Alzheimer’s disease is a progressive cognitive dysfunction syndrome that occurs in old age and is caused by neurodegeneration, cerebrovascular lesions, infections, trauma, tumors, nutritional and metabolic disorders, etc. According to its etiology, it is mainly divided into four categories: Alzheimer’s disease (AD), vascular dementia (VD), mixed dementia (MD), and other types of dementia (trauma, intracranial hematoma, etc.).
Clinical symptoms
The main clinical manifestations of Alzheimer’s disease are progressive distant and near memory impairment, loss of analytical and judgmental ability, emotional changes, behavioral disorders, and even blurred consciousness, with an insidious course and slow progression.
1.Main manifestations of early dementia
①Memory: memory impairment; time and orientation impairment; thinking and judgment impairment.
②Behavior: mildly impaired language function; inattention; loss of initiative and motivation, lack of enthusiasm for life and work; emotional indifference or become easily stressed and agitated, may appear melancholy, suspicious, stubborn, calculating and even aggressive behavior.
③Living ability: the ability to learn just and master new skills decreases, and it takes longer to finish the work and tasks that can be done competently before, and cannot finish complex tasks.
2.Mid-term dementia main performance
(1) Memory: significant intelligence decrement, with obvious cognitive dysfunction and increasing difficulty in speaking; serious forgetfulness of near things, distant forgetfulness is affected, and impairment of calculation and comprehension and judgment may occur.
(2) Behavior: personality changes are obvious, emotional instability, inattention, abnormal behavior, some may have hallucinations, delusions, etc.
(3) Living ability: the ability to take care of oneself in life is reduced, unable to live independently, needing assistance from others, such as dressing, going to the toilet, etc., becoming very dependent.
3.Late stage performance
Without effective treatment and care in the early stage, the disease will progress quickly to the late stage.
(1) Memory: unable to recognize family members, friends and familiar objects, or even their own appearance, unable to write their names, unable to recognize their surroundings; unable to do simple addition and subtraction; unable to communicate with language; not knowing the year, month, season, etc.
(2) Behavior: body convulsions, accompanied by difficulty in swallowing and stiffness of limbs; difficulty in walking, starting to need a wheelchair and finally bedridden; unable to eat independently, dress, etc.; also very abnormal behavior in public places.
(3) Ability to live: almost complete loss of ability to take care of oneself, incontinence, disturbance of day and night rhythm, etc.
Rehabilitation treatment
At present, there is no fundamental breakthrough in the treatment of Alzheimer’s disease. Clinical care and cognitive function training are especially important to improve the quality of life of Alzheimer’s patients.
1.Rehabilitation training
Because of the different mechanisms and manifestations of various cognitive dysfunctions, rehabilitation treatment should be chosen flexibly according to the patient’s condition, and the duration of each session should not be too long.
(1) Memory training
Patients with dementia still retain the ability to extract memories. Suitable memory training activities should be formulated according to the patient’s condition to encourage the recall of past life experiences and restore or improve the patient’s memory through information stimulation such as action, language, sound and images, such as matching games, puzzle activities, question and answer activities, or memorizing some numbers and repeatedly training from simple to complex.
For those with severe memory impairment, memory is helped by preparing a schedule of daily life activities, making work and rest plans, and hanging and placing calendars. For things that are easily forgotten or procedures that are often wrong, set up reminder signs to help memory.
①Instantaneous memory training: digital memory breadth training.
②Short-term memory training: increasing the number, time, and as well as the retention time of the recognized pictures or items.
③Long-term memory training: guide the patient to recall what happened a few days ago or the content of a TV program watched. According to the type and degree of the patient’s memory impairment, perform targeted memory training, gradually increase the degree of difficulty from simple, and give frequent verbal feedback such as guidance and encouragement during the training process.
(2) Intellectual training
Intellectual training involves many aspects such as general knowledge, social adaptability, calculation power, analytical and synthesis ability, logical association ability, and flexibility of thinking. Encourage the elderly to participate in more social activities and use their hands and brains, such as reading and writing more, learning new languages, cultivating various hobbies, visiting museums, charades, jigsaw puzzles, playing chess, etc. Exposure to a wide range of people from all walks of life, to exercise the ability to express and understand, as well as the ability to solve problems and adapt to society.
① Thinking training: including logical reasoning, analysis and comprehensive comprehension and expression skills, such as asking patients to read newspapers with unlimited content and briefly retelling after reading; some activities that require their own hands and brains, such as puzzles and stacking blocks according to drawings; performing arithmetic exercises, addition and subtraction within 100, and assessing their correctness within a specified time; summarizing and classifying many word cards, pictures of objects and physical objects.
②Social adaptation training: such as participating in various social activities to improve the patient’s social adaptation reins efforts and enhance the interest in interacting with others.
(3) General knowledge training: Patients are trained in general knowledge, such as through repeated questions and reminders of some general knowledge, or by combining it with real life for better effect, which can enhance the extraction and re-storage process of general knowledge and slow down the forgetting speed.
(3) Cognitive-specific rehabilitation methods
(1) Error-free learning techniques: Since patients’ ability to correct errors is significantly reduced, error-free learning methods emphasize the development of good habits to avoid errors at early learning. Focused training on a particular point of cognitive dysfunction of the patient, repeated reinforcement, and deeper memory of the information obtained can ensure correct learning and memory.
②Cancellation cueing technique: That is, at the beginning of training and learning, provide partial cues to help information reproduction, and gradually remove this cue as learning progresses. Encourage the patient to self-cue to increase the patient’s initiative and ability to participate. For example, if the cue word “fruit” is used to remember apples, the patient’s recollection of apples is accelerated by cueing “fruit”, and then the cue is gradually removed during training.
(4) Life skills training
Patients with Alzheimer’s disease should actively train their daily living ability as much as possible, such as dressing and undressing, eating, toileting, washing face, combing hair, brushing teeth, traveling, taking medication, etc. Develop training steps, divide the whole exercise into several small parts, and train gradually from easy to difficult, first let the patient complete the designated tasks alone as much as possible, and then ask the patient to shorten the time to complete the tasks as much as possible on this basis.
2.Dietary treatment
Daily diet should be diversified, with more brain-healthy foods, high protein, high vitamin, high fiber, low cholesterol, low fat, low sugar and low salt diet.
①Foods rich in fiber: such as cereals, wheat, fresh fruits and vegetables, etc., are beneficial to brain health protection.
②Foods rich in lecithin: such as soy products, mushrooms, etc. Lecithin is an important substance for nerve cell metabolism and repair.
③All kinds of nuts: peanuts, walnuts, pine nuts, hazelnuts, sunflower seeds, etc., rich in linoleic acid, which has a protective effect on nerve cells.
3.Psychotherapy
Individualized psychotherapy and cognitive-behavioral therapy are carried out for the personality characteristics, education and social experience of the elderly.
Patients with Alzheimer’s disease need long-term rehabilitation training. If patients have different degrees of cognitive dysfunction, aphasia and reduced ability, they are very likely to be irritable, irritable and depressed, so good psychological guidance is the basis for effective rehabilitation training.
Patients should perform physical activities and exercises within their ability, pay attention to maintain optimism, reduce adverse stimuli, maintain harmonious interpersonal relationships, communicate more with others, participate in group activities, strengthen their own emotional compensatory capacity, improve poor living environment, accompany, care and enlighten patients, give them affirmation and praise, reduce their stress and loneliness, and avoid depression due to long-term worries.
For patients with mental abnormalities, antipsychotic drugs can also be used as appropriate. The drugs can improve the symptoms or stop their deterioration to a certain extent, but they should be used with caution and the dosage should not be too high.
4.Drug treatment
(1) Improve choline neurotransmission drugs
At present, four kinds of acetylcholinesterase (AchE) inhibitors (tacrine, anisin, esnon, galantamine) and an N-methyl-D-aspartate (NMDA) receptor antagonist (meperidine hydrochloride) are commonly used.
(2) Drugs to improve cerebral blood circulation and brain cell metabolism
Mainly including brain metabolism activator and brain circulation improvement agent, such as brain rehab, Ducoxib, Sidetown, hexoketone cocaine, brain pass, etc.
(3) Calcium antagonists
These drugs can easily cross the blood-brain barrier, selectively dilate the cerebral blood vessels, reduce the damage or death of nerve cells caused by the inward flow of calcium ions, and thus improve memory and cognitive function.
(4) Hormonal drugs
The use of estrogen for Alzheimer’s disease may relieve symptoms in female patients and may delay or prevent the progression of the disease. This aspect of estrogen’s action is related to its antioxidant effect, reducing cell damage from amyloid deposition, promoting neuronal repair, and preventing neuronal cell death.
(5) Non-steroidal anti-inflammatory drugs
Small doses of aspirin may reduce the deterioration of Alzheimer’s disease. In addition, NSAIDs such as ibuprofen, diclofenac, and neproxen may be effective drugs for the treatment of Alzheimer’s disease.
(6) Free radical scavengers and antioxidants
The main ones are vitamin E, melatonin, curcumin, desferrioxamine, idebenone, tirazat mesylate, vitamin C, etc.
(7) Muscarinic receptor agonists
High doses of muscarinic M1 agonist Janumetrin can significantly improve the cognitive function and motor behavior of Alzheimer’s patients, but the drug has serious gastrointestinal and cardiovascular side effects.
(8) Traditional Chinese medicine
He Shou Wu, Epimedium, Cuscuta, Atractylodes, Poria, Ginseng, Panax Ginseng, Lycium, Fructus Lycii, Yuan Zhi and Ziziphi, etc. have the effect of enhancing nerve growth factor, promoting brain development, maintaining and improving memory function, and delaying brain aging and brain atrophy.
(9) Note on taking medication
Patients must be accompanied when taking medication, patiently explain and persuade, and help them to take all the medication to avoid forgetting, wrongly taking or refusing to take the medication; the medication can be crushed and mixed with rice for patients to take, and it is necessary to check whether patients swallow the medication after taking it to prevent them from vomiting it up after being left unattended; for patients with depression, hallucination and suicidal tendency, family members must manage the medication well and put it in a place where the patient cannot reach or find it; bed-ridden, difficulty in swallowing, the patient must take the medication and put it in a place where the patient cannot find it. Patients who are bedridden or have difficulty swallowing should not swallow pills, it is best to crush them and dissolve them in water, and patients who are unconscious should be injected with drugs through a gastric tube.