Aim: To slow the regression of the mental faculties.
Alzheimer's disease can in fact be treated in line with present scientific standards, but there is no cure. Hence, the objectives of Alzheimer therapy are to slow the deterioration in mental capacity, improve the symptoms, preserve the remaining faculties and relieve the strain on relatives in the provision of care. The desire is to help patients remain in their familiar surroundings for as long as possible. Hence, medicinal therapy plays an important part in Alzheimer's disease.
Alzheimer's. Diagnostics, Therapy & Treatment
Diagnostics. How is Alzheimer's identified?
To date there is no classic examination method which can be used to diagnose Alzheimer's disease with certainty. Sufferers and their relatives should consult a specialist in neurology or psychiatry if they suspect Alzheimer's disease. You will be asked by the doctor to begin with about events so far, e.g. when any abnormality was first observed. A psychopathological test will be used to determine consciousness, orientation, attention, retention, misperceptions and moods. A laboratory test cannot yet detect Alzheimer's, but will be able to clarify any other possible causes for the condition. These could be hormone disorders, vitamin deficiencies, metabolic disorders and rare chronic infectious diseases such as neurosyphilis. To this aim, the doctor will take a blood test and possibly also a sample of the cerebrospinal fluid.
Treatable causes can be found by using methods of tomography.
Some of the rare, potentially treatable causes can be identified with the aid of computer tomography or magnetic resonance imaging. Images of slices of the brain are taken with such methods. More recent methods enable the circulation in the brain and activity of certain areas of the brain to be visualised. Repeated examinations can, as a rule, detect any advance in the degeneration of the brain though such information mostly serves only to confirm the clinical development.
Psychometric test methods for confirming diagnosis.
To confirm the diagnosis, further psychometric test methods are advisable in order to promptly and objectively assess the mental faculties or any losses thereof. The severity of the impaired brain function can be determined using the Mini Mental State Examination (MMSE). This is a ten-minute test which examines, for example, orientation, memory, attention and arithmetic, speech and constructive practice. There are also more extensive tests for examining singular aspects more closely. A suitable third-party assessment, particularly in advanced stages, is the Nurse Observations Scale for Geriatric Patients (NOSGER). This examination considers cognitive, affective and motor aspects.
Therapy. Types of treatment
Medicinal therapy for acetylcholine deficiency.
As the disease progresses, it is mostly the nerve cells which work with the neurotransmitter acetylcholine (AChH) which are destroyed. The neurotransmitter acetylcholine is involved in learning processes and attentiveness. Alzheimer's results in a deficiency of acetylcholine, whereby electrical impulses between the nerve cells are no longer transmitted correctly. Substances called acetylcholinesterase inhibitors ensure that the neurotransmitter is again made available in increased quantities in the brain. Hence they can improve the transmission of information. Studies have demonstrated that the intake of medication during the early to moderate stages of the disease can influence the daily activities. Occasional side effects occur in the form of nausea and, rarely, vomiting. In the presence of severe liver disease and severe cardiac dysrhythmias, their use must first be carefully considered.
Medicinal therapy for a surplus of glutamate.
The second group of medicines involves glutamate antagonists. Glutamate is also a neurotransmitter and has the most potent, excitatory effect on the nervous system. It is used by the excitatory cells during learning processes. In Alzheimer's patients, release and uptake by the cells is disrupted. As a result, too much glutamate becomes available: the neurotransmitter damages the nerve cells and leaves them to perish. The active substance memantine should prevent this from happening. Caution is necessary, however, when administering memantine to patients with renal dysfunction. According to most recent information, no clear recommendation could be given to the combination of AChH and memantine.
Use of psychopharmaceuticals in the advanced stage.
The earlier medicinal therapy is commenced, the greater the success. If the disease is already very advanced, it is most important to treat the typical symptoms of the disease with a variety of psychopharmaceuticals. Antidepressants such as citalopram and sertraline have a stimulating effect, are tolerated well and cause few interactions with other medicines. Modern antipsychotics (neuroleptics) are used for behavioural disorders, restlessness, aggression and delusions. However, circulatory disorders may occur if these medications are taken for prolonged periods. After a few weeks, therefore, an attempt should be made to reduce the dose or even discontinue these medicines altogether, under the supervision of the attending doctor.
Intensive care from relatives or special facilities.
Alternatives or supplements to medicinal therapy in the treatment of behavioural symptoms entail the intensive care of the patient by his or her relatives, or by therapeutic facilities. At therapeutic facilities, individual therapies of an artistic nature are offered in addition to daycare at day centres, without straining the limits of a patient's abilities. Often, another positive factor is interaction with pets, such as dogs.