Keeping Your Memory Intact - Understanding Alzheimer's


Seyi is a 52-year-old man and has been married for 30 years to his wife, Kemi. Seyi was a marketing manager at a beverage company until recently.

For three decades, he and his wife lived the life of a typical Nigerian family raising their four children to adulthood. But over the last few months, things have not been the same.


About 15 months ago, Kemi started to notice that her husband had been forgetting where he kept things. It was something they joked about. Soon, he started forgetting whole events after a couple of hours; he would forget that he had eaten in the morning or that he had received a call from someone.

Seyi was getting frustrated that he was forgetting things but Kemi initially dismissed it as something normal. Everyone forgets things, right?


It became a cause of concern to Kemi when she started noticing that he was forgetting people that came to see him and soon his forgetfulness started affecting tasks at work.

At this point, she realized that it can't be normal. Her husband was now forgetting relevant facts and events about his life.

He had begun wandering off and getting lost. The highlight was when he couldn't remember the name of their last child. That finally took them to the hospital.


Seyi was surprised when the doctors told him he had Alzheimer's. He thought it was a disease of the elderly. But as the doctor explained to him, not only the elderly are affected, middle-aged people could be affected as well.


Alzheimer's disease, also referred to as Alzheimer's is a chronic neurodegenerative disease that causes progressive memory loss and loss of cognitive function. It is the most common cause of dementia (60-70% of cases).


Dementia is a term used to describe various symptoms of cognitive decline. Other causes of dementia include alcohol, trauma, etc.


Alzheimer's is a slowly progressing disease that gradually worsens.




CAUSES OF ALZHEIMER'S


The cause of Alzheimer's is not fully understood yet. But what is common to all cases are structural disorder and dysfunction of proteins in the brain.

These dysfunctions could be linked to genetic disorders (a minority of cases) or could be sporadic.


These dysfunctional proteins constitute the major pathogenesis of Alzheimer's.


There are two proteins that are of major concern in research:


    - Plaques: Amyloid precursor proteins (APP) are proteins that normally help neuro patients after injury. After use, the APP is supposed to be broken down and recycled by certain enzymes to leave soluble fragments.


If there is a defect in the enzymes, or insufficient breakdown of the proteins or overproduction there can be accumulation insoluble fragments which cluster to form beta-amyloid plaques. They are extra neuronal deposits. These deposits can have a toxic effect on neurons and disrupt neuron to neuron signalling in the brain which can lead to symptoms such as memory dysfunction.


Amyloid plaques can also deposit around blood vessels in the brain and cause amyloid angiopathy characterized by weakened blood vessels


    - Tangles: These are interneuronal depositions of proteins. Normally, tau proteins play a part in the internal support and transport system of the neurons.

In Alzheimer's, tau proteins change shape and organize themselves into structures called neurofibrillary tangles. The tangles disrupt transport systems in the neurons and are toxic to the cells.


One of the oldest hypotheses to explain the disease is the cholinergic hypothesis which proposes that Alzheimer's disease is caused by reduced synthesis of the neurotransmitter acetylcholine.


The cholinergic hypothesis has not held substantial ground, largely because medications intended to treat acetylcholine deficiency have not been very effective.




RISK FACTORS


Age: Increasing age is the greatest known risk factor for Alzheimer's. Alzheimer's is not part of normal ageing but the likelihood of the disease occurring increases with age.


Genetics: The risk of developing Alzheimer's is higher if a first-degree relative has the disease. Most genetic mechanisms of the disease remain largely unexplained. It predisposes to early onset Alzheimer's, which occurs in the multimers


Down syndrome: The chromosomal abnormality, trisomy 21 has been linked to the development of Alzheimer's. The gene that codes for Amyloid Precursor Protein is on chromosome 21 and as such, there is an extra copy of this gene which translates to hyperproduction and insufficient breakdown of APP leading to the formation of beta-amyloid.


Sex: there appears to be a slight female predominance for the disease. This might be associated with a longer life span in women.


Head trauma: People who suffered severe head trauma in the past have a greater risk of developing Alzheimer's disease.


Lifestyle: Research has shown that lifestyle and cardiovascular health patterns such as obesity, lack of exercise, smoking, hypertension, high cholesterol, type 2 diabetes, etc are risk factors contributing to the development of Alzheimer's disease.


Poor sleep patterns:  Researchers have linked poor sleep patterns to Alzheimer's.



SIGNS AND SYMPTOMS


Early symptoms include difficulty remembering recent events (loss of short-term memory). As the disease progresses, memory impairment worsens and other symptoms can arise like language dysfunction, disorientation, loss of motivation, mood swings and behavioural issues.

It is common to find wandering and getting lost in the patient's history.


Memory loss

Although memory lapses are normal and common, the memory loss in Alzheimer's is persistent. It worsens and affects the patient's functionality at home and at work. A patient could forget lines of conversation and as such repeat statements or questions several times.

At work, the patient could forget appointments or events. Getting lost even in familiar places is another presentation. Have you ever lost a key?

People with Alzheimer's occasionally misplace their possessions whether they are kept in conspicuous locations or not.


Other cognitive functions

Thinking and reasoning - Patients encounter challenges in concentrating and thinking. Tasks having to do with numbers, dates, time, etc are especially difficult.


Making judgement it is not uncommon for patients to make a decision that can be seen as irrational or unreasonable. Irrational decision making can be seen in simple tasks like picking what to wear, eating in a public restaurant, social interactions, etc.


Behaviour The brain changes in Alzheimer's can affect the  mood and behaviour in several ways including:

-         depression

-         social withdrawal

-         mood swings

-         paranoia

-         aggressive

-         wandering

-         apathy

-         loss of restraint

-         delusions: beliefs that are not real or correct that an individual strongly believes in despite all realistic proof provided against them

-         sleeping disorders, etc.



STAGES IN ALZHEIMER'S

Early stage Alzheimer's

~       Not remembering episodes of forgetfulness

~        Forgets names of family or friends

~        Changes may only be noticed by close friends or relatives

~       Some confusion in situations outside the familiar

Middle stage Alzheimer's

~        Greater difficulty remembering recently learned information

~        Deepening confusion in many circumstances

~        Sleep disorders

~        Getting lost

Late stage Alzheimer's

~        Thinking disorder

~        Problems speaking

~        Repeats the same conversations

~        More abusive, anxious, or paranoid


DIAGNOSIS

It is difficult to diagnose Alzheimer's as the only definitive way to make a diagnosis is a brain biopsy after autopsy.

Usually, a clinician takes the patient's medical history and family medical history, search for a sign of neurological regression and would exclude other causes of dementia. Advanced medical imaging with computed tomography (CT) or magnetic resonance imaging (MRI), and with single-photon emission computed tomography (SPECT) or positron emission tomography (PET).

Assessment of intellectual functioning including memory testing can further identify the state of the disease




PREVENTION

Alzheimer's disease is not exactly a preventable condition. But one can reduce the risk of occurrence by modifying some lifestyle risk factors. Risk factors of cardiovascular disease have been linked to Alzheimer's and as such, steps to improve cardiovascular health modify or reduce risk factors of Alzheimer's disease.


These include:

-         regular exercise

-         improved diet

-         reduced alcohol

-         no smoking

-     participating in activities that improve or preserve thinking skills e.g.reading, games, dancing, social events, board games, etc.



TREATMENT

There is no cure for Alzheimer's disease and the available treatments offer relatively small symptomatic benefit but remain palliative in nature. Current treatments can be divided into pharmaceutical, psychosocial and caregiving.



Medications:

Five medications are currently used to treat Alzheimer's:

            - Acetylcholinesterase inhibitors: tacrine, rivastigmine, galantamine and donepezil

-NMDA receptor antagonist: memantine


No medication has been clearly shown to delay or halt the progression of the disease.



COPING WITH ALZHEIMER'S

Here are a few tips to help in coping with Alzheimer's


Keeping notes: Keeping notes of events that happened of things to can be helpful for patients with Alzheimer's. They can have a book or stick the notes to a fridge or board. So when they forget, they can still remember.


Family support: It is important for them to have the support of the family. It gradually becomes hard for the patients to function independently but with the help of family, they can thrive.


         Engaging in activities: Games, social activities, sports, etc. All these can be of help.


             See a doctor: The patient should not be too far from the doctor. There should be regular consultations with the doctor to follow up on the progress of the disease and assess or improve coping skills. These ensure the individual has as functional a life as possible.

             


Counselling and Support: This disease takes a huge toll on the loved ones of the patient. The mood swings of the affected person can cause emotional pain to the loved ones. This coupled with the physical demands of caring for someone who can not take care of themselves as well as before the onset of Alzheimer's can be a huge task. Thus, there should be times when they can air their feelings, take a break and spend time on themselves too.


                A system of more than one carer is helpful in this regard. They can care for the patient and still cater to their needs and earn a living to cover for themselves and the care of the patient who may not be able to work anymore. In addition, having a bigger support network of caring members in their community or carers of other people with Alzheimer's e.g a support group can make it easier for these relatives and loved ones.



Author: Bola Owate



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Au



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