Alzheimer’s Disease and Cognitive Disorders

Alzheimer’s Disease and Cognitive Disorders Overview

Alzheimer’s disease is the most common cause of dementia. It is a degenerative condition, which means that it progressively gets worse over time. Its intensity can range from mild to severe.

With Alzheimer’s, two changes occur around the same time:

• Inside brain cells, proteins called neurofibrillary tangles begin to form.
• Outside of brain cells, in the gray matter of the brain, another abnormal protein called beta-amyloid starts to be deposited. These are known as senile or amyloid plaques.

At first, the number of tangles and plaques are small and they are found in areas of the brain that are important for memory. Over time, the number of plaques and tangles increases and spreads throughout the brain. This process eventually results in the death of brain cells and a decrease in the mass of the brain as a whole. This reduction in mass can sometimes be seen on x-rays.

Dementia is a general term used to describe loss of social skills and the ability to think and reason clearly. Dementia is not a disease itself but a cluster of symptoms that often occurs together. It can be caused by a number of different conditions or diseases. People with dementia usually have the following symptoms:

• Severe memory problems
• Trouble with speech
• Difficulty with abstract thinking
• Poor judgment

These symptoms usually develop very slowly over a long period, although sometimes they may appear to start abruptly or to worsen after an injury, illness, or an operation.

The milder forms of the symptoms described above can be normal or signs of other conditions. Careful evaluation by an experienced physician is needed to confirm or rule out a diagnosis of Alzheimer’s.

Please seek the help of a licensed medical professional if you are concerned about your health, and dial 9-1-1 if you are experiencing an emergency.

This type of drug is believed to work by replenishing a chemical in the brain that is important for memory. Cholinesterase inhibitors are used for mild, moderate, and severe Alzheimer’s disease.

Memantine (Namenda^®) is another type of drug used to treat Alzheimer’s disease and works in a different way than cholinesterase inhibitors. It blocks certain receptors in the brain which may protect nerve cells from too much stimulation. It is used in moderate to severe Alzheimer’s, often in combination with one of the cholinesterase inhibitor drugs.

These drugs cannot cure or reverse Alzheimer’s disease. However, there may be a moderate improvement or stabilization of symptoms for a period of time. There is clear evidence that people who take these medications do better in the long run than those who do not.

Some people with Alzheimer’s develop depression, which may be treated by an antidepressant medication, counseling, or both. A small percentage may become agitated or see and hear things that are not really there (auditory and visual hallucinations). Most of the time hallucinatory symptoms can be addressed without medications. Occasionally, small doses of antipsychotic medications such as risperidone or quetiapine may be necessary for limited periods.

Cognitive and Physical Rehabilitation

At some institutions, researchers are looking at ways to help those with Alzheimer’s improve their memory. Because this type of treatment is new, it is unknown how much it can help long-term.

In the advanced stages of Alzheimer’s disease, some patients may develop problems with walking, balance, and muscle tone. These symptoms can be helped by physical therapy. At Barrow Neurological Institute at Dignity Health St. Joseph’s Hospital and Medical Center, our highly trained rehabilitation team is skilled in the care of Alzheimer’s. We offer both inpatient and outpatient neuro-rehabilitation.

General Measures

It is important for people with Alzheimer’s to maintain optimal general health. Anything that worsens your medical condition can also worsen dementia.

Maintaining physical and intellectual activity is also important. However, it is important to not stress someone beyond their capacities. Our Alzheimer’s specialists can discuss with you which activities are appropriate and may be helpful.