Alzheimer’s

It represents the most frequent cause of dementia in Western countries, reaching 60% of cases. It is a primary degenerative disease of very heterogeneous symptoms, with insidious presentation, of progressive course, unknown cause and multifactorial.

There are a series of risk factors according to the different studies:

• Age: the most important predisposing factor, between 65 and 85 years old; the frequency roughly doubles every 5 years.
• Female sex: being a woman is an independent risk factor.
• Low educational level: the formative years create a "cognitive reserve" that exerts a protective effect against deterioration; symptoms take longer to become apparent.
• cardiovascular diseases: hypertension, stroke, myocardial infarction.
• Family history of dementia: there is a genetic component that has not yet been well explained. A small proportion of cases occur in families that inherit mutations on chromosomes 1, 14, or 21, with dementia usually presenting before age 50. If a family member has Alzheimer's it does not mean that it will be transmitted to their children. Most cases appear spontaneously.
• Other factors: severe head trauma, aluminum poisoning, diabetic men, etc.

The main clinical features are as follows:

• Generally early and gradual involvement of recent memory, such as forgetting names, for example. Initially, they try to hide it, but the patient or their relatives consult for the first time after an average waiting period of 2 years, that is, when it interferes with their daily life.
• Multiple, progressive and even deterioration of higher intellectual functions: deterioration of language with loss of vocabulary and ability to speak and understand; loss of skills in the execution of motor acts such as dressing, shaving ...; impaired ability to recognize people or objects through the senses; decreased judgment capacity; alterations in orientation ability. If the patient does not do what is asked of him, it is not that he does not want to do it, but that he does not know how to do it because he has forgotten.
• Appearance of psychiatric symptoms and behavioral disturbances in more than 50% of patients. They may have delusions, for example about theft of belongings, visual hallucinations, agitation, anxiety, depression and dysphoria, verbal aggressiveness, repetitive language, ... They may have sleep disturbances such as insomnia, fragmented sleep and various nocturnal awakenings. Sometimes the patient is unable to stay still with a tendency to constantly move in the house, wandering senselessly and sometimes with a tendency to run away from home: this is what has been called wandering.
• Neurological clinic: gait and posture disturbances, seizures, myoclonus, etc.
• Progression towards loss of independence. Patients end up not being able to use themselves to dress, eat, walk, and control urine and bowel movements. They come to not recognize their own relatives. There is a tendency to isolation, not being able to live without help in the end, but smiling is one of the last things you lose.

There are 10 warning signs of Alzheimer's disease, which can be warned by suggesting that a person may be initiating this disease, usually insidious onset:

• Memory loss that affects work capacity.
• Difficulty carrying out familiar tasks.
• Problems with language
• Disorientation in time and place.
• Poor or diminished judgment.
• Problems with abstract thinking.
• Things placed in the wrong places.
• Unexplained changes in mood or behavior.
• Changes in personality
• Loss of initiative.

Of interest

The treatment of Alzheimer's disease is divided into a specific treatment (with some drugs already recognized in the treatment of this disease and others still under study or with unclear results) and a treatment for psychological and behavioral disorders. Non-pharmacological treatments are also very important.