ALZHEIMER’S DISEASE Vs. DEMENTIA- A REVIEW

About Authors:
Ms. Kanika Soni, Ms. Pooja Dhiman*, Mr. Sandeep Singh
Chitkara University, Kalujhanda, Atal Shiksha Kunj,
Barotiwala, Solan [H.P], INDIA
*pooja.dhiman@chitkarauniversity.edu.in

Abstract-
Alzheimer's disease, the commonest cause of dementia in older people which causes immense distress to patients, their caregivers and families. The aetiology of Alzheimer's disease remains unknown, and no treatments reverse or stabilise the disease. Current management focuses on establishing an accurate clinical diagnosis, ensuring appropriate services are provided, supporting caregivers and treating associated non-cognitive problems because Alzheimer’s disease is the main cause of dementia. Dementia affects memory, thinking, language, judgment, behaviour, and a person’s ability to perform normal daily activities. Dementia is a word that describes symptoms of the gradual deterioration of mental functioning that cannot be explained by normal aging. Dementia occurs primarily in people who are over the age of 65, or in those with an injury or disease that affects brain function. While dementia is most commonly seen in the elderly, it is not a normal consequence of the aging process.

REFERENCE ID: PHARMATUTOR-ART-1947

Causes and symptoms of dementia- Dementia is caused by the death of brain cells. Brain cells can be destroyed by brain diseases, such as Alzheimer’s disease, or strokes (called vascular or multi-infarct dementia), which decrease blood flow to the brain. Lewy body dementia is another common cause attributed to changes in brain tissue. Other causes can include AIDS, high fever, dehydration, hydrocephalus, systemic lupus erythematosus, Lyme disease, long-term drug or alcohol abuse, vitamin deficiencies/poor nutrition, hypothyroidism or hypercalcemia, multiple sclerosis, brain tumor, or diseases such as Pick’s, Parkinson's, Creutzfeldt-Jakob, or Huntington's. Dementia can also result from a head injury that causes hemorrhaging in the brain or a reaction to a medication. In most cases, the symptoms of dementia occur gradually, over a period of years. Symptoms of dementia caused by injury or stroke occur more abruptly. Difficulties often begin with memory, progressing from simple forgetfulness to the inability to remember directions, recent events, and familiar faces and names. Other symptoms include difficulty with spoken communication, personality changes, problems with abstract thinking, poor personal hygiene, trouble sleeping, and poor judgment and decision making. Dementia is extremely frustrating for the patient, especially in the early stages when he or she is aware of the deficiencies it causes. People with dementia are likely to lash out at those around them, either out of frustration or because their difficulty with understanding makes them misinterpret the actions of others. They become extremely confused and anxious when in unfamiliar surroundings or with any change in routine. They may begin a task, such as cooking, then wander away aimlessly and completely forget what they had been doing. Dementia is often accompanied by depression and delirium, which is characterized by an inability to pay attention, fluctuating consciousness, hallucinations, paranoia, and delusions. People in advanced stages of dementia lose all control of bodily functions and are completely dependent upon others. Dementia usually first appears as forgetfulness. Mild cognitive impairment is the stage between normal forgetfulness due to aging, and the development of AD. People with MCI have mild problems with thinking and memory that do not interfere with everyday activities. They are often aware of the forgetfulness. Not everyone with MCI develops AD. Symptoms of MCI include:

1. Difficulty in performing more than one task at a time
2. Forgetting recent events or conversations
3. Taking longer to perform more difficult activities
4. Difficulty solving problems
5. Difficulty performing tasks that take some thought, but used to come easily, such as balancing a check book, playing complex games (such as bridge), and learning new information or routines.
6. Language problems, such as trouble finding the name of familiar objects.
7. Losing interest in things previously enjoyed, flat mood.
8. Misplacing items.
9. Personality changes and loss of social skills.
10. Getting lost on familiar routes.

Diagnosis of dementia- Dementia is diagnosed through a study of the patient’s medical history and a complete physical and neurological exam. Doctor will also evaluate the patient’s mental functioning with tests of mental status, such as those that require the patient to recall words, lists of objects, names of objects, and recent events. Diagnostic tests, such as blood tests, X-rays, or Magnetic Resonance Imaging (MRI), positron emission tomography (PET), or Computed Tomography (CT) scans, helps to determine the cause of the dementia.

Treatments for Dementia- In some instances, treating the cause of dementia may successfully reverse some or all of the symptoms. This is the case when the cause is related to a vitamin/nutritional deficiency, tumor, alcohol or drug abuse, reaction to a medication, or hormonal disorder. When dementia is related to an irreversible destruction of brain tissue, such as with Alzheimer’s disease, Lewy body dementia, or multiple strokes, treatment involves improving the patient’s quality of life as much as possible. This includes maintaining a stable, safe, supportive environment and providing constant supervision. Many patients enjoy therapeutic activities, such as crafts or games, designed specifically for people with dementia. Some medications, such as donepezil and tacrine, have been effective in improving the mental functions of those in the beginning stages of dementia. Patients with hallucinations and delusions may also be treated with antipsychotic drugs, while antidepressant medications are used to treat depression. There is currently no known way to prevent dementia associated with Alzheimer's disease. Only the risk of dementia associated with stroke can be decreased by maintaining a healthy lifestyle, following a heart-healthy diet, and controlling high blood pressure and high cholesterol. Healthy lifestyles, including not smoking and not abusing drugs and alcohol, go a long walk with people in good health.
Caring for a person with dementia is quite stressful.

Causes of Alzhmeir’s Diseas:-Actual cause of Alzheimer’s disease is still unknown. It may be because of combination of various genetic and environmental factors that trigger the process in which brain nerve cells are destroyed.

Genetic factors:- Genetics plays a role in early-onset Alzheimer's, a rare form of the disease that usually occur in families. Research is going on to detect genetic targets for late-onset Alzheimer's, which is the more common form. At this time, only one gene, apolipoprotein E (ApoE) has been found to be linked to late-onset Alzheimer's disease. However, only a small percentage of people carry the form of ApoE that increases the risk of late-onset Alzheimer's. Other genes or combinations of genes may be involved.

Environmental Factors: - Environmental factors that may play a role in Alzheimer’s disease or that trigger the disease process in people who have a genetic susceptibility. Current study says there is an association between serious head injuries in early adulthood and Alzheimer’s development. Lower educational level, which may decrease mental activity and neuron stimulation, can also be a cause of Alzheimer’s disease. Infections, metals, or industrial toxins can become a cause Alzheimer’s disease. The person having following characters may get AD, if the person

1. is older. However, developing AD is not a part of normal aging.

2. Being female

3. Having high blood pressure for a long time

4. History of head trauma

5. Have a close blood relative, such as a brother, sister, or parent with AD.

6. Have certain genes linked to AD, such as APOE epsilon4 allele

7. The following may also increase your risk, although this is not well proven:

Symptoms Of Alzheimer’s Disease - The symptoms ofalzheimer’s disease are listed below.

1. Dementia symptoms include difficulty with many areas of mental function, including:

2. Language

3. Memory

4. Perception

5. Thinking and judgment (cognitive skills)

6. Emotional behavior or personality

As the AD becomes worse, symptoms are more obvious and interfere with your ability to take care of ourself. Symptoms of AD include:
1. Change in sleep patterns, often waking up at night.
2. Delusions, depression, agitation.
3. Difficulty doing basic tasks, such as preparing meals, choosing proper clothing, and driving.
4. Difficulty reading or writing.
5. Forgetting details about current events.
6. Hallucination, arguments, striking out, and violent behaviour.
7. Poor judgment and loss of ability to recognize danger.
8. Using the wrong word, mispronouncing words, speaking in confusing sentences.
9. Withdrawing from social contact.

People with severe AD can no longer understand language, recognize family members, and perform basic activities of daily living, such as eating, dressing, and bathing, incontinence, swallowing problems.

Diagnosis Of Alzheimer’s Disease- Alzheimer’s disease can only be diagnosed after death when an autopsy of the brain is performed. However, doctors use a variety of tests to make a probable diagnosis of Alzheimer’s. The doctor will investigate patient’s health history, including other medical conditions the patient has, recent or past illnesses, and progressive changes in mental function, behavior, or daily activities. The doctor use to ask about use of prescription drugs and lifestyle factors, including diet and use of alcohol. The doctor will evaluate the patient’s hearing and vision, and check blood pressure and other physical signs. A neurological test will also be conducted to check the patient’s reflexes, coordination, and eye movement.Blood, urine, and spinal fluid samples will be evaluated to found other possible causes of dementia, such as thyroid imbalances or vitamin deficiencies.A number of psychological tests are used to assess difficulties in attention, perception, memory, language, and problem-solving, social, and language skills. These tests can also be used to evaluate mood problems such as depression. One commonly used test is the Mini-Mental State Exam (MMSE), which uses a series of questions and tasks to evaluate cognitive function. Brain imaging tests are useful for ruling out blood clots, tumors, or other structural abnormalities in the brain that may be causing signs of dementia. These tests include magnetic resonance imaging (MRI) or computed tomography (CT). Functional and volumetric MRIs, as well as positron-emission testing (PET) scans, have some ability to predict the early Alzheimer disease.

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