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Alzheimer Hastalığı demansın (bunamanın) en sık nedeni olup geri dönüşü olmayan ilerleyici bir hastalıktır. Zaman içinde hastaların bellek kapasitelerinde azalmalar olur ve mantıklı düşünme, öğrenme ve iletişim kurabilme yetenekleri bozulur. Kişilik değişiklikleri ve diğer psikolojik sorunlar eşlik edebilir. Hastalık beynin temel yapıtaşı olan nöron adı verilen beyin hücrelerini, özellikle bellekle ilgili ana alanları daha fazla etkileyerek belirtilerin oluşmasına sebep olur.

Araştırmacılar normal yaşlanmanın etkileriyle Alzheimer Hastalığı’nın başlangıcı arasındaki sınırları netleştirmeye çalışmaktadır. Bellek ve dikkat yetenekleri açısından kişinin normal yaşlanmasıyla hastalığın erken dönemi arasında bir süreklilik var olduğu düşünülmektedir. Bu geçiş sürecine hafif kognitif bozukluk denmektedir. Bu durumdaki yaşlıların belleklerinde hafif etkilenme olmakla birlikte henüz içgörü, muhakeme etme ve günlük yaşam aktiviteleri normal olup mesleki aktiviteleri çok hafif etkilenmiş olabilir. Bu bireylerin zamanla zihinsel ve işlevsel yetenekleri diğerlerine göre daha hızlı azalma gösterir. Bu nedenle bu olguların daha sonraki yıllarda Alzheimer Hastalığı’na dönüşebileceği düşünülmektedir. Hastalığın başında bellekle ilgili bölgeler etkilendiği için ilk aşamadan itibaren unutkanlık en belirgin olan bulgudur.

Alzheimer Hastalığı beynin bellekle ilgili yapılarından belki de en önemlisi olan hipokampustan başlayarak beynin korteksinde frontal, temporal ve parietal alanlara da yayılarak konuşma ve anlamayı da içiren lisan yetenekleri, plan yapma, muhakeme etme, işleri sıraya koyma, gibi işlevleri de bozması yanında zaman ve mekan bilgisinde de bozulmalara sebep olarak gerek ev içinde gerekse ev dışındaki çevrede yönelim kaybı olur. Beyinde duygularımızla ilgili olan alanların hasarlanmasıyla da duygu durumunda bozulmalar, depresyona eğilim, sıkıntı hali, durgunluk, isteksizlik, içe kapanma, bazen sıkıntıdan yerinde duramama gibi ve daha ileri aşamalarda da halüsinasyon ve suçlamalar gibi davranışsal belirtiler ortaya çıkabilir. Bu belirtilerin ortaya çıkmasında limbik sistem adı verilen içgüdülerimizi, dürtü ve duygularımızı oluşturan alanların hasarlanması yanında belirtilen alanlarda etkili olan bazı nörotransmitter adı verilen hücreler arası iletişimde rol alan maddelerin salgılanmasındaki azalmalar da hastalığın ortaya çıkışında önemli rol oynar. Bu maddelerden en önemlisi olan asetilkolin adı verilen maddenin eksilmesi hafızanın oluşturulması ve bilginin geri çağrılması görevlerinde bozukluklara sebep olur. Bir yandan hücrelerdeki azalma diğer yandan bahsedilen maddelerin azalması, dikkat, yeni bilgi öğrenme, önceki öğrenilenleri çağrıştırma, mekan ve zamana ait bilgilerde bozukluklarla birlikte gerek mesleki, gerek ev içi işlevlerin bozulmasına sebep olarak hastalığın hafif ve orta evrelerinin oluşumunu sağlar.

Hastalığın seyri kişiden kişiye farklılıklar gösterir. Bu farklılıklar yaş, ailede benzer hastalığın varlığı, kişilik özellikleri, damarsal hastalıklar, kalp hastalığı ve diabet gibi hastalıkların varlığı, sosyal yaşam aktivitelerinin durumu gibi faktörler hastalığın her bireyde farklı şekilde seyretmesine sebep olur. Ancak hastalığın seyrinde hemen her olguda benzer bulgular var olduğundan hastalığın hangi aşamada olduğuna bu bulgulardan yola çıkarak karar verilebilir.

Hastalığın erken evresindeki erken uyarı bulguları genellikle belirsiz olduğundan herhangi bir sorunun olup olmadığının anlaşılması zor olabilir. Bazı bulgular yakınları tarafından fark edilse bile sosyal ve çevresel faktörlere yorumlanabileceğinden gözden kaçırılmış olabilir. Bu erken dönemdeki olgular ve yakınları bu belirsizlik nedeniyle endişe duymazlar. Bazı belirtilerin varlığı aileler için önemlidir, bunlar; aynı soruları tekrarlama, konuşma sırasında cümlenin bazı yerlerinde takılma ve neden bahsettiğini unutma, kelime bulma güçlükleri, soyut düşünmede zorluklar, yakın zamanda olan olayları hatırlayamama, daha önceden bilinen bazı işlerin yapılmasında güçlük çekme, eşyaları her zamanki yeri dışında yerlere koyarak uzun süre arama, belli bir neden olmaksızın sinirlilikler veya aşırı ilgisizlik durumları, araç kullanırken daha önce bir çok kez gittiği yerleri adresleri bulamama ve zamanı karıştırma gibi belirtilerin varlığı aileleri uyaran belirtiler olmalıdır. Bu durumdaki bireylerde oluşan belirtiler kendisi ve yakınları tarafından yorgunluğa, beslenme bozukluklarına, uykusuzluğa, stres durumlarına atfedilebilir. Bu bireyler bu süreçte hala mevcut mesleki aktivitelerini yapmaya devam edebilir.

Bu durumda olan bireyler eğer mevcut bulguların farkında iseler daha sıkça depresyon belirtilerini gösterebilir. Bu durum da bazen tanıyı güçleştirerek gecikmesine sebep olabilir. Bahsi geçen belirtilerin ilerlemesiyle kişinin kendisi, yakınları hatta iş arkadaşları bazı sorunların olduğunu fark edebilirler. Bu olgular gerek ailenin gerekse kendilerinin vardıkları sonuçlar nedeniyle doktora başvurabilirler, genellikle de bu aşamada doktora başvurulduğu bilinmektedir. Bu evre artık orta evre olarak bilinir. Bu evrede de önceki bulgulara ilaveten ilaçlarını almayı unutma, daha önce kullandığı eşyanın kullanımında beceriksizlik, yazma okuma ve diğer iletişim yollarında zorluklar, toplum kurallarına uyumsuzluk, gece giderek artan huzursuzluk, yemek yapma, alışveriş işleri, yapacağı işlerin planlanması ve uygulanması gibi durumlarda bozukluklar yanında içe kapanma huzursuzluk, sıkıntı, öfke patlamaları, uyku düzeninde bozulmalar sıkça görülen belirtilerdendir.

Hastalık ilerlerken hastalar duruma ve mevsime uygun giysileri seçmekte zorlanabilir, Başlangıçta sorun olmazken, ilerleyen zamanlarda tek başına banyo yapmakta kendi kişisel bakımını yapmakta güçlük çekebilir, ilaçlarını almakta zorlanabilir, hele yalnız yaşayan birisiyse ilaçlarını düzgün olarak alması çok daha karmaşık hale gelebilir. Bunun için değişik stratejiler geliştirilerek ilaç kullanımının maksimum ölçüde doğru olmasına özen gösterilmelidir. İlerleyen zamanlarda ev güvenliğine ilişkin konular da önem kazanmaktadır. Ütünün, değişik amaçlı ev araçlarının, özellikle elektrikle ve doğal gazla çalışan araçlar gibi ev araçlarının hatta elektrik prizlerinin kontrolü gerekir. Evde yalnız olarak kalan olgularda veya diğer yaşayan bireylerin evde olmadıkları zamanlarda bu sorunlar ciddi sıkıntılara sebep olabilir. Evden amaçsızca çıkıp geri dönememe durumları ve kaybolmalar hastayı ve yakınlarını oldukça sıkıntıya sokan durumlar olabilir. Tuvalet ihtiyacı ve altına kaçırmalar hem hastayı hem de yakınlarını etkiler, hasta başlangıç zamanlarında bunu ciddi bir stres olarak değerlendirebilir bu durum başlı başına hastanın evden çıkmamasına ve sosyal yaşamının kısıtlanmasına yol açabilir.

Davranışsal olarak kaygı önemli bir durumdur, olgular kendi aileleri, işleri ve hatta yarım kalmış işleri için kendilerini sorumlu hissedebilir ve bunun sonucunda gerginlik, güvensizlik ve farklı şekillerdeki korkuları hissedebilirler. Bazan da ilgisizlik en fazla görülen semptom olabilir, bu durum normalde bir olay karşısında yoğun tepkiler verebilecek kişide tam tersine kayıtsızlık şeklinde ortaya çıkabilir. Bazen sürekli hareketsiz oturma hatta sadece yatma davranışı, motivasyon kaybı, öfke, sinirlilik sık ağlama nöbetleri, iştah ve uyku düzeni bozuklukları, hastalığın ilerlemesiyle daha belirgin olmaya başlayabilir. Yakınlarının ve bakım verenin peşinden ayrılmama, sürekli ve anlamsız taleplerde bulunma davranışı sık görülür yine takıntılı düşünce ve inançlar nedeniyle hastalar hem kendi yaşamını hem ailesinin yaşamını olumsuz etkileyebilirler.

Olmayan şeyleri görmek ve duymak şeklinde ortaya çıkan halüsinasyonlar hastalığın ilerlemesiyle daha fazla kendisini belli edebilir. Eşya saklama hastalığın başından orta evreye kadar sıklıkla görülen bir bulgu olup bazen evde sosyal sorunlara yol açabilir. Eşyaların olmadık yerlerde saklanması ve bazan da biriktirme davranışı sıkıntıya yol açabilir. Alzheimer hastaları bellek bozukluğu nedeniyle aynı hareketi tekrarladığını ve sorduğunu fark etmeksizin bu davranışını devam ettirebilir.

Yine ev içinde amaçsızca dolaşmalar sık görülen semptomlardan olup anksiyetenin önemli göstegesi olarak kabul edilebilir. Hastalığın ilerlemesiyle uyku düzenindeki bozukluklar aşırı uyku halinden günlerle hiç uyumamaya kadar giden uyku düzeni bozuklukları sık görülen durumlar olup aileyi, bakıcıyı ve hastanın kendisini olumsuz etkileyen bir durum olarak karşımız çıkar.

Tüm bu semptomlarla baş edebilmenin değişik yolları aile bireylerinin hepsinin sabırlı yardımcı, hoşgörülü yaklaşımları, hastanın sosyal çevrenin içinde tutulması ve gerektiğinde doktor kontrolleri ve önerileri ve katkılarıyla daha kolay baş edilebilir duruma gelebilir.

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