Alzheimer disease

Clinic

• AD is a neurodegenerative disease that usually starts slowly and progressively worsens
• It accounts for 60–70% of cases of dementia worldwide.
• While dementia is a general term, Alzheimer's disease is a specific brain disease.
• Alzheimer is marked by symptoms of dementia that gradually get worse over time.
• It first affects the part of the brain associated with learning, so early symptoms often include changes in memory, thinking and reasoning skills.

Sign / Symptoms	First symptoms	Early stage	Middle stage	Late stage
Short term memory loss	+++
Executive functions	Mild
Semantic memory	Mild
Apathy / Depression	Mild
Language problems	---	Vocabulary shrinkage / Decreased word fluency	Paraphasias Reading / Writing skills	Aphasia
Apraxia	---	+++
Sarcopenia	---	+	++	+++
Long-term memory	---	---	Recognising close relatives
Emotional lability	---	---	+++
Confusion			Sundowning Illusionary misidentifications Anosognosia

• The most common early symptom is difficulty in remembering recent events.
• As it advances, symptoms can include
  • Problems with language (Word- Hunting)
  • Disorientation / Visuospatial functioning (Easily getting lost)
  • Mood swings
  • Loss of motivation
  • Self-neglect
  • Behavioral issues
  • Reasoning / Judgment
  • No Insight

Stages

• It has three stages, with a progressive pattern of cognitive and functional impairment. It is known to target the hippocampus which is associated with memory, and this is responsible for the first symptoms of memory impairment. As the disease progresses so does the degree of memory impairment.

First symptoms

Mild cognitive impairment (MCI) such as

• Short term memory loss
• Subtle problems with the executive functions of attentiveness, planning, flexibility, and abstract thinking
• Impairments in semantic memory
• Apathy and depression can be seen at this stage.
  • Apathy remaining as the most persistent symptom throughout the course of the disease

Early stage

• Alzheimer's disease does not affect all memory capacities equally. Older memories of the person's life (episodic memory), facts learned (semantic memory), and implicit memory (the memory of the body on how to do things, such as using a fork to eat or how to drink from a glass) are affected to a lesser degree than new facts or memories.
• Difficulties with language, executive functions, perception (agnosia), or execution of movements are more prominent than memory problems.

• Language problems are mainly characterized by a shrinking vocabulary and decreased word fluency, leading to a general impoverishment of oral and written language.
• In this stage, the person with Alzheimer's is usually capable of communicating basic ideas adequately.
• Apraxia (Fine motor tasks such as writing, drawing, or dressing, certain movement coordination and planning difficulties) may be present, but commonly unnoticed.
• Decreased performing tasks independently
• The prevalence rate of sarcopenia is significantly higher in early AD, mild AD, and moderate AD than normal.

Middle stage

• Paraphasias: Speech difficulties become evident due to an inability to recall vocabulary, which leads to frequent incorrect word substitutions
• Reading and writing skills are also progressively lost.
• Complex motor sequences become less coordinated as time passes so the risk of falling increases
• Failing to recognise close relatives
• Impaired long-term memory

• Behavioral changes such as Emotional lability (Wandering, irritability, crying, outbursts of unpremeditated aggression, or resistance to care giving)
• Sundowning
• 30% of people with Alzheimer's disease develop illusionary misidentifications and other delusional symptoms.
• Subjects also lose insight of their disease process and limitations (Anosognosia).
• Urinary incontinence can develop.

Late stage

• Language is reduced to simple phrases or even single words, eventually leading to complete loss of speech.
• Despite loss of verbal language abilities, people can often understand and return emotional signals.
• Aggressiveness can still be present,
• Extreme apathy
• Unablity to perform even the simplest tasks independently
• Muscle mass and mobility deteriorates to the point where they are bedridden and unable to feed themselves.
• The cause of death is usually an external factor, such as infection of pressure ulcers or pneumonia, not the disease itself.

Pathophysiology

• Most affected parts are Hippocampus, then temporal and parietal lobes.

• Amyloid causes inflammation around the senile plaques of the brain, and too much build up of this inflammation leads to changes in the brain that cannot be controlled, leading to the symptoms of Alzheimer's.

Miasmatic analysis

By using the entities of first stage, TBE is prefered

		TBE
First stage TBE	Cognition impaired	+++
	Memory weakness	+++
	Memory weakness, lost	+++
	Ataxia	+++
	Muscular atrophy	+++
	Confusion	+++
	Concentration impaired	+++
Middle stage	Emotional lability	+++
	Urine incontinence	+++
End stage	Brain degenerative disease
	Demetia

Some points

• Most of middle and end stage sign/ Symptoms od Alzehimer disease are not specially related to its underlying miasm. In other word they are only occured because of brain degeneration is spreading. Therefore I search for some miasms that could induce this chronic degeneration. Recent research confirms this claim.
• TBE does not induce Depressed mood directly, but do you know anyone who forget his daily works and still remain hopeful ?