September 29, 2015





First described by a German psychiatrist Alois Alzheimer, Alzheimer’s disease is the most common ofdementia, a general term for loss of intellectual abilities significant enough to interfere with daily life. AD accounts for 60 to 80 % of dementia cases. It is a chronic neurodegenerative disease of the elderly (>65 yrs of age) that progresses gradually over time with a clinical course of 8 to 10 years before a terminal event. Rarely, the disease can affect patients in their 40s or 50s when it is called young-onset AD.


The most common early symptom is difficulty in remembering recent events (amnesia). As the disease advances, patients have disorientation even in familiar surroundings with path finding difficulties, problems in communication, alteration in behaviour, and difficulty in managing financial affairs, household chores and tendency to get lost in conversations. Gradually patients become withdrawn and apathetic, remaining aloof and alone most of the time. The behaviour changes lead to symptoms of hallucinations and delusions which may be particular problem for family members. Eventually patients become bed-ridden, incontinent, and unresponsive (vegetative state) with death occurring due to some terminal event like urine or chest infection.


The cause of AD is poorly understood. Genetics plays a major role, particularly in those in which AD runs in families. Apart from genes, mid-life hypertension, smoking, head injuries, etc are also known risk factors. Pathologically, it is primarily believed due to deposition of protein called AMYLOID in the brain tissue and due to deficiency of brain neurotransmitter ACETYLCHOLINE.


Early diagnosis requires detailed history and neurological examination along with neuropsychological tests. Advanced imaging techniques like MRI, PET, SPECT help in diagnosing the patients at the earliest stages. Also CSF analysis for biomarkers helps in identification of patients in pre-clinical stages.


There is no cure for AD. But medicines are available which provide symptomatic benefit and slow the progression of disease. Acetylcholinesterase inhibitors are the drugs commonly used in AD which help slow the decline in memory and other intellectual abilities. Also many anti-psychotic medicines help to alleviate the behavioural problems which are a source of distress to both patients and care-givers. Also,psychotherapy helps in managing the neuropsychiatric problems like anxiety, depression and mood disorders associated with the disease. Changes in the living environment of the patient can increase patient safety and reduce the burden on caregivers. Examples of such modifications include adhering to simplified routines, avoiding frequent change in living place, placing of safety locks, labelling of household items to cue the patient and accompanying the patient whenever he is out of the home or in unfamiliar surroundings.

Although AD has no cure at present, but early diagnosis and proper management in the hand of an expert can go a long way in improving the quality of life of the patient and decreasing care-giver burden.

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