• Nov. 22, 2023
• MD Özlem GÜNGÖR TUNÇER
• 0

Stages of Alzheimer's Disease

It is divided into mild, medium and severe stages.

Mild phase:

It is a period when the patient begins to lose his productivity and his close circle becomes aware of his poor performance. Difficulty remembering recent events, repeating the same questions, and word finding difficulties are the main features. At this stage, the patient may get lost in unfamiliar places, have difficulties such as being inattentive while driving, slowing down reactions, confusing directions, and may have problems in financial matters such as bank transactions and bill payments. Hobbies have become unsustainable. Although she can continue her household chores, she has lost some of her former care. His interest in reading books and newspapers and TV and current events has decreased. With the contribution of the awareness of deficiencies, symptoms of depression may be observed in some patients. In this period, visual-spatial impairment, impairment in remote memory, naming difficulties, impairments in attention and abstraction-planning skills are observed, with immediate memory being at the forefront.

Middle stage:

The patient has now lost his independence outside the home. New learning is almost never possible anymore. Although he generally preserves information about his first-degree relatives, he confuses information such as the number and names of his grandchildren. Difficulties arise such as difficulty in choosing the appropriate clothing for the season or time of day, and mixing the order of clothes while dressing. There may be delusions of theft and infidelity. He doesn't want to be alone. Disturbance in sleep-wake rhythm, frequent awakenings at night and frequent naps during the day occur.

Heavy phase:

The patient may confuse his/her spouse, child, or own parents, and may not be able to recognize his or her face in the mirror. Complete supervision is required for basic daily living activities such as dressing, washing and eating. The vocabulary has become quite poor. Can talk to people on television as if they were in the house. Walking and movement gradually decrease, and in the future, even sitting becomes impossible, and one may become bedridden. Urinary incontinence becomes increasingly evident. Epileptic seizures may occur. Examination of patients in severe stages is extremely difficult and sometimes not possible; findings such as tone changes and gait disorders are more evident.

How is Alzheimer's disease diagnosed?

Clinical history, neurological examination findings, neuropsychological tests, and cerebrospinal fluid biomarkers are important in diagnosis. In brain magnetic resonance imaging (MRI); Atrophy can be seen in the temporal lobes and medial parietal cortex. FDG PET and amyloid-PET studies can be used as an auxiliary diagnostic method.

How to plan the treatment of Alzheimer's disease?

The basis of treatment is cholinesterase inhibitors and memantine, which have a symptomatic effect on cognitive functions. In Alzheimer's disease; Mood disorders such as depression and anxiety are common. In the presence of depression, anti-hypertensives such as β-blockers, which may cause or aggravate depression, should first be discontinued and more appropriate medications should be switched, and anti-depressant group medications should be added to the treatment. In the treatment of anxiety, benzodiazepine group drugs should be avoided unless absolutely necessary due to their cognitive depressant effects. Some atypical neuroleptic drugs may be preferred in the treatment of delusions, hallucinations, agitation and aggression.

Patients suffering from insomnia may be advised to avoid stimulants such as coffee and tea after sunset and drink warm milk some time before bedtime. Anti-depressant and sedative medications can be used. Melatonin or melatonin receptor agonist drugs can be added to the treatment to regulate the circadian rhythm.

Occupational rehabilitation contributes to the improvement of cognitive performance, functionality and emotional balance.

Environmental adjustments such as reducing light and calming sounds have been shown to positively affect eating behavior, and listening to music during bathing and eating has been shown to reduce agitation and aggression.

It is known that changing the subject, diverting the patient's attention and switching to a different activity can be effective in the presence of agitation and aggression. It can be seen that listening/watching audio or video recordings of family members has a similar calming effect.

Modifiable risk factors in Alzheimer's disease

There are some modifiable risk factors in Alzheimer's Disease, and it is very important to identify and correct them. These include diabetes mellitus, hypertension, smoking, depression, mental and physical inactivity, malnutrition, obesity and low education level.

How effective are genetic factors in Alzheimer's disease?

Only 1-2% of all cases are diagnosed with the disease through simple Mendelian inheritance - autosomal dominant transmission. These patients typically have early-onset disease.

Is it possible to protect from Alzheimer's disease?

The Mediterranean diet has been shown to improve cognitive function as a protective factor. The Mediterranean diet means a diet rich in fresh vegetables and fruits, grains, especially fish and olive oil.

It is estimated that mental and physical activity has a protective effect by activating plasticity in the brain tissue, increasing brain blood circulation and connections between brain cells, and reducing inflammation and amyloid plaque formation.

Controlling diabetes and hypertension and the risk of cerebrovascular disease also have an important place among preventive measures.

It is also thought that exposure to rich stimuli increases cognitive reserve, and mental activities such as reading, engaging in artistic activities, and playing games reduce the risk of Alzheimer's.

Among the most important recommendations to protect cognitive reserve: The primary priorities are learning new information (such as a new language, chess), getting enough sleep, reducing stress that negatively affects attention, concentration and memory, and being in an active social life.