Alzheimers Risk Factors and Prevention - Research Paper Example

Alzheimer’s disease Alzheimer’s is a progressive and irreversible brain disease that affects memory and as the disease progresses the person is unable to carry out simple routine tasks. There has been widespread knowledge about mental deterioration as people age; however, a definite diagnosis of a medical condition involving abnormalities in the brain cells was made by a German Physician Dr. Alois Alzheimer in 1906 after whom the name of the disease has been coined. He discovered the condition while performing the autopsy on one of his patients who had suffered from severe memory problems and confusion. During the autopsy the doctor noted dense deposits of neuritic plaques surrounding nerve cells and twisted bands of nerve fibers inside the cells. The presence of plaques and tangles during a brain autopsy is now taken as a definitive diagnosis of the condition. There have been several additional researches that have been carried out by scientist around the world since the discovery of the disease. In the 1960s researchers found connectivity between the cognitive decline and the number of plaques and tangles present in the brain. Since the 1970s scientists have made major discoveries pertaining to the complex functioning of the nerve cells in these patients and also with increasing developments in the field of genetics, genes responsible for susceptibility to this disease both in the early stages and later in life have also been unraveled. Apart from the genetic factors other lifestyle related and environmental risk factors are also being widely being explored (A History, 2009; Alzheimer’s disease, 2010). Alzheimer’s is a progressive disease and before the symptoms are noticed sufficient damage to the brain would have already taken place. Studies reveal that this damage could occur anywhere between 10 to 20 years before the onset of the clinical signs and symptoms. Beginning with the development of tangles within the entorhinal cortex and plaques in other regions of the brain, the disease affects the functioning of neurons that eventually results in lost communication between the brain cells. When such damage occurs within the hippocampus region of the brain as the disease progresses, it affects the memory and processing skills of the individual (Alzheimer’s disease, 2010). Thus most prominent early sign of the disease is memory loss (Alzheimer’s disease, 2010; Alzheimer’s symptoms, 2009; Symptoms, 2009). Other common early symptoms include confusion, attention disorders, personality changes, difficulty with languages and sudden mood swings. The occurrence of these symptoms are in no particular order, may fluctuate and do vary in severity (Alzheimer’s symptoms, 2009). However, the progress of the disease has now become predictable and the symptoms progress in three stages beginning with the mild stage to the moderate and finally to the severe stage (Alzheimer’s disease, 2010; Alzheimer’s symptoms, 2009; Symptoms, 2009). The symptoms during the mild stage can last from 2 to 4 years and these include progressive memory loss, getting lost, develop a withdrawn attitude, inability to manage finances, difficulty in organizing and planning, repeated questioning, delay in completion of daily routine, misplacing things, personality or mood changes and changes in communication (Alzheimer’s disease, 2010; Alzheimer’s symptoms, 2009; Symptoms, 2009). Individuals tend to get angry and frustrated and such an attitude is reflected in their work and hence they may begin to have work-related problems (Alzheimer’s symptoms, 2009). The moderate stage can last longer for up to 2 to 10 years and definitive changes in the individual are clearly observed during this stage as they become disabled and apart from performing simple tasks they require assistance for more complex activities (Alzheimer’s symptoms, 2009). Research has revealed that these apparent changes are due to changes occurring within the brain in regions that control language, reasoning, senses and consciousness (Alzheimer’s disease, 2010; Symptoms, 2009). Memory loss is more advanced in this stage with the individual unable to recollect recent happenings and recognize people. They also tend to confuse past happenings with that of the current situation and become confused. At this stage people have disoriented speech and suffer from an inability to learn, read and write normally. They tend to wander and might also experience hallucinations, delusions and paranoia with loss of control over body and thought process (Alzheimer’s disease, 2010; Alzheimer’s symptoms, 2009; Symptoms, 2009). When the individual realize their situation they become more depressed, irritable and withdrawn and have sleep related disturbances (Alzheimer’s symptoms, 2009). In the final stage in addition to the complete loss of mind control and inability to carry out simple tasks such as eating individuals are unable to control basic bodily functions such as swallowing, bowel and bladder functions. This is the stage when the plaques and tangles have spread throughout the brain and hence the brain tissue has undergone considerable shrinkage (Alzheimer’s disease, 2010). They tend to sleep often as there is no coordination between the body and the mind and while awake are almost completely lost and do not communicate. Hence they need to be under constant supervision (Alzheimer’s disease, 2010; Alzheimer’s symptoms, 2009; Symptoms, 2009). Their compromised physical state and bedridden state make them susceptible to various infections and illnesses (Alzheimer’s symptoms, 2009). The exact cause for the occurrence of Alzheimer’s disease is still unknown; however, researchers have identified several risk factors which could initiate the various neurological changes that occur within the brain over a period of time which leads to the occurrence of various symptoms of the disease later in life. One of the major risk factor that is being studied is aging and age-related changes that occur within the brain given the higher incidence of the disease in older adults (Alzheimer’s disease, 2010). Most of the individuals affected by the disease are above 65 years and studies show that the risk doubles every five years after 65. Those above 85 years have a 50 percent chance of developing the disease (Alzheimer’s risk factors, 2009; Risk factors, 2010). Some of the age-related changes that have been identified include atrophy of certain parts of the brain, inflammation and production of unstable free radicals within the brain. Familial history of Alzheimer’s is considered to be another potential risk factor for the occurrence of the disease as presence of the disease in more than one family member increases the risk further (Risk factors, 2010). The genetic component of the disease has been extensively analyzed by scientists and potential genes identified. As the disease predominantly occurs after 65 years no specific genetic inheritance pattern is associated with the disease. However, research has revealed that the inheritance of the Apolipoprotein E (ApoE) gene could be a risk factor for the late-onset form of the disease. There are three forms of this gene: ApoE2, ApoE3 and ApoE4 and the inheritance of a single copy or two copies of the ApoE4 form of the gene subsequently increases the risk of developing the disease while the ApoE2 gene protects against (Alzheimer’s disease, 2010; Alzheimer’s risk factors, 2009; Risk factors, 2010). Other potential genes that have been identified include UBQLN1, SORL1, TOMM40, CLU, PICALM and CR1 (Alzheimer’s disease, 2010; Alzheimer’s risk factors, 2009). While these genes are associated with late-onset Alzheimer’s disease, another rare form of the disease termed familial Alzheimer’s disease manifests early in life and affects about 10% of patients with Alzheimer’s. This disease could occur as early as 35 years as opposed to the late-onset form of the disease due to gene mutations in one of the three genes located in chromosomes 1, 14 and 21. Other potential risk factors that facilitate the progress of Alzheimer’s disease include high blood pressure that could damage blood vessels in regions of the brain that govern memory and thought processes. High cholesterol may also accelerate the changes that occur in the brain. High levels of blood sugar that results in diabetes may also harm the brain and contribute to disease progression. Excessive production of free radicals which attack molecules due to their unstable nature can lead to tissue damage and when this occurs within the brain of an individual with Alzheimer’s disease it may accelerate neuronal damage. Other factors that are being studies include head injury and the risk of developing Alzheimer’s disease in the future, inflammation and heart ailments due to high blood pressure and heart disease that may have an affect on the functioning of the brain (Alzheimer’s risk factors, 2009; Risk factors, 2010). While these are the risk factors identified, scientists believe that a healthy lifestyle that includes nutritious diet, physical activity and engaging in tasks that help maintain mental health and well being will definitely help to reduce cognitive decline especially among older adults and prevent the occurrence of diseases such as Alzheimer’s (Alzheimer’s disease, 2010; Risk factors, 2010). The number of people affected with Alzheimers disease is likely to increase as the population ages and hence scientists and the medical community are stressing on the need for early identification of the disease so that beginning of an early treatment process could help to slow the relentless brain damage that occurs as the disease progresses. However, given the slow pace of disease progression it is quite difficult to know when exactly the disease begins. Researchers have stressed the importance of home monitoring for those above 75 years which may help to identify changes in daily routine signaling the start of the disease process (DeMarco, 2008). While memory loss is usually associated with old age, the other symptoms that relate to the condition include problems with recollecting and speaking right words, low recognizing ability, inability to use simple things like a pencil and to perform simple routine tasks such as turning off the stove or shutting the doors and windows. Persistence of such symptoms coupled with personality changes such as agitation and irritability are sufficient signs that help determine the presence of the disease. Identification of mild symptoms can be difficult and the doctor will have to be appraised about family history, past and present medical condition and behavior of the individual in order to enable diagnosis. (Early Alzheimers, 2007). Given the importance of diagnosing the condition at an early stage to facilitate better prognosis and help preserve brain function, there are several blood tests and scans that are available. Blood, urine and spinal fluid samples are generally screened which help to detect the presence of any deficiencies. Additionally the individual is also subjected to psychological tests in order to assess the memory, cognitive status and language skills using questionnaires and activities. Imaging studies are also carried out using MRI, CT or PET scans which help to rule out any other problems within the brain. However while these tests facilities the treatment process a definitive diagnosis of the disease is only possible during autopsy of the brain (Alzheimer’s disease, 2010; Simon, 2009). A latest inclusion to the above are in-home monitors which track the cognitive abilities of people. A pilot study that utilized the home monitors found that impaired participants showed greater variation than normal people in daily activities such as walking speed. Other studies are also training participants in computers to enable them to take online memory and cognition tests. Such monitoring will enable doctors to keep track of their patient’s condition on a daily basis rather than once or twice a month (DeMarco, 2008). A more recent study found that neuronal or cell death that is associated with Alzheimers disease also causes damage to cells at the back of the eye. Through a study in mice the study found that apoptosis of the cells in the eye took place early in the disease which later leads to cell explosion or necrosis. The study used different dyes to identify apoptotic and necrotic cells and it also found that as the disease progresses necrosis of cells increased. Extending the application to humans by using a safe eye drops to study the cells in the eye could help in early diagnosis of the condition (Hamzelou, 2010). Since the disease includes symptoms which overlap with those associated with other diseases, Alzheimers disease can often be misdiagnosed. Dementia is one particular disorder which is often confused with Alzheimers disease as many of the symptoms are similar in both cases. Dementia is common in several disorders and Alzheimers disease can also cause dementia. However, some cases of dementia are reversible when the right treatment is afforded (Alzheimer’s symptoms, 2009; Simon, 2009, Eddy, 2002). Some people with memory problems may actually have amnestic mild cognitive impairment (MCI). These individuals have a higher degree of memory related problems due to the occurrence of strokes within the brain when vessels get blocked thus resulting in low blood supply and finally tissue damage (Eddy, 2002). People who only have MCI do not experience all of the symptoms associated with Alzheimers disease; however, their risk of developing Alzheimers disease in the future is higher compared to normal individuals (Alzheimer’s disease, 2010; Alzheimer’s symptoms, 2009). Other diseases whose symptoms overlap with those of Alzheimers include Parkinson’s disease in which the individual suffers from inability to control movements, Huntington’s disease which is a degenerative brain disorder with many similar symptoms such as memory loss and personality changes. Another disease termed Creutzfeldt-Jakob disease which is usually caused by infection has many similar symptoms as that of Alzheimers and is only definitely diagnosed during autopsy. People who experience depression are also often considered to have Alzheimers disease though they might not have any motor or language difficulty and memory loss might occur only in the most severe case of depression. Another condition in which the brain is affected is normal pressure hydrocephalus caused due to a blockage in the flow of the spinal fluid that in turn accumulates in the brain compressing the tissues. Symptoms occur depending on which tissues are compressed and are mostly similar to that of Alzheimers disease. This disease can however, be confirmed using MRI or CT scans. Pick’s disease is another condition in which the nerve cells of the brain are affected and these individuals experience memory loss, confusion and show personality changes. A definitive diagnosis for this disease can only be made after an autopsy. Lewy body dementia includes symptoms of both Alzheimers disease and Parkinson’s disease and occurs due to accumulation of certain protein deposits within the brain. Symptoms such as memory loss, confusion and lack of coordinated movements are associated with this disease. Binswanger’s disease in which people have lesions in the white-matter of the brain also show similar symptoms as that of Alzheimers. Insufficient levels of vitamin B1 can cause a brain disorder termed Wernicke-Korsakoff syndrome with symptoms such as memory loss and confusion. Apart from these diseases, conditions such as brain tumor may also cause symptoms similar to Alzheimers. While many of the disease lack a definitive diagnosis, some can be confirmed with the help of scans such as MRI and CT. Hence a proper diagnosis is vital to determine the course of the treatment as while a wrong treatment might be effective due to the overlapping symptoms, it will not alleviate the underlying problem and thus will not benefit the individual when the disease progresses to the final stage (Eddy, 2002). Given the complexity of the disease there is no single treatment that can cure the disease and hence a combination of medication and other therapies are often prescribed for people with Alzheimers disease. While all the treatments that are available at present slow or delay the mental deterioration by improving cognitive abilities and help manage behavioral problems in the affected individual they do not completely cure the disease (Alzheimer’s disease, 2010; Alzheimers approved drugs, n.d). Medications are the first line of treatment given for people with the disease. While they do not offer complete cure, medications help the individuals to cope well with the condition and lead a more or less normal, independent and comfortable life by delaying the progress of the disease. The medications are generally prescribed depending on the severity of the disease. For those with mild to moderate Alzheimers disease cholinesterase inhibitors are generally prescribed (Alzheimers disease Medication, 2009). This class of drugs helps to improve memory, thinking, language and behavioral skills of the individual by increasing the levels of acetylcholine, a chemical messenger, by preventing its breakdown in the brain. This chemical is vital for memory and though processes and is released by certain brain cells to facilitate cell to cell communication. In the normal state the released acetylcholine is generally broken down by enzymes such as cholinesterase after the communication process in order for it to be recycled. However in the case of Alzheimers disease the cells that produce the messenger are damaged during the course of the disease and as a result the amount of the messenger produced decreases drastically. Thus by administering cholinesterase inhibitor class of drugs the activity of the enzymes mediating the break down of the chemical messenger is blocked thereby maintaining the amount of acetylcholine which helps in cell to cell communication thus delaying the occurrence of the associated symptoms for some period of time as they do not change the disease process (Alzheimer’s disease, 2010; Alzheimers disease Medication, 2009; FDA-Approved treatments, 2007). The three major cholinesterase inhibitors that are prescribed are Donepezil (Aricept), Galantamine (Razadyne) and Rivastigmine (Exelon). These three drugs are most effective when the disease is diagnosed at an early stage. Studies carried out with the three drugs showed modest improvement in the quality of life and though all the three drugs work in the same manner the response to the drugs differs from one individual to another. While these drugs are well tolerated by individuals they are sometimes associated with minor side-effects such as vomiting, nausea and loss of appetite (Alzheimers approved drugs, n.d; FDA-Approved treatments, 2007). The patient will have to be monitored when a drug treatment is begun and the right dosage should be decided by the physician (Alzheimers disease Medication, 2009). Tacrine was the first cholinesterase inhibitor that was introduced which is not prescribed nowadays as it was found to be associated with possible liver damage (Alzheimers approved drugs, n.d; Alzheimers disease Medication, 2009; FDA-Approved treatments, 2007). For the moderate and severe cases of Alzheimers disease, memantine which is marketed as Nemanda is generally prescribed. This drug is an N-methyl D-aspartate antagonist which helps prevent overexposure of the brain to excess levels of glutamate. While normal levels of glutamate is required for information processing, its storage and subsequent retrieval, excess glutamate may cause damage to the nerve cells within the brain (Alzheimers approved drugs, n.d; Alzheimers disease Medication, 2009; FDA-Approved treatments, 2007). This drug is usually prescribed for those in the later stages of the disease to help them perform their daily functions. While some studies have shown that intake of the drug results in a small improvement in the functioning of the affected individual, many other studies have found no improvement in activities or overall functioning of the individual. Some of the adverse effects of this drug include dizziness, headache and constipation (FDA-Approved treatments, 2007). In addition to the above drugs, studies have shown that daily intake of vitamin E slows the disease progression to some extent. A similar modest improvement is obtained with the use of selegiline, a drug used for Parkinson’s disease. More recently studies are investigating the effect of the female hormone estrogen, steroid prednisone and other non-steroidal inflammatory drugs for treatment of Alzheimers disease (Alzheimer’s risk factors, 2009; Alzheimers approved drugs, n.d). While most of the drugs prescribed as of now help people to cope with the memory and daily functioning, there are no specific drugs that help in the management of behavioral problems. New treatments are being developed by scientist to address this problem which will help to make people more comfortable and confident. More advanced treatment strategies are focusing on treating the underlying condition rather than just the symptoms. In addition to all the treatment, doctors also stress on the need for caring individuals with Alzheimers disease as it could provide a strong emotional support to the individual. Awareness programs for those affected and their families will help one to understand the illness and devise strategies to cope well with the disease. Participation in support group programs will also help to boost the morale of the affected individual and caregivers as they will get to know about the experiences of people with the same disease and also gain emotional support and comfort (Alzheimer’s disease, 2010). Studies also suggest that eating a wholesome diet and regular exercise could definitely slow the progression of the disease if not prevent it (Alzheimer’s risk factors, 2009). Thus greater strides are being made to understand and treat Alzheimers disease. While there is still no definitive cure for the disease, advances in medicine and support programs has helped to make the lives of those affected more comfortable by providing the much needed hope and support. Research on the genetics of the disease is providing better insights to the occurrence of the disease and will in the near future help to successfully manage or even prevent the occurrence of Alzheimers disease (Alzheimer’s disease, 2010). References 1. A History of Alzheimers disease. (2009). Retrieved April 12, 2010, from, http://www.ahaf.org/alzheimers/about/understanding/history.html 2. Alzheimer’s disease fact sheet. (2010). Retrieved April 12, 2010, from, http://www.nia.nih.gov/Alzheimers/Publications/adfact.htm 3. Alzheimer’s symptoms and stages. (2009). Retrieved April 12, 2010, from, http://www.ahaf.org/alzheimers/about/symptomsandstages.html#symptoms 4. Symptoms. (2009). Retrieved April 12, 2010, from, http://www.nia.nih.gov/Alzheimers/AlzheimersInformation/Symptoms/ 5. Alzheimer’s risk factors and prevention. (2009). Retrieved April 12, 2010, from, http://www.ahaf.org/alzheimers/about/risk/#riskfactors 6. Risk factors. (2010). Retrieved April 12, 2010, from, http://www.alz.org/alzheimers_disease_causes_risk_factors.asp#Introduction 7. DeMarco, B. (2008). It is Difficult to catch the early signs of Alzheimer’s. Retrieved April 12, 2010, from,http://www.alzheimersreadingroom.com/2008/11/it-is-difficult-to-catch-early-signs-of.html 8. Early Alzheimers disease. (2007). Retrieved April 12, 2010, from, http://www.athealth.com/consumer/disorders/alzheimers2.html 9. Hamzelou, J. (2010). Early signs of Alzheimers are in the eye. Retrieved April 12, 2010, from, http://www.newscientist.com/article/dn18385-early-signs-of-alzheimers-are-in-the-eye.html 10. Simon, H. (2009). Alzheimers disease- diagnosis. Retrieved April 12, 2010, from, http://www.umm.edu/patiented/articles/what_symptoms_of_alzheimers_disease_000002_5.htm 11. Eddy, K.P. (2002). Conditions with symptoms similar to Alzheimer’s which could cause a misdiagnosis. Retrieved April 12, 2010, from, http://www.essortment.com/family/alzheimersdisea_swzm.htm 12. Alzheimers approved drugs. (n.d). Retrieved April 12, 2010, from, http://www.alzinfo.org/alzheimers-treatment-cognitive.asp#1 13. Alzheimers disease Medication Fact Sheet. (2009). Retrieved April 12, 2010, from, http://www.nia.nih.gov/Alzheimers/Publications/medicationsfs.htm 14. FDA-Approved treatments for Alzheimer’s. (2007). Retrieved April 12, 2010, from, http://www.alz.org/national/documents/topicsheet_treatments.pdf Read More