Alzheimer’s disease

What is Alzheimer's disease?

Alzheimer’s disease is also known medically as Alzheimer’s disease and colloquially as just “Alzheimer’s”. It is the most common form of dementia. People with dementia gradually lose some of their mental abilities over a longer period of time. This loss becomes noticeable in various ways: Memory becomes noticeably weaker, orientation and language skills deteriorate, and other people are often no longer recognized. In the end, people with Alzheimer’s are no longer able to lead an independent life.

Around 153,000 people live with dementia in Switzerland, most of whom suffer from Alzheimer’s disease. In the population as a whole, it is mainly older people who are affected: The proportion of Alzheimer’s sufferers among 80 to 90-year-olds is around 20 percent, and more than 30 percent among those over 90. In rare cases, however, early diseases that occur before the age of 60 are also possible. Women are more likely to develop Alzheimer’s dementia than men.

Alzheimer’s disease is a chronic disease in which various areas of the brain deteriorate. At best, this progression can be temporarily halted with medication, but it cannot be cured. Relatives of people with Alzheimer’s need to know: Normal everyday life becomes more difficult to cope with from month to month and more and more mental abilities decline. At the end of their illness, those affected spend their lives dependent on medical and nursing care.

How does Alzheimer's disease develop?

Alzheimer’s dementia is a so-called degenerative disease. This means that body cells die or are damaged – in this case nerve cells of the brain, which in extreme cases can lose up to 20 percent of its mass. The symptoms vary depending on which areas are affected. For example, the reduction in size of the hippocampus – a small part located deep inside the head – leads to memory loss. If, on the other hand, certain parts of the cerebrum shrink, this leads to speech disorders and reduced orientation. Alzheimer’s disease almost always affects several different areas of the brain.

Despite many years of Alzheimer’s research, it is not yet clear exactly why tissue loss (atrophy) occurs in the brain of those affected. Mutations (changes in genes) could play a role. What is certain is that Alzheimer’s patients have certain protein deposits in their brains, known as plaques. They restrict communication between the brain cells and lead to their death. These clumped proteins were already described by the neurologist Alois Alzheimer, who discovered the disease and gave it his name, who died in 1915.

Symptoms: How does Alzheimer's manifest itself?

A typical characteristic of Alzheimer’s disease is that its symptoms do not appear suddenly, but begin gradually. Over the months and years, they increase more and more. The signs of the disease can vary from person to person and there is no fixed sequence. The symptoms often manifest themselves like this:

• Memory loss (amnesia): At first it is often only names that are forgotten, later also days of the week and objects. Many sufferers repeat the same questions several times in a row.
• Word-finding disorders: Even simple terms disappear from the repertoire of the vocabulary; those affected often try to find substitute words.
• Visual-spatial disorders: At some point, Alzheimer’s patients can no longer tell what time it is when they look at a clock.
• Disorientation: Sooner or later the time comes – the Alzheimer’s sufferer has lost their way and doesn’t know where they are.
• Loss of the ability to act (apraxia): The original independence diminishes; even simple practical activities such as dressing or making coffee are no longer possible at some point. Just as little as reading, writing, arithmetic and other mental abilities.
• Loss of body control: When Alzheimer’s dementia is at an advanced stage, many sufferers can no longer control their bowels and bladder.

The consciousness of people with Alzheimer’s is usually not clouded, and the sensory organs also normally function without impairment. In the early stages of Alzheimer’s disease, many sufferers are able to maintain a seemingly intact “façade” so that outsiders hardly notice the internal changes in those affected. However, when Alzheimer’s dementia reaches its final stage after a few years, this has changed fundamentally: Patients are now helpless and completely dependent on carers.

Diagnosis: How can Alzheimer's be diagnosed?

A misplaced pair of glasses, a missed appointment – such forgetfulness is quite normal and increases with age for most people. The objects you are looking for are often found in the usual places, and concentration often helps you to remember them. The situation is different for people with Alzheimer’s: they often don’t even remember what they have done, and they are increasingly likely to leave objects in unusual places. For example, a slipper may turn up in the fridge or a magazine may end up in the washing machine.

When such conspicuous signs of the disease become recognizable, Alzheimer’s disease has already progressed for several years and the brain has been damaged accordingly.

Alzheimer’s diagnosis: symptoms lasting longer than six months

It is not always easy for doctors to make a diagnosis of Alzheimer’s – and certainly not at an early stage. Initially, the symptoms observed (e.g. forgetfulness, reduced attention, disorientation) could also occur as an accompaniment to another neurological disease – a disease that may even regress. Many doctors therefore wait and see. Only when the typical Alzheimer’s symptoms appear for six months can the disease be safely diagnosed as Alzheimer’s disease.

There is currently no simple blood test that can clearly detect Alzheimer’s dementia at an early stage. However, various research groups are working on this.

Alzheimer’s tests MMST and TFDD – free of charge on the Internet

If it is not yet clear at an early stage whether Alzheimer’s disease is actually present, certain tests can provide more clarity. For example, the MMST and TFDD tests, which are available free of charge (also on the Internet), are widely used and provide a reliable impression of various brain functions. This is done with the help of simple questions (“What time of year is it now?”) and various tasks. For example, objects should be named and short sentences repeated. A clock test, in which a simple clock face with a specific time is to be drawn, is also often informative. All these tests should be carried out under the guidance of medical professionals wherever possible.

Medical Alzheimer’s diagnosis with imaging techniques

In a well-equipped hospital, specialized doctors can use various imaging techniques to determine whether certain changes in the brain can be attributed to Alzheimer’s disease. The following methods are mainly used:

• Electroencephalography (EEG): An EEG examination visualizes the brain waves in the form of curves on a screen. In Alzheimer’s patients, the curves show characteristic deviations.
• Magnetic resonance imaging (MRI): This imaging procedure (also known as magnetic resonance imaging ) can be used to take sectional images of the inside of the brain. The images can show, for example, whether the hippocampus, which is important for memory, has changed.
• Computed tomography (CT): This also involves taking several brain images “slice by slice”, in this case using X-rays.
• Positron emission tomography (PET): PET images show the brain at work: areas that are currently active have a higher metabolism than less active areas of the brain. The differences are displayed in different colors. A reduced metabolism in certain parts of the brain is a sign of dementia.

Cerebrospinal fluid examination for suspected Alzheimer’s disease

Another way of detecting signs of Alzheimer’s disease is to examine spinal fluid (cerebrospinal fluid). This so-called nerve fluid is extracted from the lower spine using a thin hollow needle and then analyzed. If the CSF examination reveals abnormal levels of certain proteins – tau proteins and beta-amyloid – this is a strong indication of Alzheimer’s disease. In a healthy brain, these harmful proteins are broken down, but in Alzheimer’s patients they accumulate as clumps on the nerve cells and cause them to die.

Prognosis: How does Alzheimer's progress?

Familiar everyday movements are often retained for a long time in people with Alzheimer’s – for example combing their hair or spreading butter on a slice of bread. However, unlike such practiced motor skills, the mind becomes increasingly weaker, so that at some point there are hardly any connections between cognitive abilities (thinking skills) and actions. For example, it can happen that a sick person combs their hair but uses a toothbrush to do so. Or that an Alzheimer’s patient takes the knife to spread butter on the table.

Unfortunately, the mental degradation cannot be stopped so far. At best, it can be slowed down, but it cannot be improved. In many cases, people affected by Alzheimer’s have a life expectancy of five to ten years after diagnosis. As the patient’s immune system becomes weaker and weaker over time, the risk of life-threatening infections, such as pneumonia, increases.

Treatment: How is Alzheimer's treated?

The choice of useful medication for dementia patients is limited. Only a few active substances have been shown in studies to temporarily delay the progression of Alzheimer’s disease; no drug has been successful in curing the disease. In addition to many dubious (because ineffective) offers, the following agents are mentioned, which can have a positive effect on brain performance:

• Acetylcholinesterase inhibitors: The active substances donepezil, rivastigmine and galantamine interfere with biochemical processes in the brain by delaying the breakdown of the messenger substance acetylcholine; this neurotransmitter transmits signals between the nerve cells.
• Memantine: This active ingredient improves the transmission of nerve signals and can therefore also have a positive effect on memory performance.
• Ginkgo biloba: The extract obtained from a plant can protect nerve cells by improving the metabolism in the brain and reducing dangerous deposits (plaques).

Risk factors: Can Alzheimer's be prevented?

Even though there is no certain way to prevent Alzheimer’s disease, various studies indicate that there are risk factors that promote the disease. These include high blood pressure (hypertension), obesity, lack of exercise, smoking, poorly controlled blood sugar levels in diabetes and excessive alcohol consumption. But social isolation and a lack of mental activity are also part of it. Avoiding these risk factors can also be a sensible preventive measure against numerous other diseases.