SNP Browser for Human [Homo spaiens] Genetic Disorders

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DiseaseID HGD1
Genetic Disorder ALZHEIMER DISEASE
Gene Name APP, PSEN1, PSEN2
Description

Alzheimer’s disease is a brain disorder named for German physician Alois Alzheimer, who first described it in 1906. Scientists have learned a great deal about Alzheimer’s disease in the century since Dr. Alzheimer first drew attention to it. Alzheimer's destroys brain cells, causing problems with memory, thinking and behavior severe enough to affect work, lifelong hobbies or social life. Alzheimer’s gets worse over time, and it is fatal. Today it is the seventh-leading cause of death in the United States. Death usually results from general inanition, malnutrition, and pneumonia. The typical clinical duration of the disease is eight to ten years, with a range from one to 25 years. About 25% of all AD is familial (i.e., two or more persons in a family have AD) of which about 95% is late-onset (after age 60-65 years) and 5% is early-onset (before age 65 years).

Symptoms

Increasing and persistent forgetfulness. At its onset, Alzheimer's disease is marked by periods of forgetfulness, especially of recent events or simple directions. But what begins as mild forgetfulness persists and worsens. People with Alzheimer's may repeat things and forget conversations or appointments. They routinely misplace things, often putting them in illogical locations. They frequently forget names, and eventually, they may forget the names of family members and everyday objects. ? Difficulties with abstract thinking. People with Alzheimer's may initially have trouble balancing their checkbook, a problem that progresses to trouble recognizing and dealing with numbers. ? Difficulty finding the right word. It may be a challenge for those with Alzheimer's to find the right words to express thoughts or even follow conversations. Eventually, reading and writing also are affected. ? Disorientation. People with Alzheimer's often lose their sense of time and dates, and may find themselves lost in familiar surroundings. ? Loss of judgment. Solving everyday problems, such as knowing what to do if food on the stove is burning, becomes increasingly difficult, eventually impossible. Alzheimer's is characterized by greater difficulty in doing things that require planning, decision making and judgment. ? Difficulty performing familiar tasks. Once-routine tasks that require sequential steps, such as cooking, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer's may forget how to do even the most basic things. ? Personality changes. People with Alzheimer's may exhibit mood swings. They may express distrust in others, show increased stubbornness and withdraw socially. Early on, this may be a response to the frustration they feel as they notice uncontrollable changes in their memory. Depression often coexists with Alzheimer's disease. Restlessness also is a common sign. As the disease progresses, people with Alzheimer's may become anxious or aggressive and behave inappropriately.

Causes Scientists do not yet fully understand what causes AD. There probably is not one single cause, but several factors that affect each person differently. Age is the most important known risk factor for AD. The number of people with the disease doubles every 5 years beyond age 65. Family history is another risk factor. Scientists believe that genetics may play a role in many AD cases. For example, early-onset familial AD, a rare form of AD that usually occurs between the ages of 30 and 60, is inherited. The more common form of AD is known as late-onset. It occurs later in life, and no obvious inheritance pattern is seen in most families. However, several risk factor genes may interact with each other and with non-genetic factors to cause the disease. The only risk factor gene identified so far for late-onset AD is a gene that makes one form of a protein called apolipoprotein E (ApoE). Everyone has ApoE, which helps carry cholesterol in the blood. Only about 15 percent of people have the form that increases the risk of AD. It is likely that other genes also may increase the risk of AD or protect against AD, but they remain to be discovered. Scientists still need to learn a lot more about what causes AD. In addition to genetics and ApoE, they are studying education, diet, and environment to learn what role they might play in the development of this disease. Scientists are finding increasing evidence that some of the risk factors for heart disease and stroke, such as high blood pressure, high cholesterol, and low levels of the vitamin folate, may also increase the risk of AD. Evidence for physical, mental, and social activities as protective factors against AD is also increasing.
Diagnosis There's no one test to diagnose Alzheimer's disease. Typically, doctors start the diagnostic process by ruling out other diseases and conditions that also can cause memory loss. Small, undetected strokes, for example, can cause dementia by temporarily interrupting blood flow to the brain. People with Parkinson's disease, a degenerative nerve disorder, also can develop dementia. Depression, too, can cause lapses in memory. In addition, many older adults are on multiple medications that may impair their ability to think clearly. To help distinguish Alzheimer's disease from other causes of memory loss, doctors typically rely on the following: ? Medical history. Doctors may ask about a person's general health and past medical problems. They'll want to know about any problems a person may have in carrying out daily activities. If possible, doctors will also want to speak with a person's family or friends to get more information. ? Basic medical tests. Blood tests may be done to help doctors rule out other potential causes of the dementia, such as thyroid disorders or vitamin deficiencies. ? Mental status evaluation. These tests screen memory, problem-solving abilities, attention spans, counting skills and language. They help doctors pinpoint specific problems a person may have with cognition. For instance, doctors might test recent and long-term memory by asking: What day is it today? Or: When was World War II? Recall tests are another example. Doctors may list familiar objects, and then ask a person to repeat them immediately, and again five minutes later. ? Neuropsychological testing. Sometimes doctors undertake a more extensive assessment of memory, problem-solving abilities, attention spans, counting skills and language. This is especially helpful in trying to detect Alzheimer's and other dementias at an early stage. Doctors use formal psychological tests to determine if a person's mental abilities are as expected for his or her age and education. The patterns of any mental deficits observed during neuropsychological testing can help doctors sort out possible causes of dementia. ? Brain scans. Doctors may want to take a picture of the brain using a brain scan. Several types of brain scans are available — including a computerized tomography (CT) scan, a magnetic resonance imaging (MRI) scan and a positron emission tomography (PET) scan. By looking at images of the brain, doctors may be able to pinpoint any visible abnormalities. Researchers are studying whether brain scans can eventually be used to detect an increased risk of Alzheimer's in healthy people before symptoms begin. Using the methods above, doctors can accurately diagnose 90 percent of Alzheimer's cases. Alzheimer's can be diagnosed with complete accuracy only after death, using a microscopic examination of brain tissue, which checks for plaques and tangles. Genetic testing for Alzheimer's is in its beginning stages. Blood tests are available that can tell whether a person carries the genetic mutations believed to be associated with Alzheimer's, but the tests can't tell who will or will not get the disease.
Treatment Currently, there's no cure for Alzheimer's disease. Doctors sometimes prescribe drugs to improve symptoms that often accompany Alzheimer's, including sleeplessness, wandering, anxiety, agitation and depression. But only two varieties of medications have been proved to slow the cognitive decline associated with Alzheimer's. Cholinesterase inhibitors This group of medications — which includes donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl) — works by improving the levels of neurotransmitters in the brain. Donepezil has been approved by the Food and Drug Administration for the treatment of mild, moderate and severe Alzheimer's disease. Donepezil also appears to delay the onset of Alzheimer's for about a year in people who have mild cognitive impairment (MCI). People who have MCI have more memory problems than other people their age, but they are not demented. Cholinesterase inhibitors don't work for everyone. As many as half the people who take these drugs show no improvement. Other people may choose to stop taking the drugs because of the side effects, which include diarrhea, nausea and vomiting. Memantine (Namenda) The first drug approved to treat moderate to severe stages of Alzheimer's, memantine (Namenda), protects brain cells from damage caused by the chemical messenger glutamate. It sometimes is used in combination with a cholinesterase inhibitor. Memantine's most common side effect is dizziness, although it also appears to increase agitation and delusional behavior in some people.
     

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