KATHMANDU: Alzheimer’s is a brain disease that causes a decline in memory, reasoning, thinking, and organizational skills.

It eventually impairs the ability to perform basic daily tasks. The symptoms of Alzheimer’s disease typically develop slowly over several years and vary at each stage of the condition.

Alzheimer’s is a form of dementia, a broad term used to describe a decline in mental function.

Alzheimer’s is a specific disease under this umbrella. Other types of dementia can have similar symptoms, and it’s possible to experience more than one type simultaneously, making it difficult to determine whether one has Alzheimer’s.

Common symptoms of Alzheimer’s disease include memory loss, language problems, and impulsive or unpredictable behavior.

One of the primary features of Alzheimer’s is the presence of plaques and tangles in the brain, as well as the loss of connections between nerve cells (neurons).

This impairs the brain’s ability to transmit information effectively between different areas or to the muscles and organs.

Stages of Alzheimer’s Disease

Alzheimer’s disease ranges from mild to severe:

• Mild Alzheimer’s Disease:
  People with mild Alzheimer’s disease experience memory problems and thinking difficulties, including:
  • Personality and behavior changes, such as becoming upset or angry easily, hiding things, or pacing
  • Difficulty handling money or paying bills
  • Taking longer than usual to perform daily tasks
  • Wandering and getting lost
• Moderate Alzheimer’s Disease:
  As the brain becomes damaged in areas responsible for language, reasoning, senses, and consciousness, individuals may experience:
  • Difficulty recognizing friends or family
  • Increased memory loss and confusion
  • Impulsive behavior
  • Inability to learn new things
  • Difficulty coping with new situations
  • Hallucinations and delusions
• Severe Alzheimer’s Disease:
  In this final stage, plaques and tangles spread throughout the brain, causing significant brain tissue shrinkage, leading to:
  • Dependency on others for care
  • Inability to communicate
  • Inability to leave the bed for most of the day

Causes of Alzheimer’s Disease

• Family history
• Age
• Head injury
• Down syndrome
• Depression
• Environmental factors
• Cerebrovascular disease
• Cardiovascular disease
• Lifestyle factors
• Genetics
• Diabetes

Risk Factors

• Age: Over 65
• Genetic predisposition
• Family history
• Poor overall health
• Cardiovascular issues
• Cerebrovascular problems
• Head injury

Symptoms at Different Stages

Alzheimer’s progresses through different stages, ranging from mild to severe cognitive decline:

• Mild Alzheimer’s Disease (Stage 1):
  This stage lasts from 2 to 4 years and may include:
  • Decreased energy and motivation
  • Loss of interest in work and social activities
  • Mild coordination issues
  • Language problems
  • Recent memory loss
  • Personality and behavior changes
  • Mood swings
• Moderate Alzheimer’s Disease (Stage 2):
  The brain regions responsible for language, reasoning, and consciousness are damaged. Symptoms include:
  • Inability to learn new things
  • Delusions
  • Trouble sleeping
  • Hallucinations
  • Impulsive behavior
  • Confusion and memory loss
  • Rambling speech
• Severe Alzheimer’s Disease (Stage 3):
  In this stage, plaques and tangles are widespread throughout the brain, causing significant tissue shrinkage. Symptoms include:
  • Dependence on others for care
  • Inability to communicate
  • Extreme mood swings
  • Difficulty expressing thoughts or processing information
  • Major confusion

Diagnosis

• Physical exam
• Medical history review
• Neurological exam (function test)
• Mental status tests
• Cognitive tests
• Imaging techniques

Treatment

There is no known cure for Alzheimer’s disease, and it is not possible to reverse the death of brain cells. However, treatment can relieve symptoms and improve quality of life for individuals, their families, and caregivers.

Important elements of dementia care include:

• Activities and daycare programs
• Effective management of co-occurring conditions
• Involvement in support groups

Disease-modifying Drugs:
Two drugs—Lecanemab (Leqembi) and Donanemab (Kisunla)—address the underlying biology of Alzheimer’s by removing beta-amyloid clumps from the brain.

Medication:
Several drugs are approved to treat the cognitive symptoms of Alzheimer’s, believed to work by altering neurotransmitter levels in the brain:

• Donepezil (Aricept)
• Memantine (Zunveyl)
• Galantamine (Razadyne)
• Rivastigmine (Exelon)
• Donepezil and Memantine (Namzaric)

Emotion and Behavior Treatments:
In some cases, doctors may recommend medications for symptoms such as:

• Antianxiety drugs
• Antidepressants (for low mood)
• Antipsychotic drugs (for hallucinations or delusions)

Prevention

• Exercise: Regular physical activity has been shown to improve brain health and may lower Alzheimer’s risk.
• Avoid Smoking and Excessive Alcohol: Smoking and heavy alcohol consumption increase Alzheimer’s risk, while quitting smoking and limiting alcohol intake offer long-term benefits.
• Healthy Diet: A diet rich in fruits, vegetables, whole grains, olive oil, and lean proteins, especially fish, is linked to a lower Alzheimer’s risk.
• Sleep Intervention: Poor sleep quality or disorders like sleep apnea can increase Alzheimer’s risk. Improving sleep habits can help.
• Stress Management
• Manage Diabetes and High Blood Pressure

Complications

• Cognitive Decline:
  • Memory loss (initially short-term, progressing to long-term)
  • Difficulty communicating and understanding language
  • Disorientation (confusion about time, date, or location)
• Behavioral Changes:
  • Sleep disturbances
  • Mood swings
  • Aggression and agitation
• Physical Health Complications:
  • Weight loss and malnutrition
  • Increased risk of infections (aspiration pneumonia, pressure sores)
• Loss of Independent Functioning:
  • Inability to manage finances
  • Incontinence (loss of bladder and bowel control)
• Psychiatric Issues:
  • Depression (awareness of cognitive decline)
  • Hallucinations
  • Delusions and paranoia
• Complications from Coexisting Conditions:
  • Heart disease
  • Neurological conditions (e.g., Parkinson’s disease)
  • Diabetes
• End-of-Life Issues:
  • Severe cognitive decline
  • Difficulty swallowing, incontinence, and loss of mobility

Conclusion

Alzheimer’s is a brain disease that leads to a decline in memory, reasoning, thinking, and organizational skills, eventually impairing the ability to perform basic daily tasks.

While there is no cure, treatments can alleviate symptoms, improve quality of life, and manage co-existing conditions.

Supportive care, medication, and lifestyle changes are essential for helping individuals cope.

Preventative measures, including regular exercise, a healthy diet, and stress management, may also reduce Alzheimer’s risk.

As the disease progresses, complications such as cognitive decline, behavioral changes, and physical health issues become more prevalent, ultimately leading to a loss of independent functioning.