Alzheimer’s disease is a degenerative disease that causes a progressive decline in cognitive abilities and memory. Little by little, nerve cells are destroyed in areas of the brain related to memory and language. Over time, it becomes more difficult for the person to remember events, recognize objects and faces, remember the meaning of words and exercise judgment.

In general, symptoms appear after age 65 and the prevalence of the disease increases sharply with age. However, contrary to popular belief, Alzheimer’s disease is not a normal consequence of aging.

Alzheimer’s disease is the most common form of dementia in the elderly, accounting for about 65% of dementia cases. The term dementia includes, in a very general way, health problems marked by an irreversible decrease in mental faculties. Alzheimer’s disease differs from other dementias in that it progresses gradually and primarily affects short-term memory in its early stages. However, the diagnosis is not always obvious and it may be difficult for doctors to differentiate Alzheimer’s disease from Lewy body dementia, for example.

Prevalence

Alzheimer’s disease affects approximately 1% of people aged 65 to 69, 20% of people aged 85 to 89 and 40% of people aged 90 to 95. In India, approximately 51,00,000 people have Alzheimer’s disease or a related dementia.

It is estimated that 1 in 8 men and 1 in 4 women will suffer from it during their lifetime. To the extent that women live longer, they are more likely to develop it one day.

Due to increased life expectancy, this disease is becoming more common. It is estimated that within 20 years, the number of people affected will double in India.

Brain damage

Alzheimer’s disease is characterized by the appearance of very specific lesions, which gradually invade the brain and destroy its cells, the neurons. The neurons in the hippocampus, the region that controls memory, are the first to be affected. It is not yet known what causes these lesions to appear.

Dr. Alois Alzheimer, a German neurologist, named the disease after him in 1906. He was the first to describe these brain lesions during the autopsy of a woman who died of dementia. He had observed abnormal plaques and entanglements of nerve cells in her brain that are now considered the main physiological signs of Alzheimer’s disease.

Here are the 2 types of damage that appear in the brains of affected people:

Excessive production and accumulation of beta-amyloid proteins in certain areas of the brain. These proteins form plaques, called amyloid plaques or senile plaques, which are associated with the death of neurons.

The “deformation” of certain structural proteins (called Tau proteins). The way the neurons are entangled is then modified. This form of injury is called neurofibrillary degeneration.

In addition to these lesions, inflammation contributes to altering neurons. There is still no treatment that can stop or reverse these pathological processes.

Causes

The causes of Alzheimer’s disease are not known. In the vast majority of cases, the disease appears because of a combination of risk factors. Aging is the main factor. Risk factors for cardiovascular disease (hypertension, high cholesterol, obesity, diabetes, etc.) also seem to contribute to its development. It is also possible that infections or exposure to toxic products play a role in some cases but no formal evidence has been obtained.

Genetic factors also play an important role in the onset of disease. Thus, certain genes may increase the risk of being affected, although they are not directly the cause of the disease. Researchers have found that about 60% of people with Alzheimer’s disease carry the Apolipoprotein E4 or ApoE4 gene. Another gene, SORL1, also seems to be often involved. However, many individuals carry these genes and will never get the disease and, conversely, some people without these genes may develop the disease.

There are also hereditary forms of the disease but they account for less than 5% of cases. Only 800 families in the world have been identified. Children who have a parent with Alzheimer’s disease in its hereditary form are at 1 in 2 risk of developing the disease themselves. The symptoms of the family form appear early, sometimes before the age of 40. However, even if several members of the same family are affected by this disease, it does not necessarily mean that it is the hereditary form.

Evolution of the disease

Alzheimer’s disease progresses over several years and its progression varies greatly from person to person. We now know that the first lesions appear in the brain at least 10 to 15 years before the first symptoms.

These usually appear after the age of 60. On average, once the disease occurs, life expectancy is 8 to 12 years. The older the disease, the more rapidly it tends to get worse. When it occurs around age 60 or 65, life expectancy is about 12 to 14 years; when it occurs later, life expectancy is only 5 to 8 years. It is currently impossible to halt the progression of the disease.

Light stage. Memory loss occurs occasionally. Short-term memory, the ability to remember recent information (a new phone number, words on a list, etc.), is the most affected. People with Alzheimer’s try to overcome their difficulties by using memory aids and their loved ones. Mood changes and slight spatial disorientation can also be observed. The person with Alzheimer’s has more difficulty finding words and following the thread of a conversation. At this stage, it is not certain whether it is Alzheimer’s disease. Over time, symptoms may remain stable or even decrease. The diagnosis is confirmed if memory problems increase and if other cognitive functions deteriorate (language, object recognition, complex movement planning, etc.);

Moderate stage. Memory problems are getting worse. Memories of youth and middle age become less accurate but are better preserved than immediate memory. It is becoming increasingly difficult for people with dementia to make choices; their judgment is beginning to be impaired. For example, it gradually becomes more difficult for them to manage their money and plan their daily activities. Disorientation in space and time becomes more and more obvious (difficulty remembering the day of the week, birthdays…). It is becoming increasingly difficult for people with the disease to express themselves verbally; Between the moderate and advanced stages, unusual behavioural problems sometimes arise: for example, aggressiveness, atypical, filthy language or a change in personality traits.

Advanced (or terminal) stage. At this stage, the patient loses his autonomy. Permanent supervision or accommodation in a care centre becomes necessary. Psychiatric problems can occur, including hallucinations and paranoid delusions, aggravated by severe memory loss and disorientation. Sleep problems are common. Patients neglect their personal hygiene, become incontinent and struggle to feed themselves. If left unattended, they can wander in vain for hours.

Diagnostics

To make the diagnosis, the doctor uses the results of several medical examinations. First, he questions the patient to learn more about how his memory loss and other difficulties he experiences in everyday life manifest themselves. Tests to assess cognitive faculties are carried out, depending on the case: tests of vision, writing, memory, problem-solving, etc. In case of memory problems, even when paying attention, the patient’s test performance will be abnormal.

In some cases, various medical tests may be performed to exclude the possibility that the symptoms are due to another health problem (vitamin B12 deficiency, thyroid malfunction, stroke, depression, etc.).

If deemed necessary, the physician may also advise the patient to have a brain imaging examination (preferably MRI, magnetic resonance imaging) to observe the structure and activity of different areas of the brain. Imaging makes it possible to highlight the loss of volume (atrophy) of certain areas of the brain, characteristic of neuron degeneration.

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