Alzheimer’s disease is a progressive degenerating process of neural tissue aﬀecting mainly the frontal and temporal lobes of the BRAIN in middle and late life. There is probably a genetic component to Alzheimer’s disease, but early-onset Alzheimer’s is linked to certain mutations, or changes, in three particular GENES. Examination of aﬀected brains shows ‘senile plaques’ containing an amyloid-like material distributed throughout an atrophied cortex (see AMYLOID PLAQUES). Many remaining neurons, or nerve cells, show changes in their NEUROFIBRILS which thicken and twist into ‘neuroﬁbrillary tangles’. First symptoms are psychological with insidious impairment of recent memory and disorientation in time and space. This becomes increasingly associated with diﬃculties in judgement, comprehension and abstract reasoning. After very few years, progressive neurological deterioration produces poor gait, immobility and death. When assessment has found no other organic cause for an aﬀected individual’s symptoms, treatment is primarily palliative. The essential part of treatment is the provision of appropriate nursing and social care, with strong support being given to the relatives or other carers for whom looking after suﬀerers is a prolonged and onerous burden. Proper diet and exercise are helpful, as is keeping the individual occupied. If possible, suﬀerers should stay in familiar surroundings with day-care and short-stay institutional facilities a useful way of maintaining them at home for as long as possible.
TRANQUILLISERS can help control diﬃcult behaviour and sleeplessness but should be used with care. Recently drugs such as DONEPEZIL and RIVASTIGMINE, which retard the breakdown of ACETYLCHOLINE, may check
– but not cure – this distressing condition. About 40 per cent of those with DEMENTIA improve.
Research is in progress to transplant healthy nerve cells (developed from stem cells) into the brain tissue of patients with Alzheimer’s disease with the aim of improving brain function.
The rising proportion of elderly people in the population is resulting in a rising incidence of Alzheimer’s, which is rare before the age of 60 but increases steadily thereafter so that 30 per cent of people over the age of 84 are aﬀected.