Last week, more than 12 million fans of “Coronation Street” tuned in to witness the final moments of one of the soap’s most enduring characters, Mike Baldwin. Once a domineering sharp-minded businessman, the soap followed his progression over a number of months to the extremely confused and venerable state he was in when he left our screens. This decline in mental ability was diagnosed on the show as Alzheimer’s Disease. (ALZ-hy-merz)
These stories are of course make-believe and dramatized for the sake of entertaining us, the audience. However, for millions of people in the UK, Alzheimer’s is very much a real disease with very real life altering effects – for both the sufferer and anybody close to them.
With this issue being in the media spotlight so intensely over recent months, and more people than ever being familiar with the illness, I thought I’d take this opportunity to raise awareness of this extremely prevalent, yet drastically misunderstood, mental illness.
What is Alzheimer’s Disease?
Alzheimer’s disease is a progressive and degenerative brain disorder that is currently irreversible. It’s the most common form of dementia (di-MEN-shuh), meaning it worsens cognitive function (intellectual impairment, memory loss, disorientation), changes personality (restless, moody) and may eventually lead to death. Research shows that 5% of people over the age of 65 years and 20% of those over 85 years have the disease. Dealing with the disease can also be difficult for family members and caregivers. It may be of help to understand that the changes seen are not the fault of anyone – they are sadly part of the disease that cannot be avoided.
What Causes Alzheimer’s Disease?
Although genetics are thought to be important, no one knows exactly what causes Alzheimer’s disease. Something we do know for sure though, is that physical changes do take place in the brain.
Alzheimer’s disease affects brain cells called neurons. These neurons send messages to each other, allowing us to think, remember, and speak. Sometimes the flow of these messages are disrupted by deposits of a naturally occurring protein called Amyloid that form in the cortex and hippocampus (thinking and memory areas of the brain). These deposits are known as Amyloid Plaques and Tau Tangles. As we get older, it is normal for some of these deposits to form but in people with Alzheimer’s disease, there are many more deposits in the brain, making it harder to think, remember, and perform simple tasks. In addition to this, in Alzheimer’s there is a reduction in a chemical called Acytylcholine (Ass-a-tile-choline). This “tells” cells in the brain to recall information or to solve a problem, so if there’s less of it, these functions are worsened. Slowly, the deposits cause connections between neurons to be lost and eventually many of them die. This makes it near impossible for messages to get from one area of the brain to another, causing the severe memory loss and confusion seen in severe Alzheimer’s.
Alzheimer’s has a gradual onset and is separated by doctors onto 3 broad categories.
1) Mild ® Confusion and memory loss
Problems with routine tasks
Getting lost in familiar surroundings
2) Moderate ® Difficulty in daily activities eg. Eating or showering
Difficulty in recognizing family or friends
3) Severe ® Loss of speech
Loss of bowel and bladder control
Total dependence on others
Its important to realize that these are not set-in-stone and so a sufferer may have some symptoms from one or two groups and may have none from another.
The rate at which the illness progresses vary from person to person, but the average life expectancy from diagnosis is 8 years. Some patients though exceed expectation and live longer than 20 years.
It is also important to realize that memory problems or behavioral changes do not necessarily mean the individual has Alzheimer’s. It is essential that medical advice be sought, as these symptoms can be indicators towards many other illnesses such as
– Small strokes
– Thyroid disease
– Alcohol abuse
– Chronic stress
How is it Diagnosed?
Because nobody really understands the cause of the disease, there is currently no specific test used to diagnose Alzheimer’s. Despite this, it is diagnosed with 90% accuracy thanks to careful physical, psychiatric and neurological examinations. This acts to “rule out” other illnesses that it could be (small stokes, thyroid disease etc) making the diagnosis more and more probable.
The only way the diagnosis can be confirmed is to inspect the brain after death.
1) Medical History and Exam
– A short interview on any past medical problems, medications, alcohol use, tobacco use and illnesses that run in the family. Hearing, eyesight, blood pressure and pulses will also be assessed.
2) Urine and Blood Samples
– Blood cells, glucose levels and thyroid hormones are all important in “ruling out” other illnesses.
3) Cognitive Assessment
– Mini tests that assess memory, problem-solving, co-ordination and mental arithmetic
May give clues to the doctors as to how likely Alzheimer’s is.
4) Brain Imaging
– CT , MRI and PET scans are all very useful to doctors in looking at the brain. CT and
MRI allows them to rule out strokes and tumours, and PET lets them assess which parts of the brain are less active than they should be.
Unfortunately, there is currently no treatment that can reverse Alzheimer’s. Non-drug methods include therapies that stimulate the sufferer and reduce stress including art, music, playing with toys and reminiscing about past memories.
Although no drug can cure the disease, some have shown to reduce symptoms. These include:
1) Cholinesterase Inhibitors eg. Aricept, Exelon. (increases acetylcholine in the brain)
2) NMDA antagonists eg. Ebixa (helps to maintain brain activity)
Early Warning Signs of Alzheimer’s Disease
Although forgetting dates and misplacing items happens naturally as we get older, it shouldn’t really be a day-to-day event. If you find that you’re forgetting things more frequently or it’s interfering with daily activities, it may be time to seek a medical opinion.
It is often the case that the sufferer fails to notice any changes in behaviour or memory in themselves, meaning a partner or carer may indeed be responsible for highlighting any changes and suggesting a visit to the doctor. This can be difficult for both parties involved but must be addressed as soon as possible, as an early diagnosis will ultimately maximize the sufferer’s quality of life.
These 10 questions have been devised to highlight possible early warning signs:
1. Is your loved one forgetting things more often, such as appointments, people’s names, or telephone numbers? Is this forgetfulness affecting his or her ability to get things done?
2. Is the person having a hard time doing familiar tasks, such as buttoning his or her shirt, paying bills, or using the TV?
3. Is the person putting things in strange places, such as placing keys in the refrigerator?
4. Is the person under your care forgetting common words or losing his or her train of thought while talking with you?
5. Is the person having a hard time doing complex tasks, such as balancing a checkbook or keeping track of plots in movies and books?
6. Have you noticed that the changes in the person’s behavior are leaving the person confused, suspicious, or afraid?
7. Is the person sometimes confused about what day it is or how to get to familiar places, such as his or her own home or the shop?
8. Has the person lost interest in hobbies, clubs, or other things he or she used to enjoy?
9. Have you noticed that the person is avoiding other people, including family and friends?
10. 10. Does the person have a harder time now making choices than in the past?
The more “yes” answers given here suggests a greater early warning sign of potential Alzheimer’s, but by no means gives a conclusive diagnosis. As mentioned before, this can only be done by skilled medical professionals after thorough examination.