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الرئيسية » 🀄موسوعة الامراض » مرض الزهايمر Alzheimer Disease (AD)

مرض الزهايمر Alzheimer Disease (AD)

مرض الزهايمر

Alzheimer Disease (AD)

نظرة عامة

ما هو مرض الزهايمر؟

مرض الزهايمر هو شكل من أشكال الاختلال العقلي الدائم و الذي يتّسِم بفُقدان الذاكرة و حدوث انخفاض تدريجي في القدرة على التفكير و تدهور مهارات اللّغة و الكلام ، بالإضافة إلى حدوث تغيُّرات شخصيّة و سلوكيّة تؤثر في نهاية المطاف على الحياة اليوميّة. يُقدّر عدد المُصابين حاليا في الولايات المتحدة بما يُقارب الـ 5 ملايين أمريكي.

على الرغم من تشابه بعض أعراض مرض الزهايمر مع أعراض التقدُّم في السِن ، إلا أن مرض الزهايمر ليس عَرَضا طبيعيا للشيْخوخة. يحدث المرض نتيجة لتراكُم نوع من البروتينات في المُخ يُسمّى لوَيحات الخرَف (senile plaques – SPs) و وجود تشابُك فى الألياف العصبيّة (NFTs) مما يؤدي إلى حدوث تلف و موت الخلايا العصبيّة. كنتيجة لتدمير الخلايا العصبيّة ، يحدث نقص فى مستويات مواد بعينها تُعرَف بالنواقل العصبيّة (و أكثرها أهميّة هى مادة الأسيتايل كولين acetylcholine) و التي تُساعد على نقل إشارات المُخ. بمرور الوقت تؤدي الإصابة بمرض الزهايمر إلى نقص التفاعُل بين مناطق المُخ المُختلفة.

علاقته مع التقدُّم فى السِن

إن خطر الإصابة بمرض الزهايمر و أمراض خرَف الشيْخوخة الأخرى تزداد بشكل كبير مع التقدُّم في السِن. حيث ما يقرُب من10% إلى 12% من الناس يكونون عُرضة للإصابة بخرَف الشيْخوخة عندما يصلون إلى عُمر 65 سنة ، و ترتفع نسبة الخطر إلى 50% لدَى الأشخاص الذين يبلغون الـ100 سنة. طِبقاً لمؤسّسة الزهايمر الأمريكيّة ، فإن نسبة الإصابة بالمرض قد تصل إلى 16 مليون شخص بحلول عام2050 خاصةً لدَى الأشخاص ممن بلغوا أو تجاوزوا عُمر الشيْخوخة.

عموما ، فإن “الإصابة المُتأخّرة للمرض” تحدث في الأشخاص ممن تعدّى عُمرهم الـ65 سنة و لا يُعتقد كَوْنه مرضا وراثيا. أما “الإصابة المُبكّرة للمرض” ، فتحدث قبل عُمر الـ 65 سنة بمُعدّل 5% إلى 10% من الحالات و يميل لكَوْنه مرضا وراثيا بشكل أكبر.

العلاقة الوراثيّة (الجينيّة)

يبدو أن مرض الزهايمر يحدث نتيجة مجموعة مُختلفة من الأسباب التى مازالت غير مفهومة بشكل جيّد حتى الآن. إذ يوجد 3 أنواع من الجينات الوراثيّة التي تتحكّم في ظهور الأشكال النادرة من مرض الزهايمر الوراثي المُبكّر و المعروف بمرض الزهايمر من النوع الثالث (EOFAD) (لم يتم تحديد الوظائف الطبيعيّة لتلك الجينات بعد). تحدث في هذه الجينات الثلاثة (المعروفة بـ PSEN1 و PSEN2 و APP) طفرات مُعيّنة تؤدي إلى إنتاج بروتينات غير طبيعيّة تُسبب الإصابة بمرض الزهايمر. و هناك احتماليّة لانتقال هذه الطفرات الوراثيّة (الجينيّة) إلى كل أبناء الشخص المُصاب بنسبة 50%. و بالرغم من ذلك ، فقد اقتصر ظهور تلك الطفرات فى الجينات الثلاثة على عدد قليل جدا من العائلات فقط.

فى الوقت الراهن ، يُمكن إجراء فحص لكل من جين (presenilin I gene) (جين PSEN1 الموجود على الصِبغى رقم14) ، و للجين (presenilin II gene) (جين PSEN2 الموجود على الصِبغى رقم1) ، و الجين المسئول عن تكوين البروتين المُكوّن لمادة الأميلويد (amyloid precursor protein gene) (جين APP الموجود على الصِبغى رقم 21). هذه الفحوصات مُتوفّرة حاليا و لكن لا يُطلب إجراؤها بشكل كبير.

كما تم أيضا اكتشاف العديد من الجينات الأخرى التي ترتبط بحدوث إصابات مُتأخّر بمرض الزهايمر ، لكن لا يُعتقد كَوْنها سببا مُباشرا لها. هذه الجينات “المُحتملة” قد تُفسر سبب ارتفاع مخاطر الإصابة المُتأخّرة بمرض الزهايمر عند الأشخاص ممن لدَيهم أفراد آخرين فى عائلتهم مُصابين بالمرض.

يُعد جين (APOE) من أكثر الجينات المعروفة قابليّة للإصابة مُسببة حدوث إصابة مُتأخّرة بمرض الزهايمر. حيث يعمل هذا الجين على إنتاج بروتين (apolipoprotein E) ، و هو البروتين الذى يُساعد فى نقل الدهون و الكولستيرول الموجود في الدم. لهذا الجين ثلاثة أشكال أو نُسخ: (e2) و (e3) و (e4). بحيث يمتلك كل شخص زوج من جينات (APOE) المُكوَّن من مزيج من هذه النُسخ الثلاثة. إن النُسخة (e3) من الجين هى الأكثر شيوعا ، و توجد بنسبة60% في عامة الناس. أما النُسخة (APOE e44) من الجين ، فغالبا ما تتواجد في أغلب الحالات الوراثيّة للمرض و تُعد عاملا لزيادة خطر الإصابة بمرض الزهايمر.

قد يتفاوَت خطر الإصابة بمرض الزهايمر تبعاً للعِرق إذ يتضاعف بمُعدّل أربع مرات في الأمريكيّين من ذَوي الأصول الأفريقيّة ، بينما يقل للضِعفيْن في الأمريكيّين من ذَوي الأصول الإسبانيّة ، و يختلف ذلك نسبياً لدَى القوقازيين. كما توجد عوامل خطورة أخرى للإصابة بمرض الزهايمر ، مثل الإصابة بداء السُكرى من النوع الثاني و الحالات المُتوسّطة من مُقاومة هرمون الإنسولين ، و السِمنة المُفرِطة ، و ارتفاع ضغط الدم ، و نقص الدهون في الدم (dyslipidemia) ، و ارتفاع نسبة علامات الالتهاب مثل بروتين سى التفاعلى (C-reactive protein – CRP).

كما أن مُعظم الأشخاص المُصابين بمُتلازمة داون (Down syndrome) ، و التي تحدث بسبب وجود تثلُّث غير طبيعى فى الصِبغى رقم 21 ، سوف يُعانون في نهاية الأمر من بعض التغيُّرات العقليّة التي ترتبط بمرض الزهايمر ، و يحدث ذلك عادةً عند بلوغهم سِن الأربعين أو الخمسين من عُمرهم. إذ أن التغيُّر المرضي الحادث في عقول هؤلاء البالغين المُصابين بحالة داون يُشبه كثيرا التغيُّر المرضي الحادث للمُصابين بمرض الزهايمر. إن وجود صِبغى إضافى على الزوج رقم 21 يؤدي إلى إنتاج بعض البروتينات الزائدة و التي تتراكم مُكوّنة ترسُّبات (لوَيحات الخرَف senile plaques) مُشابهة لتلك التي نراها في مرض الزهايمر. إلا أن المُصابين بحالة داون لا يزداد لدَى أقربائهم مُعدّل خطر الإصابة بمرض الزهايمر حيث أن وجود هذا الصِبغى (رقم 21) الزائد يقتصر عليهم فقط دون أقربائهم.

في عام 2011 ، تم إطلاق معايير و إرشادات توجيهيّة جديدة من أجل تشخيص الإصابة بمرض الزهايمر من قِبل ثلاث مجموعات عمل لخبراء ترأسهم جمعية الزهايمر و المعهد الوطني للشيخوخة (NIA) التابع للمعاهد الوطنيّة الصِحيّة الأمريكيّة.

تقوم مقالاتهم بتوسيع تعريف مرض الزهايمر ليشمل ما يلي:

مرض الزهايمر ما قبل التدخل الطبى (Preclinical Alzheimer disease) – و الذي يشمل تغيُّرات في المُؤشّرات الحيَويّة لكن بدون أعراض ظاهريّة (و الذي يُمكن الاستفادة به حاليا فقط فى البحث العلمي).

مرض الزهايمر المصحوب بتغيُّرات طفيفة في الإدراك (Mild cognitive impairment – MCI) – يحدث فيه تغيُّرات بسيطة فى الذاكرة و فى مهارات التفكير ، لكنه لا يؤثر على النشاطات اليوميّة.

الخرَف (الاختلال العقلي) الناتج عن مرض الزهايمر (Dementia due to Alzheimer disease) – يؤثر المرض على الذاكرة و التفكير و العديد من التصرُّفات السلوكيّة و التي تؤثر سلباً على قدرة الشخص على أداء مهامه اليوميّة.

تهدف هذه الإرشادات التوجيهيّة إلى توفير المزيد من المعلومات حوْل فهم مرض الزهايمر في الوقت الراهن ، و توفير إطار للبحوث المستقبليّة ، و اقتراح دور أفضل لاستخدام المُؤشّرات الحيَويّة في المستقبل.

الاختبارات المعمليّة

لا توجد فحوصات معمليّة مُتاحة من شأنها تشخيص الإصابة بمرض الزهايمر خلال حياة المريض. فحالياً ، لا توجد سوَى طريقة وحيدة لتأكيد الإصابة بمرض الزهايمر و ذلك عن طريق الفحص المِجهري لجُزء من أنسجة المُخ بعد حدوث الوفاة. حيث يقوم الأطباء المُتخصّصين فى علم الأمراض بالبحث عن سِمات المرض مُتمثّلة في لوَيحات الخرَف و التشابك العصبي الليفي. و حيث أن تكوُّن كل من لوَيحات الخرَف و التشابك الليفي يحدث بشكل طبيعي نتيجة للشيْخوخة أيضا ، فإنه يجب مُقارنة عيّنة من الشخص المراد فحصه بعيّنة أخرى من شخص آخر سليم من نفس العُمر بغرض التأكُّد من حدوث الإصابة.

يُمكن للأطباء المعالجين إجراء تشخيص عملي دقيق لمرض الزهايمر باستخدام العديد من الفحوصات و الوسائل لاستبعاد أسباب أخرى قد تُسبب الاختلال العقلي (الخرَف) الحادث. عند ظهور أعراض الخرَف على شخص ما ، يتوجّب على الطبيب تقييم التاريخ المرضي للمريض على المستوى الشخصي و العائلي (و يُفضل أن يشمل ذلك عِدّة أجيال) ، حيث يتم البدء بإجراء فحص بدني ، يتم خلاله تحديد سِن الإصابة بالمرض ، كما يتم إجراء العديد من الفحوصات العصبيّة و النفسيّة لقياس مستوَى الذاكرة ، و المهارات اللغويّة ، و غيرها من الوظائف الإدراكيّة.

كما قد يستخدم الطبيب المعالج مجموعة من الفحوصات المعمليّة التقليديّة بغرض استبعاد أوْجه القصور و غيرها من الأمراض و الحالات التي قد تؤثر على الذاكرة. كما سيقوم الطبيب بالبحث عن حالات الإفراط في تعاطي أدوية ما ، كما قد يطلب إجراء فحوصات تصويريّة ، مثل التصوير بالأشعة المقطعيّة (CT) و التصوير بالرنين المغناطيسي (MRI) بغرض الكشف عن وجود إصابات أو أوْرام أو سكتة دماغيّة و التي يُمكن أن تكون سبب ذلك الخرَف ، و قد يبحث أيضا عن ضمور في المُخ ، حيث أن انكماش حجم المُخ قد يحدث لاحقا مع تطوُّر حالة المرض.

إذا اشتبه الطبيب المعالج فى الإصابة بمرض الزهايمر ، فقد يتم إجراء بعض الفحوصات المعمليّة الأقل شيوعا بغرض التفريق بين الزهايمر و أشكال الاختلال العقلي الأخرى و بغرض رصد المخاطر الوراثيّة.

فيما يلى قائمة بالفحوصات التى تساعد على تصنيف مرض الخرَف:

تستخدم تلك الفحوصات بغرض استبعاد مُسبّبات الإصابة بمرض الخرَف بخلاف مرض الزهايمر

يرتبط بــ

العينة

الفحص

وجود نقص فى فيتامين (B12)

عينة دم

فيتامين (B12)

خلل فى وظيفة الغدة الدرقية

عينة دم

هرمون الثايروكسين (T4)

خلل فى وظيفة الغدة الدرقية

عينة دم

الهرمون المنبه للغدة الدرقية (TSH)

الإصابة بمرض فقر الدم (أنيميا) أو بالعدوى

عينة دم

صورة الدم الكاملة (CBC)

وجود خلل فى توازن أملاح الصوديوم و البوتاسيوم و الكلور و درجة حمضية الدم (pH)

عينة دم

تحليل الأملاح

وجود التهاب

عينة دم

تحليل (CRP)
و اختبار سرعة الترسيب فى الدم (ESR)



الإصابة بمرض الإيدز (AIDS)

عينة دم

اختبار الجسم المضاد تجاه فيروس (HIV)

الإصابة بمرض الزهرى (Syphilis)

عينة دم

تحليل عدوى الزهرى (Syphilis)

استخدام مخدرات ممنوعة

عينة بول

تحليل تعاطى الأدوية

ما زالت البحوث جاريَة ، و يجري حاليا دراسة مُؤشّرات حيَويّة جديدة بالإضافة إلى المُؤشّرات الحيَويّة المعروفة (Tau/Aß42) و (APOE genotypee) و (PSEN1) و (PSEN2) و (APP).

طُرق العلاج

فى الوقت الراهن ، ليس هناك أي طريقة للوقاية أو لعلاج مرض الزهايمر. قد يتمكّن بعض الناس من البقاء على قيْد الحياة لمدة 25 عاما مع إصابتهم بالمرض ، لكنهم يعيشون فى المُتوسّط لفترة تتراوح بين 8إلى 10 سنوات. يتمثّل العلاج في محاولة إبطاء تقدُّم المرض ، و تخفيف الأعراض المرضيّة ، و التحكُّم فى سلوكيّات المريض ، و توفير الدعم و التعليم للشخص المُصاب. في بدايات المرض قد يستطيع الأشخاص المُصابين بمرض الزهايمر أن يعيشوا حياة طبيعيّة إلى حدٍ ما مع قدر بسيط من الدعم ، كمُساعدتهم على التذكُّر و تنظيم أمور حياتهم. و خلال هذا الوقت يستطيع الشخص وَضع الخِطط و المُشاركة في اتخاذ القرارات المُتعلّقة بالرعاية في المستقبل.

قد يُساعد التشخيص المُبكّر للمرض لدَى البعض في تلقّي فائدة ما عن طريق تعاطي العقاقير المُثبّطة لإنزيم الكولينيستريز (cholinesterase inhibitors) ، و هي عقاقير من شأنها الحِفاظ على القُدرات الفكريّة من خلال الحِفاظ على وظيفة مادة الأسيتايل كولين (acetylcholine) كناقل عصبي ، مثل أدوية جالانتامين (galantamine) ، و دونيبيزيل (donepezil) ، و ريفاستيجمين (rivastigmine). على قدر الإمكان ؛ يتم تقييم الأدوية الأخرى التي يتعاطاها الشخص المُصاب و التي قد تزيد الحالة سوءا ، مثل الأدوية المُثبّطة للجهاز العصبي المركزي ، و مُضادات الاكتئاب ، و مُضادات الهيستامين ، و الأقراص المُنوّمة ، و المُسكّنات.

خلال تطوُّر مرض الزهايمر ، فإنه يُمكن استخدام بعض الأدوية المُضادة للاكتئاب و لكن بكميات بسيطة ، إلى جانب إجراء بعض التعديلات في البيئة المُحيطة بالمريض و ذلك لجعل البيئة المنزليّة أكثر أماناً و أُلفة للمريض ، و الذي من شأنه تهدئة بعض الأمور الشخصيّة و السلوكيّة لاسيّما أعراض الاكتئاب و الانفعالات و جنون العظمة و العُنف.

على الرغم من أن البحوث الجاريَة عن التأثيرات الوقائيّة و العلاجيّة تُبشّر بالخير ، إلا أن هناك بعض الأدوية التي لا يُمكن وَصفها. لأنها قد تُسبب الكثير من الآثار الجانبيّة الخطيرة. يلزم إجراء مزيد من الدراسات من أجل تحديد مدَى فاعِليّتها و سلامتها على المدَى الطويل.

أسئلة شائعة

بالإضافة إلى مرض الزهايمر ، ما هي المُسبّبات الأخرى للارتباك و ضعف الذاكرة و انخفاض المهارات المعرفيّة؟

تُعد بعض حالات النسيان المؤقتة أمر طبيعي و لا ينبغي أن تدعو للقلق إلا إذا زادت وتيرتها أو تداخلت مع مهام الحياة اليوميّة. مع ذلك ، فإن بعض أسباب انخفاض القُدرات المعرفيّة إلى جانب مرض الزهايمر ، تشمل ما يلي:

● التفاعُلات الدوائيّة أو الآثار الجانبيّة و الإفراط في تعاطي الأدوية ، لذا تأكّد من إخبار طبيبك المعالج عن جميع الأدوية التي تتعاطاها.

● نقص التغذيَة ، مثل نقص فيتامين (B12).

● وجود تاريخ مرضي للإصابة ببعض الأمراض التي قد تسهم في اختلال القُدرات العقليّة ، بما في ذلك الإصابة بداء السُكري ، أو بارتفاع ضغط الدم ، أو بأمراض الكُلَى أو الكبد أو الغدة الدرقيّة.

● وجود أوْرام فى المُخ ، و إصابات الرأس ، و حالات استسقاء الدماغ ذات الضغط الطبيعي (normal pressure hydrocephalus).

● الأمراض التنكُسيّة (الضمور Degenerative diseases) ، بما في ذلك انخفاض القُدرات المعرفيّة المُرتبطة بالعُمر ، و داء هانتينجتون (داء الرقص Huntington’s Chorea disease) ، و مرض الشلل الرعّاش (Parkinson disease) ، و داء بيك (Pick).

● الأمراض المُعدِيَة ، مثل عدوَى فيروس نقص المناعة البشرية (HIV) / مرض الإيدز (AIDS) ، أو مرض كروتزفيلد-جاكوب (Creutzfeldt-Jakob) ، أو التهاب السحايا (أغشيَة المُخ meningitis) ، أو التهاب الدماغ (encephalitis) ، أو عدوَى الزُهري (syphilis).

● القلق و الاكتئاب.

● حالات التسمُّم بالمعادن الثقيلة (كالتسمُّم بالرصاص).

● نوْبات الصرع و التشنُّجات.

هل هناك طريقة للمُشاركة في جهود البحث العلمي المُتعلّقة بمرض الزهايمر؟

نعم. إن الأفراد المُصابين و غير المصابين يُمكنهم المُشاركة في التجارب الطبيّة. إضافة إلى ذلك ، يُمكن للناس التبرُّع بنسيج المُخ لأحد أفراد الأسرة بعد وفاته. حيث يحتاج العلماء إلى عيّنات من النسيج لبعض الأشخاص المُصابين بالمرض و أنسجة من الأشخاص المُسنّين الآخرين الغير مُصابين بالمرض بغرض المُساهمة في معرفة أسباب المرض و إيجاد دواء فعّال له. يمكنك العثور على مزيد من المعلومات عن التجارب الطبيّة التي تخص المرض في الموقع الإلكترونى ClinicalTrials.gov.

هل هناك صِلة بين مرض جنون البقر و مرض الزهايمر؟

على الرغم من تشابه بعض الأعراض بين مرض اعتلال المُخ الإسفنجي البقري (bovine spongiform encephalopathy) (و المعروف عادةً يمرض جنون البقر) و مرض الزهايمر ، إلا أنه لا يوجد دليل حتى الآن على وجود علاقة بين المرضيْن.

حول: هلال سود
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