This article is based on reporting that features expert sources.
Introduction
Alzheimer’s is a deadly disease associated with cognitive and functional decline and death.
The neurodegenerative disease affects the patient’s memory and learning and distorts and damages brain cells.
It starts with mild symptoms and gradually becomes severe, and finally leads to death.
Treating and caring for AD patients is expensive, though the disease remains incurable. It is crucial to watch out for Alzheimer’s symptoms if you have senior adults in the family.
Early detection of the disease may help combat the symptoms with available medications and therapies.
What Is Alzheimer’s Disease?
When Alois Alzheimer – the German psychiatrist and neuropathologist – asked his patient Auguste Deter, a 51-year aged woman, what her name was, she replied Auguste. When asked about her surname, she replied Auguste and her husband’s name too followed it.
Auguste could not differentiate between cauliflower and spinach and pork and potatoes. She lived with confusion, disorientation, and hallucinations for years. After her death, Alzheimer did an autopsy on her brain and put it under a microscope.
He noted thick fibers around cells, crushing their contents. Alzheimer also noted tangles of smooth plaques distorting the cells’ shape. He concluded that Auguste suffered a serious condition of the cerebral cortex.
Auguste’s case was the first recorded case of Alzheimer’s Disease, and the continued neuropathologic assessment of AD is yet to suggest a definitive cure for the neurodegeneration that affects millions of people.
To date, Alzheimer’s Disease is considered a progressive condition that starts with mild symptoms that worsen, eventually leading to death.
Symptoms of Alzheimer’s disease: The Common and the Beyond
As a progressive disease, the symptoms vary and change depending on which stage it is in. The common symptoms and early signs of Alzheimer’s include memory loss, difficulty with reasoning, speaking, reading, writing problems, time and place confusion, etc.
However, as Andrea Atkins writes about Alzheimer’s symptoms, they may go beyond the commonly known ones. In her write-up, she details the surprising symptoms of Alzheimer’s, as mentioned by Dr. George Perry, the editor-in-chief of the Journal of Alzheimer’s Disease and Dean of the College of Sciences at the University of Texas.
The Not-So-Common Early Signs of Alzheimer’s You Shouldn’t Ignore
If you notice a personality or behavioral change or sudden law-breaking activities such as stealing, it may signal Frontotemporal Dementia that damages the brain’s sides and frontal parts.
Frequent falling is another sign of Alzheimer’s Disease. Also, if the senior adult in your family or someone you know forgets the functions of objects, don’t ignore the signs. Depression is also counted as a possible sign of Alzheimer’s.
In this case, the brain receives the hunger signal but cannot react with a proper response. Additionally, unfocused staring and the inability to recognize and respond to sarcasm are symptoms of the brain not working properly.
The Telltale Early Signs of Alzheimer’s
Now you know the surprising symptoms of Alzheimer’s Disease, here’s a lowdown on the most common signs that appear at the early stage of the disease.
- Loss of memory: And we are not talking about the occasional memory slips when you forget a special day, or a billing date, or where you have left your umbrella or keys. You get serious when you find it difficult to remember events and appointments, have problems staying organized, make losing things a routine, and keep misplacing objects and disrupt daily life.
- Trouble Performing Ordinary Tasks: Paying bills, making decisions, locking the door, getting dressed – these are some of the ordinary tasks we need to perform in our daily existence. When a person finds difficulties performing these simple tasks, that could be one of the Alzheimer’s symptoms.
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When Expressing Your Thoughts Becomes Challenging: Having trouble with language – speaking, reading, and writing – indicates a possibility of Alzheimer’s. Struggling to find the right words while speaking, having difficulty expressing thoughts, and struggling with spelling, all point to primary progressive aphasia (PPA) resulting from frontotemporal dementia.
- Disorientation: Spatial disorientation is another symptom of AD. Patients with AD show the tendency to wander, or they may get lost in the familiar neighborhood due to critical disorder of right hemisphere neocortical areas[2] associated with visuospatial processes.
Possible Factors That Cause Alzheimer’s
You won’t get a straight answer to this question. Scientists are still uncertain and researching the real causes of Alzheimer’s Disease.
Current research suggests that not one but multiple factors play a role in the progression of Alzheimer’s from mild to severe. Here are some of the factors responsible for AD:
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Aging: Though people in their 30s and 40s may get AD, older adults are mostly affected. A person below 65 with AD is considered an early-onset AD patient. However, less than 10% of AD patients fall in this category. Late-Onset Alzheimer’s Disease is the most common that affects patients in their mid-60s and later. With aging, the build-up of beta-amyloid and tau increases in and around the brain cells. Plaque and tangles caused by the deposits damage the brain’s memory area.
- Genetics: Family history may play a role in developing Alzheimer’s. A gene named APOE ε4 is linked to AD risk. Having a pair or one APOE ε4[3] allele puts the owner at a greater risk of having Alzheimer’s. However, a person with the APOE ε4 allele may never have Alzheimer’s. While the science indicates the role of genetic mutation as one of the reasons for AD, extensive research is required to identify persons having greater risks of getting Alzheimer’s, how lifestyle and environment impact Alzheimer’s risk, and what sets the ball rolling for Alzheimer’s.
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Health: Obesity, type-2 diabetes, high cholesterol, hypertension, physical inactivity, smoking – all these lifestyle factors are linked to Alzheimer’s. Having CVDs increases Alzheimer’s risks. Hearing loss and social isolation may also cause AD.
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Environmental factors: Can environmental factors such as pollution, living close to power lines for a long time, and occupational exposure to aluminum, calcium, and iron levels in water and soil increase the risk of AD? This study[4] says moderate evidence is available that they do. However, more data and intense research are required to confirm these factors as being one of the causes of
- Lifestyle Factors: Lifestyle factors impact the body’s cellular and molecular mechanisms. Excessive protein build-up in and around the brain cells could be a major reason for Alzheimer’s Disease. Deposits of amyloid and tau cause plaque and tangle. When the brain cells are affected, they produce a lower amount of neurotransmitters. A study[5] says AD patients have low levels of acetylcholine, a vital neurotransmitter involved in processing memory and learning.
Stages of Alzheimer’s Disease
Alzheimer’s is a progressive disease that slowly damages cognitive functions. The damages are mostly irreversible and worsen with time.
Dr. Rong Li, a professor of cell biology, and her team have come up with the stages of Alzheimer’s and Alzheimer’s symptoms visible in each stage. Here’s how she describes each:
Preclinical stage: Preclinical stage is when the changes start inside the brain, but there’s no indication or symptoms. It may last for years.
Mild, early-stage: At the early stage, people experience mild cognitive impairment (MCI). Patients start forgetting events and appointments, have difficulty managing daily tasks, and have difficulty sequencing and decision-making.
Personality and behavioral changes are also noticed at this stage. Wandering or getting lost is common at this stage. Getting upset, imagining things, and not caring about appearance are the noticeable behavioral changes you may find.
Moderate, middle stage: The middle stage may be the longest when the confusion and memory loss worsens. The symptoms at this stage include:
- Forgetting events
- Difficulty learning new things
- Difficulty planning events
- Forgetting phone numbers and addresses
- Having trouble with language
Patients at this stage may have trouble recognizing family and friends or remembering details about them.
They may find it difficult to remember the day of the week, need assistance while getting dressed or when grooming, including using the washroom and other self-care activities, such as brushing teeth and bathing.
Patients also show behavioral changes, and they become suspicious. (Auguste Deter, the patient Dr. Alzheimer met, suspected her husband of having an affair.) AD patients in the moderate stage may experience hallucinations, delusion, and paranoia.
Impulsive behavior is another sign of moderate AD, and patients can show restlessness, agitation, anxiety, and sleep disorder.
Late, severe stage: The patients’ cognitive health continues deteriorating as Alzheimer’s progresses from moderate to severe stage.
The patients experience limited movement and physical capabilities at this stage, such as eating, sitting, and walking. The communication becomes incoherent. Patients may lose the ability to have a conversation.
They also need a caregiver’s assistance in performing all activities. Sooner or later, the patients also can’t swallow food and may lose bladder and bowel control. AD patients with severe Alzheimer’s also may contract pneumonia.
Can Alzheimer’s Be Treated? What Are the Available Treatments?
Alzheimer’s disease is a progressive disease with no definitive cure on the table. From mild to severe, the stages of the disorder involve a complex process, and the available treatments slow down the condition’s progress from one stage to another.
New treatments are now available to help patients manage Alzheimer’s symptoms and slow down the progress rate.
Early diagnosis of AD has certain benefits. Most medicines are useful in the early and middle stages. Additionally, they get the opportunity to enroll in clinical trials.
Aducanumab: New Ray of Hope for AD Patients
The newest medication available from June 2021 is Aducanumab. The medicine got approval through the FDA’s Accelerated Approval Program and is said to reduce amyloid deposits in the brain that cause plaque and check the progression of the disease.
Aducanumab is the only medication that has a disease-modifying tag to it. However, clinical outcomes are still uncertain about this drug.
Doctors may analyze the cerebrospinal fluid of the patients to make an accurate diagnosis to determine the presence of amyloid deposits in the brain.
Routine MRIs could be performed on patients on Aducanumab to ensure there’s not an event of brain swelling or bleeding inside.
Usual Medications Available for Treating Mild to Moderate Alzheimer’s Disease
Early detection is the most beneficial for the patients and their families and caregivers. The formal diagnosis helps the doctor to plan the treatment that works best for the patients.
AD patients with mild to moderate symptoms are often prescribed Galantamine, Rivastigmine, and Donepezil.
These drugs are cholinesterase inhibitors that prevent the breakdown of acetylcholine, the neurotransmitter responsible for maintaining cognitive functions.
The progression of Alzheimer’s Disease reduces the production of acetylcholine in the brain, affecting cognition, so after a point, these medications don’t work.
Treatment for Moderate to Severe Alzheimer’s Disease
Memantine, an NMDA antagonist, is prescribed for patients with moderate to severe AD. Memantine blocks the overactive NMDA receptors.
It allows the neurotransmitter glutamate to connect to a cell and transfer calcium, which is important for memory and learning. Doctors can recommend taking a combination of NMDA antagonists and cholinesterase inhibitors.
Donepezil is also an FDA-approved medication doctors use in all stages of Alzheimer’s Disease. Donepezil is also a cholinesterase inhibitor that prevents acetylcholine breakdown. It may improve memory, awareness, and cognitive functions.
The medications come with their share of side effects. Higher doses may worsen side effects. Patients need continuous monitoring for side effects.
When on medication, it is crucial to consult the doctor before taking any additional vitamins and supplements. Doctors often prescribe sleep aids, anti-anxiety, antipsychotics, and anticonvulsants to manage Alzheimer’s symptoms.
The Importance of November As National Alzheimer’s Awareness Month
Abby Altman, a geropsychologist[7] and a senior mental health expert, has written about the importance of celebrating November as the National Alzheimer’s Awareness Month.
She has emphasized how important it is to understand its devastating effects on the patients and their families and how important it is to understand the symptoms and early signs of Alzheimer’s for early diagnosis and available treatments for patients[8].
She has also discussed ways in which people can support AD patients and make a difficult journey easier.
In 1983, the former US president Ronald Reagan decided to designate November as the Alzheimer’s Disease Awareness Month to spread awareness on the killer disease.
According to the CDC, Alzheimer’s Disease has affected nearly 5.8 million Americans last year. By 2060, the experts fear, the number will touch 14 million.
At present, Alzheimer’s Disease ranks sixth as a death-causing condition. Unfortunately, scientists have yet to figure out the exact causes behind Alzheimer’s disease.
A host of factors play a role in the progression of the disease, and limited treatments are available to arrest its rapid progression from one stage to another.
The current treatment scenario includes helping patients maintain cognitive health, helping them manage symptoms, and delaying the disease’s progression. Creating awareness about the disease is one of the ways patients can have timely detection and make the public health system work.
Frequently Asked Questions
Alzheimer's is prevalent in the aged population. Though Early-Onset Alzheimer's affects people between the 30s and mid-60s, such cases are rare and represent 10% of people with AD. Late-onset Alzheimer's Disease affects people in their mid-60s and is most common.
Researchers say that chronic stress could be a contributing factor to Alzheimer's Disease. As this study[6] mentions, chronic stress impacts the HPA axis, an important stress response pathway that controls cortisol production. AD patients have increased levels of cortisol and dysregulated HPA axis. Neurodegeneration could be a result of elevated cortisol levels.
There could be a link between genetics and AD. Having APOE ε4 alleles increases the chance of developing the disease. However, people having APOE ε4 alleles may never have Alzheimer's Disease.
Conclusion
Living with Alzheimer’s Disease can be devastating for the patients and their families. While we don’t know the reasons that contribute to the development of Alzheimer’s disease, we can try to prevent the deadly disease by adopting healthy habits.
Eating antioxidant and anti-inflammatory foods may help improve brain health and lower the risk of AD. Social interaction, exercise, and creative activities may prevent cognitive decline.
Quitting smoking, maintaining the ideal weight, managing blood sugar, controlling cholesterol, and getting enough sleep can improve brain health.
