Introduction
With the world-wide population ever increasing, so does the number of people diagnosed with Alzheimer’s disease. On average one in nine people aged 65 and older (11.3%) have Alzheimer’s disease (Alzheimers, n.d.), not including the possibility of early-onset Alzheimer’s disease, notably occurring in people aged 30 – 40 (John Hopkins Medicine, n.d.). Alzheimer’s disease is the most common type of dementia, or more specifically, neurodegenerative dementia (Centers for Disease Control and Prevention, 2019). Dementia is the decrease in or loss of cognitive functioning (thinking, reasoning, memory, etc.) as well as behaviour (National Institute on Aging, 2017). Dementia exists on a spectrum as mild memory loss or more severely, motor impairment, debilitating functioning to the extent of removing independence and creating reliance on another for basic activities. Alzheimer’s is not only disease that can mask itself subtly in forgetfulness, but also be so pervasive, intrusive, debilitating, and most of all life taking. Due to nature and variability of Alzheimer’s disease, individuals should be informed and educated about this disease to help prevent early onset, spot early warning signs, and help assist those affected.
Alzheimer’s disease and its effects on the brain
Although there is numerous research regarding Alzheimer’s disease, it is a disease that continues to be studied. A healthy brain contains billions of neurons that received, process, and send information in the brain, however, communication is disrupted in a brain affected by Alzheimer’s disease. It is found that in early stages of Alzheimer’s, there is a build-up of proteins in the brain that form amyloid plaques and tau tangles (Stutzmann, 2007). Amyloid plaques form clumps of proteins amongst neurons that disrupt cell function (Alzheimer’s Association, 2016). On the other hand, tau usually help transport nutrients between neurons, but when affected by Alzheimer’s, tau bind to other tau forming long threads that cause tangles and disrupt neuron transport harming synaptic communication (Alzheimer’s Association, 2016). Furthermore, a in a healthy brain, neurons die and diminish when not needed, but the brain does not lose neurons in large numbers. Thus, the changes that occur due to Alzheimer’s disease result in the brain losing neural connections at an increased rate (Stutzmann, 2007).
Warning signs and symptoms of Alzheimer’s disease
Alzheimer’s disease is a form of dementia; therefore, signs and symptoms carry similarities, but can vary widely from person to person. Most notably, according to the Centers for Disease Control and Prevention (2019), Alzheimer’s affects:
- Memory: Forgetting recent events (what you did this morning, where you put your keys, forgetting the name of a recent visitor, etc.), and having difficulties forming new memories (Huang, 2021).
- Attention: Comorbid with memory, attention declines and questions and conversations are repeated, asking for things (items, meals, etc.) that has already been received.
- Communication: Speech may change slightly through use of simpler words due to the inability to remember complex vocabulary, or unable to find the correct vocabulary entirely.
- Reasoning, judgment, and problem solving: The ability to judge a situation and reason accordingly diminishes (undressing in public when it is hot or lashing out at help because it is misinterpreted as a threat), (Huang, 2021).
- Visual perception beyond typical age-related changes in vision: There is increased difficulty when interpreting external cues (visual and auditory) and they could become disorientated.
However, Alzheimer’s can differ greatly from person to person, so it is not to say that occasionally forgetting things warrants panic, as abnormalities in daily functioning also develop later in life, however, it is good practice to note the incident for future comparison.
The varying stages of Alzheimer’s disease
Alzheimer’s disease is progressive and worsens over time. Progression is different from person to person. Generally, there are three stages of Alzheimer’s disease:
- Early-stage/Mild Alzheimer’s: characterised by increased memory loss and decreased cognitive functioning. Symptoms may include, getting lost, increased task completion time, question repetition, and personality changes (National Institute on Aging, 2017; gov, n.d.).
- Middle-stage/Moderate Alzheimer’s: certain areas of the brain are damaged and neurons diminish. Symptoms due to neural damage may include language and speech, conscious thought, sensory information, inability to recognise once familiar people, and completion of complex tasks (National Institute on Aging, 2017; gov, n.d.).
- Late-stage/Severe Alzheimer’s: Brain tissue shrinks significantly, communication is difficult, entirely dependant on others for care, and possibly bedridden due to bodily decline.
The causes of Alzheimer’s disease
There are many factors that contribute to the development of Alzheimer’s disease such as environmental factors, biological factors, and psychological factors. Alzheimer’s disease is complex and there is no single, definitive cause but rather, it is a combination of various risk factors which will be discussed next. The largest risk factor for developing Alzheimer’s disease is age, according to Bhushan (2018), the majority of people who suffer from Alzheimer’s disease are aged 65 years or above. It has also been proven that genetics plays a role in the development of Alzheimer’s disease, evidence thereof began to emerge in the 1990’s. It was found that Alzheimer’s disease was implicated in genetic mutations of the amyloid precursor protein (APP) (Chui et al., 1985), presenilin (PSEN) genes (Levy-Lahad et al., 1995) and allelic variation in apolipoprotein E (Apo E) (Strittmatter et al., 1993).
Blass and Zemcov (1984) found that Alzheimer’s disease may also be a result of mitochondrial dysfunction as an early marker of Alzheimer’s disease is the presence of swollen and distorted mitochondria accompanied by a decline in the cerebral metabolic rate. Furthermore, the genetic aspect of Alzheimer’s disease may be due excess maternal versus paternal inheritance, consistent with mitochondrial inheritance (Blass & Zemcov,1984). Other plausible causes of Alzheimer’s disease that are still being investigated are degeneration of anatomical pathways, including the cholinergic and cortico-cortical pathways, exposure to aluminium, head injury, or malnutrition, a compromised blood brain barrier, immune system dysfunction, and infectious agents (Armstrong, 2013).
The treatment of Alzheimer’s disease
Neurodegenerative dementias, like Alzheimer’s disease, currently have no known cure. It is, however, possible to be medicated against symptoms resulting from Alzheimer’s such as anxiety, insomnia, change in mental function, and other behaviour changes (Wang & Reddy, 2017; Kuns et al., 2020). Research is still underway to develop more treatment options.
Although it cannot be treated as of yet, practices can be implemented to decrease chances of developing Alzheimer’s disease. These practices include, but are not limited to, healthy lifestyle, regular exercise, maintaining social contact (Centers for Disease Control and Prevention, 2019).
Care: Safety and supportive measures
There are various ways to help people affected by Alzheimer’s retain some form of independence and cope with the different changes such ass memory loss. Firstly, one must consider the environment that the affected is choosing to stay in. Antonangeli (1994) notes that there need to be three goals when considering the environment. The environment must be, 1) calming and reassuring, 2) safe and supportive, and 3) provide the affected individual with appropriate things to do. Furthermore, Huang (2021) notions that the environment needs to help with orientation. This is achieved by using visible calendars, clocks with large numbers, ambient noises (radio/stereo), well-lit rooms, and sufficient night-lighting.
Structure and routine should be put in place to further assist with orientation, independence, and provide a sense of security and stability. Routine assists people with Alzheimer’s to remember, and possibly assist with sleeping better Huang (2021)
Staying active could assist in decreasing the rate at which Alzheimer’s disease affects the brain, by slowing symptom growth. Exercise interventions might improve cognitive functioning of Alzheimer’s disease or slow down the decline of cognition (Du et al., 2018). Furthermore, activities scheduled regularly can help maintain the feeling of independence and feeling of being needed by focusing attention on pleasurable or useful tasks Huang (2021).
Although there is no known cure for Alzheimer’s disease, it should be noted that people affected require the love and support from the people around them.
HELPLINE NUMBERS:
Alzheimer’s South Africa
National helpline: 0860 102 681
Email: info@alzheimers.org.za
Website: https://alzheimers.org.za/
Southern Cape
Tel: 044 877 0417
Fax: 044 877 0417
Email: managersc@alzheimers.org.za
Western Cape
Tel: 021 979 2724
Fax: 086 238 5366
Email: managerwc@alzheimers.org.za
DementiaSA
National helpline: 0860 636 679
Website: https://www.dementiasa.org/
Tel: 021 421 0077/0078 or 021 418 5888
Fax: 021 418 2772
General email: info@dementiasa.org
[1] Author writes in her capacity as Vice-chairperson of the PsySSA Student Division’s Media and Marketing Subcommittee. The PsySSA Student Division is a division of the Psychological Society of South Africa (PsySSA).
References
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