Alzheimer’s is the most common form of dementia found in the elderly population and is manifested by cognitive and behavioral disturbance that also interfere with the social and occupational functioning of the individuals. The most widely accepted risk factor for developing Alzheimer’s is age. The current aetiological factors associated with Alzheimer’s are believed to be a neuroinflammatory response, mitochondrial dysfunction, compromised blood-brain barrier and immune system dysfunction, etc. The currently available drugs for the treatment of Alzheimer’s have only symptomatic effects. So, a combination of drugs along with some therapeutic approaches can help in the reduction of symptoms seen in affected individuals.
A lot of researches now also focuses on dietary habits and their effects on the prognosis of this disease. Many new preventive measures have also been identified which can help the individual from developing this disorder. The aim of the present review paper is to understand the current trends in the field of research pertaining to Alzheimer’s disease which increase and even improve our understanding of this disease. The present review paper is comprehensive in its approach as it gives equal emphasis on both the pharmacological as well as non-pharmacological treatment.
It also includes various preventive measures that can be adopted in the lifestyle of an individual to prevent worsening of the symptoms and even high-risk individuals can benefit from it. This review paper will be beneficial for the entire scientific community including students as it combines biological, psychological, and social aspects of Alzheimer’s. It provides thorough knowledge about this disorder through research-based evidence. It will help the researchers to direct their researches in relation to the already done and to establish. The main objective of this review paper is to analyze the research done in this field over the last decade and how the advancements in the scientific society has led to the changes in the types of researches conducted now. This review focuses on the practical implications of the recent research findings related to this disorder which could help the community at large by providing awareness about this disorder and also explain the important aspects pertaining to it.
A systematic search for collecting literature was done using keywords: etiology of Alzheimer’s, prevention of Alzheimer’s, treatment of Alzheimer’s, and non-pharmacological treatment of Alzheimer’s. the research articles were collected from the available online databases like EBSCO, Jstor, and ProQuest research library. The articles were collected from the researches done In the last one decade. All the articles were reviewed based on the different themes. An attempt was made to understand the practical implications of the advancements made in the scientific literature and how the understanding of the same can help the individuals currently suffering from this disorder and also the ones who are at high risk of attaining it.
Results and Discussion
Etiology of Alzheimer’s
Over a decade back it was understood that the hippocampus is the initial site of Alzheimer’s and cholinergic neurons act as protective factors for hippocampus but due to depletion in these neurons hippocampus becomes more vulnerable to risk factors which might not affect a normal individual with proper cholinergic system. As the research in this field progressed various other factors were also identified which could serve as a causal factor for Alzheimer’s. Excessive exposure to aluminum was also identified as an important which can put an individual at risk.
Developing Alzheimer’s, it was found that aluminum along with Abeta peptides plays an important role in the pathogenesis of Alzheimer’s ). Later a sequence of events that take place in an Alzheimer’s affected brain were identified which starts with an initial injury leading to a chronic neuroinflammatory response and a discontinuous cellular change of the cell types of the brain. Genetic studies showed that innate immunity levels of an individual is a factor for late-onset of Alzheimer’s. Also, degeneration of the neural pathways and blood vessels leads to the formation of proteins such as -amyloid and tau. These proteins then spread to different association areas of the brain and later to primary sensory areas. This variations in the spread of these proteins lead to heterogeneity of the disease.
The understanding of the causes of Alzheimer’s has grown over the last decade from considering age to beta amyloids as the causal factor. With an increase in technological advancement, our understanding of the disease has also advanced. It has been identified that although Alzheimer’s initially starts in the hippocampus but also spreads to other parts of the brain with progression. The initial head injury or genetic influence can lead to the initiation of symptoms of Alzheimer’s and leads to neuroinflammatory response in the brain. This understanding about the causal factors of Alzheimer’s has led to the development of more effective techniques for the treatment of the disease.
Prevention of Alzheimer’s
There are a lot of methods by adopting which we can prevent an individual from acquiring Alzheimer’s to a great extent. earlier it was understood that maintaining the physical abilities of the elderly can help them reduce the risks of attaining Alzheimer’s . Along with this, it was also found that adopting and maintaining a healthy lifestyle can decrease the risk factors for attaining Alzheimer’s like adopting healthy eating habits and doing physical exercise, etc.
Naturally occurring phenolic phytochemicals like curcumin, resveratrol and EGCG are commonly found in fruits and other food materials have antioxidative properties which can easily cross the blood-brain barrier and can act at specific targets which are implicated in the pathogenesis of Alzheimer’s. New approaches in the prevention of Alzheimer’s include mentally stimulating activities, rich social networks, and social engagement along with high education levels as protective factors for Alzheimer’s.
Alzheimer’s disease can be prevented by including some of the changes in the daily routine of the individuals. These preventive measures are not difficult to adopt and can be easily adjusted into a normal lifestyle. some of these are by reducing one's exposure to the high-risk substances for Alzheimer’s like aluminum as mentioned in the etiology of Alzheimer’s. along with this taking food rich in phenolic phytochemicals will act as a protective factor against developing this disease. Along with this engaging in physical activity is also helpful for individuals. Everybody should adapt these factors In their lifestyle. Treatment of Alzheimer’s Pharmacological treatment. For the treatment of Alzheimer’s, it was suggested that lipoic acid has a variety of properties that can help in reducing the progression of Alzheimer’s. it has been found that lipoic acid increases acetylcholine production and also increases glucose uptake. Lipoid acid increases the levels of glutathione, all these functions of lipoic acid slows down the progression of Alzheimer’s. it can be combined with nutraceuticals in order to decrease inflammation and oxidative stress to provide a combined treatment for Alzheimer’s.Overexpression of peroxisome proliferator-activated receptor gamma (PPAR) in cultured cells decreases A secretion. Along with this it also has direct effects on mitochondrial function and ATP production which plays an important role in energy metabolism which leads to its beneficial effects on memory and other cognition in patients with Alzheimer’s. it also has an anti-inflammatory action on the CNS of affected individuals Intravenous immunoglobulins contain naturally occurring autoantibodies that identify and block the harmful effects of A that are present in Alzheimer’s affected brains. IVIG also exhibits an immunomodulating effect on the microglial cells thus helping in improving the condition of individuals with Alzheimer’s.
Another method that can be combined with pharmacological treatment is transcranial magnetic stimulation which produces changes in the cognition and behavior of the patients with Alzheimer’s, these effects might be due to the changes focal cortical circulation which is an increase in synaptic activity or might be due to modulation of the cognitive reserve which might still be possessed by the patients A lot of changes have come in the field of treatment of Alzheimer’s using pharmacological methods. Almost all the methods focus on the reduction of beta amyloids.
The treatment methods also focus on the neuroinflammatory action in the brain which is considered to be due to the progression of Alzheimer’s in the brain. Some of the treatments also help me restoring memory impairments by working on energy metabolism in mitochondria. Transcranial magnetic stimulation helps in the modulation of cognitive reserve which might still be present in the individuals. Non Pharmacological treatment. for the treatment of Alzheimer’s along with pharmacological treatment a combination of therapy is considered to be more effective. Reality orientation therapy is considered to increase the effect of cholinesterase inhibitors on cognitive functions. Another advantage of this therapy is that it can be given by caregivers only and that too at home without any additional charges. It can improve the self-esteem of the patients and also helps them retain information for longer periods of time. Individuals with most progressive disease are more likely to benefit from it. Apart from this some other therapies like reminiscence therapy, music memory lane, activity group help in improving the quality of life of the affected individuals.
Cognitive stimulation program, errorless learning, individual-based intervention, procedural memory stimulation help in decreasing memory problems faced by these individuals. Multisensory stimulation have high success rates in improving behavioral functioning. Most of these interventions can be provided in the home settings making it more easily available forpatients. A large number of deficits are seen in the cognitive functioning of patients with Alzheimer’s. in order to treat them cognitive stimulation therapy and cognitive training have proven to be very helpful. Along with this these therapies also have functional benefits for individuals with AD.
Cognitive training also was not reported to have any adverse effects on the patients and is completely safe to administer. Even short term and medium-term training was effective in building confidence in patients and they also reported an increase in memory capacity and general quality of life (Bahar-Fuchs, Clare, & Woods, 2013). Psychotherapies are a low-cost treatment for patients with Alzheimer’s as compared to other treatment methods. These are
mainly helpful for patients immediately after diagnosis where adjustment is required In the family and also for emotional regulation. Both family therapy and individual therapy are equally effective for patients with Alzheimer’s
Along with pharmacological treatment combining psychotherapy has proven to be more effective. Moreover, psychotherapies are more cost-effective than pharmacological treatment and have proven to be effective too. Some of these therapies like reality orientation therapy can be provided by the caregivers at home and thus is more accessible to the patients. Moreover, cognitive stimulation therapy and cognitive training helps in improving the cognitive deficits in patients for their better adjustment in the life. Also, these therapies do not have any adverse side effects as compared to other pharmacological treatments. Psychotherapies both family and individual-based can help to reduce the caregiver's burden and improve the quality of life of the affected individuals.
The limitations of the present review are that only a limited number of articles were reviewed and all the articles were collected only from the available online databases and no printed journals were reviewed. Moreover the articles under each theme very few to get a real picture of the trends prevailing in the different aspects of Alzheimer’s over a decade. For the future study, a large number of articles should be reviewed along with collecting articles from printed journals along with online databases to make precise conclusions.
The present review paper incorporates a large variety of research conducted in the field of Alzheimer’s. the paper contains different articles under the various sub-themes which helps to get a comprehensive understanding of the disease rather than just focusing on only one aspect. Apart from the limitations it has shown how the research in this field over a decade and how our understanding of this disorder has grown which has been helpful for the