Alzheimer's Disease

The treatment of Alzheimer's disease includes environmental structuring and drug therapy. Environmental structuring involves providing a safe, nonstimulating milieu that provides consistency and comfort for the patient. Drug therapy is aimed at improving memory rather than curing the disease. Several cholinergic drugs, such as donepezil hydrochloride and physostigmine salicylate, are anticholinesterase inhibitors that prevent the breakdown of acetylcholine to enhance cognitive function. Antidepressants and psychotropic medications should be reserved for patients who have secondary diagnoses such as depression and hallucinations.

Characteristic pathophysiological changes in the brain are neurotic plaques, neurofibrillary tangles, and marked cerebral atrophy. In addition to structural changes, abnormalities in the cranial neurotransmitters may also occur. Acetylcholine, for example, may be reduced by as much as 75% , contributing to cognitive impairment.

The diagnosis is usually made by ruling out other causes of cognitive dysfunction, although a variety of laboratory tests also are employed in some settings.

The disease begins with a mild memory loss (Stage I), which then progresses to deterioration of intellectual functions, personality changes, and speech and language problems (Stage I). In the terminal stage (Stage III), patients depend on others for activities of daily living. Seizures, hallucinations, delusions, paranoia, or depression can occur in either Stage III or III.

There are probably multiple interacting causes, including some genetic risk factors. These include the presence of the apolipoprotein epsilon 4 allele in late-onset disease and presenilin genes in early onset AD. People with Down Syndrome are at increased risk for the disease. Environmental agents, especially viruses and aluminium toxicity, previous head trauma, and immunological factors are possible etiologies.

Alzheimer's disease is a  chronic, progressive, degenerative cognitive disorder that accounts for more than 60% of all dementias. The most common form occurs in people above 65 (senile dementia of the Alzheimer’s type) but the presenile form can begin between the ages of 40 and 60. The illness causes significant functional disability.