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Alzheimer’s disease

 


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Condition
Alzheimer’s disease
Class
Central nervous system
Description
Alzheimer's disease is the most common cause of dementia in the United Kingdom, affecting around 465,000 people and responsible for about 60% of the 800,000 cases of dementia currently being treated.

Most cases of Alzheimer's disease develop in those aged 65 or over. Under the age of 65, Alzheimer's disease is relatively rare, affecting about 1 person in 1000 or approximately 16,000 people. Over the age of 65 about 1 in 14 are affected. The risk of developing Alzheimer's disease continues to increase with age, doubling every 5 years, so that by the age of 85 nearly 1 in 2 people will have some signs of the disease.

Women have a slightly greater chance of developing Alzheimer's disease than men.
Causes
The exact cause or causes of Alzheimer's disease are not known. A number of theories have been suggested including the production of large amounts of a protein called beta-amyloid that forms plaques that injure brain cells, or to abnormal aggregations of tau protein that form tangles inside nerve cells. An increase in the level of the excitatory transmitter glutamate may be involved, but the long-held belief that a decline in the level of a transmitter called acetylcholine is involved is no longer thought responsible.

Whatever the causes of Alzheimer's disease may be, the effects on the brain are clear. Nerve endings and brain cells begin to die. This causes the brain to shrink and gaps to appear in important areas. The areas commonly affected are those involved in receiving and storing information.

Age seems to be the biggest factor implicated in the development of Alzheimer's disease, but some people are more likely to develop the disease because of particular genes they have inherited. The risk of developing Alzheimer's disease is also increased if the person has suffered a severe head injury, or has Down's Syndrome.

Things that increase the risk of heart disease such as smoking, high blood pressure, high cholesterol levels and lack of activity also increase the risk of Alzheimer's disease.
Symptoms
Alzheimer's disease is a progressive disease, gradually getting worse over time. Alzheimer's disease typically begins with lapses in memory, difficulty finding the correct words for everyday objects and mood swings. These mild symptoms are often mistaken for the natural signs of ageing. However after six months or so, a pattern will start to emerge. Appointments will be routinely forgotten, names and faces get muddled, and shopping or driving can become an ordeal when money makes no sense, and left and right get mixed up.

Personality changes can occur and sufferers often burst into tears for no apparent reason. In more advanced cases, inhibitions are often lost and the person's behaviour becomes more unsettling. Wandering around the streets in undone pyjamas is not uncommon. The person affected may become severely confused and may experience hallucinations, often becoming demanding and sometimes violent. Personal hygiene may be ignored, and incontinence of urine and faeces is common.

The final stages of Alzheimer's disease see the disintegration of the personality and sufferers become completely dependent on their carers. Death usually occurs from other complications, such as pneumonia, brought on by the person's frail condition.
Treatment
There is no cure for Alzheimer's disease and none is likely in the near future. Treatment is aimed at slowing down the rate of mental decline. Scientific evidence confirms that drugs licensed for dementia may provide initial improvements and stabilisation of symptoms for the majority of people with Alzheimer's disease. The drugs may help to improve memory or slow memory loss. Other benefits include improving alertness and motivation. It may take several months of treatment before there is a noticeable improvement, but many people report improved mood and an ability to do things that they had forgotten how to do.

Three drugs, known as anticholinesterases, are currently recommended on the NHS for the treatment of people with mild to moderate Alzheimer's disease. The three drugs are donepezil, galantamine and rivastigmine and appear to work by maintaining levels of the transmitter acetylcholine in the brain by preventing its breakdown.

A fourth drug, memantine, which works by blocking the effects of glutamate, is also available for the treatment of people with severe Alzheimer's disease or for people with moderate Alzheimer's disease who are intolerant of or have a contraindication to the anticholinesterases. See below for NICE guidance on Alzheimer's disease.
When to see your pharmacist
There are no medicines proven to work that a pharmacist can recommend for people with Alzheimer’s disease. There is limited evidence that in some the herbal remedy Ginkgo biloba can delay the progression of the disease and even make a small improvement in symptoms such as forgetfulness and confusion. However, more research is needed.

Pharmacists can however provide support by offering advice about nursing care and voluntary organisations and by offering advice on matters such as incontinence.
When to see your doctor
Consult your doctor if you are concerned about someone who is close to you and are worried that they may have Alzheimer's disease. The doctor will carry out a physical examination and ask a series of questions to test the person's thinking and memory. If the doctor suspects Alzheimer's disease, the person will be referred to a consultant with special experience of dementia who will be able to confirm the diagnosis and assess the severity of the condition.

Treatment has to be started by the specialist, but can be continued by the person's doctor provided the person's mental condition is reviewed regularly by an appropriate specialist team.
Reducing the risks of getting Alzheimer’s disease
Researchers agree that Alzheimer's disease is present 10 years or more before the disabling mental problems appear. By the time that drug therapy is started many of the changes that have occurred in the brain are irreversible. Consequently, at best, current drug therapy can only help slow the progression of the disease.

It is important therefore to do all that one can do to reduce the risks of getting Alzheimer's disease.

There is evidence to suggest that maintaining a healthy lifestyle, getting your cholesterol and blood pressure checked regularly can reduce the chances of getting Alzheimer's disease. Studies have found that people who are obese (body mass index greater than 30) in middle age have a four times greater risk of developing Alzheimer's disease than those that maintain normal body weight (body mass index between 20 and 25). By eating healthily and exercising regularly, you can lessen your risk of developing Alzheimer's disease and other forms of dementia as you get older.

Not smoking is also very important. Stopping smoking is the single most important way of reducing heart attacks, strokes and cancer, and it has also been shown to reduce the risks of Alzheimer's disease. People who continue to smoke beyond the age of 65 increase their risk of Alzheimer's disease by 70%.

Other ways of combating the effects of Alzheimer's disease is to establish and maintain a structured routine, and to try and lead as normal a life for as long as you can. Mental activity such as puzzles, crosswords and reading all appear to help.
Living with Alzheimer’s disease
Receiving the news that you, a parent or close relative has Alzheimer's disease can come as a devastating shock to many families. You will be concerned about what the future holds and will have so many questions that you may feel overwhelmed. Furthermore, as the disease progresses you will need more support and supervision, and eventually nursing care. While your doctors and nurses are the best people to talk to about your or your relative's individual medical condition and treatment, there are a number of organisations that are a great source of support and advice to help you cope with the medical, social, legal and financial aspects of the disease. See Further Information section below for names and details of organisations.
Financial and legal advice for carers and sufferers
People with dementia should organise their financial and legal affairs while they are still able, so that that their wishes are carried out later when they are unable to manage things themselves. It is important to seek the advice of a solicitor when completing any legal documents to ensure that the documents are legally valid.
The Alzheimer's Society produces a useful information sheet on Financial and Legal Tips that provides contact information for solicitors experienced in helping people with dementia and their carers. (See: www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=160)
Age UK has an excellent website that tells you more about benefits and how you claim them. (See: www.ageuk.org.uk/money-matters/claiming-benefits). The following is a list of just some of the financial benefits available to those affected by Alzheimer's disease:

Carer's allowance - Help for those who are unable to work because they are caring for someone with a disability
Council tax benefit - Help with payment of council tax
Disability benefits - Help getting around for those who have mobility problems
Health benefits - Help with the cost of prescriptions, dental and eye costs
Housing benefit - Help with rent for those with lower incomes
Pension credit - A benefit which tops up weekly income
Social fund - Extra help with expenses for those who already claim pension credit
Winter fuel payment - Help with heating bills when the weather is cold
Driving and dementia
Anyone given a diagnosis of dementia that holds a current driving licence or wants to reapply for a new licence must, by law, inform the DVLA if they wish to continue driving. Other people may also contact the DVLA if they are concerned about a person's fitness to drive. Notification of the diagnosis should be sent with the person's full name, address, date of birth and the driver number on the driving licence to:
Drivers Medical Group
DVLA
Swansea
SA99 1TU
Web: www.dft.gov.uk/dvla/medical.aspx

The DVLA will send the person a questionnaire that seeks permission for the DVLA to obtain medical reports from the person's doctor and/or specialists. Based on the medical information it receives, it will make a decision as to whether the person can continue to drive or not. The DVLA may also ask the person to take a driving assessment.

A person with a diagnosis of dementia must also immediately inform their car insurance company. If they do not, their policy may become invalid.

The Alzheimer's Society produces a useful information sheet on driving and dementia and provides tips on stopping driving.(See:www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=144)
NICE Guidance Explained
NICE (National Institute for Health and Clinical Excellence) is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health. One of NICE's roles is to produce guidance on the use of new and existing medicines within the NHS.

The NHS is legally obliged to provide funding in England and Wales for medicines approved by NICE. If your doctor thinks that a treatment approved by NICE is right for you, you should be able to have it on the NHS. If a treatment is not recommended by NICE, then you will not be able to have that treatment on the NHS.

In March 2011, the NICE guidance on Alzheimer's disease was revised. The main points can be summarised as follows:

  • donepezil, galantamine and rivastigmine are now recommended as options for managing mild as well as moderate Alzheimer's disease, and
  • memantine is now recommended as an option for managing moderate Alzheimer's disease for people who cannot take AChE inhibitors, and as an option for managing severe Alzheimer's disease.
Copies of the guidance are available at www.nice.org.uk/guidance/index.jsp?action=byID&o=13419
Further information
The following are some of the main organisations that provide information, guidance and support on all manner of things for people affected by Alzheimer's disease and for their carers.

Alzheimer's Society
The UK's leading care and research charity for people with dementia, their families and carers.

Alzheimer's Society
Devon House
58 St Katharine's Way
London E1W 1LB
Tel: 020 7423 3500
Fax: 020 7423 3501
Helpline:0845 300 0336
Email: enquiries@alzheimers.org.uk
Web: www.alzheimers.org.uk

Alzheimer Scotland - Action on Dementia
Helps people with dementia, carers and families, providing practical services across Scotland and campaigning to improve public policies.

Alzheimer Scotland
22 Drumsheugh Gardens
Edinburgh EH3 7RN
Tel: 0131 243 1453
Fax: 0131 243 1450
Helpline: 0808 808 3000
Email: alzheimer@alzscot.org
Web: www.alzscot.org

Alzheimer Society of Ireland
This society is the leading dementia specific service provider in Ireland.

The Alzheimer Society of Ireland
National Office
Temple Road
Blackrock
Co Dublin
Tel: (01) 207 3800
Fax: (01) 210 3772
Helpline: 1 800 341 341
Email: info@alzheimer.ie
Web: www.alzheimer.ie

Alzheimer's Research UK
Alzheimer's Research UK is the UK's leading dementia research charity specialising in finding preventions, treatments and a cure for dementia. The charity provides free information on Alzheimer's disease and related conditions.

Alzheimer's Research UK
The Stables
Station Road
Great Shelford
Cambridge
CB22 5LR
Tel: 01223 843 899
Fax: 01223 843 325
Email: enquiries@alzheimersresearchuk.org
Web: www.alzheimersresearchuk.org

Dementia UK
Dementia UK is a national charity, committed to improving quality of life for all people affected by dementia.

Dementia UK
6 Camden High Street
London
NW1 0JH
Tel: 020 7874 7200
Fax: 020 7874 7219
E-mail: info@dementiauk.org
Web: www.dementiauk.org

Age UK

Age UK is the new force combining Age Concern England and Help the Aged in England that works to improve later life for everyone by providing life-enhancing services and vital support. The charity provides information for the elderly on finance and how to stay healthy, as well as guidance on choosing a care home.

Age UK
York House
207-221 Pentonville Road
London
N1 9UZ
Tel: 0800 169 87 87
Email: contact@ageuk.org.uk
Web: www.ageuk.org.uk

Reviewed on 16 July 2011


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