Currently, doctors use a paper-based mental examination test to diagnose Alzheimer’s patients. The Mini Mental Score Examination (MMSE) is a series of questions and tests, each question is evaluated with points scored given based on the answers given. If all questions were answered correctly, the maximum score is 30 points. However, any score below 27 the patient
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will be considered to have memory problems but not necessarily dementia. Below are the 6 different types of questions and tests included in the MMSE test [13]:
Orientation – Such as identifying current location, time and date
Registration – Repeat and learn individual words
Attention and Calculation – Spell words backward or systematic mathematical equations
Recall – Remember individual words learned previously during the Registration stage
Language – Name different objects, repeat sentences, follow instructions and write sentences
Copying – Draw simple shapes such as pentagons [22]
This test is commonly used for complaints of memory problems. However, as one of many other tests, MMSE test is also used by doctors to diagnosis Alzheimer’s disease and other types of dementia [13].
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Risk Factors of Alzheimer’s disease
Although, there are many opinions stating that Alzheimer’s disease is a heredity based disease, other research shows that many Alzheimer’s disease cases could be prevented by lifestyle changes such as exercise, eating healthily and not smoking. Scientists might not agree but the results of their research could potentially mean that they are right, and that Alzheimer’s disease can develop from lifestyle or could simply be a genetic disease.
Figure 2-4 Identified Risk Factors of Alzheimer ’s disease
Figure 2-4 shows the currently recognised risk factors of Alzheimer’s disease, details of these risk factors and references to related studies are included in the following table (Table 2-1) :
Medi
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Gene
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Age has been identified as the biggest risk factor of AD, as it only affects people over the age of 50+ Confirmed: APP PS1 PS2 High risk: APOE Diabetes Obesity Stroke Depression HIV Infection Down's Syndrome Cholesterol Heart Disease Head Trauma Blood Pressure Stress Poor Diet Substances Alcohol Laziness Smoking Aluminium Low Social Activity Low Mental Activity Female No Education Employment
25 | P a g e Table 2-1 Alzheimer's Disease Risk Factors Summary
Risk Factor Description Category Citation
AGE In almost all cases symptoms of Alzheimer’s start to show from the age of 50+.
Characteristic (Demography)
[23] APP, PS1, and PS2 These three genes have been identified as
causative genes of Alzheimer’s Disease.
Genetics [24]
APOE Apolipoprotein E (APOE) gene increases a person’s risk of developing Alzheimer’s disease.
Genetics [23][24]
DIABETES A known cardiovascular risk factors is type 2 diabetes, it increases the risk of Alzheimer’s disease in mid-life or later life.
Medical History [23][25]
OBESITY Obesity is one of the cardiovascular risk factors that increases the risk of Alzheimer’s disease in mid-life.
Medical History [23]
STROKE Stroke is related to almost all of the cardiovascular disease that are considered to be high risk factors of Alzheimer’s disease and dementia in general.
Medical History [23][25][26]
DEPRESSION People with history of depression in mid-life or later life have shown to have increased rates of dementia.
Medical History [23] [27]
HIV INFECTION People with HIV sometimes develop cognitive impairment.
Medical History [23] DOWN’S
SYNDROME Down’s syndrome carries a gene that produces one of the key proteins (APP gene – Amyloid precursor protein) which is a causative gene of Alzheimer’s Disease.
Medical History [23]
CHOLESTEROL Cholesterol is a fatty substance, which, causes the development of Alzhemere’s Disease risk factors such as diabetes, high blood pressure, and other cardiovascular disease.
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HEART DISEASE Heart disease shares ApoE as a genetic link with Alzheimer’s disease, and it is also a vascular risk factor to onset of Alzheimer’s.
Medical History [25]
HEAD TRAUMA A severe blow to the head increases the risk of later dementia such as Alzheimer’s disease.
Medical History [23]
BLOOD
PRESSURE High blood pressure is a risk factor of dementia, and beside this blood pressure can cause strokes and strokes are risk factors of dementia.
Medical History [23]
STRESS Stress affects the immune system, which is known to play an important role in the development of dementia.
Medical History [28][29][30]
POOR DIET An unhealthy diet can affect a person’s risk of developing dementia and cardiovascular disease such as type 2 diabetes.
Lifestyle [23][27]
SUBSTANCES Drug abuse have been suggested as possible risk factor of dementia.
Lifestyle [23][27] ALCHOHOL Heavy and chronic drinking results in
specific dementia-type symptoms.
Lifestyle [23][27] LAZINESS
(PHYSICAL INACTIVITY)
Mid-life physical inactivity increases the risk of all-cause dementia.
Lifestyle [23][27]
SMOKING Smoking increases the risk of developing dementia, especially Alzheimer’s disease.
Lifestyle [23] [27] ALUMINIUM Research on Aluminium concentrations in
water showed that he risk of Alzheimer's disease was 1.5 times higher in areas where the aluminium concentration exceeded 0.11 mg/l than in areas where concentrations were less than 0·01 mg/l.
Lifestyle [31]
LOW SOCIAL
ACTIVITY Very few studies report the long-term effect of mid-life social isolation or loneliness on risk of dementia in to older age.
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LOW MENTAL ACTIVITY
Mental activities in mid-life are associated with a lower risk of dementia in later life.
Lifestyle [27][32][33] FEMALE Women are more likely to develop
Alzheimer’s disease than men.
Characteristic (Demography)
[23] ETHNICITY People from certain ethnicities are at higher
risk of dementia than others.
Characteristic (Demography)
[23] NO EDUCATION Many research studies have associated lower
education with a greater risk for dementia. Suggesting that the effect of education on risk for dementia may be best evaluated within the context of a lifespan developmental model.
Characteristic (Demography)
[23][34]
EMPLOYMENT Low level of job control is associated with higher multivariate adjusted risk of dementia.
Characteristic (Demography)
[35]