Alzheimer's: diagnosis and treatment

Senile dementia is the third health problem of overdeveloped countries, after cardiovascular accidents and cancer. The increasing public interest, biomedical and political, for Alzheimer's derives from the marked upward progression of its prevalence in Western societies.

The life expectancy of those over 65 has increased sharply over the past decades. The life expectancy in western society reaches 82 years of life, with a one-quarter increase in the risk of severe dementia.

It is now accepted that dementia is a symptomatic complex that can be caused by more than 70 different pathological processes. Symptoms of dementia include recent memory loss, loss of linguistic functions, inability to abstract thinking, inability to self-care, personality disorder, emotional instability and loss of sense of time, and from space.

These characteristics differentiate dementia from mental retardation in that they are mental faculties that are lost once acquired and exercised for a long time, whereas in mental retardation they never come to be acquired in full. Dementia also differs from the delirium in which it develops with a drop in attention and temporary confusion, accompanied by the transient loss of certain cognitive functions, depending on the agent responsible for the delusional picture.

The first record of a senile mental deficiency is found in the Law of Solon written in Greece about 400 BC. A.Cornelius Celsius introduced the terms dementia and delirium in his work Medicine in Ancient Rome.

It was not until 1906 that Aloisius Alzheimer, a German neurologist, showed the case of a 51-year-old patient with dementia, and discovered changes in the neurofibrils. The patient presented disorientation, memory loss, jealousy, perceptual deficit, aphasia, apraxia, agnosia paraphasia, persecutory mania and rapid progression of the disease. The German school of Krepelin and later Fisher discovered the so-called senile plaques with amyloid content in cerebral pathology.

Possible Causes of Alzheimer's

Despite the efforts made in the last 20 years to identify the factors involved in the genesis of Alzheimer's disease, its cause is still an enigma.

From years ago, six etiopathogenic theories of Alzheimer's disease have been considered:

Cholinergic Deficiency

- Genetic error

- Accumulation of abnormal proteins

- Infectious agent, the environmental toxin

- Deficient cerebral flow

- The secondary traumatic and psychosocial factor.

From a genetic point of view, some families show a hereditary pattern, as is the case of some patients with early onset, before 65 years, that affects less than a quarter of Alzheimer's patients. It is caused by genetic mutations in chromosomes 1,14, and 21.

Although no specific gene has been identified in late Alzheimer's disease; genetic factors play an important role in the development of the disease.

Other factors are being investigated, such as the presence of aluminum, the importance of tau protein or levels of synucleotide in blood, among others.

Classification of dementias

Scientific research on Alzheimer's disease has led to a deeper classification of dementias:

- Taupatías. It is related to the alteration of tau protein. Includes dementias of Alzheimer's disease, fronto-temporal dementia, dementia, progressive supranuclear palsy, cortico-basal, Pick's disease, Jacob's Creutzfeldt disease, Strausler, Gersman's disease and progressive primary aphasia.

- Synucleopathies. Includes multisystem atrophy, nigro-striate degeneration, dementia associated with Parkinson's disease, olivopontocerebellar atrophy, and dementia with Lewy bodies. Parkinson's disease is a six-fold greater risk of developing dementia than the healthy population.

Symptoms of Alzheimer's

Alzheimer's disease has different symptoms, both cognitive and motor, such as:

- Amnesia

- Asfasia of the language

- Agnosia

- No face recognition

- Apraxia on dressing

- Learning Disorder

- Disorientation

- Muscle contractures

- Convulsions

- Incoordination of motor

Alzheimer's also presents functional symptoms among which are:

- Dificulty to walk

- Difficulty eating

- Difficulty dressing and grooming

- Difficulty maintaining the home

- Difficulty in financial management

The disease can also occur through behavioral symptoms such as:

- Attacks of fury

- Manic-depressive episodes

- Violence

- Catastrophic reactions

- Sleep disorders

- Wanderer

- Obscene language

- Hallucinations

- Sexual disorders

- Social maladaptation

- Personality disorders

There are symptoms associated with Alzheimer's disease, among which are delirium, gustatory, visual or olfactory hallucinations. Also, some of the general symptoms are sweating, constipation, hypotension and sleep disturbance.

Diagnosis of Alzheimer's

The tests in the diagnostic process constitute an important diagnostic tool. Some of these tests are:

- Amyloid pet

- Scaner

- Spect

- Functional brain magnetic resonance

- Cerebral spectroscopy, eeg

- Neuropsychological study

- General analytical thyroid tests, vit. b12, folic acid

- Analysis of lcr: beta amyloid and tau protein

Alzheimer's Treatment

There are several treatments to try to combat Alzheimer's. They are usually based on acetyl collisnesterase inhibitors and glutamate effects blockers. Some of the most used therapies are:

- Cognitive stimulation therapy. Psychotherapy and specialized psychosocial support are indispensable in the management and treatment of Alzheimer's disease. Admission to 24-hour residence or day residences is necessary in some cases.

- Investigations in the treatments try to interfere in the development of pathological amyloidogenesis and different vaccines have been tested: such as experimental EB1D, a new immunogen that creates antibodies against neuritic plaques, where beta amyloid protein accumulates, atypical neuroleptics in delusions and hallucinations, as well as in conduct disorders. Also inhibitors of serotonin reuptake and other non-tricyclic antidepressants.

- It is also important to give psychological care to caregivers of Alzheimer's patients.

There are high expectations regarding the treatment of Alzheimer's disease, the great economic and social investment that is already giving its first fruits.