Alzheimer's: symptoms, causes and treatment

By Cristiano Antonino On Jan 17, 2023

Alzheimer’s disease is the most common form of dementia, i.e. decline in mental faculties: according to official estimates, it accounts for 50-80% of dementia cases and affects 600 thousand people in Italy alone

It is not a sudden disease, but a progressive one: it causes a slow decline in memory, reasoning and thinking abilities.

Those affected gradually lose their self-sufficiency until they become completely dependent on others.

It is no coincidence that this disease is considered the main cause of disability in ageing.

Alzheimer’s disease, what it is

Alzheimer’s consists of a progressive loss of brain capacities and functions: the mnestic, cognitive and functional ones.

Although there are forms of the disease with an early onset (even at the age of 45), the vast majority of people show the first symptoms after the age of 65.

The incidence of the disease increases with advancing age.

Women fall slightly less ill than men in the early forms, while they are slightly more affected in the later-onset forms.

The fact that the disease is more common after a certain age does not mean that older people are all destined to fall ill.

With ageing, it is normal to be subject to some memory problems and a slowing down of thinking, but Alzheimer’s is quite another thing: a real disease that affects only a segment of the population.

Alzheimer’s disease causes

To date, the causes of Alzheimer’s disease are not entirely known.

However, experts have identified some of the mechanisms and processes that lead to the onset of the disease.

First of all, it has been observed that the brain affected by dementia undergoes ‘atrophy’: that is, it shrinks in volume (by around 20%) due to the early death of a very large number of neurons (nerve cells) in ‘critical’ brain areas, for example, the hippocampus and temporal lobe, which control memory circuits; the frontal lobe, especially the left one, which controls language; and the parietal lobe, which is responsible for the use of objects.

Secondly, studies have shown that in the presence of Alzheimer’s disease, excessive deposits of ‘toxic’ material accumulate in the brain.

In detail, fragments of a protein – called beta amyloid – accumulate in the spaces between nerve cells and form plaques.

Inside the cells, on the other hand, twisted fibres of another protein called tau accumulate. In addition, neurofibrils – the constituents of neurons – form tangles that prevent proper ‘dialogue’ between one nerve cell and another.

In addition, in the case of Alzheimer’s, the contacts between nerve cells (synapses), which regulate a person’s behaviour and allow memories, emotions, sensations, knowledge to be created and deposited in the brain, are progressively reduced.

This happens due to both the reasons just listed and the reduction of neuromediators, in particular acetylcholine, which are chemicals that underlie nerve transmission.

Finally, substances – such as glutamate – that cause nerve cells to become overactive, leading them to degeneration at an early stage.

Predisposing factors

The reasons behind the mechanisms that lead to the development of Alzheimer’s are not yet known.

There seems to be a basic genetic predisposition, present from birth, but the causes that turn it into the actual clinical manifestation are not known.

It has also been seen that certain factors have a certain correlation with the disease.

Here are the main ones:

violent head trauma (with a state of coma or at least prolonged amnesia) during life;
family history of dementia (among parents, grandparents, uncles, etc.), associated with the presence of particular genetic alterations;
circulation disorders and heart disease: it appears that brain health is closely related to the health of the heart and blood vessels;
low schooling (in the sense of poor ‘use’ of one’s brain functions).

Alzheimer’s disease symptoms

Alzheimer’s is a sneaky and insidious disease that initially shows no particular signs of its presence.

Patients and relatives hardly notice in the early stages that something is wrong. The first symptoms are almost always slight memory loss and a progressive inability to learn new concepts or techniques.

Difficulty expressing oneself and understanding others is also often present.

Over time, the affected person may

experiencing a decrease in visual-spatial perceptual abilities, confusing time and place;
change mood, character and personality;
have problems making judgements;
being unable to do mathematical calculations and reasoning that require a certain logic;
psychiatric manifestations are also often present, such as anxiety, depression, irritability, social withdrawal, apathy.

There may also be an inversion of the sleep/wake cycle and a tendency to ‘wander’ (i.e. to leave the house without a specific purpose and wander around all day for no reason) and to constantly move about one’s environment like a caged tiger.

The advanced stages

The more the disease progresses, the more the difficulties increase: performing normal activities becomes more and more problematic, even performing mundane gestures such as dressing or washing one’s hands can be very difficult.

Memory loss becomes more and more pronounced: the person does not remember names, does not recognise loved ones and the places where they live. In addition, he or she finds it difficult to speak, write and move about in space.

As the disease progresses, the patient ends up becoming completely dependent on others: he has difficulty walking, stiffness of the limbs, urinary and faecal incontinence; he can only pronounce words spoken by others or repeat sounds or moans, sometimes he is even mute; he may have ‘infantile’ behaviour, such as bringing everything to his mouth.

A number of tests are needed to diagnose Alzheimer’s

The most important are those that allow a neurological assessment and include ‘neuropsychological tests’ for the brain functions most affected at an early stage (e.g. memory, language, writing, calculation, etc.).

An imaging test of the brain such as a CT scan or, better still, brain MRI is also indispensable.

PET can also be used to investigate whether the brain areas at risk ‘work’ (i.e. receive blood and consume oxygen and glucose) normally or not.

The specialist can also make use of more detailed and specific investigations.

Alzheimer’s disease, treatments

Unfortunately, Alzheimer’s disease is currently incurable. In fact, there are still no treatments that can counteract it and stop its progression.

However, there are drugs that manage to slow down the worsening of symptoms and improve the quality of life of patients and their families.

For example, drugs that work by increasing neurotransmitters in the brain are used.

In the early and middle forms, cognitive and physical rehabilitation is also very useful, which can slow down the progression of the disease and also improve the lives of patients and their families.

The rehabilitation programme is established by a team of different specialists and may include visual and acoustic exercises of increasing complexity.

Behavioural and educational interventions; participation in mood-enhancing activities; reality orientation therapy (ROT) aimed at orienting the patient with respect to his or her personal life, environment and space; counselling; and pet therapy can also be very beneficial.