Alzheimer

Alzheimer’s: short overview

• Causes: Dying of nerve cells in the brain by protein deposits
• Risk factors: Age, high blood pressure, elevated cholesterol, vascular calcification, genetic factors
• early symptoms: dwindling short-term memory, disorientation, word finding disorders, altered personality, weakened immune system
• Diagnosis: Combination of several tests, doctor consultation, dementia test, brain scan by CT or MRI, CSF diagnostics
• Treatment: no cure, symptomatic therapy with anti-dementia drugs, neuroleptics, antidepressants, non-drug therapy, such as cognitive training
• Prevent: healthy diet, regular exercise, demanding memory, many social contacts

Alzheimer’s: causes and risk factors

In the brain of Alzheimer’s patients, neurons and their connections gradually die off. As a result, the brain shrinks by up to 20 percent: The furrow furrows on the surface of the brain deepen, the brain chambers expand. The destruction of nerve cells begins in the so-called olfactory brain. He then accesses brain regions responsible for memory. At some point, it covers the entire brain surface.

The Meynert basal nucleus is particularly affected early on in cell death: The nerve cells of this deeper-lying brain structure produce the nerve messenger acetylcholine. The cell death in the Meynert basal core thus triggers a significant lack of acetylcholine. As a result, the processing of information is disturbed: those affected can barely remember events that occurred just a short while ago. Your short-term memory is dwindling.

Protein deposits kill nerve cells

In the affected brain regions are two different types of protein deposits that kill the nerve cells. Why these form is unclear.

Between the nerve cells and in some blood vessels, hard, indissoluble plaques form Beta-amyloid, These are fragments of a larger protein whose function is still unknown.

Normally, beta-amyloid is broken down. In Alzheimer’s patients, this cleanup process no longer works in the brain and the protein fragment is deposited there. This inhibits the energy and oxygen supply to the brain – nerve cells die.

In addition, abnormal tau fibrils are formed in Alzheimer’s patients in the nerve cells of the brain – insoluble, twisted fibers from the so-called Tau protein, They disrupt the stabilization and transport processes in the brain cells, causing them to die.

Alzheimer’s: risk factors

The main risk factor for Alzheimer’s is the age: only two percent of the under 65-year-olds get sick. At least one in five is affected by the age group 80-90, and more than one third by the over-90s.

Age alone does not cause Alzheimer’s. Rather, experts assume that even more risk factors must be added before it comes to disease outbreak.

Overall, the following factors may favor Alzheimer’s disease:

• Age
• genetic causes
• high blood pressure
• elevated cholesterol level
• increased homocysteine ​​level in the blood
• Vascular calcification (arteriosclerosis)
• badly adjusted blood sugar in diabetes
• oxidative stress caused by aggressive oxygen compounds that play a role in the formation of protein deposits in the brain

There are other factors that may increase the risk of Alzheimer’s disease but need further research. These include inflammation in the body that persists for a long time: they could damage brain cells and promote the formation of protein deposits, researchers believe.

Other potential Alzheimer risk factors include low overall education, head injuries, brain infection by viruses, and autoimmune antibodies in the elderly.

Aluminum & Alzheimer’s

Autopsies have shown that the brain of deceased Alzheimer’s patients has an increased aluminum concentration. But that does not necessarily mean that aluminum causes Alzheimer’s. Animal experiments on the other hand argue that if you give aluminum to mice, they still do not get Alzheimer’s disease.

Instead, increased aluminum levels may be a consequence of the disease rather than an Alzheimer’s cause. Whether this really is so, must be explored in further studies.

Is Alzheimer’s heritable?

Only about one percent all Alzheimer’s patients have the familial form of the disease: Alzheimer’s disease is triggered by various gene defects, which are passed on to others. Affected by the mutation are the amyloid precursor protein gene and the presenilin-1 and presenilin-2 genes. Anyone who carries these mutations, in any case of Alzheimer’s disease, and already between the 30th and 60th year of life.

However, the vast majority of Alzheimer’s patients show the sporadic form of the disease, which generally does not break out until after the age of 65. Although the sporadic Alzheimer’s form also seems to have a genetic component, this involves changes in the gene for the protein Apo-lipoprotein E, which is responsible for the transport of cholesterol in the blood. Changes in this gene do not lead to the safe onset of the disease, but only increase the risk for it.

In general, the older a person is when Alzheimer outbreaks, the lower the risk for relatives to contract.

Alzheimer’s: symptoms

In the course of Alzheimer’s disease, symptoms increase and new symptoms develop. Therefore, below you will find the symptoms sorted by the three stages in which the course of the disease is divided: early stage, middle stage and late stage:

Alzheimer’s symptoms in the early stages

First are Alzheimer’s symptoms minor memory lapsesConcerning short-term memory, for example, patients can not find recently stored items or remember the content of a conversation. You can also lose the thread in the middle of a conversation. This increasing forgetfulness and distraction can confuse and frighten those affected. Some also respond with aggressiveness, defense, depression or withdrawal.

Also on Finding words You can sometimes recognize Alzheimer’s, but there may be other causes for it. In the case of a word-finding disorder, the person concerned sometimes no longer knows well-known terms.

More early Alzheimer’s signs can slight orientation problems, Drive weakness as well as slowed thinking and speaking.

Everyday life can usually be managed without any problems in mild Alzheimer’s dementia. Only in more complicated matters, the victims often need help, for example, when keeping their bank account or when using public transport.

Alzheimer’s symptoms in the middle stage of the disease

Alzheimer’s symptoms are in middle stages of disease aggravated memory disorders: In recent events, patients are less and less able to remember, and even the long-term memories (such as your own wedding) are fading gradually. Familiar faces are becoming worse recognized.

Also the Difficulties to orient oneself temporally and spatially, reinforce each other. The patients, for example, look for their long-dead parents or find their usual supermarket no longer home.

In addition, the patients need now also at simple activities like cooking, combing or bathing more and more Help, An independent life is then hardly possible.

Also the communication with the patients becomes increasingly difficult: the affected people often can not form complete sentences. They need clear requests, which often have to be repeated before they sit down at the dining table, for example.

Other possible symptoms of Alzheimer’s disease in middle disease stages are increasing urge to move and strong unrest, The patients, for example, run restlessly or constantly ask the same question. Delusional fears or beliefs (such as being robbed) can occur.

Alzheimer’s symptoms in the late stages

In the late stage of the disease are the patients completely dependent on care, Many need a wheelchair or are bedridden. They no longer recognize family members and other close people. The speech is now limited to a few words. Finally, patients can no longer control the bladder and bowel (urinary and fecal incontinence).

Increasing problems with chewing, swallowing, breathing, and limb stiffening are typical late-stage Alzheimer’s symptoms. Due to the weakened immune system, it often leads to infections (such as pneumonia), which then often lead to death.

Alzheimer’s disease is atypical in about one-third of patients who become ill at a young age (a small group overall):

• Some patients develop behavioral changes towards antisocial and conspicuous behavior similar to those in frontotemporal dementia.

• In a second group of patients word finding disorders and slower speech are the main symptoms.

• In a third form of the disease, vision problems occur.

Alzheimer’s: examinations and diagnosis

If you find yourself or a loved one increasingly forgetful, you should consult a family doctor. If necessary, this will be referred to a neurologist, psychiatrist or a memory ambulance. The latter is a department of a hospital specializing in brain disorders. There is a series of investigations. So far, there is no single examination and no specific laboratory test, with an Alzheimer’s diagnosis could be clearly put.

Survey of the medical history (medical history)

If Alzheimer’s is suspected, the doctor will first talk in detail with the patient. He asks him about his complaints and possible previous illnesses. In addition, the doctor will ask about any medications the patient is taking. Because some preparations can affect the brain performance. In the conversation, the doctor also pays attention to how well the patient can concentrate.

Ideally, a close person accompanies the patient to this doctor’s talk. Because in the course of Alzheimer’s disease, the nature of the affected person can change. This can result in periods of aggressiveness, suspicion, depression, fears and hallucinations. Such changes are sometimes faster for people than for those affected.

Physical examination

After the interview, the doctor will routinely examine the patient. For example, it measures the blood pressure and checks the muscle reflexes and the pupil reflex.

dementia tests

With a dementia test can be determined by simple exercises, if there is a dementia. For example, patients should remember and repeat as much as possible from a list of ten terms. Important dementia tests are the watch test, MMST and the DemTect. However, at an early stage, dementia can not be recognized well and one can not make any statement as to whether Alzheimer’s or another dementia condition exists.

In addition to such short tests, more extensive neuropsychological examinations are often carried out.

Apparative investigations

When there are clear signs of dementia, the patient’s brain is usually Computed tomography (CT) or magnetic Resonance Imaging (MRI) examined. So it can be found out if the brain substance has decreased. This would confirm the suspicion of dementia.

Imaging examinations of the skull also serve to identify other conditions that may be responsible for the dementia symptoms, such as a brain tumor.

laboratory tests

Also based on Blood and urine samples The patient can find out whether a disease other than Alzheimer’s causes dementia. This can be, for example, a thyroid disorder or a shortage of certain vitamins.

Relatively reliable results are provided by the CSF: A sample of the cerebrospinal fluid (CSF) is taken from the lumbar spine and examined in the laboratory. If the levels of certain proteins (amyloid protein and tau protein) in the CSF are characteristically altered, Alzheimer’s disease is very likely to be present.

If the doctor suspects that the patient is suffering from the rare hereditary form of Alzheimer’s disease, a genetic test can provide certainty.

Alzheimer’s: treatment

There is only one symptomatic treatment for Alzheimer’s – healing is not yet possible. However, the right therapy can help patients to cope with their everyday lives for as long as possible. In addition, Alzheimer’s medicines and non-drug therapies relieve patients’ discomfort and improve quality of life.

anti-dementia drugs

In drug-based Alzheimer’s therapy different groups of active ingredients are used:

So-called Cholinesterase (like donepezil or rivastigmine) block an enzyme in the brain that breaks down the nerve messenger acetylcholine. This messenger substance is important for communication between the nerve cells, for concentration and orientation. In Alzheimer’s patients, insufficient acetylcholine is produced.

This deficiency can be compensated for some time in the early to middle stages of the disease with cholinesterase inhibitors: everyday activities are thus easier for those affected. In addition, cognitive skills such as thinking, learning, remembering, and perceiving are retained longer.

In moderate to severe Alzheimer’s dementia is often the active ingredient memantine given. Like cholinesterase inhibitors, it may delay the reduction of mental capacity in some patients. More specifically, memantine prevents excess of the neurotransmitter glutamate from damaging brain cells. Experts suspect that in Alzheimer’s patients, a glutamate excess contributes to the death of nerve cells.

Extracts from the leaves of ginkgoTrees are designed to improve the circulation in the brain and protect the nerve cells. Patients with mild to moderate Alzheimer’s dementia may be better able to cope with everyday activities. In high doses, Ginkgo also seems to improve memory and alleviate mental discomfort, as some studies show.

Other drugs in Alzheimer’s

Alzheimer’s disease is often associated with mental health problems and behavioral changes, such as aggressiveness, passivity, restlessness or anxiety. If non-drug treatments do not help, the doctor may call so-called neuroleptics (like risperidone or haloperidol).

However, these agents can cause serious side effects, increase the risk of stroke and increase mortality. Their application is therefore closely monitored. In addition, neuroleptics should be dosed as low as possible and not taken long-term.

Many Alzheimer’s patients also suffer from depression. On the other hand, antidepressants such as citalopram, paroxetine or sertraline help.

In addition, existing basal and concomitant diseases such as elevated blood lipid levels, diabetes or high blood pressure must also be treated with medication.

Non-drug treatment

Non-drug therapies are very important in Alzheimer’s. They can help to delay the loss of mental abilities and to maintain independence in everyday life as long as possible.

For example, one helps Reality orientation training the patient to find his way in space and time. The spatial orientation is supported, for example, by colored markings of various living spaces such as the bathroom and kitchen. Timing can be improved by using clocks, calendars and pictures of the current season.

Especially in mild to moderate Alzheimer’s dementia can be cognitive training It can be useful: It can train the ability to learn and the ability to think. These include, for example, simple puns, the guessing of concepts or the addition of rhymes or well-known proverbs.

As part of a behavior therapy helps a psychologist or psychotherapist, the patient to deal better with mental complaints such as anger, aggression, anxiety and depression.

To keep the memories of earlier stages of life, the autobiographical work: Relatives or caregivers ask Alzheimer’s patients specifically about their past lives. It can help photos, books or personal items to evoke memories.

through occupational Therapy let everyday skills be maintained and promoted. For example, Alzheimer’s patients practice dressing, combing, cooking, and hanging up laundry.

Other non-drug-related procedures that are used in Alzheimer’s disease include art and music therapy, physiotherapy, aromatherapy and “Snoezelen” (stimulation of the senses such as touch, smell, taste, etc.).

Prevent Alzheimer’s

Like many diseases, the likelihood of getting Alzheimer’s can be reduced by a healthy lifestyle. There are several factors that favor Alzheimer’s and other dementias. These include, for example, elevated cholesterol, obesity, hypertension and smoking. Such risk factors should therefore be avoided or treated as far as possible.

Besides, one seems Mediterranean diet to prevent Alzheimer’s and other forms of dementia with a lot of fruit, vegetables, fish, olive oil and wholegrain bread.

Also regular exercise and sports can reduce the risk of disease: The reason is that physical activity stimulates, among other things, the metabolism and circulation in the brain. This allows nerve cells to network better and denser, which promotes their communication.

The risk of Alzheimer’s and other forms of dementia also decreases if one spends his life in work and play mentally active is. For example, cultural activities, puzzles and creative hobbies can stimulate the brain and preserve memory.

As studies prove, can also a lively social life Dementia diseases like Alzheimer’s Prevent: The more people are involved and engaged in communities, the greater the likelihood of being mentally fit even in old age.

Alzheimer’s disease: history and prognosis

Alzheimer’s disease causes death on average after eight to ten years. Sometimes the disease is also much faster, sometimes slower – the time span ranges from three to twenty years. In general, the later the disease occurs, the shorter the Alzheimer’s disease.

Additional information

guidelines:

• S3 guideline “Dementia” of the German Society of Neurology (as of 2016)

Support Groups:

• German Alzheimer Society e.V., self-help dementia

• Internet portal “Wegweiser Dementia” by the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth