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Q) My mother has been diagnosed with Alzheimer’s. What can you tell me about it?
A) Alzheimer’s disease (AD) is the most common type of dementia diagnosed in Canada today. It is an irreversible, progressive brain disorder that slowly robs the victim of their memories and thinking skills.
In the U.S. it is currently ranked as the 6th leading cause of death but recent estimates indicate that the disorder may have moved up to third, just behind cancer & heart disease. While it can strike either sex, there are a greater percentage of females diagnosed with it although this may well be explained by the fact that they tend to live longer.
Most people with AD have the late-onset form in which symptoms first rear their ugly head in the mid sixties. There are an unfortunate few (less than 5% of all Alzheimer’s cases) who can begin to suffer from the symptoms of AD at ages as young as 30.
As of yet, scientists do not fully understand what causes Alzheimer’s although those with early-onset are usually due to a genetic mutation.
Late-onset AD probably arises from a complex interaction of genetic, lifestyle and environmental factors which slowly change the brain over decades starting long before the symptoms begin to appear.
These brain changes involve the build-up of two proteins within it.
One protein is called beta amyloid and it acts as sticky plaque that seems to interfere with the connections (known as synapses) between neurons (brain cells) so that they don’t coordinate as effectively together. The other protein is tau which forms “tangles” inside neurons and contributes to their destruction.
There are undoubtedly other changes within the brain (such as damage to the blood vessels) that may also be involved in the degenerative process. Over time, brain cells begin to die. Some of these produce acetylcholine which is a chemical messenger (i.e. neurotransmitter) that enables brain cells to speak to one another. This relentless destruction eventually shrinks the size of the brain itself.
The first symptoms vary from person to person. In general however, the first indication is mild memory loss which is similar in nature to that seen in the normal aging process.
Over time this memory loss becomes more substantial and confusion and an inability to concentrate or reason begins to occur. Patients may lose items, forget how to perform easy jobs such as operating the dishwasher or have difficulty with recalling the date. Eventually, judgement is irrational, numerous personality changes are noted (anger, irritation, distrust, depression...), speech becomes challenging and the ability to read or write is lost.
Diagnosis is done by conducting test that evaluate memory, problem solving and other cognitive skills as well as CT scans, MRI’s, PET’s and blood & urine tests to rule out other possible causes. If the diagnosis is made, medications may be prescribed.
It’s important to be realistic about just what can be accomplished by the currently available medications. They are incapable of curing or halting AD’s inevitable advance. But they can, at least for a little while and sometimes longer, help ease many of the symptoms such as memory loss or trouble with focusing. While as a group, their overall benefits are modest, some patients show much greater improvement than is typically noted.
In Canada, the three main drugs we use are known as the cholinesterase inhibitors. They include donepezil (Aricept), galantamine (Reminyl) & rivastigmine (Exelon). This family is designed to boost the level of acetylcholine in the brain by slowing down its breakdown ensuring that the dwindling available supply lasts longer than it normally would.
Some patients will notice improvements in their memory & ability to concentrate while others may not see that initial boost but will experience a slowing in the rate of their cognitive decline. As with any drug, some will show no improvements whatsoever. Side effects tend to be mild and are generally limited to nausea, vomiting and diarrhea.
If a person does not respond to or tolerate one member of this family, an alternative member may well work out better. As such, it is not uncommon to see patients change between the three drugs. Eventually, as the acetylcholine producing cells continue to perish, these drugs will become relatively ineffective.
In later stages of the disease a doctor might prescribe memantine (Ebixa), a drug which prevents glutamate from exerting its normal effects. As brain cells die, they release glutamate into the brain and excesses of this amino acid can “overstimulate” causing increased agitation and confusion in some patients.
Along with these unique Alzheimer’s drugs physicians will frequently use standard antidepressants to help the many patients who also suffer from depression. Ideally drugs such as Celexa & Zoloft will have a calming effect on those individuals while helping them cope with the grief that is part and parcel of this disease.
Other AZ patients can suffer from psychotic symptoms such as paranoid behaviour or hallucinations. To treat these symptoms, antipsychotic drugs such as risperidone or olanzapine can be tried. They should be used very cautiously however as they can have troubling side effects such as confusion, sedation and weight gain and there is controversy as to whether they actually increase the risk of mortality when used in the demented elderly.
With the absence of drugs that can reverse the damage that has been done to the brain, many specialists are telling both the affected and those at risk of Alzheimer’s to focus on risk factors they can control.
Diet seems to play a central role & the MIND diet looks very promising. It seems to reduce the incidence of AD by 53% in strict adherents and 35% in those who “sort of” adhere to its guidelines. The diet is easy to follow, not particularly restrictive or expensive and focuses on whole grains, fish, poultry, beans, fruits and vegetables.
For more specific information, refer to our column from earlier this summer).
Daily physical and mental exercises are also deemed to be critical to ongoing good mental health. As well, there appears to be a relationship between cognitive decline and conditions such as heart disease, high blood pressure, diabetes and obesity so keeping those in line would seem to be more than prudent.
For more information about this or any other health related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination in Port Elgin and Kincardine.
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Sunday, October 23, 2016