- Loss of memory
- Speech difficulty
Psychiatric or behavioral
- Feeling of hopelessness or sadness
Alzheimer’s disease (AD) is a progressive degenerative disease of the brain. The disease gradually affects the neurons which are associated with memory, reason, language and behavioral changes. Neurotransmitters (chemical messengers in the brain) like acetylcholine are involved in transmission of messages within the brain. The deficiency of these chemicals also leads to breakage of connections within the nerve cells which brings the onset of AD. Starting with mild forgetfulness, the disease worsens to unmanageable behavioral changes as the brain cells are progressively damaged.
The cause of Alzheimer’s disease has not yet been completely understood. However, two proteins have been found to be involved. Extracellular beta amyloid (Aβ) deposition and intracellular tau hyperphosphorylation are thought to cause neuronal dysfunction in AD. There are several factors known to affect the development of Alzheimer's disease including age, family history, head injury, depression, hypertension, diabetes, high cholesterol, and overall general health.
The primary goals of treatment for Alzheimer's are to improve the quality of life and manage the neuropsychiatric or behavioral symptoms of the disease. While significant research into disease modifying agents and approaches are under evaluation, currently approved treatments are symptomatic and do not aid in modifying the natural progression of the disease. Key to successful management lies in early detection of the symptoms and diagnosis of the disease. Treatment involves both pharmacological and non-pharmacological treatments as well as family support. Special care should be taken along with behavioral interventions and healthy diet for patients with AD.
Medications like Cholinesterase inhibitors and N-methyl D-aspartate (NMDA) antagonist are prescribed to treat symptoms of Alzheimer’s.
- Cholinesterase inhibitors donepezil (Aricept*), rivastigmine (Exelon*), and galantamine (Razadyne*) are used as the first-line of treatment for mild-to-moderate AD. In the case of severe AD, donepezil (Aricept*) is prescribed. Cholinesterase inhibitors (CIs) delay the degradation of acetylcholine, which plays an important role in the memory, learning, and other cognitive processes.
- NMDA receptor antagonist like memantine (Namenda*) is used to reduce the behavioral and psychological symptoms of dementia and improve the cognitive ability of people with moderate to severe AD. Memantine contributes to the increased level of glutamate (chemical involved in transmitting messages along nerve cells to the brain) which is associated with memory and learning process.
Behavioral symptoms such as anxiety, depression, sleep disturbance or irritability are treated with antidepressants and anti-anxiety drugs.
Non-pharmacological treatments act as a best alternative to medications and it involves laborious interventions that aim to maintain or improve the cognitive functions of AD patients. Mild psychiatric symptoms such as depression are approached with day programs and daily exercise while sleep disturbance can be managed with bright light therapy. However, in case of severe symptoms both pharmacological and non-pharmacological treatments are recommended.
Care assessment and family support
The functional capacity of the patient is assessed and a care plan is scheduled by healthcare professionals or social care services. Family support involves cognitive stimulation programs that aim to improve the memory, problem-solving skills, and language ability of patients. Behavioral management interventions involve effective management of behavioral symptoms with proper guidelines and strategies.
In addition to providing a peaceful atmosphere, the sleep pattern and regular food habits of AD patients are maintained with the help of family support. Education, counseling, and other support services are provided to the caregivers by mental health practitioners. Caregivers are well educated with the implementation of dietary and lifestyle changes as well as the physical and emotional support for the patient. Patients diagnosed with advanced Alzheimer's disease are recommended to join support groups.