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Alzheimer's disease Synonyms and keywords:AD;Alzheimer's; Alzheimer dementia; Alzheimer disease; Alzheimer sclerosis; Alzheimer's syndrome; Alzheimer-type dementia; Presenile and senile dementia; Primary senile degenerative dementia; Senile dementia of the Alzheimer type; SDAT; Alzhiemer dementia; Alzhiemer's; Alzheimer's dementia care; Alzheimer's caregiving

Overview

Alzheimer's disease is the most common cause of dementia among older people. Dementia is a loss of thinking, remembering, and reasoning skills that interferes with a person's daily life and activities. Other causes of dementia include blood vessel disease in the brain (called vascular dementia), Parkinson's disease, frontotemporal dementia, and Lewy body dementia. The first case of Alzheimer's disease was described by a German psychiatrist named Alöis Alzheimer in the year 1901. For many decades after Alzheimer's original description, there was little progress in defining the pathogenesis of AD occurred. In the mid 1970's, it was found that the levels of acetylcholine decrease in brains of individuals undergoing neurodegeneration due to Alzheimer's disease. In early 1980's major advances in biochemistry and molecular genetics allowed the use of compositional analyses and immunocytochemistry to explain the structure of tangles and plaques found in the brains of Alzheimer patients. The term Alzheimer's disease was subsequently formally adopted in medical nomenclature to describe individuals of all ages with a characteristic common symptom pattern, disease course, and neuropathology. Alzheimer's disease may be classified according to severity into mild, moderate and severe dementia. It may also be classified based on age of onset into early onset and late onset Alzheimer's disease. Another method of classification of Alzheimer's disease is based on the course of disease into pre-dementia, early dementia, moderate dementia and advanced dementia. Alzheimer disease (AD), is a progressive neurodegenerative disorder. The dysfunction of amyloid precursor protien (APP) metabolism and the resulting build up of of Aβ peptides and their aggregation in the form of senile plaques in the brain parenchyma of individuals have been considered pivotal for neurodegeneration in the disease. Cognitive impairment in patients with AD is closely associated with synaptic loss in the neocortex and limbic system. The microscopic histopathological features of alzheimer's disease consist of neurofibrillary tangles, senile plaques, neuronal loss, and with or without cerebral amyloid angiopathy. Alzheimer's disease may be caused by trisomy of chromosome 21, familial inheritance of mutations in either presenilin 1 gene, presenilin 2 gene or APOE4 gene. Presenilin mutations are associated with early onset Alzheimer's disease, whereas APOE mutations are associated with late onset disease. Environmental factors, such as aging, low level of education and head trauma may also contribute to the development of Alzheimer's disease. An estimated 5.5 million Americans of all ages have Alzheimer's disease. An estimated 10,000 per 100,000 individuals aged greater than 65 years have been known to be living with Alzheimer's disease in the United States. The diagnosis of Alzheimer's disease (AD) is made on the basis of clinical criteria described by either the National Institute on Aging and the Alzheimer's Association (NIA-AA) or DSM-V (Diagnostic and Statistical Manual of Mental Disorders, fifth edition). Histopathologic examination for diagnosis of Alzheimer's disease is rarely done. Elderly patients presenting with progressive decline in memory and other cognitive impairments such as aphasia, agnosia or apraxia should be suspected for Alzheimer's disease. In these patients, mental status examination (MSE) and neuropsychological testing should be performed to further evaluate the status of cognitive abilities. Diagnostic tools for the examination of the patient include mini- mental status examination (MMSE), Montreal Cognitive Assesment (MOCA) and instruments of activities of dailing living (IADL). Characteristic findings on MRI suggestive of Alzheimer's disease include reduced hippocampal volume and medial temporal lobe atrophy. There is no known cure for Alzheimer's disease (AD). Available treatments offer relatively small symptomatic benefit but remain palliative in nature. Current treatments can be divided into pharmacological, psychosocial, and caregiving. Acetylcholine esterase inhibitors increase the amount of acetylcholine in the brain and are a major part of pharmacotherapy for Alzheimer's disease. Major drugs include, donepezil, rivastigmine and galantamine, these drugs help with the cognitive symptoms of the disease. Associated psychosis and depression may be managed with antipsychotics and selective serotonin reuptake inhibitors (SSRIs). Caregiving plays a pivotal role in the management of patients suffering from Alzheimer's disease.

Historical Perspective

• In 1901 when Alöis Alzheimer, a German psychiatrist, identified the first case of what became known as Alzheimer's disease in a fifty-year-old woman whom he referred to as Auguste D.
• Alöis Alzheimer followed her until she died in 1906, at which point he reported the case publicly for the first time
• In the following five years, eleven similar cases were reported in the medical literature, some of them already using the term Alzheimer's disease