How does Alzheimer's disease cause death

Dementia, Alzheimer's

Alzheimer's dementia is the most common type of dementia. What they have in common is the progressive loss of nerve cells and their connections, the synapses. The brain can shrink by up to 20 percent. The result is a sometimes dramatic loss of the ability to think and memories


Clinical picture


Explanation:

Alzheimer's dementia, also known colloquially as "Alzheimer's", is the most common form of dementia and thus belongs to the group of neurodegenerative diseases. What they have in common is the progressive loss of nerve cells and their connections, the synapses. One of the characteristics of Alzheimer's dementia is the formation of fibrous protein fragments that accumulate in the nerve cells. On the other hand, proteins, so-called "plaques", are deposited between the nerve cells. Both forms lead to the death of the nerve cell. The brain can shrink by up to 20 percent. The result is a sometimes dramatic loss of the ability to think and memories.
Cells in the Maynert basal core, a deeper brain structure, die particularly early. The nerve cells located here produce the messenger substance acetylcholine. If less and less of it can be produced due to cell death, this reduces the ability to process information and memory performance. The later death of nerve cells in the cerebral cortex is accompanied by an uncontrolled release of the neurotransmitter glutamate, which is required for learning and memory processes. Information processing is also impaired as a result.

 

Symptoms:

The disease initially begins unnoticed in only a small area of ​​the middle temporal lobe. It spreads slowly. Only when the temporal lobe and the hippocampus necessary for memory are reached do the first memory disorders appear. The dementia is only clearly recognizable when the cerebral cortex is severely affected, especially the parietal and temporal lobes (see graphic). As the disease damages different parts of the brain as it progresses, symptoms vary in intensity depending on the stage.
Before the state of dementia is reached, doctors speak of a "slight cognitive disorder": those affected often find it difficult to remember information and to access it. In addition to these memory disorders, attention deficits and problems in spatial perception can also occur. In contrast to later stages, however, those affected are aware of the disease. In the early stages, the sick still manage to cope with their everyday lives. You are then also fully competent.
The speed at which the disease progresses varies from person to person. But it is progressing continuously. If simple everyday actions can no longer be carried out without problems, one speaks of dementia. This is divided into three stages, each of which lasts an average of three years: mild, moderate and severe dementia.
The mild dementia is characterized by the increasingly limited ability of the sick to remember new information. It is becoming more and more difficult for them to organize their everyday life. Word-finding disorders and temporal and spatial disorientation can also occur. Therefore, sick people often need help with more demanding everyday tasks, such as banking or using public transport. Your ability to judge and make decisions is limited, but not completely extinguished. Psychological symptoms such as depression, mood swings and listlessness can also occur.
In the stage of moderate dementia, it is no longer possible to lead an independent life. Now the memory of earlier and significant memories, such as the place of birth, occupation or the names of the children, also fades. Gradually the sense of time is lost. Communication with other people is made more difficult, as those affected can neither form complete sentences nor understand more complex utterances by others. The awareness of one's own illness also disappears. Some people feel like they have been transported back to earlier stages of life. Others no longer recognize their own loved ones. The pronounced changes in behavior are particularly stressful for family members. They include aggressiveness, misjudgments, delusional beliefs, physical restlessness and, less often, hallucinations.
Finally, severe dementia is marked by a profound mental decline, which manifests itself in an ability to articulate that is limited to a few words or has completely dried up. The sick are in great need of care: They can become incontinent or bedridden. Alzheimer's dementia is not fatal. In the last stage of the disease, however, the susceptibility to infection increases - the most common cause of death is pneumonia.

 

Causes:

To date, the causes of Alzheimer's disease have not been fully clarified. The greatest risk factor in non-hereditary Alzheimer's dementia is age. Genetic factors favor the disease, but are not responsible for it. The causes of the very rare hereditary Alzheimer's dementia have been researched in more detail: Mutations in the genetic material lead to an increased production of protein fragments, which in turn cause cell death.

 

Numbers:

Today around 1.2 million people in Germany live with dementia. Almost two thirds of them suffer from dementia of the Alzheimer's type. About 200,000 new types of dementia are diagnosed each year, of which about 120,000 are Alzheimer's. By 2050, the number of people with dementia will rise to 2.6 million unless there is a breakthrough in therapy.

 

treatment


Diagnosis:

In addition to the anamnesis of the doctor, the observations of the caregivers are an indispensable source of information. The time of the first symptoms, their development, behavioral problems and biographical background are important.
Imaging methods such as magnetic resonance imaging or computed tomography (CT) can help in the middle and advanced stages of the disease to differentiate Alzheimer's dementia from other diseases that show similar clinical symptoms. The MRI or CT images then show a significantly reduced brain mass, as a result of which the convoluted furrows are deepened and the cerebral chambers are enlarged.
If a disease-causing mutation is suspected, diagnostic genetic tests can clarify the reason for Alzheimer's dementia. If a genetic change is found, it can also be looked for in healthy relatives.

 

Therapy:

There is no cure for Alzheimer's dementia, but the progression of symptoms can be slowed down. Drug therapy aims to compensate for the reduced transmission of information due to the disturbed release of messenger substances. The active ingredients donepezil, galantamine and rivastigmine take over the function of the messenger substance acetylcholine in mild to moderate dementia. The success of the treatment varies from person to person, but on average the memory and brain performance can be maintained for around a year. The lack of signal transmission in the late stage due to the lack of the messenger substance glutamate can be temporarily compensated for by the active ingredient memantine. Mental symptoms such as depression, anxiety or delusions can be treated with medication and behavioral therapy. The disease can be treated with non-medication as a support. Speech therapy, physiotherapy and occupational therapy can be prescribed by a doctor. The aim of these procedures is to activate the sick physically and mentally, to improve their mood or to strengthen their self-confidence.
Targeted disease prevention is not yet possible because too little is known about Alzheimer's. However, a positive influence of mental, social and physical activity as well as a healthy diet is assumed.






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