Alzheimer’s Disease: Symptoms, Stages, Causes, Treatments.

Introduction – Alzheimer’s Disease

Alzheimer’s disease is a neurodegenerative disease that involves brain shrinking and brain cells death. Alzheimer’s disease has been the most common cause of dementia, which is a progressive decline in cognitive, social, and behavioral abilities that hinders a patient’s independence.

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Alzheimer’s disease’s precise causes are not fully understood. On a fundamental level, brain proteins stop functioning normally, disrupting the work of brain cells (neurons) and initiating a series of toxic reactions. Brain cells are harmed, lose connections with one another, and ultimately die. 

Scientists believe that Alzheimer’s disease is caused in the majority of cases by a combination of genetic, lifestyle, and environmental factors that gradually affect the brain. Less than 1 percent of Alzheimer’s diseases are caused by specific genetic alterations that virtually guarantee a person develops the illness. These uncommon occurrences typically result in the onset of the disease in middle age.

The damage typically begins in the memory-controlling region of the brain, but the process will start years before the onset of symptoms. The loss of neurons spreads to other regions of the brain in a somewhat predictable manner. In the advanced stage of the disease, the brain will have significantly shrunk. Researchers attempting to comprehend the cause of Alzheimer’s disease are focusing on two proteins:

• Plaques:  The beta-amyloid protein is a subunit of a larger protein. These fragments appear to have a damaging effect on neurons and disrupt cell-to-cell communication when they clump together. These clusters combine with other cellular debris to form amyloid plaques, which are larger deposits.
• Tangles:  Tau proteins play a role in the internal support and transport system of neurons, which transports nutrients and other essential resources. In Alzheimer’s disease, tau proteins transform into neurofibrillary tangles by reorganizing themselves. The tangles are toxic to cells and disrupt the transport system.

Symptoms

Alzheimer’s disease is mainly characterized by memory loss. A person suffering from this condition, at an early age, starts failing to recall recent conversations and events. As the disease advances, memory loss worsens and additional symptoms emerge. 

Initially, a person with Alzheimer’s disease could be aware of memory and thought organization difficulties. However in the late stages, a friend or family member is more likely to observe the worsening of symptoms.

Changes in the brain caused by Alzheimer’s disease lead to problems with Memory

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Everyone experiences occasional short-term memory loss, but Alzheimer’s disease is characterized by persistent and worsening memory loss that impairs the ability to function at home or work.

Persons with Alzheimer’s may:

• Repeat statements and inquiries repeatedly
• Forget interactions, assignments, and events, and later not recall them at all.
• Frequently lose possessions, quite often placing them in illogical places.
• Get lost in familiar surroundings
• Eventually, forget household members and commonplace objects
• Have difficulty identifying objects, expressing thoughts, or taking part in conversations due to a lack of words.

Logic and reasoning

• Alzheimer’s disease impairs concentration and cognition, particularly regarding abstract concepts like numbers.
• Multitasking is particularly difficult, and managing finances, checking accounts, and making payments on time can be challenging. A person with Alzheimer’s may eventually lose the ability to recognize and handle numbers.

Making decisions and judgments

• Alzheimer’s disease diminishes the capacity to make rational judgements and decisions in everyday circumstances. A person may, for instance, make poor or completely out of character decisions in social situations or wear inappropriate clothing for the weather. It may be more challenging to react appropriately to daily challenges, such as food on the stove that is burning or unpredicted driving scenarios.

Planning and performing routine duties

• As the disease progresses, activities that once required a series of steps, such as planning and preparing meals or playing a familiar game, become difficult. People with advanced Alzheimer’s disease frequently forget how to perform fundamental tasks such as bathing and dressing.

Alterations in personality and conduct

Moods and behaviors can be affected by Alzheimer’s disease-related brain alterations. The potential issues are the following:

• Loss of interest
• Depression
• Social isolation
• Mood swings
• Disregard for others
• Irritability and rudeness
• Alters sleeping habits
• Wandering
• Complete lack of inhibition
• Delusions, including the notion that something has been taken

Stages

The Global Deterioration Scale (GDS), created by Dr. Barry Reisberg, gives caregivers an overview of the deterioration of an individual’s cognitive function for patients with degenerative dementia, such as Alzheimer’s disease. It is broken down into 7 varying stages. Stages 1-3 are the stages preceding dementia. Stages 4 through 7 are dementia stages. At stage 5, an individual is no longer capable of surviving without assistance. 

Each stage within the GDS is numbered (1-7) with brief titles (e.g., Forgetfulness, Early Confusion, etc.) and a brief listing of the symptoms characteristics for that stage. Caregivers can approximate a patient’s stage in the disease progression by observing the behavioral characteristics of the patient and comparing them with the GDS.

Individuals with Alzheimer’s disease tend to experience a similar progression from the onset to the end of the disease. A number of healthcare providers and the Alzheimer’s Association have adopted and implemented this framework for understanding the progression of the disease.

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Stage 1: Normal Performance

During this stage, Alzheimer’s is not observable and no impairments or other symptoms of dementia are noticeable.

Stage 2: Very Mild Decline

The person may experience minor memory difficulties or misplace items in the house, but not to the extent that the memory loss can be distinguished from normal age-related memory impairment. The individual will continue to perform well on memory evaluations, and loved ones and physicians are unlikely to detect the disease.

Stage 3: Mild Decline

At this point, family and friends may begin to notice cognitive deficits. Physicians will be able to identify cognitive impairment based on a patient’s performance on memory tests.

People in stage 3 will struggle in numerous areas, including:

• Remembering new people’s names
• Organizing and making plans
• Finding the appropriate words in conversation
• Individuals with Alzheimer’s disease in stage three may also frequently lose personal belongings, including valuables.

Stage 4: Moderate Decline

In the fourth stage of Alzheimer’s, the disease’s symptoms manifest. People with Alzheimer’s at the fourth stage:

• Possess a weak short-term memory (may not remember what they ate for breakfast, by noon)
• May forget the specifics of their past lives.
• Financial incompetence and inability to pay bills
• Have difficulty with elementary mathematics

Stage 5: Mildly severe decline

During stage five of Alzheimer’s, individuals require assistance with numerous daily tasks. Individuals in the fifth stage of the disease may experience:

• Significant confusion
• Having trouble dressing properly
• Inability to recall simple personal information such as one’s own phone number.

Individuals in stage five continue to function well. Typically, they can still take showers and use the restroom independently. Additionally, they typically retain some knowledge of their family members and personal histories, particularly their youth and childhood.

Stage 6: Severe Decline

Individuals in the sixth stage of Alzheimer’s disease require constant monitoring and regular professional care. Their symptoms include:

• Inability to recall majority of personal history details
• Inability to identify faces other than those of close friends and family
• Confusion or unawareness of surroundings and environment
• Loss of bowel and bladder control
• Significant personality alterations and potential behavioral issues
• The requirement for assistance with daily activities such as toileting and bathing.
• Wandering

Stages 7: Very Severe Decline

The seventh and final stage of Alzheimer’s disease. Due to the terminal nature of the disease, individuals in stage seven are approaching death. In the seventh stage of the disease, patients are unable to communicate or respond to their surroundings. While they may still be able to speak, they have no understanding of their condition and require support with all daily life activities. In the final stages of Alzheimer’s, the ability to swallow may be lost.

Treatment

There is no treatment capable of curing Alzheimer’s disease or altering the progression of the disease in the brain. Medications may temporarily alleviate symptoms or slow their progression. Sometimes, these treatments can help Alzheimer’s disease patients maximize function and maintain independence for some time. 

Drugs

Current Alzheimer’s medications can temporarily alleviate memory and other cognitive symptoms. Currently, three types of medications are used to treat cognitive symptoms:

Cholinesterase inhibiting agents:

These medications enhance cell-to-cell communication by preserving a chemical messenger that Alzheimer’s disease depletes in the brain. These are typically the first medications tried, and the majority of patients experience modest symptomatic improvement. 

Cholinesterase inhibitors may also alleviate neuropsychiatric symptoms like agitation and depression. Cholinesterase inhibitors commonly prescribed include donepezil (Aricept), rivastigmine (Exelon), and galantamine. The most common adverse effects of these medications include diarrhea, nausea, appetite loss, and sleep disturbances. Serious side effects may include abnormal heart activity in patients with certain heart disorders.

• Memantine (Namenda). Memantine can inhibit the effects of glutamate excess. Glutamate is a chemical in the brain that is released in greater quantities during Alzheimer’s disease and damages brain cells. This medication slows the progression of moderate to severe Alzheimer’s disease by acting on a different network of brain cell communication. Occasionally, it is combined with a cholinesterase inhibitor. Dizziness and confusion are relatively uncommon side effects.
• A relatively new drug called aducanumab (Aduhelm) is only recommended for early-stage Alzheimer’s patients. It is believed to reduce the accumulation of protein plaques in the Alzheimer’s brain.

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Creating a secure and supportive atmosphere

Adapting the living environment to the needs of a person with Alzheimer’s disease is an essential component of treatment. Establishing and strengthening routine habits and reducing memory-demanding activities can make life much easier for someone with Alzheimer’s.

You can support a person’s sense of well-being and continued ability to function by taking the following actions:

• Keep keys, mobile phones, wallets, and other valuables in the same location at home to avoid losing them.
• Maintain medications in a secure area. Utilize a daily checklist to monitor dosages.
• Plan for finances to be on automatic deposit and automatic payment.
• Have the person with Alzheimer’s carrying a cell phone with location capability so that a care provider can track its location. Program essential contact numbers into the cell phone.
• Install alarm detectors on windows and doors.
• Make sure routine appointments are on the same day and at the same time as often as possible.
• Utilize a calendar or whiteboard at home to record daily obligations. Develop the practice of checking off completed tasks.
• Remove extra furniture, clutter, and discard rugs.
• Install dependable handrails on staircases and in bathrooms.
• Make sure that slippers and shoes are both comfortable and grippy.
• Decrease the number of mirrors. Alzheimer’s patients may find images in mirrors to be frightening.
• Ensure that the Alzheimer’s patient is carrying identification or is wearing a medical alert bracelet.
• Keep photographs and other sentimental objects in the house.

Alzheimer’s disease is a devastating degenerative brain disorder that robs people of their memories, thinking skills, and independence. There is no known cure for Alzheimer’s disease. However, treatments are available that can help improve the quality of life for people with the condition and their caregivers. There are ways you can help support those with Alzheimer’s and their caregivers, and we urge you to learn more about this terrible disease. If you know someone who is affected by Alzheimer’s, be sure to offer your support and understanding.

Featured Image Credit: Photo by Tim Doerfler on Unsplash

References

1. Daroff RB, et al. Alzheimer’s disease and other dementias. In: Bradley’s Neurology in Clinical Practice. 7th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. https://www.clinicalkey.com. 
2. Alzheimer’s disease: Common medical problems. National Institute on Aging. https://www.nia.nih.gov/health/alzheimers-disease-common-medical-problems. 
3. Cholinesterase inhibitors in the treatment of dementia. https://www.uptodate.com/contents/search. 
4. Early-stage caregiving. Alzheimer’s Association. https://www.alz.org/help-support/caregiving/stages-behaviors/early-stage. 
5. Coping with late-stage Alzheimer’s disease. National Institute on Aging. https://www.nia.nih.gov/health/coping-late-stage-alzheimers-disease.