Alzheimer’s Disease

Alzheimer’s disease is the most common form of dementia. It is
a degenerative disease leading to the loss of important brain
cells. This causes symptoms that may include confusion, memory
loss, impairment of reasoning and rationality, restlessness, speech
disturbances, exaggerated emotional reactions and other problems
that generally show a progressive deterioration.

DESCRIPTION

As the population grows older, the incidence of Alzheimer’s
disease is increasing. Studies show that 1 in 5 people over 80 may
suffer from the disease. Alzheimer’s disease goes through several
stages until the severe form of dementia develops. It is difficult
to diagnose and sometimes the person with Alzheimer’s might have to
be referred to a specialist such as a geriatrician.

The course of this disease is quite variable often with a gradual
onset. Early symptoms include problems in remembering recent events
and difficulty performing familiar tasks or learning new ones.
There may be changes in personality and behaviour, impaired
judgement and difficulty in finding words and finishing thoughts.
Confusion occurs about the time of day and the date. Some people
with Alzheimer’s believe that the present day is actually some time
in the past and may talk about an event from many years ago, as if
it were happening today.

As the disease progresses it may deprive the person of the ability
to care for themselves. It has been suggested that people with
Alzheimer’s can suffer much confusion and distress from struggling
with the frustrations of everyday life.

ALZHEIMER’S AND DEMENTIA

A commonly asked question is “what is the difference between
Alzheimer’s disease and dementia”?

 

Dementia is a term that is used to describe a group of
symptoms and is not a disease in itself. These symptoms include;
loss of memory, confusion, disorientation, personality changes etc.
There are many different forms of dementia and each has its own
cause. Alzheimer’s disease is the most common form of dementia,
accounting for between 50 and 70 percent of all cases. Other forms
include vascular dementia, dementia associated with progressed
Parkinson’s disease, dementia with Lewey bodies, Frontal Temporal
Lobar Degeneration (FTLD), Huntington’s disease, Alcohol-related
dementia (Korsakoff’s syndrome), Creutzfeldt-Jacob disease
etc.

CAUSE

No conclusive cause of Alzheimer’s disease has been
determined. However, the following characteristics of Alzheimer’s
can be noted:

• A connection with certain chemical messengers appears to be
  present. 
• The nerve cells that die as a result of Alzheimer’s Disease
  often contain the chemical messenger called acetylcholine.
• People with Alzheimer’s have been found to have lowered levels
  of the key enzyme choline acetyltransferase in their brains. This
  enzyme is needed to form the chemical messenger
  acetylcholine. 
• Attempts to increase brain levels of acetylcholine using
  medicines have been unsuccessful.
• Low levels of other messengers in the brain may also play a
  role (e.g. serotonin and noradrenaline).
• 5-10% of cases run in families. In some cases, defects in a
  particular chromosome are linked with the disease. 

RISK FACTORS

The following genetic, behavioral, and environmental risk
factors all appear to contribute to the development of Alzheimer’s
disease. 

• Age
• Genetic factors
• Caucasian
• Female
• Cardiovascular risk factors: heart disease, high cholesterol
  levels, high blood pressure, and stroke; and
• Lower education.

TREATMENT OPTIONS

A person with Alzheimer’s disease should be under the care of
a Doctor and be carefully monitored. Symptoms such as depression
and agitation usually can be alleviated by prescription drugs.
Areas to look at include a complete medical history, a thorough
physical and neurological examination, a mental status test, a
psychiatric assessment and tests for comprehension and insight.
Early diagnosis is very important as a means of ruling out
treatable causes of dementia and to check for complicating
conditions. New image-making techniques such as MRI (magnetic
resonance imaging) may also be used.

Recommendations for the prevention and management of early stage
Alzheimer’s disease include;

• Weight loss and having a healthy diet;
• Reduction of elevated cholesterol levels and high blood
  pressure; and
• Complex leisure activities with physical, mental, and social
  interactivity components.
   

Supportive measures can be taken to help a patient feel more
comfortable and reduce behavioural disturbances. 

1. Allow the person to have personal belongings and familiar
   objects nearby, such as photographs.
2. Encourage orientation with a clock and calendar.
3. Keep the environment pleasant and calm by reducing noise,
   ensuring adequate lighting and minimising clutter.
4. Ensure any treatable deficits are corrected (hearing aids,
   glasses, dentures etc).
5. Use television, radio or music for relaxation but not as a
   substitute for activity.
6. Maintain social activity and mobility levels as much as
   possible.
7. Ensure basic physical needs are met (food, water, warmth,
   cleanliness etc).

DIET HINTS

• The diet for this ailment should be directed towards keeping
  the person with Alzheimer’s as physically healthy as possible. If
  the person has other medical problems, the severity of the
  Alzheimer’s symptoms may be increased. Concentrate on food that is
  fresh. Eat raw or lightly steamed vegetables if possible to retain
  the maximum nutrient content. Include the green leafy variety of
  vegetables daily, as these are a rich source of vitamins and
  minerals. Studies have shown that individuals with diets high in
  fruit, fibre, folic acid, vitamin C, beta-carotene, iron and zinc,
  and lower intakes of saturated fats have improved cognitive
  function compared with those who do not. 
• Make sure that the diet contains an adequate amount of
  protein-rich foods, which include lean meats, fish, eggs, chicken
  (without the skin), nuts, seeds, peas and beans. 
• Oysters are an excellent dietary source of zinc.
• Keep the intake of sugar and refined carbohydrates to a
  minimum. Examples of these foods include sugar, honey, glucose,
  cakes, biscuits, chocolate, puddings, jam and icecream. Foods that
  contain white flour are not recommended as these are generally
  lower in vitamin content and high in calories.
• Animal and vegetable fats are to be moderated in a healthy diet
  e.g., butter, milk and cheese as well as coconut and palm oil. Try
  to always cook with olive oil which is a stable oil and less likely
  to cause damage to cells within the body than other cooking
  oils. 
• Keep the bodyweight to a reasonable level. 
• Avoid added salt and watch alcohol consumption.

PREVENTION

Fruit and vegetable juices may play an important role in
delaying the onset of Alzheimer’s disease, particularly among those
who are at high risk for the disease.

Some evidence suggests that dietary intake of
homocysteine-related vitamins (vitamin B12 and folate),
antioxidants (e.g. vitamin C and E), unsaturated fatty acids and
also moderate alcohol intake (especially wine) may reduce the risk
of Alzheimer’s disease.

VITAMINS/MINERALS/HERBS

• If the diet is inadequate a multi-vitamin with antioxidants may
  help to provide additional nutrients to support good health.
• Ginkgo biloba is a herb which may be helpful in some cases of
  early stage  Alzheimer’s disease and vascular dementia Ask
  your Pharmacist for advice about dosage and contraindications.

 

Note: If a patient is taking low dose aspirin or prescribed
anticoagulants it is advisable to start on low doses of Ginkgo
biloba under the supervision of a medical practitioner.

ORGANISATIONS & SUPPORT GROUPS

See the Alzheimer’s Association of Australia topic on the
Healthpoint.

PHARMACIST’S ADVICE

1. Follow the Diet Hints. 
2. Have regular exercise to help stimulate blood circulation.
3. Introducing mental stimulation, within the patients’ ability,
   may be of benefit. It is thought that lack of mental stimulus may
   worsen the symptoms or promote the onset of Alzheimer’s. Ask your
   health care professional for advice.
4. If the diet is inadequate a multi-vitamin with antioxidants may
   help to provide additional nutrients to support good
   health. 
5. A clinical study has shown that smokers have an increased risk
   of developing Alzheimer’s disease and other forms of dementia. Ask
   your Pharmacist for advice about quitting smoking.