Alzheimer's Disease

Private Ankara Magnet Hospital, which provides services to patients and their families with Alzheimer's disease, provides neurological and psychiatric examinations, meetings with dietitians and psychologists, as well as neuropsychological tests, enabling early diagnosis of Alzheimer's and appropriate treatment planning.

Alzheimer's and Aging Diagnosis and Treatment Services

In the treatment of Alzheimer's disease, our patients are evaluated by our neurologists and psychiatrists at Private Ankara Magnet Hospital, and after a series of procedures consisting of various blood, urine, MRI, EEG and neuropsychological tests, early diagnosis of the disease, medical follow-up, medical and social rehabilitation are provided.

For individuals with a family history of Alzheimer's disease, necessary tests and analyses are conducted to assess the risk of developing the disease. As a result of these analyses, individuals at risk are counseled on how to prevent and prevent the progression of the disease, and those in the at-risk group are regularly monitored.

What is Alzheimer's Disease?

Alzheimer's Disease

Alzheimer's disease, a disease of advanced age and part of normal aging, is also known as a disease of senility. It is a disorder characterized by the gradual damage to certain parts of the brain over time, leading to deterioration in all aspects of daily life, including memory, functions, and behavior.

Alzheimer's disease is a disease of old age, and the number of people affected by it is increasing daily. This is due to the increasing number of elderly people worldwide.

An important reason for the increase in the elderly population is the gradual decrease in the young population and the success of prevention methods developed against diseases such as cardiovascular diseases and cancer, which often cause death, in extending life expectancy.

According to research, there are currently over 40 million Alzheimer's patients worldwide, and based on these studies, it is estimated that this number will reach 115 million by 2050. In Türkiye, 600,000 families are currently struggling with the disease. These numbers are growing daily. By 2050, Türkiye is expected to have the fourth highest number of Alzheimer's patients in the world.

Early diagnosis through awareness campaigns about Alzheimer's disease is crucial for controlling the disease in its early stages. These awareness campaigns improve the quality of life of both Alzheimer's patients and their families, reduce their problems, and reduce treatment costs.

Although the exact cause of Alzheimer's disease is not known, some risk factors have been identified and identified thanks to research.

These;

1. Age (non-modifiable factor): Alzheimer's disease is not a part of normal aging; however, the risk of developing this disease increases with age.
2. Past depression (modifiable factor). Untreated depression increases the risk.
3. Vascular disease (modifiable factors such as heart attack, high blood pressure, high cholesterol, etc.)
4. Past head trauma
5. Low education level
6. Lack of exercise, obesity risk, diabetes
7. Smoking and exposure to tobacco smoke
8. Research shows that people with poor sleep patterns are associated with an increased risk of Alzheimer's disease.
9. People with mild cognitive impairment (MCI) face a significant risk of developing dementia.
11. Patients with Down syndrome have a very high risk of developing Alzheimer's disease due to having a higher than normal number of copies of the protein that causes beta-amyloid formation on chromosome 21.
12. APOE4 carrier status.

The average duration of the disease is 8-10 years. However, in some Alzheimer's patients, the disease progresses very slowly, while in others, it progresses more rapidly. Alzheimer's disease is divided into three stages: early, moderate, and advanced.

History of Alzheimer's Disease

The first to describe the disease was German neuropsychiatrist Alois Alzheimer. In 1902, a 51-year-old patient, Auguste Deter, was brought to Dr. Alzheimer by his wife for a consultation due to advanced stages of forgetfulness and behavioral disturbances. Dr. Alzheimer examined and monitored the patient, and upon his death in 1906, performed an autopsy. Brain samples obtained from the patient revealed thinning of the cortex and various accumulations within and around the cells.

Alzheimer's Diagnosis According to DSM-V

DSM-V (Diagnostic and Statistical Manual of Mental Disorders) is a scientific field that updates the diagnostic and diagnostic hallmarks of mental illnesses. Based on scientific and currently accepted knowledge, the following conditions must be met for a diagnosis of Alzheimer's dementia according to the DSM-V.

Alzheimer's Diagnosis According to the World Alzheimer's Association

The World Alzheimer's Association has outlined some important symptoms that individuals should be aware of to help them determine if they or a loved one has Alzheimer's disease. Experiencing one or more of these symptoms is sufficient to prompt a consultation with a healthcare provider or physician.

• Impairment in mixed attention functions
• Impairment of executive functions
• Difficulty in learning and memory impairment
• Language impairment
• Perception disorder
• Impaired social cognition

Alzheimer's Diagnosis According to the World Alzheimer's Association

The World Alzheimer's Association has outlined some important symptoms that individuals should be aware of to help them determine if they or a loved one has Alzheimer's disease. Experiencing one or more of these symptoms is sufficient to prompt a consultation with a healthcare provider or physician.

• Forgetfulness that affects our daily lives (memory disorders primarily relate to the recent past)
• Difficulty in planning and calculating
• Inability to perform tasks that were previously performed without problems
• Experiencing uncertainty and confusion regarding the concepts of event, time, person and place
• Difficulty perceiving images (losing the ability to perceive)
• Weakening of speaking and understanding abilities (continuously asking the same questions)
• Losing things and not being able to find where you put them
• Difficulty making judgments and decisions
• Withdrawing from social activities, inability to perform simple daily activities
• Psychological disorders
• Experiencing personality changes such as tension, stress, aggression and depression
• Constantly getting lost, not being able to remember familiar surroundings
• Sleeping problems
• Difficulty moving without assistance
• Hallucinating and experiencing delusions (behavioral symptoms)

Stages of Alzheimer's Disease

According to research conducted in 2011, the disease stages were defined as follows.

Stage 1: Externally normal (Preclinical)

Stage 2: Very mild disorder

Stage 3: Mild impairment

Stage 4: Moderate impairment

Stage 5: Moderately severe disorder

Stage 6: Severe disorder

Stage 7: Very severe disorder

Stage 1 begins long before Alzheimer's disease is recognized by both the patient and physician. Stages 2 and 3 can also be combined to describe mild cognitive impairment.

Preclinical Stage:  The period in which no signs of disease are present but brain damage has already begun is considered preclinical. Diagnosis during this period is not possible through physical examination. However, measuring biomarkers can definitively determine the presence of the disease.

Mild cognitive impairment (MCI): This  is defined as forgetfulness, perceived by the patient or a loved one, and loss of memory or other areas of memory (such as skills or language), but otherwise able to carry on with daily life without any problems. Individuals experiencing these problems have a 15% risk of developing significant dementia in later years. Some researchers further divide this stage into two categories: very mild cognitive impairment and mild cognitive impairment.

Alzheimer's disease is the period in which the signs and symptoms of the disease are clearly noticeable.

Early-middle stage:  It begins with symptoms such as mild forgetfulness, inability to remember words and learn new things, fatigue, withdrawal from social life, asking the same questions, extreme apathy, difficulty remembering names, and depression.

Severe mid-stage:  The patient experiences noticeable changes in their daily activities. They are unable to cook or use cutlery, behave in a manner inconsistent with social norms, struggle to put on or take off their clothes, neglect toileting and personal hygiene, and are unable to find their way around the house or its rooms. Personality changes may also be evident.

Stress, withdrawal, restlessness and anger, loss of consciousness, impaired motor skills, deterioration in social relationships, paranoia, hallucinations, pessimism, prolonged sitting or lying down, and sleep disturbances in some patients can often be observed during this phase. In such cases, seeking psychological support can provide relief to the patient and their families. At Private Ankara Magnet Hospital, we provide support to Alzheimer's patients and their families with our expert psychologists and psychiatrists.

Advanced and severely advanced stages:  This stage is characterized by the patient becoming completely dependent on others for their own survival. Every patient has a caregiver.

Physical problems are frequently experienced. Impaired bladder and bowel control, speech, or ability to follow simple commands, hallucinations, emotional disturbances, loss of awareness of walking, sitting, bathing, eating, and constant movement and wandering may be observed. This stage is known to be more problematic for caregivers than for the patient. In the most severe stage, the patient becomes bedridden.

It should be noted that the medications used in Alzheimer's patients should be continued during this period.

While there is no cure for Alzheimer's disease, it is possible to both slow the disease process and reduce the severity of some symptoms. Early and accurate diagnosis is crucial for this.

Reasons

The most significant cause of Alzheimer's disease is age. It is a disease most commonly encountered by people over the age of 60-65. Another contributing factor to Alzheimer's disease is gender, which is more common in women. This is due to the longer life expectancy of women. Low education levels, stress, depression, head trauma (from past traumas), high blood pressure, diabetes, other metabolic diseases, and genetic factors are among the causes of Alzheimer's disease.

How to Understand Alzheimer's?

The first symptom of Alzheimer's disease is forgetfulness. Neuropsychiatric tests performed after the patient's consultation with the doctor provide clear information about the presence of the disease, the type of dementia it's missing, and the stage of Alzheimer's disease. Patients with Alzheimer's symptoms are often referred to neurology clinics. Diagnosis is made through evaluations and tests conducted by our specialist physicians at the neurology clinic of Private Ankara Magnet Hospital. To make a diagnosis, our specialist physician must answer several questions, including the patient's health history, medication use, ability to perform daily activities (and to what extent), and personal and behavioral changes. Based on these answers, doctors conduct medical scans to measure memory, problem-solving, attention, counting, and language skills. Standard blood and urine tests are also performed to screen for any conditions that may have similar symptoms to Alzheimer's. A definitive diagnosis of Alzheimer's disease requires brain scans such as magnetic resonance imaging (MRI), positron emission tomography (PET), and electroencephalography ( EEG ). Although the findings of all these tests reveal evidence of the disease, imaging methods make it more clear that the disease is Alzheimer's.

How Does Alzheimer's Affect the Brain?

The primary cause of dementia is damage to brain cells and tissues. This damage makes communication between cells impossible and prevents normal brain functions from functioning properly.

Brain cells, called neurons, make up brain tissue. These cells can be negatively affected by many internal and external factors.

Brain tissue consists of distinct areas, each equipped with different functions. These distinct areas allow us to think, speak, develop skills, plan, learn, and behave socially.

Damage to the cells and tissues of these specific regions causes their specific functions to deteriorate and become damaged over time. Each type of dementia is caused by the impact of different brain areas.

Bad, harmful accumulations inside and between cells cause the communication of cells to be disrupted and the tissues to shrink (atrophy) and become damaged, thus causing disease symptoms to appear.

With the atrophy of the hippocampus region, forgetfulness, the first and most important symptom of Alzheimer's disease, manifests itself.

What Should Be Done to Protect Yourself from Alzheimer's?

The most important risk factor for Alzheimer's disease is genetic predisposition. A family history of Alzheimer's and the onset of the disease between the ages of 40 and 65 suggest a genetic predisposition.

The likelihood of developing the disease increases with age. Other factors that increase the risk of developing Alzheimer's include head trauma, long-term depression, chronic alcohol use, smoking, hypertension, high cholesterol, diabetes, and vascular disease. Private Ankara Magnet Hospital offers a smoking cessation clinic and services.

Is it possible to prevent Alzheimer's and what can be done?

Because the exact cause of Alzheimer's disease isn't known, there's no definitive way to prevent it. However, some lifestyle changes can reduce the likelihood of developing the disease.

To protect against Alzheimer's;

• Staying active by doing regular mental and physical exercise,
• Taking regular walks,
• Keeping your blood pressure and sugar levels under normal control,
• Increasing your consumption of vegetables and fruits. Especially opting for a Mediterranean diet.
• To prevent head injuries (traumas) that may occur as a result of an accident by using seat belts and helmets,
• Quitting alcohol and cigarette use.

Who is it most common in?

The risk factors for Alzheimer's disease in a person are:

Age:  Alzheimer's disease generally occurs in people aged 60-65. While the disease affects 5% of the population over 65, the incidence doubles every five years, reaching one in every two people aged 80-85. However, recent research suggests that the disease can begin 20-30 years before it's noticed, and if the disease's progression is investigated, diagnosis can be made in people in their 40s and 50s.

Gender:  Women have a longer life expectancy than men. Given this, the disease is expected to be more common in women.

Depression

Past Diseases: Diseases such as cardiovascular diseases, hyperlipidemia, diabetes, and thyroid disease are risk factors for Alzheimer's disease.

Head Traumas

Education:  People with low education levels are more likely to develop the disease. As education levels increase, the incidence of the disease decreases.

Heredity and Genetics:  25% of Alzheimer's disease cases are genetic and run in families. Research has identified many genes thought to be involved in the disease. These genes, which cause brain and brain cell damage in the disease, promote the formation of neurofibrillary tangles and amyloid plaques. The presence of APOE4 epsilon 4, increased by faulty coding on chromosome 19, is a valuable laboratory measurement for indicating the likelihood of Alzheimer's disease.

Biomarkers:  Current research suggests that Alzheimer's disease can be diagnosed 20-30 years before the disease manifests itself, with some laboratory findings supporting the presence of pathologically accumulating proteins in the brain. Abeta 42 and tau proteins can be obtained from cerebrospinal fluid and are called biomarkers.

Alzheimer's Diagnosis and Tests

The physician  listens to the patient's and their family's history, which may be indicative of the disease. He or she then confirms the core findings expressed by the patient and/or family member.

A screening test is used to detect the presence of dementia. The most common screening test is the Mini Mental State Examination. This short screening test examines the patient's ability to perceive time, place, learning, numerical processing, recall, naming, sentence writing, and visual memory.

This test aims to assess the extent of impairment in memory and other areas. It focuses on whether patients understand and answer questions accurately and follow instructions correctly. While it doesn't fully diagnose dementia, it does provide information about cognitive decline. Neuropsychologists then perform other tests to reach a diagnosis.

Neuropsychological Tests

To diagnose Alzheimer's, a psychologist will perform detailed neuropsychological tests based on the patient's screening test, often a Mini Mental State Examination, to confirm the core findings and identify any deficits related to other thought problems. Neuropsychological tests consist of numerous tests that provide concrete data on memory, daily life, and physical behavior.

Neurophysiological Studies

Neurophysiological studies are invaluable in the differential diagnosis of certain diseases. The most important neurophysiological examination is the EEG (electroencephalography). Neurophysiological studies, particularly in cases of Creutzfeld-Jacob disease, can now quickly diagnose certain dementias with highly specific findings.

Radiological Examinations

A radiologist  may use computed tomography (CT) or magnetic resonance imaging (MRI) to identify affected or damaged areas of the brain. Sometimes, a volumetric or functional MRI may be used to calculate the volume of a lost or damaged brain area or to monitor the functioning of an area.

Nuclear Medicine Examinations

In recent years, nuclear medicine has gained importance to distinguish how brain functions are metabolized in normal life and in diseases such as dementia, and to demonstrate that the accumulation of amyloid, the protein responsible for Alzheimer's disease, begins years in advance. Amyloid PET is invaluable for early diagnosis and is performed by a nuclear medicine specialist.

Clock Drawing Test

Another screening test is the clock drawing test. The patient is asked to draw a clock and mark the numbers and the time inside. The ability to perform this geometric skill (constructional praxis) provides information about the patient's ability to understand and plan.

Genetic Tests and Laboratory Tests

Genetics/Biochemistry/Hematology/Microbiology

It's performed to provide a patient-specific diagnosis and provide some genetic information. Thyroid hormones, B12, folic acid, glucose measurement, hemoglobin and all other complete blood counts, sedimentation rate, electrolytes, urea, and liver function tests are mandatory. These tests are performed by our specialist physician at Private Ankara Magnet Hospital upon request.

Microbiology tests for HIV and syphilis are performed to exclude similar infectious diseases. APO E epsilon 4 can be measured. Early detection and diagnosis of Alzheimer's disease are now possible through these tests. Biomarkers are proteins known to cause the disease and are measured in patients' cerebrospinal fluid to facilitate early diagnosis.

These biomarkers can also be tested in the blood, but accurate results can only be obtained from spinal fluid, or spinal marrow. Studies have shown that these proteins begin to rise 20-30 years before the onset of the disease.

Some biomarkers used for the early detection and diagnosis of Alzheimer's disease include total tau, phosphorylated tau, Ab42-Ab40, and BACE (beta-secretase enzyme). Normal and abnormal values ​​for these proteins may vary by laboratory.

Alzheimer's Treatment

Alzheimer's disease is irreversible and has no cure. Drug treatment for Alzheimer's disease involves alleviating the symptoms of the disease and treating other comorbidities.

In addition, the aim is to improve the patient's mental memory and make his/her daily life easier.

In brain tissue loss caused by Alzheimer's, the acetylcholine substance responsible for learning decreases, while the substance called glutamate increases, which causes serious inflammation and deterioration.

In this case, the drugs aim to increase acetylcholine while decreasing glutamate. Therefore, the generic names given to these drugs are donazepil, rivastigmine, galantamine, and memantine.

Medication use is monitored. If there is improvement, the medication is continued; if not, the dose is increased or decreased.

Other Additional Treatments

In addition to medical treatment, physicians can also provide additional treatments such as behavioral therapy, physiotherapy, occupational therapy, memory studies, reality orientation studies (studies appropriate for person, place, and time orientation), biography and remembrance, music, sensory therapy, aromatherapy, and pet therapy. At Özel Magnet Hospital, our physicians assist our patients with physiotherapy .

Alzheimer's Treatment;

Medication

• Psychological support is provided by our specialist physicians at Private Ankara Magnet Hospital.
• Regular exercise
• Nutrition should be planned according to the patient's condition.

Our specialist physicians at Private Ankara Magnet Hospital provide support regarding diet and nutrition.

Adhering to a Mediterranean diet has a positive impact on the course of Alzheimer's disease. Consuming refined and sugary foods can accelerate disease progression.

Milk and dairy products

Milk and milk-based foods should be a must in your daily diet. This food group provides benefits due to its protein, calcium, phosphorus, and B vitamins.

Meat, legumes, eggs, oilseeds

Red meat, chicken, turkey, fish, eggs, chickpeas, beans, green lentils, walnuts, almonds, and hazelnuts are all in this group and can be substituted for other oily seeds. Along with protein, this group also contains iron, zinc, magnesium, minerals, and vitamins A and E.

Oils

Fat consumption should be minimized with age. Animal fat and products containing animal fat should be avoided. When meat and meat products are high in saturated fat, lean meats should be preferred.

Omega-3

Foods rich in omega-3 fatty acids include fish, walnuts, and flaxseed. Adequate intake of omega-3 reduces the risk of Alzheimer's disease. To ensure adequate omega-3 intake, fish should be consumed two to three times a week.

Vegetables and fruits

Research has shown that vitamins C and E, found in fresh fruits and vegetables, significantly reduce the risk of developing Alzheimer's disease. Foods high in vitamin E, such as raw almonds, sunflower seeds, olives, extra virgin olive oil, avocados, and spinach, should be included in our daily diet.

Foods like strawberries, broccoli, bell peppers, kiwi, melon, cauliflower, broad beans, blueberries, rosehips, raspberries, and blackberries are rich in vitamin C and water-soluble, making them difficult to store in the body. Therefore, they should be consumed daily and included in our diet.

Cereals and grain products

Whole-grain bread, pasta, bulgur, noodles, vermicelli, and cracked wheat are all included in the grain group. Grains and grain products are our primary source of energy. They are important for digestive and nervous system function. Therefore, soups, in particular, can be consumed at every meal.

Psychological Support for Relatives of Alzheimer's Patients

Having a family member diagnosed with Alzheimer's disease can exacerbate the anxiety and difficult acceptance of the behavioral and personality changes brought on by the disease. This can lead to anxiety about the future.

The diagnosis of Alzheimer's disease begins a distressing, worrying, and exhausting period of treatment for the patient's family. The problems and anxieties experienced, and the attempts to suppress them, negatively impact the psychological well-being of the patient's family.

In such a situation, relatives of the patient are likely to experience depression, anxiety disorders, or other stress-related illnesses. Therefore, it is recommended that relatives of Alzheimer's patients begin seeking psychological support.

How Should Alzheimer's Patient Relatives Behave and What Should They Pay Attention to When Communicating with Their Patients?

When communicating with a patient, it's crucial to speak calmly and gently. Avoid a commanding or harsh tone. Focus on using short, clear, and concise sentences. Offering two options on any topic can help facilitate communication.

The memory loss experienced by patients during this period can lead to them misrepresenting events that weren't real or misremembering names. In such cases, attempts to change the patient's thoughts should be avoided. This can cause further stress. Instead, we can encourage the patient by sharing their perception and trying to understand them.

How Should Relatives of Alzheimer's Patients Cope with Difficult Situations Such as Aggressive Behavior, Outbursts of Anger, Loss of Control, and Anxiety Attacks?

In such situations, try to speak in a calm tone, maintain a positive approach, and use reassuring language. Angry or fearful behavior from relatives during crisis management will complicate the crisis intervention process. We must not let patients sense this. If the patient feels this way, their aggressive behavior and anger will escalate. Similarly, anger from relatives can trigger aggressive behavior. Therefore, it's important to approach the patient with caution by acting calmly and reassuringly, expressing this verbally, and maintaining a safe distance from potential physical attacks. In such situations, physically intervening with the patient is not the right approach.

Try to identify the events that trigger the patient's aggressive behavior. You can try to redirect their attention. In situations where you can't control them, always seek help from your doctor.

Alzheimer's Symptoms

Memory Loss:  The most significant and first symptom of the disease is forgetfulness. Alzheimer's patients forget recent information, people, and events. As the disease progresses, the individual begins to forget more frequently and loses track of what they did and information. Forgetfulness begins in the early stages of the disease, often forgetting simple things.

• Don't lose your key

• Forgetting names, not being able to remember them

• Don't forget your appointments

• Inability to go where you need to go due to the concept of time

• Don't forget to give money or get change when shopping

• Forgetting to eat uncovered. • The degree of forgetfulness gradually increases in later periods.

• Confusion about the way home or where the rooms are located

• Do not think your son is your father and your daughter is your mother

• Do not add sugar to meals instead of salt

• Not being able to locate a hidden item

• Difficulty performing daily activities. Many patients are unable to plan and complete their daily tasks. They begin to have difficulty performing complex tasks such as cooking, choosing clothing, talking on the phone, and performing daily physical activities.

The patient loses skills they once excelled at. They can't knit, hammer nails, cook, play instruments, go to the toilet, bathe, or eat—in other words, they become unable to sustain themselves. They urinate and defecate in their pants or in various places around the house.

Psychiatric and Behavioral Disorders: Although behavioral and psychiatric symptoms are present from the very beginning of the disease, they become more distressing in later stages. Alzheimer's patients experience sudden, unexplained mood swings; they may cry easily or withdraw, suddenly and excessively become stressed and angry. They may become insomniacs, constantly on the move, wander aimlessly, hallucinate, talk to mirrors, eat constantly or not eat at all, exhibit suspicious behavior, hide belongings, and shout. Other Findings

Speech difficulties:  Patients may have difficulty remembering words or may stumble when speaking. Sometimes it may be difficult to understand what the patient says or writes. They may experience confusion.

Confusion of time and place:  Alzheimer's patients may confuse days, months, and sometimes seasons, meaning they lose track of time and place. They may get lost in familiar places, forget where they are, or lose track of why they are there. They may confuse or forget things they do regularly, familiar places, their home, their work, time, hours, months, and seasons. In other words, they may forget everything they know and confuse a familiar face.

Difficulty in evaluating and making decisions: The  child has difficulty choosing and deciding on food and clothing, and over time, they lose their decision-making ability. Difficulty in abstract thinking skills.

Misplacing things:  People with Alzheimer's disease often misplace things in unusual places and may even have difficulty remembering them later.