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Alzheimer’s disease Causes, Symptoms and Treatment

The Alzheimer’s disease is a degenerative disease that causes a progressive decline in cognitive function and memory . Gradually, destruction of nerve cells occurs in brain regions related to memory and language. Over time, it is increasingly difficult for the person with memory to remember events, to recognize objects and faces, to remember the meaning of words and to exercise judgment.

In general, the symptoms appear after 65 years and the prevalence of the disease increases sharply with age. However, contrary to popular belief, Alzheimer’s disease is not a normal consequence of aging.

The Alzheimer’s disease is the form of dementia most common in the elderly; it accounts for about 65% of dementia cases. The term dementia includes, in a very general way, health problems marked by an irreversible decrease of mental faculties . Alzheimer’s disease differs from other dementias in that it evolves gradually and mainly affects the short-term memory in its early stages. However, the diagnosis is not always clear and it can be difficult for doctors to differentiate Alzheimer’s disease from Lewy body dementia, for example.

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Is there a difference between normal aging and Alzheimer’s disease?

According Judes Poirier, a researcher at the University Institute Douglas Mental Health, Alzheimer’s can be seen as a form very accelerated aging. In theory, if we lived to 150 or 160 years, it is almost certain that we would all have Alzheimer’s. According to the researcher, for Alzheimer’s to occur in one’s 60s, one must be predisposed to the disease by heredity, lifestyle, and so on.

Prevalence

The Alzheimer’s disease affects about 1% of people aged 65 to 69, 20% of those aged 85 to 89 years and 40% of those 90 to 95 years. In Canada, about 500,000 people have Alzheimer’s disease or a related disease.

It is estimated that 1 in 8 men and 1 in 4 women will suffer during their lifetime. As women live longer, they are more likely to be infected one day.

Due to the prolongation of life expectancy , this disease is becoming more common. It is estimated that within 20 years the number of people will double in Canada.

Brain attack

The Alzheimer’s disease is characterized by the appearance of lesions very specific that gradually invade the brain and destroy its cells, the neurons . The neurons of the hippocampus, the region that controls memory, are the first affected. We do not know yet what causes the appearance of these lesions.

A German neurologist, gave its name to the disease in 1906. He is the first to describe these brain injuries during autopsy of a dead woman with dementia. In his brain, he had observed abnormal plaques and tangles of nerve cells now considered the main physiological signs of Alzheimer’s disease.

Here are the 2 types of damage that occur in the brains of people with:

  • Excessive production and accumulation of beta-amyloid proteins in certain areas of the brain. These proteins form plaques , called amyloid plaques or senile plaques that are associated with neuron death.
  • The “deformation” of some structural proteins (called Tau proteins ). The way the neurons are entangled is then modified. This form of injury is called neurofibrillary degeneration .

To these lesions is added inflammation that contributes to altering the neurons. There is still no treatment that can stop or reverse these pathological processes.

Causes of Alzheimer’s disease

The causes of Alzheimer’s disease are not known. In the vast majority of cases, the disease appears due to a combination of risk factors. The aging is the main factor. Risk factors for cardiovascular diseases (hypertension, hypercholesterolemia, obesity, diabetes, etc.) also seem to contribute to its development. It is also possible that infections or exposure to toxic products play a role in some cases but no formal proof has been obtained.

The genetic factors also play an important role in causing the disease. Thus, some genes may increase the risk of being affected, although they are not directly the cause of the disease. Indeed, researchers have discovered that about 60% of people with Alzheimer’s disease carry the Apolipoprotein E4 or ApoE4 gene. Another gene, SORL1, also seems to be often involved. However, many individuals carry these genes and will never have the disease and, conversely, some people without these genes can develop the disease.

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There are also hereditary forms of the disease but they account for less than 5% of cases. Only 800 families have been listed in the world. Children with a parent with Alzheimer’s disease in its hereditary form have 1 in 2 risk of having the disease themselves. Symptoms of the familial form appear early, sometimes before age 40. However, even if several members of the same family are affected by this disease, this does not necessarily mean that it is the hereditary form.

Evolution of the disease

The Alzheimer’s disease evolves over several years and its progression varies greatly from one person to another. We now know that the first lesions appear in the brain at least 10 to 15 years before the first symptoms.

These usually appear after the age of 60 years. On average, once the disease starts, life expectancy is 8 to 12 years. The older the disease, the more it tends to get worse quickly. When it occurs around the age of 60 or 65, life expectancy is about 12 to 14 years; when it occurs later, life expectancy is only 5 to 8 years. It is currently impossible to stop the evolution of the disease.

  • Light stage. Of memory loss occurs occasionally. Short-term memory that is, the ability to retain recent information (a new phone number, the words in a list, etc.), is the most affected. People with Alzheimer’s disease try to overcome their difficulties by using reminders and their loved ones. Mood changes and slight disorientation in space can also be observed. The person has more trouble finding their words and following the thread of a conversation.

    At this point, it is not certain whether it is Alzheimer’s disease. Over time, symptoms may remain stable or even decrease. Diagnosis is confirmed if memory problems become worse and other cognitive functions deteriorate (language, object recognition, complex motion planning, etc.);

  • Moderate stage. The memory problems are amplified. The memories of youth and middle age become less accurate but are better preserved than immediate memory. It is increasingly difficult for people with choices to make choices; their judgment begins to be altered . For example, they are gradually becoming more difficult to manage their money and plan their daily activities. Disorientation in space and time becomes more and more obvious (difficulty remembering the day of the week, birthdays …). Affected people have more and more difficulty expressing themselves verbally;

    between the moderate and advanced stages, unusual behavioral problems sometimes arise: for example, aggression, atypical, fouls language or a change in personality traits.

  • Advanced stage (or terminal). At this point, the patient loses his autonomy . A permanent monitoring or accommodation in a nursing home becomes necessary. Psychiatric problems may occur, including hallucinations and paranoid delusions, aggravated by severe memory loss and disorientation. Sleep problems are common. Patients neglect their personal hygiene, become incontinent and struggle to feed themselves. If left unattended, they can roam for hours.

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The person can die of another disease at any stage of Alzheimer’s. However, in its advanced stages, Alzheimer’s disease becomes a deadly disease , such as cancer. Most deaths are caused by pneumonia caused by difficulty swallowing. Patients may allow saliva or some of what they eat or drink into their airways and lungs. This is a direct consequence of the progression of the disease. Alzheimer’s disease is now the 7 Th  leading cause of death in Canada, according to Statistics Canada.

Diagnostic of Alzheimer’s disease

Warning: it is not because you forget your keys, an appointment or the name of someone who has Alzheimer’s disease. These occasional forgetfulness is normal at any age and is usually related to inattention. If they are common, they can mask a depressive or anxious state. Only tests done by a doctor can determine if one is suffering from a real memory disorder. Often, family members are worried about their loved ones and ask for a consultation.

To make the diagnosis , the doctor uses the results of several medical examinations. First, he questions the patient to find out more about how his memory loss and the other difficulties he experiences in everyday life are manifested. Of tests to assess cognitive faculties are made, as the case of vision tests, writing, memory, problem solving, etc. In case of memory impairment, even with attention, the patient’s test performance will be abnormal.

In some cases, various medical tests may be performed to rule out the possibility that the symptoms are attributable to another health problem (vitamin B12 deficiency, malfunction of the thyroid gland, stroke , depression, etc.).

If deemed necessary, the physician may also advise the patient to undergo a brain imaging test(preferably an MRI, magnetic resonance imaging) to observe the structure and activity of different areas of his brain. Imaging can highlight the loss of volume (atrophy) of certain areas of the brain, characteristic of degeneration of neurons.

The hope of early diagnosis

There is a great deal of research going on around the world to create tools to diagnose disease at an earlier stage, when memory loss is mild, or even before the onset of symptoms. In fact, the disease sets in insidiously long before the symptoms of dementia appear. Several tests, still experimental, show that it is possible to obtain an early diagnosis: memory tests, brain imaging tests or blood tests or cerebrospinal fluid .

The symptoms of Alzheimer’s disease

  • Alteration of short-term memory (name of new people encountered, events of previous hours or days, etc.);
  • Difficulty retaining new information;
  • Difficulty performing familiar tasks (locking doors, taking medications, finding things, etc.);
  • Difficulty in language or aphasia (difficulty finding words, speech less understandable, use of invented or inappropriate words);
  • Difficulty following a conversation, a path of thought;
  • Difficulty or inability to plan (meals, budget, etc.);
  • Gradual loss of sense of direction in space and time (difficulty finding the day of the week, remembering the season, birthday, time of day, unable to find his way. ..);
  • Disorders of gestures or apraxia (difficulties to write, to button his jacket, to use everyday objects, to wash …);
  • Difficulty in grasping abstract notions and reasoning;
  • Difficulty in recognizing objects, the faces of relatives ( agnosia );
  • Progressive impairment of long-term memory (loss of childhood memories and adulthood);
  • Changes in mood or behavior, sometimes aggression or delirium;
  • Personality changes;
  • Gradual loss of autonomy.

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People at risk for Alzheimer’s disease

  • People aged 60 and over. The age is the main risk factor: the risk of developing the disease doubles every 5 years from 65;
  • The women (because they live longer than men);
  • People who have a parent , brother or sister with Alzheimer’s disease. Their risk of being reached in turn is increased by 10% to 30% compared to the rest of the population;
  • People whose parent has the inherited familial form of Alzheimer’s disease. Children with an affected parent have a 50% chance of having the disease themselves;
  • People of Hispanic and African American origin are more likely to have the disease (up to 2 times more).

Risk factors

Most important factors

  • Systolic hypertension;
  • High cholesterol;
  • Diabetes poorly controlled by medication
  • Smoking.

Lesser factors

  • Serious head trauma with loss of consciousness (occurring, for example, in boxers);
  • Obesity;
  • Personal history of depression.

Prevention of Alzheimer’s disease

Can we prevent?
Currently, there is no clearly effective way to prevent Alzheimer’s disease. Some measures, however, seem to help preserve cognitive abilities and reduce the risk of developing the disease. Here are the most studied.
Preventive measures at the research stage

General measures

It is possible to reduce the risk of suffering from Alzheimer’s disease by intervening medically, paying attention to lifestyle habits (healthy eating, exercise, etc.) and avoiding certain risk factors, such as high blood pressure. , diabetes, hypercholesterolemia and smoking.

The hormone replacement in women at the age of menopause or anti-inflammatory drugs intake (such as aspirin and ibuprofen) could provide some protection against Alzheimer’s disease, according to studies population, but the prospective studies on this subject have proved negative.

Food

For general advice on the key elements of a healthy diet.

Various studies have been conducted to find out if a particular diet could prevent Alzheimer’s by delaying aging. Here are 3 avenues currently explored:

  • The Mediterranean diet . This type of diet typical of countries bordering the Mediterranean protects against cardiovascular diseases and improves life expectancy. It is distinguished, in particular, by a large consumption of olive oil, fruits, vegetables and fish and by a moderate ingestion of red wine (to know more, see our chart Mediterranean diet).

This diet could help prevent Alzheimer’s disease. A prospective study conducted in 2006 among 2,258 Americans indeed indicates that people whose diet is closest to the Mediterranean diet are less likely to suffer from Alzheimer’s disease. The same team of researchers also noted that this type of diet reduces mortality associated with the disease.

These observations were confirmed in 2009 by a study conducted on a cohort of 1,796 French people aged 65 and over. According to the study, the Mediterranean diet is associated with a lower cognitive decline. Scientists explain in part its protective effect on neurons by its high content of antioxidants . Eicosapentenoic acid (EPA), an omega-3 fatty acid found in fish, appears to be particularly protective ;

  • Caloric restriction. A low calorie diet delays aging and increases life expectancy. Scientists wanted to know if the amount of calories ingested daily influenced the risk of suffering from Alzheimer’s disease. In a prospective 4-year study, published in 2002, US researchers collected data on dietary intake of 980 people aged 75, on average. During the study, 242 people developed Alzheimer’s disease.

The subjects who consumed the most calories and had a genetic background that predisposed them to this disease (they were carriers of the ApoE4 gene) were more affected than those who absorbed the least calories. Studies in animals suggest that caloric restriction increases brain neuronal resistance to Alzheimer’s disease, Parkinson’s disease and stroke . It also limits the normal neuronal loss associated with age  ;

  • A diet rich in antioxidants . Many studies confirm that antioxidants reduce the harmful effects of free radicals on neurons. Although there is not yet enough evidence to recommend a specific diet to prevent Alzheimer’s disease, according to the authors of a review of the scientific literature,some foods rich in antioxidants should be favored. The authors target foods rich in folic acid, vitamin B6 and vitamin B12.

Physical activity

The benefit of regular physical activity for the prevention of dementia and cognitive decline has been shown by several epidemiological studies and recent clinical trials. One of them showed that a moderate physical training program at home (3 sessions of 50 minutes per week, or 20 minutes of walking a day, for 24 weeks), allowed to improve the cognitive performance of people with memory problems. Moreover, adults practicing physical activities regularly appear less frequently affected by Alzheimer’s disease.

Mental training

Several recent prospective studies have shown that people regularly engaged in stimulating mental activities (reading, learning, memory games, etc.), whatever their age, are less likely to suffer from dementia 18 . For example, the case of the famous Nun Study, an epidemiological study on aging and Alzheimer’s disease. This study has been conducted since 1986 with 678 nuns of the School Sisters of Notre Dame, a community where the average age is 85 years and where many sisters are over 90 years. In these nuns, who lead a healthy life, have a good diet and little stress, the rate of Alzheimer’s disease is significantly lower than that of the general population. Significantly, many of them are highly educated and carry out intellectual activities that are very demanding for their age.

Thus, keeping an active mind throughout one’s life promotes the maintenance and growth of connections between neurons, which would delay dementia. In addition, some believe that a high level of education helps to make it easier to pass the cognitive tests used to diagnose Alzheimer’s disease. This would make up for the effects of the disease longer.

Several ongoing trials attempt to evaluate the effects of regular mental training in people with onset of Alzheimer’s disease. However, it appears that the effects of this type of exercise are less marked when cognitive decline began .

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Medical treatments for Alzheimer’s disease

To date, it is impossible to cure Alzheimer’s disease. However, many drugs are developing and bring hope. The therapeutic approaches that are currently in the research stage, are designed to address the pathological process of the disease in the hope of cure or stop it. In addition, there are medications that alleviate symptoms and, to some extent, improve cognitive functioning.

The effectiveness of the treatments is evaluated by the doctor after 3 to 6 months. If applicable, the treatments are then modified. For now, treatment benefits are modest and drugs do not prevent the disease evolve .

The Fondation pour la Recherche Médicale estimates that in 2016 there are nearly 900,000 people affected by Alzheimer’s disease in France.

Pharmaceuticals

The following medications are prescribed. We cannot know a priori which will be best for the patient. It may take a few months to find the right treatment . According to the studies, after 1 year of medication, 40% of people see their condition improve, 40% have a stable state and 20% do not feel any effect.

Cholinesterase inhibitors

They are mainly used to treat mild or moderate symptoms . This family of drugs helps to increase the concentration of acetylcholine in certain areas of the brain (by decreasing its destruction). Acetylcholine allows the transmission of nerve impulses between neurons. It has been noted that people with Alzheimer’s disease have lower levels of acetylcholine in the brain because the destruction of their nerve cells reduces the production of this neurotransmitter .

In the Canadian market, there are currently 3 cholinesterase inhibitors (the enzyme that destroys acetylcholine):

  • The donepezil or E2020 (Aricept). It is taken in tablet form. It relieves mild, moderate and advanced symptoms of the disease;
  • The rivastigmine (Exelon). Since February 2008, it is also offered as a skin patch: the drug is absorbed slowly by the body for 24 hours. Rivastigmine is suitable for patients with mild or moderate symptoms;
  • The galantamine hydrobromide (Reminyl). It is sold as a tablet taken once a day for mild to moderate symptoms.

These drugs lose their effectiveness over time, as the neurons still produce less and less acetylcholine. In addition, they can cause side effects such as nausea and vomiting, loss of appetite and stomach upset. In this case, it is important to see your doctor, who will adjust the dose as needed.

In the United States and France, tacrine (Cognex) is used as a cholinesterase inhibitor . However, it can cause serious side effects and is not approved in Canada.

NMDA receptor antagonist

Since 2004, memantine hydrochloride (Ebixa) is given to relieve moderate or severe symptoms of the disease. This molecule works by binding to the NMDA (N-methyl-D-aspartate) receptors on neurons in the brain. It takes the place of glutamate which, when it is present in large quantities in the environment of neurons, contributes to the disease. There is no indication, however, that this drug slows the degeneration of neurons.

Current research

Significant efforts are invested in the search for new drugs. The main objectives are:

  • Destroy the beta-amyloid protein plates , by injecting antibodies capable of suppressing them. These plaques are, indeed, one of the most important brain lesions of the disease. Such an antibody has been developed (the name of the molecule is bapineuzumab) and is undergoing clinical evaluation in people with the disease. This approach is called “therapeutic vaccine”. Another solution tested would be to activate certain cells of the brain (microglia) so that they eliminate the plates in question;
  • Replace the neurons. The scientific community is very hopeful about the replacement, by transplantation, of neurons destroyed by the disease. Nowadays, researchers manage to create cells that look like neurons from stem cells obtained from human skin. However, the method is not fully developed. It does not yet make it possible to create neurons that have all the properties of “natural” neurons.

Physical exercise

Doctors strongly encourage people with Alzheimer’s disease to exercise . It improves strength, endurance, cardiovascular health, sleep, blood circulation and mood, and boosts energy and energy. In addition, physical exercise has particularly beneficial effects for people with this disease:

  • it helps to maintain motor skills;
  • it gives an impression of meaning and purpose;
  • it has a calming effect;
  • it maintains the level of energy, flexibility and balance;
  • It reduces the risk of serious injury in the event of a fall.

People who take care of the sick can kill two birds with one stone by exercising together their patients.

Social support

Considered as a component of treatment, social support to patients is crucial. Doctors advise various strategies for family and caregivers of patients.

  • Make regular visits to patients to provide support as needed;
  • Provide them with aide-mémoires;
  • Create a stable and calm life structure in the house;
  • Establish a bedtime ritual
  • Ensure that their immediate environment is of little danger;
  • Ensure that they always have a card (or bracelet) in their pocket with an indication of their state of health, as well as phone numbers in case they stray.

Associations also offer support in various forms.

To communicate well

It is difficult to communicate with a person suffering from Alzheimer’s disease. Here are some tips.

To do

1. Bring the person in front, looking into their eyes. Introduce yourself if necessary.
2. Speak slowly and calmly, with a friendly attitude.
3. Use simple and short terms.
4. Demonstrate an attentive listening attitude.
5. Try not to interrupt; avoid criticizing or arguing.
6. Ask only one question at a time and allow enough time for the answer.
7. Make your suggestions in a positive way. Instead of saying “let’s not go there,” for example, say “Let’s go to the garden.”
8. When talking about a third person, constantly use his name instead of “he” or “her”.
9. If the person has difficulty making a choice, offer a suggestion.
10. Show empathy, patience and understanding. Touch the person, or hug, if you think it helps.

Not to do

1. Do not talk about the person as if she was not there.
2. If it can be avoided, do not correct it and do not try to confront it.
3. Do not treat her like a child.

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