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Alzheimer’s disease

Malaltia d'Alzheimer a Vall d'Hebron

Alzheimer’s is a degenerative brain disease that causes the progressive loss of memory and other mental functions. This limits daily activities and also often results in behavioural disorders. It is the most common form of dementia and is generally linked to age, although there are cases of it appearing early. 

Description

Symptoms

  • Cognitive symptoms: the first symptoms are often a loss of recent memory and being forgetful. Later on, other mental functions such as orientation, language, recognition of people, places and objects, loss of skills, etc. can occur. In some cases the first symptoms may be speech problems, disorientation and recognition disorders or behavioural disorders.
  • Effect on daily activities: at the start of the illness the patient may function well with reminders and aids for lapses in memory, but the disease progressively affects more complex activities (complex tasks, finances, etc.), routine activities (domestic tasks, using the phone, shopping) and finally basic tasks (dressing, washing, going to the toilet, etc.)
  • Psychological and behavioural  disorders: in the initial stages there may be emotional disorders (anxiety, depression) and personality changes. As the disease progresses other behavioural disorders may appear such as agitation, aggression, hallucinations, delirium, motor skills disorders.

 

Who is affected by Alzheimer’s disease?

  • Alzheimer’s is linked to ageing, and the risk increases exponentially with age: between 65 and 70 years old the risk is 5%, and goes up to 40% between 85 and 90 years old.  
  • There is an inherited form of Alzheimer’s that makes up 2% of all cases and that almost always starts before 65 years of age.

 

Diagnosis

Doctors will base diagnosis on a reliable medical history recorded by the patient and a reliable informant. This is generally a close family member who lives with the patient and sees them frequently.  The presence and severity of cognitive deficiencies are confirmed with an assessment scale for mental functions. A blood test and brain imaging test (CT or MRI scan) is performed to rule out other causes of dementia. This test can lead to clinical diagnosis in most cases with clear and typical symptoms. Although assessment is usually carried out in a primary care facility, the patient will visit the Neurology or Geriatrics Department to confirm diagnosis and assess the suitability of specific treatment.

Where diagnosis is in question (those with mild symptoms, atypical initial signs or progression, symptoms before 70 years old,  where another degenerative disease is suspected, or coexistence with other diseases that may alter the mental state - i.e. psychiatric illness, etc.) patients are referred to the Neurology Department Dementia Unit, where on a case by case basis they will complete basic tests together with a full neuropsychological examination, special tests, lumbar puncture or other neuroimaging tests (MRI scan, glucose or amyloid PET scan).  

 

Typical treatment

  • Unfortunately there is currently no treatment to cure Alzheimer’s or to stop it progressing.
  • A healthy lifestyle (Mediterranean diet, physical exercise, avoiding toxic habits), prevention of cardiovascular disease, keeping intellectually active and maintaining good social relationships can delay the onset of age-related Alzheimer’s.
  • Once the disease is diagnosed, medication is available (acetylcholinesterase inhibitors and mematine) to slow its progression.
  • In the mild and moderate stages of the disease, cognitive stimulation can be useful to maintain the abilities that are in decline for as long as possible.  
  • Psychological and behavioural disorders are treated with non-pharmacological methods (psychosocial therapies) or with medication aimed at improving the predominant psychological and behavioural symptoms (antidepressants, anxiolytics or other tranquillizers).
  • Finally, the Neurology Department Dementia Unit takes part in clinical trials of new medicines which patients may volunteer to take part in if they meet the inclusion criteria.

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