Causes, incidence, and risk factors
Alzheimer's disease is the most common cause of intellectual
decline with aging. The cause is unknown. Several factors are
proposed to be responsible. The neurochemical factors include
lack of the substances used by the nerve cells to transmit nerve
impulses, including acetylcholine, somatostatin, substance P,
and norepinephrine. Environmental factors include exposure to
aluminum, manganese, and other substances. The infectious factors
include prion (virus-like organisms) infections that affect
the brain and central nervous system. In some families (representing
5 to 10% of cases) there is an inherited predisposition to development
of the disorder, but this does not follow strict Mendelian patterns
of inheritance. It is found that the presence of a gene which
produces a substance called apolipoprotein E4 increases the
chances that the disease may eventually occur.
The incidence is approximately 9 out of 10,000 people. This
disorder affects women slightly more often than men and occurs
primarily in older individuals.
Symptoms
Awareness of intellectual decline, initially; inability to
perform purposeful movements (not caused by motor or sensory
impairment); inability to use objects properly
Difficulty with any previously learned, skilled sequential
movement; trouble naming objects (anomia); "word-finding"
deficits in conversation; dementia, including
Gradual onset of intellectual decline, inability to concentrate;
disorientation; confusion; memory losses; slow, uncontrolled
movement; incontinence
Prevention
There is no proven prevention at this time.
Signs and Tests
The disorder is tentatively and/or provisionally diagnosed
by the health care provider based in part on the history and
progression of symptoms, and by ruling out other causes of
dementia, including dementia due to metabolic causes. The
history may show progressive decline in memory, judgment,
and orientation, with changes in mood and behavior.
Atrophy (shrinking) of the frontal or temporal lobes of the
brain, generalized atrophy, and/or other "signal"
changes in the white matter may appear on:
head CT scan
head X-rays
MRI of the head
An EEG (electroencephalography) may show nonspecific changes.
A lumbar puncture and cerebrospinal fluid (CSF) examination
is normal.
Treatment
There is no known definitive Alzheimer's disease. Treatment
is aimed at relief of symptoms and protection from the effects
of the deteriorating condition.
Tacrine or cognex may be used, and the results vary. Other
treatments may be attempted, but most are considered experimental
or have had variable results.
.
The patient's sensory functions should be evaluated and augmented
as needed with such things as hearing aids, glasses, and cataract
surgery.
Eventually, 24-hour monitoring and assistance may be required
to provide a safe environment, control aggressive or agitated
behavior, and meet physiologic needs. This may include in-home
care, boarding homes, adult day care, or convalescent homes.
Exercise is important and should be encouraged.
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Alzheimer's
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