Understanding Grandpa (A case of Alzheimer's Disease)

Never ever fail to get a chance to talk to your grandparents or parents.  Never take them for granted, don't be too focused on your own life, money making or work.  Remember, you have them to thank for why you are here in the world.  I don't mean to be so dramatic but to tell you honestly, I made that mistake.  My grandpa has AD (Alzheimer's disease) while I was busy with my own life.  He used to pick me up when I was in high school.  We have loved his story about how he became number 1 in all his classes in his elementary days.  How can I tell him now that I love him?  How can I thank him for all the good things he has done for us?

Introduction and Etiology (Cause).  Unfortunately, the exact cause of AD is unknown.  It is the most common cause of dementia (memory loss, difficulty with thinking and speech and problem solving).  Dr. Alois Alzheimer, a German psychiatrist, first described this condition.  AD affects the brain, this disease evolves gradually from mild to severe brain cell destruction over time.  It is more common in 65 and above age group but can also appear in persons less than 65 years old (early-onset Alzheimer's).  

AD is common in persons 65 years old and above

We don't know the cause but certain factors are noted to increase the risk of developing the disease.  Age is the greatest risk factor.  The risk doubles every 5 years for persons above 65 years old.  Gender:  women are affected twice as compared to men (sigh of relief) for reasons that are unclear.  There are different opinions in literatures regarding Genetic inheritance.  Wikipedia says it's 70% genetic but some works describe that genetics play a minor role.  Although, for someone with a close relative (parent or sibling), the risk is increased compared to the general population.  However, AD is not inevitable, everyone can reduce the risk by living a healthy lifestyle.  More info below, promise.  Certain medical conditions such as diabetes, stroke, heart problems, hypertension (increased blood pressure), increased cholesterol and obesity in mid-life are all known to increase the risk of Alzheimer's.  Previous severe head injury is also noted to increase the risk.  

What happens in the brain in people with AD (pathophysiology)?  Proteins build up in the brain to form structures called 'plaques' and 'tangles', why, we don't know.  There are many theories though.  This leads to loss of connections between nerve cells and loss of brain tissue.  It is also noted that there is a shortage of some important chemicals which help transmit signals in the brain.  As the disease progress, gradual death of brain cells are observed.

Symptoms.  AD starts with mild symptoms and get worse over time.  In most people, the earliest symptoms are memory lapses.  They may have difficulty recalling recent events and learning new information.  Long term memory loss will manifest in the late stage of the disease.  Patients will have problems with thinking, reasoning, perception and communication.  They can also have mood changes like anxiety, irritability and depression.  They may even have hallucinations.  A typical behavioral change would be to repeat a question over and over again.  Eventually, problems with memory loss, communication, reasoning and orientation become severe and the patient will need to have full support and care.  The progression of the disease vary from person to person.  On average, AD patients will live 3-10 years after the appearance of the first symptoms.  AD is not actually the cause of death, pneumonia is commonly the culprit.  

Diagnosis.  Early identification of symptoms is the key.  No single laboratory test is available for AD.  The doctor will rule out first other conditions that have similar symptoms, such as infections, vitamin and thyroid deficiencies, depression and side effects of medication.  If AD is suspected, he/she is then referred to a specialist - Adult Psychiatrist, Neurologist or a Geriatrician.  A brain scan can be done to show the brain changes and rule out other pathology like tumor or stroke.  The scan will show that the hippocampus (part of the brain) has shrunk.  It is good to note that there is a criteria for the diagnosis of AD (let the doctor worry about that).

Treatment and Support.  With all the advance technology that we have, there is still no cure for AD.  However, there are numerous ways that can be done to enable someone to live well with the condition.  Drugs can temporarily alleviate some symptoms or slow the progression of the disease.  Donepezil, Rivastigmine and Galantamine are used for the early stages.  These can help with memory problems, improve concentration and motivation.  Memantine is used in advanced stage.  The three drugs used for the early stages prevent the destruction of acetylcholine, which is an enzyme needed for brain signal transmission.  Memantine, on the other hand, protects the brain cells from the destructive effects of glutamate.  

It is beneficial for a person with AD to keep up with activities that he/she enjoys.  Exercising the mind by reading or doing puzzles definitely help.  Over time, the patient will become agitated and/or aggressive, a sedative is likely to help him/her relax.  Anyone, caring for the person is likely to find the behaviour distressing.  Support for carers is very important too.

Lean meat, very minimal fats, with veggies

Prevention, as promised.  Staying physically fit and mentally active are the two important elements, not so difficult to do, right?  Evidence suggests that rates of dementia are lower in people who remain physically, mentally and socially active throughout their lives.  It is good to indulge in activities like reading, writing, learning a foreign language, playing musical instruments, playing sports, bowling and walking.  Long term use of NSAID's (pain relievers like paracetamol and ibuprofen) is associated with decreased risk of developing AD.  Do also remember that these drugs will also increase the incidence of gastritis and ulcers.  Japanese and Mediterranean diet are thought to lower the risk and diet with increased saturated fats and simple sugars can raise the risk.  So, let's go Jap food!

New Hope.  Researchers are still conducting trials of new drugs for AD.  One drug which prevents the formation of plaques in the brain was successfully tested in mice.  Human trials are next.  Amyloid therapy are also noted to slow the progression of the disease.

On a final note, especially to my siblings and cousins, give more attention and love to your/our parents and grandparents before it's too late.