Alzheimer's disease is a progressive disease and nevromozachna often Mediter-
shtanata form of dementia (50-60% of all other forms of Demel-
tion). The disease took its name from a German neurologist Alois Alzheimer,
which in 1906 had noticed peculiar changes in the brain of a patient
died of an unusual disease.
It is estimated that around 4.5 million in America and around 24 million worldwide suffer from this disease and
states that this figure in 2040 will be doubled and will exceed 80 million, since per-
increasingly aging population poveche.V Greece, according to recent study of disease occurrence number of hospital-
which the changes estimated at 141,000.
The frequency of proya disease was 14% for adults over age 65 and increases to 40%
patients aged over 80 years. It occurs more often in women than in men, which Preferences
lag that is due to the lack of nevrozashtitni forces of estrogen in women after the onset of menu-
Alzheimer's disease and is economically a major problem for public
zdrave.Godishno in America for a patient suffering from this disease costs ranged from 40 to 70 000
dollars, and total over 110 billion dollars annually.
Alzheimer's disease shows characteristic Neuropathological changes in the brain of patients, such as amyloid
deposits (plaques) consisting mainly of a protein in-amyloid and neuro fibrotic assemblies
degraded neurons for one pathological form of τ-protein, containing more phosphorus molecule
Although the implementation of many trials and tests worldwide, the cause of disease
of Alzheimer is currently unknown. Too many factors are identified as
pathogens causing the disease.
There are some genes more than 200 today, which are found on chromosomes 1, 14 and 21 that connect
with early onset and disease progression. These genes are responsible for metabolism of proteins
preselin 1 and 2, which causes the protein metabolism of APP, also of the protein β-amyloid. ΑΡΡ is
a protein derived from β-amyloid, which as mentioned above
constitutes the basic element of neuropathology of the disease.
As a result, any pathological changes in these genes
cause the accumulation of β-amyloid in the brain. This amyloid is
neurotoxic and activates the process of elimination (programmed
cell death), which kills nerve cells. Apart from β-amyloid,
many other proteins involved in the process of dropping out.
Another gene that is believed to predispose to the emergence of the disease
One of the most important risk factors include older age, having more of those suffering from this disease are
aged over 65 years of age vazrast.Kolkoto increases, the greater the risk of occurrence of the disease.
Diabetes is associated with increased risk for the manifestation of disease Alzheimer. There are several
opinions as to how its impact on the occurrence of the disease patogeniyata.
(A) Diabetes causes damage to brain blood vessels that can cause
vascular dementia. Vascular dementia is a lot of times while the disease of Alzheimer, by
believes that because the symptoms of Alzheimer appeared earlier damage to the already
caused to the brain.
(B) According to recent research on experimental animals, but also on brain tissue of patients with Alzheimer
were found decreased levels of insulin. Alzheimer's disease has emerged as a variety of
possible diabetes (diabetes type 3).
(D) Drugs that are used in diabetes, is now used experimentally to combat
disease of Alzheimer.
Risk factors for cardiovascular disease
Cardiovascular risk factors such as increased blood pressure and high cholesterol sasvarzani with increased risk for onset of disease Alzheimer. It is believed that high blood pressure and
hiperholisterinemiyata can increase the risk of Alzheimer's disease with increased
accumulation of β-amyloid. Patients having both these factors are more likely to
develop the disease than those who only have one.
As less educated, the greater the risk for onset of disease Alzheimer.
People with low education (> 7 years), especially women, have to 4ri times more likely to develop
Trauma to the brain
It was found that traumatized brain is a causal relationship with increased risk for the emergence of
disease appears Alzheimer.Pri boxers dementia pugilistica, a form of dementia that
show pathological changes similar to those of disease Alzheimer.Saglasno some research
re-traumatisation in animals and in humans accelerates the concentration of β-amyloid and
resulting in brain failure occurs.
Heart surgery - bypass
Heart surgery is associated with increased risk for development of postoperative cerebral
damage that may occur as a temporary loss of memory and executive
inoperable. For patients with bypass surgery poyavyavanito risk of the disease is 70%.
The only sure way to diagnosing Alzheimer's disease is an autopsy of brain tissue and
establishment of amyloid deposits (plaques) and nevrofibrozni nodes, which, however, be made after
as the patient is pochinal.Vapreki it can be diagnosed with great accuracy for a "probable"
Alzheimer's disease when the patient is alive.
For the diagnosis requires the following actions:
Careful and detailed clinical examination by an experienced neurologist to obtain a complete medical history.
Nevropsihicheski review which is needed to ascertain the state of memory and mental
functions such as attention, learning, recall, language and the optical horizon. Also
review and possible breaches in the performance of daily duties (cooking, management
The most commonly performed nevropsihicheski method that is used is the study MMSE (mimi Mantal
MMSE consists of 11 questions and examines five areas of mental function: orientation,
attention, short and direct recall, language and ability to follow and implement
simple oral and written directions.
The assessment varies depending on the degree of mental activity from 0 to 30 (if any response is
true). 10 ratings refer to orientation, memory 3, 3 for direct and short-term recall, 5
attention to language and 9 activity.
Other nevropsihometrichni methods that are used are CDR (Clinical Dementia Rate) and GDS (Global Deterioration Scale). Also neuropsychiatric tests can be used to distinguish
diagnosis of Alzheimer's disease from other dementias such as vascular dementia, dementia of particles (of
cells) Lewy Body, teporalnata-frontal dementia and others.
? Blood tests. Perform blood and biochemical izsledvane.Izsledvat is omotsisteina, vitamins
B12, thyroid function, the genes mentioned above, but also other factors that may be associated with
functions of memory.
? Nevrovizualni research.: Computed Tomography (CT) and Magnetic rezonatna imaging (MRI)
which can be seen kortekovata brain atrophy and cerebral cortex in particular
? PET (Positron Emmission Tomographia) and SPECT (single photon emission computed tomography), which are
current research and are not considered mandatory. PET shows brain function and can be
see differences in brain function in normal brain and brain of a patient with Alzheimer. SPECT is
used to measure blood flow in different parts of the brain and help define
specific brain functions that are affected by the disease of Alzheimer. Today, with the above nevrovizualni
methods can measure even the number of amyloid deposits (plaques) in a living brain.
Examination of proteins in cerebrospinal fluid
(ΕΝΥ). It has been shown that ΕΝΥ, β-amyloid is reduced and τ
protein is increased in patients with Alzheimer disease in
compared with normal people. In particular, the combination
of these indicators has shown high accuracy
diagnosis. Taking ΕΝΥ is done with
bone marrow puncture.
There are some criteria for rapid diagnosis of
(1) The National Institute of Neurological
criteria violations NINSDS-ADRDA, which are
Secure Alzheimer's disease
Has any criteria to Alzheimer disease
and established findings of takannopatologichni
disease after autopsy and biopsy.
Chance of Alzheimer's disease
Is established by clinical examination and nevropsihicheski and includes:
• Progressive violations of two or more brain functions including memory.
• Index between 40 and 90 years old
• Lack of systematic or other diseases of the brain that can lead to dementia.
Possible Alzheimer's disease
• dementia syndrome of unknown cause with atypical initial symptoms, and development
• Not due to any of the diseases that can cause dementia.
Amazing Alzheimer's disease
A demented syndrome that has any of the following: sudden onset, outbreak of
neurological degradation and disturbance (walking) - early in the course of development
(2) The American Psychiatric Clinic criteria DSM-IV-TR, which are:
• The development of multiple mental disorders, which occur as memory impairment and
one of the following: aphasia, omission nesaznatelnost disorders and executive functions.
• Mental disorders show a decrease compared to the previous level of functionality
patient and cause problems in public and executive function
• characterize the disease is a gradual start and permanent mental failure
• Mental failure is not due to any other disease of the central nervous system
systemic diseases or conditions caused by substances that can cause progressive
reductions in memory and cognitive abilities (functions).
• The violation did not appear during a psychiatric illness.
Symptoms that appear in Alzheimer's disease can be seen from the symptoms that appear
mild, moderate and severe disease.
Mild - early
The patient exhibits a loss of close to pamet.Poyavyavat language problems (patient can not find
specific words). You can replace or to form words which somehow resemble
forgotten duma.Pita constant for the same neshta.Zapochva have problems in their everyday
activities (eg forgets where things are, put your stuff in awkward places, lost his
orientation, first in terms of time and then to place and appear
problems in financial management. You may pay a different amount, instead, that he owes).
It also reduces the time posvetyava for his favorite pursuits. Avoid dealing with new
things, no interest, no more mood as before.
Average shape - next stage
The patient is unable to learn and remember new information. There is a problem for the identification of individual
persons and relatives, as well as his personal veshti.Ne can organize your thoughts and has trouble
follow written directions. Develop and conduct disorders in general a total withdrawal from
public affairs. Maybe he needed help from caring for him for major activities
daily reality (eg eating, dressing, daily hygiene). patient is lost and unable to move in
home alone. There is a danger to fall or herself if he is alone at home.
Severe - final stage
The patient does not recognize myself and those family mu.Sashtestvuva complete loss of near and
distant memory. Talk quite unconnected with the poor and readable dictionary. Unable to move tofood and to do any daily work. Appears izspuskane urine and feces.The patient is swallowing difficult and the risk of starvation and pneumonia. The last stage issilent and ends with coma and death, mainly from infection. And is dependent solely on opovavaothers and many times have put him in hospice care perennial.
An important category of symptoms that occur in Alzheimer's disease are neuropsychiatric and
symptoms of behavior that represent a single clinical autonomy. This occurs at
80% of patients and appear at different stages during the disease. Violations of
Sentiment is seen mainly in the initial stages of Bolla, and psychotic and overexcitation
violations are observed in subjects with moderate form of bolestta.Tezi symptoms may occur in
severe illness, simply become less visible due to deterioration of
patient and the prevalence of neurological symptoms.
A major risk factor for physical and mental condition of the person cared for.
The basic symptoms are:
The incidence of depression seen in patients with Alzheimer varies around 20-40%. Patient exhibits reduced
mood, loss of energy and apparent loss of interest and enjoyment of any activity.
Being in about 70% of cases and are usually paranoid in nature. The patient thinks
others steal it, is worried because they think that their wife mami.Postoyanno them are
dvizhenie.Pogreshnite present appear in the advanced stage of disease. Patient seen at home
people who do not exist in reality.
Patients have stress problems that have not previously engaged them. Characteristically, the stress and develop
fear lest alone.
Frequency increases with the development of bolestta.Bezsanieto causes stress and intolerance in the patient
trying to replace the lost hours of sleep during the day ..
Aggressive behavior is manifested or by word or deystviya.Tozi symptom appears in the middle stage
development of disease Alzheimer. Changing the location of people and the environment contributes to the manifestation
• removal of conditionalities (inhibitions)
There are some established factors that may prevent the occurrence of disease Alzheimer. Under
conducted studies have identified a number of factors that can minimize the risk of occurrence
the disease. The main ones are:
Maintaining good physical condition
Maintaining good physical condition, which is managed with exercise, but also limiting
cardiovascular risk factors such as increased blood pressure, increased cholesterol and
increased weight may act prophylactically to bolestta.Sistematichnite appearance of even lighter
exercise (usually walking, gymnastics, swimming or any other form of exercise)
reduced to 40% risk of manifestation of dementia or Alzheimer's disease in adults.
Good nutrition and special diet srednozemnomorskoto, which is rich in fruits, vegetables and olive oil
protective act for the occurrence of disease Alzheimer. Persons who use srednozemnomorskoto
meals are 68 percent less chance of disease compared with persons who can away from this
prototype of a meal. Back excessive consumption of many unsaturated fats was associated with
occurrence of disease Alzheimer. Foods that should be preferred are the following:
• foods rich in ω-3 fatty acids (fish Sato sardines, salmon, mackerel). Fatty acids ω-3
may, under some studies to reduce inflammation of the brain and help
regeneration of nerve cells.
• Fruits and vegetables
• Antioxidant vitamin C foods (fruits, vegetables) and vitamin E (vegetable oils, legumes,
The administration of NSAIDs is associated with lower risk for the emergence of
dementia, which is believed to be due to the fact that inflammation plays a role
patogeniyata disease Alzheimer. It also found that some anti-inflammatory
drugs can reduce the production and accumulation of β-amyloid.
Believes that high levels of cholesterol play an important role patogeniyata disease and recognized
as one of risk factors. Therefore, drugs that lower cholesterol (statins) can
have a protective role in the development of disease Alzheimer.
Mental exercises and in particular activities such as chess, crossword-solving, reading
newspapers, keep the brain awake and reduce the risk of occurrence of the disease Alzheimer. Persons
less involved with such activities threatened twice to develop the disease than those who
deal redovno.Saglasno some theories that attributed to formation of a mental type "charge" in
brain activities increase the flexibility of the human brain that can
use alternative networks neurotic to replace lost ones.
However, when used for the first time in humans in clinical conditions cause
cerebral meningitis and was discontinued use her Still, scientists remain
efforts for a new vaccine against Alzheimer's disease trying
to find ways to keep its medical outcomes and reduce unwanted
impact. However, when used for the first time in humans in clinical conditions
cause meningitis and brain had stopped her use, however scientists
continue their efforts for a new vaccine against Alzheimer's disease trying to find
ways to keep its medical outcomes and reduce undesirable effects.
Some studies have shown that estrogens, which are used by women to cope with
symptoms of menupauzata may act nevrozashtitno.Zatova opinion exists that can
reduce the occurrence of Alzheimer's disease or reduce the course of the disease. It is now confirmed to something
such, however, many questions remain unanswered and are being investigated by scientists in connection with any
favorable role of estrogen in disease of Alzheimer.
Way of overcoming
It should be noted that there is no treatment that has been shown to stop disease Alzheimer.
However, in recent years have found some resources that are given to patients in the early and
mid-stage disease may delay development for her it is very important to be placed
diagnosis as possible time.
One category of drugs that is used extensively in
treatment of Alzheimer's disease are cholinesterase blockers.
Cholinesterase blockers are enzymes that break down the substance
atsetiloholin, which participates in the transmission of information between
nerve cells and is believed to be important for the functioning of memory and
absorption znaniya.Pri disease Alzheimer, destroyed cells
producing atsetiloholin destroyed, reducing the
way its levels in the brain.
As a result, the suspension of these enzymes by drugs leads to increase in atsetiloholina
Treatment with cholinesterase blockers may cause a slight increase in symptoms and temporary
stabilize or reduce the pace of mental maturity in patients with mild to moderate form of the disease
Tacrine (Sognex) is the first tool to block cholinesterase, which was exploited. Noted was
However, it can cause liver damage, and this patient should be monitored frequently
liver function. Given this adverse effect, the drug is rarely used.
Donepezil (Anticept) was found to improve mental functioning and daily activities in
connection with the dummy drug in studies for up to one year in patients with mild or moderate
form of the disease significantly improves Alzheimer.Sashto distortions in behavior, especially
stress, depression and apathy.
Rivastigmine (Exelon) can overcome the negative symptoms of dementia and increased
mental functions in longtime use in comparison with apparent drug. Also
enhances the activity of the sick and the performance of their daily activities. Exelon no clinically
significant relationships when prescribing rear with 22 categories of drugs, an important fact, given
that adults take many medications. It also improves the behavior of the offense
patients with Alzheimer and especially apathy, delusions and false predstvi, reducing the need
acceptance of psychotropic drugs. It was recently permitted the use of diadermalni patches that
placed on the skin of the patient's body once a day.
Galantamine (Reminyl) exhibits a dual mechanism of action. Apart from stopping
atsetiloholinesterazata increases the concentration of atsetiloholin through its effect on
nicotinic receptors. Γalantamina in studies lasting one year is found that
improves mental functions of patients, while maintaining daily activities and mental functions
at least 12 months. It also slows the emergence of behavior problems and believes that influences
effective to overcome the problems of the other blockers.
In common adverse symptoms of cholinesterase blockers are: dizziness, vomiting,
diarrhea, headache and loss of appetite.
Memantine (Ebixa) is a new drug in the stock of doctors for treating disease
Alzheimer. Mechanism of action is different from that of blockers холинестеразата.Мемантинът
is one of the competitors of NMDA receptors and protects the brain from increased levels of glutamic
acid. Used for treatment of mild and severe Alzheimer's disease and helps
maintain certain daily functions (napr.vazmozhnostta to visit the bathroom alone for
few months more)
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