Alzheimer’s disease, commonly abbreviated as AD, is the most common type of dementia. In the year of 1906, it was first described by Alois Alzheimer in, who was a German psychiatrist and neuropathologist. Hence, this was named after him.
Management: Studies have reported that, there is practically no cure for the disease. As of 2012 , there are no concrete treatments available to stop or reverse the disease from progressing further. Hence, as the disease progresses, the symptoms get worser, and finally results in death. The current available treatments can be classified into pharmaceutical therapy, psychosocial therapy and caregiving.
Pharmaceutical: Presently five drugs are used in the treatment of the cognitive signs and symptoms of Alzheimer’s disease; amongst which four are acetylcholinesterase inhibitors, which are namely, tacrine, rivastigmine, galantamine, and donepezil; and the fifth one is memantine, which is an NMDA receptor antagonist.
Two studies have reported the efficacy of medical marijuana in the inhibition of the progress of Alzheimer’s disease. THC, is the active ingredient present in marijuana, may help in the prevention of the formation of deposits in the brain which is related at this disease. THC, when compared with the drugs available in the commercial market was found to hinder the action of acetylcholinesterase more effectively
Acetylcholinesterase inhibitors are found to be effective in reducing the rate of catabolism of acetylcholine, thereby increasing the concentration of acetylcholine in the brain and thus compensating the loss of acetylcholine resulting from the death of cholinergic neurons. Donepezil, available in the market as Aricept, galantamine available in the market as Razadyne, and rivastigmine available in the market as Exelon are some of the cholinesterase inhibitors, which are approved for the management of AD symptoms. There is substantial evidence for the efficiency of these drugs in mild to moderate degree of Alzheimer’s disease. There is approval of only donepezil for the treatment of advanced stage of AD. There is no adequate evidence that, the use of these drugs is effective in delaying the onset of AD, when administered to persons with mild cognitive impairment.
Memantine, available in the market as Akatinol, is a noncompetitive NMDA receptor antagonist. It was initially utilized as an anti-influenza agent. The action of this agent is basically on the glutamatergic system. It blocks NMDA receptors and hinders them from being overstimulated by glutamate. There has been substantial evidence in the support of the efficacy of memantine in treating moderate to severe degree of Alzheimer’s disease. However, its effectiveness in the initial stages of AD are not yet clear. However, the combined therapy with memantine and donepezil has been found to be of statistical significance, but of only marginal clinical effectiveness.
Antipsychotic medications are of discrete use in lowering the aggressive and psychotic problems in Alzheimer’s disease with behavioral disturbances. But as these medications are associated with severe side effects, such as cerebrovascular incidents, difficulties in movement, or cognitive deterioration, this makes their routine use inadvisable. They are found to result in increased mortality rates, when used for a long duration. Huperzine, though sounds promising, requires further clinical trials before its use can be recommended.
Psychosocial interventions: Psychosocial interventions are considered as an adjunct to treatment with medications, and can be divided into behavioral-oriented, emotion-oriented, cognition- oriented or stimulation-oriented approaches. However, there is no available research on the efficacy of such psychosocial interventions. Behavioral interventions are mainly aimed at the identification and reduction of the past experiences and consequences of problematic behaviors. This is found to be effective in reducing certain behavioral problems like incontinence, but not very effective in certain behavioral problems like wandering, and in overall functioning. Emotion-oriented interventions: These include reminiscence therapy, validation therapy, supportive psychotherapy, sensory integration, which is also known as Snoezelen(a specifically designed room for sensory integration therapy), and simulated presence therapy. Supportive psychotherapy is found to be effective in assisting people with mild impairment adjust to their disease. Reminiscence therapy involves group discussions of previous experiences, or discussions with the individual, with the help of photographs, household articles, music and speech recordings, etc. Thus if found to be beneficial for cognition and mood behavioral problems.
Simulated presence therapy, as the name suggests, involves playing a recording with the speech of the closely attached relatives of the person with Alzheimer’s disease. The fundamental of validation therapy is acceptance of the reality, whereas sensory integration involves exercises with an aim to stimulate the senses. The cognition-oriented therapies involve reality orientation and cognitive retraining. Reality orientation consists of the orientation of time, place or surroundings of the person with Alzheimer’s disease. On the other hand cognitive retraining aims at improving impaired capacities, and cognition deficits. Stimulation-oriented therapies include any form of recreational activities such as, art, music and pet therapies, practice of a regular exercise,etc… The change in the person’s daily routine, through stimulation is found to be effective in improving behavior, mood, as well as function to a lesser extent. However, there is little evidence in support of the efficacy of these therapies.
As Alzheimer’s disease gradually renders the patients incapable of attending to their own needs, caregiving is mandatory in the treatment and management over the course of the disease. During the early and moderate stages, certain modifications with slight changes in the lifestyle, such as the placing of safety locks, enables increase patient safety and reduce the burden of the caretaker. When the patient becomes incapable to feed themselves, then the caretaker should break food into smaller pieces. The necessity of a feeding tube usually arises at the time of swallowing difficulties, or with the progression of the disease. During the final stages of the disease, palliative treatment is recommended to provide relief from discomfort until death.