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Alzheimer's disease (AD) can also be called as Alzheimer disease, Senile Dementia of the Alzheimer Type (SDAT) or shortly as Alzheimer's. This disease is a very common form of dementia. Dementia is characterized by loss of or reduction in memory and other cognitive abilities. It is caused by various diseases and status that result in damaged brain cells.
When a person is affected with Alzheimer disease, synapses of neurons will begin to fail to transfer information. This will continue with more declination of synapses and deterioration of cells. Brains with advanced Alzheimer's show rapid shrinkage from loss of cells and distributed debris from dead and dying neurons.
The picture from http://www.chm.bris.ac.uk/webprojects2002/wrigglesworth/brainimaging.htm show a comparison of image using PET scans between mild Alzheimer's and normal brain. a patient that face greater amount of language dysfunction than problems with spatial sight display a significant reduction in metabolism in left frontal, temporal and parietal lobes. If there is greater visual impairment, the image will have a diminished glucose metabolism in the right parietal lobe.
Alzheimer's disease is categorized as a primary cerebral disease of unknown etiology characteristic of neuropathological and neurochemical features. During the onset, it is commonly insidious and slowly developing steadily over 2 to 3 years but can at times be considerably longer. The onset is recorded to be in the middle of adult life or earlier (Alzheimer's disease presenile onset), but the incidence is much higher in later age (Alzheimer's disease of senile onset). Presenile onset patients are mostly with onset before the age 65-70. There are much higher chances of early onset in people with a family history of a similar dementia, characteristics of temporal and parietal lobe damage such as dysphasia or dyspraxia. On the other hand, another onset course is much slower and to be characterized by more general disability of higher cortical functions.
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The picture from http://www.health.com/health/static/hw/media/medical/hw/n5551132.jpg shows part of the brain that has been shaded according to its function. This is the part that is affected by the Alzheimer disease.
From http://www.ukessays.com/essays/health/dementia.php, the abilities that are affected by Alzheimer's are:
1) Ability to form coherent speech or understandably speech or
2) Ability to identify or recognize objects, assuming intact
3) Ability to perform motor activities, assuming intact motor
abilities, sensory function and comprehension of the required
4) Ability to think abstractly, make sound judgments and
plan and fulfill complex job
â€¢ The decline in cognitive abilities must be severe enough to
interfere with daily life.
http://www.azpsychiatry.info/icd/cognitive/alzheimersdementia.htm explain that characteristic changes in the brain when a person is said to be Alzheimer's patient: a marked decrease in the number of neurons, especially in the hippocampus, substantia innominata, locus ceruleus, and temporoparietal and frontal cortex; appearance of neurofibtilly tangles made of paired helical filaments; neuritic (argentophil) plagues, which consists of largely of amyloid and show an obvious progression in their development; and granulovacuolar bodies. Neurochemical changes can also be seen besides a marked reduction in the enzyme choline acetyl-transferase, in acetylcholine and other neurotransmitters and neuromodulators inside our brain.
Alzheimer Disease is still incurable till now.
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MMSE: Mini Mental State Examination
Graph of progression of the symptom of Alzheimer's disease from http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=inserm2&part=alzheimer
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Data of current and projected number of people with Alzheimer's or another dementia worldwide from http://seniorjournal.com/images/Symbols/Mental/DementiaProj22050.gif of 2009 World Alzheimer Report.
Alzheimer's Association has made a draft of some of the drugs which are used and has been the outline for Medicare National plans do cover for the drugs. At present, there are only 2 types of medications which have the approval by the U.S Food and Drug Administration (FDA) for treatment of cognitive symptoms of Alzheimer's disease.
Based on http://www.alz.org/alzheimers_disease_treatments.asp, medical professionals have divided the treatment into 2 categories which basically based on the symptoms of the Alzheimer's patients which is cognitive symptoms and behavioral and psychiatric symptoms.
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Treatment for cognitive symptoms
At serotonin (5-hydroxytryptamine, 5-HT) receptors, memantine acts as non-competitive antagonist which will produce stronger effect than what occurring at NMDA receptor. So generally, this drug will regularize the glutamate reaction (another chemical messenger important for learning and remembering) in the patient's body. The chemical messenger, glutamate will not be in excess in case of cells damaged by Alzheimer's disease. Attachment of glutamate to cell surface "dock sites" called NMDA (N-methyl-D-aspartate) receptors will allow calcium to flow freely into the cell. After some time, this will lead to critical overexposure to calcium and causes number of cell being damaged even faster. Different with the presence of memantine, the destructive chain of events will be prevented by partially blocking the NMDA receptors.
At different neuronal nicotinic acetylcholine receptor (nAChRs), memantine will act as a non-competitive antagonist which at potencies almost similar to the NMDA and 5-HT3 receptor. However, this is still in doubt as it is very difficult to ascertain with accuracy because of the rapid desensitization of nAChR in number of experiments. As most patients of Alzheimer's suffered neurological degeneration, this has been always related to the glutamate receptors which eventually over activated that turnout to be dreadful.
Drugs that commonly been prescribed based on Alzheimer's Association are donepezil (Aricept), rivastigmine (Exelon) and Galantamine (Razadyne). The main function of these drugs being prescribed are to make sure acetylcholine level at highest as possible and delay the worsening of brain function as long as possible.
One of the drugs, rivastigmine for instance, is used to inhibit both butyrylcholinesterase and acetylcholinesterase. By inhibiting both of these enzymes, there will be less acetylcholine that is degraded thus keeping the acetylcholine level at safe. It is important to keep the level high enough as they play an important role in connecting the peripheral nerve system (PNS) with central nerve system (CNS). By doing this, Alzheimer's sufferer communications among nerve cells are supported and some clinical trials even show dramatical results.
This drug however has some side effects such as nausea, vomiting, diarrhea, anorexia and weight loss. Rivastigmine is seen to have stronger side effects than the other because of its strong potency of its dual inhibitory mechanism. However the effects have been decreased after the introducing of rivastigmine patch that has more stable and consistent active ingredients than the oral method.
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Galantamine (Razadyne, Nivalin, Reminyl) is a type of chemical used to treat mild to moderate Alzheimer's disease and in the meantime with numerous memory damages. It is believed that this drug which actually a type of carbamate (ester from carbamic acid, NpCOOH) will decreases the rapid memory damage because of presence of cholinesterase enzyme that capable of breaking down acetylcholine. By inhibiting the enzyme, the level and the action of neurotransmitter acetylcholine can be increased or at least at constant and without further decrement. In the other word, this drug works by increases cholinergic function by increasing the concentration of acetylcholine in the brain.
Pictures above from http://www.neurosciencemarketing.com/blog/wp-content/photos/ritalin.jpg show some tablets of donepezil.
Donepezil (commonly misspelled as donezepil is also called as E2020) is mainly function as reversible acetylcholinesterase inhibitor. This drug is majorly to treat some cognitive symptoms in Alzheimer's patients such as sleep apnea, autism, and others. The drug works by increases the level of acetylcholine which is a type of brain chemical. For the record, donepezil is the only drug that is approved to be prescribed for advanced Alzheimer's disease patients.
The effects that have been detected usually are vomiting, nausea, loss of appetite, increasing bowel movement frequency.
Treatment for behavioral and psychiatric symptoms
A.Medications that are currently being used are;-
Antidepressant medicines for low mood and irritability:
Anxiolytics is used for anxiousness, restlessness, verbally tumultuous resistance and demeanour:
Antipsychotic drugs specifically for delusions, aggressiveness, agitation, hallucinations, hostility and uncooperativeness. Example of drugs from http://www.alz.org/alzheimers_disease_standard_prescriptions.asp:
There are some tips and indicators from the governments and guidance to use the medicine on the individuals with alzheimer's:
The patient's behavioral symptoms are due to mania or psychosis
The residential is experiencing relentless suffering or disconsolate, a significant reduction in function or substantial difficulty receiving needed care
The symptoms that present is a danger to the people around and residents
A person with dementia should not be sedated or restrained by antipsychotic medications. The minimum dosage should be usedÂ for least period of time possible. Countrary side effects must be monitored carefully.
Eventhough this drugs are frequently used medications for agitation, physicians would also prescribe a mood stabilizer or seizure medication, such as:
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Treatment for sleeping changes in a person with Alzheimer's
The main objective of this treatment is to improve the sleep routine and environment besides reducing the patients' daytime napping. This treatment is more preferable than through medications because it does not have side effects like each of medicine does. The treatment is done by creating conducive sleeping environment and encourage the Alzheimer's patient to rest at correct time such as:
Alcohol, nicotine, and caffeine is prohibited
Time regulation is maintain for meals and for going to bed and getting up
Any pain must be treated
Medication before bedtime is disallow for patient who are taking cholinesterase inhibitor
Setting comfortable temperature room
Watching television during wakefulness must be discourage
Nightlight and safety objects are provided
Regular exercise is encouraged, but not later than 4 hours before bedtime
Encourage morning light exposure
If the person awake, the patient is discouraged to stay on bed. Only used bed for sleep
There are some cases non-drug treatment fail to restore the sleep changes or some of them are followed by disruptive nighttime behaviors. Experts recommend the patient to have a treatment with "begin low and go slow." The risk treatment for older patient who is cognitively impaired must be put in consideration. This is including risk of falls and fractures, confusion and reduction in the ability to care for oneself.
When the medication is conducted, it must be discontinue when the sleep pattern has restored and stable to normal. An extreme caution must be put on when a decision to used antipsychotic drug is being considered. Such drugs even have been put with a labeled of 'black box' warning about their risk and that they do not have the approval from FDA to treat dementia symptoms.
From http://www.alz.org.sa/en_content/alzheimer_disease/treatment.htm, the drugs that are still being used:
Older "classical" antipsychotics such as haloperidol
Tricyclic antidepressants, such as nortriptyline and trazodone
"Sleeping pills" such as zolpidem, zaleplon and chloral hydrate
Benzodiazepines, such as lorazepam, oxazepam and temazepam
"Atypical" antipsychotics such as risperidone, onlanzapine and quetiapine
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There is still no absolute permanent treatment for Alzheimer disease. Even though there are some well developed medicines that are prescribed and approved by the authorities such as United States Food and Drugs Administration (FDA) and World Health Organization (WHO), there are still some researchers that showing some other alternatives solutions which literally help to treat Alzheimer's disease.
Picture A Picture B
Picture A from http://www.healthmonthly.co.uk/images/big/neurozan.jpg and picture B from http://farm4.static.flickr.com/3023/3549309514_2e79b4095f_o.jpg shows the packet of neurozan.
This latest invention has grabbed all the eyes of medical professionals from entire world. This new medicine contained numbers of nutrients which mainly to increase brain function and memory to optimum level as it is specially made for Alzheimer's patients. This drug have phospholipids phosphatidylserine, phosphatidylcholine and lecithin, co-enzyme Q10 (CoQ10), docosahexaenoic acid (DHA), B vitamins, antioxidants, minerals and amino acids.Â Â
Docosahexaenoic acid (DHA) is an omega 3 fatty acid which capable of helping to increase the speed and efficiency transmission of impulse along neurons. The benefits achieve when the powerful omega 3 from neurozan concentrated into myelin sheath which is an insulating layer that forms around nerve cells.
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B vitamins that are mainly concerned in treating Alzheimer's patients are B2, B6, B12, and folic acid. Because of this founding, B vitamins are added in neurozan. This founding also said that B vitamins are vital to work together with homocysteine that at normal level. Homocysteine is an amino acid that is a non-essential protein which means naturally made in human body. Normally, homocysteine will be converted into two main brain nutrients which are full of benefits. The nutrients are glutathione and S-adenosylmethionine (SAMe). However, the conversion can only be done in adequate amount of B vitamins. If it is not enough, the enzyme to convert homocysteine to these brain nutrients will not work properly. As a consequence, homocysteine will increase in excess and increases probabilities of peripheral vascular disease (peripheral arteries), coronary heart disease and stroke. So, adequate amount of B vitamins in daily diet is important to ensure our brain can function at optimum.
Vitamin E has a natural antioxidant that is said to have a protective role which might help prevent any damage to the brain by free radicals. Normally cell will functioning and produces a byproduct called a free radical. This substance will ruin any genetic material and cell structures, neuron to be specific. The damage it made is called oxidative stress and it is believed that this is why Alzheimer's disease develops well in a patient. However this vitamin E do not have a solid proof to prevent or slower the progress of Alzheimer's disease yet but there are some positive results that suggest high dose of vitamin E may result in some mild functional improvement but not cognitive improvement.
This plant is well-known for its great memory and concentration enhancer effects. Its extract contains compounds that able to positively affect the cells brain and body cells. This extract is understood to have antioxidant and anti-inflammatory properties which enable the extract to prevent reduction of cell membranes and act as neurotransmitter function regulator. This has been the reason why in Europe, people using the extract to alleviate cognitive symptoms which connected to the number of neurological conditions.
However, this plant has a side effect, it will cause increase blood flow especially at brain area. Any accident that can cause bleeding can be risky which has probabilities of death. Some investigation on the efficiency of this plant's extracts to cure Alzheimer disease is still cannot be proven.
Picture A Picture B
Pictures A from http://www.bombayharbor.com/productImage/0878733001249971564/Ginkgo_Biloba_Extract.jpg shows the ginkgo biloba plant and picture B from http://content.costco.com/Images/Content/Product/647768.jpg shows a processed and manufactured ginkgo biloba extracts.
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