Old age for many is synonymous with Dementia and Alzheimer’s. Alzheimer’s looms as a fear hanging over old age. Alzheimer’s as a chronic disease affects whole families and relationships as well as the individual sufferer. Being progressive, Alzheimer’s causes general deterioration, and is the most common form of dementia. It is estimated that 46.8 million people were living with Dementia worldwide in 2015, and with the aging populations of many developed countries, this is only set to increase. Despite it being a chronic and long-lasting disease, most sufferers don’t in fact receive a formal diagnosis.
Alzheimers is a physical degenerative disease: there are real physical changes taking place in the brain. Proteins build up over time in the brain and cause a loss of connections between nerve cells and ultimately cell death, and loss of brain tissue. Additionally, there is a shortage over time of some essential chemicals that support and enable brain function.
Alzheimer’s causes a range of different cognitive difficulties for sufferers, however, the symptoms vary from one individual to another. There is no set profile for an Alzheimer’s sufferer. Broadly, Alzheimer’s causes memory loss, difficulties with thinking and rational thought, problem-solving and logical thinking, and language problems.
The symptoms of this chronic disease start in a mild form and develop over time, usually a period of several years. Predominantly the first symptoms to be noticed involve memory problems, particularly focused on recalling recent events or when required to learn new information.
Alzheimer’s then goes on to cause further problems, usually with logical thinking, reasoning, perception, communication and language, concentration, planning, organisation and executive functioning, and orientation.
As Alzheimer’s develops in to its later stages then the sufferer may experience further exacerbation of the above symptoms as well as sometimes becoming delusionary or experiencing hallucinations. Unfortunately in the later stages it is also not uncommon to see character changes, most notably with Alzheimer’s patients becoming increasingly aggressive, agitated and anxious.
Alzheimer’s can be categorised in to three broad types:
Early Onset Alzheimer’s: Only accounting for approximately 10% of Alzheimer’s sufferers, Early Onset patients experience the beginning of symptoms prior to the age of 65, with many noticing an onset of symptoms in their forties and fifties.
Late Onset Alzheimer’s: The most common form of Alzheimer’s affects those over the age of 65, hence it is associated with old age, and being an elderly person’s disease.
Familial Alzheimer’s Disease (FAD): is a form of Alzheimer’s is definitely linked to genetic causes. Whilst there is some debate and research underway regarding the genetic link of Alzheimer’s there are only a very small proportion of cases definitely linked to genetics, only accounting for approximately 1% of Alzheimer’s sufferers. These sufferers usually experience their earliest symptoms in their forties.
As with all chronic diseases there are certain factors that make an individual less or more likely to develop Alzheimer’s disease as they age.
Age: Age alone is the biggest factor in the increase of prevalence in Alzheimer’s. As populations age then a larger proportion will be at risk of developing dementia and Alzheimer’s.
Gender: Women are considerably more likely to develop Alzheimer’s than men. This relationship cannot simply be explained by women living longer, but is a risk factor in itself.
Genetic Link: Research is underway, and more is needed, to identify the genetic links of Alzheimer’s further. However, there does seem to be some genetic link, particularly for those with Early Onset Alzheimer’s.
Down’s Syndrome: Individuals with Down’s Syndrome are more likely to develop Alzheimer’s disease compared to the general population, largely thought to be due to chromosomal differences and premature aging.
Other Chronic Conditions: Alzheimer’s is more common in individuals with other long term chronic conditions such as diabetes, heart problems, high blood pressure, and high cholesterol. Obesity in mid-life and strokes are also associated with Alzheimer’s. As such, lifestyle factors are definitely thought to play a part in the likelihood of developing the disease.
Depression: There is a link between those suffering from depression and Alzheimer’s.
Given its degenerative, progressive nature, management of Alzheimer’s needs to focus on management and enabling individuals and their families to maintain their quality of life for as long as possible. The aims of Alzheimer’s management are to maximise the individual’s daily function as well as providing a safe environment.
Treating Cognitive Symptoms: Drug therapy for Alzheimer’s has developed enormously over the past two decades. Treatments, especially early on in the course of the disease, can be used to alleviate, and even slow down, some of the symptoms. For example: medications such as Donepezil, Rivastigmine and Galantamine.
Handling Behavioural Symptoms: Help and support can be given to individuals to help them manage their own, or their loved ones, behavioural symptoms such as controlling aggression, agitation, anxiety and psychosis.
Support for the Caregiver: Alzheimer’s can place a huge burden on those caring for the individual sufferer. Education, support and respite needs to be given to the caregiver to ensure the patient themselves gets the best care.
The aim of any Alzheimer’s management programme should include monitoring and evaluation to enable to the management plan to be adapted over time.
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