Alzheimer’s disease (AD) is a neurological degenerative disease that causes dementia, accounting for close to 60 percent of dementia patients in the United States (1). This disease is an irreversible and progressive brain disease, which slowly destroys cognitive memory and thinking skills. In most cases of patients with AD, symptoms first appear after age 60(2). Alzheimer’s disease is the most common cause of dementia among older people ages 65 and older (3).The disease is named after Dr. Alois Alzheimer (4). In 1901, Dr. Alzheimer, a neuropathologist and colleague of Emil Kraepelin, noticed changes in a patient he was observing at the Frankfurt Asylum, named Auguste Deter. The 51-year-old patient exhibited strange behavioral symptoms, including the loss of short-term memory. On November 4th, 1906, during a lecture at the 37th Conference of South-West German Psychiatrists in Tubingen, Alois Alzheimer described “eine eigenartige Erkrankung der Hirnrinde” (a peculiar disease of the cerebral cortex), thus diagnosing the first ever Alzheimer’s patient (5).
Complex chemical and electrical processes that take place within our brains let us speak, move, see, remember, feel emotion, and make decisions (6). Inside a normal healthy brain, tens of billions of cells called “neurons” are constantly communicating with one another, and receiving messages as electrical charges travel down the axon to the end of the neuron. The electrical charges release chemical messengers are called neurotransmitters. The transmitters move across microscopic gaps known as synapses, between the neurons. They bind to the receptor sites on the dendrites of the next neuron. This cellular circuitry thus enables communication within the brain. Healthy neurotransmission is important for the brain to function well (7). Alzheimer's disease disrupts this intricate interplay. By compromising the ability of neurons to communicate with one another, the disease over time destroys memory and thinking skills (8).
Although scientific data can’t point to the exact starting point of Alzheimer’s, it seems likely that damage that the brain degeneration starts a decade or so before problems become evident and symptomatic(9). During the preclinical stage of Alzheimer’s disease, while one is free of visual symptoms, toxic changes are taking place in the brain (10). Abnormal deposits of proteins form amyloid plaques throughout the brain, and the once-healthy neurons begin to work less efficiently. Over time, neurons lose the ability to function and communicate with each other, and they eventually die (11). Before long, the damage spreads to a nearby structure in the brain called the hippocampus, which is essential in forming memories (see diagram). As more of the neurons die, affected brain regions begin to shrink. By the final stage of Alzheimer’s, the damage is widespread, and the hippocampus has shrunk significantly (12).
Alzheimer's disease is usually diagnosed based on the person's history, history from relatives, as well as observations of the person's behaviors. The diagnosis often stems from clinical observation as well as analysis of family history and other behaviors (14). The characteristic neurological and neuropsychological features and the absence of alternative conditions are supportive (15). Advanced technology such as a CT scan, a MRI or a PET scan can be used to help exclude other cerebral pathology or subtypes of dementia (16). Moreover, it may predict conversion from prodromal stages (mild cognitive impairment) of Alzheimer's disease (17). Memory problems are typically one of the first warning signs of cognitive brain damage, due to the development of the Alzheimer’s (18). A decline in other aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment, may also signal the very early stages of Alzheimer’s disease (19). As Alzheimer’s disease progresses, memory loss worsens, and changes in other cognitive abilities are very evident in the individual (13). Problems can include, for example, getting lost, trouble handling money and paying bills, taking longer to complete normal daily tasks, and having some mood and personality changes not previously seen before (20). In moderate Alzheimer’s disease, damage occurs in areas of the brain that control language, reasoning, sensory processing, and conscious thought (21). Memory loss and confusion grow worse, and people begin to have problems recognizing their close family and friends. They may be unable to learn new information, unable to carry out relatively simple tasks that may involve more than one step (such as getting dressed), or be able to cope with new situations (22). They may have hallucinations, paranoia, and delusions, or behave impulsively(23). By final stage Alzheimer’s, also known as “Severe AD”, plaques and tangles have spread throughout the brain, and brain tissue has shrunk significantly. People with severe Alzheimer’s cannot communicate on their own and are therefore completely dependent on others for their care (24). Towards final stage “Severe AD,” the person may be in bed most or all of the time as the body shuts down (25).
Regarding current available treatment options, Alzheimer’s is a very complex neurological disease, and there is no single “magic pill” likely to cure or prevent it (26). That’s why current treatments options focus on several different angles including; helping people maintain mental function; managing behavioral symptoms; and slowing/delaying the disease. The FDA has approved two types of medication to treat the cognitive symptoms of Alzheimer's disease, albeit with limited success (27). This includes cholinesterase inhibitors such as Aricept, Exelon, Razadyne, and Cognex, as well as Memantine (Ex: Namenda) used to treat/contain the cognitive symptoms such as memory loss, confusion, and problems with reasoning and thinking.
Alzheimer's is the sixth leading cause of death in the United States (28). In 2006, there were 26.6 million sufferers worldwide. Alzheimer's is predicted to affect 1 in 85 people globally by 2050 (29). As of 2012, more than 1,000 clinical trials have been or are being conducted to test various compounds in AD (30). Mental stimulation, exercise, and a balanced diet have been suggested as ways to delay cognitive symptoms in healthy older individuals (31). Furthermore, people who engage in intellectually stimulating activities such as reading, playing board games, completing crossword puzzles or playing musical instruments, showed a reduced risk in Alzheimer's disease (32).Studies have also shown that people who eat a Mediterranean diet have a lower risk of AD (33, 34). And lastly, there is limited evidence that light to moderate use of alcohol, particularly red wine, is associated with lower risk of AD (35). We all must take preventive measures upon ourselves to hopefully eradicate this terrible disease from our midst.
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