Journal of Tropical Diseases & Public Health

Alzheimer's disease

Alzheimer's disease is a progressive neurodegenerative disorder that primarily affects memory, thinking, and behavior. It is the most common cause of dementia in older adults.

Causes and Risk Factors

• Genetic Factors: Certain genes increase the risk of developing Alzheimer's, including the APOE e4 allele.
• Age: The risk increases significantly with age, particularly after 65.
• Family History: A family history of Alzheimer's can raise the likelihood of developing the disease.
• Lifestyle Factors: Poor cardiovascular health, lack of physical activity, and unhealthy diet may contribute to risk.
• Other Health Conditions: Conditions such as diabetes, hypertension, and high cholesterol may increase risk.

Pathophysiology

• Amyloid Plaques: Abnormal clumps of beta-amyloid protein build up in the brain, disrupting communication between neurons.
• Neurofibrillary Tangles: Abnormal tau protein forms tangles inside neurons, leading to cell death and brain atrophy.
• Neuroinflammation: The immune response in the brain can contribute to neuronal damage.

Symptoms

1. Early Symptoms:
   • Memory loss, particularly difficulty remembering recent events.
   • Difficulty with problem-solving and planning.
   • Confusion with time or place.
   • Trouble understanding visual images and spatial relationships.

2. Later Symptoms:
   • Increased memory loss and confusion.
   • Difficulty speaking, swallowing, or walking.
   • Changes in mood and personality, including depression and anxiety.
   • Loss of ability to perform daily tasks and ultimately requiring full-time care.

Diagnosis

• Clinical Assessment: Medical history, cognitive testing, and neurological exams.
• Neuroimaging: MRI or CT scans to rule out other causes and assess brain changes.
• Biomarkers: PET scans and cerebrospinal fluid analysis to detect amyloid plaques and tau tangles.
• Cognitive Tests: Standardized tests to assess memory, problem-solving, and language skills.

Treatment

• Medications:
  • Cholinesterase Inhibitors: Drugs like donepezil, rivastigmine, and galantamine can help manage symptoms in early to moderate stages by increasing levels of acetylcholine.
  • NMDA Receptor Antagonists: Memantine can help with moderate to severe symptoms by regulating glutamate activity.
  • Other Treatments: Newer medications and therapies are under investigation, focusing on disease-modifying strategies.

• Non-Pharmacological Interventions: Cognitive stimulation, physical activity, and social engagement can improve quality of life and delay progression.

Care and Support

• Caregiver Support: Education, respite care, and support groups are essential for caregivers.
• Home Modifications: Simplifying the living environment can help individuals maintain independence.
• Legal and Financial Planning: Early planning for future care needs and financial decisions is crucial.

Impact on Public Health

• Prevalence: Millions of people worldwide are affected, with numbers expected to rise as the population ages.
• Economic Burden: The costs of care, treatment, and lost productivity associated with Alzheimer’s are substantial, impacting families and healthcare systems.
• Research: On-going studies aim to better understand the disease, discover effective treatments, and identify prevention strategies.

Recent Developments

• Research Advances: Promising therapies targeting amyloid and tau proteins are being explored, along with lifestyle interventions for prevention.
• Public Awareness: Increased awareness about Alzheimer’s disease and its impact on individuals and families has led to advocacy for better funding and resources for research and care.