Alzheimer disease
Alois Alzheimer Psychiatrist and neuropathologist Alois Alzheimer (1864 - 1915): After he was named the disease
Summary:
In Alzheimer's disease, the brain loses some of its function. The loss of intellectual abilities is due to the destruction of brain cells where it comes to deposits and to a drastic decrease of nerve mediators. Sufferers lose the ability to absorb new information. Most comes completely lost touch with reality. In the advanced stage of Alzheimer's disease patients living in fragmented memories from the past and often no longer recognize their loved ones. The personality changes, some trains connect overly prominent. Often the day-night rhythm is disturbed. Alzheimer's disease is the most common form of dementia in old age. With drugs and activation of the remaining intellectual abilities, the course of the disease slowed down somewhat, a cure is not possible.
* CAUSES
* * COMPLAINTS
DIAGNOSIS TREATMENT
* * LIVING WITH THE DISEASE
examined 1906 German psychiatrist and neuropathologist Alois Alzheimer, the brain of a recently deceased patient who had suffered from dementia. He found a shrunken brain and under the Microscope, he discovered bundles of nerve cell protein (fibrils) and patchy deposits from other nerve cell proteins (plaques). Both were from previous underlying nerve cells in the brain. The shrinkage of the brain, the formation of fibrils and plaques and the loss of connections between nerve cells are the four most important structural changes in the brain that occur in Alzheimer's disease known today as a form of dementia. The deposits cripple important functions of the brain. This includes the formation of neural mediators. Probably in the early stages of the disease causes a disturbance of the chemical transmission of information between nerve cells. This concerns especially those nerve cells that are dependent on the transmitter substance acetylcholine. It decreases by up to 90 percent. The lack of acetylcholine, information can be stored and retrieved much worse. For other carrier substances, it is also to decrease. When serotonin may take up to 60, in case of somatostatin up to 70 percent. The further progress of these changes, the more can the "higher" brain functions and there, especially the intellectual capacity to. In the course of the disease perish all areas of the brain. This leads to further disruption in language, thought, spatial orientation ability and practical action. The changes in the brain begin at least ten years before showing the first symptoms. This is true not only for Alzheimer's disease, but for all dementias. Alzheimer's disease usually occurs after 65 Years on. Nearly 6 percent of people over 65 suffer in the developed world has some form of dementia, with Alzheimer's disease is the most important cause. The proportion of those affected by dementia doubles every five-year increments, but is expected to reach 35 to 40 percent of a plateau. With age, the second large group of dementia - vascular dementia - and more important.
causes
The causes of Alzheimer's disease are not yet fully understood. It should, however, Several factors in the development of the disease must be involved. They include genetic factors, inflammatory processes and environmental influences. Crucial individual genetic factors are likely to be up five percent of those affected only, if ill family members of several generations. Then the symptoms usually set before the 60th Age of one. Overall, the genetic predisposition as a risk factor but a more important role. Their estimates concede a share of 30 percent. Recently, a gene was identified, although belonging to the regulation of blood lipids, but favors the deposition of pathological substances in and around nerve cells. Therefore, it is suspected to promote the development of Alzheimer's disease. Genetic factors might also be a tendency to autoimmune reactions, which are also used as a cause in question. Maybe it comes with age to changes in the genes that promote the immune system attacks the own body. This could, ultimately, the destruction of brain cells and Alzheimer's disease to result. A considerable share of the destruction of brain cells are likely to have inflammatory processes. How far pathogens play a role (viruses are under discussion) and how much are the inflammation of active substances from brain cells, it has to be clarified yet. Also, environmental toxins, and traumatic brain injury with loss of consciousness (Statistically unique from the age of 40 years) is listed as Alzheimer beneficial factors. Occasionally, a poor education is mentioned. That's true but only partly. It should rather be that a good education - or a good "physical condition" of the brain - an incipient Alzheimer's disease can cover relatively long. This is also the fact that people with good education for Alzheimer's disease but later occurs or is discovered, the victims die, but it quickly. Why Women are affected slightly more often than men is not yet fully understood. In part it is due to the higher life expectancy, it may in part with the estrogen deficiency after menopause are related. Several studies have attempted to determine the risk of Alzheimer's disease. The results are quite different. What is certain is the genetic characteristic apolipoprotein E e4 allele (relative risk 6.2), dementia in first degree relatives (RR 3.5), hypothyroidism (RR 2.3) depression (RR 1.8) and severe head- brain injury (RR 1.8) in the history of more than 40 years and mother at birth (RR 1.7). There
early
reliable methods of early detection do not exist. But there are some signs of Alzheimer's disease, the relatively early . Occur You should always be the occasion for a medical examination. A possible early treatment can prevent the progression of the disease is not, but delay the occurrence of severe symptoms. An early investigation is important because while other causes of dementia as a change in pressure or brain tumors can be detected and treated. First signs of Alzheimer's disease may be that the person no longer recalls the people he actually know would, recent events often forgetting that he is not in a familiar world they are and that he is familiar, everyday activities such as the closing of shirt buttons or make the use of household appliances difficulties. Language problems may be noticed by the person everyday things can not rename or talking often loses the thread. Orientation problems in terms of time and place may occur. Situations are incorrectly assessed, for example, road hazards. Understanding the value and importance of money can be lost. Things are laid out confusing distraction and the person believes might be robbed. Apparent reason, there is mood swings. Also, loss of interest in the work or hobbies can be an indication. Similarly, if the person concerned is becoming increasingly difficult to make decisions. The assessment of mental and emotional capacity of a people is always proportionate to see the starting level.
age forgetfulness
Not everyone who suffers from forgetfulness, has Alzheimer's disease. Usually it is a normal age forgetfulness.
suggests that:
it occurs only temporary and not within months or few years steadily worse * forget rather unimportant things and moved, but are often not the wallet or passport * The Shifted to usual places again found to be * only details are forgotten, but not all experiences help * concentration and reflection, can at least help a bit later * "mnemonics," to remember the things * notes and other memory aids to help on the forgetfulness of time * the absence of other disorders, such as in thinking and discernment, orientation, - to remember the forgotten in the recognition of things and people in the skill in reading, writing and arithmetic, the drive and attention
pseudo dementia
Quite often go over-forgetfulness and concentration problems also stems from psychological causes, and also have nothing to do with Alzheimer's disease . do They are especially depression, agitation and anxiety. This is called a "pseudo-dementia". In contrast to Alzheimer's disease, the symptoms disappear when the mental impairment is treated. However, some depressions are associated with an increased risk for dementia.
complaints
Alzheimer's disease can run individually very different and does not always follow the rough division into stages. The course depends on the location, extent and distribution of the changes in the brain. It also depends on the personality, the level of education, the circumstances and the physical condition of the person concerned. The disease can also progress at different rates. Usually the speed will remain as it is in its infancy.
First stage
The symptoms in the first stage (mild dementia) are relatively harmless, but lead to an impairment in daily life. Often fall on the first obvious difficulty errands like phone calls or use of technical devices. The subject has problems with things that have to do with numbers, for example, simple errands to the bank. The short-term memory can be affected in the lurch. He repeats phrases or activities which he has just been said or done. He is always asking the same thing. It can be difficult for the victim to find the right word. It can be difficult to correct Judgments or conclusions to be drawn from different conditions. The interested party is prone to passivity and inaction. Asked about the date and time, he can not answer. The first disease-related changes in the affected solve most of shame, fear, anger and depression out.
Second stage
The symptoms in the second stage (moderate dementia) are so strong that the person is no longer able to lead an independent life. If anything, this is only possible with intensive support of familiar people. The memory can be affected so far in the Sticht that he even forgets the names of the people next to him. The Activities of daily life (dressing, bathroom, toilet, food) are hardly alone possible. The interested party has trouble finding the room in the apartment. Outside the house, he lost his way. Often, he says, to see someone who is not present or he is holding a present for someone completely different. The passivity turns into a big trouble and a strong urge to move. Those affected wander aimlessly in the home or outside force - in particular the night. The day-night cycle was reversed. The sense of time lost. The language is concentrated more and more. The individual shall be more indistinct and difficult to understand in his statements. The personality changes that affected people can be aggressive.
Third stage The third stage (severe dementia) is the person completely dependent on family members or other caregivers, this often recognize but no more. With new information, the memory not do anything more. Also dominates the person only a few words. This may come severe physical symptoms. The position is prone, the walk small steps and slow. Sufferers often fall. Food is sometimes despite help very difficult. Blame may be as severe dysphagia. Control over bladder and bowel is lost. Often changed the sexual behavior, sexually certain approximations occur randomly and without warning. Finally, the person falls and physically and is bedridden. The risk of life-threatening infections is increasing.
diagnosis
The diagnosis can be made with a certainty of 80 to 90 percent. 100 percent could be achieved in brain tissue only by microscopic examination. The risky procedure for removal of brain tissue is not done because the treatment options for those affected and thus does not change when the diagnosis is absolutely secure. Essential to the diagnosis, the symptoms are and how they evolve. To to determine the extent of dementia, are used standardized neuro-psychological tests. This memory, thinking, language and the recognition and use of objects to be studied. Many of the diagnostic procedures are performed to rule out other causes of symptoms than Alzheimer's disease. With a blood test can be identified inflammatory diseases, hormone or vitamin deficiencies. Liver function tests provide an indication of alcohol abuse. A study of thyroid function is evidence of thyroid disease. Also, HIV infection may be cause of dementia. With a computed tomography or magnetic resonance imaging may circulatory disorders and tumors in the brain that lead to an increase in brain pressure, are detected. More detailed information on the Alzheimer's disease, methods that examine the activity of the brain. These can be studies with SPECT or PET, in which blood flow and metabolism are examined in the brain. An examination of the cerebrospinal fluid, which can be achieved by lumbar puncture (laboratory testing) is taken from the spinal canal, also provide evidence of Alzheimer's disease. In affected individuals, certain protein substances are often used in high or low concentration. The treatment of nerve cells and nerve connections that are lost in Alzheimer's disease can not be restored. However, there are treatment options, the quality of life of those affected - can improve - and the family. They consist of medical therapy and special training programs for activation and mental abilities.
prognosis
A cure is not possible, the disease continues to improve. Most patients die after an illness lasting five to eight years in a project funded by the bedridden infection, such as pneumonia.
Drug treatment
With the currently available medications, the consequences of brain injury be delayed, at least for a time out. Acetylcholinesterase inhibitors can compensate for the lack of the neurotransmitter Acetylcholesterin part and achieve an improvement in memory and concentration. Nootropics rain including the brain metabolism. To delay the progression of dementia is recently a new drug available. Akatinol-Memantine has a different mechanism of action as acetylcholinesterase inhibitors and provides an alternative when other drugs have failed to date. Also accompanying symptoms of Alzheimer's disease can be alleviated by medication. Antidepressants are effective against the low mood and anxiety, neuroleptics against anxiety, delusions and hallucinations. Anxiety can be alleviated with anxiolytics, the mobility with an anti-Parkinson's agents can be improved.
Physical therapy and other non-drug therapies
methods of physical therapy can do much to enable the parties concerned and cheer. Physical therapy, walking and relaxation exercises can do well. Because the feeling remains for a long time rhythm, can also bring proceedings in music therapy success. This can listen to music, making music or dance therapy may be. Our focus is that the person has joy in the respective activity. It also highlights the self-esteem. In this sense also acts as the validation, in which is it is the combination of specific interaction techniques and a certain attitude towards the person concerned. The special focus is to take the affected seriously and respected. It also attempts to help him in maintaining the memory of events of his life. In self-preservation therapy (SET) is a neuro-psychological training methods that tries to be, loss of continuity alleviate, poverty experience, personality change and loss of self-knowledge. Onset of impairment may be partly offset with methods of occupational therapy. It is all about skills to cope with everyday life. Trained therefore will attract activities such as, washing, ironing, floor sweeping, dusting, washing dishes or dry, peel potatoes and fruit or cake.
Brain Training
are by far not all methods for improving memory and concentration for Alzheimer's patients benefit. Some can even be counterproductive. Namely, when it is about learning new strategies go shopping, because the patients suffer precisely under the diminishing ability to learn new things. Such exercises lead to the person concerned so its shortcomings in mind constantly, causing disappointment and frustration. The also applies to forms of reality orientation training (ROT). A mental activation of those concerned is quite possible - only to have specific procedures for the Brain Training needed. They are offered in specialized centers, such as memory clinics, where contact with their family doctor, the neurologist or the neurological department can be prepared in hospitals. In these processes, attempts to further strengthen existing skills. This can be done through a so-called multimodal activation training, which consists of mental, social and physical elements. Plays a central role in working with images. The combination of mental and physical activity therefore leads to particularly good results because the physical activity of the blood circulation and stimulates the metabolism in the brain. A noticeable improvement in the status of those concerned, however, can be practically achieved only in the first stage of the disease. There are not many nerve connections have been lost through the training and the remaining connections can be enabled or even new ones are closed. Damaged regions of the brain can be "bypassed" so for a while. However, it is impossible to "fix" again, or halt the progression of the disease.
Additional measures
a complete listing and classification of complementary medicine Recognized method in, doubtful, not generally recognized or secured futile therapeutic procedures in view of the insufficient data make difficult to implement. A selection and assessment of certain forms of therapy but given yet: Review of the assessment may change in the next few years again, and is also currently no consensus opinion dar. * The natural remedies include herbal medicines and preparations from the leaves of the Ginkgo biloba tree. Some studies provide evidence that they may improve dementia symptoms. * As an unconventional, not scientifically accepted treatment method, but which are felt by individuals as helpful to the administration of vitamins such as vitamin E, stabilize the membranes of nerve cells and prevent the destruction of nerve cells, or is delayed. A clear indication, however, has so far not been demonstrated. In high doses it may have a preventive value. * Is less appropriate the use of enzyme therapy, in which the formation of "immune complexes" is intended to prevent the blood. The effect of the method is not well studied. Bloody detoxifying process, weaken the parties may be rejected entirely. Moreover, this can result in infections. This can happen even with the self-blood therapy, which is rejected as well. Also from the chelation is not recommended because it can result in a shortage of calcium and essential heavy metals. These deficiencies promote convulsions. Is not recommended that further cell and organotherapy in which products are made from tissues of newborn animals or animal fetuses injected or swallowed. This can lead to allergic reactions to fatal shock. Moreover, the spreading of diseases may occur. The oxygen and ozone therapy has no proven effect against dementia. Living with the disease, the well-being of those affected depends largely on the social environment that offers him the ideal case, safety and security. The person concerned needs protection from failures and excessive demands. He should not be confronted with tasks that can not satisfy it. Direct questions can not answer. At the same time he needs encouragement, to use the remaining skills and to train. Affected parties should be able to live out his desire to move, by which he also degrades tensions and fears. He needs a social environment where we can provide it - even bother if all acts are futile, or.
members
The diagnosis of Alzheimer's disease is for the members as to the person concerned a heavy blow. At least at the beginning of the care of those affected is almost always taken over by the family. Of fundamental Importance is the sharing of care responsibilities. It helps if it is clear who does what and when. Participation in a self-help group or family member can be a great support. The members are not only exposed to stresses such as occur in the treatment of severely chronically ill family members forever. This includes the need for constant presence, the high physical stress, lack of hope of change or fear of further deterioration - which in Alzheimer's disease occurs, too - and problems with incontinence of the patient. Furthermore, any person belonging to fight too often with the feeling that not many family demands longer able to be and give up their own needs and interests must. Also conflicts with other employees on the grounds of lack of support can occur. Finally, the members to a large extent on the support of friends and neighbors need to be able to answer most of them without the same degree. Given in Alzheimer's disease are also special problems such as disorientation of the individual concerned, his forgetfulness and often problematic behaviors. His change in character can strain relations between carers and cared for and increasing change. This can go so far that the affection is lost.
handling the person concerned
the beginning is often underestimated the person in his intellectual abilities. On the other hand, the losses are often not perceived, displaced and glossed over. The individual shall be criticized and encouraged and that leads to excessive demands. Detailed discussions with doctors and victims can reduce resulting from misunderstandings and tensions. Members can influence their behavior affected negatively or positively. Studies have shown that training for members of the need for admission to a nursing home can be delayed by about a year. When the training is about understanding the to have dementia caused and to help the families to see the world, at least in part through the eyes of the person concerned. It is for dealing with people with dementia to promote, not argue who's right and not to speak in commanding tone. It is better to make as few questions that require a good memory and not to point out shortcomings. It helps more, access the remaining possibilities back. In the presence of the person concerned to speak about his shortcomings, the impact is negative. Help can only be accepted if it is given in a form so that it can be assumed. Complex issues which can take several sensory channels, are not met. It is better to address those concerned if you are in his field of vision is, while access to familiar rituals and gestures back. Supporting facilities (day care centers in Germany, specialized day care centers in Austria) can help ensure that this does not lead to overloading of the supervisor. The type of childcare centers in such a day is tailored to the Alzheimer's disease. Many offer suitable methods of physiotherapy and occupational therapy. A structured daily schedule provides for uniformity, which provides for a settling-in period is generally so much security that the parties feel comfortable. Care facilities may also the concern for the person concerned to take, if the family needs holiday. Almost 90 percent of moderate to severe dementia need care or are suffering from severe functional limitations. Two thirds to three quarters of all dementia patients to move in the course of the disease in a nursing home. The average disease duration up to the home recording is 3 to 3.7 years. It affects on average 2.6 to 3.1 years in the home.
license
The risk of accidents increases in the first three years of disease on three-or four-fold. If a person feels increasingly insecure and moves slowly or other very aggressive and erratic driving, then an examination by a neurologist is necessary. Even without a license, some stakeholders do not give up the car. Then it may be necessary to hide the key.
hedging and Sachwalterschaft
It makes sense for the person concerned from the outset to take out liability insurance. In advanced stages, then a legal services (in Germany) / Sachwalterschaft (Austria) - necessary - usually by family members. This also protects the parties against actions and misunderstandings that he can not control.
Testament
a will, which was created in an advanced stage of disease , may be appealed. That will always long succession processes after themselves. It is therefore useful if the person holds his will at the very beginning of the disease.
Psychological care
the supervision of a trained psychotherapist at the beginning of the disease can help patients to overcome his destiny.
care at home
Many sufferers want a care and care in their own homes. There are financial and technical support services to (care). If the conditions are right for personal care at home, to cooperation with an outpatient Nursing optimal nursing care outside the hospital. Who takes care of a good organization of care and appropriates the necessary knowledge about nursing practice, can keep the loads within limits. Also contributes to an individual adjustment to the apartment.
