Alzheimer Disease

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Alzheimer Disease
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Specialty scores for Alzheimer Disease

Overview

Alzheimer's disease (AD) is a chronic, slowly progressive, irreversible neurodegenerative disorder characterized by memory and cognitive decline severe enough to interfere with a person's daily, social, and/or occupational life. It is the most common cause of dementia in the elderly, accounting for 60% to 70% of all cases.

Cause of Alzheimer disease

The exact cause is unclear. However, the following genetic and environmental factors might incite the disease cascade in Alzheimer:

  • Aging: Aging is the greatest risk factor for dementia due to AD. The prevalence is 2% to 3% at the age of 65 years and then doubles every 5 years
  • Genetics/family history: A family history of the disease in a first-degree relative (i.e. parent or sibling) constitutes the second most common risk factor
  • APOE 4 genotype
  • Obesity
  • Diabetes mellitus
  • Hypertension and hypercholesterolemia
  • Chronic exposure to cigarette smoke
  • Traumatic brain injury
  • Down syndrome

Signs and Symptoms

The history should be ideally obtained from a close relative as these patients lack awareness of their symptoms, a condition called anosognosia.

Early symptoms of AD include:

  • Forgetfulness
  • Difficulty with word finding during conversation (anomia)
  • Difficulty in making new memories ("short-term" memory)
    • "Long-term" memory remains relatively intact, until later stages
  • Apathy
  • Unusual slowness in carrying out activities of daily living
  • Behavioral symptoms
    • Anxiety
    • Depression

As the disease advances, the patient experiences following symptoms:

  • Recklessness with self-care
  • Language disturbances
  • Wandering and getting lost
  • Extrapyramidal symptoms like parkinsonism, bradykinesia, tremor, dystonia, and tardive dyskinesia
  • Inability to perform more complex tasks such as paying bills
  • Behavioral symptoms
    • Agitation
    • Sleep and circadian rhythm disturbances
    • Delusions
    • Violent behaviors
    • Hallucinations

Diagnosis

The diagnosis of AD relies on clinical and neuropathologic features.

  • A CT or MRI scan shows gross cerebral atrophy
  • The neuropathologic hallmarks of AD are β-amyloid neuritic plaques and intraneuronal neurofibrillary tangles.Accumulation of alpha-synuclein in the form of Lewy bodies can also be found in certain brain regions

Treatment

To date, there is no cure for AD. The symptomatic treatment available offers minimal, if any benefit. Medications like acetylcholinesterase inhibitors (rivastigmine, galantamine, tacrine, and donepezil) and an NMDA receptor antagonist (memantine) are approved for their use in AD. Other symptomatic treatments like antidepressants for managing depression also have a role in AD.

FDA Approved Medicines

  • FDA approved caprylidene, sold as Axona, manufactured by Accera for the treatment of Alzheimer's disease ( Alzheimer Disease ) in year 2009.
  • FDA approved donepezil hydrochloride, sold as ARICEPT, manufactured by Eisai for the treatment of Alzheimer's Disease ( Alzheimer Disease ) in year 1996.
  • FDA approved rivastigmine tartrate, sold as Exelon, manufactured by Novartis for the treatment of the treatment of mild to moderate dementia of the Alzheimer's type ( Alzheimer Disease | Dementia ) in year 2000.
  • FDA approved memantine HCl, sold as Namenda, manufactured by Forest Laboratories for the treatment of moderate to severe dementia of the Alzheimer�s type. ( Alzheimer Disease | Dementia ) in year 2003.
  • FDA approved memantine hydrochloride extended-release + donepezil hydrochloride, sold as Namzaric, manufactured by Forest Laboratories for the treatment of moderate to severe dementia of the Alzheimer's type ( Alzheimer Disease | Dementia ) in year 2014.