Brain Function and Disorders

Dementia and Alzheimer’s Disease

Alzheimer’s disease is a progressive brain disorder that causes memory loss and cognitive impairment. There are many types of dementia, but Alzheimer’s disease accounts for 60% of cases.

As we age, our brains shrink and lose their ability to function properly. Alzheimer’s disease is one of the most common forms of dementia.

Alzheimer’s disease means

Alzheimer’s disease is a degenerative brain disease and the most common form of dementia. Dementia is not a specific disease. It’s an overall term that describes a group of symptoms.

What is dementia?

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Memory loss is an example. Alzheimer’s is the most common type of dementia.

What is Alzheimer’s?

Alzheimer’s is a type of dementia that causes problems with memory, thinking, and behaviour. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks.

Alzheimer’s disease vs dementia

While dementia is a general term, Alzheimer’s disease is a specific brain disease. It is marked by symptoms of dementia that gradually get worse. Alzheimer’s disease first affects the part of the brain associated with learning, so early symptoms often include changes in memory, reasoning skills.

Dementia types

  • Alzheimer’s is the most common cause of dementia, a general term for memory loss and other cognitive abilities serious enough to interfere with daily life. Alzheimer’s disease accounts for 60 percent to 80 percent of dementia cases.
  • Alzheimer’s is not a normal part of ageing. The greatest known risk factor is increasing age, and most people with Alzheimer’s are 65 and older. But Alzheimer’s is not just a disease of old age.
  • Alzheimer’s worsens. Alzheimer’s is a progressive disease, where dementia symptoms gradually worsen over several years. In its early stages, memory loss is mild, but with late-stage Alzheimer’s, individuals lose the ability to carry on a conversation and respond to their environment. On average, a person with Alzheimer’s lives four to eight years after diagnosis but can live as long as 20 years, depending on other factors.
  • Alzheimer’s has no current cure, but treatments for symptoms are available and research continues. Although current Alzheimer’s treatments cannot stop Alzheimer’s from progressing, they can temporarily slow the worsening of dementia symptoms and improve quality of life for those with Alzheimer’s and their caregivers.
  • Today, there is a worldwide effort underway to find better ways to treat the disease, delay its onset, and prevent it from developing.

Alzheimer disease symptoms

The most common early symptom of Alzheimer’s is difficulty remembering newly learned information.

Just like the rest of our bodies, our brains change as we age. Most of us eventually notice some slowed thinking and occasional problems with remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work may be a sign that brain cells are failing.

The most common early symptom of Alzheimer’s is difficulty remembering newly learned information because Alzheimer’s changes typically begin in the brain’s part that affects learning. As Alzheimer’s advances through the brain, it leads to increasingly severe symptoms, including disorientation, mood, and behaviour changes; deepening confusion about events, time and place; unfounded suspicions about family, friends, and professional caregivers are more serious memory loss and behaviour changes; and difficulty speaking, swallowing, and walking.

People with memory loss or other potential signs of Alzheimer’s may find it hard to recognize they have a problem. Signs of dementia may be more obvious to family members or friends. Anyone experiencing dementia-like symptoms should see a doctor as soon as possible.

Earlier diagnosis and intervention methods are improving dramatically, and treatment options and sources of support can improve the quality of life.

What causes Alzheimer’s disease?

Alzheimer’s disease is thought to be caused by the abnormal build-up of proteins in and around brain cells. One protein involved is called amyloid, deposits of which form plaques around brain cells. The other protein is called tau, deposits of which form tangles within brain cells.

Alzheimer’s diagnosis

There is no single test that proves a person has Alzheimer’s. While physicians can almost always determine if a person has dementia, it may be difficult to determine the exact cause. Diagnosing Alzheimer’s involves a complete assessment that considers all potential causes.

Medical history

During the medical workup, your doctor will review your medical history. He or she will want to know about any current and past illnesses, as well as any medications you are taking. The doctor will also ask about key medical conditions affecting other family members, including whether they may have had Alzheimer’s disease or other dementias.

Physical exam and diagnostic tests

During a medical workup, you can expect the physician to:

  • Ask about diet, nutrition, and the use of alcohol.
  • Review all medications. (Bring a list or the containers of all medicines currently being taken, including over-the-counter drugs and supplements.)
  • Check blood pressure, temperature, and pulse.
  • Listen to the heart and lungs.
  • Perform other procedures to assess overall health.
  • Collect blood or urine samples for laboratory testing

Information from a physical exam and laboratory tests can help identify health issues that can cause symptoms of dementia. Conditions other than Alzheimer’s that may cause confused thinking, trouble focusing or memory problems include anaemia, infection, diabetes, kidney disease, liver disease, certain vitamin deficiencies, thyroid abnormalities, and problems with the heart, blood vessels and lungs.

Neurological exam

During a neurological exam, the physician will closely evaluate the person for problems that may signal brain disorders other than Alzheimer’s. The doctor will look for signs of small or large strokes, Parkinson’s disease, brain tumours, fluid accumulation on the brain, and other illnesses that may impair memory or thinking.

The physician will test:

  • Reflexes
  • Coordination, muscle tone, and strength.
  • Eye movement.
  • Speech
  • Sensation

The neurological exam may also include a brain imaging study.

Mental status tests

Mental status testing evaluates memory, ability to solve simple problems, and other thinking skills. Such tests give an overall sense of whether a person:

  • Is aware of symptoms.
  • Knows the date, time, and where he or she is.
  • Can remember a short list of words, follow instructions and do simple calculations.

Mini-mental state exam (MMSE) and the mini-cog test

The MMSE and Mini-Cog test are two commonly used assessments.

During the MMSE, a health professional asks a patient a series of questions designed to test a range of everyday mental skills. The maximum MMSE score is 30 points. A score of 20 to 24 suggests mild dementia, 13 to 20 suggest moderate dementia, and less than 12 shows severe dementia. On average, the MMSE score of a person with Alzheimer’s declines about two to four points each year.

During the Mini-Cog, a person is asked to complete two tasks:

  1. Remember, and a few minutes later, repeat the names of three common objects.
  2. Draw the face of a clock showing all 12 numbers in the right places and time specified by the examiner.

The results can help a physician determine if further evaluation is needed.

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Computerized tests

A growing area of research is the development of devices to administer computer-based tests of thinking, learning, and memory, called cognitive tests.

The U.S. Food and Drug Administration (FDA) has cleared several computerized cognitive testing devices for marketing. Some physicians use computer-based tests such as these besides the MMSE and Mini-Cog. Computerized tests have several advantages, including giving tests exactly the same way each time. Using both clinical tests and computer-based tests can give physicians a clearer understanding of the cognitive difficulties experienced by patients.

Mood assessment

Besides assessing mental status, the doctor will evaluate a person’s sense of well-being to detect depression or other mood disorders that can cause memory problems, loss of interest in life, and other symptoms that can overlap with dementia.

Brain imaging

A standard medical workup for Alzheimer’s disease often includes structural imaging with magnetic resonance imaging (MRI) or computed tomography (CT). These tests are primarily used to rule out other conditions that may cause symptoms similar to Alzheimer’s but require different treatment. Structural imaging can reveal tumors, evidence of small or large strokes, damage from severe head trauma, or a build-up of fluid in the brain.

Imaging technologies have revolutionized our understanding of the structure and function of the living brain. Researchers are studying other brain imaging techniques so they can better diagnose and track the progress of Alzheimer’s.

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