Alzheimer's Disease

• Typically, it begins over the age of 65.

• It has an insidious onset and a slowly progressive course.

• >Initially, memory impairments are mild.

• Later, progressive memory impairment develops.

• Over time, attention and concentration, speech, comprehension Disorders develop in writing, reading, perception of what you see, perception of space, insight, foresight, analysis and planning abilities.

• As a result, the severity of the mental disorder also prevents independence in daily living activities.

 

What is the incidence of AD?

• So far in the world Meta-analysis of prevalence studies (the ratio of all cases to the population in a certain period of time) reveals that AD, which is around 4-5% between the ages of 65-70, increases exponentially every 5 years and reaches up to 50% in the 90s.

What changes are seen in the brain?

• It is one of the neurodegenerative diseases of the brain, that is, caused by cell loss. Amyloid beta peptide (Aβ), which causes senile plaques, tau (τ) protein, which causes neurofibrillary tangles, loss of neurons and synapses due to these protein disorders, gliosis, and loss of cholinergic axons that provide nerve conduction, are among the mechanisms of formation of the disease.

 

What are the Stages of AD?

• When the threshold of functional impairment is exceeded, mild, It is divided into sub-stages as moderate and severe.

• The course up to this threshold is called mild cognitive impairment

• Before AD shows its clinical symptoms. It has an initial phase that lasts for many years and during which only the pathological features of the disease evolve

• The typical patient, who is responsible for 90% of all AD cases, has no family history

• There is a family history of AD in cases with early onset (early onset (under 65 years of age), rapid progression type AD)

 

What are the findings in the mild phase? 

• If he is still working, he has lost his productivity in his job

• Although monotonous jobs that do not require creativity can be continued at the beginning, colleagues are aware of the decrease in performance and retirement becomes inevitable in a short time

• Difficulty in remembering recent events, repeating the same questions, finding words difficulties are the main features that attract the attention of relatives

• Although he can still walk and travel in familiar places, he may get lost in unfamiliar places

• Inattention to signals while driving. , difficulties such as slowing down reactions and confusing directions have begun.

• Errors occur in financial matters such as banking transactions and bill payments.

• Bank card, fails to learn and use innovations such as mobile phones

• Hobbies (sewing-embroidery, gardening, artistic pursuits, skill games, etc.) have become unsustainable

• Difficulties in kitchen work have begun, such as deterioration in the taste of food

• Although she can continue to do household chores such as laundry and dishes, she has lost some of her former care in these too.

• Interest in reading and current affairs through newspapers and TV has decreased.

• There is no problem in dressing, washing, table habits and basic hygiene yet.

• Behavioral symptoms are absent except for irritability, blunted affect, and a tendency to deny and decreased spontaneity, and social conformity is well preserved.

• Sleep quality begins to deteriorate

• Sexual interest and appetite are impaired

• With the contribution of noticing the deficiencies, symptoms of depression may be at the forefront in some cases. However, depression often manifests itself with motivational symptoms such as reluctance rather than affective symptoms such as expression of grief

 

What are the Findings in the Middle Stage?

• When the middle stage of dementia is reached, the patient has completely lost his independence outside the home

• Although he can go out with supervision, he is left alone. Otherwise, he cannot find his way

• He may mess up the rooms in other people's houses

• New learning is almost never possible anymore

• Comprehension, reading and writing gradually deteriorate; Towards the end of the universe, his signature may become unrecognizable.

• Although he generally preserves information about his immediate family, he confuses information such as the number of his grandchildren, their names, and their schools

• His functionality at home has become extremely superficial. However, it may be at the level of helping to clear the table or chop vegetables.

• During dressing, such as difficulty in choosing the appropriate clothing for the season or time of day, mixing up the order of clothes (such as underwear on a shirt), buttoning the wrong buttons, etc. Difficulties begin

• When you cannot use a knife at the table, your food must be cut beforehand.

• Eating by spilling and scattering becomes increasingly evident. Mistakes such as mixing the cutlery and trying to pick up liquids with a fork may occur.

• When washing, the need for help first begins with adjusting the heat and cold.

• They occasionally experience urinary incontinence at night. He can perform functions such as toilet mechanics and washing his hands and face on his own

• Behavioral symptoms are now beginning to be emphasized. He may have delusions of theft, abandonment and infidelity.

• He is afraid of being alone and constantly wants his relatives (spouse, child) in front of him

• Doctor Upcoming appointments, such as walk-in visits, can lead to obvious anticipatory anxiety.

• Disruption of the sleep-wake rhythm has now become evident. The night is filled with frequent awakenings and daytime sleepiness

 

 What are the symptoms in the severe phase? 

• He may confuse his relative (spouse, child) with his parents, and may not be able to recognize his own face in the mirror

• Basic daily life activities such as dressing, washing and eating now require full supervision.

• Difficult swallowing has also emerged recently

• Vocabulary has become extremely poor

• In recent periods, all ability to speak is lost

• Movement It becomes increasingly difficult to watch and towards the end, even sitting becomes impossible.

• It can be observed that people on television talk as if they were at home, and talk to their own image in the mirror as if they were strangers

• While movement is preserved, aimless wandering, hoarding, aimless repetitive movements may be observed

• Disruptions in toilet mechanics (problems with proper cleaning after urination or defecation, flushing the flushing fluid), Urinary incontinence becomes increasingly evident

• Epileptic seizures may occur

 

AD Risk Factors What are?

 

Non-modifiable risk factors

 

• Advanced age  

• Genetics (Family history of AD)

 

Modifiable risk factors

 

• Nutrition deficiency or malnutrition

• Obesity

• Smoking

• Heavy Alcohol intake

• Sleep Disorder

• Social isolation

• Depression

• Lack of Mental Activity

• Lack of Physical Activity

• Low Education

• Hearing Loss

• Diabetes Mellitus

• Hypertension

• High Cholesterol

• Stroke History

• Head Trauma

• Hypothyroidism

• Electro-magnetic field (EMF) exposure

• Air Pollution

 

What should be done to protect against AD?

 

• Good education in childhood

• Especially reading when you are a child and a teenager (be below)

• If there is a hearing problem, treat it, avoid exposure to excessive noise

• Stay away from air pollution

• Si not to smoke alcohol and not to be a secondhand smoke

• Avoiding head trauma

• Not to drink excessive alcohol

• Not gaining excessive weight

• Doing physical exercise such as brisk walking, sweat-inducing aerobic exercise and dancing twice a week

• Eating a Mediterranean Diet (a diet rich in grains, vegetables, fruits, cheese, milk, especially fish, and olive oil)

• Treatment if there is diabetes

• Enriching relations with relatives and friends, being in social relationships such as going out to the cinema, restaurants, clubs, and for association activities.

 

How is AD diagnosed?

 

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Although established biochemical biomarkers are currently only CSF (cerebrospinal fluid) biomarkers, body fluids that are easier to access, especially blood and plasma, are also being studied intensively in terms of candidate biomarkers.

 

• Neuroimaging biomarkers Structural imaging with MRI (Magnetic Resonance Imaging)  and metabolic imaging with PET (Positron emission tomography) .

 

Which drugs are used in the treatment of AD?

 

Cholinesterase inhibitors and Memantine added in the middle stages are drug treatments that slow down the disease.

 

Treatment of mood disorders such as depression, mania and anxiety  

 

Treatment of psychotic symptoms such as delusions and hallucinations

 

Treatment of agitation and aggression

 

Treatment of impulsivity and impulse control defects

 

Insomnia should be treated.

 

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