Alzheimer's 101: Understanding early symptoms, precautions and diagnosis

Dementia is a broad category of diseases involving the brain that leads to forgetfulness and reduction in the ability to think and reason. Globally, about 46 million people suffer from dementia. Out of them, Alzheimer’s disease (AD) constitutes about 50 to 70 per cent of all the cases.

AD is named after German psychiatrist Alois Alzheimer, who noticed changes in the brain tissue of a woman who died of unusual symptoms of forgetfulness and behavioural abnormalities. This is a neurodegenerative disease and is progressive after its onset.

It usually affects elderly individuals after the age of 65 years with a majority of individuals over 85 years old. It is characterised by progressive memory loss that severely affects their activities of daily living.

Early symptoms include

• Memory impairment, more so for recent events
• Repeatedly misplacing phone, money, important things, etc
• Confusion with the names of relatives
• Frequently getting lost in familiar surroundings
• Difficulty in calculations
• Difficulty in finding the right words
• Not able to manage finances
• Fragmented sleep and insomnia
• Changes in olfactory functions
• Impairment in judgment 
• Repeating things

The early signs may persist for many years before the patient comes for a consultation. This is an insidiously progressive disease but the rate of progression varies from person to person. The symptoms that appear in later stages include

• Behavioural abnormalities, including aggression, agitation, irritability and confusion 
• Requiring considerable assistance in daily chores, like dressing and eating
• Withdrawing oneself from social activities
• Unable to control bowel and bladder movement
• Unable to communicate
• Seizures

Diagnosis

Presently, there is no definite investigation modality available for diagnosing Alzheimer’s, but with accurate and complete medical history, it can be diagnosed by a neurologist with up to 90 per cent accuracy. The progression of the disease can be quantified by various dementia scales available like Mini-Mental State Examination, Montreal Cognitive Assessment and Clinical Dementia rating scale. 

Brain imaging, preferably MRI, is required for evaluation of Alzheimer’s and also for ruling out other structural causes of dementia. In AD, there is significant cortical atrophy of medial temporal lobe, which is its characteristic finding. The functional neuroimaging methods like FDG-PET, SPECT may be helpful in delineating the disease.

While no cure or disease-modifying drugs are currently available, symptomatic treatment is given to the patients. Maintaining a healthy lifestyle, which includes an increase in physical activity and being on a balanced diet may delay the progression of the disease. Steps are also taken to modify vascular risk factors in patients and control hypertension and diabetes. They are also given cognitive training.

Rima Khanna, Consultant, Department of Neurology, Fortis Hospital Shalimar Bagh.