Alzheimer's and dementia
Aricept is used to treat Alzheimer's disease
Alzheimer's disease is a progressive, degenerative and irreversible brain disorder that causes intellectual impairment, disorientation and eventually death and the most common cause of dementia.
There is no cure. It is estimated that 2-5% of people over 65 years of age and up to 20% of those over 85 years of age suffer from the disease.
What is dementia?
Dementia is an umbrella term which describes a serious deterioration in mental functions, such as memory, language, orientation and judgement.
Alzheimer's disease is one cause of dementia, but several other diseases can cause it too, including vascular disease. Alzheimer's disease is the most common cause of dementia, accounting for around two thirds of cases in the elderly.
What causes Alzheimer's?
The causes of Alzheimer's disease are not yet fully understood.
There are some very rare inherited cases caused by genetic mutations, but these account for around 1% of people with Alzheimer's.
For most cases, there is a complex interaction of many genetic, environmental and life-style risk factors, with age and genetics playing the largest part.
Some factors, such as a well-balanced diet and regular physical and mental exercise can reduce the risk of developing Alzheimer's.
Protein deposits, known as amyloid plaques and tau tangles, appear and spread in the brain, particularly in the cortex and the hippocampus.
The levels of important chemical transmitters, such as acetylcholine, are reduced. Many of the blood vessels of the brain are also damaged.
These processes are made worse by chronic inflammation in the brain and by an excess of highly reactive molecules known as free radicals, which damage brain tissue.
Gradually the connections between brain cells are lost and eventually many of the cells themselves die.
It is particularly the loss of connections between brain cells that is thought to cause the devastating symptoms of the disease.
What are the symptoms?
Alzheimer's disease has a gradual onset. The early stages of Alzheimer's disease and other dementias can be difficult to diagnose because many of the symptoms are initially subtle or common to other illnesses.
Well established features of the disease include:
* Problems with memory
* Poor or decreased judgement
* Difficulty in performing everyday tasks
* Problems with language
* Disorientation in time and place
* Problems with abstract thinking
* Change in mood and behaviour
* Change in personality
* Loss of initiative
The disease is often associated with depression, anxiety and sleep disturbance.
The rate of decline varies from patient to patient. The disease course runs anywhere from three to twenty years, with eight years being the average life span after diagnosis.
How is the disease diagnosed?
There is no single diagnostic test for Alzheimer's disease. Experts are able to observe the pattern of symptoms and perform a few simple tests over a period of time to measure any change.
Although the tests currently performed are fairly accurate, a definitive diagnosis can still only be made after death by examining the brain tissue at post mortem.
Early diagnosis is important because it helps a doctor to rule out other illnesses with similar symptoms to dementia, such as depression. It also enables new drugs to be prescribed which can improve the quality of life for both patient and carer.
Many other disease processes can mimic Alzheimer's such as thyroid imbalances, vitamin B12 deficiency, brain injuries, tumours, and severe depression.
What are memory clinics?
Specialist memory clinics operate throughout the county and offer assessment, support, information and advice to those with memory problems and their carers.
The assessment includes formal neuropsychological testing in the form of structured questions and tasks. The experts may also carry out blood tests to look for medical causes.
The staff can offer counselling and support as well as treatment.
Are there other types of dementia?
Yes. These include Dementia with Lewy bodies, which gets its name from tiny structures that develop inside nerve cells, and which trigger the degeneration of brain tissue.
Other rarer causes of dementia include progressive supranuclear palsy, Korsakoff's syndrome, Binswanger's disease, HIV and Creutzfeldt-Jakob disease (CJD).
People with multiple sclerosis, motor neurone disease, Parkinson's disease and Huntington's disease can also be at an increased risk.
What treatment is available?
Various types of therapy are used to try to stimulate Alzheimer's patients.
These include: psychological methods, art therapy, music therapy, playing with toys.
Some health professionals try to encourage patients to reminisce about past memories as a way to reduce depression without the use of drugs.
A variety of drug treatments have been shown to benefit patients. None are a cure, but they can temporarily relieve some of the symptoms in some patients:
* Cholinesterase inhibitors including donepezil (Aricept), galantamine (Reminyl) and rivastigmine (Exelon)
* NMDA receptor antagonist, namely memantine (Ebixa)
* Neuroleptics, also known as anti-psychotics or major tranquillisers - although these drugs are only used as a last resort when other methods have failed
* Antidepressants and anti-anxiety drugs
Is there controversy over availability of drugs?
Most certainly. The National Institute for Health and Clinical Excellence (NICE) says that donepezil, rivastigmine and galantamine should only be used to treat Alzheimer's once it has progressed to its moderate stages. Memantine is not recommended as an option for people with moderately severe to severe Alzheimer's disease unless it is being used as part of a clinical trial.
Campaigners argue patients in the early stages of Alzheimer's should also have access to the drugs.
This page contains basic information. If you are concerned about your health, you should consult a doctor. The Alzheimer's Society runs a helpline on 0845 300 0336 and further information is also available free from the Alzheimer's Research Trust on 01223 843899.
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