Alzheimer’s Disease – Symptoms, Diagnosis, and Treatment

 Introduction:

*Alzheimer’s Disease (AD)* is a *progressive neurodegenerative disorder* and the most common cause of *dementia* in older adults. It gradually destroys memory, cognitive skills, and the ability to perform everyday tasks. Although there’s no cure, early diagnosis and treatment can slow its progression and improve quality of life.

Pathophysiology:

Alzheimer’s involves:

- *Accumulation of β-amyloid plaques* outside neurons

- *Neurofibrillary tangles* made of *hyperphosphorylated tau protein* inside neurons

- *Loss of cholinergic neurons*, especially in the hippocampus and cortex

- Brain *atrophy* and *ventricular enlargement*

This leads to disrupted neural communication and neuronal death.

Symptoms and Signs:

*Early Stage:*

- Mild memory loss (recent events)

- Difficulty in word finding

- Misplacing items

- Confusion with time/place

*Moderate Stage:*

- Poor judgment

- Wandering/getting lost

- Personality and behavior changes

- Difficulty with daily tasks

*Severe Stage:*

- Inability to communicate

- Complete dependence on caregivers

- Loss of physical functions (walking, swallowing)

Diagnosis:

Alzheimer’s is primarily a *clinical diagnosis*, supported by history and cognitive assessment.

Diagnostic Tools:

- *MMSE* (Mini-Mental State Examination)

- *MoCA* (Montreal Cognitive Assessment)

- *MRI/CT scan* – shows brain atrophy

- *PET scan* – amyloid imaging

- *CSF analysis* – biomarkers like ↓ Aβ42 and ↑ tau protein

Treatment:

There is *no cure*, but medications and therapy help manage symptoms and slow disease progression.

Medications for Alzheimer’s Disease:

1. *Cholinesterase Inhibitors*

These drugs *increase acetylcholine* levels in the brain, improving communication between nerve cells.

*a. Donepezil (Aricept)*  

- *Dose:* Start 5 mg/day → increase to 10 mg/day  

- *Side Effects:* Nausea, diarrhea, insomnia, muscle cramps

*b. Rivastigmine (Exelon)*  

- *Dose:* 1.5–6 mg BID (oral); patch form also available  

- *Side Effects:* GI upset, weight loss, dizziness

*c. Galantamine (Razadyne)*  

- *Dose:* 8–24 mg/day (extended-release)  

- *Side Effects:* Bradycardia, vomiting, fatigue

2. *NMDA Receptor Antagonist*

*a. Memantine (Namenda)*  

- *Use:* Moderate to severe Alzheimer’s  

- *Dose:* 5–20 mg/day  

- *Side Effects:* Headache, confusion, dizziness, constipation  

- *Mechanism:* Regulates glutamate to protect neurons from excitotoxicity

3. *Newer Therapies (under research/limited use):*

- *Aducanumab* (targets amyloid plaques) – controversial efficacy  

- *Lecanemab* – recent approval in some countries

Supportive Management:

- *Cognitive therapy* and memory exercises  

- *Family/caregiver education*  

- *Occupational therapy*  

- *Antipsychotics or antidepressants* (if behavioral issues present, used cautiously)

Conclusion:

Alzheimer’s Disease is a challenging, life-altering condition. While current treatment can't reverse it, *early intervention*, *medications*, and *supportive care* can significantly improve patient and caregiver quality of life. Ongoing research offers hope for better treatments in the future.