How to Diagnose and Treat Alzheimer’s Disease
There is still no remedy for Alzheimer’s disease, the dreaded, debilitating illness that now plagues tens of millions of people worldwide. But there are some treatments that can hold back its progress. The symptoms typically associated with Alzheimer’s disease, such as loss of memory, mood changes, delusions and disorientation, are actually symptoms of dementia whereby Alzheimer’s is by no means the only possible cause of it.
In fact, dementia can be also caused by a number of other, often treatable, disorders such as depression, alcoholism, head injury, encephalitis or thyroid disease. For example, one form of dementia, called multi infarct dementia, is the result of multiple strokes, hence, by treating high blood pressure, an underlying cause of the strokes, the symptoms of dementia can be reduced. It is estimated that there are more than seventy different medical conditions that can cause symptoms similar to those of Alzheimer’s.
Causes and Risk Factors for Alzheimer’s Disease
The incidence of Alzheimer’s disease typically increases with age, e.g. 10% over age 65 and nearly 50% over 85. The only established risk factors, other than age, are family history and genetics, although scientists are looking into other possible causes that might be involved. Circa 15% of patients with Alzheimer’s have a strong family history of the disease, often with early onset (in the 50s, 40s or even 30s), also known as familial Alzheimer’s disease.
Genes also seem to play a major role in the most common form of Alzheimer’s disease, known as sporadic, late-onset Alzheimer’s, occurring after age 65. The presence of a gene that produces a protein called apolipoprotein E4 (APOE4) appears to increase a person’s risk of developing late-onset Alzheimer’s. But that gene alone does not seem to be enough to cause the disease. Other genes and possibly other factors also influence who gets Alzheimer’s disease and when.
Some studies suggest other possible risk factors, such as thyroid disease, head injury and high blood pressure. Some scientists see a similarity between Alzheimer’s and heart disease that can be caused by the interaction of several factors, both genetic and environmental. For example, it was found that Alzheimer’s patients have high blood levels of homocysteine, a substance associated with heart disease and low levels of vitamin B9 (folic acid) and vitamin B12. But, neither heart disease nor low levels of these two vitamins necessarily lead to Alzheimer’s disease.
Since we do not know yet what causes Alzheimer’s and there is no effective cure for it, doctors are emphasizing symptom control through medication and lifestyle changes to improve the quality of life for people with this disease and their families.
Diagnosing Alzheimer’s Disease
There is practically no such thing as a definitive diagnostic test for Alzheimer’s disease. That means Alzheimer’s basically is a diagnosis of exclusion, i.e. the diagnosis is made only after ruling out other possible causes of the existing symptoms. This is done by a complete clinical examination which includes taking a person’s medical history and conducting a physical exam, neuropsychological tests and other tests of mental ability. Close observation by family members is important too since they are the ones most frequently relied upon for feedback about the person under evaluation.
Neuropsychological tests are conducted to examine functions, such as balance and coordination, as well as sensory abilities, such as pain sensitivity. Tests are also used to determine a patient’s ability to remember numbers and objects and orientation to time, place and person. Other tests include blood and urine analyses and an examination of spinal fluid. The aim of these tests is to detect decreased levels of Vitamin B9 and B12 in blood and an elevated protein level in urine and spinal fluid, which are characteristic of Alzheimer’s disease.
Brain imaging, such as computerized tomography (CT) scanning, magnetic resonance imaging (MRI), magnetic resonance spectroscopy imaging (MRSI), positron emission tomography (PET) scanning or single-photon emission computed tomography (SPECT) scanning may be used to detect abnormalities in the brain, such as abnormal sugar metabolism, and exclude other conditions. A biopsy of brain tissue can also be performed in order to detect characteristic plaques and neurofibrillary tangles though it is rarely done.
The course of Alzheimer’s disease is really difficult to project. The disease can run anywhere from three to twenty years, with the average being about eight years. Although the speed of its progression and the types and extent of impairments vary greatly from person to person, eventually all patients with Alzheimer’s disease lose their ability to function and need to be cared for.
In the early stages, patients with Alzheimer’s disease show minor symptoms that are often blamed on emotional stress and old age. They may misplace things or fear going out, preferring to stay home. Gradually, they become increasingly more forgetful, particularly about most recent events.
As the disease progresses, memory loss worsens and other symptoms, such as confusion, mood disorders, irritability, behavior problems and aggressiveness, are likely to emerge. In the middle stages, judgment and decision-making abilities deteriorate noticeably. It is not uncommon for Alzheimer’s patients at this stage to deny or be unaware of the full extent of their limitations.
In the later stages, physical problems appear, including loss of coordination, lack of personal hygiene, loss of speech and incontinence. Some patients eventually lose the ability to walk, eat and swallow and may require round-the-clock care.
Treatments for Alzheimer’s Disease
At this moment only four medications are approved by the Food and Drug Administration to treat cognitive problems associated with Alzheimer’s: acetylcholinesterase inhibitors, such as rivastigmine (Exelon), donepezil (Aricept), galantamine (Razadyne), and an NMDA receptor antagonist memantine (Namenda).
Acetylcholinesterase inhibitors prevent the loss of acetylcholine, a chemical messenger, essential for normal brain function, which is deficient in Alzheimer’s patients. These medications produce modest improvements in some patients with mild to moderate symptoms. However, some doctors believe that, even when no actual improvement can be seen, they may halt deterioration for several months or more.
Memantine is a different class of drug and it works by blocking excess activity of glutamate, a substance in the brain which is believed to reduce the symptoms of Alzheimer’s disease. Memantine has been shown to produce small improvements in some patients with moderate-to-severe Alzheimer’s disease. It is important to realize that medications will not help everyone while they may induce negative side effects, such as nausea, vomiting, diarrhea or constipation and headaches.
Other Potential Remedies for Alzheimer’s
Researchers have long observed that arthritis patients are less likely to fall victim of Alzheimer’s disease. It is now believed that the so-called nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen and possibly even aspirin, which are the primary treatment for arthritis, can also help to fend off Alzheimer’s disease. In fact, inflammation is a contributory factor in the formation of the plaques and tangles that characterize Alzheimer’s. The latest research shows, however, that NSAIDs are only effective in preventing the disease, not as a treatment for an existing condition.
Another interesting fact observed in several studies is that postmenopausal women on estrogen replacement therapy have a lower incidence of Alzheimer’s disease. It is now believed that estrogen plays a key role in the production of the acetylcholine that Alzheimer’s patients are deficient in, while blocking deposits of harmful plaque. However, lot more research is needed to show whether estrogen therapy (estradiol) can really help to fend off Alzheimer’s disease in post-menopausal women. It is also important to note that estrogen can increase a woman’s risk of stroke, heart attack and breast and uterine cancers.
Vitamin E therapy is considered as another potential remedy that may slow the progression of Alzheimer’s, possibly because of vitamin’s E antioxidant properties. Damage to brain cells is accelerated when free radicals combine with the substance that creates the harmful plaque found in Alzheimer’s. However, many doctors do not recommend vitamin E therapy, as there is little scientific evidence that it is effective.
In order to treat some symptoms of Alzheimer’s disease, such as depression, anxiety, agitation, restlessness, sleeplessness, aggression, delusions and hallucinations, doctors may prescribe mood-altering drugs. There are a number of different antidepressants to choose from. However, some of these medications have side effects such as confusion, memory loss, drowsiness and incontinence that can actually make the Alzheimer’s disease seem worse.
Although there is not much scientific evidence to date to support the use of nondrug techniques in the treatment of Alzheimer’s disease, some experts believe that yoga, relaxation exercises, visualization, meditation and aromatherapy can calm patients with Alzheimer’s disease, thus reducing the severity of their symptoms. Regular physical exercise may also help. There is also increasing appreciation of the role the environment, such as extraneous noise, plays in relieving symptoms. There are no specific foods or diet that can help Alzheimer’s patients but a generally healthy diet remains important as individuals with Alzheimer’s disease, like everyone else, feel better when they are physically fit.