed.
- Period of minor impairment - patients may notice a decrease in intellectual abilities and memory impairment.
- The initial degree of dementia - the close environment begins to notice something is amiss. Most often, you can confirm the presence of the disease clinically.
Each of the stages has its own characteristic features and approaches for providing medical care.
The development of the disease at a young age
Early Alzheimer's disease develops before the age of 65; it is difficult to diagnose it in time due to the non-specific clinical picture. The first signs appear in the form of forgetfulness, inability to plan and do those things that were previously easy. The patient gets tired of mental work faster: keeping information in memory is becoming increasingly difficult.
Alzheimer's disease: causes and early treatment
The initial stage develops over 7 years. Initial changes in the patient's condition occur under the influence of various factors. In the case of an established cause, all forces are sent to eliminate it. As a rule, local treatment gives good results.
Alzheimer's patients may complain of:
- memory impairment;
- the occurrence of forgetfulness;
- loss of ability to think;
- psycho-emotional disorders.
Perhaps Alzheimer's disease has already become noticeable to relatives. Initial symptoms do not always directly indicate brain dysfunction, but many still seek medical help and find out about the diagnosis in time.
Memory impairments are short-term and long-term in nature, while the patient is not always able to notice deterioration. The most disastrous forgetfulness: often people with Alzheimer's disease leave gas or electricity turned on, which leads to emergency situations. Perhaps the manifestation of the loss of long-term memory in the form of forgetfulness of past events. Partial restoration of memory occurs during associations. Memory impairments are rapidly progressing: after 6 months, the symptoms become more pronounced and life-threatening to the patient.
Loss of ability to think depends on the level of intelligence before the development of the disease. Sometimes a sharp change of interest becomes a characteristic symptom: watching TV instead of reading complex literature and other cases. The process of information processing and environmental perception is disrupted, as a result of which the patient is lost in space and time.
Mental disorders as the driving force of Alzheimer's
Serious psychoemotional problems can cause Alzheimer's disease. The causes and treatment of such symptoms lie in brain damage and impaired conduction of nerve impulses. Insufficient synthesis of acetylcholine leads to the formation of amyloid plaques. Prolonged depressive states adversely affect the functioning of the nervous system, and dementia develops against the background of weakened activity.
Violations of the emotional state provokes Alzheimer's disease. The initial symptoms of a mental disorder are expressed in severe anxiety, the commission of abrupt and unnecessary actions, complaints of restless and intermittent sleep. At times, there are attacks of acute psychosis, characterized by a panic fear of persecution, longing. They provoke a state of change of any nature: from moving furniture to moving to another home. The progression of the disease is accompanied by a change in general anxiety to indifference. Treatment of a person with severe mental disorders involves, in particular, the use of antidepressants and psychotropic drugs.
Alzheimer's disease: causes, treatment at the 2nd stage
Serious memory damage, characteristic exclusively for this disease, becomes noticeable and more severe in the second stage of the development of pathology. The patient can no longer recall individual events even with the associative and other help of relatives. First of all, patients forget recent incidents, while the distant past still remains in their memory.
Violations of short-term memorization lead to erroneous orientation in time. Dementia sufferers are not able to accurately determine the time span of an event. In the stage of moderate development of the disease, memory is filled with non-existent memories that may have bizarre content.
Progression leads to a complete loss of baggage of knowledge, especially acquired in mature years and having a complex structure. Only those skills that were grafted from early childhood and are repeated throughout life are preserved. For example, knowledge of the native language, ways of communicating with people and self-service.
A distinctive feature of dementia in stage 2 is the preservation of emotional memory and the lack of actual. Often, patients do not remember whether they have children or grandchildren, but contact with them causes revival, joy.
Loss of intelligence
The dominant factor of the 2nd stage is a violation of mental abilities, which ultimately leads to a loss of independence. Developing dementia can be divided into mild, moderate and severe.
The manifestation of mild dementia is expressed in the loss of the ability to manage money: it is not possible to correctly fill out accounts, to calculate the amount payable. The acquired vocabulary is gradually lost, speech becomes scarce. Usually patients at this stage try to avoid communication. The fine motor skills of the hands are disturbed , which leads to illegible writing. Gross grammatical errors appear that were not there before.
Moderate dementia is characterized by the loss of writing and reading skills, often the patient’s speech becomes incomprehensible due to forgetfulness of words, followed by replacement with similar ones. A person becomes more helpless: unable to dress on their own on the weather, find their way home, forgets to turn off the stove or water. At the 2nd stage of Alzheimer's disease with moderate dementia, the patient already needs constant help and the presence of relatives.
Severe dementia
The last stage of Alzheimer's disease is characterized by complete dependence on other people. The patient is not able to independently take food, go to the toilet, conduct hygiene procedures. The speech becomes incoherent and incomprehensible, the gait is disturbed, which makes independent movement difficult.
The swallowing reflex is also gradually disturbed. Death occurs as a result of prolonged exhaustion of the body from sepsis or serious diseases.
Parkinson's disease dementia
Parkinson's and Alzheimer's disease for an ordinary person has a similar clinical picture, only a qualified specialist can make an accurate diagnosis. Emerging dementia has distinctive features. Alzheimer's disease is characterized by a more serious impairment of memory and intelligence. With parkinsonism, only a slowdown in speech and thinking is observed. A common feature of neurodegenerative diseases is the deterioration of the psychoemotional state. Patients for a long time are in a state of depression and acute psychosis.
The pictures show that Alzheimer's disease (photo above) and Parkinson's (photo below) affect the brain to varying degrees. The first ailment develops in the temporal lobe and the hippocampus, arising amyloid plaques lead to the death of nerve connections (the brain begins to “dry out”).
Parkinsonism affects the musculoskeletal system to a greater extent: the spine bends more and more, the patient becomes lower and lower. Concerned by the ongoing tremor of the hands, movements become discoordinated.
Initial stage treatment
We examined in general terms what constitutes Alzheimer's disease. The causes and treatment of the disease at the moment are not fully understood by science. Doctors are constantly conducting research in search of an effective medicine, but so far no unique drug has been created that can defeat the disease.
The treatment is carried out comprehensively, consisting of:
- therapy for mental disorders;
- general strengthening of the body;
- establishing metabolism in the brain;
- vascular strengthening;
- general Alzheimer's therapy.
It is important to start taking medications on time and monitor the careful implementation of all medical recommendations. You need to observe the development of the disease in dynamics.
To treat mild to moderate dementia, these drugs are used:
- "Pyribedil" - improves the transmission of nerve impulses in the dopaminergic and norepinephrine synapses of the central nervous system. Improve memory and mental abilities.
- "Pentoxifylline", "Vinpocetine" - improve blood circulation, prevent the formation of blood clots in the vessels of the brain.
- Ginkgo biloba extract - stimulates the production of neurotransmitters, protects brain cells from toxins, improves blood circulation.
- "Cinnarizine", "Nimodipine" - dilate the vessels of the brain, protect cells from the harmful effects of excess calcium.
- Pyrrolidone and its derivatives - improves the oxygen supply of the brain, contributes to the normalization of protein synthesis in brain cells.
- "Actovegin", "Cerebrolysin" - contribute to the restoration of information chains, stimulate the processes of intracellular exchange.
Hormone therapy
Scientists agreed that the development of Alzheimer's disease contributes to a decrease in the synthesis of acetylcholine. The balance between the production of acetylcholinesterase and the neurotransmitter acetylcholine is disturbed, which causes inhibition of the functions of neurons. Cells become shriveled, the synapse space is empty, and neurons die. An autopsy in 100% of cases confirms Alzheimer's disease. A photo of the brain of a healthy and sick person allows you to see the pathology even to an ordinary person.
Reducing the synthesis of acetylcholinesterase allows you to restore the interaction between neurons and slow down the formation of amyloid plaques. Clinical trials have shown the effectiveness of cholinesterase inhibitors. Patients have a decrease in dementia, memory is restored, self-care skills and orientation in space and time return.
To date, 3 drugs blocking cholinesterase are generally recognized:
- "Aricept" ("Donepezil", "Aricept") - has a central effect, it is used 5-10 mg per day.
- "Reminyl" (galantamine hydrobromide) - has a general effect, is practically non-toxic, concentrates well. Apply 8-12 mg per day.
- "Exelon" ("Rivastigmine") - has a central effect, more effective than other drugs in rapidly progressive forms of Alzheimer's disease. Available in the form of tablets, patch, solution. The initial dose is 3 mg per day.
The use of cholinesterase inhibitor medications gives approximately the same results, however, each patient has a different response to hormone therapy. If one of the drugs does not fit, the doctor replaces it with an analog. It is possible to judge the results of treatment only after a three-month course at the maximum permissible dosage.
The main contraindications are diseases of the gastrointestinal tract, heart and urinary tract. The use of bronchial asthma and epilepsy is also not recommended.
Treating severe dementia
Irreversible brain changes cause Alzheimer's disease. The causes of the pathology is a question that constantly torments researchers. At the last stage of the disease, it is possible to use only one drug approved by world medicine - Memantine. Degenerative processes in neurons are no longer controlled by cholinesterase alone, the situation is becoming more complicated. Brain astrocytes begin to produce a toxin - glutamate, which destroys neurons and the astrocytes themselves.
Memantine regulates glutamate metabolism, which prevents brain intoxication. Many experts practice the use of "Memantine" in conjunction with cholinesterase inhibitors, which often gives good results.
The drug is well perceived by the body, has few contraindications (epilepsy and impaired renal function). The US and EU countries have been using Memantine to treat Alzheimer's disease for 10 years.
Symptomatic therapy
The treatment is based on the use of selective serotonin reuptake inhibitors (Fluoxetine, Citalopram) and norepinephrine. In addition to the positive effects on the psyche, drugs help eliminate signs of mild dementia. The use of typical antidepressants can lead to the development of Alzheimer's disease, therefore, with severe depression, tricyclic antidepressants are prescribed.
With psychotic disorders, antipsychotics are used. However, it should be borne in mind that they increase the manifestation of dementia. They are used only in extreme cases, and doctors prescribe exclusively mild drugs.