ORCHIDS, THE INTERNATIONAL

SCHOOL

BANGALORE

Investigatory Project in Biology

Topic:
Alzheimer’s And
Dementia

Submitted to
Ganga Ma’am

Submitted by
Ronald Samuel R
 Grade: XI

CERTIFICATE

This is to certify that bonafide

student of class has successfully completed the
project titled in the laboratory of
prescribed by the Central Board of
Secondary Education for the AISSCE for the year

Teacher in – charge HOD Principal

External Examiner Date:

 Acknowledgement

I wish to express my gratitude to my Ganga Ma’am

teacher who has been instrumental in helping me
complete this project.

I also wish to express my sincere thanks to our beloved

Principal Dr Leena Pascal, The Management of ORCHIDS
for having changed our focus from exam- based learning to
knowledge-learning which I now understand will go a long
way in molding my future ahead for better prospects.

I wish to thank my parents, friends and all those who have

directly or indirectly contributed towards completion this
project effectively.
 Index
S.NO Content
1. Introduction to Alzheimer’s and Dementia
2. About Alzheimer’s Disease?
3. Brief history about Alzheimer’s disease
4. What are the different types of Alzheimer’s disease?
5. Symptoms of Alzheimer’s disease
6. Clinical Treatment of Alzheimer’s disease
7. About dementia
8. Brief history about dementia
9. What are the different types of dementia?
10. Symptoms and early signs of dementia?

11. Dementia Complications

12. Clinical treatment of Dementia

13. Conclusion
 14. Bibliography

Alzheimer’s And
Dementia
Introduction
Alzheimer’s and dementia

Many people use the terms “Alzheimer’s disease” and “dementia”

interchangeably, but this isn’t correct. Although Alzheimer’s disease
is the most common form of dementia, not everyone with dementia
has Alzheimer’s:
  Dementia is a brain disorder that impacts a person’s ability to
communicate and to perform everyday activities.
 Alzheimer’s disease is one form of dementia with a targeted
impact on parts of the brain that control a person’s ability to
think, remember, and communicate with language.

About Alzheimer’s Disease?

Alzheimer’s (AHLZ-high-merz) is a disease of the brain that causes

problems with memory, thinking and behavior. It is not a normal part
of aging. Alzheimer’s gets worse over time. Although symptoms can
vary widely, the first problem many people notice is forgetfulness
severe enough to affect their ability to function at home or at work,
or to enjoy hobbies. The disease may cause a person to become
confused, get lost in familiar places, misplace things or have trouble
with language. It can be easy to explain away unusual behavior as
part of normal aging, especially for someone who seems physically
healthy. Any concerns about memory loss should be discussed with a
doctor.
Brief history about Alzheimer’s disease

A German doctor named Alois Alzheimer first observed Alzheimer’s

disease in 1906. He described a patient known as Auguste D. who
had memory loss and other problems with thinking. After the
patient’s death, Dr. Alzheimer noted that parts of the patient’s brain
were shrunken. A psychiatrist who worked with Dr. Alzheimer named
the condition in 1910.

What are the different types of Alzheimer's

disease?
Early-Onset Alzheimer's

The subtype of Alzheimer's disease affecting people below 65 years

of age is referred to as early-onset Alzheimer's. This condition is very
rare (5 out of 100 Alzheimer's patients). The changes usually happen
when the patients reach their late 40s or early 50s. Distinct features
of this condition are considered the outcome of a defect in
Chromosome 14.

Late-Onset Alzheimer's

Majority of Alzheimer's cases are late-onset, affecting people older

than 65 years of age. The exact genetic trigger is not yet identified.
Yet, several risk factors have been named by scientists, and further
research is ongoing.

Another subcategory of the condition is familial Alzheimer's disease

(FAD). This condition is very rare (1 out of 100 cases). A person can
only be diagnosed with FAD when the specific genotypic pattern of
illness is characterized by the family members, and exact risk can be
predicted.

Alzheimer's disease can take a toll on the patient’s cognitive,

physical, and social abilities. The early detection of the disease is
crucial in preventing or slowing down its progression.
Symptoms of Alzheimer’s disease

Even for a given type of dementia, symptoms can vary from patient
to patient.

Symptoms are usually progressive over time. For example,

the symptoms associated with Alzheimer’s disease (AD) are often
described in stages, or phases, representing the ongoing,
degenerative nature of the disease.

Mild Alzheimer’s disease

In addition to memory loss, early clinical symptoms will likely include:

 confusion about the location of usually familiar places

 taking longer to accomplish normal daily tasks
 trouble handling money and paying bills
 poor judgment leading to bad decisions
 loss of spontaneity and sense of initiative
 mood and personality changes and increased anxiety

Moderate Alzheimer’s disease

As the disease progresses, additional clinical symptoms may include:

 increasing memory loss and confusion

 shortened attention span
 problems recognizing friends and family members
 difficulty with language
 problems with reading, writing, or working with numbers
 difficulty organizing thoughts and thinking logically
 inability to learn new things or to cope with new or unexpected
situations
 inappropriate outbursts of anger
 perceptual-motor problems (such as trouble getting out of a
chair or setting the table)
  repetitive statements or movement, occasional muscle twitches
 hallucinations, delusions, suspiciousness or paranoia, irritability
 loss of impulse control (such as undressing at inappropriate
times or places or using vulgar language)
 Exacerbation of behavioral symptoms, such as restlessness,
agitation, anxiety, tearfulness, and wandering — especially in
the late afternoon or evening, which is called “sundowning.”

Severe Alzheimer’s disease

At this point, plaques and tangles (the hallmarks of AD) can be seen
in the brain when looked at using an imaging technique called MRI.
This is the final stage of AD, and symptoms may include:

 inability to recognize family and loved ones

 loss of sense of self
 inability to communicate in any way
 loss of bladder and bowel control
 weight loss
 seizures
 skin infections
 increased sleeping
 total dependence on others for care
 difficulty swallowing
Alzheimer’s disease complications

Restlessness and agitation

People diagnosed with AD commonly have periods of agitation and

anxiousness. A loved one’s ability to reason and understand certain
situations can also decline as the disease progresses. If they can’t
make sense of a confusing world, they can become fearful and
agitated.

You can do things to help a loved one feel safe and calm. You can
start by providing a safe environment and removing any stressors
that could cause agitation, such as loud noise. Some people with AD
also become agitated when their physically uncomfortable. Their
agitation might increase if they’re unable to speak or express how
they feel. Take steps to make sure their pain, hunger, and thirst
levels remain at a comfortable level. You can also calm agitation by
reassuring them that they’re safe.

Bladder and bowel problems

Bladder and bowel problems are other complications of AD. As the

disease progresses, a loved one may no longer recognize the
sensation of needing to use the bathroom. They may also be unable
to respond quickly to urges. This can result from limited mobility or
limited communication skills. A loved one may also become confused
and use the restroom in inappropriate places, but you can help them
cope.

If possible, remind your loved one to use the bathroom and offer
help. You can also make it easier for them to get to the bathroom
alone. Make sure they can easily remove clothing and install night
lights to ensure they get to the bathroom safely at night.

If mobility is an issue, your loved one may appreciate a commode

near their bed or undergarments for incontinence.

Depression
Some people with AD also have depression and don’t know how to
cope with a loss of cognitive functions. The symptoms of depression
may include:

 sleeping problems
 changes in mood
 withdrawing from friends and relatives
 difficulty concentrating

The symptoms of depression can be similar to the general symptoms

of AD. This can make it difficult to determine whether your loved one
is experiencing depression or just the normal symptoms of AD. A
doctor can refer your loved one to a geriatric psychiatrist to make
this determination.

Treatment options for depression in people with AD include

attending support groups and speaking with a therapist. Speaking to
others with AD can also be helpful. Getting regular exercise and
participating in activities they enjoy can also improve their mental
outlook. In some cases, a doctor may recommend antidepressants.

Falls

AD can also affect balance and coordination. The risk of falling

increases as the disease worsens. This can lead to head trauma and
broken bones.

You can reduce your loved one’s risk of falling by assisting them as
they walk and making sure pathways are clear in their home. Some
people with AD don’t want to lose their independence. In this case,
you might suggest walking aids to help them maintain their balance.
If a loved one is home alone, get a medical alert device so they can
contact emergency services if they fall and can’t get to a phone.

Infections

AD can cause your loved one to lose control of normal body

functions, and they may forget how to chew food and swallow. If this
happens, they have an increased risk of inhaling food and drinks. This
can cause pulmonary aspiration and pneumonia, which can be life-
threatening.

You can help someone avoid this complication by making sure they
eat and drink while sitting up with their head elevated. You can also
cut their food into bite-size pieces to make swallowing easier. The
symptoms of pneumonia include:

 a fever
 a cough
 shortness of breath
 excess phlegm

Pneumonia and other respiratory infections need medical treatment

with antibiotics. If you notice that your loved one coughs after
drinking, you should alert their doctor who may refer them to a
speech therapist for further evaluation.

Wandering
Wandering is another common complication of AD. People with AD
can experience restlessness and sleeplessness due to disruption in
their normal sleep patterns. As a result, they may wander out of the
home believing that they’re running an errand or going to work. The
problem, however, is that a loved one may leave home and forget
their way back. Some people with AD wander from home at night
when everyone is asleep.

Make sure your loved one wears a medical alert bracelet with:

 their name
 their address
 their phone number
 your contact information

You can also keep loved ones safe by installing an alarm system,
deadbolts, and bells on the door.

Malnutrition and dehydration

It’s important that your loved one eats and drinks enough fluids.
However, this can be difficult because they may refuse to eat or drink
as the disease progresses. Also, they may be unable to consume food
and drinks because of difficulty swallowing.

The symptoms of dehydration include:

 a dry mouth
 headaches
  dry skin
 sleepiness
 irritability

Your loved one may be malnourished if they’re losing weight, they

have frequent infections, or they experience changes in their level of
consciousness. Visit during mealtimes and help with preparing meals
to ensure they don’t experience dehydration or malnutrition.
Observe your loved one eating and drinking to ensure they consume
plenty of fluids. This includes water and other beverages, such as
juice, milk, and tea. If you’re concerned about dehydration or
malnutrition, speak with their doctor.

Clinical Treatment of Alzheimer’s disease

A number of medicines may be prescribed for Alzheimer's disease to

help temporarily improve some symptoms.

The main medicines are:

Acetyl cholinesterase (ACHE) inhibitors
These medicines increase levels of acetylcholine, a substance in the
brain that helps nerve cells communicate with each other. They can
currently only be prescribed by specialists, such as psychiatrists or
neurologists. They may be prescribed by a GP on the advice of a
specialist, or by GPs that have particular expertise in their use.
Donepezil, galantamine and rivastigmine can be prescribed for
people with early- to mid-stage Alzheimer's disease. The latest
guidelines recommend that these medicines should be continued in
the later, severe, stages of the disease. There's no difference in how
well each of the 3 different ACHE inhibitors work, although some
people respond better to certain types or have fewer side effects,
which can include nausea, vomiting and loss of appetite. The side
effects usually get better after 2 weeks of taking the medication.

About dementia
Dementia is not actually a disease. It is a group of symptoms.
“Dementia” is a general term for behavioral changes and the loss of
mental abilities.
This decline — including memory loss and difficulties with thinking
and language — can be severe enough to disrupt daily life.

Brief history about dementia

The term dementia derives from the Latin root demens, which means
being out of one's mind. Although the term "dementia" has been
used since the 13th century, its mention in the medical community
was reported in the 18th century. Even though the Greeks postulated
a cerebral origin, the concept was not restricted to senile dementia
and included all sorts of psychiatric and neurological conditions
leading to psychosocial consequences. In the 19th century,
individuals with dementia were recognized as patients, deserving
medical care from specialists called alienists, and senile dementia
became a medical disease. Subsequently, progresses in
neuropathology allowed its fragmentation into different
neuropathological conditions
What are the different types of dementia?

Dementia can be categorized in many different ways. These

categories are designed to group disorders that have particular
features in common, such as whether or not they are progressive
and which parts of the brain are affected.

Some types of dementia fit into more than one of these categories.
For example, Alzheimer’s disease is considered to be both
progressive and cortical dementia.

Here are some of the most commonly used groupings and their
associated symptoms.

Lewy body dementia (LBD)

Lewy body dementia (LBD), also called dementia with Lewy bodies, is
caused by protein deposits known as Lewy bodies. These deposits
develop in nerve cells in the areas of the brain that are involved in
memory, movement, and thinking.

The symptoms of LBD include:

 visual hallucinations
 slowed movement
 dizziness
 confusion
 memory loss
 apathy
 depression

Cortical dementia

This term refers to a disease process that primarily affects the

neurons of the brain’s outer layer (cortex). Cortical dementias tend
to cause problems with:

 memory
 language
 thinking
 social behavior
Subcortical dementia

This type of dementia affects parts of the brain below the cortex.
Subcortical dementia tends to cause:

 changes in emotions
 changes in movement
 slowness of thinking
 difficulty starting activities

Frontotemporal dementia

Frontotemporal dementia occurs when portions of the frontal and

temporal lobes of the brain atrophy (shrink). Signs and symptoms
of frontotemporal dementia include:

 apathy
 lack of inhibition
 lack of judgement
 loss of interpersonal skills
 speech and language problems
 muscle spasms
 poor coordination
 difficulty swallowing
Vascular dementia symptoms

Caused by brain damage from impaired blood flow to your

brain, vascular dementia symptoms include:

 trouble concentrating
 confusion
 memory loss
 restlessness
 apathy

Progressive dementia

As the name implies, this is a type of dementia that gets worse over
time. It gradually interferes with cognitive abilities like:

 thinking
 remembering
 reasoning

Primary dementia

This is dementia that does not result from any other disease. This
describes a number of dementias including:
  Lewy body dementia
 frontotemporal dementia
 vascular dementia

Secondary dementia

This is dementia that occurs as the result of a disease or physical

injury, such as head trauma and diseases including:

 Parkinson’s disease
 Huntington’s disease
 Creutzfeldt-Jakob disease

Mixed dementia

Mixed dementia is a combination of two or more types of dementia.

The symptoms of mixed dementia vary based on the types of
changes to the brain and the area of the brain undergoing those
changes. Examples of common mixed dementia include:

 vascular dementia and Alzheimer’s disease

 Lewy bodies and Parkinson’s disease dementia

Symptoms and early signs of dementia?

The general signs and symptoms of dementia include difficulty with:

 memory
 communication
 language
 focus
 reasoning
 visual perception

The early signs of dementia include:

 loss of short-term memory

  difficulty remembering specific words
 losing things
 forgetting names
 problems performing familiar tasks such as cooking and driving
 poor judgment
 mood swings
 confusion or disorientation in unfamiliar surroundings
 paranoia
 inability to multitask
Dementia Complications

Dementia can affect many body systems and, therefore, the ability to
function. Dementia can lead to:

 Poor nutrition. Many people with dementia eventually reduce or

stop eating, affecting their nutrient intake. Ultimately, they may
be unable to chew and swallow.
 Pneumonia. Difficulty swallowing increases the risk of choking or
aspirating food into the lungs, which can block breathing and
cause pneumonia.
 Inability to perform self-care tasks. As dementia progresses, it can
interfere with bathing, dressing, brushing hair or teeth, using the
toilet independently, and taking medications as directed.

Clinical Treatment of Dementia

Most types of dementia can't be cured, but there are ways to

manage your symptoms.
Medications
The following are used to temporarily improve dementia symptoms.
 Cholinesterase inhibitors: These medications — including
Donepezil (Aricept), rivastigmine (Exelon) and galantamine
(Razadyne) — work by boosting levels of a chemical messenger
involved in memory and judgment.
Although primarily used to treat Alzheimer's disease, these
medications might also be prescribed for other dementias,
 including vascular dementia, Parkinson's disease dementia and
Lewy body dementia.
Side effects can include nausea, vomiting and diarrhea. Other
possible side effects include slowed heart rate, fainting and sleep
disturbances.
 Memantine: Memantine (Namenda) works by regulating the
activity of glutamate, another chemical messenger involved in
brain functions, such as learning and memory. In some cases,
memantine is prescribed with a cholinesterase inhibitor.
A common side effect of memantine is dizziness.

 Other medications: Your doctor might prescribe medications

to treat other symptoms or conditions, such as depression, sleep
disturbances, hallucinations, parkinsonism or agitation.
Therapies
Several dementia symptoms and behavior problems might be treated
initially using nondrug approaches, such as:

 Occupational therapy: An occupational therapist can show you

how to make your home safer and teach coping behaviors. The
purpose is to prevent accidents, such as falls; manage behavior
and prepare you for the dementia progression.
 Modifying the environment: Reducing clutter and noise can
make it easier for someone with dementia to focus and function.
You might need to hide objects that can threaten safety, such as
knives and car keys. Monitoring systems can alert you if the
person with dementia wanders.
 Simplifying tasks: Break tasks into easier steps and focus on
success, not failure. Structure and routine also help reduce
confusion in people with dementia.
Conclusion
Alzheimer's disease is the most common type of dementia. It is a
progressive disease beginning with mild memory loss and possibly
leading to loss of the ability to carry on a conversation and respond
to the environment. Alzheimer's disease involves parts of the brain
that control thought, memory, and language.Dementia is a
degenerative disease that eventually affects a person's ability to live
independently. There are many types of dementia, although
Alzheimer's disease is the most common type.

Bibliography
Alzheimer, A.  (1991).  On certain peculiar diseases of old age.  History
of Psychiatry, 2(5 pt1). Amaducci, L. A., Rocca, W. A., & Schoenberg, B.
S.  (1986).  Origin of the distinction between Alzheimer’s disease and
senile dementia: How history can clarify nosology.  Neurology, 36(11),
1497-1499. Berrios, G. E.  (1990).  Alzheimer’s disease: A conceptual
history.  International Journal of Geriatric Psychiatry, 5(6), 355-
365.Blass, J. P.  (2005). Commentary on “Diagnosis of Alzheimer’s
disease: Two decades of progress”. Perspectives on
“Perspectives”.  Alzheimer’s & Dementia, 1(2), 124-125. Caselli, R. J.,
Beach, T. G., Yaari, R., & Reiman, E. M.  (2006).   Alzheimer’s disease a
century later.  The Journal of Clinical Psychiatry, Cohen, G. D. 
(2001). Criteria for success in interventions for Alzheimer’s
disease.  American Journal of Geriatric Psychiatry,

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