What is Alzheimer’s disease and How to deal with it ?

Alzheimer’s disease 

Alzheimer’s disease is a progressive neurologic disorder that causes the brain to shrink (atrophy) and brain cells to die which is the most common cause of dementia a continuous decline in thinking, behavioral and social skills that affects a person’s ability to function independently.

 

ETIOLOGY

• Unknown but involves amyloid beta accumulation initially, then synaptic dysfunction, neuro-degeneration, and eventual neuronal loss
• Age, genetics, systemic disease, behaviors (smoking), and other host factors may influence the response to amyloid beta and/or the pace of progression toward the clinical manifestations of AD.

 

RISK FACTORS

• Aging, family history, Down syndrome
• Hypertension, cardiovascular, and carotid artery disease
• Smoking
• Head trauma

 

GENERAL PREVENTION

• Intellectual challenge (puzzles) and regular physical exercise may offer preventive benefit.
• You have to control your vascular risk factors (e.g., hypertension) and you have to monitor your cholesterol as well.
• Physical activities may help to prevent or delay cognitive decline.
• Ginkgo biloba extracts (120 mg/day) is beneficial especially if your condition is associated with memory loss and loss of cognition.
• Coenzyme Q10.
• Omega-3 fatty acids.

GENERAL MEASURES

• You need to optimize treatment of associated associated conditions (including hearing and vision loss).
• You have to monitor your environment for safety and security and avoid sudden changes in environment.
• High-fat (70%) diet found to be as effective in slowing progression as medications in small trials.

 

PHARMACOLOGICAL MANAGEMENT

First-Line Of Treatment

• Donepezil (Aricept): Start at 5 mg/day, you may increase to 10 mg/day after 1 month.
• Rivastigmine: Start at 1.5 mg PO BID, increase by 1.5 mg BID every 2 weeks; maintenance 6 to 12 mg/day
• Galantamine: Start at 4 mg BID for 4 weeks, then increase by 4 mg BID every month with goal of 16 to 24 mg/day dose.
• N-methyl-d-aspartate (NMDA) receptor antagonists.
  • Monotherapy or in combination with acetylcholinesterase inhibitors.

• Memantine: 5 mg/day, you may increase gradually to target dose of 10 mg after 4 weeks. Moreover, it improves behavioral issues.

 

References

1. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447
2. https://www.memoryrate.com/?dkt_nbr=030603amoply&msclkid=14053cf22b7a1fa0bf3c5cf7a873a699
3. B McGuinness, D Craig, R Bullock, et al. Statins for the prevention of dementia. Cochrane Database Syst Rev. 2016;(1):CD003160.
4. CC Tan, JT Yu, HF Wang, et al. Efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer’s disease: a systematic review and meta-analysis. J Alzheimers Dis. 2014;41(2):615–631.