ALZHEIMER MORE THANLOSS OF MEMORY

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ALZHEIMER: MORE THAN LOSS OF MEMORY

JUAN SEBASTIAN PARRA: sebasparra2005@gmail.com

JUAN SEBASTIAN PINZON: juanpinzoncoy1009@gmail.com

ABSTRACT
Alzheimer's disease is a neurological disorder that causes the death of nerve cells in the brain. The
first symptoms are usually attributed to old age, as it occurs in people over 65 years and age is one
of the main risk factors. As the disease progresses, other symptoms become evident, such as
impaired cognitive abilities, difficulty performing daily tasks, loss of temporal or spatial
orientation, behavioral changes, and even involvement of several internal organs. In its advanced
stages, Alzheimer's disease eventually leads to death.

KEY WORDS: Alzheimer disease, dementia, memory loss, neurological disorder, progressive
disease.
INTRODUCTION
Ageing is generally associated with progressive biological deterioration and increased health
problems. All individuals show changes with age.
One of the conditions that can affect an elderly person is dementia, the most common of which is
Alzheimer's disease.
Alzheimer's disease is a brain disease that causes problems with memory, thinking and behavior.
It's not a normal part of aging.
Alzheimer's gets worse over time. Although the symptoms can vary greatly, the first problem
people notice is the loss of short-term memory, but this progresses to become a real impediment
to their ability to function on their own.
The disease can cause a person to get confused, get lost in familiar places, lose things, or have
problems with language.
The general objective of this research is to carry out a complete bibliographic review that allows
us to understand what Alzheimer's disease consists of, what its symptoms are, the criteria for
diagnosis, the risk factors, the epidemiology and the treatment to follow.
To complement the theoretical review, a survey of 96 people was created and applied to
determine what people's knowledge of Alzheimer's disease is, then a family with an Alzheimer's
patient was chosen and a semi-structured interview was conducted with which information was
obtained to confront the theoretical aspects worked with. The results obtained are presented
below.
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THEORICAL FRAMEWORK
Dementia is the loss of cognitive function, that includes thinking, reasoning, etc. Dementia
includes a mild state, when it is beginning to affect cognitive function, to a severe extent, where
the person is completely dependent on others for develop activities of daily live.
Alzheimer's is the main form of dementia; it is an irreversible, degenerative disease of the brain
that affects memory and the ability to think, even leading to the inability to perform simple tasks.
The probability of developing the disease doubles every five years after 65 years. After 85 years,
the risk reaches almost 50%. (la enfermedad de Alzheimer, 2015).
Alzheimer is divided into three stages: mild, moderate and severe.
The first stage or mild stage is characterized by memory failure and lack of concentration. There
may also be moderate speech disorders, inaccuracy in actions of some complexity and in some
cases lack of coherence.
Once the disease has advanced to the second stage, the family has to take care of the patient day
and night. There is severe dementia, but the patient still retains mobility, but there is a high risk of
an accident. In addition to this, a behavioral disorder is beginning to develop.
In the last phase the patient requires full time help, is at risk of falling and injury, and is finally
bedridden. He has also been losing his ability to speak, and must finally be mobilized, groomed
and fed. (Donoso, 2003).
SYMPTOMS
The symptoms of AD are variable and can be grouped into 3 spheres: cognitive, behavioral and
functional. Cognitive deficits and behavioral disturbances must lead to an alteration in the
activities of the patient's daily life in order for the diagnosis of dementia to be established.
The majority of patients with AD (60-70%) follow a typical evolutionary pattern. It starts with
immediate memory loss, while long-term memory is maintained until advanced stages.
Subsequently, there are increasingly marked deficits in other areas, such as orientation, language,
difficulty in finding one's way around familiar places, problems with money management or
everyday instruments such as the telephone or washing machine, difficulties in reading and
writing, or in recognizing familiar faces. The most common behavioral symptom is apathy.
Although these symptoms are the best known, AD often has other behavioral and affective
symptoms, such as visual or auditory hallucinations and delusional ideas (in 40-70%). Others are
psychomotor agitation, irritability and disinhibition.

DIAGNOSTIC
Because there are no biological tests to make the diagnosis, it is based on the application of
clinical criteria.
The following table presents the most commonly used ones to diagnose Alzheimer's disease
according to National Institute of Neurological and Communicative Disorders ans Stroke -
Alzheimer’s Disease and Related Disorders Association (McKhann, 1984):
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Criterios para el diagnóstico clínico de enfermedad de Alzheimer probable

Demencia, diagnosticada mediante examen clínico y documentada con el Miniexamen
Mental de Folstein, la escala de demencia de Blessed u otras similares, y confirmada con
tests neuropsicológicos Deficiencias en 2 o más áreas cognitivas Empeoramiento
progresivo de la memoria y de otras funciones cognitivas No alteración del nivel de
conciencia Comienzo entre los 40 y los 90 años, con mayor frecuencia después de los 65
años Ausencia de alteraciones sistémicas u otras enfermedades cerebrales que pudieran
producir el deterioro progresivo observado de la memoria y de las otras funciones
cognitivas.
Apoyan el diagnóstico de “enfermedad de Alzheimer probable” Deterioro progresivo
de alguna función cognitiva específica (afasia, apraxia, agnosia) Alteraciones conductuales
y en la realización de las actividades diarias habituales Antecedentes familiares de
trastorno similar, especialmente si obtuvo confirmación anatomopatológica Pruebas
complementarias Líquido cefalorraquídeo normal, en las determinaciones estándar EEG
normal, o con alteraciones inespecíficas, como incremento de la actividad de ondas lentas
Atrofia cerebral en TAC, se objetiva su progresión en observación seriada
Aspectos clínicos compatibles con el diagnóstico de “enfermedad de Alzheimer
probable”, tras excluir otras causas de demencia Mesetas en la progresión de la
enfermedad Síntomas asociados de depresión, insomnio, incontinencia, ideas delirantes,
ilusiones, alucinaciones, accesos emocionales, físicos o verbales, alteraciones de la
conducta sexual, pérdida de peso Otras alteraciones neurológicas en algunos pacientes,
especialmente en los que se hallan en fase avanzada, como hipertonía, mioclonías o
alteración de la marcha Convulsiones, en fase avanzada de la enfermedad TAC cerebral
normal para la edad del paciente.
Aspectos que convierten el diagnóstico de “enfermedad de Alzheimer probable” en
incierto o improbable Instauración brusca o muy rápida Manifestaciones neurológicas
focales como hemiparesia, alteración de la sensibilidad o de los campos visuales, o
incoordinación en fases tempranas de la evolución Convulsiones o alteraciones de la
marcha al inicio o en fases muy iniciales de la enfermedad
Diagnóstico clínico de enfermedad de Alzheimer posible Demencia, con ausencia de
otras alteraciones sistémicas, psiquiátricas y neurológicas que puedan causar esa demencia,
pero con una instauración, manifestaciones o patrón evolutivo que difieren de lo expuesto
para el diagnóstico de “enfermedad de Alzheimer probable” Presencia de una segunda
alteración, cerebral o sistémica, que podría producir demencia pero que no es considerada
por el clínico como la causa de esta demencia En investigación, cuando se produce
deterioro gradual e intenso de una única función cognitiva, en ausencia de otra causa
identificable Criterios para el diagnóstico de enfermedad de Alzheimer definitiva Criterios
clínicos de “enfermedad de Alzheimer probable” Comprobación histopatológica, obtenida
a través de biopsia o autopsia
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EPIDEMIOLOGY OF ALZHEIMER
It is estimated that 22 million people worldwide suffer from the disease, and that in the next three
decades it will double. According to the Alzheimer's Association International, the disease can
begin as early as age 50.
The following graph shows the global projection of the disease, up to 2050, including mild and
severe phase:

Taken from: http://newsroom.ucla.edu/stories/sounding-the-alarm-on-a-future-epidemic:-alzheimer-s-

disease

RISKS FACTORS
Although scientists know that Alzheimer's disease involves a failure of nerve cells, the reason why
this happens is still unknown. However, they have identified certain risk factors that increase the
likelihood of developing Alzheimer's disease.
“La EA se considera una enfermedad de causa multifactorial y, en este sentido, se han identificado
diferentes factores de riesgo. Sin duda, el factor de riesgo más importante es la edad”. (Villar,
Molinuevo &Gómez, 2004)
Age
Age is the main known risk factor for Alzheimer's disease. Most people with the disease are 65 or
older. One in nine people in this age group have Alzheimer's disease. Almost one third of people
aged 85 or older have Alzheimer's disease.

Familiar Alzheimer's and genetics

Research has shown that people whose father, mother, brother or sister have Alzheimer's are more
likely to develop the disease than those without a close relative with Alzheimer's disease. The risk
increases if more than one family member suffers from the disease.
Two categories of genes influence the fact that a person develops a disease: the risk genes and the
determining genes. Risk genes increase the likelihood of developing a disease, but don`t guarantee
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that it will occur. The determining genes directly cause a disease, which ensures that whoever
inherits one will develop a disorder. According to Villar, Molinuevo & Gómez, (2004): “podemos
decir que los factores genéticos que intervienen en la EA se pueden dividir en genes de
susceptibilidad, que actuarían como factores de riesgo, y genes determinantes, que cuando están
presentes determinan, casi al 100%, la presencia de la enfermedad”
Cerebrovascular disease
More and more studies show the strong influence between cardiovascular disease and Alzheimer's,
so it is suggested to control blood pressure, in order to reduce the appearance of cognitive
impairment
PATHOLOGICAL ANATOMY
Macroscopically, the brain shows a decrease in its size as a result of the progressive loss of synaptic
terminations and neurons that make up the grey substance. Microscopically, extensive neural loss
is observed, and 2 lesions characteristic of amyloid plaques and neurofibrillary tangles. (Villar,
Molinuevo &Gómez, 2004).

TREATMENT
Currently there are no treatments to stop the progression of the disease, however current drugs can
provide a temporary improvement of symptoms and thus improve the lives of patients and their
caregivers. Fortunately, a global effort is now being made to find better ways to treat the disease,
slow its progression and prevent its development. Establishment and prevent its development. (la
enfermedad de Alzheimer, 2015)

According to Romano, M., Nissen, M.D., Del Huerto, N., & Parquet, C. (2007):

Ciertas vitaminas ayudan al mantenimiento de las funciones cognitivas en estos pacientes como
vitaminas B12, B6, Ácido fólico. (15,16) Se ha probado la eficacia de fármacos
anticolinesterásicos que tienen una acción inhibidora de la colinesterasa, la enzima encargada de
descomponer la acetilcolina, el neurotransmisor que falta en el Alzheimer y que incide
sustancialmente en la memoria y otras funciones cognitivas. Con todo esto se ha mejorado el
comportamiento del enfermo en cuanto a la apatía, la iniciativa y la capacidad funcional y las
alucinaciones, mejorando su calidad de vida. (p.11)

METHOD OF INVESTIGATION

A 9 question survey was developed to determine how well people know about Alzheimer's disease,
its symptoms and treatments, in order to compare this information with the theoretical aspects
collected in the literature review. The survey was answered by 96 people among young people and
adults, and is made up of the following questions:
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1. Do you know what Alzheimer is?
 The purpose of this question is to find out how many people are aware of
the existence of this disease.

2. You have Alzheimer

 The reason for this question is to be aware of the number of respondents
suffering from Alzheimer

3. If yes, what degree of Alzheimer's disease do you have?

 This question was asked to find out what degree of the disease the people
who previously answered yes have.

4. Do you have any family members who have Alzheimer's?

 The idea of this question is to identify people who have family members
with the disease to compare what they say to the theory.

5. Do you know what the risk factors are?

 The purpose of this question is to know if people know about risk factors,
so we will know if people are prevented and prone to the disease.

6. What are the symptoms of the disease?

 This question was asked to find out if people are aware of the symptoms
of this disease.

7. What can the family do to prevent behavior problems in people with Alzheimer's
disease?
 to know how much people, know about the importance of family in
managing the disease and how aware they are of the family member's
condition

8. Where do you get important information about your health?

 This question is intended to tell us if people know where to get important
health information.

9. Do you know what the treatments for Alzheimer's disease are?

 The purpose of this question is to find out how much people know about
the treatment and alternatives to this disease
In addition, a person who had a family member with Alzheimer's disease was selected and a
semi-structured interview was conducted to obtain more detailed information and compare it
with the biographical review.
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RESULTS

Of the people surveyed, 95 said they are aware

of the disease, however, subsequent responses
show that there is a high level of ignorance of
various aspects of the disease.

Despite the fact that two people claim to suffer

from Alzheimer's, there was probably confusion
in their answers, as the population surveyed is
healthy.

As in question 2, those who answered that if they

suffered from the disease, they claim that they are in
a serious stage. These results can be discarded
because if they had, they would not have solved the
survey.

14.74% say they have relatives with the disease,

while 21.05% do not know if they have it or not.
More than 60% have no relatives suffering from
Alzheimer's disease
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89.25% know what the risk factors are, and for

10.75% of respondents skin colour is one of
them.

88.54% know what the symptoms of the disease are

and only 11.46% are unclear about this aspect.

In this question the answers were more

scattered. While 50% know what the family
should do to avoid behavior problems in those
with the disease, the other 50% are not clear.

Of respondents, only 70.53% receive important

health information in a medical office; the rest go to
the Internet and social networks

84.38% know some of the most important

treatments used for this disease.
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DISCUSSION AND CONCLUSIONS

From the semi-structured interview, information was obtained about the case of an elderly man,
diagnosed at the age of 75, who began with small omissions, increasingly constant forgetfulness,
until he forgot which was his home and even the face of his daughters and wife.
As for his behavior, the family said he became stricter: all meals had to be at the same time and
therefore he lived on the clock. She has many cravings but usually couldn't eat. He resented going
out and changing any established routine.
He lost interest in the visits and music that were his greatest passions. Little by little he became
aggressive.
The family is unaware that Alzheimer's not only involves memory loss, but also many organs of
the body are affected, because the brain loses part of its functions and neuronal connections are
increasingly impaired.
As stated by Donoso (2003) and other authors, in its last stage the disease is usually quite
degenerative. All systems begin to be affected and therefore the kidneys, lungs, bladder, etc. fail.
In this case, the patient lost the sense of smell, was ordered not to eat, because the intestine stopped
working and apparently the body did not know what to do with the food. He lost sphincter control,
his legs didn't respond, so he couldn't stand up....the deterioration was such that he died.
It can be concluded that Alzheimer's is a degenerative disease of the nervous system, which goes
beyond memory loss, as it involves the gradual and progressive deterioration of the patient's health,
to make him or her a completely dependent being.
The role of the family in the care of the patient is very important, as ignorance of the symptoms
and treatments may even help further or accelerate the deterioration. It is vitally important that
family members understand that many of the patient's actions are involuntary.
The bibliographic review allowed to know in depth important aspects of the disease and to have
guidelines to design the survey and the semi-structured interview that were applied as part of this
research.
The survey applied is an instrument that made it possible to determine that the people surveyed
had heard of Alzheimer's disease and knew some generalities about it. However, it is insufficient
to state that they know in depth about the symptoms, risk factors, stages, criteria for diagnosis,
treatments, among others.
The semi-structured interview was very useful to gather information about the patient's behavioral
and physical changes, as well as the role that the family plays in this process.
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REFERENCES

De la enfermedad de Alzheimer, S. (2015). Enfermedad de Alzheimer. Journal of Alzheimer’s

Disease, 43, 949-955.

De Alzheimer, E. (2000). Enfermedad de Alzheimer. Revista Colombiana de Psiquiatría, 29(2),

119.
Donoso, A. (2003). La enfermedad de Alzheimer. Revista chilena de neuro-psiquiatría, 41, 13-
22.

Fernández, M. & Marín, P. (2001). Progresos en Enfermedad de Alzheimer. Temas de Medicina

interna. Universidad Católica de Chile.

McKhann G, et al. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA

Work Group under the auspices of Department of Health and Human Services Task Force on
Alzheimer’s Disease. Neurology 1984; 34:939-44.

Romano, M., Nissen, M. D., Del Huerto, N., & Parquet, C. (2007). Enfermedad de Alzheimer.
Revista de posgrado de la Vía Cátedra de Medicina, 75, 9-12.

Villar, A., Molinuevo Guix, J. L., & Gómez-Isla, T. (2004). Enfermedad de

Alzheimer. Jano, 67(1.537).