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If any one faculty of our nature may be called more wonderful than the rest, I do think it is memory. There seems something more speakingly incomprehensible in the powers, the failures, the inequalities of memory, than in any other of our intelligences," wrote Jane Austen, the English writer. This most wonderful gift, if you loose, can make your life chaotic.

The enduring disorder in memory retention is known as Alzheimer's disease. Generally, the disease affects the brain tissues after one reaches forty years. Once affected, Alzheimer's gradually destroys the ability to reason, remember, imagine and learn. It is marked by abnormal clumps (plaques) and irregular knots (neurofibrillary tangles) of brain cells. For reasons not well understood, these plaques and tangles take over healthy brain tissues, devastating the areas of the brain associated with intellectual function.


These factors influence the condition but are not necessarily the causes.

Risk factors are :
>Increasing Age.
>Family history and genetics.
>Sex of the person.
>Environmental factors.


The affected individual may not be aware of these changes at first, but friends, relatives and co-workers notice that the person:

>Is increasingly and persistently forgetful.
>Mildly disoriented.
>Frequently loses or misplaces familiar items.
>Has mild difficulties performing arithmetic calculations.


>Has noticeable memory loss.
>Frequently uses words inappropriately.
>Begins to lose the ability to perform normal tasks of daily living, involving muscle coordination, such as cooking, dressing, bathing, shopping, or signing a checkbook (apraxia).
>May wander off, become agitated, start confusing day from night, and fail to recognize friends and relatives with whom they were very close with.
>Loses the ability to recognize and use familiar objects, such as clothing (agnosia).


>Becomes uncomprehending and mute.
>Loses all self-care ability.
>Is unable to feed, dress and bathe him or herself. If the person has a sudden onset of these symptoms or early symptoms such as seizures, gait problems, or loss of vision and coordination -- it's less likely that they indicate Alzheimer's.


There are no quick, simple, reliable, inexpensive and noninvasive tests available to diagnose Alzheimer's disease, before the individual suffers significant damage. Diagnosis of Alzheimer's rests largely on the judgment of physicians experienced in dealing with similar illnesses.

The hallmarks of Alzheimer's disease is plaques and tangles in brain tissue. However this cannot be used to establish a diagnosis as it is seen only after an autopsy . Getting the right diagnosis is the first step in planning any treatment.

There are other causes of dementia that requires to be ruled out before labeling a patient as suffering from Alzheimer's disease. Some of these are reversible and include thyroid and Vitamin deficiencies. About 60% of dementia is due to Alzheimer's and about 15% are related to vascular diseases. There is also a category where there is mix of both Alzheimer's and vascular disease. A new entity has recently been added called 'Lewy Body disease' that can also cause dementia.
A complete physical and neurological examination is the first step before investigations are undertaken. After this the patient requires a psychiatric assessment. It is important for someone close to the patient to be interviewed to learn about the patient's daily activity and understand their emotional state.
Ruling out Parkinson's disease, stroke or tumors of the brain is essential. Memory tests are undertaken for recall of events.
Once the physical and mental assessment is over, blood tests and radiological investigations are done to rule out anemia and vitamin deficiency. Tests related to the thyroid kidney and liver are also carried out.
The brain imaging is done using CT scan or MRI or the newer PET scan to understand if there are any apparent changes in the overall size of the brain and the memory associated areas of the brain such as hippocampus.
Sometimes it may be essential to undergo an EEG test of the brain where the signals are picked up by recorder and analyzed. A spinal tap to analyze the CSF fluid may also need to be done.
Alzheimer disease causes deposition of plaques that contain an insoluble protein called beta amyloid. Under the microscope one can recognize the presence of these "neurofibrillary tangles" due to a protein called 'Tau'. T his protein encourages the formation of microtubules and these transport chemicals inside cells. Tangles are the hallmark of Alzheimer's but Tau is also a suspect in causing the disease.


No drugs are available to treat Alzheimer's disease. But the doctors give medicines to improve behavioral symptoms that often accompany Alzheimer's, including sleeplessness, wandering, anxiety, agitation and depression.

At present there is no known cure for Alzheimer's disease. However by following a multi-disciplinary approach a patient with this condition can improve the overall quality of life. The specialists who are involved with the treatment of this condition include:

>Sleep Medicine Specialists
>Physical Rehabilitation >Medicine specialists

The treatment plan should be tailor-made for each patient. One must also keep in mind that there are many clinical trials that are currently underway and some patients may benefit from the newer drugs that are not necessarily approved by FDA.
The treatment aims at controlling the symptoms of the disease and helps in controlling changes in memory, mood and behavior that commonly occur with Alzheimer's disease.
There are many medications currently available and this section provides an overall view of the current medications that are used for the conditions and the rationale for their use.




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