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Alzheimer's disease is probably the best-known illness associated with advanced age. Find out how to recognise the warning signs.
Alzheimer's disease is a progressive, mysterious illness that robs people of their memory, personality and eventually all cognitive function. The disease is named after Alois Alzheimer, the German physician who first identified the condition during the autopsy of a woman who had suffered what was believed to be a mental illness in 1906.
Dr. Alzheimer discovered the clumps of plaques and twisted fibres of neurofibrillary tangles that resulted from the disease's destruction of nerve cells within the brain.
Incidence
Alzheimer's affects 20 million people worldwide. Around half of the 750,000 people in the UK who suffer from dementia are affected by Alzheimer's. It usually affects those aged 65 or older, but it can affect people young as 40, though this is considered rare.
Who's at risk?
New research from the United States suggests that optimism and a positive emotional outlook in early life may ward off the disease. This study also showed that stroke and head trauma may increase a person's risk for developing the debilitating disease. Diet and deficiencies of the nutrient folate, or folic acid, may also play a role, according to findings from a 1998 study in the UK.
The major risk factor is age. In the UK, five to ten per cent of people aged 65 to 74 and 20 to 25 per cent of people aged over 75 years of age suffer from it. There's some evidence that women are at greater risk than men, but this is probably because women live longer than men. It may be that genes play an important role in determining who will develop Alzheimer's, but only 15 per cent of sufferers have a positive family history.
Symptoms
For some individuals, early symptoms like forgetfulness, difficulty using or remembering words and difficulty concentrating get mistaken for what many people consider "natural" symptoms of aging. But in Alzheimer's they will get worse over time. The short-term memory problems that trouble many people as they age don't progress to more serious symptoms.
The severity and progression of AD symptoms do not follow any pattern; some people have AD only for the last five years of their life, while others may live with it for as many as 20 years.
Mild symptoms include:
Confusion and memory loss
Personality changes
Judgment problems
Difficulties with routine tasks
Getting lost or disoriented in familiar places
Moderate symptoms include:
Difficulty with personal care such as bathing and dressing
Anxiety, agitation and paranoia
Insomnia or sleep disturbances
Wandering and pacing
Trouble with or inability to recognise familiar faces
Severe symptoms include:
Loss of speech
Loss of appetite
Loss of bladder and bowel control
Complete dependence on caregiver
Diagnosis
There is no simple, single test used to diagnose AD. Although healthcare professionals skilled in treating people with Alzheimer's can diagnose "probable" Alzheimer's, the only definitive way of identifying Alzheimer's is to look at a piece of brain tissue under a microscope during an autopsy. Surgery is considered too high risk an option for diagnosis.
Warning signs
Memory loss: frequent forgetfulness or unexplainable confusion
Difficulty performing familiar tasks such as not being able to remember how to brush teeth
Language problems: forgetting common and simple words
Disorientation, like getting lost frequently in familiar places
Poor or decreased judgment, such as wearing pyjamas to the supermarket
Performing basic calculations that were once a common task is now sometimes impossible
Misplacing things
Changes in mood or behaviour and personality changes
Loss of initiative: someone may lose interest in one or more of their usual interests
Investigations
GPs, as well as neurologists and geriatricians (people who care for the elderly), diagnose and treat Alzheimer's. Diagnosis will require thorough medical history details and a family interview, including questions about the patient's current mental and physical conditions.
Neurological tests, including a computerised tomography (CT) scan, as well as a mental health evaluation with memory-related questions, blood tests, blood pressure screening, ECG, EEG and urine tests will all be necessary to exclude other causes of ill health.
However, in the earlier stages of Alzheimer's, brain scan results are often normal, as the plaques and tangled neuron fibres won't show up on a scan. A brain scan can help to identify other neurological problems, such as stroke.
Treatment
While there is no cure yet available for Alzheimer's, there are a handful of medical treatments that can help alleviate some of the behavioural and cognitive symptoms resulting from the disease.
Two drugs are available in the UK that may slow mental deterioration. Donepezil (Aricept) and rivastigmine (Exelon). An investigation into the benefits of vitamin E and selegiline - a drug used in the treatment of Parkinson's disease - is ongoing.
When to seek medical advice
If you think you have Alzheimer's or suspect someone you know might be experiencing symptoms of the disease, it's important to consult with medical professionals as soon as possible. Early diagnosis can help to rule out other medical reasons for symptoms.
Because AD eventually affects an individual's ability to care for him or herself, short- and long-term planning is recommended. Care support, a living will and end-of-life decisions, among other things, should be discussed with your family.
Prognosis
Alzheimer's disease is a progressive degenerative disease, and patients ultimately lose the ability to care for themselves. The rate of progress is variable, and following diagnosis the majority of patients continue to live in the community with support until the last years of their life.
Helpful organisations
Alzheimer's Disease Society
Gordon House
10 Greencoat Place
London SW1P 1PH
Helpline: 0845 3000 336
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