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ALZHEIMER'S DISEASE 

Alzheimer's disease is one of the leading causes of dementia and it has become one of the dreadful clinical entities. Millions of people over age 65 are affected worldwide and this has brought on realistic concern to all of us when we think of our parents entering into the age group of 65 to 70. I would provide brief outline of this dreadful disease and present treatment.  

Dementia is a presenting symptom of Alzheimer's disease. Dementia is a syndrome of acquired cognitive impairment in an alert individual that is sufficient to compromise functional abilities. The single most important tool is in dementia diagnosis is a comprehensive clinical assessment. The goals of this assessment include:  

·        To detect deficits in memory and other aspects of cognition, such as language dysfunction, recognition of objects, persons or places, performing previously learned tasks or skills, judgment and " executive " functions (planning, initiation and sequencing of action).  

·        To determine whether the deficits represent a decline from previous abilities.  

·        To ascertain whether the deficits are sufficient to interfere with persons conduct of accustomed activities.  

Diagnostic Criteria:  

The standardized criteria proposed  by McKhann et al have been widely accepted for Alzheimer's disease  and provide three levels of  diagnostic certainty.  

1.     Probable Alzheimer's disease is characterized by gradual onset of and progression of memory impairment in the absence of other neurologic, psychiatric and systemic disorders.  

2.     Possible AD is considered when the symptoms, onset, or course is slightly atypical, When language dysfunction is an initial symptom or when other potentially dementing illness is present but not considered to be the `main cause of dementia.

3.     Definite AD is confirmed by postmortem examination  

The clinical diagnostic accuracy has reached the level where Alzheimer's disease now is considered a diagnosis of inclusion, rather than simply one of exclusion.  

Clinical Course:  

The onset of early stage dementia is so insidious that it may be years before the person seeks evaluation. In the very mild cases, typical findings would be subtle memory loss as manifested by forgetting names, misplacing items, repeating questions and incorrect recall of recent event. Personality changes may include diminished social interaction and passivity and at times these observations are seen in " nondemented  elderly people." In Alzheimer's patients symptoms occur more constantly and over the time they progress in severity.   

As the disease progress to mild stage, memory deficits become overt and interfere with usual activities (missed appointments, propensity to become lost when driving etc.). There is disorientation to time and place. May have difficulty in word finding, hesitant speech, impaired judgment and problem solving skills - inappropriate financial decisions, calculation errors or diminishing driving abilities.  

The mildly affected people usually remain capable of " self care " and to a casual observer they look and act normal and in puts from relatives or caregivers become important.  

In the moderate stage, new information is recalled inaccurately and may be lost and long term memory may also be impaired (believe that long deceased relatives are still alive). There is progressive disorientation and may even not recognize relative, familiar places. Self care is neglected, disturbing personality changes and symptoms of depression, delusion, hallucinations, restlessness, aggression and wandering.   

As the disease reaches the severe stage, only fragments of memory remain, although emotional recognition of immediate family may occur, progressive deterioration of personality and complete dependence on caregivers for even basic self care functions. Death usually occurs as a result of complications of a prolonged vegetative state and usual period from on set of dementia to death varies between 10-20 years.  

Treatment:  

There is no specific treatment, however, early to mild stage dementia patients are treated with " ARICEPT." This drug may improve memory or prevent deterioration of memory. This medication comes in 5 and 10 mg strength and requires only one dose. Once stage of hallucination, delusion or aggression has reached, patients require stronger psychotropic agents.  

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