Mental illness has now become a serious concern worldwide. In addition to being extremely distressing on their own, mental health conditions also come with certain other health conditions, making the situations worse for victims. For example, people with Alzheimer’s show symptoms of mental illness. Therefore, the question “Is Alzheimer’s a mental illness?” is very common.
1. Is Alzheimer’s a Mental Illness?
Alzheimer’s disease itself is not a mental illness, but certain mental health conditions are associated with it.
2. What Is Alzheimer’s Disease?
Alzheimer’s disease is a brain disorder. More specifically, it is a progressive and fatal neurodegenerative disorder. It affects the cognitive function, memory, and behavior of the patient.
Alzheimer’s disease was named after Alois Alzheimer (1864-1915), the German neuropathologist who first described it in 1907. It is the most common cause of Dementia. In the DSM-5, Dementia is defined as a “major (or mild) neurocognitive disorder associated with Alzheimer’s disease”.
Every case of Alzheimer’s disease is associated with a characteristic dementia syndrome that has an imperceptible onset. This is usually a slow but progressively deteriorating course, that ends in delirium and death.
Alzheimer’s Disease is the 6th leading cause of death in the United States; every 65 minutes, someone in the U.S. is diagnosed with it.
3. How Does Alzheimer’s Disease Affect the Brain?
The temporal lobes of the brain are the first regions to be damaged in a person suffering from Alzheimer’s disease. As the hypothalamus is located in that region, memory impairment is the earliest symptom of this brain disorder. Loss of brain tissues in the temporal lobes is likely the reason why delusions are found in certain patients with Alzheimer’s Disease.
Toxic changes start occurring in the brain, including abnormal buildups of certain proteins that form amyloid plaques and tau tangles. Healthy neurons stop functioning and lose connection with other neurons, resulting in their death.
4. What Are the Symptoms of Alzheimer’s Disease?
People with Alzheimer’s exhibit a cluster of symptoms. The main symptoms of this neurodegenerative disorder include:
4.1. Memory Loss (Dementia)
One of the key symptoms of Alzheimer’s disease is difficulty remembering recent events, conversations, or appointments. The patients eventually forget the names of family members and everyday objects. As Alzheimer’s worsens, people experience greater memory loss.
4.2. Difficulty with Language and Confused Speech
With suffering from the brain disease struggle with vocabulary. They have trouble recalling words and finding the right vocabulary to convey their thoughts and feelings. Verbal fluency is significantly affected and individuals find it hard to complete sentences. Confused speech is detectable in the early and moderate stages of Alzheimer’s Disease. Slurring and repetition of the same sentences and phrases are also common.
4.3. Impaired Judgment and Decision-Making
Alzheimer’s disease affects the parts of the brain that are involved in remembering, understanding, and/or processing information. They struggle with reasoning and communication. This results in impaired judgment and affects decision-making; these are very common symptoms of this major neurodegenerative disorder.
4.4. Difficulty Performing Familiar Tasks
Individuals with Alzheimer’s also find it hard to perform routine stuff. One may forget something as basic as driving to a familiar location or even have significant difficulty creating a grocery list.
4.5. Changes in Mood, Behavior, and Personality
Behavioral changes are common in people with Alzheimer’s. They start showing signs of anxiety and depression. They show rapid mood swings and can be hard to deal with. Confusion, fear, and paranoia are also common. Patients may also do things that are completely uncharacteristic of them.
Common personality changes include Apathy, Paranoia, Social Withdrawal, Loss of Interest in activities that the patient used to enjoy, sensitivity to others, Lack of Initiative and Inability to Make Decisions.
4.6. Trouble with Abstract Thinking
Individuals affected by Alzheimer’s Disease often lose the ability to solve problems or draw conclusions. They struggle to see the ‘big picture’. This usually begins during the middle stages of this brain disorder and worsens with time.
4.7. Difficulty Recognising Familiar Faces
Alzheimer’s impairs one’s ability to recognize familiar faces. Patients often don’t recognize the faces of their friends, colleagues, and even their own family members. Also, they can’t recall the names of people who are close to them.
4.8. Social Withdrawal
Too much stimulation becomes extremely distressing for people with Alzheimer’s, especially in the middle and later stages. By this time, their socializing and communication skills have noticeably deteriorated; this is what causes reluctance to interact with others and patients mostly prefer being isolated.
5. Psychiatric Disorders Associated with Alzheimer’s Disease
The mental illnesses manifest mainly due to memory impairment, which is a key symptom of Alzheimer’s Disease. In the initial stages, Alzheimer’s is marked by anxiety and depression, which come secondary to memory impairment problems. Patients also start experiencing delusions. With time, delusions keep getting more bizarre, leaving the patients in a confused and fearful state. As the disease progresses, patients show severe deterioration in visuospatial memory accompanied by obscene language and violent behavior.
Increased agitation may even require restraints to keep the patient in control.
In the later stages of Alzheimer’s, screaming, cursing, and banging become common. The patient is unable to contain urine or fecal matter and also shows gait apraxia. Restraints are often necessary in these last stages of Alzheimer’s Disease.
6. Stages of Alzheimer’s Disease
There are 7 clinical stages of Alzheimer’s Disease. Stages 1-3 are referred to as the pre-dementia stages, and stages 4-7 are called the dementia stages. At stage 5, it becomes impossible for the patient to survive without assistance.
6.1. Stage 1
In this stage, the patient appears completely healthy and mentally stable. There are hardly any signs of dementia and there are no noticeable symptoms of cognitive or functional deterioration. The patients don’t exhibit any behavioral or mood changes at all.
6.2. Stage 2
This stage mainly comprises subjective memory loss and age-related forgetfulness. People around 65 years old or older begin complaining about functional and/or cognitive difficulties. They are unable to recall names as easily as they could before and often forget where they have kept things. They may also show erratic behavior sometimes.
6.3. Stage 3
This stage is characterized by mild cognitive impairment. Patients in this stage of Alzheimer’s disease show subtle but noticeable deteriorations in various aspects of life. Job performance is compromised, and learning new skills becomes quite difficult. Patients may not notice these symptoms themselves but their close ones definitely will.
Individuals in this stage often repeat queries and their capacity to perform executive tasks declines.
6.4. Stage 4
This stage mainly features moderate cognitive decline and mild dementia. At this stage, Alzheimer’s Disease can be diagnosed accurately. They are unable to manage complex activities of daily activities, which, in turn, makes it impossible for the patient to live independently. Patients face difficulty in paying rent, ordering from a menu in a restaurant, writing checks with the correct date and amount, preparing meals, and other such simple tasks.
6.5. Stage 5
Stage 5 is characterized by moderately severe cognitive decline and moderate dementia. The deterioration in this stage is severe. Patients frequently cannot recall significant moments or people in their life. They may forget their address, their phone number, or from which college they graduated on several occasions. Simple calculations become challenging for patients in this stage of Alzheimer’s disease.
6.6. Stage 6
This phase is characterized by severe cognitive decline and moderately severe dementia. Stage 6 can be further divided into 5 different stages. The symptoms are summarised below.
6.6.1. Stage 6a
In addition to not being able to choose what clothing to wear based on occasions or weather conditions, patients in this stage of Alzheimer’s Disease find it challenging to wear their own clothes properly. For example, if left completely unsupervised, Alzheimer’s patients may put their clothing on backward or may not be able to put their arm in the correct sleeve.
6.6.2. Stage 6b
In this stage of the brain disorder, patients find it challenging to bathe independently. Their symptoms deteriorate to the point where they cannot adjust the temperature of the bathing water. If someone assists them with adjusting the water temperature, they may still be able to bathe without any other help. As this stage evolves, the problems are further intensified. Patients start facing problems even with daily hygiene practices like brushing their teeth properly.
6.6.3. Stage 6c, 6d, 6e
As Alzheimer’s disease evolves further, the mental health conditions associated with it get worse. Patients in the later substages of Stage 6 show deterioration in toilet habits. The patient, for example, may not be able to place or use the toilet paper properly. Later, in these substages, the patients show urine and fecal incontinence. Urine incontinence comes earlier (at stage 6c) and fecal incontinence follows (at stage d).
Fortunately, there are ways to treat this incontinence or even prevent it entirely by frequent toileting. Appropriate bedding, absorbent undergarments, etc. would also be necessary.
Patients in the 6th stage of Alzheimer’s disease do not recall their own birthplace or schools properly and have little to no knowledge of significant moments in their life. They will frequently mistake the identity of people close to them or may even confuse them with one another. The ability to calculate deteriorates so severely that even wee-educated patients have difficulty counting backward. Problems with speech intensify as well.
Erratic behavior becomes very common and mood swings are rapid. Emotional changes, in addition to having a neurochemical basis, are psychological reactions to the patient’s own circumstances. Patients thus lose interest in productive and/or recreational activities. They begin to pace around, displace objects, and feature other forms of purposelessness and anxiety. Fear, frustration, and shame are very common too. Verbal outbursts become very frequent and patients are often threatened.
The duration of the moderately severe stage of Alzheimer’s disease lasts about 2.5 years in people who do not have additional health problems.
6.7. Stage 7
The 7th stage of Alzheimer’s is characterized by very severe cognitive decline and severe dementia. People at this stage fully depend on others for daily activities for their survival. There are six identifiable substages to this final stage of Alzheimer’s disease.
6.7.1. Stage 7a
Speech becomes very limited; the patient’s vocabulary in this stage is about half a dozen intelligible words or fewer. The duration of the 7a stage is approximately 1 year.
6.7.2. Stage 7b
Speech may get limited to a single intelligible word at this stage. So, we could say that in the second substage, intelligible speech is lost. The duration of the 7b stage is approximately 1.5 years.
6.7.3. Stage 7c
In addition to losing their speech, patients also lose their ambulatory ability and need constant assistance to move around if required. However if good care is taken during the early phase of Stage 7, the onset of loss of ambulation can be postponed. In Alzheimer’s patients who remain alive, this substage lasts for about 1 year.
6.7.4. Stage 7d
At this stage, the victims lose the ability to ambulate and can’t even sit up independently. They require armrests to assist them in sitting up in the chair. The duration of this stage is also about a year.
6.7.5. Stage 7e
People in this stage of Alzheimer’s Disease lose the ability to smile. The duration of the 7e stage is approximately 1.5 years.
6.7.6. Stage 7f
Victims can’t hold their heads up independently anymore and are diagnosed with various other conditions including pneumonia and infected ulcerations. Physical as well as neurological changes become more and more evident. Such changes include physical rigidity followed by contractures. Rigidity is found mainly in the passive motion of major joints like the elbow.
Neurological reflex changes are also found. Infantile, primitive, or developmental reflexes are found in patients as AD evolves. These changes include the sucking reflex, the Babinski reflex, and the grasp reflex.
People with Alzheimer’s usually die during the course of the 7th stage.
7. What Causes Alzheimer’s Disease?
The exact causes of this neurodegenerative brain disorder are not fully understood. Yet, studies have concluded that a combination of genetic, environmental, and lifestyle factors contribute to the development of Alzheimer’s Disease.
Let us look at some of the factors that are likely to contribute to the development of AD:
7.1. Genetic Factors
Family history is a high-risk factor for acquiring Alzheimer’s Disease. Certain genes like the apolipoprotein E (APOE) gene have been linked to an increased risk of developing AD. Though having these genes don’t necessarily mean that the person would develop Alzheimer’s, these genes make the person more prone to it. Research suggests that people with a parent or sibling who has AD are more prone to it than those who do not have a first-degree relative suffering from the disease.
7.2. The Age Factor
The elderly are more at risk of developing this brain disorder. People over the age of 65 are the ones most likely to develop Alzheimer’s Disease. Also, the symptoms of this disease intensify as the victim gets older.
7.3. Amyloid Plaques and Tau Tangles
Abnormal protein buildups in the brain are one of the leading factors contributing to the development of AD. Beta-amyloid plaques and tau tangles affect the healthy functioning of neurons, which leads to cell damage and death. These deposits play a critical role in the progression of Alzheimer’s Disease.
Neuroinflammation is considered one of the cardinal features of Alzheimer’s. Pro-inflammatory cytokine signaling contributes to neurodegeneration and neuroprotection in various ways. Induction of proinflammatory signaling causes discharge of immune mediators which, in turn, affects neurons, causing cell damage and death.
7.5. Environmental Factors
Some major environmental factors that contribute to the development of this brain disorder are stated below:
Researchers have found traces of this metal in the brains of people with Alzheimer’s disease. Aluminium turns up more than normal in some autopsy studies of AD patients, but not all of them. Aluminum is found in small amounts in numerous household products and food. This led to the fear that aluminum ingested in food or absorbed in other ways could lead to Alzheimer’s Disease. To date, scientists say that they are uncertain if there is a relationship between aluminum exposure and Alzheimer’s disease.
Some reports suggest that having very little quantity of zinc in the body could contribute to the development of AD. This was suggested by autopsies that found very low levels of zinc in the brains of AD patients, especially in the hippocampus.
A recent study, however, suggests that excess zinc could be the problem. In the lab experiment, it was found that zinc caused soluble beta-amyloid from cerebrospinal fluid to form clumps similar to the plaques of Alzheimer’s disease.
7.5.3. Food-Borne Poisons
Toxins found in foods are also suspected to contribute to AD development. Two amino acids found in certain legumes in India, Africa, and Guam are likely to cause neurological damage. Both of these amino acids enhance the action of the neurotransmitter glutamate, which is also implicated in Alzheimer’s disease.
An outbreak of a neurological disorder similar to Alzheimer’s Disease was seen in Canada. The outbreak occurred among people who had eaten mussels that were contaminated with domoic acid. This chemical, again, is a glutamate stimulator. These toxins could definitely shed some light on the mechanisms that lead to neurodegeneration.
Viruses are the causing agents in some neurological diseases. These viruses lurk in the patient’s body for decades until a combination of circumstances stirs them to action. Researchers, for years, have sought a virus or other infectious agents in people with Alzheimer’s. Though there is no hard evidence that links viruses to AD, a study in the 1980s proved some data that keep the possibility alive.
7.6. Cardiovascular Health
Conditions affecting a person’s cardiovascular health have been linked to Alzheimer’s Disease. Some such common conditions are diabetes, high blood pressure, and high cholesterol. This condition affects the blood supply to the brain and contributes to brain damage, making the person prone to this brain disorder.
7.7. Lifestyle Factors
A study from the University of Minnesota attributed 41% of dementia cases to 12 modifiable lifestyle factors. Obesity, high blood pressure, and lack of exercise contributed the most to the risk of dementia and thus, Alzheimer’s. Some other risk factors include depression, smoking, hearing loss, and binge drinking, to mention a few.
7.8. Head Trauma
Some studies have shown that there is an increased risk of developing Alzheimer’s disease in older people with a history of moderate TBI (Traumatic Brain Injury); they had a 2.3 times greater risk of developing AD than seniors with no such history. Patients with a history of severe TBI had a 4.5 times greater risk.
Some other studies (but not all) have found a link between moderate and/or severe TBI and the risk of cognitive decline as well as dementia.
7.9. Sleep Disorders
Sleep apnea, insomnia, and other sleep disorders have been linked to the development of Alzheimer’s Disease. It is safe to say that sleep disturbances lead to an increased risk of cognitive impairment and AD pathology.
7.10. Hormonal Changes
A sudden drop in estrogen levels after women reach menopause makes them more vulnerable to Alzheimer’s Disease.
8. What Causes Death in Alzheimer’s Patients?
The most common cause of death in people with Alzheimer’s Disease is pneumonia. Aspiration is a common cause of terminal insomnia. Another common cause of death in AD patients is infected decubital ulcerations. In addition to these, the possibility of demise due to mortality conditions common in elderly people including stroke, heart disease, and cancer, also remains.
9. How Is Alzheimer’s Disease Treated?
There is currently no cure for Alzheimer’s Disease. Several treatments and interventions can help in managing the symptoms, slowing down the progression of the disease, and improving the quality of life for those who are affected by it. This fatal brain disorder is treated with a combination of medications, lifestyle modifications, and supportive care. Working closely with health professionals can help in developing an effective treatment plan for AD patients.
The approaches commonly used to treat Alzheimer’s Disease are as follows:
9.1.1. Cholinesterase Inhibitors
Drugs such as donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne) may be prescribed to a patient with Alzheimer’s Disease. These drugs help in improving memory, thinking, and communication by increasing the levels of some particular brain chemicals.
9.1.2. NMDA Receptor Antagonist
Memantine (Namenda) is another drug that is usually prescribed to patients in the later stages of Alzheimer’s Disease. This drug helps in regulating glutamate activity and is also known to potentially slow down the process of cognitive decline in patients with AD.
9.2. Behavioral Interventions
9.2.1. Cognitive Stimulation
People with Alzheimer’s are encouraged to engage in activities that stimulate one’s mind. These activities involve puzzles, games, and social interaction to slow down the process of cognitive decline as much as possible.
9.2.2. Structured Routine
AD patients are made to follow a consistent daily routine. This provides a sense of stability and can help reduce anxiety in people with Alzheimer’s Disease.
9.2.3. Communication Strategies
Effective communication techniques are introduced to individuals affected by Alzheimer’s. Using simple language and visual cues can help in reducing frustration and improve interaction with others.
9.3. Lifestyle Modifications
9.3.1. Physical Exercise
Regular physical exercise is known to have positive effects on one’s cognitive functions as well as overall well-being.
Physical activity reduces the risk of vascular problems such as diabetes and high cholesterol, which could cause agents of Alzheimer’s. Thus, exercise can lower the risk of AD in individuals.
9.3.2. Healthy Diet
A balanced diet is necessary for people with Alzheimer’s Disease.
AD patients are given a lot of vegetables, fruits, whole grains, low-fat dairy products, whole grains, protein, etc.
Foods containing high saturated fat and cholesterol are limited as much as possible. These foods like butter, solid shortening, lard, and fatty cuts of meats are bad for heart health and should be avoided.
Refined sugar contains calories but lacks other essential nutrients like vitamins, minerals, and fiber. Therefore it’s best to replace refined sugar with healthier options such as fruit or juice-sweetened baked goods. But, in the later stages of AD, when patients lose appetite, adding sugar to foods could encourage them to eat.
Foods with high sodium are limited and less salt is allowed to be consumed by people with Alzheimer’s. Too much consumption of sodium affects blood pressure and thus should be avoided. Instead, spices and herbs can be used to season foods.
9.3.3. Mental Stimulation
In order to maintain cognitive function in Alzheimer’s Disease, it is important that they participate in mentally stimulating activities. These activities include reading, solving puzzles, learning a new skill, or engaging in creative hobbies.
9.3.4. Social Engagement
Patients with Alzheimer’s Disease show signs of social withdrawal due to their difficulty in speech and communication. Encouraging AD patients to engage themselves in activities that involve social interaction can help in managing these symptoms and keep them functioning.
Patients should be encouraged to stay socially active and maintain healthy connections with family and friends. This will provide them with both emotional support and cognitive benefits.
9.4. Supportive Care and Safety Measures
9.4.1. Safety Precautions
It is important to ensure a safe living environment for Alzheimer’s patients. There should be no potential hazards and locks and alarms should be used to prevent the patients from wandering.
9.4.2. Assistance with Activities of Daily Living
As Alzheimer’s Disease progresses, it becomes impossible for patients to live independently. They need assistance with simple daily activities like brushing their teeth and wearing clothes. Assistance with daily activities is thus one of the most essential forms of care people with Alzheimer’s require.
9.4.3. Support for Caregivers
Caregivers, who play a crucial role in helping people with Alzheimer’s, should be provided with support and resources. This will help the caregivers in managing challenges related to caregiving, thus, making the treatment more effective for AD patients.