All About Alzheimer’S Disease

Alzheimer’s disease is an irreversible brain disorder that continuously destroys functions of the brain such as memory and thinking and is the leading cause of dementia. In a recent article published by the National Institute on Aging it states, “Alzheimer’s disease is characterized by changes in the brain, including amyloid plaques and neurofibrillary, or tau, tangles, that result in loss of neurons and their connections”. It is known as a highly progressive disease and it is characterized by a decline in areas such as memory, language, personality, behavior, and loss of daily functions. Because the symptoms of Alzheimer’s gradually increase over time, the death rate of this disease is quite high. The early stages begin with mild memory loss but as the disease progresses to later stages, individuals often lose the ability to perform daily functions like carrying out conversations and performing simple tasks. For example, it is common to see individuals present with symptoms such as disorientation, mood changes, and confusion about occasions, time, and place. Individuals with more severe cases of Alzheimer’s find difficulty with speaking, swallowing and walking.

The direct cause of Alzheimer’s is still unknown and remains to be one of the biggest questions of researched diseases. With this, the leading risk factor of Alzheimer’s is increasing age, although it is not directly linked to the direct cause of the disease. As studies continue to show the prevalence of Alzheimer’s, the numbers are overwhelming. According to a study published through the Alzheimer’s Association, approximately 5.7 million Americans live with Alzheimer’s. The numbers are staggering as an estimated 5.5 million of these cases include individuals from age 65 and older. Only approximately 200,000 of these cases account for individuals below the age of 65. As stated in the article, “The percentage of individuals with Alzheimer’s Dementia increases by 3 percent from age 65-74, 17 percent of people age 75-84, and 32 percent of people age 85 and older”. Alzheimer’s disease affects more women than men as almost two-thirds of Americans with this disease are women. Of the 5.5 million Alzheimer’s individuals over the age of 65, 3.4 million are women and 2 million are men. Looking at the prevalence of Alzheimer’s in relation to geography, the highest rates of Alzheimer’s are in Florida, California, and New York. Each of these states accounts for more than 400,000 cases with California presenting with 650,000 for individuals over the age of 65. Although the staggering population of each of these states contributes to the high percentage of this disease, Alzheimer’s continues to be a vocal focus for improvement in research.

[bookmark: _Hlk33357830]Studies suggest that symptoms such as depression and decreased cognitive awareness appear in 98.5% and 99.1% of individuals with Alzheimer’s as this disease progresses to more severe stages. As deterioration of the brain progressively worsens with age, signs such as reliability on others to assist with activities of daily living for example, changing clothes, brushing teeth, taking showers, and cooking food, become more apparent. Also, confusion in proprioception becomes an easily visible sign with individuals in the mid to later stages of Alzheimer’s. A study on the pathology of Alzheimer’s suggest that as tau hyperphosphorylation occurs, the number of functional tau in the brain drastically changes, which leads to a detachment of tau from microtubules. This study continues to suggest that the loss of tau most likely contributes to neurodegeneration, resulting in memory loss and other functions of the brain. In addition to tau hyperphosphorylation, the formation of amyloid plaques is directly linked with synapse loss and neuronal cell death. The combination of these two degenerative processes eventually affects areas in the cerebral cortex responsible for language, reasoning, and social behavior, causing a staggering decline in the ability to perform functional activities. Alzheimer’s disease affects individuals at different rates, but on average people over the age of 65 are estimated to live 4 to 8 years after diagnosis, while others live for as long as 20 years. Depending on the areas of the brain most affected by Alzheimer’s, it is guaranteed that learning and memory will be affected and basic activities such as walking and swallowing will be impaired. Unfortunately, individuals with severe Alzheimer’s need critical care as they lose the ability to perform the simplest of tasks and as the brain deteriorates this eventually results in death.

The diagnostic process for identifying Alzheimer’s disease in individuals comprises of several tests. Diagnosing Alzheimer’s in individuals who are no longer living requires a post-mortem evaluation of brain tissue, though cerebrospinal fluid and positron emission tomography biomarkers. The positron emission tomography test uses a tracer to view images of tissues and organs and determine whether they are functioning properly. More recent diagnostic advances have been made using an injection of a radiolabeled tracer. In the procedure, “Individuals undergo a specialized positron emission tomography scan that detects the deposition of amyloid peptides into plaques in the living brain”. A more-invasive procedure that involves lumbar puncture but saves money includes the examination of cerebrospinal fluid tau peptide. This method holds a 90% accuracy rate but carries the risks of infection and disease involved with a lumbar puncture procedure. In addition to being highly invasive, the results often take weeks to develop due to the lengthy analysis process. Although these tests may be invasive and lengthy, the accuracy of these tests makes the process of identifying individuals with Alzheimer’s a much easier one.

Although Alzheimer’s disease has thoroughly defined diagnostic criteria, it is important to be thorough in detail in order to differentiate Alzheimer’s from other diseases that present similar signs and symptoms. In a study done on Alzheimer’s disease, Marcelo Magalhaes states, “The physician should present the arsenal of differential diagnoses of clinical features that potentially mimics Alzheimer’s disease”. The problem is that there are a variety of other conditions that present similar criteria to that of Alzheimer’s disease. One of these is dementia with lewy bodies, which is studied to be due to parkinsonism. Diagnostically, dementia with lewy bodies is due to abnormal deposits of alpha synuclein in the brain and differentiates from Alzheimer’s in that aspect of testing. Like Alzheimer’s, individuals with lewy bodies often experience hallucinations and sleep disorders. Frontotemporal lobar degeneration and hippocampal sclerosis have unique neuropathological features but present many of the same features such as memory loss and spatial disorientation. Perhaps one of the most difficult distinguishes to make is between dementia caused by cerebrovascular disease or Alzheimer’s. Often times, these two coexist while individuals with Alzheimer’s have amyloid angiopathy and degenerative changes affecting capillaries. In many cases it is difficult to distinguish one disease from another due to the overlapping existence and characteristics of each but Alzheimer’s disease typically occurs from the age of 65 and older, initiates the strongest progression of memory loss, and attacks the parts of the brain named the entorhinal cortex, hippocampus, and cerebral cortex. Although the diseases listed previously present similar characteristics, serious memory loss is often spared while sleep disorder, mood anxiety, and uncontrolled body movements are more common.

Due to the complexity of Alzheimer’s disease, it is highly unlikely that any medication holds the strength to completely inhibit this disease from progressively worsening. One of the most commonly prescribed medications is called a cholinesterase inhibitor and they work to prevent the breakdown of acetylcholine, a brain chemical believed to be important for memory and thinking. As Alzheimer’s progresses, the brain produces less and less acetylcholine, which makes cholinesterase inhibitors less effective. Surgically, there are no interventions that are proven to cure Alzheimer’s or slow memory loss. As for rehabilitative management, physical therapy proves to be one of the best interventions for an individual with Alzheimer’s. In an article done through the American Physical Therapy Association (APTA), several physical therapists explained the importance of physical therapy as an opportunity to improve the quality of life for individuals with Alzheimer’s. Often times, these types of patients are fall risks. In order to avoid this from occurring, physical therapy introduces strengthening, balance, and gait training. In the same article, Jan Bays recalled a treatment with an Alzheimer’s patient. This individual was not cooperative with the treatment but Jan learned that he had always been interested in birds. With this information, she incorporated building a birdhouse into the therapy sessions. Jan Bays states, “During that functional activity, I caught his attention through building while working with him on standing tolerance, balance, gait, transfers, lower extremity strengthening, dual-task management, and safety awareness”. Often times, these patients will resist their caregivers but diving into the history of the patient to relive meaningful memories serves as an open door to improving daily activities like transfers, balance, and gait. While providing physical therapy to dementia patients can be difficult, patience and creativity are two characteristics that can provide more of an impact for a patient than any drug can.

Although Alzheimer’s disease is an irreversible brain disorder that continuously destroys functions of the brain such as memory and thinking, it is important to remember the importance of physical therapy as it can be applied as one of the most beneficial tools any individual with Alzheimer’s can use. It is also important to understand the weaknesses of the individual so that one may specifically gear a program towards strengthening the patient’s weaknesses. Recognizing that individuals approaching the age of 60 who present signs and symptoms such as depression, memory loss, and difficulty performing daily activities is very important. Individuals who display signs and symptoms like such should be immediately tested by a professional in order to recognize the particular disease and slow the rapid process of brain deterioration. As mentioned previously, patience and creativity while working with individuals with Alzheimer’s is vital because these individuals are often difficult to work with. Thinking outside of the box plays an enormous role in the cooperation of a dementia patient and provides opportunities for health improvements that medication or surgical interventions can’t achieve.