Alzheimer's disease

Alzheimer's disease is a progressive mental disorder that brings about changes in the brain slowly leading to dementia. Named after the German physician Alois Alzheimer, Alzheimer's disease has 2 characteristic neuronal changes : Loss of cholinergic cells in the basal forebrain and the development of neuritic plaques in the cerebral cortex. Neurofibrillary tangles can also occur due to Neuritic plaques.

Here the brain cells degenerate and die thus causing a decline in the mental functioning and memory of a person. Alzheimer's disease (AD) or Presenile dementia as it was earlier known as, is one of the primary causes of dementia. The levels of the brain neurotransmitters serotonin, norepinephrine and acetylcholine are found to be low in AD. This kind of brain disorder causes loss of social and intellectual skills of a person. In severe cases it interferes with the day-to-day activities of a person.

Alzheimer's disease causes

• Most scientists believe that Alzheimer's disease is caused due to increase in production and accumulation of a protein called beta-amyloid protein. The accumulation of this protein leads to nerve cell death.
  
• Environment factors that causes a change in the brain's functioning can also lead to Alzheimer's disease
  
• Genetic causes
  
• Abnormal levels of elements like aluminum and lead
  
• Chronic cerebrovascular condition resulting from high blood pressure can lead to cerebral microbleeds. These microbleeds over a long period can result in mild cognitive impairment.
  
• Head injury
  
• Some viruses
  
• Lifestyle changes that causes change in the brain's functioning can also lead to Alzheimer's disease
  
  

There are 4 major cognitive deficits arising out of AD :

1. Amnesia : Memory loss is probably the most common symptoms of Alzheimer' disease.
2. Aphasia : Loss of Language - Failure to recollect names of objects
3. Apraxia : Inability to perform voluntary movements
4. Agnosia : Inability to recognize people and places

• Forgetfulness, unusual difficulty in remembering things
  
• Mild confusion
  
• Occasional memory lapse
  
• Disorientation day, date, etc.
  
• Problem with speaking and writing
  
• Problem in thinking and reasoning
  
• Decision making problems
  
• Depression, anxiety, mood swing and many such behavioral problems
  
• Problems with cognitive skills like calculating, judgment, etc
  
  

Alzheimer's disease diagnosis

1. A physical examination and a neurological examination to check:

• Muscle tone and strength
  
• Sense of touch and sight
  
• Reflexes
  
• Balance
  
• Coordination, etc.
  

2. Brain imaging (CT scans, MRI) to check for tumors, etc.
3. Lab tests for thyroid etc so as to rule out other possibilities for memory loss

Treating Alzheimer's disease

As this disease is of degenerative nature, there is no permanent cure. Early diagnosis and changes in lifestyle can slow down its progression or improve the quality of life for the afflicted.

• Drugs to deal with cognitive changes and memory symptoms
  
• Drugs to increase acetylcholine or butylcholine levels. eg; Donepezil hydrochloride or rivastigmine, a cholinergic agonist or Cholinesterase inhibitor.
  
• Vitamin E combined with Cholinesterase inhibitors
  
• Alternate medicines like Ginkgo Biloba, Brahmi, Gotu kola, Ginseng and St. John's Wort
  
• Exercise
  
• Well balanced and nutritious food
  
• Lifestyle changes that help deal with and improve the current condition
  

Theanine

Theanine is an amino acid that is found in green tea. Theanine is used generally to treat anxiety, prevent Alzheimer's disease and high blood pressure. Many a times, it is prescribed in combination with cancer drugs so as to make the cancer drugs more effective. The chemical name for theanine is r-glutamylethylamide. Theanine is believed to reduce stress and anxiety without inducing a tranquilizing effect.

The chemical structure of theanine is similar to glutamate which is a naturally occurring amino acid in the body that helps to transmit nerve impulses in the brain. A few effects of theanine appear to be similar to that of glutamate. Scientific evidence points out that theanine stimulates the production of alpha waves in the brain. This induces a feeling of relaxation in the user. Theanine also aides the body in producing other calming amino acids, such as dopamine, GABA, and tryptophan and they in turn help the body to relax.

How does theanine work ?

Theanine passes the blood-brain barrier to enter the brain. As it enters the brain, it increases serotonin and/or dopamine concentrations considerably in the areas of striatum, hypothalamus, and hippocampus. Also known as the 'feel good chemicals', serotonin and dopamine make a person feel good when its concentration increases.

Theanine is supposed to have the following benefits:

• Reduces the effects of PMS in women.
  
• Relieves anxiety.
  
• Used to treat high blood pressure.
  
• Improves the treatment effect of cancer drugs.
  
• Prevents dementia and conditions like Alzheimer's disease.
  
• Heightens mental acuity.
  
• Supports the immune system.
  
• Improves or promotes concentration.
  
• Improves learning performance
  
• Promotes weight loss.
  

Dementia

According to statistics, dementia affects about 36 million people globally and about 10% of people develop the disease at some point in their lives. It becomes more common with age. As more people are living longer, dementia is becoming more common in the population as a whole. Also known as Senility, dementia is a broad category of brain diseases that causes gradual decrease in the ability to think and remember. It is a collective term that is used to describe various underlying brain disorders or damage that can lead to memory loss, language and thinking.

While the likelihood of dementia increases with age, it is not to be misunderstood with normal part of aging. Light cognitive impairments and poorer short-term memory can happen as normal part of aging and this is known as age related cognitive decline and not dementia.
Alzheimer's disease is the best known and most common form of dementia, although there are others types including Vascular Dementia, Lewy Body Dementia and Frontotemporal dementia.

Causes

The loss or damage of nerve cells or neurons in the brain can cause dementia. Alzheimer's disease is the leading cause. Dementia can also be caused by head injury, a stroke or brain tumor. Brain cell death caused by conditions such as cerebrovascular disease like stroke can cause vascular dementia. This prevents adequate blood flow, depriving brain cells of oxygen.

Post traumatic dementia is directly related to brain cell death caused by injury. Some repetitive injuries suffered by sports players are linked to certain form of dementias appearing later in life. Dementia can also be caused by diseases such as Prion disease, from certain types of proteins, HIV infection, medication interactions, depression and vitamin deficiencies. A small proportion of dementia cases run in families.

Signs and symptoms

Other than the decrease in the ability to think and remember even daily functions, some common symptoms of dementia are:

• Emotional problems
  
• Problems with language, communication and forgetting simple words or using wrong ones
  
• Reduced motivation
  
• Recent memory loss – asking the same questions repeatedly
  
• Difficulty in completing familiar tasks – like making a drink or cooking a meal
  
• Disorientation with time and place, getting lost on a previously familiar street and not knowing to get home again
  
• Poor judgment and total distraction
  
• Problems with abstract thinking such as dealing with money
  
• Misplacing things and forgetting about doing this
  
• Mood swings and changes quickly through set of moods
  
• Personality changes and becoming irritable, suspicious and fearful
  
• Loss of initiative.

Diagnosis

The first thing is to assess memory performance and cognitive health. A healthcare professional would ask a set of questions to test knowledge of facts that should be known to any adult to get an indication whether there is dementia or not. The patient is asked to complete the standard tests, and answers are recorded to form a diagnostic indication. Tests to assess a person's mental ability are conducted and test scores are ascertained. Questions such as 'What is your age', 'What is the time', 'What is the year', Counting 20 backward etc are asked. One task for the patient is to write the hours of a clock face around a blank circle on a piece of paper and with accurate relative spacing. These cognitive tests measure dementia symptoms and other tests help to narrow down, if for example, it is Alzheimer's disease.

Treatment

As brain cell death cannot be reversed, there is no known treatment to cure a degenerative cause of dementia symptoms or fully halt its progress. The aim is to provide care and treat symptoms rather than their underlying cause and manage the disorder. If dementia symptoms are due to reversible, non-degenerative cause, treatment is possible to prevent or halt further brain tissue damage.

Symptoms of Alzheimer's can be reduced by drugs to improve the person's quality of life. Educating and providing emotional support is imperative. Exercise programs are beneficial. Treatment of behavioral problems of psychosis with antipsychotics is not usually recommended due to increased risk of death.

Prevention

Other than age which is the biggest predictor of dementia, certain risk factors are modifiable. These risk factors include:

• Smoking and alcohol usage
  
• Atherosclerosis
  
• High levels of bad cholesterol
  
• Above average blood levels of homocysteine, a type of amino acid
  
• Diabetes
  
• Mild cognitive impairment which can sometimes, if not always, lead to dementia.