Alzheimer’s Disease

  • It typically starts over the age of 65.

  • It has an insidious onset and slowly progressive course.

  • Initially, memory disorders are mild.

  • Later, progressive memory impairment develops.

  • Over time, impairments in attention and concentration, speaking, understanding, writing, reading, perceiving what is seen, perceiving space, insight, foresight, analysis and planning skills develop.

  • As a result, the severity of the mental disorder also hinders independence in activities of daily living.

What is the frequency of AD?

  • The meta-analysis of prevalence studies (the ratio of all cases in a certain time period to the population) conducted in the world reveals that AD, which is 4-5% between the ages of 65-70, increases exponentially every 5 years and reaches up to 50% in the 90s. .

AH’ What changes are seen in the brain?

  • It is a neurodegenerative disease of the brain that is caused by cell loss. Amyloid beta peptide (Aβ) causing senile plaques, tau (τ) protein causing neurofibrillary tangles, loss of neurons and synapses due to these protein disorders, gliosis and loss of cholinergic axons that provide nerve conduction are involved in the formation mechanisms of the disease.

What are AD Stages?

  • When the functional impairment threshold is exceeded, it is divided into sub-stages as mild, moderate and severe.

  • The course up to this threshold is called mild cognitive impairment.

  • AD has an initial stage, which lasts for many years before showing clinical signs, during which only the pathological features of the disease evolve.

  • The typical patient, who is responsible for 90% of all AD cases, has no family history.

  • There is a family history of AD in early-onset (early under 65 years old), rapid-progressing type AD cases.

What are the Findings in the Mild Stage?

  • If he is still working, he has lost his productivity at work.

  • While monotonous jobs that do not require creativity can be sustained at the beginning, co-workers are aware of poor performance and retirement soon becomes inevitable.

  • Difficulty remembering events from the recent past, repeating the same questions, difficulty finding words are the main features that attract the attention of relatives.

  • Although still able to roam and travel in familiar places, he may get lost in unfamiliar places

  • Difficulties such as inattention to signaling, slowing down in reactions, confusing directions have started while driving.

  • Errors occur in financial affairs such as bank work, bill payments.

  • Fails to learn and use innovations such as bank cards, mobile phones

  • Hobbies (sewing-embroidery, gardening, artistic pursuits, skill games, etc.) have become unsustainable

  • Difficulties have started in kitchen work such as deterioration in food taste.

  • Although he can carry on with household chores such as laundry and dishes, he has lost some of his former care.

  • Decreased interest in current affairs through reading and newspaper-TV

  • There is no problem in dressing, washing, table habits and basic hygiene yet.

  • There are no behavioral symptoms other than irritability, blunting of affect, and decreased spontaneity with a tendency to denial, and social conformity is well preserved.

  • Sleep quality begins to deteriorate

  • Sexual interest and appetite are disturbed

  • With the contribution of recognizing the deficiencies, depression symptoms may be at the forefront in some cases. However, depression often presents with motivational symptoms such as aversion rather than affective symptoms such as an expression of grief.

What are the Findings in the Middle Stage?

  • When the middle dementia stage is reached, the patient has completely lost his independence outside the home.

  • Although he can go out on the street with supervision, he cannot find his way if left alone.

  • May mess up rooms in other people’s homes

  • New learning is almost never possible anymore

  • Comprehension, reading and writing gradually deteriorate; towards the end of the universe his signature may be unrecognizable

  • Although it usually preserves information about first-degree relatives, it confuses information such as the number of grandchildren, their names, and schools.

  • Its functionality at home has become extremely superficial. However, it can be helpful in clearing the table or chopping vegetables.

  • Difficulty in choosing clothes suitable for the season or time of day, mixing the order of the clothes (such as underwear on a shirt), buttoning the wrong buttons during dressing.

  • When he cannot use the knife at the table, his food must be cut beforehand.

  • By gradually pouring and scattering, the food becomes clear. Mistakes can occur, such as mixing cutlery, trying to pick up liquids with a fork.

  • In washing, the need for help arises, starting with regulating the heat and cold.

  • Nocturnal urinary incontinence occurs. Toilet mechanics can perform functions such as washing their hands and face.

  • Behavioral symptoms are now beginning to be emphasized. May have delusions of theft, abandonment, and infidelity

  • He is afraid of being alone and wants his relatives (wife, child) in front of his eyes all the time.

  • Upcoming appointments, such as doctor’s visits, can lead to overt anticipatory anxiety

  • The disruption in the sleep-wake rhythm is now evident. Frequent awakenings at night and frequent napping during the day

What are the Findings in the Severe Stage?

  • May confuse relatives (wife, child) with their parents, may not recognize their own face in the mirror

  • Basic activities of daily living, such as dressing, washing, eating, now require full supervision.

  • Difficulty in swallowing also occurs lately.

  • Vocabulary is extremely poor

  • In recent years, all speaking ability is lost.

  • It becomes increasingly difficult to move and even sitting becomes impossible towards the end.

  • Talking about people on TV as if they are at home, talking as if they are strangers with their own image in the mirror can be observed.

  • While the movement is preserved, aimless wandering, hoarding, aimless repetitive movements can be observed.

  • Disturbances in toilet mechanics (proper cleaning after urination or stool, problems with flushing), urinary incontinence becomes increasingly evident

  • Epileptic seizures may occur

What are AD Risk Factors?

Non-modifiable risk factors

  • advanced age

  • Genetics (Familial AD)

Modifiable risk factors

  • Malnutrition or malnutrition

  • Obesity

  • Cigaret

  • Heavy alcohol intake

  • Sleeping disorder

  • Social Isolation

  • Depression

  • Lack of Mental Activity

  • Lack of Physical Activity

  • Low Education

  • Hearing loss

  • Diabetes Mellitus

  • Hypertension

  • High Cholesterol

  • Stroke History

  • Head Trauma

  • hypothyroidism

  • Electro-magnetic field (EMF) exposure

  • Air pollution

What should be done to prevent AD?

  • Good education in childhood

  • Reading especially as a child and teenager

  • Engaging in mental activities such as reading, artistic activity, playing games

  • Hypertension control (systolic blood pressure below 130)

  • If there is a hearing problem, treatment should be done, not to be exposed to excessive noise.

  • stay away from air pollution

  • Not smoking and not being a passive smoker

  • avoiding head trauma

  • not drinking too much alcohol

  • not gaining excess weight

  • Physical exercise such as brisk walking, sweating aerobic exercise and dancing twice a week

  • Eating a Mediterranean Diet (a diet rich in cereals, vegetables, fruits, cheese, milk, especially fish, olive oil)

  • If you have diabetes, its treatment

  • Being in a social relationship such as the richness of relatives and friends, going out for the purpose of cinema, restaurant, club, association activities.

How is AD Diagnosed?

  • Although established biochemical biomarkers are only CSF (cerebrospinal fluid) biomarkers for now, body fluids that are easier to access, especially blood and plasma, are being studied intensively in terms of candidate biomarkers.

  • Neuroimaging biomarkers Structural imaging with MRI (Magnetic Resonance Imaging) and metabolic imaging with PET (Positron emission tomography).

Which drugs are used in the treatment of AD?

Cholinesterase inhibitors and memantine added in the middle stage are drug treatments that slow down the disease.

Treatment for mood disorders such as depression, mania, and anxiety

Treatment of psychotic symptoms such as delusions and hallucinations

Treatment of agitation and aggression

Treatment of impulsivity and impulse control defects

Insomnia should be treated.

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