Alzheimer

Updated on

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

Alzheimer's is the most common type of dementia. The slowly progressing brain disease leads to memory loss, confusion and disorientation. Alzheimer's is not curable, but it can be alleviated and slowed down. Read more about the topic here: How does Alzheimer's disease develop? How do you recognize the disease at an early stage? How can their progression be slowed down? How can you prevent Alzheimer's disease?

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F00G30

Alzheimer's: Brief Overview

What is Alzheimer's? The most common form of dementia, affects around 20% of people over the age of 80. Differentiation of presenile (65 years)
Causes: Death of nerve cells in the brain due to protein deposits
Risk factors: age, high blood pressure, high cholesterol levels, vascular calcification, diabetes mellitus, depression, smoking, little social contact, genetic factors
Early symptoms: dwindling short-term memory, disorientation, word-finding disorders, changed personality, weakened immune system
Diagnostics: by combining several tests, consultation with a doctor, brain scans using PET-CT or MRT, liquor diagnostics
Treatment: no cure, symptomatic therapy with antidementia drugs, neuroleptics, antidepressants; non-drug therapy (e.g. cognitive training, behavioral therapy)
Prevention: a healthy diet, regular exercise, memory demands, lots of social contacts

Alzheimer's: causes and risk factors

In the brain of Alzheimer's patients, nerve cells and their connections to one another gradually die off. As a result, the brain shrinks by up to 20 percent: the convoluted furrows on the surface of the brain deepen, the cerebral chambers expand. The destruction of the nerve cells begins in the so-called olfactory brain. It then encroaches on regions of the brain that are responsible for memory. At some point it encompasses the entire surface of the brain.

The brain shrinks in Alzheimer's

In Alzheimer's disease, nerve cells die. This causes the brain to slowly shrink. Especially the so-called spiral furrows on the surface of the brain deepen and the cerebral chambers expand.

The Meynert basal core is particularly affected by cell death at an early stage: the nerve cells in this deeper brain structure produce the neurotransmitter acetylcholine. Cell death in the Meynert basal nucleus thus triggers a considerable deficiency in acetylcholine. This disrupts information processing: those affected can hardly remember events that have occurred recently. So your short-term memory is dwindling.

Protein deposits kill nerve cells

In the affected brain regions there are two different types of protein deposits that kill the nerve cells. It is unclear why these form.

Beta-amyloid: Hard, indissoluble plaques made of beta-amyloid form between the nerve cells and in some blood vessels. These are fragments of a larger protein, the function of which is still unknown.

Normally, beta amyloid is broken down. In Alzheimer's patients, this clean-up process no longer works in the brain, so that the protein fragment is deposited. This inhibits the supply of energy and oxygen to the brain - nerve cells die.

Plaques in the brain in Alzheimer's disease

In Alzheimer's disease, amyloid beta proteins clump together to form plaques. These disrupt communication between the nerve cells, more and more of which die off over time.

Tau protein: In addition, abnormal tau fibrils - indissoluble, twisted fibers made from the so-called tau protein - form in the nerve cells of the brain in Alzheimer's patients. They disrupt the stabilization and transport processes in the brain cells, so that they die.

Alzheimer's: Risk Factors

The main risk factor for Alzheimer's is age: only two percent of those under 65 develop this form of dementia. In the 80 to 90 year old age group, however, at least one in five people is affected, and in the over 90 year olds even more than a third suffers from Alzheimer's.

Age alone does not cause Alzheimer's. Rather, experts assume that other risk factors must be added before the disease breaks out.

Overall, the following factors can promote Alzheimer's disease:

age
genetic causes
high blood pressure
increased cholesterol
high level of homocysteine in the blood
Vascular calcification (arteriosclerosis)
poorly controlled blood sugar in diabetes
oxidative stress, caused by aggressive oxygen compounds that play a role in the formation of protein deposits in the brain

There are other factors that may increase the risk of Alzheimer's disease that need further research. This includes inflammation in the body that persists for a long time: it could damage brain cells and promote the formation of protein deposits, researchers believe.

Other possible Alzheimer's risk factors are a low general level of education, head injuries, a brain infection from viruses and an increase in autoimmune antibodies in the elderly.

Aluminum & Alzheimer's

Autopsies have shown that the brains of deceased Alzheimer's patients have an increased aluminum concentration. But that doesn't necessarily mean that aluminum causes Alzheimer's. Animal experiments speak against it: If you give aluminum to mice, they still do not get Alzheimer's disease.

Rather, elevated aluminum levels may be a consequence of the disease and not a cause of Alzheimer's. Whether this is actually the case needs to be researched in further studies.

Three questions about Alzheimer's

Three questions for

Priv.-Doz. Dr. Dr. med. Hans-Herrmann Fuchs,
Specialist in neurology and psychiatry
1
I've been very forgetful lately. Can that be Alzheimer's?

Priv.-Doz. Dr. Dr. med. Hans-Herrmann Fuchs
Don't worry - most of the time, the onset of memory disorders is normal old-age forgetfulness. However, it becomes problematic when the problems become more and more serious and further deficits are added - such as attention and perception disorders, disorders of cognitive processing speed, temporal and spatial disorientation, loss of divided attention, arithmetic disorders. Then dementia is very likely.
2
How clearly can the diagnosis of Alzheimer's be made?

Priv.-Doz. Dr. Dr. med. Hans-Herrmann Fuchs
In addition to the typical symptoms, there are some examination methods. This includes special thinking and memory tests as well as imaging procedures (magnetic resonance imaging of the brain, PET). A nerve water examination for special changes (tau proteins, ß-amyloid) can also be helpful. Overall, the diagnosis can be made with a probability of over 75 percent. The diagnostic options will certainly improve in the future.
3
As an Alzheimer's patient, can I do something to slow the disease down?

Priv.-Doz. Dr. Dr. med. Hans-Herrmann Fuchs
Yes, take your medication regularly! There are several (e.g. so-called cholinesterase inhibitors, memantine, galantamine) that can slow the progression of Alzheimer's disease. It is also good to complete cognitive training and to exercise regularly. A regression of the symptoms or a cure of the disease is unfortunately not possible with the current means.
Priv.-Doz. Dr. Dr. med. Hans-Herrmann Fuchs,
Specialist in neurology and psychiatry
Dr. Fuchs works in the private outpatient clinic for neurology in the Marianowicz Center and in the private clinic at Jägerwinkel / Tegernsee.

Is Alzheimer's Disease Hereditary?

Only about one percent of all Alzheimer's patients have the familial form of the disease: Alzheimer's is triggered by various genetic defects that are passed on. The mutation affects the amyloid precursor protein gene and the presenilin-1 and presenilin-2 genes. Anyone who carries these mutations will definitely develop Alzheimer's disease between the ages of 30 and 60.

The vast majority of Alzheimer's patients, however, show the sporadic form of the disease, which generally only breaks out after the age of 65. It is true that the sporadic form of Alzheimer's disease also seems to have a genetic component: This involves changes in the gene for the protein apo-lipoprotein E, which is responsible for transporting cholesterol in the blood. However, changes in this gene do not lead to a certain outbreak of the disease, but only increase the risk of it.

In general, the older someone is when Alzheimer's disease breaks out, the lower the likelihood that it is a familial form. Relatives usually do not have to worry that they may have inherited the disease.

Alzheimer's: symptoms

In the course of Alzheimer's disease, the symptoms worsen and new complaints are added. That is why you will find the symptoms below, sorted according to the three stages into which the course of the disease is divided: early stage, middle stage and late stage:

Early Alzheimer's Symptoms

The first Alzheimer's symptoms are small memory gaps that affect short-term memory: For example, patients cannot find objects that have recently been put down or cannot remember the content of a conversation. You can also “lose the thread” in the middle of a conversation. This increasing forgetfulness and absent-mindedness can confuse and frighten those affected. Some also react to this with aggressiveness, defense, depression or withdrawal.

Alzheimer's can also sometimes be recognized by word-finding disorders, but there can also be other causes for such. In the case of a word-finding problem, those affected can sometimes no longer remember familiar terms.

Other early signs of Alzheimer's can be slight orientation problems, lack of drive and slowed thinking and speaking.

With mild Alzheimer's dementia, everyday life can usually still be managed without any problems. Those affected often only need help with more complicated things, for example with keeping their bank account or using public transport.

Middle-stage Alzheimer's symptoms

Alzheimer's symptoms in the middle stages of the disease are exacerbated memory disorders: Patients can remember less and less recent events, and long-term memories (such as their own wedding) gradually fade. Familiar faces are less and less recognized.

The difficulties in orienting oneself in time and space are also increasing. For example, patients look for their long-dead parents or cannot find their way home from the usual supermarket.

In addition, patients now need more and more help with simple activities such as cooking, combing or bathing. An independent life is then hardly possible.

Communication with patients is also becoming increasingly difficult: those affected can often no longer form whole sentences. They need clear prompts that often have to be repeated before they sit down at the dining table, for example.

Other possible Alzheimer's symptoms in the middle stages of the disease are an increasing urge to move around and severe restlessness. The patients, for example, restlessly pace back and forth or keep asking the same question. Delusional fears or beliefs (such as being robbed) can also arise.

Late-stage Alzheimer's symptoms

In the late stages of the disease, the patients are completely in need of care. Many of them need a wheelchair or are bedridden. You no longer recognize family members and other people close to you. The ability to speak is now limited to a few words. Eventually, patients can no longer control their bladder and bowel (urinary and fecal incontinence).

Increasing problems with chewing, swallowing and breathing as well as stiffness of the limbs are typical late-stage Alzheimer's symptoms. The weakened immune system often leads to infections (such as pneumonia), which in many cases lead to death.

Atypical Alzheimer's disease

Alzheimer's disease is untypical in around a third of patients who develop the disease at a young age (a small group in total):

Some patients develop behavioral changes towards antisocial and conspicuous behavior that are similar to those in frontotemporal dementia.

In a second group of patients, difficulty finding words and slow speech are the main symptoms.

A third form of the disease causes problems with vision.

Alzheimer's: examinations and diagnosis

If you notice increasing forgetfulness in yourself (or a loved one), you should see a family doctor. If necessary, they will refer you to a neurologist, psychiatrist or memory clinic. Such an outpatient clinic is a department of a hospital that specializes in brain disorders. Various tests are carried out there to investigate the suspicion of Alzheimer's disease. So far there has been no single examination and no specific laboratory test with which an Alzheimer's diagnosis could be made unambiguously.

Medical history survey

If Alzheimer's is suspected, the doctor will first talk to you in detail to collect your medical history (anamnesis). He asks you about your symptoms and any previous illnesses. In addition, the doctor will ask about all the medications you are taking. Because some preparations can impair brain performance. During the conversation, the doctor also pays attention to how well you can concentrate.

Ideally, someone close to you will accompany you to this consultation with the doctor. Because in the course of Alzheimer's disease, the personality of the person affected can also change. Phases of aggressiveness, suspicion, depression, fears and hallucinations can occur. Such changes are sometimes noticed more quickly by fellow human beings than by those affected.

Physical examination

After the interview, the doctor will routinely examine you. For example, he measures blood pressure and checks the muscle reflexes and the pupillary reflex.

Dementia tests

With a dementia test, simple exercises can be used to determine whether you have dementia. For example, you have to memorize and repeat as many as possible from a word list with ten terms. Important dementia tests are the clock test, MMST (Mini Mental Status Test) and the DemTect (dementia detection test). At an early stage, however, dementia cannot be easily recognized. In addition, such tests do not allow a distinction between different forms of dementia (Alzheimer's, vascular dementia, etc.).

In addition to the short tests mentioned, more detailed neuropsychological examinations are often carried out.

Apparative investigations

If there are clear signs of dementia, the patient's brain is usually examined using positron emission computed tomography (PET / CT) or magnetic resonance imaging (MRI, also known as magnetic resonance imaging). This is how you can find out whether the brain matter has decreased. This would corroborate the suspicion of dementia.

Imaging examinations of the skull are also used to identify any other diseases that may be responsible for the symptoms of dementia, such as a brain tumor.

Laboratory tests

Blood and urine samples from the patient can also be used to determine whether a disease other than Alzheimer's is causing the dementia. This can be, for example, a thyroid disease or a lack of certain vitamins.

Liquor diagnostics provide relatively reliable results: a sample of the cerebrospinal fluid (liquor) is taken from the lumbar spine (lumbar puncture) and examined in the laboratory. If the concentrations of certain proteins (amyloid protein and tau protein) in the CSF are characteristically changed, there is a high probability that Alzheimer's disease is present.

If the doctor suspects that the patient has the rare hereditary form of Alzheimer's disease, a genetic test can provide certainty.

Alzheimer's: treatment

There is only symptomatic treatment for Alzheimer's disease - a cure is not yet possible. However, the right therapy can help patients manage their everyday lives independently for as long as possible. In addition, Alzheimer's medication and non-drug therapy measures alleviate the patient's symptoms and thus improve their quality of life.

Antidementia drugs

Various groups of active ingredients are used in drug therapy for Alzheimer's disease:

So-called cholinesterase inhibitors (such as donepezil or rivastigmine) block an enzyme in the brain that breaks down the neurotransmitter acetylcholine. This messenger substance is important for communication between the nerve cells, for concentration and orientation.

Sufficient acetylcholine is no longer produced in Alzheimer's patients. In the early to middle stages of the disease, this deficiency can be compensated for for some time with cholinesterase inhibitors: this makes everyday activities easier for those affected. In addition, cognitive abilities such as thinking, learning, remembering and perceiving are retained longer.

The active ingredient memantine is often given in moderate to severe Alzheimer's dementia. Like cholinesterase inhibitors, it can delay the decline in mental performance in some patients. More precisely, memantine prevents an excess of the neurotransmitter glutamate from damaging the brain cells. Experts suspect that in Alzheimer's patients an excess of glutamate contributes to the death of nerve cells.

Ginkgo leaf extracts (Ginkgo biloba) are said to improve blood flow to the brain and protect nerve cells. Patients with mild to moderate Alzheimer's dementia may be able to cope better with everyday activities again. In high doses, ginkgo also appears to improve memory and alleviate psychological complaints, as some studies show.

Other drugs for Alzheimer's

Alzheimer's disease is often associated with psychological complaints and changes in behavior, such as aggressiveness, passivity, restlessness or anxiety. If non-drug measures do not help, the doctor may prescribe so-called neuroleptics (such as risperidone or haloperidol).

However, these active ingredients can have serious side effects. These include an increased risk of stroke and increased mortality. The use of neuroleptics is therefore closely monitored. In addition, these drugs should be dosed as low as possible and not taken long-term.

Many Alzheimer's patients also suffer from depression. On the other hand, antidepressants such as citalopram, paroxetine or sertraline help.

In addition, other existing underlying and concomitant diseases such as increased blood lipid levels, diabetes or high blood pressure must be treated with medication.

Non-drug treatment

Non-drug therapies are very important in Alzheimer's. They can help to postpone the loss of mental abilities and to maintain independence in everyday life for as long as possible.

For example, reality orientation training helps patients to find their way around in time and space.Spatial orientation is supported, for example, by colored markings in various living rooms such as the bathroom and kitchen. The time orientation can be improved with the help of clocks, calendars and pictures of the current season.

Cognitive training can be particularly useful in mild to moderate Alzheimer's dementia: It can train the ability to learn and the ability to think. Simple word games, guessing terms or adding rhymes or well-known proverbs are suitable for this.

As part of behavior therapy, a psychologist or psychotherapist helps patients deal better with psychological complaints such as anger, aggression, fears and depression.

Autobiographical work is suitable for keeping memories of earlier stages of life alive: relatives or carers ask Alzheimer's patients specifically about their previous life. Photos, books or personal items can help bring back memories.

Everyday skills can be maintained and promoted by means of occupational therapy. For example, Alzheimer's patients practice dressing, combing, cooking and hanging up laundry.

Other non-drug methods that are used in Alzheimer's disease are, for example, art and music therapy, physiotherapy, aromatherapy and "Snoezelen" (stimulation of the senses such as touch, smell, taste, etc.).

Alzheimer's: course and prognosis

Alzheimer's disease leads to death after eight to ten years on average. Sometimes the disease also progresses much faster, sometimes more slowly - according to the current state of knowledge, the time span ranges from three to twenty years. In general, the later the disease occurs, the shorter the course of Alzheimer's disease.

Prevent Alzheimer's

As with many diseases, the chances of getting Alzheimer's can be reduced by a healthy lifestyle. Factors such as high cholesterol levels, obesity, high blood pressure and smoking can promote Alzheimer's and other dementias. Such risk factors should therefore be avoided or treated as far as possible.

In addition, a Mediterranean diet with lots of fruit, vegetables, fish, olive oil and whole grain bread seems to prevent Alzheimer's and other forms of dementia.

Regular exercise and sport can also reduce the risk of the disease: The reason is that physical activity stimulates the metabolism and blood circulation in the brain, among other things. This enables nerve cells to network better and more closely, which promotes their communication.

The risk of Alzheimer's and other forms of dementia also decreases if you are mentally active throughout your life, both at work and in your free time. For example, cultural activities, puzzles, and creative hobbies can stimulate the brain and preserve memory.

As studies show, a lively social life can also prevent dementia diseases such as Alzheimer's disease: the more you go out among people and get involved in communities, the greater the likelihood of being mentally fit even in old age.