Alzheimer's Disease

What is Alzheimer's disease?

Alzheimer's disease (AD) affects brain cells. It slowly destroys memory and thinking skills. Over time, the ability to speak, remember, control emotions, and make decisions may be lost.

Alzheimer’s disease causes about two thirds of all cases of dementia. Dementia is a gradual loss of the ability to think, remember, reason, and plan. Dementia is the most common reason people start living in a nursing facility.

Almost everyone knows about Alzheimer’s disease. This makes most people feel very aware of memory problems as they get older. Anxiety about early stages of Alzheimer’s can be quite stressful for families with a relative who has had the disease.

What is the cause?

Alzheimer's disease happens from changes in the brain. Abnormal protein clusters, called neurofibrillary tangles, form in nerve cells in the brain. Over time these clusters get bigger and there are more of them. The nerve cells stop working and die. Parts of the brain start to shrink. What causes these changes is not well understood. It might be a number of things, like genes, the environment, and lifestyle.

Age is the most important known risk factor for AD. AD may start between the ages of 30 and 65. However, most people don’t have signs of the disease until after 65.

Scientists have found genes that increase the risk for Alzheimer’s in some families. Members of these families may start showing signs of the disease in their 30s, 40s, and 50s. This is a rare type of AD. Fewer than 10% of the people with Alzheimer's have this type of early-onset disease. Other genes may increase the risk for having the disease at an older age.

Things such as a healthy diet, regular physical activity, an active social life, and challenging mental activities might help to reduce the risk of Alzheimer’s disease.

What are the symptoms?

The symptoms of Alzheimer's disease are different from person to person. They also change as the illness gets worse.

The first symptom is forgetfulness. Almost everyone starts to have some memory problems as they get older. If someone is in the early stages of AD, however, these problems are more obvious than they are in others of the same age. You have trouble remembering recent events, activities, or the names of familiar people or things. Your attention span gets shorter. It’s harder to focus. But, at this stage, being forgetful does not have a big effect on your lifestyle or work. This stage of memory problems is often called minimal cognitive impairment.

Over time the memory loss gets worse. There are problems with reading, writing, and understanding. You have trouble knowing how to pay for things with money. You may misplace or lose things. You may get lost while driving or even when you are at home.

As the disease gets worse, you completely forget things that happened recently. You may forget some of your past as well. However, in general, recent memory is affected more than long-term memory.

Alzheimer’s disease does not have much effect on the ability to walk or move around, so even if you have very advanced memory loss, you may be able to get around and even wander off.

In later stages of AD you will often be confused. It will be hard to recall major facts about yourself or others. Things and people that were once familiar become unfamiliar. There may be mood and personality changes. You may have false beliefs (delusions). Or you may see or hear things that are not there (hallucinations). You may be anxious. You may be restless and tend to wander late in the day (a problem called sundowning).

How is it diagnosed?

A test of brain tissue after death is the only specific test for Alzheimer's disease. However, healthcare providers have ways to see if Alzheimer's disease is a likely cause of your symptoms.

• You will have a careful medical history and physical exam.
• You will have tests of your mental abilities (memory, problem solving, counting, and language).
• Several tests may be done to see if other illnesses are causing the symptoms. For example, blood and urine tests can check for problems such as thyroid disease, diabetes, or kidney disease. It is also important to rule out major depression, which can cause many of the same symptoms as Alzheimer's disease.
• CT or MRI scans may be done to take pictures of the brain. Scans show a lot of detail about the brain, but they do not show Alzheimer’s disease directly. Experts disagree about the usefulness of these scans. Some experts say that they are needed to rule out other brain problems that would require different treatment. Others say that the scans are usually not needed. They say that if someone has symptoms of Alzheimer’s, they should be treated, so scanning is not necessary.

Some tests used in research studies look for certain proteins in the spinal fluid called tau proteins. These proteins show up at higher levels in people who have Alzheimer’s disease. Testing for these proteins is a way to show that dementia is from Alzheimer’s rather than from other causes. These tests are not currently recommended for routine use. They are not accurate enough for highly reliable predictions of the presence or severity of Alzheimer’s. Also, getting spinal fluid is a complicated procedure. Since treatment is guided more by a person’s problems than by their tau levels, the test is not generally recommended.

Sometimes, for research studies, a test may be done for a gene that may increase the risk for developing Alzheimer’s disease. This test is not usually done for regular diagnosis and care of a person with Alzheimer’s disease.

How is it treated?

There is no cure for Alzheimer's disease. The goal of treatment is to control symptoms and improve quality of life as much as possible. This includes treating other illnesses, eating a healthy diet, and getting regular exercise.

Some medicines work to slow memory loss. Most have a modest effect early in the disease. This means that the loss of the ability to do daily activities that require good memory and thinking does not happen quite as fast as without the medicine. Donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon) are drugs that may slow memory loss early in the disease. Memantine (Namenda) may help slow memory loss in later stages of the disease.

These memory medicines help slow down the decline of memory and function, but the drugs do not reverse or stop the decline. None of these medicines can cure Alzheimer's disease, and they are costly and have side effects. You should not expect big improvements. People whose disease is very severe will not benefit. Talk to your healthcare provider about these issues.

Other medicines are being studied to see if they might be helpful. The Alzheimer’s Association runs a service to help people be a part of ongoing research studies.

Many people who have Alzheimer's disease are depressed, especially in the earlier stages. Most do not show sadness as much as a loss of pleasure and joy. Depression during the late stages of Alzheimer's disease may cause feelings of hostility or agitation and a loss of interest in eating or drinking. Depression makes brain function much worse. Medicines for depression or anxiety may help.

How long will the effects last?

Alzheimer's disease (AD) cannot be cured. Brain function keeps getting worse until death. The time between the start of memory problems and death can be from 5 to 15 years. The prospect of living a long time with the need for total care and supervision is one of the most troubling parts of coping with Alzheimer’s disease.

How can I help take care of someone with this disease?

While still possible, people who have AD should be involved in decisions about the care they need or want to have. Someone with AD may fear embarrassment from loss of independence and needs to be reassured sincerely and often. Sometimes people who have Alzheimer's do not think they need help and may resist it. But as the disease gets worse, bowel and bladder control is lost, as is the ability to walk, speak, and even swallow food or liquids.

Friends and family, as well as the person with AD, should join support groups as soon as possible after the disease is diagnosed. Everyone's needs must be considered and balanced. Caregivers will become emotionally and physically worn out if they have no help or no time away from caregiving.

If you are going to be the main caregiver for a person with Alzheimer’s disease, get training. Training programs for caregivers is as important to the person’s health as any of the medicines.

Community resources are very important. To find these services, talk with your healthcare provider, county health department, or visiting nurses association:

• Social workers find and organize help, including possible financial aid.
• Home healthcare agencies provide the services of nurses, medical social workers, and therapists. They also provide home health aides for personal care.
• Out-of-home services include adult day care centers, mental health services, transportation; and nursing facilities.

Is a power of attorney needed?

Yes, it is important to have a durable power of attorney for medical and financial matters. The person with Alzheimer’s should sign a power of attorney before he or she becomes unable to make legal decisions. If desired, a living will should be made out as well. Ask your healthcare provider for more information about these documents.

What can be done to help prevent Alzheimer's disease?

Alzheimer's disease cannot be prevented until its causes are better understood. However, if you have a family history of Alzheimer's, tell your healthcare provider. Early diagnosis may allow you to take advantage of new treatments as they become available.

Many researchers think that you can reduce your risk of getting Alzheimer’s disease, at least a little bit, by having a healthy lifestyle. Steps you can take include not smoking, getting more exercise, eating more fruits and vegetables, and not drinking a lot of alcohol. The Alzheimer’s Society in the United Kingdom (Great Britain) has a simple set of instructions that you can use as a guide. See http://www.alzheimers.org.uk/site/scripts/download_info.php?downloadID=56&fileID=362.

How can I get more information?

For more information on coping with this disease, talk to your healthcare provider. Another good source of information is:

Alzheimer's Association
Web site: http://www.alz.org
24-hour helpline: 1-800-272-3900 (TDD: 1-866-403-3073)

Many Web sites offer information and products for AD. Talking with people in support groups and with caregivers and a trusted healthcare provider can help you sort through all of the information.