Alzheimer's disease is the most common type of dementia. It is a progressive brain disease that causes problems with memory, thinking and behaviour. Symptoms usually develop slowly and get worse over time. The disease is caused by the death of a large number of nerve cells, resulting in an interruption of signal transmission in the brain. The dying of neurons in the brain leads to a gradual and irreversible deterioration of the patient's condition - loss of memory, difficulties in communication and speech, mood swings, the appearance of aggression, the inability to perform even elementary actions. So far, no cure has been found and Alzheimer's disease has a fatal end. However, there are methods and medications to slow the progression of the disease, especially when diagnosed at an early stage.
It is important to keep in mind that Alzheimer's is not a natural aging process, although the risk of dementia and Alzheimer's disease in particular increases proportionately with age and the majority of patients are over 65. About 5% of cases are of people between 40 and 50 years of age. Therefore, due to increasing life expectancy and correspondingly an increasing percentage of elderly people, the number of patients is expected to triple by 2050 worldwide.
Since the consequences of Alzheimer's disease usually directly affect and are devastating not only for the patient but also for the relatives who are involved in his or her care, the victims of the disease are actually much more numerous. These statistics have led leading experts in the field to describe Alzheimer's disease as "the epidemic of the 21st century”.
As it is a progressive disease (which means that the structures and chemistry in the brain become increasingly damaged over time) the manifestations of dementia worsen with the years (such as a person's ability to remember, understand, communicate and reflect gradually declines). In the beginning the memory loss is very mild, but gradually it progresses to complete inability to handle even routine chores.
The main symptoms are the same throughout the disease, but worsen as the years go by, with new symptoms gradually appearing. The symptoms are as follows: memory loss, specifically recent memory; problems with expression and communication; difficulty learning new tasks; inability to comprehend; general confusion, disorientation in time and/or space; difficulty with abstract thinking, lapses in judgment; difficulty performing familiar activities; behavioural and personality changes; sudden mood swings, lack of initiative/apathy.
They can be divided into two groups – cognitive (memory related) and non-cognitive (related to other physical or behavioral problems) symptoms. The development of symptoms is due to structural changes in various centres of the brain and cerebral cortex. The more these changes are worsened, the more the symptoms are expressed in the patient's life, gradually leading to their complete dependence on others. In the beginning, patients cannot cope with complex tasks and new activities, the most common being errors in dealing with finances, difficulties in using the telephone and public transport. As the disease progresses, performance of all activities is impaired to the point of inability to self-care.
Alzheimer’s disease can also be defined within 4 stages of the disease: mild, moderate, advanced and terminal. Of course, there can be variations in the subdivision of the phases, but these stages are important when deciding what kind of treatment is appropriate for the patient.
The initial stage – mild/early dementia:Memory loss and other cognitive impairments are mild, but become increasingly noticeable. The person can still cope with the symptoms, compensate for them and continue to function independently. Characteristics of this stage can be: mild aphasia, avoiding unfamiliar places, difficulty writing and using some objects, manifestation of apathy and depression, need for reminders for some activities of daily living.
Intermediate stage - moderate dementia:
Changes become more noticeable. The harm they bring to the patient becomes more and more visible. Mental functions weaken, personality changes. Problems on the physical level begin to manifest. The person becomes more and more dependent on someone else’s care for daily activities. Characteristics of this stage can be: impaired memory of recent events, moderate aphasia, getting lost in unfamiliar places, lack of ability to perform complex acquired habits, depression, restlessness, agitation, need not only for reminders, but also for assistance with most activities of daily living.
Late stage – advanced dementia
Symptoms intensify as does personality change. The person becomes increasingly dependent on somebody else’s care. Characteristics of this stage can be: confusion of time (present and past), expressive and receptive aphasia, does not recognize familiar places, abnormal slow performance of movements, delusions, confusion, needs reminders and assistance with all activities of daily living.
Terminal stage of dementia
Complete personality deterioration. Physical problems dominate, loss of control over bodily functions. The person is totally dependent on somebody else’s care for even the simplest activities. Characteristics of this stage can be: lack of connection between present and past, hardly speaks, lack of reaction to the world around, few spontaneous movements, complete passivity, inability to care for oneself.
The symptoms of these stages do not develop in a linear progression. Some symptoms may manifest earlier or later than described in the established phases, or may not manifest at all. Also, some patients move from phase to phase in a periodic recurrence. The phases may also overlap - some patients cope with some tasks and not with others, i.e. they exhibit symptoms of two phases simultaneously as if they were in them at the same time. Some symptoms may appear and then disappear, for example loss of orientation. But memory loss always gets worse with time.
The exact duration of the phases cannot be determined either. Just as each person is completely unique, so is the course of the disease - everyone goes through a particular phase for a different amount of time. How a person's illness progresses depends very much on personal subjective factors such as age, the presence or absence of other illnesses, the level of care and support they receive.
Dementia is another important term that needs to be defined when talking about Alzheimer’s disease. Dementia is a syndrome characterized by a decline in multiple cognitive functions significant enough to disrupt patients' activities of daily living and occurring at a normal level of consciousness. Most typical of dementing illnesses is the decline of mental abilities and functions such as memory, language, thinking, planning, and recognition of people and objects. The impairments are beyond what is accepted as the normal range as one ages. Symptoms gradually erode the ability to perform daily activities such as driving, housework, even personal care such as toileting, dressing, eating.
Dementia can be caused by one or several health problems. Among the main and known to science causes are: vascular diseases, infections, injuries, intoxications, genetic, metabolic and neoplastic diseases. There are still many types of dementia for which it is not known what causes them, for example Alzheimer's disease. These dementias are classified as 'degenerative'. The term was chosen to indicate that their root cause is unknown, and that they are irreversible and there is as yet no known cure for them.
Some types of dementia can be partially or completely cured. The extent of the cure usually depends on how quickly the root cause of the disease is found and how quickly it is treated. However, some forms of dementia are irreversible and there is no cure for them, such as dementia due to Alzheimer's disease.
Scientists are working on finding a cure for the Alzheimer’s disease, but there is no approved medicine so far. There are drugs for treatment of the Alzheimer’s disease’s symptoms such as Rivastigmine and Galantamine for treatment of mild to moderate phase and Donepezil and Memantine for treatment of moderate to advanced phase.
These drugs work by regulating neurotransmitters - the chemicals that carry information messages between neurons. They can also have a positive impact on certain behavioural syndromes. Treatment can be given in combination with other medications and results in significant improvements in patients' cognitive function, overall functioning and activities of daily living, as well as slowing the progression of the disease.
There are also different non-medical therapies and treatments for coping with the symptoms of the disease. These approaches improve communication with the patient and stimulate his/her cognition, memory, orientation, etc. which helps for dealing with present symptoms, but also for slowing down the pace of the disease. In this kind of treatment different areas are integrated in care such as technology, art, animals, sport, etc.
The AIDA methodology proposes innovation by integrating two areas in care – technology and art, which makes another step forward in the creation of more effective therapies for people with dementia.
