Alzheimer’s is a neurodegenerative disease characterized by the progressive deterioration of cognitive functions accompanied by alterations in behaviour, personality and affectivity of the patient. Alzheimer’s disease has a multi-factor etiology, with a number of different features not obviously related to each other directly, but which collectively contribute to trigger the degenerative process of the brain.
From the pathophysiological point of view, Alzheimer’s disease is characterized mainly by the presence in the brain of tiny but numerous beta-amyloid plaques (Aβ) and neurofibrillary tangles of tau-hyperphosphorylated protein (p-tau). The tau-hyperphosphorylated protein and the beta-amyloid (specifically the Aβ42 variant) are proteins produced by the brain, which it can no longer eliminate. Both of these proteins then accumulate and start to damage neurons many years before symptoms of memory disturbance appear.
- Cognitive symptoms: at the onset there are memory deficiencies (or memory loss episodes) and spatio-temporal disorientation; during the progression of the disease there occurs: apraxia, ataxia, alexia, agraphia, deficiency in abstract reasoning, acalculia, agnosia and visuo-spatial deficiency.
- Non-cognitive symptoms: changes in mood (depression, euphoria, emotional lability), anxiety, changes in personality (indifference, apathy, disinhibition, irritability); psychosis (structured paranoid delusions, mis-identifications, hallucinations); agitation (verbal or physical aggression, persistent vocalization); psychomotor disorders (wandering, aphthalic affection, akathisia); neurovegetative symptoms, abnormalities in sleep rhythm, appetite and sexual behaviour);
The following (or later) stages, are characterized by the loss of advanced functions (work, hobbies, interpersonal relationships) as well as instrumental functions (managing finances, the home, medication, the use of any means of transport and communication). In the advanced stages of the disease the loss of basic functions occurs (personal hygiene, eating, dressing, moving around the house and maintaining continence).
In the final stages the subject becomes totally dependent on others.
- Cognitive and behavioural rehabilitation
- Environmental adaptation: reduction of the impact of cognitive and non-cognitive deficits ok
- Prevention and treatment of complications
- Planning assistance and family support
- Instruction, education and support for caregivers
- Cognitive symptoms (cholinesterase inhibitors: Donezepil, Rivastigmine, Galantamine) and Vit. E
The benefit of drug treatment is estimated at between 18% and 25%.
- Non-cognitive symptoms: psychomotor psychosis and agitation: atypical antipsychotics (Risperidone, Olanzapine, Quietapine, depression: SSRI (Citalopram, Sertraline, Paroxetine, Fluioxetine), insomnia: Zolpidem, Trazodone, Mirtazapine.