Senile dementia is the third leading health problem in overdeveloped countries, after cardiovascular accidents and cancer. The growing public, biomedical and political interest in Alzheimer’s disease stems from the marked upward progression of its prevalence in Western societies.
The life expectancy of those over 65 years of age has increased dramatically in the past decades. Life expectancy in Western society has reached 82 years, increasing the risk of severe dementia by a quarter.
It is now accepted that dementia is a symptom complex that can be caused by more than 70 different pathological processes. Symptoms of dementia include loss of recent memory, loss of language functions, inability to think abstractly, inability for self-care, personality disorder, emotional instability, and loss of sense of time and space.
These characteristics differentiate dementia from mental retardation in that they are mental faculties that are lost once acquired and exercised over a long period of time, whereas in mental retardation they are never fully acquired. Dementia also differs from delirium in that delirium develops with a temporary drop in attention and confusion, accompanied by the transient loss of certain cognitive functions, depending on the agent responsible for the delusional picture.
The first record of senile mental deficiency is found in the Law of Solon written in Greece around 400 BC. A.Cornelius Celsius introduced the terms dementia and delirium in his work De Medicina in Ancient Rome.
It was not until 1906 when Aloisius Alzheimer, a German neurologist, showed the case of a 51-year-old patient with dementia, and discovered changes in the neurofibrils. The patient presented disorientation, memory loss, jealousy, perceptual deficit, aphasia, apraxia, paraphasia, agnosia, persecutory mania and rapid progression of the disease. The German school of Krepelin and later Fisher discovered the so-called senile plaques with amyloid content in the brain pathology.
Possible causes of Alzheimer’s disease
Despite the efforts made in the last 20 years to identify the factors involved in the genesis of Alzheimer’s disease, its cause still remains an enigma.
Six etiopathogenic theories of Alzheimer’s disease have been considered for years:
– Cholinergic deficit
– Genetic failure
– Accumulation of abnormal proteins
– Infectious agent, environmental toxin
– Deficient cerebral flow
– Secondary traumatic and psychosocial factors.
From a genetic point of view, some families show a hereditary pattern, as in the case of some patients with early onset, before the age of 65, which affects less than a quarter of Alzheimer’s patients. It is caused by genetic mutations in chromosomes 1, 14 and 21.
Although no specific gene has been identified in late-onset Alzheimer’s disease, genetic factors play an important role in the development of the disease.
Other factors are being investigated, such as the presence of aluminum, the importance of the tau protein or the levels of synucleotide in blood, among others.
Classification of dementias
Scientific research on Alzheimer’s disease has led to further classification of dementias:
– Taupathies. It is related to the alteration of the tau protein. It includes the dementias of Alzheimer’s disease, frontotemporal dementia, dementia, progressive supranuclear palsy, cortico-basal, Pick’s disease, Creutzfeldt Jacob disease, Strausler, Gersman’s disease and primary progressive aphasia.
– Synucleopathies. Includes multisystem atrophy, nigrostriatal degeneration, dementia associated with Parkinson’s disease, olivopontocerebellar atrophy and dementia with Lewy bodies. Parkinson’s disease poses a six times greater risk of developing dementia than the healthy population.
Symptoms of Alzheimer’s disease
Alzheimer’s disease presents different symptoms, both cognitive and motor, such as:
– Amnesia
– Language asphasia
– Agnosia
– Non-recognition of faces
– Dressing apraxia
– Learning disorder
– Disorientation
– Muscle contractures
– Seizures
– Motor incoordination
Alzheimer’s also presents functional symptoms including:
– Difficulty walking
– Difficulty eating
– Difficulty dressing and grooming
– Difficulty maintaining a home
– Difficulty with financial management
The disease may also present through behavioral symptoms such as:
– Attacks of rage
– Manic-depressive episodes
– Violence
– Catastrophic reactions
– Sleep disturbances
– Wandering
– Obscene language
– Hallucinations
– Sexual disorders
– Social maladjustment
– Personality disorders
There are symptoms associated with Alzheimer’s disease including delirium, gustatory, visual or olfactory hallucinations. Also, some of the general symptoms are sweating, constipation, hypotension and sleep disturbance.
Diagnosis of Alzheimer’s disease
Tests in the diagnostic process are an important diagnostic tool. Some of these tests are:
– Pet amyloid
– Scanner
– Spect
– Functional brain MRI
– Cerebral spectroscopy, e.e.g.
– Neuropsychological study
– General analysis thyroid tests, vit. b12, folic acid, folic acid.
– l.c.r. analysis: beta amyloid and tau protein
Treatment of Alzheimer’s disease
There are several treatments to try to combat Alzheimer’s disease. They are generally based on acetylcholysesterase inhibitors and blockers of the effects of glutamate. Some of the most commonly used therapies are:
– Cognitive stimulation therapy. Psychotherapy and specialized psychosocial support are indispensable in the management and treatment of Alzheimer’s disease. Admission to a 24-hour residential or day care facility is necessary in some cases.
– Research in treatments tries to interfere in the development of pathological amyloidogenesis and different vaccines have been tested: such as the experimental EB1D, a new immunogen that creates antibodies against neuritic plaques, where the beta amyloid protein accumulates, atypical neuroleptics in delusions and hallucinations, as well as in behavioral disorders. Also serotonin reuptake inhibitors and other non-tricyclic antidepressants.
– It is also important to provide psychological care to the caregivers of Alzheimer’s patients.
There are great expectations regarding the treatment of Alzheimer’s disease, the great economic and social investment that is already bearing its first fruits.