By Kasmiah Mustapha

ALZHEIMER'S disease (AD) is named after Dr Alois Alzheimer, a German doctor. In 1906, Dr Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. He found abnormal clumps (amyloid plaques) and tangled bundles of fibres (neurofibrillary tangles). These plaques and tangles in the brain are considered as signs of the disease.

CAUSES

Scientists do not fully understand what causes Alzheimer's. There probably is not one single cause, but several factors that affect each person differently. Age is the most important known risk factor.

Genetics may also play a role in many cases. For example, a rare form of the disease that usually occurs between the ages of 30 and 60, is inherited.

Scientists are also looking at education, diet, and environment to learn what roles they might play in the development of this disease. Scientists are finding increasing evidence that some of the risk factors for heart disease and stroke, such as high blood pressure, high cholesterol, and low levels of the vitamin folate, may also increase the risk of the disease. Evidence for physical, mental, and social activities as protective factors against Alzheimer's disease is also increasing.

THE STAGES OF ALZHEIMER'S

The time from diagnosis to death varies - as little as three years if the patient is over 80 when diagnosed to as long as 10 or more years if the patient is younger. Although the course of it is not the same in every patient, symptoms seem to develop over the same general stages.

PRECLINICAL ALZHEIMER'S

The disease begins in the entorhinal cortex, which is near the hippocampus, the structure that is essential to the formation of short- and long-term memories. Affected regions begin to shrink. These brain changes probably start 10 to 20 years before any visible signs and symptoms appear. Memory loss, the first visible sign, is the main feature of mild cognitive impairment.

MILD ALZHEIMER'S

As the disease begins to affect the cerebral cortex, memory loss continues and changes in other cognitive abilities emerge. The clinical diagnosis of Alzheimer's disease is usually made during this stage. The symptoms include:

* Memory loss

* Confusion about the location of familiar places (getting lost begins to occur)

* Taking longer to accomplish normal daily tasks

* Trouble handling money and paying bills

* Poor judgment leading to bad decisions

* Loss of spontaneity and sense of initiative

* Mood and personality changes, increased anxiety.

The growing number of plaques and tangles first damage areas of the brain that control memory, language, and reasoning. This leads to a situation in mild Alzheimer's disease in which a person seems to be healthy, but is actually having more and more trouble making sense of the world around him or her. The realisation that something is wrong often comes gradually because the early signs can be confused with changes that can happen normally with ageing.

MODERATE ALZHEIMER'S

By this stage, Alzheimer's damage has spread further to the areas of the cerebral cortex that control language, reasoning, sensory processing, and conscious thought. Affected regions continue to atrophy and signs and symptoms of the disease become more pronounced and widespread. Behaviour problems, such as wandering and agitation, can occur. More intensive supervision and care become necessary, and this can be difficult for many spouses and families. The symptoms of this stage are:

* Increasing memory loss and confusion

* Shortened attention span

* Problems recognising friends and family members

* Difficulty with language; problems with reading, writing, working with numbers

* Difficulty organising thoughts and thinking logically

* Inability to learn new things or to cope with new or unexpected situations

* Restlessness, agitation, anxiety, tearfulness, wandering - especially in the late afternoon or at night

* Repetitive statements or movement, occasional muscle twitches

* Hallucinations, delusions, suspiciousness or paranoia, irritability

* Loss of impulse control such as sloppy table manners, undressing at inappropriate times or places, or vulgar language.

* Perceptual-motor problems such as trouble getting out of a chair or setting the table.

Behaviour is the result of complex brain processes, all of which take place in a fraction of a second in a healthy brain. When a patient has Alzheimer's, many of these processes are disturbed, and this is the basis for many distressing or inappropriate behaviours.

SEVERE ALZHEIMER'S

In the last stage of Alzheimer's, plaques and tangles are widespread throughout the brain, and areas of the brain have atrophied further. Patients cannot recognise family and loved ones or communicate in any way. They are completely dependent on others for care. All sense of self seem to vanish. Symptoms include:

* Weight loss

* Seizures, skin infections, difficulty swallowing

* Groaning, moaning, or grunting

* Increased sleeping

* Lack of bladder and bowel control

At the end, patients may be in bed most of the time. Most people with Alzheimer's die from other illnesses, mainly aspiration pneumonia. This type of pneumonia happens when a person is not able to swallow properly and there are food or liquids into the lungs.

TREATMENT

There is no cure for Alzheimer's. Treatment focuses on relieving and slowing down the progress of the symptoms.

An individual with Alzheimer's should always be under medical care. Much of the day-to-day care, however, is handled by family caregivers. Medical care should focus on optimising the individual's health, safety, and quality of life while helping family members cope with the many challenges of caring for a loved one with Alzheimer's. Treatment most often consists of medications and non-drug treatments such as behaviour therapy.

Sources: National Institute of Aging (www.emedicinehealth.com/alzheimer_disease)