Are Older Adults With Early Alzheimer's More Likely To Fall?

Contact: Audrey Hu Whatsapp/hp: 0086 13880143964 Email: audrey.hu@wecistanche.com

Precious memories, years of experience, the ability to take care of yourself, the dignity of being a human being... Before the end of their lives, everything slipped away from their fingers without any reluctance. They clenched their fists but couldn't leave anything behind. Regrettably, every 3 seconds on the planet, one more person suffers from the above problems. Alzheimer's disease (hereinafter referred to as "AD", commonly known as Alzheimer's) is the root of all this. At the early stage of Alzheimer's Disease, memory loss is mainly due to the gradual loss of daily living ability, accompanied by mental symptoms and behavioral disorders. The disease progresses progressively. In the late stage, dysphagia and bedridden often occur. The onset of Alzheimer's Disease is about ten years, and it is often complicated by infection disease death. With unknown causes, difficult diagnoses, and incurable, humans seem powerless to fight Alzheimer's disease.

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Relevant studies have shown that AD patients often experience an asymptomatic period for about 20 years before obvious clinical symptoms appear. According to a survey on the current status of AD diagnosis and treatment in the Chinese Journal of Geriatrics, the average time from symptom onset to the first diagnosis of Alzheimer's Disease patients in China is more than 1 year, and 67% of the patients are already moderately severe at the time of diagnosis, missing the best intervention. stage.

The general lack of awareness of the disease has contributed to the delay in diagnosis and treatment, and a survey of 70,000 people in 155 countries found that two-thirds of people still believe that Alzheimer's Disease is a normal phenomenon of aging.

The clinical manifestations of AD in general patients are mainly manifested as memory loss, learning ability decline, language ability impairment, short-term memory impairment, long-term memory impairment, obvious impairment of language function, and significant decline in comprehension ability. Living needs assistance with cooking, which may manifest as incontinence. For severe AD, various functions will be severely damaged, activity will be reduced, bedridden, incontinence, difficulty in eating, and life will be completely dependent on nursing. Complications such as malnutrition, bedsores, anemia, and pneumonia may occur.

Several major symptoms identify Alzheimer's disease

memory

Everyone has occasional memory loss. It is normal to forget where the keys are or the name of a familiar person, but memory loss associated with Alzheimer's Disease is persistent and progressive, affecting a person's ability to work and live. AD patients experience the following:

Repeating some questions and words over and over without him realizing that the question had been asked before;

forgetting conversations, appointments, or events, and not being able to recall them later;

Things are often misplaced, in illogical places;

Completely forget the names of family members or the names of everyday objects.

Disorientation, unable to correctly identify the spatial orientation

People with AD can't remember the date, the season, where they were, or even the living environment they were in at the time. Alzheimer's Disease can also disrupt your brain's ability to interpret what you see, making it difficult to judge your surroundings. Ultimately, these questions can get you lost in familiar surroundings.

Speak and write

AD can cause difficulty concentrating and thinking, especially with abstract concepts such as numbers. Many people find that managing their funds, balancing accounts, remembering bills, and making timely payments have significant difficulties that develop into an inability to recognize and process data.

Make judgments and decisions

It becomes increasingly difficult to respond effectively to everyday problems, such as food burnt on the stove or unexpected situations while driving.

Plan and complete familiar tasks

During advanced stages of the disease, there is difficulty with everyday activities that require several consecutive steps, such as planning, cooking, or playing a favorite sport. Eventually, people with advanced AD can forget the most basic skills, such as dressing in clothes or bathing.

Changes in personality and behavior

Such as depression, anxiety, alienation, mood swings, lack of trust in others, more stubborn temper, irritability and assertiveness, changes in sleep habits, confusion, loss of control, delusions.

The symptoms of AD patients mainly include the above points, but different patients may have different symptoms, and the care can vary from person to person and take different nursing methods.

Older adults with early Alzheimer's disease prone to falls

The research and development found that even without cognitive problems, those with AD-related brain injury had an increased risk of falls.

Falls are the leading cause of fatal injuries among older adults, with more than 800,000 hospitalizations and approximately 30,000 deaths each year in the United States. Some risk factors are well known—advanced age, vision or balance problems, muscle weakness—but another unrecognized factor is early AD. Older adults in the early stages of AD, those who are unlikely to develop dementia, are more likely to fall before cognitive problems arise.

In older adults who fall without cognitive problems, the neurodegenerative process that leads to AD dementia may have already begun, researchers at Washington University School of Medicine in St. Louis have found. The findings were published online in the Journal of Alzheimer's Disease. Research suggests that older adults with a history of falls should be screened for AD, and new strategies may be needed to reduce the risk of falls in early-stage patients.

"In the field of fall research, we generally think that if you lose strength and balance, you are at risk of falling," said co-senior author Susan Stark, Ph.D., associate professor of occupational therapy, neurology, and social work. "If you lose For strength and balance, the recommended treatment is strengthening strength and balance. But if someone falls for other reasons, possibly because his or her brain has started to accumulate AD-related damage, that person may need completely different treatment. We also It's not known what treatments will be available, but we hope to use this information to make new treatment recommendations that reduce the risk of falls in this population."

In 1987, John C. Morris, MD, then an intern at Washington University, found that older adults with Alzheimer's dementia were twice as likely to suffer a traumatic fall than their peers without dementia. many. Morris is now the Harvey A. and Dorismae Hacker Friedman Distinguished Professor of Neurology and director of the University's Charles F. and Joanne Knight AD Research Center.

Since Morris' discovery more than three decades ago, scientists have learned that AD patients' brains begin to change decades before memory loss and confusion become apparent. First plaque formation of amyloid, followed by tangles of tau protein. Some brain regions begin to shrink, and communication networks between distant parts of the brain begin to decline. Stark and her colleagues have shown that the link between AD and falls holds true even during silent periods of the disease: people with so-called preclinical AD, despite having no apparent cognitive problems, are at a higher risk of falls. Increase.

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To better understand the risk of falls in people without cognitive symptoms, first author Audrey Kelemen, a graduate student in Stark's lab, and colleagues followed 83 people over the age of 65 for a year. At the start of the study, all participants were assessed as cognitively normal by a qualified neurologist. Each participant filled out a monthly calendar, recorded their own falls, and underwent brain scans for signs of amyloid, atrophy, and impaired connectivity.

The researchers found that the presence of amyloid in the brain did not increase the risk of falls, but neurodegeneration did. The participants who fell had smaller hippocampi, the region of the brain responsible for memory that shrinks in AD. Their somatomotor networks -- the web of connections involved in receiving sensory input and controlling movement -- also showed signs of decline. The researchers concluded that falls are most likely to occur during the preclinical neurodegenerative phase of AD, the last five years or so before memory loss and confusion appear.

"Since I started working on this project, I've started asking my patients questions about falls, and it's hard to say how often this moderator has begun to understand what's going on with this person," said co-senior authors Beau M. Ances, MD, Ph.D., Ph.D. said Daniel J. Brennan, MD, professor of neurology and professor of radiology and biomedical engineering. Ances treats patients with dementia and other neurological disorders at the University of Washington Medical Campus.

"When a person's mobility decreases, even if he looks normal, that can be a signal that needs further evaluation," Ances said. , let's dig a little deeper into this, what else?"

Researchers have begun further experiments to better understand why brain changes in AD patients put people at risk for falls, so they can develop recommendations to prevent falls. At the same time, a few simple changes can go a long way in protecting older adults from devastating falls, Stark said.

"A lot of falls can be prevented just by making the environment safer," Stark said. Simple changes can help, but they won't hurt:

Make sure the fish tank is not slippery;

Make sure you can easily get up from the toilet;

Balance and strength training;

Check your medication prescription to see if certain medications or combinations of medications increase your risk of falling.

Knowing that we have specific fall prevention treatments for preclinical AD patients, there is still a lot we can do to make people safer. "

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[Patient Story]

Ms. M (73 years old)

Ms. M was taken to the doctor's clinic by her daughter for evaluation. She had been living alone until her daughter met in the past when she discovered the problem. The daughter lives in another city and calls Ms. M every week, but has not seen each other for 6 months. During a recent phone call, the mother appeared distraught, interrupting the conversation frequently and repeatedly expressing her "concern." When asked what she was worried about, Ms. M said: "I don't know."

The daughter drove to her mother's house six hours later and decided to stay with her for a few days. When arriving, the daughter was shocked to see how thin her mother had become. Apart from pudding, fruit, and applesauce, there was little to eat in the house. The daughter found out that her mother had broken her dentures and her skin was swollen.

The mother said the coffee machine and TV were broken, but the daughter found that they were not. The mother often said to go to the room to get a bath towel for her daughter but came back empty-handed. She forgot what she was going to do. Mothers were often unable to name objects, such as dressers and gas stoves. At night, she became more irritable and couldn't sleep. She said she had to "go and see if the kids were sleeping." o my daughter brought Ms. M to the outpatient clinic. When she saw the doctor, Ms. M greeted the doctor warmly and asked how his mother was. She mistook the doctor for a friend's son, when in fact it was the first time she had met the doctor.

During the examination, Ms. M exhibited frequent inattentiveness and was unable to follow the instructions given by the doctor or nurse. She knew her name, but not where she was or the date. When the doctor asks questions, she appears agitated, says she doesn't want to answer, or tries to cover herself up ("I know, I just don't want to answer")

Ms. M complained of easy fatigue and epigastric tenderness. She was 20 pounds underweight and pale. Laboratory reports showed she had iron deficiency anemia, low albumin, and dehydration.

Mr. L (71 years old)

Mr. L was referred to a psychiatrist by his GP as he was not responding to any medication. According to his wife's statement, L showed that the man who retired at the age of 67 had unexpectedly changed his temperament less than a year after retirement. He stopped golfing and playing other sports. He does not go out and refuses to participate in social events. Instead, he sits on the couch all day watching TV or taking naps. His wife said he sleeps 10-13 hours a day instead of the normal 7 hours.

The wife is worried that Mr. L is depressed, which she thinks is caused by retirement. So she asked her family doctor to prescribe medication, and the family doctor agreed and prescribed antidepressants. But Mr. L's symptoms did not improve, and the family doctor referred him to a psychiatrist.

Mr. L's past psychiatric history was noted as one of his younger brothers suffered from severe depression and was treated with psychotherapy and antidepressant medication. His mother developed dementia in her 70s.

Mr. L graduated from university and had a smooth career. Before retiring at the age of 67, he was already a senior executive of a company. He has been married to his wife of 45 years, says he has no major marital problems and has three children and four grandchildren, all of whom are healthy. Before that, he had been outgoing and full of energy.

Mr. L suffers from high blood pressure and high cholesterol and is taking medication for these conditions. He displayed alertness and cooperation during DSM-5 (Depression Assessment), with steady but slightly slow speech. Mr. L has a limited range of emotional expression and denies feeling sadness and guilt, but feels he can eventually adjust to the shock of retirement. He is aware of his wife's current concerns, and he also thinks that his current problem is low energy and does not like activities. He blames retirement for the changes, but he will adapt slowly.

In another test, Mr. L managed to say what year it was, but could not say the month and day, or the day of the week. He memorized one of the three objects in two minutes (forgot the other two), did five mental arithmetic subtractions, got two wrong (three was right). Four ordinary objects were named correctly, and a complex sentence was repeated without error.

On the clock drawing test, he was able to draw a clock ring and also correctly write 1 to 12 in the clock ring and they were in the correct position, but he couldn't figure out the long hand and the shorthand at 2:10 where the needle should be.

Assessment tests showed problems with memory, attention, and numbers, as well as failure on the clock drawing test. Both of the above-mentioned patients (Ms. M and Mr. L) underwent further tests and examinations and were finally diagnosed with AD.

Regarding Mr. L, the doctor added his medical history: 3 years of social withdrawal. There is a family history of a brother with depression and a mother with dementia in later life. The main symptoms are slow reflexes, lack of attention, inability to concentrate, and lethargy.

Regarding Ms. M, her nutrition and dehydration problems stemmed from the loss of self-care ability caused by dementia: broken dentures, inability to cook by herself. The doctor gives the corresponding treatment.

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Uncle Wang (80 years old)

Uncle Wang has had progressive memory decline for 3 years. He likes to go out and take the bus, but he often can't find his way home. The situation is progressive, and sometimes he can't even find his home in the community. I don’t know how to cook in my personal life, and I need family supervision or assistance in the convenience of daily life such as hygiene, diet, toileting, and daily living. You need someone to support or take care of you when walking to prevent falls and injuries. Because he lives in a high-rise building, he is even more afraid that he will fall accidentally. In June 2011, Uncle Wang was hospitalized and discharged after his symptoms improved. Recently, the symptoms have been repeated, and the family dare not let the old man go out, but the old man is always clamoring to go out. Because the elderly need to be taken care of like children, they have their own ideas. Under the dual pressure of work and care, the children are almost mentally broken down. I most hope that someone can replace them so that they can have a little breathing time after getting off work.

The example of Uncle Wang shows the typical needs of elderly people with AD in life care, that is, they cannot take care of themselves but can still move, and the symptoms of dementia are gradually worsening. Family members not only need to pay huge time and economic costs, are physically and mentally exhausted, and their personal living space is sharply compressed, but also face a lack of professional care knowledge and huge psychological pressure. Due to the lack of nursing skills, the family members of the patients feel unable to understand and cope with the dementia symptoms and mental state of the elderly with AD, and cannot communicate with the elderly normally, which is emotionally unacceptable.

Scientists have studied quinolinic acid, aluminum trichloride, and β-AP in mice with Alzheimer’s disease and found that cistanche glycoside can improve the learning and memory ability of patients with Alzheimer’s disease, reduce the content of malondialdehyde in the brain and Glutathione peroxidase activity. And cistanche glycoside can reduce the activity of superoxide dismutase and reduce the activity of acetylcholinesterase. In addition, cistanche glycoside can reduce the apoptosis rate of brain cells and reduce the accumulation of calcium in brain tissues, and protect the ultrastructure of the hippocampus. Studies have shown that cistanche glycoside has the following mechanisms: 1. Enhance the activity of free radical scavenging enzymes 2. Reduce lipid peroxidation 3. Reduce calcium content in brain tissue 4. Inhibit brain cell apoptosis. Generally speaking, cistanche glycoside achieves the effect of resisting Alzheimer's disease through an antioxidant mechanism.

Scientists also found that cistanche extract can increase the protein expression level of nicotinic acetylcholine receptors in human cells, and attenuate cell damage caused by β-amyloid peptides outside hippocampal neurons. Cistanche extract can attenuate the lipid peroxidation reaction in the cell, promote the growth of cell axons, and increase the level of nerve growth factor in the cell. Cistanche extract can increase hippocampal axon growth, neuron differentiation, and synapse formation in the brain, and stimulate the secretion of nerve growth factors in the cerebral cortex and hippocampus. These mechanisms can significantly improve memory.

The highest content of the total glycosides of cistanche phenethyl alcohol is echinacoside, which can significantly increase the protein content and antioxidant capacity of brain tissue, reduce the activity of acetylcholinesterase and the content of interleukin-2 in serum.

Another important component of Cistanche phenethyl alcohol glycosides is acteoside. This ingredient can significantly improve cell survival, reduce cell apoptosis, and the production of reactive oxygen species.

In summary, the Cistanche deserticola extract has a good preventive and resistant effect on Alzheimer's disease.

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