Alzheimer’s

Symptoms

Alzheimer’s disease manifests itself in a continuously progressive loss of memory and mental and cognitive abilities. Possible symptoms of the disease include:

  • Disorders and loss of memory. Initially, mainly short-term memory is affected (learning new things), later long-term memory is also affected.
  • Forgetfulness, confusion
  • Disorientation
  • Speech, perception and thinking disorders, motor disorders.
  • Personality change, mental illness, e.g. agitation, distrust, depression, psychosis.

The disease begins with mild discomfort and ends years later with a loss of one’s personality and independence. It eventually takes a fatal outcome. Alzheimer’s disease is a disease and goes far beyond the normal forgetfulness of old age. It was first described by German physician Alois Alzheimer in the early 20th century.

Causes

The cause of the disease is structural change and destruction of the brain‘s nerve cells and their connections to each other. Alzheimer’s disease is the most common dementia. Two proteins are predominantly blamed for cell destruction and inflammatory processes: beta-amyloid, which forms amyloid plaques between neurons, and tau protein, which forms intraneuronal tau fibrils. However, the exact causes are not yet clear. Apart from the rare genetic variant (5%), the development is multifactorial (95%). Risk factors include:

  • Advanced age
  • Female gender
  • Heredity (genetics)
  • Head injuries
  • Environmental factors, unhealthy lifestyle (e.g. diet, exercise).

Diagnosis

The diagnosis is made in specialist care based on the patient’s history, physical examination, with questionnaires (mental abilities, such as ADAS-Cog), laboratory tests and imaging. Other causes of memory impairment, such as depression or vitamin B12 deficiency, must be excluded.

Nonpharmacologic treatment

While normal daily life with minor restrictions is possible at the beginning, Alzheimer’s patients require complex, time-consuming, and cost-intensive care in the longer term. Alzheimer’s places great demands on family members and caregivers.

Drug treatment

Currently, there is no causal treatment with which Alzheimer’s can be cured. The available medications can alleviate symptoms or somewhat influence the course. However, they cannot ultimately prevent further progression. Cholinesterase inhibitors are indirectly cholinergic and thus improve the symptoms of the disease. They lead to an increase in the residence time and concentration of the neurotransmitter acetylcholine in the nervous system. The effects are based on the inhibition of acetylcholinesterase. This enzyme is responsible for the breakdown of acetylcholine into choline and acetic acid. The drugs are approved for the treatment of mild to moderate dementia:

NMDA antagonists are antagonists at NMDA receptors. Persistent excitation of the central nervous system by glutamate at the NMDA receptor may contribute to symptomatology. Memantine is approved for the treatment of moderate to severe Alzheimer’s disease:

The new active ingredient oligomannate was approved in China in 2019 in capsule form. Other drugs (selection):

  • Ginkgo in the form of standardized extracts
  • Other smart drugs (off-label, without approval for this indication).
  • Psychotropic drugs such as antidepressants and neuroleptics for symptomatic treatment of mental disorders.
  • Vitamin E as an antioxidant, omega-3 fatty acids.
  • Non-steroidal anti-inflammatory drugs such as indomethacin

Numerous drugs are in the development phase, but so far neither registered nor available on the market. A well-known example is the antibody aducanumab from Biogen.