Scientists suggest that Alzheimer’s disease is merely the product of the aging process manifested in the brain. This disease is named after Alois Alzheimer – a German neurologist. It was discovered in 1906 in a female patient came to Dr Alois Alzheimer with the complaint of memory loss, disorientation and severe dementia. The doctor could not cure her and after some years, she died.

After her death, Dr Alois Alzheimer preformed an autopsy of her brain and found two abnormalities due to this disease. The first was tangled clumps of nerve cells and patches of disintegrated nerve cell branches called plaques.          Dr Alzheimer considered these were the possible causes of this disease, which is valid till today. But he mistakenly thought it was a disease of the middle ages, because the patient was relatively young. Elderly people possessing such symptoms were not treated for Alzheimer’s disease. Contemporary experts considered such occurrence due to ageing. But today the entire scenario has changed. Alzheimer’s disease involves a specific pathological process rather than being a normal consequence of age.

Alzheimer’s disease is marked by memory lapses and confusion.  The patient forgets the day, month and layer. She or he forgets simple arithmetic work like adding, subtracting, multiplying, dividing, even counting upto 100. The patient can not cook, balance cheque book, count changes, drive and in the last stages, there is complete bodily and behavioral deterioration.

But the clinical picture may vary from person to person, depending upon the acuteness of brain degeneration, premorbid personality trait, the kind of stressor and the degree of environmental support. The patient withdraws from active engagements of everyday life; social and other interests are narrowed, mental alertness is reduced; adaptability is lowered. There is intolerance in new ideas and changes in daily routine. There is self-centeredness of thought and activities. The patient preoccupies with eating, digestion and excretion. Surprisingly, when the symptoms become more severe, some additional symptoms may appear like impaired memory of recent events, empty speech, messiness, impaired judgement, agitation and confusion. These specific symptoms may vary from patient to patient and from day to day for the same patient. There is individual difference in the progress of this disease.

The cognitive decline can be divided into five stages. The first stage is complaint of memory deficits- the patient forgets the names of the persons whom he knew well. The second is increased cognitive decline and sign of confusion. In this stage, the patient loses or misplaces valuable things. In the third stage, there is moderately severe cognitive decline and intensified confusion, or early dementia. In this stage, the patient starts forgetting the names of the family members. The fourth stage is severe cognitive decline and confusion or middle dementia. In this stage, the patient is largely unaware of all recent events and experiences. The fifth stage is very severe cognitive decline and confusion or late dementia. In this stage, the patient loses all verbal abilities, needs help in eating and using the toilet.

In some cases of Alzheimer, the patient develops symptoms of paranoid reaction. The patient becomes suspicious, uncooperative and abuses others. In early stages, the memory loss and disorientation may not be prominent, because the patient remains logical in alleging others of indulging in harmful activities. The patient develops jealousy delusion in which he persistently accuses his spouse, who is often of advanced age and physically debilitated, of being sexually unfaithful. The patient thinks that the family members may be engaged in various foul deeds like poisoning the food, plotting to steal the patient’s funds, and so on. But the patient rarely physically attacks the suspect evildoer. This paranoid orientation develops only in those individuals who have been sensitive and suspicious. In some rare cases, the patient engages in meaningless activities like hoarding useless objects or performing some household task in a ritualized manner.

Some patients develop depression. A depressed Alzheimer’s patient has morbid preoccupations and delusions like hypochondriacal ideas about having various harmful diseases. If the patient is physically able, suicide is possible in some cases.

What causes Alzheimer’s?

Alzheimer is of two types:

a) Sporadic- does not run in the family;

b) Familial- it runs in the family.

Initially, it was thought that Alzheimer’s disease was caused by three kinds of abnormal changes in the brain. First, the appearance of senile plaques (small areas of dark coloured matter) on the debris of damaged nerve terminals. Second, the tangling of the normally regular pattern of neurofibrils (stand-like protein filaments) with neural cells bodies. The abnormal appearance of small holes in neuronal tissues called granulo- vacuoles that occur due to cell degeneration. These alterations in the brain material give birth to brain atrophy.

But the advancement of science has enabled researchers to find out more causes of Alzheimer’s disease. It is found that acetylcholine is an important neurotransmitter that pays an important role in the meditation of memory, when neurons, especially those responsible for release of acetylcholine may cause Alzheimer’s disease. But this opinion too is criticized on many grounds. Some investigators think the abnormal level of aluminium, a neurotoxin, is related to Alzheimer’s disease. Infection and environmental factors may also have an influence on the progress of the disease, but the extent of this is not fully known.

The cause of Alzheimer’s disease is not fully understood. Even genetic factors cannot be neglected. Researchers have proved that Alzheimer’s disease is linked with Down syndrome. Some studies have linked this disease to an abnormality on chromose 21, which has been identified as the location of gene for a protein called beta amyloid, which is found in the characteristic clumps and plaques of Alzheimer’s disease.

Laboratory studies have shown that beta amyloidal fragments can kill nerve cells. However, it is not completely clear whether the presence of beta amyloid in the brain is the cause or result of the process of brain cell degeneration might be due to a protein called apolipoprotein (ApoE). A high percentage of Alzheimer’s patient at least one gene coding for the type of ApoE protein known as E. ApoE may be a risk factor for Alzheimer just like cholesterol is a risk factor for heart disease.

Treatment:-From the days of Alois Alzheimer till today, there is no known treatment-medical or psychological or rehabilitative. No medical aid has been developed that can retard, stop or reverse the deterioration of the brain. Since senile dementia, depression, Parkinson’s disease, adverse drug reaction and other diseases overlap its effect, it is very difficult to locate the effect of this disease. Its effect can be established only after an autopsy of the brain, which is possible only after death.

But now brain-imaging techniques may help in establishing the disease. Furthermore, its effect can be detected by a decrease in metabolic function or cerebral blood flow in certain areas of the brain. Applying these techniques, the therapist should locate the ailment; only then medical help could be provided to the patient. Medication may be helpful for those patients who experience difficulty in modulating emotions and impulses. Some depressed patients of Alzheimer’s disease may get relief by the use of stimulant drugs.