A guide to understanding Alzheimer’s Disease-Part II

The second part of Dr Chawla’s series on Alzheimer’s deals with diagnosis and treatment. You can read the first part here.

DIAGNOSIS AND TREATMENT

The diagnosis of Alzheimer’s is made by clinical suspicion based on the patient’s symptoms. It is supported by the Mini mental status assessment by the Mini Cog test which includes three item recall and the clock drawing test. The test shows the presence or absence of dementia.

A suggestive Mini Cog test in the absence of other systemic illness or brain disease which itself could cause these deficits, for example nutritional deficiencies, inflammatory or other brain disorders and also absence of disturbances of consciousness suggests Alzheimer’s disease. A Brain CT scan and other investigations may be required to rule out other causes. The CT or MRI scan may show decrease in the size of the brain or brain atrophy.

Prognosis & treatment

Alzheimer’s disease is a progressive disease which starts in old age, usually after 65 years. The condition gradually worsens and death usually occurs 6-12 years after the onset. Rare patients may survive for twenty or more years of the disease. It is important to understand that at this time there is no treatment which can arrest or cure the disease process. The aim of investigations is to rule out any treatable causes of dementia like vitamin and nutritional deficiencies, infective or vascular disorders and treat them.

There are no drugs which can stop the neuro-degenerative process. There are some groups of drugs which can be tried in early stages to slow the progression of cognitive decline related to thinking and memory loss but none is proven to be highly effective. Basic management often depends on social and support services and involvement of the family members in supporting their elderly as they become more and more dependent on others for their day-to-day activities. Symptomatic relief can be provided by tranquilisers and sedatives to help sleep and calm the patient. If there are delusions and hallucinations then anti psychotic drugs may have to be used.

The drugs which have been used to halt the progression of Alzheimer’s disease are:

a) Cholinergic drugs: Acetyl- choline is a neuro- transmitter which is considered deficient in the patients of Alzheimer’s. To enhance its activity in the brain, drugs like Donepezil (Aricept), Rivastigmaine(Exelon), Tacrine(Cognex) and Galantamine have been used. Another drug Memantine which is approved for use in moderate to severe disease, affects another neuro- transmitter glutamine in the brain. Drugs like anti-oxidants, vitamins A, C and E, anti-inflammatory agents and hormones are shown to be of no value. General management includes nutrition, hydration, skin care, mobility and care and safety of the patient.

There is no way known to prevent Alzheimer’s disease. The progression may be slowed by some of the drugs mentioned above. General measures which are recommended for all ageing individuals like keeping physically and mentally active, regular walk and exercise, learning new things, remaining socially active and involved, taking vitamins and avoiding nutritional deficiencies and active spiritual leanings are some measures which may help.