Alzheimer’s Disease

Alzheimer’s disease (AD) is one of the most devastating brain disorders of elderly humans and is the most common form of dementia. As you know, AD is a significant public health problem secondary to the increased life expectancy of the general population and a better appreciation of the socioeconomic consequences of the disease. It was defined by Alois Alzheimer’s in 1906 using criteria of progressive memory loss, disorientation, and pathological markers i.e. Senile plaques and neurofibrillary tangles. that usually occurs in old age. It is a progressive, non-reversible neurodegenerative disorder associated with cognitive deficits and behavioral disturbances.

• Genetic factors play an important role and about 15% of the cases are familial.
• Development of senile plaques with Beta-amyloid deposition. It is still unclear whether the senile plaques are the cause or a by-product of AD. However, the dysfunction in the metabolism of amyloid precursor protein with subsequent increase in insoluble deposits of amyloid beta-peptide accounts for the progression of AD.
• The accumulation of neurofibrillary tangles in neurons is a second distinguishing feature of AD. Neurofibrillary tangles are mostly formed by chemically altered tau protein.
• Neuronal loss particularly in the hippocampus and cortex.

Types of dementia: –

1. Early-onset type (between the mid-30s and ’60s)
2. Late-onset type (older than ’60s)

Clinical manifestations: –

• Stage I
  Effects of aging on memory, but not AD.
• Stage II

1. Absent-mindedness
2. Forgetting appointments
3. Misplacing belongings
4. Impairment in language and word-finding difficulty
5. Difficulty in organizing and expressing thoughts
6. You are forgetting routines, familiar things, skillful work, etc.

• Stage III

1. Poor judgment and deepening confusion
2. Speech impairment
3. Repeating the same conversation
4. Repeating favorite stories or making up stories to fill gaps in memory
5. Difficulty in recently learned rememorizing.
6. Poor bladder & bowel control
7. Changes in personality and behavior

• Stage IV

1. More aggressive or more passive
2. Loss of self-awareness
3. Abusive, Anxious, Paranoid
4. Requires daily assistance with personal care
5. The decline in physical abilities & complete loss of judgment.

Investigations: –

1. Neuroimaging: – MRI, PET Scan
2. Routine laboratory blood tests.
3. Optional laboratory examinations

Probable pathogenesis and symptomatology of AD can be correlated with Vatapaithika Unmada and Atatwabhinivesa. Unmada is characterized by vibhramsa (Perversion) of Mana (Mind), Buddhi (Intellect), Sanja (Consciousness), Jnana (Knowledge), Smriti (Memory), Bhakti (Desire), Sheela (Manner), Chestha (Behavior), and Achara (Conduct). Lack of smriti occurs due to the obscuring nature of Thamo guna in the body. On aging, Vatadosha increases in the body leading to subsequent vitiation of Rajas and tamas, the psychic doshas. Pathologically all these vitiations of doshas lead to, an average of buddhi and mana.

The following therapies can be effectively advocated for symptomatic improvement and betterment in the quality of life. They include: –

1. Vamana (Emesis)
2. Mruduvirechana (Purgation)
3. Nasya (Nasal drops)
4. Sirodhara
5. Talapothichil
6. Pizhichil

• After proper samsodhana karma, Medhyarasayanas (Herbal intellect rejuvenators) are advised. It gives longevity, the tremendous potentiality of the body and senses, and memory.
• Also, the drugs like Brahmi, Jeevaneeya gana dravya, Sankhapushpi can be utilized.
• It is also advised to provide familial support and inculcate into him, understanding, patience, memory etc.
• Yoga and meditation also help improve symptoms and quality of life.