Alzheimer’s disease, commonly known as dementia, is a major health hazard for the elderly, seriously affecting their quality of life and imposing a serious economic burden on families and society. To promote the awareness of Alzheimer’s disease, it helps to detect the signs of the disease at an early stage and seek medical treatment at an early stage, which plays an important role in slowing down the progress of the disease and improving the ability of patients in daily life.
I. Causes of Alzheimer’s disease
1, genetic factors: APP, PS1, PS2 gene mutations cause early-onset Alzheimer’s disease. ApoEε4 gene is a risk gene for late-onset Alzheimer’s disease, and those who carry ApoEε4 gene have a significantly higher risk of developing the disease.
2. Age: The prevalence of Alzheimer’s disease increases exponentially with age.
3. Gender: The prevalence of Alzheimer’s disease is higher in women than in men. This may be related to changes in hormone levels in women after menopause.
4.Literacy: Low literacy is a risk factor for Alzheimer’s disease.
5.Socio-economic status: People with low social status and poor economic status have an increased risk of Alzheimer’s disease.
6, underlying diseases: traumatic brain injury, hypertension, diabetes, hyperlipidemia, obesity, depression, etc. are risk factors for Alzheimer’s disease.
7, bad habits: smoking, alcoholism, etc.
Second, the clinical manifestations of Alzheimer’s disease
Early stage: The early symptoms of Alzheimer’s disease are often overlooked by patients’ families and friends, and even mistaken for the symptoms of aging and normal aging. The main symptoms of early stage Alzheimer’s disease are.
1, memory loss, forgetfulness: often forgetting things, and can not remember afterwards, repeatedly asking the same question, forgetting the answer that has been told.
2. Forgetting the front and the back: for example, not remembering to bring the prepared meal to the table, or even completely forgetting the meal that has been prepared.
3.Insensitive words: Confusing language expressions and inappropriate use of words.
4.Incorrect judgment of time and place: Can’t remember what day of the week or month it is, may get lost near home and don’t know how to get home.
5.Loss of judgment: May go out while the gas is on or cooking.
6.Loss of abstract thinking ability: Often forget how to organize numbers, forget the password you set for deposits, and have trouble remembering the amount of deposits.
7.Randomly put things away: Often put things in inappropriate places, such as putting watches in cookie boxes, or collecting waste products, such as rotten paper, drink bottles and other garbage as treasures.
8, temperamental: can change from the usual state to a tearful, uncontrollable emotion in a few minutes, or shoot up, angry.
9.Change in personality: angry, suspicious or scared at every turn, not the same as the original personality.
10.Loss of initiative: becoming lazier than before, unwilling to participate in activities, even activities that were originally enjoyed, and not enthusiastic about people.
Among the above 10, memory loss and transient forgetfulness are usually the earliest, most serious and core symptoms.
Middle stage: When the disease enters the middle stage, the patient shows a decline in daily living ability, such as: unable to complete activities such as cooking, hygiene, shopping, etc. independently; needing to rely on others for assistance in hygiene issues such as going to the toilet, washing clothes, dressing, etc.; getting lost at home or near other familiar environments; showing mental behavior symptoms such as irritability, paranoia, trance, repetition, hallucinations, etc.; showing personality changes such as not paying attention to hygiene, personality changes, such as lack of attention to hygiene, grooming, and even loss of shame (e.g., urinating and defecating in public places).
Late stage: Patients need the assistance of others in daily life, lose the ability to move around, cannot eat, do not recognize family members, friends and familiar things, and need to use a wheelchair to move around or even be bedridden.
Diagnostic methods of Alzheimer’s disease
1.Neuropsychological assessment: Neuropsychological assessment can assess whether the patient has cognitive impairment and clarify the area and severity of cognitive impairment.
2.Blood biochemical examination: It helps to find out the etiology of treatable cognitive impairment, such as vitamin B12 deficiency, folic acid deficiency, hypothyroidism, syphilis infection, HIV infection, etc.
3.Imaging examination: cranial CT or MRI and other imaging examinations can detect intracranial lesions, such as tumor, subdural hematoma, hydrocephalus, cerebrovascular lesions, etc. Cranial hippocampal scan can clarify the degree of hippocampal atrophy, which helps to diagnose Alzheimer’s disease.
4. Lumbar puncture cerebrospinal fluid examination: it can further exclude whether the dementia is caused by syphilis infection; by detecting specific proteins such as beta amyloid and phosphorylated tau protein in cerebrospinal fluid, it can make etiological diagnosis of dementia and help achieve early diagnosis of Alzheimer’s disease patients who have not entered the dementia stage and are still in preclinical stage without dementia manifestation.
IV. Treatment of Alzheimer’s disease
At present, the treatment of Alzheimer’s disease is mainly through drugs to improve patients’ symptoms. Although drug treatment cannot reverse patients’ cognitive function, it can slow down the rate of cognitive decline and extend the life expectancy of early Alzheimer’s disease patients by 3-5 years.
1. Drugs to improve cognitive function: These drugs mainly enhance the activity of enzymes and improve brain tissue metabolism, or change the pathological process of Alzheimer’s disease, or enhance the synthesis and metabolism of neurotransmitters to restore brain function and information transmission, or improve blood flow supply and the utilization of oxygen and glucose by brain cells, so as to reduce the damage of pathogenic factors to the brain. These include cholinesterase inhibitors such as donepezil and carbamate; NMDA receptor antagonists such as meperidine; brain metabolism activators such as piracetam and oracetam; and calcium channel antagonists such as nimodipine.
2, the control of psycho-behavioral symptoms of drugs: Alzheimer’s disease patients common psycho-behavioral symptoms include depression, anxiety, emotional indifference, emotional high or disinhibition. The drugs used to improve psycho-behavioral symptoms mainly include antidepressants, benzodiazepines, mood stabilizers and atypical antipsychotics. The principles of drug use for controlling psychobehavioral symptoms are: (1) start at low doses; (2) slowly increase the dose; (3) try to use the smallest effective dose; (4) individualize treatment; (5) pay attention to drug interactions.
V. Care and nursing of patients with Alzheimer’s disease
1.How to create a safe home environment?
Try to create a safe and humane home environment for patients. On the one hand, it should be as simple as possible and reduce the number of dangerous objects in the room; on the other hand, some small cues can help patients find what they need. A sense of control over the environment is an important factor for patients to maintain self-esteem, so try to discuss with the patient before rearranging the room.
① Remove unnecessary items and furniture from the home.
② Add safety features: mark thresholds and stairs and install handles in appropriate places.
③Ensure that the room is well lit and that strong daylight needs to be blocked by curtains. Be aware that reflections from mirrors and metal surfaces can make patients feel uncomfortable.
④ The passage between the living room and the bedroom should be spacious enough for patients to walk.
⑤ Check the safety of windows and doors, such as installing window locks and controlling the size of window opening to prevent patients from falling through the windows.
⑥water heaters with water temperature set below 49 degrees Celsius to avoid scalding.
(7) Check the placement of portable heaters and fans to avoid injury to patients.
2. Handle dangerous objects.
①Sharp utensils should be locked in drawers to avoid patient contact.
②Try to use appliances that can be turned off automatically, such as kettles and heaters.
③ Do not place locks on bathroom doors to avoid patients locking themselves in the bathroom.
④Patients should be supervised when taking medication to avoid getting the wrong medication or dose.
3.How to deal with memory impairment? (Patients with Alzheimer’s disease often forget words and can’t remember things, or even don’t know where they are.)
① Daily arrangement: arrange the things the patient has to do every day in a certain order.
② Use of reminders: Pee notes, calendars, alarm clocks, etc. are good ways to help with memory.
③ Marking furniture and objects in the home and in the environment often visited, such as marking directions and names, to reduce the frustration caused by forgetting words.
④ Carrying a memo.
⑤ writing down important information in a book, such as phone numbers, names, times and places of meetings, ideas and opinions, etc.
⑥Selecting times when the patient is at his or her best to work on relatively complex matters. Continuous memory stimulation can slow down the progress of the disease. Forms of stimulation include dancing, singing, puzzles, reading, drawing, etc.
4.How to cope with communication difficulties? (People with Alzheimer’s disease sometimes have difficulty finding the right words to express themselves and understanding what others say.)
① Keep communication as simple as possible, such as simple words, short sentences or conversations that the patient is familiar with.
② Emphasize eye contact and try to avoid noise interference when talking.
③Repeat expressions to ensure that the patient can understand them, or ask the patient to repeat after them.
Use different ways of expression: “tell” and “show” can have different effects, supplemented by gestures and body language to help communication. Encourage more, do not rush. Humor at the right time to relieve tension.
5.How to deal with the difficulty of daily living? (As the disease progresses, the patient’s ability to get up and go about daily life will get worse.)
(1) Eating: ① Adjust the recipe first, the patient’s taste may change; ② Try eating less and more meals when the patient’s appetite is poor; ③ Make sure the patient has a long enough meal time, never rush; ④ Choose easy-to-use tableware; ⑤ Talk more about food-related topics during meals; ⑥ Stick to the principle of simplicity, a simple table layout and non-patterned dishes help the patient maintain attention. Do not eat while watching TV to avoid distraction.
(2) Bathing: ① Make bathing a pleasurable event, such as gentle conversation, massage, playing soft music, using scented soap, etc.; ② Prepare in advance and arrange all the details; ③ When the patient’s self-care deficit is getting worse and he/she cannot understand how to bathe, the caregiver can break down the bathing process into one simple action, instruct the patient on each step, and encourage the patient to (2) Do it by yourself.
(3) Dressing: ① The number of clothes available should not be too large, choose clothes that are comfortable and easy to wear; ② Mark the drawers to indicate which clothes are put in each drawer; ③ Take out the clothes to be worn and arrange them according to the order of dressing; ④ Choose clothes or smocks with zippers and shoes with Velcro, try to avoid clothes with buttons or straps and shoes that need to be tied; ⑤ Female patients try to Choose front-open corsets and do not wear long socks, which may affect blood circulation; male patients should preferably choose flat shorts; ⑥If the patient is resistant to the caregiver’s help, the caregiver can leave for a while to let him calm down and go back to help him after a while; ⑦Give more encouragement and praise so that the patient has confidence in himself.
(4) Toileting: ①Place brightly colored instructional diagrams on the passage to the bathroom and the bathroom door; ②Continuously remind the patient to go to the bathroom every 2-3 hours to form a habit; ③The amount of water should be limited after dinner until bedtime; ④A night pot can be placed in the bedroom at night to facilitate use; ⑤Attend to observe and identify some special manifestations of the patient who wants to go to the bathroom, such as fidgeting or pulling clothes, etc., and should (6) when incontinence occurs, the patient may be agitated, at this time should not scold, should express understanding and give comfort, and then evaluate the cause of occurrence afterwards, and tell the patient to try to avoid it in the future.
(5) Household chores: ① Encourage patients to do household chores within their ability, such as washing dishes, sweeping the floor, etc.; ② When patients participate in household activities, give more praise and encouragement to increase their motivation to participate.
(6) Activities and exercise: Encourage patients to adhere to daily activities and exercises, such as walking or participating in activities and exercises for the elderly in the community, which can help delay cognitive decline and improve sleep.
6. How to cope with behavioral changes? (As the disease progresses, patients with Alzheimer’s disease may develop abnormal behaviors such as irritability and aggression.)
①Find the triggers of behavioral changes as much as possible and try to avoid their recurrence.
(ii) Reassure the patient by talking and reassuring him or her to keep him or her calm.
③Distraction is an effective way to alleviate inappropriate behavior.
④ Do not punish the patient or ignore him/her.
⑤ If the patient likes to hide things, try to find a pattern, such as what they like to hide and where they hide it, etc.
⑥If the patient is aggressive, try not to scold, insult or provoke them, but put yourself in the patient’s shoes and imagine how they feel and what they are trying to say.
(vii) Sudden aggression can be distressing and draining to the caregiver; try to find ways to ease the caregiver’s emotions.
⑧ Inform the patient of these abnormal behaviors when visiting the doctor.
7. How to deal with the patient’s sleep disorder? (Patients with Alzheimer’s disease often have altered sleep habits, such as day and night reversals.)
① Encourage patients to perform appropriate activities every day and pay attention to the reasonable arrangement of activity and rest time.
②Take some measures of orientation training to reinforce the concept of day and night.
③Keep the patient’s room brightly lit during the day, reduce nap time, and draw the curtains at night.
④Keep the environment quiet at night, and also take some measures to promote sleep such as massage and foot bath according to the patient’s physical condition.
⑤ Seek medical attention in time.
The above information is only scientific knowledge and cannot replace professional health care professionals. If you or your family members have problems in this area, please consult a doctor or other health care professional in the memory disorder clinic, neurology, psychogeriatric or psychiatric department.