What are the symptoms of Alzheimer's?

Alzheimer's disease is actually what we often call senile dementia, but many friends do not know much about this disease and cannot rely on the symptoms of the disease to discover the disease. The more obvious symptoms of Alzheimer's disease are memory loss, decreased judgment, urinary incontinence, inability to take care of oneself, etc. When mild symptoms appear, they can actually be alleviated through physical exercise.

The first stage (1 to 3 years) is the mild dementia period. Symptoms include memory loss, especially forgetfulness of recent events; decreased judgment ability, the patient cannot analyze, think, and judge events, and has difficulty dealing with complex problems; he is careless at work or housework, cannot independently carry out shopping and financial affairs, and has difficulty in socializing; although he can still do some familiar daily tasks, he is confused and puzzled by new things, emotionally indifferent, occasionally irritable, and often suspicious; he has time orientation disorder, can orient himself to places and people, but has difficulty orienting himself to his geographical location, and has poor visual-spatial ability of complex structures; he has a small vocabulary and has difficulty naming.

The second stage ( 2 to 10 years) is the moderate dementia period. It is manifested by severe damage to short and long-term memory, decreased visual-spatial ability of simple structures, and disorientation to time and place; severe impairment in problem solving and distinguishing similarities and differences between things; inability to carry out outdoor activities independently, requiring help with dressing, personal hygiene, and maintaining personal appearance; inability to calculate; various neurological symptoms, including aphasia, apraxia, and agnosia; emotions change from indifference to irritability and restlessness, frequent walking, and urinary incontinence.

The third stage (8 to 12 years) is the severe dementia stage. The patient is completely dependent on his caregiver, has severe memory loss, and only fragmentary memories remain; he is unable to take care of himself in daily life, has incontinence, is mutist, and has limb rigidity. Physical examination shows positive pyramidal tract signs and primitive reflexes such as grasping, groping, and sucking. Eventually they fall into a coma and usually die from complications such as infection.

examine

1. Mini-Mental State Examination (MMSE): It is concise in content, short in measurement time, and easily accepted by the elderly. It is currently the most common scale for clinically measuring the degree of intellectual impairment of this disease. The total score of the scale is related to the level of cultural education. If illiteracy is ≤17 points; primary school level is ≤20 points; secondary school level is ≤22 points; and university level is ≤23 points, it indicates cognitive impairment. Further detailed neuropsychological testing should be conducted to assess various cognitive functions including memory, executive function, language, practical and visual-spatial abilities. For example, the ADAS-cog is an 11-item cognitive ability test battery specifically designed to detect changes in the severity of AD, but is mainly used in clinical trials. Assessment of daily living ability: For example, the Assessment of Daily Living Ability (ADL) scale can be used to assess the degree of impairment of patients' daily living functions.

The scale consists of two parts: one is the physical self-care ability scale, which measures the patient's ability to take care of himself (such as dressing, undressing, combing hair and brushing teeth, etc.); the other is the tool use ability scale, which measures the patient's ability to use daily life tools (such as making phone calls, taking the bus, cooking for oneself, etc.). The latter are more susceptible to cognitive decline in the early stages of the disease. Assessment of behavioral and psychiatric symptoms (BPSD): including the Behavioral Pathology Rating Scale for Alzheimer's Disease (BEHAVE-AD), the Neuropsychiatric Symptom Inventory (NPI), and the Cohen-Mansfield Agitation Inventory (CMAI). Baseline assessments are often required based on information provided by informed persons. They can not only detect the presence or absence of symptoms, but also evaluate the frequency and severity of symptoms, and the burden on caregivers. Repeated assessments can also monitor treatment effectiveness. The Cornell Depression Scale for Dementia (CSDD) focuses on evaluating the agitation and depression manifestations of dementia, and the 15-item Geriatric Depression Scale can be used to evaluate depressive symptoms in AD. CSDD has higher sensitivity and specificity but is not related to the severity of dementia.

2. Hematological examinations are mainly used to detect existing concomitant diseases or complications, identify potential risk factors, and exclude other causes of dementia. Including blood routine, blood sugar, blood electrolytes including blood calcium, kidney function and liver function, vitamin B12, folic acid level, thyroid hormone and other indicators. Serological tests for syphilis, human immunodeficiency virus, and Borrelia burgdorferi should be performed on high-risk groups or those with clinical symptoms.

3. Neuroimaging examination Structural imaging: used to exclude other potential diseases and detect specific imaging manifestations of AD. Head CT (thin-layer scan) and MRI (coronal) examinations can show significant atrophy of the cerebral cortex, especially the hippocampus and medial temporal lobe, supporting the clinical diagnosis of AD. Compared with CT, MRI is more sensitive for detecting subcortical vascular changes (eg, critically located infarctions) and changes suggestive of specific diseases (eg, multiple sclerosis, progressive supranuclear palsy, multiple system atrophy, corticobasal degeneration, prion disease, frontotemporal dementia, etc.).