Memory will decline rapidly and even personality will change. Be wary of this disease!

Author: Xing Yan, Chief Physician of Aviation General Hospital

Reviewer: Jiang Yuwu, Chief Physician, Peking University First Hospital

There is a common disease among the elderly, which is characterized by a rapid decline in memory and even personality changes. It is commonly known as Alzheimer's disease.

Senile dementia, medically known as Alzheimer's disease, is a common, insidious, progressive brain degeneration disease in middle-aged and elderly people.

Figure 1 Original copyright image, no permission to reprint

The prevalence of Alzheimer's disease almost doubles with age. For example, the prevalence for people over 65 years old is about 5%, and the prevalence for people over 85 years old can reach 25%.

1. Who is more likely to develop Alzheimer's disease?

The cause of Alzheimer's disease is still unclear. Pathology and autopsy have revealed that there are amyloid plaques deposited between brain neurons, neurofibrillary tangles, and tau protein phosphorylation.

Alzheimer's disease is mainly seen in middle-aged and elderly people. After research, many risk factors have been found, such as high-risk factors for cerebrovascular disease, such as hypertension, diabetes, and hyperlipidemia; history of epilepsy; hypothyroidism; vitamin deficiency, such as folic acid and vitamin B12 deficiency; immune diseases that lead to decreased body resistance; severe depression; long-term exposure to heavy metals such as aluminum and mercury, as well as pesticides; head trauma that causes impaired consciousness; living alone, etc. In addition, postmenopausal women and those with a family history of Alzheimer's disease also have a higher risk of developing the disease.

Through clinical research and some large-scale, multi-center research and analysis, it was found that these factors have a certain correlation with Alzheimer's disease, but the exact cause is still unclear. It can only be said that these are high-risk factors.

2. In addition to memory loss, what other symptoms does Alzheimer's disease have?

In patients with Alzheimer's disease, the cerebral cortex will experience large-scale atrophy, with atrophy of the parietal lobe, temporal lobe, and hippocampus being more common.

The main symptom is memory loss. In the first 1-3 years, the main symptoms are short-term memory loss; in about 3-8 years, long-term memory also declines; after 8-12 years, memory is basically lost.

Memory loss progresses significantly, and may even decline rapidly within half a year. The forgotten content cannot be recalled even after being reminded.

Figure 2 Original copyright image, no permission to reprint

The second is functional decline. Language and calculation ability decline, unable to understand familiar words, and calculation ability also declines; date and space discrimination difficulties, not knowing what day it is, unable to find the door; judgment declines, unable to judge weather conditions, unable to choose appropriate clothes, etc.; apraxia and agnosia, the arms are strong but do not know how to use them, unable to use chopsticks to eat or brush teeth normally, do not recognize familiar people or even themselves, and cannot take care of themselves.

The third is mood changes. You may experience impulsivity, suspicion, delusion, auditory hallucinations, visual hallucinations, etc. You may also feel restless when sleeping at night, or become depressed and irritable.

Figure 3 Original copyright image, no permission to reprint

3. What tests are needed to diagnose Alzheimer’s disease?

First, the doctor will determine whether the patient meets the characteristics of Alzheimer's disease based on the patient's medical history or symptoms.

Secondly, we will choose some examination methods. The first is scale measurement. There are some common scales for cognitive impairment internationally, as well as special cognitive impairment scales, and mental behavioral scales, including depressive disorder scales. The scales are used to measure and score to see whether the standards are met. If the score is below this value, some further imaging examinations will be performed.

Imaging examinations mainly include thin-layer CT scans or MRIs to see if there are any symptoms consistent with Alzheimer's disease. For example, imaging changes such as atrophy of the entire brain lobe and deepening of the cerebral sulci. In addition, MRIs can also rule out some diseases that cause dementia, such as hydrocephalus, cerebral decapitation, and cerebral infarction.

There are other further examinations, such as SPECT or PET examinations, EEG examinations; some can further undergo lumbar puncture, mainly to test amyloid protein or Tau protein, to determine whether it meets the requirements of Alzheimer's disease, which can be used as a biomarker.

There are also blood tests, such as biochemical tests, including blood sugar, blood lipids, folic acid, vitamin B12, and thyroid function, which can cause high-risk factors for cognitive impairment.

Most cases of Alzheimer's disease can be considered through clinical symptoms, Alzheimer's disease-related scales, and neuroimaging changes. The final diagnosis may still require pathology or genetic testing. For hereditary precocious dementia, genetic testing can be used to confirm the diagnosis.

4. Is there a cure for Alzheimer’s disease?

Alzheimer's disease cannot be cured at present. The only way is to use some drugs and non-drug treatments such as transcranial magnetic stimulation to improve symptoms and delay the progression of the disease.

If the patient has some mental and emotional problems in the middle and late stages, some drugs to improve depression, anxiety and other emotions can be used appropriately; some vitamin B12, vitamin D3, etc. can also be supplemented.

Figure 4 Original copyright image, no permission to reprint

Reasonable care can also help delay the progression of the disease. Some daily care or training is also very important for helping Alzheimer's patients delay the disease. Family members can recall the past with the patient, mark the patient's daughter, son, grandson, and granddaughter in the photo, help the patient sort out the relationship and remember the appearance of relatives, which is also conducive to exercising memory.