Alzheimer's Disease Treatment in Delhi, India

The symptoms of Alzheimer's disease can vary and tend to worsen as the disease progresses. The most common symptoms include:

• Memory loss: It is often one of the first and most noticeable symptoms of Alzheimer's. It may start with forgetting recent events or conversations and gradually progress to forgetting important information, such as names, dates, and familiar places.

• Difficulty with problem-solving and planning: People with Alzheimer's may have trouble concentrating, making decisions, or following complex instructions. They may also experience difficulty with tasks that require organisation or planning.

• Confusion and disorientation: Individuals with Alzheimer's may become disoriented in familiar surroundings, forget where they are or how they got there, and have difficulty recognising people or objects.

• Language and communication problems: They may have difficulty finding the right words or may struggle to follow conversations. They may also repeat themselves or have trouble understanding written or spoken language.

• Impaired judgment and decision-making: Alzheimer's can affect a person's ability to make sound judgments or decisions. They may exhibit poor judgment in financial matters, personal grooming, or safety precautions.

• Personality and behavioural changes: They may experience changes in personality, mood swings, and behavioural issues. They may become withdrawn, irritable, anxious, or exhibit uncharacteristic aggression or agitation.

• Loss of initiative and motivation: A person with Alzheimer's may lose interest in activities they used to enjoy, have reduced initiative to start new tasks, and may need prompting or assistance to engage in daily activities.

The exact causes of Alzheimer's disease are not fully understood, but a combination of factors contributes to its development.

• Age: Increasing age is the most significant risk factor for Alzheimer's disease. The chances of developing the disease significantly increase after the age of 65. However, Alzheimer's is not a normal part of ageing, and not all older adults will develop the disease.

• Genetics: There are two types of Alzheimer's disease: familial (early-onset) and sporadic (late-onset). Familial Alzheimer's is rare and typically caused by specific gene mutations inherited from parents. Sporadic Alzheimer's, which is the most common form, has a complex genetic component, with multiple genes influencing the risk of developing the disease.

• Amyloid plaques and tau tangles: The accumulation of abnormal proteins in the brain is a hallmark of Alzheimer's disease. Beta-amyloid protein forms plaques between nerve cells, and tau protein forms tangles within nerve cells. These abnormalities disrupt the normal functioning of brain cells and contribute to their degeneration and death.

• Neurotransmitter imbalances: Alzheimer's is associated with disruptions in the levels of certain neurotransmitters, which are chemical messengers that facilitate communication between brain cells. Reduced levels of acetylcholine, a neurotransmitter involved in memory and learning, are commonly observed in individuals with Alzheimer's.

• Inflammation and oxidative stress: Chronic inflammation and oxidative stress in the brain have been implicated in the development and progression of Alzheimer's disease. Inflammation can lead to the production of harmful molecules that damage brain cells over time.

• Lifestyle and environmental factors: Certain factors, such as a sedentary lifestyle, poor diet, smoking, obesity, high blood pressure, diabetes, and cardiovascular diseases, can increase the risk of Alzheimer's.

Diagnosing Alzheimer's disease involves a comprehensive evaluation that includes a medical history assessment, physical examination, cognitive tests, and sometimes additional tests to rule out other possible causes of the symptoms. Here is an overview of the diagnostic process:

Medical history and physical examination

The doctor will review the individual's medical history, including any symptoms, family history of Alzheimer's or other dementias, and current medications. The doctor performs a physical examination and also carries out an entire neurological examination by testing the following:

• Reflexes

• Muscle tone and muscle strength

• Ability to stand from a chair and walk a few steps

• Sense of sight and hearing

• Coordination

• Balance

Cognitive and neuropsychological tests

A series of tests are performed to evaluate cognitive function, memory, thinking, and problem-solving abilities. These tests may involve answering questions, performing tasks, and memory recall exercises. Commonly used tests include the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA).

Medical and laboratory tests

Thyroid function, vitamin B12 levels, and liver and kidney function and additional tests may be performed to detect other potential causes of cognitive decline.

Brain imaging

Imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) scans may be used to assess the structure of the brain and identify any abnormalities that could be associated with Alzheimer's disease. These scans can help rule out other conditions that may mimic Alzheimer's symptoms.

Neuropsychiatric evaluation

In some cases, a neuropsychiatric evaluation may be conducted to assess mood, behaviour, and psychiatric symptoms that could be related to Alzheimer's or other conditions.

Biomarker tests

In certain situations, biomarker tests may be used to detect specific changes in the brain associated with Alzheimer's disease. These tests may include cerebrospinal fluid analysis or positron emission tomography (PET) scans using specific tracers that can detect amyloid plaques and tau tangles.

There's no specific alzheimer treatment, however, certain medications slow its progression, mainly in the early stages. Other medications help with mood changes and other behaviour issues.

Aducanumab-avwa (Aduhelm)

This human monoclonal antibody focuses on the fundamental pathophysiology of the disease by decreasing amyloid-beta plaques in the area of the brain.

Donepezil (Aricept), Galantamine and Rivastigmine (Exelon)

These medications improve the working of the brain during the early stages of the disease and delay the rate of worsening symptoms.

Memantine (Namenda)

This drug helps brain cells avoid excessive brain chemical glutamate, which Alzheimer's-damaged cells make too much of. This drug protects against neural damage and has fewer side effects than other drugs.

Memantine-Donepezil (Namzaric)

This medication is a combination of donepezil and memantine and is meant for patients with moderate to severe Alzheimer's.

Tacrine (Cognex)

This was the first drug the FDA approved for treating Alzheimer's disease. It acts by slowing the breakdown of acetylcholine, which helps nerve cells in the brain send messages to each other.

• Age

• Family history

• Down syndrome

• Sex: Females more prone than males

• Mild cognitive impairment

• Head trauma

• Air pollution

• Excessive alcohol consumption

• Poor sleep patterns

• Lack of exercise and obesity

• High blood pressure

As Alzheimer's disease progresses to its final stages, brain changes involve several physical functions like swallowing, balance, and bowel and bladder control. Here are some common complications associated with Alzheimer's disease:

• Worsening cognitive decline: As Alzheimer's disease progresses, the cognitive decline continues, leading to increased memory loss, difficulty with language and communication, impaired judgment, and problems with reasoning and problem-solving. This decline can make it challenging for individuals to perform daily activities and maintain independence.

• Behavioural and psychological symptoms: Many individuals with Alzheimer's experience agitation, aggression, anxiety, hallucinations, depression, and delusions. 

• Functional impairment: Alzheimer's can cause a decline in functional abilities, making it difficult for individuals to perform activities of daily living, such as dressing, bathing, eating, and using the toilet. As the disease progresses, individuals may require assistance and supervision for these activities.

• Communication difficulties: Communication problems, including difficulty finding words, understanding spoken language, and expressing thoughts coherently, can arise as Alzheimer's advances. This can lead to frustration and isolation for the individual and challenges for caregivers in understanding and responding to their needs.

• Increased dependency: As the disease progresses, individuals with Alzheimer's typically become increasingly dependent on others for their care and support. This places a significant burden on family members or caregivers who may need to provide assistance with daily activities, supervision, and coordination of medical care.

• Risk of falls and accidents: Alzheimer's disease can impair balance, coordination, and judgment, increasing the risk of falls and accidents. This necessitates modifications to the living environment to enhance safety, such as removing tripping hazards and installing handrails and grab bars.

• Malnutrition and dehydration: Individuals with Alzheimer's may experience difficulties with eating, drinking, and maintaining proper nutrition and hydration. They may forget to eat or have difficulty using utensils, which can lead to weight loss, malnutrition, and dehydration. Caregivers may need to monitor and assist with meal planning and ensure adequate fluid intake.

• Susceptibility to infections: Alzheimer's disease can weaken the immune system and impair the body's ability to fight off infections. Individuals may be more prone to respiratory infections, urinary tract infections, pneumonia, and other illnesses.

While there is no guaranteed way to prevent Alzheimer's disease, certain lifestyle choices and strategies may help reduce the risk or delay the onset of cognitive decline. Here are some preventive measures that have been suggested:

• Maintain a healthy lifestyle: Adopting a healthy lifestyle can have a positive impact on brain health. This includes regular physical exercise, following a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats, and avoiding or minimising the consumption of processed foods, sugary beverages, and saturated fats.

• Stay mentally and socially active: Engaging in mentally stimulating activities, such as reading, puzzles, learning new skills, or participating in social activities, may help maintain cognitive function and promote brain health. Social interaction, staying connected with friends, family, and community, has also been associated with a lower risk of cognitive decline.

• Manage cardiovascular health: Several studies have linked heart health to brain health. It is important to manage conditions like high blood pressure, high cholesterol, diabetes, and obesity, as these are risk factors for Alzheimer's disease and can impact blood flow and overall brain health.

• Adopting a heart-healthy lifestyle, including regular exercise, a healthy diet, and managing these conditions with medical guidance, may contribute to brain health.

• Get quality sleep: Poor sleep patterns, such as insomnia or sleep apnea, have been associated with a higher risk of cognitive decline. Prioritise getting sufficient, good-quality sleep on a regular basis to support brain health and overall well-being.

• Challenge your brain: Engaging in activities that challenge the brain, such as learning new skills, playing puzzles or strategy games, or participating in educational programs, may help maintain cognitive function and potentially reduce the risk of cognitive decline.

• Manage chronic conditions and medications: Work with healthcare professionals to effectively manage chronic conditions, such as diabetes, hypertension, and depression. It is important to follow prescribed medications and treatments as directed and communicate any concerns or side effects to healthcare providers.

• Stay socially connected: Maintain a strong social support system and engage in social activities.

• Protect your head: Take steps to prevent head injuries, as traumatic brain injury may increase the risk of developing Alzheimer's disease. Use seat belts while driving, wear helmets during sports activities, and take precautions to prevent falls, especially in older adults.

Alzheimer's disease usually worsens over some time. The outlook varies, but early detection, appropriate care, and support can help individuals and their caregivers navigate the challenges associated with the disease.

Reviewed by Dr. Mukesh Kumar, Associate Director and Head (Parkinson's Disease Unit), Neurosciences, Neurology on 15-Jun-2023.

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