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Alzheimer’s Disease
Alzheimer's disease (AD) affects the mental abilities including memory, language, and cognition.Progressively it leads todementiaand death. AD usually arises in late middle age or the elderly but there is a rarefamilial subtype that occurs earlier. Because AD is so well-known, other causes of dementiaormemory loss may be
overlooked. Other possible diagnoses include normalaging (if very mild symptoms), emotional problems, fatigue,
depression, and certain medical conditions such as thyroid disease, brain tumors, multi-infarct disease, or
Huntington's disease. In its early stages, a correct diagnosis of AD can also be overlooked itself and misdiagnosedas other conditions such asdepression,dementia, simpleforgetfulness,orsenility.
Signs and Symptoms:
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Early symptoms
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Progressing symptoms
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Later symptoms
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Normal motor function(AD affects the brain but not the body)
Diagnostic Tests:
Blood tests Brain CT scan
Neuropsychological testsBrain MRI scan Memory tests Brain PET scanCognitive tests
Types of Alzheimer’s Disease:
Familial Alzheimer's disease - an early-onset inherited genetic form.
CURABLE TYPE:
Sporadic Alzheimer's disease
RARE TYPE:
Right parietal lobe syndrome related Alzheimer's disease
Spastic paraparesis related alzheimer's disease Two types of AD exist: familial AD (FAD), which is found in families where AD follows a certain inheritance pattern; and sporadic(seemingly random) AD, where no obvious inheritance pattern is seen. Because of differences in age at onset, AD is furtherdescribed as either early-onset (younger than 65 years old) or late-onset (65 years and older). Early-onset AD is rare and generallyaffects people aged 30 to 60. Early-onset AD progresses faster than the more common, late-onset forms of AD.
Causes:
Cerebral hypoxia
After recovery from hypoxia (brought on by such conditions as carbon monoxide poisoning or acute respiratory failure), thepatient may experience total amnesia for the event, along with sensory disturbances, such as numbness and tingling.
Head trauma
Depending on the trauma’s severity, amnesia may last for minutes, hours, or longer. Usually, the patient experiences brief retrograde and longer anterograde amnesia as well as persistent amnesia about the traumatic event. Severe head trauma cancause permanent amnesia or difficulty retaining recent memories. Related findings may include altered respirations and LOC;headache; dizziness; confusion; visual disturbances, such as blurred or double vision; and motor and sensory disturbances, such ashemiparesis and paresthesia, on the side of the body opposite the injury.
Herpes simplex encephalitis
Recovery from herpes simplex encephalitis commonly leaves the patient with severe and possibly permanent amnesia.Associated findings include signs and symptoms of meningeal irritation, such as headache, fever, and altered LOC, along withseizures and various motor and sensory disturbances (such as paresis, numbness, and tingling).
Hysteria
Hysterical amnesia, a complete and long-lasting memory loss, begins and ends abruptly and is typically accompanied byconfusion.
Seizures
In temporal lobe seizures, amnesia occurs suddenly and lasts for several seconds to minutes. The patient may recall an aura ornothing at all. An irritable focus on the left side of the brain primarily causes amnesia for verbal memories, whereas an irritablefocus on the right side of the brain causes graphic and nonverbal amnesia. Associated signs and symptoms may include decreasedLOC during the seizure, confusion, abnormal mouth movements, and visual, olfactory, and auditory hallucinations.
Wernicke-Korsakoff syndrome
Retrograde and anterograde amnesia can become permanent without treatment in this syndrome. Accompanying signs andsymptoms include apathy, an inability to concentrate or to put events into sequence, and confabulation to fill memory gaps. Thesyndrome may also cause diplopia, decreased LOC, head-ache, ataxia, and symptoms of peripheral neuropathy, such as numbnessand tingling.
Drugs
Anterograde amnesia can be precipitated by general anesthetics, especially fentanyl, halothane, and isoflurane; barbiturates,most commonly pentobarbital and thiopental; and certain benzodiazepines, especially triazolam.
Electroconvulsive Therapy
The sudden onset of retrograde or anterograde amnesia occurs with electroconvulsive therapy. Typically, the amnesia lasts forseveral minutes to several hours, but severe, prolonged amnesia occurs with treatments given frequently over a prolonged period.
Temporal lobe surgery
Usually performed on only one lobe, this surgery causes brief, slight amnesia. However, removal of both lobes results inpermanent amnesia.
Risk Factors:
The major risk factors for AD are
age
and
family history
. Other possible risk factors include a serious head injury and lower levelsof education. Scientists are also studying additional factors to see if they may cause the disease. Some of these factors include:
Genetic (Inherited) Factors:
Scientists believe that genetic factors may be involved in more than half of the cases of AD. For example, a protein called apolipoprotein E (ApoE) may be important. Everyone has ApoE, which helps carry cholesterol inthe blood. However, the function of ApoE in the brain is less understood. The ApoE gene has three forms. One form seems toprotect a person from AD, and another form seems to make a person more likely to develop the disease. Scientists still need tolearn a lot more about ApoE and its role in AD.Environmental Factors: Scientists have found aluminum, zinc, and other metals in the brain tissue of people with AD. Theyare studying these metals to see if they cause AD or if they build up in the brain as a result of the disease.Viruses: Some scientists think that a virus may cause AD. They are studying viruses that might cause the changes seen inthe brain tissue of people with AD.AD probably is not caused by any one factor. It is more likely to be several factors that act differently in each person. For example,genetic factors alone may not be enough to cause the disease. Other risk factors may combine with a person’s genetic makeup toincrease her or his chance of developing the disease
Treatments:
Mental stimulation Tacrine (THA, Cognex)Aricept (donepezil) - reversible acetylcholinesterase inhibitorsExelon (rivastigmine) - reversible acetylcholinesterase inhibitorsSupportive care Nursing homes
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