At first, it's just the front door key that disappears and later appears in unusual places. Then you stand in the supermarket and wonder about the meaning of the many colorful things. Later, the own flat suddenly becomes unknown territory. And in the end you do not even recognize the partner with whom you have lived a common life. Alzheimer's disease is the name of the relentless opponent, who is increasingly coming into the ring in industrialized countries and always wins in the end.
Alzheimer's: a form of dementia
Named after the neurologist Alois Alzheimer (1864 - 1915), the disease has been known for around 100 years. It is a form of dementia, that is, a decline of mental capacity, and usually occurs only in old age. In view of rising life expectancy, the risk of developing it is increasing - in Germany, up to 1.6 million people are currently affected by dementia, the majority of whom suffer from Alzheimer's disease.
It is estimated that around 5% of people over the age of 60 and 20% of those over eighty years old suffer from Alzheimer's disease. After the strokes, it is second only to the most common severe brain dysfunction in old age. However, rare, hereditary forms can also affect people over the age of thirty.
How does this disease develop?
Scientists still do not know all the mechanisms that lead to the disease. But you know that decades before the outbreak protein fragments deposit in the brain, called amyloids. These appear under the microscope either as typical small fibers (fibrils) or spherical formations (plaques). The deposits seem to prevent the exchange of information between the nerve cells, these die off after a while.
It is also known that in the rare cases where younger people are affected, the formation of amyloids in the brain due to a genetic defect starts very early. Certain gene variants increase the risk and can be determined with a blood test. However, the researchers do not yet know which triggers trigger the processes in detail and what exactly is the cause and the result.
What symptoms does the disease show?
Almost always, the disease begins with memory weakness, first of all disorders of short-term memory and concentration, later also speech disorders. The mental capacity decreases more and more, accompanied by fatigue and loss of judgment. Frequently, those affected develop depression at this stage.
Typically in the further course are behavior changes and personality disorders up to delusions. Patients are confused, anxious, restless or aggressive. They carry objects around, everyday activities such as shopping or dressing are getting worse and worse, people and objects are no longer recognized. Those affected live increasingly in the past.
In the end, they have to rely on comprehensive help, have no control over their bodily functions, can no longer speak and are often bedridden.
How is the diagnosis made?
With the utmost certainty, the disease can only be detected after the death of the patient by the typical deposits in the brain. In practice, however, it is important to diagnose the disease as early as possible, in particular to positively influence their course. The focus is on the typical medical history, usually described by the relatives.
On this basis, various studies are being carried out to exclude other physical or psychiatric disorders as the cause of dementia. These include blood tests, the ECG to assess cardiac function and a test to check lung function. In some cases, imaging techniques such as magnetic resonance imaging and computed tomography may also be indicated. Newer methods such as single-photon emission tomography (SPECT) and positron emission tomography (PET) are more informative, but extremely expensive.
The mental performance is checked by the physician by means of various neuropsychological tests (eg mini-mental status test). So the patient has to answer questions and - eg the clock face - draw, calculate, follow simple instructions and remember words. These tests are also used to assess the condition of the person in the process and to see if the therapy is effective.
What treatment is there?
Alzheimer's disease can not be cured at this time. However, some therapies are known that significantly delay the disease process. The goal is to train the everyday life skills of the person concerned and to maintain them for as long as possible. This works especially with behavioral, memory and self-preservation training as well as physiotherapy and occupational therapy.
For the patient important are a familiar environment and a regular, consistent daily routine, the demands on him must be tailored to his abilities. In addition, psychological support is particularly helpful for relatives who have a physical and mental exhausting responsibility and activity with the care of those affected.
Medication in Alzheimer's
Today, cholinesterase inhibitors and memantines are available for the treatment of Alzheimer's dementia. Cholinesterase inhibitors improve brain function. However, their effect is very different and usually does not last longer than twelve months. Memantine not only improves cognitive ability but also enhances everyday abilities. A recent study has shown that Memantine also improves in dementia-related behavioral disorders such as mood swings and restlessness.
Herbal preparations, especially those with extracts from the ginkgo tree, are also intended to promote memory. Several scientific studies show a positive effect, at least at high doses. Others, on the other hand, do not rate the effect higher than placebos.
What is the prognosis?
The course is individually very different and not exactly predictable. However, the disease progresses steadily in all cases. On average, those affected live about 8 years from the time of diagnosis - the causes of death are mostly physical illnesses as a result of bed-rest and mental and physical decline.
Present and Future
Experts warn against a new "widespread disease", which will pose an immense burden on the health and care system in the future. Researchers agree that the greatest opportunity lies in early detection of the disease long before the symptoms become visible. They assume that this could be achieved in the future with the help of a blood test or by means of imaging techniques.
To delay the onset of disease, based on current knowledge and based on American studies, healthy, vitamin-rich diet, physical and mental activity are extremely important. Currently there is an "Alzheimer's vaccine" in the experimental stage, which should prevent the deposition of protein particles. First results are encouraging. However, experts expect to have a developmental period of 10 to 20 years until they can be put to practical use.
Development of Alzheimer preventable?
Scientists at Freie Universität Berlin have made significant progress in research into Alzheimer's disease in April 2007. A research group has discovered how to prevent the development of the disease-causing amyloid beta peptide.
Until this time, the circumstances were unknown, under which this toxic peptide is formed, which leads to a degeneration of the nerve cells and thus to Alzheimer's disease. Laboratory tests have shown that the formation of the harmful substance can be prevented by altering the degradation of the precursor protein to produce shorter forms that are no longer toxic. Although the peptide arises in this way, but considerably less.