Alzheimer
A neurodegenerative disease characterised clinically by progressive deterioration of multiple cognitive functions and neuropathologically by the presence of neurofibrillary tangles and hippocampal-neocortical senile plaques. It is the most common cause of all dementias.
Cognitive disturbances that occur in the course of Alzheimer's disease
In the early stages of cognitive decline, people with Alzheimer’s disease do not remember things that happened recently, even things from minutes ago (pertaining to recent memory), yet they clearly remember things from the past (or retain knowledge learned long ago).
Either due to the disconnection of the neural networks that allow normal access to the lexicon, or due to neural destruction in areas directly involved in language, there are first and increasingly frequent problems in evoking the right word in conversations (anomia). As this problem worsens, the speech becomes increasingly empty of content, to which are added problems in comprehension, both due to the effect of the malfunctioning of immediate memory, which prevents the retention of information said a moment earlier but necessary to understand the other person’s speech, and due to the alteration of the complexity of the linguistic function itself.
Executive functions are those that make up the orderly and effective functioning of the rest of the cognitive functions. As Elkhononon Goldberg explains, they intervene like an orchestra conductor, making the different cognitive processes intervene in an ideal way to the extent that they are required for the correct execution of an activity. This leads to problems in planning (a family meeting, the organisation of the day, a trip…), logical reasoning, understanding of figurative meanings, irony…
Agnosia is defined as an impairment in the recognition of things in the absence of an impairment in perception. Depending on the perceptual route of information input, several types of agnosia can be distinguished: visual, auditory, tactile, olfactory or gustatory.
A particular form of this type of disorder is anosognosia “absence of disease recognition”. It has more to do with integrative executive functions and self-perception (more related to executive functions) and is something that, sooner or later, becomes evident in people with Alzheimer’s disease, when they show themselves to be unaware of or not attributing the importance that would be expected to their cognitive problems.
Disorder in the effective execution of voluntary, well-learned motor acts, with a purpose or intention, in the absence of physical impairments that prevent or hinder movement. Actions such as the appropriate use of cutlery, tools, buttoning buttons, tying shoelaces, drawing, making communicative gestures with the hands… are examples of everyday activities that require adequate praxical ability.
Visuospatial functions allow us to identify and locate visual stimuli in space. Their impairment can manifest itself in the form of difficulty in orienting oneself in space, difficulty in recognising and locating objects in space, or errors in calculating distances that can lead to falls or accidents when driving vehicles.
Psychological and behavioural symptomatology that may occur in Alzheimer's disease
Depression may be evident by symptoms such as crying, sadness or hopelessness, as well as loss of appetite, severe weight loss or insomnia.
A marked loss of motivation and initiative in carrying out activities. Although this in itself is a common symptom of depression, in dementia it can appear (and often does) independently. Sometimes there is a marked introversion and a tendency to isolation as a result of the confusion that the patient experiences in certain situations, which leads him or her to withdraw and show no interest. Apathy often appears at the beginning of the symptomatic process and lasts, although it may fluctuate, throughout the different phases.
This trait is the expression of an anticipatory fear of experiencing unpleasant situations, harm or misfortune. The particular difficulty that people with dementia have in foreseeing what will happen in the future, even in the immediate future, often leads to manifestations of anxiety.
Those activities that the patient may do without any apparent objective, or as a sign of the inability to regulate their impulses; motor hyperactivity (emptying drawers or cupboards, moving things around, performing the same activity repeatedly…), disinhibition (inappropriate behaviour, sexual disinhibition) or aggressiveness (verbal or physical).
Reactions that are apparently disproportionate to the stimulus that supposedly provoked them, which sounds like a frustrating situation. They are a consequence of difficulties in controlling and managing stimuli and situations. Thus, he/she may react by shouting or crying at certain noises, at disorder, when surrounded by many people… Or become very angry when in the presence of demands that exceed his/her capacities.
Erroneous interpretations of reality or false beliefs, which they hold despite the evidence and are therefore difficult to treat. The presence of delusions often leads to an attitude of mistrust towards the people around them. They may be convinced that their food is poisoned, think that someone is stealing from them when they cannot find their things, or believe that their caregiver or any close relative is conspiring against them.
The progression of ageing in itself leads to changes in sleep patterns, with more frequent awakenings during the night and early morning, often resulting in daytime sleepiness and the need to take a nap. This pattern is often even more pronounced in people with Alzheimer’s disease. In addition, if they get up in the middle of the night, they may, due to disorientation, perform activities that are inappropriate for that time of day, such as getting dressed, trying to go outside or eating.
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