10 Warning Signs of Alzheimer’s Dementia

Caring for family members with Alzheimer’s Dementia (AD) is an all-encompassing job.  People with Alzheimer’s can experience behavioral changes, get lost, and become a danger to themselves.  Though there are no cures for AD, there are some medications available that can slow down the progression or treat some of the behavioral disturbance.  It is therefore important to know the signs of if and what is not part of aging. Early diagnosis gives a chance to seek treatment and plan for the future.

In order to recognize AD, we must know about the 10 warning signs of AD:

  • Changes in mood and personality
  • Withdrawal from work or social activities
  • Misplacing things and losing the ability to retrace steps
  • Memory loss that disrupts activities of daily living
  • Challenges with planning or problem solving
  • Difficulty completing familiar tasks
  • Disorientation and confusion with time and place
  • Trouble understanding visual images and special relationships
  • Problems with words while speaking or writing
  • Decreased or poor judgment
  •             Without a doubt AD is a complex and difficult to treat. While aging is the most obvious risk factor for AD, there are also other factors that influence the progression of AD. Genetics, abnormal immune responses, and even environmental factors such as education, traumatic injury, certain drugs, hormone replacement, and oxidative stress seem to contribute to the diagnosis of AD.  Alzheimer’s Dementia (AD) is a neurodegenerative disorder that is characterized by the loss of neurons in the brain. It is the most common form of dementia affecting more than 46.8 million of people worldwide. AD is the third most common cause of death among elderly after heart Dementia and cancer. The prevalence of AD increases with advanced age; approximately 10 percent of all people age 65 and above and 50 percent of those ages 85 and older suffer from AD.

    What is the cause?

    The exact cause of AD is unknown. To this day there is no clear understanding of this complex Dementia. AD has an early onset and late onset. The early onset of AD has been linked to three genetic defects: (a) on chromosome 2, the presence of amyloid precursor protein (APP) gene; (b) on chromosome 14, the presence presenilin 1 (PSEN1); (c) and on chromosome 1, the presence of presenilin 2 (PSEN2). The late onset of AD is associated with chromosome 19, which is also involved with the apolipoprotein E gene-allele 4 (apoE4). Other involved alterations in the brain include the formation of neuritic plaques that contain amyloid beta protein (Aβ), the formation of neurofibrillary tangles, and the degeneration of cholinergic neurons with the loss of acetylcholine. The accumulation of toxic fragments of Aβ, which in turn leads to the formation of diffuse neuritic plaques, results from the failure to process and clear the amyloid protein. Loss of the amino acid acetylcholine contributes to a decline in memory and loss of attention span as well. Furthermore, there is also evidence of neuroinflammation, but the mechanisms are still under research.

    What is the origin or etiology of AD?

                The etiology of Alzheimer’s Dementia remains unknown to date. One of the most accepted theories that explain how Alzheimer’s is induced is through the excessive accumulation of Beta amieloid peptide (Aβ), which induces pathological changes and causes dementia. Due to the relationship of the possible cause of AD from the Aβ, extensive research has been devoted to the BACE1 inhibitors, which seem to initiate the blockage or suppression of Aβ in the human brain. Also the typical hallmarks of AD seem to be the appearance of extracellular amyloid plaques in the brain, starting initially in the hippocampus and then extending to the cortical grey matter. These amyloid plaques, also known as senile plaques, are the result of excessive deposition of Aβ peptides. In the past two decades there has been extensive knowledge gained regarding the formation of amyloid plaques, and more recent research is focused on the understanding of BACE1 as the critical component for the future treatment of AD.

    What are the risk factors of AD?

                There are several risk factors involved in the process of dementia. As we know, AD is the most common form of dementia and figures among the sixth leading cause of death among the elderly. Among the factors that may increase the risk of AD are depressive disorder, APOE e4 genotype, some non-steroidal anti-inflammatory drugs, diabetes mellitus, hyperlipidemia in mid-life, traumatic brain injury in males, pesticide exposure, current tobacco use and exposure, and conjugated equine estrogen with methyl progesterone.

                There is also a decreased risk of AD with the following: intake of folic acid, Mediterranean diet, HMG-CoA reductase inhibitors (statins), light to moderate alcohol intake, physical activity (high levels), and cognitively engaging activities. Nevertheless, AD is considered a complex Dementia caused by a combination of factors such as age, genetics, and the environment, and still there is no clear causal factor for the Dementia

    What are the clinical and diagnostic manifestations of AD?

                The clinical manifestations of dementia should be evaluated together with laboratory and neuropsychologic testing and brain imaging. A person with AD usually presents with progressive impairment and loss of memory, poor judgment, and difficulty making decisions. Additionally, disorientation to physical surroundings and difficulties with language can be present. There is no cure for AD, however if a specific treatable cause is identified, the appropriate treatment is initiated. It is also important to correct any nutritional deficiencies as well as any metabolic disorders that may trigger and worsen the course of AD.

    Are there any treatments available for AD?

    Unfortunately, there is no specific treatment or cure for dementia. The idea is to learn about the pathogenic mechanisms that underlie the dementia and then try to delay the conversion of cognitive decline and impairment into a full form of dementia. Therefore, the treatment is to maintain and maximize the remaining capabilities of the invidual, restore any functions if possible, accommodate the lost abilities, and control different behavioral changes. Neuroleptic medications reduce the incidence of delusions, paranoia, and hallucinations in patients with AD, while antidepressants help in cases of suspected depression.

    What about AD research

                While the research for AD continues to grow, after more than two decades of studies and theories, there is still a poor understanding of the causes of AD. The role of different processes involved in the pathogenesis of AD need to be better understood before making any significant progress. Future research needs to include a thorough and deep investigation of the pathways and mechanisms of how each one of the different theories and hypothesis work. It seems to be that, while there is a general consensus as to the possible causes and pathophysiology of AD, none of the hypotheses and theories fully explain or show results for a definitive treatment.

    Support for Caregivers

    Unfortunately, the forgetfulness that individuals with AD experience can be severe. It can affect their ability to function at home or at work, or to enjoy lifelong hobbies. AD causes a person to become disoriented, confused, and even to get lost in familiar places. Misplacing things is not uncommon or have trouble with communication.  The clinicians of At Your Service Psychiatry know how hard it is to care for loved ones with AD.  To care for others, you need to be able to care for yourself.

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