Alzheimer’s is a neurodegenerative disease that mostly occurs with old age. As a result of thinning of the brain tissue, it shows symptoms as disorders in memory, speech and motor skills. In this disease, behavior and thinking skills are affected and gradually regress during the stages of the disease.
There is an increase in incidence, especially after the age of 65. It is the most common form of dementia. There may be a delay in the detection of the disease because it appears as simple forgetfulness in the first stage and these can be confused with daily forgetfulness. The disease was first identified by the German psychiatrist and neuropathologist Alois Alzheimer in 1906, and this is why the disease is named after him.
There is no definitive cure for Alzheimer’s disease. However, some treatment methods are used to slow down its progression, improve the quality of life of patients, or treat physical symptoms. Early diagnosis can prolong the early stage of the disease, especially the slow development of the disease, and the time for patients to lead an independent life.
Incidence of Alzheimer’s Disease
In countries where the elderly population is increasing, there is an increase in diseases related to aging. Since the 2000s, Turkey has become one of the countries where the elderly population has increased. It is expected that the elderly population in the country will reach 10.3% by 2023. Between the years 2012-1017, an increase was observed in both the elderly population and the incidence of dementia-type diseases in Turkey. This means an increase in the incidence of Alzheimer’s disease in the population.
According to a study conducted in Turkey in 2017, a total of 13,600 people died in 2017 due to Alzheimer’s. Of these, 7901 are female and 4999 are male. There are approximately 44 million Alzheimer’s patients in the world today, and more than 7 million people are diagnosed with Alzheimer’s disease every year. It is thought that 75.6 million people in 2030 and 135.5 million people in 2050 will have Alzheimer’s disease.
The incidence of Alzheimer’s disease, which is one of the degenerative forms of Primary Dementia, is 50-70% among all other forms of dementia. So it is one of the most common types of dementia.
Alzheimer’s disease has an incidence of 1 in 20 in patients aged 40 to 65, 1 in 14 in patients over 65 years of age, and 1 in 6 in patients over 80 years of age. It has been defined as a global health problem by the World Health Organization.
What Are the Symptoms of Alzheimer’s Disease?
Symptoms of Alzheimer’s disease vary according to the stage the patient is in. However, in general, symptoms can be divided into two different titles, mental and physical.
• Memory loss,
• Loss of language skills,
•Regression in visual-spatial skills,
Disturbance in abstract thinking and judgment,
• Personality and behavioral changes,
• Inability to take care of oneself,
• Physical function losses are the most common symptoms.
In addition, patients may experience increased levels of paranoia, delirium, aggression, rhythm disturbances in metabolism, anxiety, depression and phobias, depending on the stages. Depression is one of the most devastating effects of this disease. Sometimes it can be even more challenging than the disease itself.
Stages of Alzheimer’s Disease
Alzheimer’s disease has three stages.
Early Stage
Since the symptoms are very mild in the early stages, the disease can be easily overlooked or confused with other diseases (depression). Although memory disorders may be seen in patients at this stage, patients can do their routine work on their own. Simple forgetfulness (such as forgetting the shopping list, key or the stove on), fading in the concept of time, difficulty in remembering the history, retelling the events described, difficulties in learning new information, regression in language skills (difficulty in remembering words, inability to find the right words), difficulties in making decisions. symptoms are seen. At this stage, the communication skills of the patients are not impaired yet.
Middle Stage
In the middle stage, the symptoms become clearer and the diagnosis is usually made at this stage. In this stage, cognitive impairments arising from the region of the brain responsible for language and speech become more frequent; Patients have difficulty repeating learned meaningful movements. This disorder, called apraxia, appears as a loss of speech ability. Patients have problems doing their routine work. They cannot do their work outside the home alone. They may begin to need help with eating, dressing, toileting and bathing. Deterioration in social relations also begins in this period. An increase in aggression, paranoia and anxiety can be observed.
Advanced Stage
In the advanced stage, which is the third stage, patients develop urinary incontinence, motor disorders, posture disorders and walking difficulties. During this period, patients became almost completely in need of care. It is dependent on others for all activities such as feeding, washing and dressing. Experience swallowing difficulties are among the cases. There is also an increase in infections and organ failure in patients at this stage, and death in these patients mostly occurs due to secondary causes such as bed infections, pulmonary embolism, and nutritional disorders.
Causes and Risk Factors
The effect of genetic factors is higher in Alzheimer’s that develops at an early age. The risks of the disease can be grouped as preventable and unavoidable risks.
Being an unavoidable factor, advanced age is the biggest risk factor for this disease, as it is for all types of dementia. The incidence of the disease increases after the age of 65, and reaches 20% on average after the age of 80.
Alcohol, smoking, substance use; low education level, sedentary life, adverse living conditions and malnutrition can be counted among the preventable risks. Cardiovascular diseases, hypertension and obesity also increase the risk of Alzheimer’s. Also, women are at higher risk than men. Especially after menopause, with the decrease of estrogen, which has the task of protecting the brain, the brain becomes more vulnerable to degenerative diseases.
Sudden loss and traumas, head injuries, brain tumors, Pick’s disease, Parkinson’s disease or other central nervous system disorders are other unavoidable factors that increase the risk of Alzheimer’s. In addition, people with a history of depression may also be at risk of developing Alzheimer’s at an advanced age.
Although the cause of the disease is not yet known, it is known that some proteins accumulated between neurons impair cell functions. However, it is not known what causes this protein accumulation.
How is Alzheimer’s Disease Diagnosed?
It is difficult to diagnose the disease at an early stage. Symptoms can be confused with everyday forgetfulness or depression. However, the abnormalities observed by the people who know the patients closely in the behavior of the patients play an important role in the diagnosis. Early diagnosis is important to slow the progression of the disease. For this reason, close follow-up of the elderly population, especially those who have more than one of the risk factors, is required. The cooperation of psychiatry, social services and patient relatives is important in the suspicion of the disease.
Psychotherapy and imaging methods are used together for diagnosis. In addition to methods such as computed tomography (CT), positron emission tomography (PET), magnetic resonance (MR), detailed anamnesis, blood tests, physical examination and neuropsychological tests are also required for diagnosis.
What are the Treatment Methods Used in Alzheimer’s Disease?
There is no definitive treatment method that eliminates Alzheimer’s or stops its progression. There are some medicated and non-medicated methods used to slow its emergence and progression. In drug therapy, drugs such as Acetylcholinesterase inhibitors and Memantine are used. In drug-free treatment, rehabilitative treatments such as dance, massage, exercises and music are applied.
What Are the Preventive Methods That Can Be Used in Alzheimer’s Disease?
Exercising, eating healthy; Avoiding alcohol, smoking and substance use are useful methods to delay the onset of this disease. Since cardiovascular diseases and obesity increase the risk of this disease, it can be a preventive factor for people to maintain their physical activity levels as they get older, and to increase neuroplasticity, especially by exercising (half-hour walks 6 days a week, short-term high-intensity aerobic activities and balance and strength training).
Diets rich in fish, vegetables and fruits also come to the fore in maintaining the general health status of people.
In addition, breathing exercises are important for patients prone to anxiety and depression.
How Should Alzheimer’s Patients Be Careed?
In diseases such as Alzheimer’s, in which patients become completely in need of care, the caregiver is at risk as much as the patient himself. For this reason, many studies are carried out to increase the quality of life of caregivers in this area. Geriatrics associations, Alzheimer’s Foundation, Turkey Alzheimer’s Association are among the places where both early-stage patients and caregivers can access a lot of information, counseling and training.