Alzheimer's disease is a progressive disease that destroys memory and other important mental functions. At first, someone with Alzheimer's disease may notice mild confusion and difficulty remembering. Eventually, people with the disease may even forget important people in their lives and undergo dramatic personality changes.
Alzheimer's disease is the most common cause of dementia - a group of brain disorders that cause the loss of intellectual and social skills. In Alzheimer's disease, the brain cells degenerate and die, causing a steady decline in memory and mental function.
Current Alzheimer's disease medications and management strategies may temporarily improve symptoms. This can sometimes help people with Alzheimer's disease maximize function and maintain independence for a little while longer. But because there's no cure for Alzheimer's disease, it's important to seek supportive services and tap into your support network as early as possible.
At first, increasing forgetfulness or mild confusion may be the only symptoms of Alzheimer's disease that you notice. But over time, the disease robs you of more of your memory, especially recent memories. The rate at which symptoms worsen varies from person to person.
If you have Alzheimer's, you may be the first to notice that you're having unusual difficulty remembering things and organizing your thoughts. Or you may not recognize that anything is wrong, even when changes are noticeable to your family members, close friends or co-workers.
Brain changes associated with Alzheimer's disease lead to growing trouble with:Memory
Everyone has occasional memory lapses. It's normal to lose track of where you put your keys or forget the name of an acquaintance. But the memory loss associated with Alzheimer's disease persists and worsens, affecting your ability to function at work and at home.
People with Alzheimer's may:
- Repeat statements and questions over and over, not realizing that they've asked the question before
- Forget conversations, appointments or events, and not remember them later
- Routinely misplace possessions, often putting them in illogical locations
- Get lost in familiar places
- Eventually forget the names of family members and everyday objects
- Have trouble finding the right words to identify objects, express thoughts or take part in conversations
Alzheimer's disease causes difficulty concentrating and thinking, especially about abstract concepts like numbers.
Multitasking is especially difficult, and it may be challenging to manage finances, balance checkbooks and pay bills on time. These difficulties may progress to inability to recognize and deal with numbers.Making judgments and decisions
Responding effectively to everyday problems, such as food burning on the stove or unexpected driving situations, becomes increasingly challenging.Planning and performing familiar tasks
Once-routine activities that require sequential steps, such as planning and cooking a meal or playing a favorite game, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer's may forget how to perform basic tasks such as dressing and bathing.Changes in personality and behavior
Brain changes that occur in Alzheimer's disease can affect the way you act and how you feel. People with Alzheimer's may experience:
- Social withdrawal
- Mood swings
- Distrust in others
- Irritability and aggressiveness
- Changes in sleeping habits
- Loss of inhibitions
- Delusions, such as believing something has been stolen
Many important skills are not lost until very late in the disease. These include the ability to read, dance and sing, enjoy old music, engage in crafts and hobbies, tell stories, and reminisce.
This is because information, skills and habits learned early in life are among the last abilities to be lost as the disease progresses; the part of the brain that stores this information tends to be affected later in the course of the disease. Capitalizing on these abilities can foster successes and maintain quality of life even into the moderate phase of the disease.
There's no specific test today that confirms you have Alzheimer's disease. Your doctor will make a judgment about whether Alzheimer's is the most likely cause of your symptoms based on the information you provide and results of various tests that can help clarify the diagnosis.
Doctors can nearly always determine whether you have dementia, and they can often identify whether your dementia is due to Alzheimer's disease. Alzheimer's disease can be diagnosed with complete accuracy only after death, when microscopic examination of the brain reveals the characteristic plaques and tangles.
To help distinguish Alzheimer's disease from other causes of memory loss, doctors now typically rely on the following types of tests.Physical and neurological exam
Your doctor will perform a physical exam, and is likely to check your overall neurological health by testing your:
- Muscle tone and strength
- Ability to get up from a chair and walk across the room
- Sense of sight and hearing
Blood tests may help your doctor rule out other potential causes of memory loss and confusion, such as thyroid disorders or vitamin deficiencies.Mental status and neuropsychological testing
Your doctor may conduct a brief mental status test to assess your memory and other thinking skills. In addition, your doctor may suggest a more extensive assessment of your thinking and memory. Longer forms of neuropsychological testing may provide additional details about your mental function compared with others' of a similar age and education level.Brain imaging
Images of the brain are now used chiefly to pinpoint visible abnormalities related to conditions other than Alzheimer's disease - such as strokes, trauma or tumors - that may cause cognitive change. New imaging applications - currently used primarily in major medical centers or in clinical trials - may enable doctors to detect specific brain changes caused by Alzheimer's.
Brain-imaging technologies include:
- Magnetic resonance imaging (MRI). An MRI uses radio waves and a strong magnetic field to produce detailed images of your brain. MRIs are used to rule out other conditions that may account for or be adding to cognitive symptoms. In addition, they may be used to assess whether shrinkage in brain regions implicated in Alzheimer's disease has occurred.
- Computerized tomography (CT). A CT scan produces cross-sectional images (slices) of your brain. It's currently used chiefly to rule out tumors, strokes and head injuries.
Positron emission tomography (PET). During a PET scan, you'll be injected in a vein with a low-level radioactive tracer. The tracer may be a special form of glucose (sugar) that shows overall activity in various brain regions.
This can show which parts of your brain aren't functioning well. New PET techniques are able to detect your brain level of plaques (amyloid) and tangles (tau), the two hallmark abnormalities linked to Alzheimer's. However, these new PET techniques are generally found in research settings or in clinical trials.
- Cerebrospinal fluid. In special circumstances such as rapidly progressive dementia or very young onset dementia, a cerebrospinal fluid examination may be performed. The spinal fluid can be tested for biomarkers that indicate the likelihood of Alzheimer's disease.
Researchers are working with doctors to develop new diagnostic tools to help definitively diagnose Alzheimer's. Another important goal is to detect the disease before it causes the symptoms.
New tools under investigation include:
- Additional approaches to brain imaging
- More-sensitive tests of mental abilities
- Measurement of key proteins or protein patterns in blood or spinal fluid (biomarkers)
Genetic testing generally isn't recommended for a routine Alzheimer's disease evaluation. The exception is people who have a history of early-onset Alzheimer's disease. However, anyone with a family history of early Alzheimer's needs to meet with a genetic counselor to discuss the risks and benefits of genetic testing.
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