Areas of widened veins in the rectum that sometimes become inflamed are called haemorrhoids or piles. A person may have internal haemorrhoids, located in the lower rectum, external haemorrhoids, which form under the skin around the anus, or both. Haemorrhoids may cause itching and bleeding with defection that coats the stool, streaks toilet tissue or drips into the toilet. Sometimes internal haemorrhoids will protrude or prolapsed, through the anus. This may allow leakage of the rectal contents.

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Last Updated on Thursday, 18 March 2010 09:55

Alzheimer's Disease Overview

Alzheimer's disease is a progressive, degenerative disease of the brain which causes thinking and memory to become seriously impaired.¹ It is the most common form of dementia and is named after the German physician Alois Alzheimer who first identified the condition in 1906.² Alois Alzheimer described the appearance of 'tangles' and 'plaques' which have since been found to be caused by a build-up of proteins in the brain and play a part in its deterioration.²

Alzheimer's disease gradually affects the ability of the brain to function properly, causing the loss of intellectual and social abilities severe enough to interfere with daily functioning.³ This happens because nerve cells, in certain areas of the brain which control a person's mental abilities, start to deteriorate and die. The reason this happens is not fully known, but may be due to the build up of plaques and tangles in the brain.

Alzheimer's disease proceeds in stages over months or years and gradually destroys memory, reason, judgment, language, and eventually the ability to carry out even simple tasks.⁴ People with Alzheimer's disease experience difficulties severe enough to have an impact on their work, social activities, and family life.⁵ While there is currently no cure for Alzheimer's disease, there are treatments to help temporarily slow the progression of the symptoms of the disease.⁶

What causes Alzheimer's disease?⁷

Scientists don't yet fully understand what causes Alzheimer's disease, but it is clear that it develops because of a complex series of events that take place in the brain over a long period of time. It is likely that the causes include genetic, environmental, and lifestyle factors. Because people differ in their genetic make-up and lifestyle, the importance of these factors for preventing or delaying Alzheimer's disease differs from person to person.⁷

Genetics play a role in some people with Alzheimer's disease. A rare type of Alzheimer's disease, called early-onset Alzheimer's disease, affects people aged 30 to 60. Some cases of early-onset Alzheimer's disease, called familial Alzheimer's disease, are inherited. Familial Alzheimer's disease is caused by mutations (permanent changes) in three specific genes. Offspring in the same generation have a 50% chance of developing familial Alzheimer's disease if one of their parents had it.⁷

Most cases of Alzheimer's disease are late-onset Alzheimer's disease, which develops after the age of 60. Although a specific gene has not been identified as the cause of late-onset Alzheimer's disease, genetic factors do appear to increase a person's risk of developing the disease. This increased risk is related to the apoliprotein E (APOE) gene. The APOE gene has several forms. One of them, APOE ε4, occurs in about 40 percent of all people who develop late-onset Alzheimer's disease. However, at least one-third of people with Alzheimer's disease do not have this form of the gene.⁷

Four to seven other Alzheimer's disease risk-factor genes may exist as well. One of them, SORL1, was discovered in 2007. Large-scale genetic research studies are looking for other risk-factor genes.⁷

Research suggests that certain lifestyle factors, such as a nutritious diet, exercise, social engagement, and mentally stimulating pursuits, might help to reduce the risk of cognitive decline and Alzheimer's disease. Scientists are investigating associations between cognitive decline and heart disease, high blood pressure, diabetes, and obesity. Understanding these relationships and testing them in clinical trials will help us understand whether reducing risk factors for these diseases may help with Alzheimer's disease as well.⁷

How many people suffer from Alzheimer's disease?

In Europe, it is estimated that one in every 20 people over the age of 65 has Alzheimer's disease and the numbers are predicted to double in Western Europe and treble in Eastern Europe by 2040.⁸ However, a report published in the UK in 2007 estimated that among those who suffer from dementia, only one-third to one-half receive a formal diagnosis.⁹ Indeed, a recent online survey amongst Americans aged 55 years and over, found that one-third of people surveyed knew someone whom they suspect might have Alzheimer's disease. Yet of those people, only 38% encouraged this person to talk to a doctor about it.¹⁰

What are the symptoms of Alzheimer's disease?

Although symptoms of Alzheimer's disease 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 lifelong hobbies.¹¹

Other symptoms include confusion, getting lost in familiar places, misplacing things and problems with speaking and writing. The list below ¹² details some of the common signs and symptoms of Alzheimer's disease:

• Abstract Thinking -- Balancing a chequebook may be hard when the task is more complicated than usual. Someone with Alzheimer's disease, however, might forget what the numbers are and what needs to be done with them.

• Disorientation -- It's normal to forget the day of the week or where you're going, but people with Alzheimer's disease can become lost on the street where they live, forget where they are and how they got there, and not know how to get back home.

• Initiative -- People often tire of housework, business activities or social obligations at times. However, a person with Alzheimer's disease may become excessively passive, sitting in front of the television for hours, sleeping more than usual or not doing usual activities.

• Judgment -- No one has perfect judgment all the time, but those with Alzheimer's disease may dress without regard to the weather, for instance wearing several shirts on a warm day. Individuals with dementia often show poor judgment about money, giving away large amounts to telemarketers or paying for repairs or products they don't need.

• Language -- All of us have trouble finding the right word from time to time, but people with Alzheimer's disease often forget simple words or substitute unusual words, making their speech or writing hard to understand. If a person with Alzheimer's disease is unable to find a toothbrush, for example, they may ask for "that thing for my mouth".

• Misplacing Items -- Anyone can temporarily misplace a wallet or key. A person with Alzheimer's disease may put things in unusual places: an iron in the freezer or a wristwatch in the sugar bowl.

• Mood Changes -- Everyone can become sad or moody from time to time. However, someone with Alzheimer's disease can show rapid mood swings (from calm to tears to anger) for no apparent reason.

• Personality -- Personalities ordinarily change somewhat with age but a person with Alzheimer's disease may have a severe personality change, becoming extremely confused, suspicious, fearful or dependent on a family member.

How is Alzheimer's disease diagnosed?

A diagnosis of Alzheimer's disease can often be difficult particularly in the early stages. It is important to distinguish Alzheimer's disease from other forms of dementia and to rule out other causes of the symptoms which require specific treatment.¹³ There is no single test to determine whether someone definitely has Alzheimer's disease. However, doctors can determine fairly accurately whether a person may have Alzheimer's disease by conducting several screening tests, which help eliminate other conditions, and by conducting a careful examination of a person's physical and mental state. The main tests used to diagnose Alzheimer's disease look at memory, language, perceptual skills, attention, orientation, problem-solving and functional abilities.¹⁴ A healthcare professional can diagnose the cause of these problems and experts estimate that a skilled physician can diagnose Alzheimer's disease with more than 90% accuracy.¹⁵

The doctors may decide on further tests such as brain scans which will locate any damaged areas of the brain. The results of these tests can provide further evidence to support diagnosis.

How is Alzheimer's disease treated?

Currently, there is no known cure or prevention for Alzheimer's disease however there are several medications available to treat its symptoms.⁶ A doctor will need to assess the most appropriate treatment for each individual and monitor the patient carefully over time to assess if modifications to treatment are needed as the symptoms of Alzheimer's disease progress. A doctor may also recommend lifestyle modifications to help manage the disease.

It is vital that Alzheimer's disease is diagnosed as early as possible. Having an early diagnosis, starting treatment and putting lifestyle modifications in place in the early stages of Alzheimer's disease can help individuals prepare for the future by managing their disease early on.¹⁶

Visit the Memory Problems? website www.aboutmemoryproblems.com for further information about Alzheimer's disease.

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Related Pages:

• Alzheimer's Disease Overview
• Memory Problems Website
• Alzheimer's IMPACT Study

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[1] Alzheimer Society of Canada. What is Alzheimer's Disease? Introduction. Alzheimer Society of Canada website. Available at URL: http://www.alzheimer.ca/english/disease/whatisit-intro.htm. Last updated March 2009. Last accessed February 2010

[2] Alzheimer's Association. What is Alzheimer's? Available at URL: http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp. Last updated 18 February 2010. Last accessed February 2010.

[3] Mayo Clinic. Alzheimer's disease definition. Available at URL: http://www.mayoclinic.com/health/alzheimers-disease/DS00161. Last updated 17 January 2009. Last accessed February 2010.

[4] Agency for Healthcare Research and Quality. Understanding Your Body: What Is Alzheimer's Disease? Agency for Healthcare Research and Quality website. US Department of Health and Human Services. Available at URL: http://www.ahrq.gov/consumer/bodysys/edbody9.htm. Last accessed February 2010.

[5] Alzheimer's Association. 10 Signs of Alzheimer's. Available at URL: http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp. Last updated 17 February 2010. Last accessed February 2010.

[6] Alzheimer's Society. Drug Treatments for Alzheimer's disease. Alzheimer's Society website. Available at URL: http://www.alzheimers.org.uk/factsheet/407. Published September 2008. Last accessed February 2010.

[7] National Institute of Aging. Causes: What causes AD? Available at URL: http://www.nia.nih.gov/Alzheimers/AlzheimersInformation/Causes/. Last updated 15th January 2010. Last accessed February 2010.

[8] Alzheimer Europe. Who Cares? The state of dementia care in Europe. Luxembourg: Alzheimer Europe; 2006; Available to purchase from URL: http://www.alzheimer-europe.org/Publications/Alzheimer-Europe-Reports. Last accessed January 2010.

[9] National Audit Office. Improving services and support for people with dementia. National Audit Office website. Available at URL: http://www.nao.org.uk/publications/0607/support_for_people_with_dement.aspx. Published July 2007. Last accessed February 2010.

[10] Alzheimer's Disease Screening Discussion Group. Alzheimer's Disease 2008: Current Attitudes and Perceptions Survey. You Can Be the One website (sponsored by Eisai Inc and Pfizer Inc). Available at URL: http://www.seethesigns.com/pdf/ADSDG_Survey.pdf. Last accessed February 2010.

[11] Alzheimer's Association. Alzheimer's Disease Facts and Figures. act website. Available at URL: http://www.actionalz.org/facts_figures.asp. Last accessed February 2010.

[12] University of California, San Francisco. Alzheimer's Disease: Signs and Symptoms. University of California San Francisco Medical Center website. Available at URL: http://www.ucsfhealth.org/adult/medical_services/memory/alz/conditions/alzheimers/. Last updated February 2008. Last accessed February 2010.

[13] Alzheimer's Society. Diagnosis and Assessment. Available at URL: http://www.alzheimers.org.uk/factsheet/426. Last updated July 2008. Last accessed February 2010.

[14] Rao SM, Swanson SJ. Neuropsychological Assessment. In: Schiffer RB, Rao SM, Fogel BS, ed. Neuropsychiatry. Philadelphia, Pennsylvania: Lippincott Williams and Wilkins; 2nd Edition, 2005: Chapter 2: Neuropsychological Assessment. 20-42

[15] Alzheimer's Association. Steps to Diagnosis. Alzheimer's Association website. Available at URL: http://www.alz.org/alzheimers_disease_steps_to_diagnosis.asp. Last updated July 2009. Last accessed February 2010.

[16] Doraiswamy PM, Steffens DC, Pitchumoni S, Tabrizi S. Early Recognition of Alzheimer's disease: what is consensual? What is controversial? What is practical? J Clin Psychiatry. 1998;59(suppl. 13):6-18.

New Memory Problems Website

Memory Problems? A new support programme for patients and carers is being launched today at the 25th Alzheimer's Disease International (ADI) Conference. This initiative, which has been instigated and funded by Eisai Europe Ltd. and Pfizer Limited, will become available across Europe during 2010. It has been created to help people recognise the early signs and symptoms of Alzheimer's disease and to distinguish these from the normal changes that occur with ageing. www.aboutmemoryproblems.com provides practical advice and tools to help anyone concerned about memory problems in a loved one to take action by talking to those affected and consulting their doctor.

"Diagnosing dementia is often difficult, particularly in the early stages, but this is when it is most important", says Professor Roy Jones from The Research Institute for the Care of Older People (RICE) Centre, Royal United Hospital, Bath, UK. "If we can diagnose and start managing Alzheimer's disease early, we can help patients and their families cope better with the situation. Unfortunately, there is no cure for this devastating disease, but there are treatments that may slow the progression of symptoms and these should be prescribed at the time of diagnosis."

The IMPACT of Alzheimer's disease^i,ii

The importance of family members and other caregivers in recognising the early signs of Alzheimer's disease was highlighted in a recent large online survey. The IMPACT (Important Perspectives on Alzheimer's Care and Treatment) study involved 1,800 doctors, caregivers, payors and members of the general public from France, Germany, Italy, Spain and the UK.

The study showed that 93% of Alzheimer's disease patients were initially brought to the doctor by a family member.1 Furthermore, two thirds (66%) of European doctors believe family members are most likely to recognise the early symptoms of Alzheimer's disease.¹ This indicates the vital role that family members can play in spotting the symptoms of Alzheimer's disease and encouraging their relative to visit a doctor.

However, the research also highlighted that many caregivers were not aware of all of the early signs and symptoms of Alzheimer's disease and that the average time from a caregiver noticing symptoms to making an appointment with a doctor was 43 weeks.² The survey found that nearly half (45%) of patients discussing Alzheimer's disease with their doctors for the first time were already experiencing moderate symptoms.1 The reasons that caregivers gave for the delay in seeing a doctor about symptoms included wanting to ensure symptoms were not temporary (38%), the belief that symptoms were a normal part of ageing (36%) and resistance from the patient (33%).²

Memory Problems? website – www.aboutmemoryproblems.com -- bridging the information gap

The Memory Problems? website includes two innovative animations. These are short educational films that bring to life some of the symptoms and behaviours that are early indicators of the disease, as well as prompting family members to take early action when they recognise these symptoms.

As many adults already search online for health information,ⁱⁱⁱ Memory Problems? website is an ideal place for worried families to begin dealing with concerns.

"It can be difficult to recognise and confront the first stages of Alzheimer's disease, so anything that helps people to recognise the early symptoms is very welcome," says Marc Wortmann, Executive Director, Alzheimer's Disease International (ADI). "There is a need for more awareness and more information about Alzheimer's disease in many European countries. The Memory Problems? campaign could therefore be a valuable resource for many people."

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Related Pages:

• Alzheimer's Disease Overview
• Memory Problems Website
• Alzheimer's IMPACT Study

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[i] IMPACT Study 2009: Global Alzheimer's Awareness Study. MD survey. Data on file Eisai Europe Ltd, Pfizer Limited.

[ii] IMPACT Study 2009: Global Alzheimer's Awareness Study. Caregivers survey. Data on file Eisai Europe Ltd, Pfizer Limited.

[iii] Study: 85% of Online Europeans Use the Internet for Health Information, Manhattan Research Releases New Cybercitizen Health® Europe Study, Shedding light on How Consumers in the United Kingdom, Germany, France, Italy and Spain Use the Internet for Health Information. Available at URL: http://www.manhattanresearch.com/newsroom/Press_Releases/online-europeans-use-internet-for-health.aspx. Last accessed: February 2010.

About the IMPACT study

The IMPACT study (Important Perspectives on Alzheimer's Care and Treatment) is a large pan-European online survey of the attitudes of caregivers, physicians, the general public and payors towards Alzheimer's disease and dementia. It was initiated and financed by Pfizer Inc. and Eisai Europe Ltd.

Rationale

Attitudes to, and awareness of, Alzheimer's disease can vary across countries, and between stakeholder groups.¹ Despite its prevalence and impact, around half of dementia cases remain undiagnosed.² Diagnosis is often difficult, particularly in the early stages,³ however if the disease is diagnosed early enough there are many things that may be done to help people prepare for the future by managing the disease early on.⁴ Early identification of dementia benefits the patient but also has benefits for the family, caregivers, healthcare systems, and society in general.⁵

Aims and objectives

The IMPACT study set out to update current knowledge on attitudes and behaviours towards Alzheimer's disease in Europe, in particular with a focus on the barriers to optimal dementia care. The overall objective is to help improve knowledge and increase understanding of this devastating disease by determining a common "reason to care" about dementia.

Study methodology⁶

IMPACT is a large online survey conducted in Alzheimer's disease and dementia, involving 1,800 people from five countries – France, Germany, Italy, Spain and the UK.

Responses were analysed from:

• 1,000 members of the general public (men and women aged 18 years and above)
• 500 physicians who treat patients with Alzheimer's disease (general practitioners and neurologists)
• 250 caregivers (spouses, children, children-in-law or grandchildren who are either currently serving or had served as the unpaid primary carer of someone diagnosed with Alzheimer's disease within the past two years)
• 50 payors

There were equal numbers of each group from each of the five countries - 200 from the general population, 100 physicians, 50 caregivers, and 10 payors from each country. For the purposes of the survey results, 51 subjects from the general public (six Alzheimer's disease sufferers and 45 primary caregivers) were excluded, and responses from a sub-population of 949 general public respondents who did not have Alzheimer's disease and who were not primary caregivers of a person with Alzheimer's disease were reported.

A 30-minute internet-based questionnaire was issued between April-May 2009 to participants to assess their opinion and perception on issues relating to aging and dementia. For caregivers, there were additional questions on the impact of caring on their life.

Key roles

The questionnaire was designed by Ipsos Marketing, in conjunction with Pfizer Inc. and Eisai Europe Ltd. The content and structure of the survey was reviewed and endorsed by a group of dementia experts, the IMPACT Steering Committee, which included Professor Roy Jones MD, Director, The Research Institute for the Care of Older People (RICE) Centre, Royal United Hospital and Professor Sandrine Andrieu, Professor of Epidemiology and Public Health, Toulouse University School of Medicine.

Results⁶

Respondents generally agreed that the symptoms of early Alzheimer's disease are difficult to recognise, and many people are unable to distinguish these signs and symptoms from normal ageing. A majority of physicians and caregivers (59% and 56% respectively) agreed that many general practitioners are unaware of the early symptoms of Alzheimer's disease. Furthermore, 46% of carers also thought that specialists had difficulty in diagnosing Alzheimer's disease in the early stages.

The average time from a caregiver noticing symptoms to contact with a physician was 43 weeks (ranging from 33 weeks in Germany to 56 weeks in Italy). Reasons that caregivers gave for the delay include waiting until symptoms were no longer temporary (38%), belief that symptoms were a normal part of ageing (36%), patient resistance to consult a doctor (33%), or they did not realise how serious the symptoms were (32%).

A majority of caregivers (60%) and the general public (68%)6 did not know, or did not believe that there were effective treatments for Alzheimer's disease. However, more than half of the general public, caregiver and physician responders agreed that early treatment could delay the progression of the disease. 75% of physicians believed that early treatment could delay progression of the disease but less than half (47%) recognised that effective treatments are available.

Most respondents recognised the devastating effects of Alzheimer's disease on caregivers and families, and a majority of caregivers, the general public, and physicians do not believe that their governments invest nearly enough in Alzheimer's disease.

Carers reported consequences for their lifestyle, including increased fatigue, loss of time for themselves or their families and a negative impact on hobbies, holidays and time off, social life, working hours, finance or health. Most carers expressed negative feelings about their role (difficult, 59%; exhausting, 55%; demanding, 46%; stressful, 45%; frustrating, 40%; and depressing, 36%).

The importance of screening for Alzheimer's disease in people aged 65 and over varied among the responder groups. Only 56% of physicians and 40% of payors believed it was extremely/very important, whereas the majority of caregivers (84%) and the general population (80%) held this view.

Conclusion

The IMPACT study has identified barriers to care for people with Alzheimer's disease. The study highlighted the difficulty of diagnosing dementia, especially in the initial stages of the disease. Caregivers and the general public felt they had insufficient information about the benefits of treatment and care, although more than half the general public, caregiver and physician responders agreed that early treatment could delay the progression of the disease.

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Related Pages:

• Alzheimer's Disease Overview
• Memory Problems Website
• Alzheimer's IMPACT Study

___________________________________________________________________

[1] Kurz A, Schulz M, Reed P, Wortmann M, Rodrigo R, von Lützau Holbein H, Grossberg G. Personal perspectives of persons with Alzheimer's disease and their carers: A global survey. Alzheimer's & Dementia 2008;4:345–352.

[2] Boise L, Camicioli R, Morgan DL, Rose JH, Congleton L. Diagnosing dementia: perspectives of primary care physicians. Gerontologist. 1999 Aug;39(4):457-64.

[3] Alzheimer's Society. Diagnosis. Available at URL: http://www.alzheimers.org.uk/site/scripts/documents.php?categoryID=200292. Last accessed February 2010.

[4] Doraiswamy PM, Steffens DC, Pitchumoni S, Tabrizi S. Early Recognition of Alzheimer's disease: What is consensual? What is controversial? What is practical? J Clin Psychiatry. 1998;59(suppl. 13):6-18.

[5] Iliffe S, Manthorpe J and Eden A. Sooner or later? Issues in the early diagnosis of dementia in general practice: a qualitative study. Family Practice 2003;20:376–381.

[6] IMPACT Study 2009: Global Alzheimer's Awareness Study. Caregivers, payors, physicians and members of the general public surveys. Data on file Eisai Europe Ltd, Pfizer Limited.

Getting to grips with your emollient

When you (or your child) have eczema, your skin is not able to create the natural protective barrier that stops water being lost, and dirt, irritants and bacteria from getting in. Your emollient is the most important part of your treatment package because it will restore the barrier function, so protecting the skin. It does this by replacing lost moisture, which means that you need to put a lot of it on.

Using enough emollient

The reality is that many people (both children and adults alike) just don't use enough emollient for it to do its job properly and for them to see the best results.

Follow these simple rules to applying an emollient:

• Put it on every day - in between and during flare-ups, even when skin is clear
• Apply it every 3-4 hours - which means at least 4 times a day
• Be generous - generally speaking you'll need far more emollient than you might imagine

You should use between 250-500g a week for children (that's 2-4 pump dispensers a month) and roughly 600g a week for adults (that's about 4 pump dispensers a month).

Building a daily emollient routine

We know that applying an emollient four times a day, each and every day, is time consuming - and it's not that enjoyable! However, trying to build emollient application into your daily routine (and that of a child) can help to make it a regular habit. Why not think of fixed points in time during the day when you could put on an emollient, for example:

• Before getting dressed in the morning

• Just after lunch (although for children special arrangements with nursery or school may need to be made)

• During an afternoon break (or for children when they get home from nursery or school)

• In the evening, after a bath or cleaning your teeth

Find out more about eczema

MSD, the makers of Diprobase, are committed to supporting people living with eczema. That’s why we’ve developed a dedicated website: www.eczemazones.co.uk. On it you can find lots more information:

• Eczema Jungle – jungle fun for the under 5s
• Eczema Robots – a blast for the under 12s
• Happy Days – support for parents and carers
• Confident living – support for adults with eczema

Each children’s zone contains lots of interactive fun, with interactive storybooks, online (and printable) charts to record how many times a day they are using their emollient, how they feel and the condition of their skin, as well as a ‘Pump Cover Maker’ and games.

For adults there is useful information on treatment options and tips on how to deal with the daily emotional and practical challenges of eczema.

Visit the site to find out more…

You might also want to download our free leaflet on childhood eczema.

Diprobase is tried and trusted

The Diprobase range of emollients has been soothing, healing and protecting sore skin for more than 25 years.

It’s free from common sensitisers and irritants such as lanolin, parabens, perfume and sodium lauryl sulphate which can aggravate eczematous skin.

Visit www.diprobase.co.uk to find out more.