senile dementia



Overview.

What is Alzheimer’s Disease?

Definition.

Alzheimer’s disease is a degenerative disease of the central nervous system.

The disease usually occurs in the elderly (over 60 years of age) and pre-elderly (45-59 years of age) populations.

It is characterized by cognitive dysfunction and behavioral impairment that worsens day by day, mainly in the form of decreased memory, intelligence, and speech, and ultimately the inability to care for oneself.

Onset

Alzheimer’s disease is the most common type of dementia in old age, accounting for 50% to 70% of dementia in old age.

The prevalence of Alzheimer’s disease is closely related to age, with the prevalence rate increasing by a factor of 1 for every 6.1 years of age increase on average; in the elderly population aged 85 years or above, the prevalence rate can be as high as 20% to 30%.

The prevalence rate in developing countries is higher than that in Western Europe and the United States.

There are about 6-8 million Alzheimer’s disease patients in China, and the prevalence rate of women is higher than that of men.

Questions you may be concerned about

Does folic acid prevent Alzheimer’s disease?

The evidence that folic acid prevents Alzheimer’s disease is not yet sufficient.

There are no drugs to prevent dementia, or Alzheimer’s disease.

Folic acid is a medication used to prevent fetal neurological malformations and to treat megaloblastic anemia. Although some studies have shown that folic acid deficiency may increase the risk of developing this disease, it has not been clinically proven and has not been used as a preventive medication for this disease.

What foods should I not eat for Alzheimer’s disease?

Patients with Alzheimer’s disease should avoid foods high in salt, fat and spicy stimulants as well as smoking and alcohol.

Dementia is known as Alzheimer’s disease. High salt, high fat, spicy stimulating food, smoking, drinking alcohol can trigger or aggravate hypertension, diabetes, hyperlipidemia and other underlying diseases, which in turn lead to cerebrovascular disease, affecting the brain function, so it is not conducive to the development of the patient’s condition.

Is it true that blood type O is not prone to Alzheimer’s disease?

It is not true that blood type O is not prone to Alzheimer’s disease.

Dementia is Alzheimer’s disease, which is related to genes, lifestyle and underlying diseases, but not blood type.

Parents suffering from Alzheimer’s disease and the person himself/herself lack of exercise, smoking, lack of sleep, high-fat diet, or suffering from high blood pressure, diabetes, obesity, etc., will increase the risk of developing this disease.

Causes

Causes

The exact cause of Alzheimer’s disease is still unclear. Most scholars believe that Alzheimer’s disease is caused by a combination of aging, genetics, lifestyle and environmental factors.

Risk factors

Age

Age is the biggest risk factor for Alzheimer’s disease.

Most people with sporadic Alzheimer’s disease start after the age of 65.

However, Alzheimer’s disease is not an inevitable consequence of aging, nor is aging itself sufficient to cause the onset of Alzheimer’s disease.

Gender

The prevalence is 19% to 29% lower in men than in women.

Heredity

Heredity is also a definite risk factor for Alzheimer’s disease.

Familial Alzheimer’s disease is inherited in an autosomal dominant manner, manifesting itself in two consecutive generations of immediate family members, with onset of the disease most often before the age of 65 years, and some after.

If an individual has a first-degree relative (including parents, siblings) with Alzheimer’s disease, his or her risk of eventually developing Alzheimer’s disease increases by 10 to 30 percent.

Cerebrovascular Disease

Different types of cerebrovascular disease, including cerebral hemorrhage, cerebral infarction, and cerebral small-vessel disease, increase the risk of Alzheimer’s disease.

Hypertension

Some studies have shown that untreated systolic or diastolic hypertension in midlife is associated with the onset of dementia 25 years later, as well as brain atrophy, senile plaques, and the formation of neurogenic fiber tangles in patients.

Hyperlipidemia

Increased levels of total peripheral blood cholesterol increase the risk of developing Alzheimer’s disease threefold.

Type 2 Diabetes

Having type 2 diabetes leads to a nearly 1-fold increased risk of developing Alzheimer’s disease.

Obesity

Obesity (primarily abdominal obesity) in midlife increases the risk of developing Alzheimer’s disease by 59%.

Smoking

Smoking increases the risk of Alzheimer’s disease.

Alcoholism

Heavy drinking itself can lead to alcoholic dementia, and heavy drinking in midlife can triple the risk of Alzheimer’s disease.

Education level

A low level of education is a risk factor for Alzheimer’s disease.

Traumatic brain injury

Severe traumatic brain injury accompanied by loss of consciousness for more than 30 minutes can increase the risk of developing Alzheimer’s disease.

Symptoms

Alzheimer’s disease has an insidious onset, starting with no obvious symptoms and progressing to a certain level of memory loss, decreased ability to perform daily living tasks, mental behavioral abnormalities, and personality changes.

Alzheimer’s disease consists of two stages: the pre-dementia stage and the dementia stage, which are described below.

Pre-dementia stage

The pre-dementia stage includes the pre-dementia stage and the dementia stage.

Pre-dementia stage

There are no clinical signs of cognitive impairment, or only very mild memory loss.

Mild Cognitive Dysfunction

Mildly impaired memory and decreased ability to learn new knowledge.

Mild impairment of attention, executive ability, comprehension, calculation, spatial orientation, and language ability, but does not affect basic daily living ability to the extent of dementia.

Stages of dementia

Depending on the degree of cognitive impairment can be broadly categorized as mild, moderate or severe.

Mild (1st to 3rd year)

Memory loss, forgetting recent events, often forgetting things done in daily life and some commonly used items.

Decreased judgment and difficulty in handling complex problems.

Inability to do shopping, handle financial affairs, etc. independently and difficulty in socializing.

Still able to do familiar daily tasks, but with reduced ability to learn new things.

Low mood, occasional irritability, becomes selfish and suspicious.

Getting lost in familiar places.

Speech vocabulary is small and it is difficult to speak one’s mind.

Moderate (2nd to 10th year)

Memory impairment continues to worsen, such as forgetting the schedule of activities, having trouble remembering loved ones, and misplacing or placing used items in illogical locations.

Decreased ability to work, learn new things and socialize, and gradual loss of previously acquired knowledge and skills.

Decreased ability to perform simple calculations and difficulty in copying numbers.

No concept of time.

Obvious visuo-spatial impairment, e.g. cannot find his room at home.

Incoherent speech, always using the wrong words.

Inability to engage in outdoor activities independently and needs help with dressing, personal hygiene and maintaining personal appearance.

Emotions change from apathy to agitation, often walking around and wandering aimlessly.

Severe (8th to 12th year)

Only fragments of memory remain.

Emotional apathy, crying and laughing, hallucinations.

Loss of speech.

Severe intellectual deterioration.

Inability to take care of personal life, incontinence.

Complications

When the disease progresses to a more severe level, it can be complicated by symptoms of various systemic diseases such as lung and urinary tract infections, pressure sores, and multiple organ failure, and eventually death due to complications.

Consultation

Department of Medicine

Neurology

Elderly people with symptoms such as memory loss, loss of self-care ability, poor speech, and change in temperament are advised to seek medical attention promptly.

Preparation for medical treatment

Information on how to get to the doctor: registration, preparation of documents, and frequently asked questions.

Tips

Family members can help the patient to record the symptoms and changes in the patient’s condition for the doctor’s reference.

If the symptoms of cognitive impairment are not easy to express, you can tell the doctor some specific examples during the consultation.

Preparation Checklist

How long have the symptoms lasted?

Do you often lose things and forget things you have promised?

Can you remember your way home when you go out recently?

Are there any changes in personality?

Do you experience hallucinations, hallucinations, etc.?

Are there any diseases such as hypertension, diabetes, hyperlipidemia, cerebral infarction, cerebral hemorrhage, etc.?

Is there a family history of Alzheimer’s disease?

Imaging tests: CT, magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT).

Routine tests: blood test, blood biochemistry

Other tests: cerebrospinal fluid test, genetic test

Donepezil, Carboplatin, Memantine, Olacetamol, Mecobalamin, Fluoxetine, Paroxetine, Risperidone, Olanzapine

Diagnosis

Diagnosis is based on

Medical history

Family history of Alzheimer’s disease or clear risk factors.

Clinical manifestations

Decline in learning ability and memory.

Decreased ability to understand, process, and solve problems.

Decreased ability to use tools.

Decreased ability to calculate.

Getting lost in familiar places.

Repetition of speech.

Mood changes.

Personality changes.

Decrease in self-care.

Laboratory Tests

Helps to find the cause of the disease and to detect potential risk factors, concomitant diseases or complications.

Hematologic tests: complete blood count, thyroid function, electrolytes, blood glucose, lipids, folic acid, vitamin B12, homocysteine test.

Cerebrospinal fluid markers associated with the diagnosis of Alzheimer’s disease are amyloid, total Tau protein, phosphorylated Tau protein, etc.

Imaging tests

It is mainly used to exclude dementia caused by other diseases, such as tumor, hematoma and hydrocephalus.

Cranial CT in patients with Alzheimer’s disease shows brain atrophy, and the brain atrophy changes are mainly in the temporal lobe and hippocampal area.

Certain diseases that cause dementia can be excluded, such as brain tumors and normal cranial pressure hydrocephalus.

It includes single photon emission computed tomography (SPECT) and fluorodeoxyglucose-positron emission tomography (FDG-PET), which helps to improve the accuracy of Alzheimer’s disease diagnosis.

SPECT mainly detects decreased cerebral blood flow in the cerebral cortex of Alzheimer’s disease patients, especially in the temporal, frontal, and parietal lobes.

FDG-PET can evaluate brain function by detecting brain metabolism, and can also detect pathological changes in Alzheimer’s disease.

Scale Measurement

Commonly used scales are listed below:

The Brief Mental State Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA) scales, which are used to assess the patient’s overall cognitive functioning, including memory, attention, numeracy, and language skills.

Wechsler Memory Scale for assessing the patient’s memory.

The Boston Naming Test, used to assess the patient’s language skills.

The Wechsler Adult Intelligence Scale Block Test (WASBT), which is used to assess the patient’s ability to recognize visuospatial relationships and analyze visual structures.

The Neuropsychiatric Behavioral Inventory (NPI), which is used to assess the presence of psychiatric and behavioral abnormalities.

Genetic testing

Individuals with a clear family history of Alzheimer’s disease are recommended to undergo genetic testing as early as possible to clarify whether they carry the causative gene.

Genetic diagnosis should be performed in a professional and qualified testing organization to ensure the accuracy of the test.

Differential Diagnosis

Alzheimer’s disease should be differentiated from the following diseases, which are characterized by cognitive decline, mental behavioral abnormalities, and reduced ability to perform daily activities.

Vascular dementia

Vascular dementia has a fluctuating progression, with situational memory impairments often not evident and executive function impairments common, often accompanied by focal neurologic signs and symptoms. Imaging shows clear ischemic or hemorrhagic lesions.

Frontotemporal dementia

Loss of self-awareness, decreased executive functioning, and personality changes occur early and progressively worsen.

Appetite is high and hunger is easy.

Stereotypic behavior, decreased speech, euphoria, severe emotional apathy, and poor self-care are common.

Memory impairment occurs mostly in the late stages.

Visuospatial and computational abilities are relatively preserved.

Characteristic atrophy of the frontal and/or temporal lobes is seen on imaging.

Dementia in Parkinson’s disease

Parkinson’s disease dementia often follows Parkinson’s disease and is particularly severe in patients with impaired executive functioning relative to other cognitive domains; patients have a decline in short- and long-term memory capacity, but it is less severe than in Alzheimer’s disease.

Defects in visuospatial functioning are also common, and are more severe than in Alzheimer’s disease. In addition, patients may have resting tremor, bradykinesia, and other movement disorders that are more typical of Parkinson’s disease.

Treatment

Aim of treatment: Reduce the symptoms and slow down the progression of the disease.

Treatment principle: There is no way to reverse or stop the progression of Alzheimer’s disease, early treatment is conducive to a better outcome.

General treatment

Effective nursing care can prolong the patient’s life and improve the quality of life, and prevent accidents such as falling and not returning home as far as possible.

When the ability of severe patients to live on their own is seriously reduced, it often leads to complications such as malnutrition, lung infections, urinary tract infections, pressure sores, etc., which require enhanced supportive and symptomatic treatment.

Medication

Improvement of physical function and quality of life by improving memory and cognitive function and controlling psychiatric symptoms.

Treatment to improve memory and cognitive function

It can improve the cognitive function and daily life ability of patients with mild to moderate Alzheimer’s disease.

It is effective in treating early mental behavioral abnormalities in mild to moderate and moderate to severe Alzheimer’s disease.

Commonly used drugs include donepezil, carboplatin, and strychnine methyl.

Mainly meperidine, which has glutamatergic neurotransmission system modulation function, can be used in moderate to severe Alzheimer’s disease.

Commonly used Olanzitan, can improve the memory and learning ability of Alzheimer’s disease patients, severe renal insufficiency is prohibited.

Appropriate oral methylcobalamin can improve the symptoms of neurological damage, but note that it should not be taken before the diagnosis is clear, so as not to mask the clinical manifestations.

Control of mental behavioral symptoms treatment

The principles of drug administration are low-dose initiation, slow increment, slightly longer interval between increments, use of the smallest effective dose possible, individualization of treatment, and attention to drug interactions.

Commonly used selective 5-hydroxytryptamine (5-HT) reuptake inhibitors, such as fluoxetine, paroxetine, citalopram, sertraline and so on.

This class of drugs is contraindicated in combination with monoamine oxidase inhibitors (such as isoniazid, selegiline, etc.).

Risperidone, olanzapine, quetiapine, etc. are available.

Avoid driving a car or operating machinery while using this class of drugs.

Other drugs

Including vitamin E, selegiline and ginkgo biloba preparations.

All medications should be used in accordance with the doctor’s instructions, and should not be adjusted or discontinued on their own.

Non-pharmacological treatment

Cognitive Intervention

It is a type of treatment that results from combining psychological theories and modalities with gamified thinking, and can repair a patient’s weakened conditioned reflexes in the early stages of the disease.

It refers to a comprehensive intervention approach that uses activities of thought, attention, and memory stimulation in an association setting to improve the patient’s cognitive and social functioning, with sustained improvements in overall cognitive functioning and quality of life for mild-to-moderate patients.

Methods of compensating for cognitive decline through training such as assisted memory can improve patients’ ability to function in daily life and reduce caregiver burden.

Control of psycho-behavioral symptoms

Methods for patients include reminiscence therapy (discussing past experiences), recognition therapy (resolving past conflicts), and music therapy.

Train and support caregivers to develop strategies for individualized non-pharmacological treatment that take into account the patient’s interests, cognition, and physical strength.

Avoid overstimulation (e.g., loud crowds, stimulating colors, etc.) and understimulation (e.g., lack of interaction, etc.) to eliminate safety hazards.

Training in activities of daily living (ADLs)

It can delay loss of function, improve the patient’s quality of life, and reduce the burden on caregivers.

The training requires an individualized training program customized by a physician or a rehabilitator.

Exercise therapy

Exercise therapy can improve the neuroplasticity of patients, improve their symptoms and slow down the disease process.

Exercise therapy has various contents, and jogging, tai chi and gymnastics are recommended for early-stage patients at home and abroad.

Physical therapy

Repetitive transcranial magnetic stimulation, transcranial direct current stimulation, transcranial alternating current stimulation, photobiomodulation, electroconvulsive therapy and so on.

High-frequency repetitive transcranial magnetic stimulation may help to improve cognitive function and mental behavioral abnormalities such as apathy, depression and agitation in patients.

Prognosis

Cure

Currently there is no cure, and the progression of the disease can be alleviated and slowed down by drug and non-drug treatments.

Most patients have a disease duration of 5 to 10 years, and some patients may survive for 10 years or longer, mostly dying from complications such as lung infections, urinary tract infections and pressure sores.

Hazards

Alzheimer’s disease can lead to a decline in the quality of life of patients, increasing the care and financial burden on families.

Daily

Daily Management

Dietary management

According to the degree of cognitive decline and the degree of eating disorders, reasonable dietary nutritional supplements are given.

A Mediterranean diet is recommended, and the patient should eat more fruits, vegetables, legumes and whole grains on a daily basis.

Salt intake is less than 6 grams and 400 grams of fruits and vegetables are consumed daily.

Ensure high quality protein, such as eggs, fish, milk and other supplements.

Reduce the intake of fats, especially trans fatty acids, such as margarine, fried foods, phylloxera.

Eat less sugar, additional added or supplemental sugar intake <25g/day.

Total energy intake should be controlled to maintain normal body weight and blood glucose, and the intake of vegetables should be increased appropriately.

Nasal homogenized meals, enteral nutrition preparations or other special medical purpose formulas should be taken.

Homemade homogenized meals should be balanced, with a combination of meat and vegetables, and the same requirements for ingredients as above.

For the elderly with swallowing disorders, thickeners should be added to the fluid diet to avoid choking and adverse events.

For nasal feeding patients, the temperature of the homogenized meal should be controlled at 38-40 ℃ (wrist test temperature without abnormal sensation), and pushed in 20-30 ml per minute at an even rate, and the amount of nasal feeding throughout the day should not be too much, and it is about 1,500-2,500 ml per day.

Family members can help the patient move around in bed during the day, turn over diligently, and then perform abdominal massage before bedtime to help digestion.

Exercise management

Appropriate physical exercise can slow down brain degeneration.

At least 150 minutes of moderate-intensity exercise (e.g. walking, jogging, etc.) or 75 minutes of high-intensity exercise (e.g. brisk walking, gymnastics, etc.) per week.

You can also do some household chores or delicate handicrafts, such as knitting sweaters and Chinese knots.

Home management

Create a quiet and comfortable living environment for the patient and avoid exposing the patient to excessive stimulation, such as noise, crowds and noises.

Family members should pay attention to the patient’s mental state, listen patiently and communicate and interact with the patient.

Keep items with potential safety hazards, such as knives and scissors, away from the patient.

To prevent the patient from getting lost, a note with home address and family contact number can be placed in the patient’s coat pocket.

Prevention

There are no drugs that can prevent Alzheimer’s disease. By controlling chronic diseases, improving diet and lifestyle habits, and performing brain exercises can help reduce the risk of developing Alzheimer’s disease.

Control of chronic diseases

Hypertension, diabetes, hyperlipidemia, etc. may directly or indirectly affect brain function, and should be standardized according to doctor’s instruction.

Body mass index is controlled at 18~23kg/m2. Body mass index = weight (kg)/height (m) squared.

Improve dietary and living habits

Choose low-salt, low-fat, high-protein, high-vitamin diet, and supplement B vitamins appropriately.

Avoid spicy and stimulating foods.

Quit drinking and smoking.

Ensure adequate sleep and avoid staying up late.

Pay attention to rest and avoid exertion.

Perform moderate aerobic exercise to help promote blood circulation and slow down brain aging.

Perform brain exercises

By participating in social activities, playing chess, chatting with others, and putting together jigsaw puzzles or models, etc., you can exercise your brain function, maintain memory function and slow down aging.