neurogenesis is unknown. Insulin
like growth factor 1 (IGF-1 are associated with an increased risk of developing
AD) stimulates neurogenesis to produce major change in hippocampal plasticity
and seems to be involved in Alzheimer’s pathology. Allopregnanolone, a
neurosteroid, aids in continued neurogenesis in the brain. Levels of
allopregnanolone in the brain decline in old age and Alzheimer’s disease
Allopregnanolone acts by reversing neurogenesis impairment thus preventing
cognitive deficitis of AD disease in various mouse models. Ephirin signaling pathway
has been shown to regulate neurogenesis in the hippocampus and have been
studied as potential target to treat some symptoms of AD. Molecule associated
with the pathology of AD, including Apo lipoprotein (ApoE), presenilin
genesPSI,PS2 and APP have also been found to impact adult neurogenesis in the
hippocampus.
Keywords: Neurogenesis, Alzheimer, Neurodegenration, Aging, Adult neurons
I.
INTRODUCTION
Alzheimer
is a disorder which affects the memory. It is a common form of dementia in
which 1-3% of population suffers globally [1]. It is considered as the
“greatest disorder of old age” since it affects person predominantly between
age of 60 and 65 [2]. WHO ranks AD among the top three illnesses that
contribute to the global burden of disease in economic terms [3]. Due to a very
high cost of its treatment it causes a huge monetary loss. It is an untold
agony to family members and caregivers imposing a huge responsibility and
burden on them. In medical terms medication and other intervention and around
30 percent persons with AD require treatment all their lives [4]. However the
scenario is not all blank. Recent research has at better understanding of AD. Much
of an etiology. From psychological theories of causation such as faulty
parenting the focus has shifted to anatomical and functional change in the
brain. Molecular process growing aberrant in the brain has also been implicated.
The study of genomics in AD is a part of the genetics research with an
approximate 90 percent hereditary factor involved [5]. The genome wide
association studies have revealed several possible risk variants. Most noted
among these are on the HLA region [5]. However these do not fully account for
the estimated heritability in AD. Gene mapping studies are viewed as critical
for the development of factors causing AD which is hereditarily perplexing and heterogeneous disorder. Mutations
in APP, PSEN1, PSEN2 have been found to be involved in early- onset of familial
AD while APOE is involved in late-onset AD [6].Moreover AD may develop
due to various factors such parental development and obstetric complication. AD
can develop in babies born in women with old age [7]. More pollution and more of high risk behavior
also seem to increase the risk to develop AD. Neurodevelopment of the infant’s
brain is susceptible to variety of viral infections such as herpes simplex
virus, be an additional risk factor AD. The first trimester of pregnancy can
cause increased permeability of cortisol across the placenta may be a risk
factor to AD [8]. Increasing evidences show association between obstetric
complication low birth weight and a later diagnosis of Alzheimer’s in many
parts of the world [9]. Parental and perinatal monitoring and interaction can reduce
damage to the fetus brain. The Pharmaceutical industry has also been active in
the last ten years in doing research on new generation of anti-psychosis drugs
for treating AD. However they do have some side effects such as metabolic
syndrome despite the promise of
biological intervention for AD there are various limitations in treatment
strategy of AD in community. Treatment of AD cannot be only biological,
pharmacological or psychological. It has been more optimism about the outcome
of Alzheimer and the fact this is the wide spread acceptance that recovery is
not impossible in Alzheimer. Some of the earliest description of the condition resembling
Alzheimer’s in India was made by ayurvedic physician Charaka over 3330 years
ago in the text Charka Samhita. This is corresponded closely with the
description in Greek medical test by Hippocrates. Subsequently India’s
contribution to AD research has not been substantive. The Madras longitudinal
study is a landmark study on course and outcome of AD. The patient have been
followed up from the first onset for 65 years and study have been generated a
lot of information on related variable like a mortality, jobs, marriage etc [10].
The study of the first episode psychosis was compared with a Canadian study
with a similar sample has thrown up some interesting cross cultured finding.
Both the study have been stopped however there was the need to promote
awareness about the disorder [11]. In early detection and prevention of
chronicity and disability was very limited due to scarcity human resources and
low research budget issues [12]. Over 90 percent severely ill patients live with their families this is
not only because families are billing to care for them, but also because
alternative option for care are practically nonexistence however there is a
need of medical attention to them in various community care centers. The number of hospital bed in the entire country
is inadequate to provide patient care in which some non-governmental
organization run community based center of care and rehabilitation. These are
only a few besides many of these are in the southern state of Tamilnadu, Karnataka
and Kerala [13]. There is need for community based care for such patients so
that they may not be disgraced by the society. They should also get medical
care and psychological based rehabilitation. There must be focus on mental
health literacy in the general population in the recent concluded randomized
control trial in India where the effectiveness of a collaborative community
based care visited the home of the patient to deliver was compared with
facility based care with Alzheimer and their families. It was seen that the
intervention of the community health worker was acceptable and effectively especially
who were more symptomatic and had greater disability. The feasibility of an
effectiveness of delivery psychological intervention through was established [14].
Critical strategies for rehabilitant have been the use of low community
volunteers trained in recognition identification and referral of person with
mental disorder performing the first level of rehabilitation has also been
facilitated by networking governmental and non-governmental organization.
Involved in social and developmental activities. The non-governmental also
embarked on community based programs. Which also officious and cost effective
were also restricted by their development of time limited funding [15]. However
collaboration with non-governmental organization is seen as an important
approach to reach out to a wide geographic area. With a share economic
commitment of the share collaboration. There have also been one of has been the
use of mobile tale psychiatry by the Alzheimer’s association Alzheimer
association use the mobile psychiatry technique. A bus fitted with mobile
equipment has been delivered mental health care to the population part of the
pudukotta district and widely accepted by the local population [16].The
community based programs have suffered from poor allocation of resources
insensitivity to the needs of people with mental illness on apart of both professional
and policy planners and indifference to mental health in general sustainability
and continuity of programs most program are time bond projects. Contingent upon
the funding resources [17].The priority is our country is to make the District
mental health program more effective and efficient promote more community based
service reducing the dependence on big hospital and reducing stigma living with
Alzheimer’s is no easy matter for person with disorder and their families need
to be geared to enhancing facilities in the community for these person and
improve awareness about this condition which in turn will facilities early
treatment and social inclusions [18].
II.
TYPES
OF ALZHEIMER DISEASE
There
are two types of AD i.e. early onset Alzheimer and late onset Alzheimer [19]. Early
onset Alzheimer is a type of disorder that strike before the age of 65. There
is no cure, but there are certain drugs to manage symptoms including memory
loss, problems of sleeping and change in behavior. The early form of Alzheimer most
often shows up at the age of 40s and 50s but symptoms can show up early. Late
onset Alzheimer’s is the most common form of the disease which happens to
people age 65 and older. It may or may not run in families. So far researcher
hasn’t found a particular gene that related to late onset of Alzheimer [20].
III.
DIAGNOSIS
There
is no one way to diagnose AD. However there are various symptoms and diagnostic
test used in combination. One of the most important aspects to diagnose AD is
that there must be at least two of the four major symptoms present over a
period of time. The main motor symptoms are loss of memory, slowness of
movement called bradykinesia, loss of balance with possible falls. Other than
these there are following scanning systems used in the diagnosis of AD [21, 22].
IV.
POSITRON
EMISSION TOMOGRAPHY
All
the more as of late the primary capacities for PET are centered around the
investigation of neurotransmitters (electrochemical signs went starting with
one mind cell then onto the next to impart), the activities of pharmaceutical
medications and the outflow of particular qualities in the cerebrum. Also, as
of late a couple PET tracers have been created that join exclusively to the
protein beta amyloid, which develops in the brains of patients with mild
cognitive impairment (MCI) and Alzheimer's ailment. PET imaging with these
specialists has the potential, alongside intellectual tests, to analyze
Alzheimer's infection in patients, and to distinguish designs that may foresee
which patients with MCI will build up Alzheimer's ailment. All the more as of late
the principle capacities for PET are centered around the investigation of
neurotransmitters (electrochemical signs went starting with one cerebrum cell
then onto the next to convey), the activities of pharmaceutical medications,
and the statement of particular qualities in the mind. psychological tests, to
analyze Alzheimer's sickness in patients, and to recognize designs that may
anticipate which patients with MCI will build up Alzheimer's infection [23, 24]
V.
ELECTRO
ENCEPHALON GRAPH
EEG
measures the electrical movement of neurons as recorded from anodes set along
the scalp. MEG (Magnetic encephalon graph) maps cerebrum action by measuring
attractive fields that are produced by neural action in the mind. Both EEG and
MEG give data about worldwide and additionally provincial neural action,
however with MEG there is less twisting of the electrical signs. Regularly
either of these electrophysiological techniques is joined with fMRI or PET to
give integral data about ordinary and aggravated cerebrum EEG is utilized
clinically to quantify physiological signs of strange cortical edginess,
essentially in the determination and administration of epilepsy and other
seizure issue. It is additionally utilized with other numerous different
measures in serious consideration to screen head-harmed patients in trance like
state, giving data that helps doctors evaluate patients' forecast. EEG is
likewise used to study rest issue. EEG recordings can be led while a patient is
inside the MR scanner. EEG and fMRI are utilized together, for occurrence, to
restrict where in the cerebrum a seizure begins and where it spreads from that
point [25, 26]
VI.
FUNCTIONAL
MAGNETIC RESONANCE IMAGING
Functional
MRI (fMRI) demonstrates the mind in real life; researchers use it broadly to
explain forms required in higher subjective working. It is very touchy so it
can recognize little changes, and is moderately reasonable contrasted with PET,
so it is the technique for decision for distinguishing territories of the mind
that are actuated when a man embraces a particular psychological or engine
undertaking. It is a circuitous measure, in any case, in light of the fact that
the time it takes for element changes to happen in blood stream is any longer
than that for neurons to shoot their electrochemical messages. Functional MRI
can be utilized to think about the revamping of capacity taking after damage to
a solitary cerebrum region [27,28].
VII.
SINGLE
PHOTON EMISSION COMPUTED TOMOGRAPHY
An
imaging innovation that is like PET is Single Photon Emission Computed
Tomography (SPECT). It is utilized for the majority of the same purposes as
PET, yet is not so much costly but rather more advantageous for clinical use.
SPECT started to be broadly utilized clinically in the 1980s on the grounds
that, not at all like PET, it distinguishes specifically discharged gamma-beams
from economically accessible stable radioisotopes. These isotopes are bigger
and have a more extended half-life than those utilized as a part of PET, yet
the imaging is less exact. In this way, patients who are found in facilities
other than at scholastic exploration establishments are significantly more
prone to get SPECT. An imaging innovation that is like PET is Single Photon
Emission Computed Tomography (SPECT). It is utilized for the greater part of
the same purposes as PET, however is not so much costly but rather more helpful
for clinical use. SPECT started to be broadly utilized clinically in the 1980s
in light of the fact that, not at all like PET, it recognizes straightforwardly
transmitted gamma-beams from economically accessible stable radioisotopes.
These isotopes are bigger and have a more drawn out half-life than those
utilized as a part of PET; however the imaging is less exact. Along these
lines, patients who are found in facilities other than at scholarly research
foundations are much more prone to get SPECT. [29, 30]
VIII.
DAT
SCAN
DaT
examine for the differential conclusion of amongst Alzheimer's and toll bodies.
DaTscan is an imaging innovation that utilizations little measures of a radioactive
medication to decide the amount of dopamine is accessible in a man's cerebrum
[31]
IX.
DIFFUSE
OPTICAL TOMOGRAPHY
Diffuse
optical tomography is a non-obtrusive procedure in which close infra-red light
is utilized to record the inside piece of cerebrum oxygenation and other
physiological change. Diffuse optical tomography framework utilizes
frequencies. Consistent wave's estimation and time determination, for example,
time related [32]
X.
DIFFUSE
TENSOR IMAGING (DTI)
It
is a molecular imaging innovation used to think about biochemical action that
happens profound inside the tissues of live lab animal models. Close infrared
(NIR) light is utilized as a part of mix with fluorescent tests. Light of a
particular wavelength is sparkled on the creature; thusly this light energizes
the objective particle to emanate light at an alternate wavelength, which is
observed by tomographic locators set around the creature to gather light
originating from different bearings. PCs join the various individual perspectives
into three-dimensional pictures [33].
XI.
TREATMENT
There
is no standard for the disease the treatment for each person is based on his or
her symptoms Treatment includes medication and other therapy. Other treatment
include life style modification like getting more rest and more exercise
Modification commonly prescribed alternative therapy and other treatment are
available But commonly we use two following treatment i.e. Pharmacological
treatment and Psychological treatment
There
is no standard for the disease the treatment for each person is based on his or
her symptoms seductive and sleeping pills. Medicines are given by different
routes such as dorsal routes and penetration routes [34, 35]
Psychological therapy: It
guides them through the process of understanding clients and their problems and
developing solution Psychotherapy theories provide a framework for therapists
and counselors to interpret a client’s behavior, thoughts, and feelings and
help them navigate a client’s journey from diagnosis to post-treatment.
Theoretical approaches are an understandably integral part of the therapeutic
process. But with so many different methods out there, how do you know which counseling
approach works best for you? Whether you’re a student learning about counseling
theories or a client looking for the right therapist, the following detailed
descriptions will give you a deeper understanding of each counseling method.
These theories are integrated throughout the curriculum are
built into a foundation grounded in the psychodynamic perspective
XII.
THERE
ARE FIVE BROAD CATEGORIES OF PSYCHOLOGICAL THERAPY
This
therapy is changing on problematic behaviors. Behavior feeling and thought discovering
by unconscious motivation psychoanalytical therapy are close working between
therapist and patient. Psychoanalysis are closely identified with Sigmund Freud it has been modified since his early
formation .Psychoanalysis or psychodynamic theory, also known as the
“historical perspective,” has its roots with Sigmund Freud, who believed there
were unconscious forces that drive behavior. The techniques he developed, such
as free association (freely talking to the therapist about whatever comes up without
censoring), dream analysis (examining dreams for important information about
the unconscious), and transference (redirecting feelings about certain people
in one’s life onto the therapist) are still used by psychoanalysts today
[37,38].
Behavior Therapy
Behavioral
therapy emphasizing the condition of person’s undesirable behavior through
pavlovian condition several variation have develop since behavior therapy. The variation is cognitive behavioral therapy (CBT)
which focused on thoughts and behaviors. Behavioral theory is based on the
belief that behavior is learned. Classic conditioning is one type of behavioral
therapy that stems from early theorist Ivan Pavlov’s research. Pavlov executed
a famous study using dogs, which focused on the effects of a learned response
(e.g., a dog salivating when hearing a bell) through a stimulus (e.g. pairing
the sound of a bell with food). B. F. Skinner developed another behavioral
therapy approach, called operant conditioning. He believed in the power of rewards
to increase the likelihood of a behavior and punishments to decrease the
occurrence of a behavior. Behavioral therapists work on changing unwanted and
destructive behaviors through behavior modification techniques such as positive
or negative reinforcement [39, 40]
XIII.
COGNITIVE
THERAPY
In the 1960s, psychotherapist Aaron Beck
developed cognitive theory. This counseling theory focuses on how people’s
thinking can change feelings and behaviors. Unlike psychodynamic theory,
therapy based on cognitive theory is brief in nature and oriented toward
problem solving. Cognitive therapists focus more on their client’s present
situation and distorted thinking than on their past. Cognitive and behavioral
therapy are often combined as one form of theory practiced by counselors and
therapists. Cognitive behavioral therapy, or CBT, has been found in research to
help with a number of mental illnesses including anxiety, personality, eating,
and substance abuse disorders [41].
XIV.
HUMANISTIC THERAPY
Humanistic therapy is a
way of dealing with situation or problems which tried to do justice with the
whole person including mind, body and spirit. This method recognizes the self-healing
capacities of the client. The humanistic therapy the works toward an authenticmeetingof
equal in the therapy relationship. Abraham Maslow is perhaps the best known
theorist peer with humanistic psychology.Humanistic therapists’ care most about
the present and helping their clients achieve their highest potential. Instead
of energy spent on the past or on negative behaviors, humanists believe in the
goodness of all people and emphasize a person’s self-growth and self-actualization.
Humanistic theories include client-centered, gestalt, and existential
therapies. Carl Rogers developed client-centered therapy, which focuses on the
belief that clients control their own destinies. He believed that all
therapists need to do is show their genuine care and interest. Gestalt
therapists’ work focuses more on what’s going on in the moment versus what is
being said in therapy. Existential therapists help clients find meaning in
their lives by focusing on free will, self-determination, and responsibility
[42].
XV.
HOLISTIC THERAPY
Holistic therapy means drawing on and blending
specific types of therapies. This approach is not linked to one particular type
of therapy as those practicing integrative counseling do not believe that only
one approach works for each client in all situations.Holistic and integrative
therapy involves integrating various elements of different theories to the
practice. In addition to traditional talk therapy, holistic therapy may include
nontraditional therapies such as hypnotherapy or guided imagery. The key is to
use the techniques and psychotherapy tools best suited for a particular client
and problem. There are various therapies that counselors can choose to study,
but the type of theory matters less than the success of the relationship
between client and therapist. In the Counseling at Northwestern online Master
of Arts in Counseling Program, students are prepared to become self-reflective
practitioners and learn to examine the factors that influence the
client-therapist relationship to become successful counselors [43].
XVI.
FUTURE
PROSPECTS
AD is a neurodegenerative condition that cause cognitive decline in
suffers Alzheimer being responsible for around 60 percent of all cases like
other forms of dementia, Alzheimer is debilitating condition the victims find
it increasingly difficult to perform the everyday task necessary for
independent living and eventually require health and social care services.
There are two major types of AD early
onset Alzheimer’s and late onset Alzheimer’s late onset can affect after 65 and
is the more common disorder being responsible for around 90 percent of all
cases. Early onset can affect before age 65 and is rare accounting less than 10
percent cases over all. Whilst the most of these cases Alzheimer’s is not
caused by mutation (that is mistakes)in particular gene (that is instruction) for
building protein or its biochemical processing into amyloid beta peptide
familial Alzheimer’s affect people in the 14th decade [44].
XVII.
CONCLUSION
Alzheimer’s
is a disorder of mind affecting 1-3 percent of the population suffers globally
“It has been greatest disorder of old age. According to WHO Alzheimer’s rank
among the top three illness cause death currently no standard treatment of this
disease. There is immediate need for the treatment of AD.
XVIII.
ACKNOWLEDGEMENTS
I
am thankful to Sharda University for giving the opportunity to work as project
research fellow of Ramalingaswamy project under supervision of Dr. Pankaj
Taneja. I also express my gratitude
towards my parents and friends for their inspiration to me for excelling in
science.
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