Alzheimer's Disease

Alzheimer's disease is a neurodegenerative condition in the brain that causes progressive cognitive decline. It is the most common type of dementia in people aged 65 and above and generally affects the patient’s memory, understanding, language, learning, calculation and judgment abilities. Behavioural changes are also noticeable as the disease progresses.   In Hong Kong, according to the Mental Health Review issued by the Food and Health Bureau in 2017, as many as 100, 000 of the elderly population suffer from dementia. 

Causes and Risk Factors  

• Age – advancing age is the most important risk factor 
• Genetics – first-degree relatives with Alzheimer’s increase the risk by 10-30%; Trisomy 21 (Down’s syndrome) is a risk factor for early-onset Alzheimers 
• Personal/medical history – history of traumatic brain injury, cardiovascular and cerebrovascular disease, depression, increased homocysteine levels, presence of APOE e4 allele and smoking are also known risk factors  

On the other hand, the following are considered factors that can lower the risk of Alzheimer’s disease: 

• Higher education 
• Healthy diet and regular aerobic exercises 
• Leisure activities like reading and playing instruments 
• Use of estrogen by women 
• Use of anti-inflammatories  

Pathophysiology 

The current medical evidence points to abnormal accumulation of what are called neuritic plaques (mostly beta amyloid) and neurofibrillary tangles in the brain as the main pathological processes for developing Alzheimer’s disease. 

Symptoms of Alzheimer's disease  

• Early stage (First 1-2 years): Patient becomes more forgetful and forgetting what just happened, has difficulty doing complex household chores, mood changes such as feeling depressed and anxious, less motivated, and may lose track of the day or get lost in familiar places 
• Middle stage (2nd to 4th or 5th year): The patient becomes more forgetful and will forget recent events and names; it becomes increasingly difficult to communicate, speak and understand, and it is challenging to live alone, they may wonder around to nowhere and ask questions repeatedly, may display inappropriate behaviour 
• Late stage (5th year and after): The patient lives with near-total dependence for activities of daily living;  is unable to recognise relatives and friends, suffers from incontinence of urine and faeces, and behaviour may become more abnormal, including increased anxiety and aggression 

Other symptoms include: 

• Loss of memory that affects daily life 
• Decreased ability to handle things and solve problems 
• Difficulty performing familiar tasks 
• Confusion about time and location 
• Difficulty understanding visual images and spatial relationships 
• Difficulty choosing words to express when speaking or writing 
• Placing objects everywhere and being unable to recall the process of putting them 
• Decline in judgment 
• Loss of enthusiasm and initiative in work or social activities 
• Mood or personality changes 
• Suspicion and even delusions of persecution 
• Hallucinations, such as seeing many children at home or hearing voices that are not there
   

Diagnosis of Alzheimer’s disease 

There is no single test to diagnose Alzheimer’s disease. Doctors need to comprehensively analyse the patient's medical and family history (that may include interviews with family members), symptoms, including cognitive assessment, blood tests and brain scans, to make a diagnosis. 

• Cognitive ability test 
• Blood test 

• Brain scan 

The Department of Neurology, Department of Medicine and Therapeutics, Chinese University, has also designed a questionnaire for preliminary assessment. If two or more of the following changes occur, it is recommended to see a doctor for further examination. 

• Decreased interest in hobbies and activities 
• Problems with judgment, such as a decline in the ability to make decisions 
• Asking the same questions or telling the same things over and over again 
• Difficulty learning new things, such as not being able to use the telephone 
• Forgetting the correct year and month 
• Unable to handle more complex financial issues, such as tax bills or miscellaneous expenses 
• Forgot a necessary appointment or follow-up date 
• Persistent problems with thinking and memory (several times or more frequently within a week) 

Alzheimer's disease treatments 

There is currently no cure for Alzheimer’s disease but there are interventions that address the symptoms of the condition.  

Medical treatment 

• Cholinesterase inhibitors drugs (donepezil, rivastigmine, galantamine): can slow down the progression of Alzheimer's disease symptoms in some patients, but are only suitable for mild to moderate patients. 
• Partial N-Methyl D-Aspartate (NMDA) antagonist  [Memantine]:  FDA-approved for use in moderate to severe Alzheimer’s disease; it blocks NMDA receptors and slows intracellular calcium accumulation. It can be used with cholinesterase inhibitors. 
• Low-dose aspirin: helpful in vascular dementia and may help prevent further strokes 
• Appropriate amounts of antidepressants, antipsychotics or tranquilizers: can stabilise the patient's mood 

Nostalgia therapy 

Put patients in a room full of decorations from their youth, stabilise their emotions and train their memory through a familiar environment. 

Multi-sensory therapy 

Use an appropriate amount of sensory stimulation to reduce excessive sluggishness or excitement. 

Other ways to help patients 

• Regular daytime activities can prevent patients from having day and night reversals 
• Use a diary to help remember appointments and to-do lists 
• Place clear reminders at home 
• Have the patient wear a neck or wristband with the address and phone numbers of relatives and friends written on it 
• Quit smoking, eat healthily and exercise moderately 
• Manage and control chronic diseases such as diabetes, hypertension and stroke

OT&P Medical Advice 

Alzheimer's disease is one of the common diseases of the elderly. Although the medical community has not yet been able to find a cure for dementia, there are currently methods that can slow down patients' memory decline, control psychological and behavioural problems, and reduce the burden on caregivers. If an elderly person around you unfortunately suffers from the disease, they should pay close attention and provide corresponding support. You can also check with a specialist.