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What is Alzheimer’s disease and How to deal with it ?

Alzheimer’s disease 

normal and diseased brain
Normal and Diseased brain

Alzheimer’s disease is a progressive neurologic disorder that causes the brain to shrink (atrophy) and brain cells to die which is the most common cause of dementia a continuous decline in thinking, behavioral and social skills that affects a person’s ability to function independently.

 

ETIOLOGY

  • Unknown but involves amyloid beta accumulation initially, then synaptic dysfunction, neuro-degeneration, and eventual neuronal loss
  • Age, genetics, systemic disease, behaviors (smoking), and other host factors may influence the response to amyloid beta and/or the pace of progression toward the clinical manifestations of AD.

 

RISK FACTORS

  • Aging, family history, Down syndrome
  • Hypertension, cardiovascular, and carotid artery disease
  • Smoking
  • Head trauma

 

GENERAL PREVENTION

  • Intellectual challenge (puzzles) and regular physical exercise may offer preventive benefit.
  • You have to control your vascular risk factors (e.g., hypertension) and you have to monitor your cholesterol as well.
  • Physical activities may help to prevent or delay cognitive decline.
  • Ginkgo biloba extracts (120 mg/day) is beneficial especially if your condition is associated with memory loss and loss of cognition.
  • Coenzyme Q10.
  • Omega-3 fatty acids.

GENERAL MEASURES

  • You need to optimize treatment of associated associated conditions (including hearing and vision loss).
  • You have to monitor your environment for safety and security and avoid sudden changes in environment.
  • High-fat (70%) diet found to be as effective in slowing progression as medications in small trials.

 

PHARMACOLOGICAL MANAGEMENT

normal and diseased brain
Normal and Diseased Brain

First-Line Of Treatment

  • Donepezil (Aricept): Start at 5 mg/day, you may increase to 10 mg/day after 1 month.
  • Rivastigmine: Start at 1.5 mg PO BID, increase by 1.5 mg BID every 2 weeks; maintenance 6 to 12 mg/day
  • Galantamine: Start at 4 mg BID for 4 weeks, then increase by 4 mg BID every month with goal of 16 to 24 mg/day dose.
  • N-methyl-d-aspartate (NMDA) receptor antagonists.
    • Monotherapy or in combination with acetylcholinesterase inhibitors.
  • Memantine: 5 mg/day, you may increase gradually to target dose of 10 mg after 4 weeks. Moreover, it improves behavioral issues.

 

References

  1. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447
  2. https://www.memoryrate.com/?dkt_nbr=030603amoply&msclkid=14053cf22b7a1fa0bf3c5cf7a873a699
  3. B McGuinness, D Craig, R Bullock, et al. Statins for the prevention of dementia. Cochrane Database Syst Rev. 2016;(1):CD003160.
  4. CC Tan, JT Yu, HF Wang, et al. Efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer’s disease: a systematic review and meta-analysis. J Alzheimers Dis. 2014;41(2):615–631.
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