Holistic Alzheimer's Care Approach
Profile
Alzheimer's disease (AD), abbreviated from its English term, is the most common type of dementia in the elderly. It impairs a patient's thinking, memory, and independence, affecting their quality of life and mortality.
The U.S. Food and Drug Administration (FDA) has described it as a "devastating disease." Globally, according to the World Alzheimer Report 2018 released by the Alzheimer's Disease International (ADI), there are currently at least 50 million dementia patients worldwide. By 2050, it is estimated to reach 152 million, with approximately 60%–70% of cases being Alzheimer's disease patients.
The challenge in treating Alzheimer's lies in the fact that its disease mechanism is not fully understood. Currently, it is widely accepted that an imbalance between the generation and clearance of β-amyloid (Aβ) is considered the initiating factor for neurodegeneration and the onset of dementia. Abnormal levels of β-amyloid form plaques between brain neurons, which are neurotoxic and lead to neuronal degeneration.
Etiology
The disease may be a heterogeneous group of conditions, arising under the influence of various factors (including biological and psychosocial factors). Research indicates more than 30 potential factors and hypotheses, such as family history, female gender, head trauma, low education level, thyroid disease, advanced or delayed maternal age, viral infections, and others.
Clinical Featur
The onset of the disease is slow or insidious, often difficult for patients and their families to pinpoint. It is more common in individuals over 70 years old (average age of onset is 73 for males and 75 for females). In a few cases, symptoms rapidly become apparent after physical illnesses, fractures, or psychological stressors. The disease is more prevalent in females (3:1 ratio to males). Main symptoms include a gradual decline in cognitive function, psychiatric symptoms, behavioral disturbances, and the gradual loss of daily life abilities. The progression is categorized into three stages based on the worsening of cognitive abilities and physical functions.
Mild dementia stage (1-3 years). Symptoms include memory loss, particularly in recent events; decreased judgment, with difficulties analyzing, thinking, and handling complex problems; carelessness in work or household chores, inability to manage shopping or financial matters independently, and social difficulties. Although the patient can still perform familiar daily tasks, they struggle with new activities, display emotional indifference, occasional agitation, and often suspicion. There is a struggle with time orientation and difficulty in understanding geographical locations. Limited vocabulary and naming difficulties are also common.
Moderate dementia stage (2-10 years). Symptoms consist of severe impairment in both short-term and long-term memory, decreased visual spatial abilities for simple structures, and difficulties in time and location orientation. Patients face challenges in problem-solving, distinguishing similarities and differences between objects, and become reliant on assistance for outdoor activities, dressing, personal hygiene, and grooming. They lose their ability to perform calculations and exhibit various neurological symptoms like aphasia, apraxia, and agnosia. Emotional indifference transforms into restlessness, constant wandering, and incontinence.
Severe dementia stage (8-12 years). Patients are entirely dependent on caregivers, experiencing profound memory loss with only fragments of memory remaining. They become unable to manage daily life activities, experiencing incontinence in bowel and bladder control. They may display silence, rigidity, and physical examination may reveal positive signs of pyramidal tract involvement, primitive reflexes like strong grasp, groping, and sucking. Eventually, they may slip into a coma and typically succumb to complications such as infections.
Examination
Cognitive assessments: Including tools such as the Mini-Mental State Examination (MMSE) to evaluate cognitive function.
Imaging studies: Brain MRI and CT scans are used to rule out other causes of cognitive impairments and detect changes in brain structure.
Electroencephalogram (EEG): Evaluates changes in brain electrical activity.
Biomarkers: Certain blood or cerebrospinal fluid biomarkers may assist in diagnosis.
Diagnosis
The diagnosis of Alzheimer's disease typically involves excluding other potential causes of cognitive impairments and is based on the patient's symptoms, clinical assessments, and imaging studies. At present, a pathological examination is still required to conclusively confirm the diagnosis of Alzheimer's disease.