What is it?

Overview

What Is It?
Symptoms of Alzheimer's disease include forgetfulness, difficulty using or remembering words and difficulty concentrating. It is the most common cause of dementia in older people.

Alzheimer's disease is perhaps one of the best-known illnesses associated with old age. A complex disease of the brain, Alzheimer's now affects as many as 5.3 million people in the United States , according to the Alzheimer's Association.

As the U.S. population grows older, the number of people with Alzheimer's disease is expected to increase. But Alzheimer's is not a normal or inevitable part of aging. It is a progressive disease that starts in one part of the brain and gradually invades other regions. As it progresses, Alzheimer's destroys nerve cells within the brain and the connections between them, leaving behind clumps of proteins called plaques and twisted fibers in brain cells called tangles. Over time, this destruction erodes the most vital abilities of human nature: language, learning, memory and reason. Personality and behavior also are dramatically affected by Alzheimer's disease.

Alzheimer's disease is the most common cause of dementia in older people. Dementia is a medical term used to describe deterioration in thinking ability severe enough to disrupt a person's normal activities and relationships. The disease usually begins in people 65 or older, but in rare instances it can affect individuals as young as 30. An estimated one in eight people over 65 have Alzheimer's disease, and 50 percent of people with the disease are over age 85.

Women are more likely to develop Alzheimer's disease than men; more than twice the number of women as men die of the disease per year. This may be in part because women live longer than men so more women have the disease at any time than men.

Early symptoms of the disease include forgetfulness, difficulty using or remembering words and difficulty concentrating. For some individuals, these early symptoms of Alzheimer's disease may be mistaken for what many people consider "natural" symptoms of aging. But symptoms caused by Alzheimer's disease worsen over time, while the short-term memory problems that trouble many people as they age do not progress to other more serious symptoms.

The rate that Alzheimer's symptoms progress varies greatly from person to person. Some people have Alzheimer's only for the last three years of life, while others may live with the disease for 20 years.

Symptoms of Alzheimer's often are divided into mild, moderate and severe phases, though symptoms in these phases often overlap. The Alzheimer's Association breaks down these phases even further. Because Alzheimer's damages the brain, unpredictable and uncharacteristic behavior is common. Anxiety, aggressiveness or compulsive behaviors—repetitious activities that the person doesn't seem to be able to control or stop—are also common. Mood swings and irritability are common and can escalate if not treated early. These behavioral patterns typically change as the disease progresses.

Mild Alzheimer's symptoms include:

• Impaired memory of personal history
• Decreased ability to complete routine tasks, such as paying bills and planning dinner for guests
• Problems performing challenging mental arithmetic; for example, trying to count backward from 75 by 7s
• Difficulty recalling recent occasions or current events
• Subdued and withdrawn demeanor, especially in situations that are socially or mentally challenging

Moderate Alzheimer's symptoms often add:

• Inability to recall important personal details, such as telephone numbers or addresses
• Confusion about the season, date or day of the week
• Problems with less challenging mental arithmetic; for example, counting backward from 20 by 2s
• Trouble choosing proper clothing for the occasion or season
• Usually no problems recalling their own names or the names of their spouse or children
• Usually no problems eating or using the toilet

Severe Alzheimer's includes symptoms listed above plus:

• Loss of awareness of their surroundings and of most recent and experiences
• Occasional forgetfulness of the name of their spouses or primary caregivers
• Problems getting dressed properly; for example, may put their shoes on the wrong feet
• Sleep problems
• Trouble with toileting details, for example, flushing and properly disposing of toilet tissue
• Increased problems with urinary or fecal incontinence
• Significant personality changes and behavioral symptoms such as paranoia, delusions, hallucinations or compulsive repetitive behaviors
• A tendency to wander and become lost

Very severe Alzheimer's includes:

• Problems speaking clearly
• Trouble eating and using the toilet independently; general urine incontinence
• Loss of the ability to walk without assistance
• Loss of the ability to smile, sit without support and hold head upright
• Reflex problems
• Rigid muscles and impaired swallowing

The major risk factor for Alzheimer's disease is age. According to the Alzheimer's Association, a person's risk of developing any form of dementia, including Alzheimer's, more than triples every 10 years after age 65.

People who have significant memory problems but no other thinking problems and are able to perform their usual daily activities are at increased risk for later developing Alzheimer's. This condition, called mild cognitive impairment (MCI), evolves to Alzheimer's at a rate of about 10 percent per year. On the other hand, some of these individuals will never develop Alzheimer's, and sometimes medications, medical problems or psychosocial issues are found responsible. Your health care professional can help assess this risk factor.

Although researchers still don't know for sure what causes Alzheimer's disease, most believe it is related to the abnormal processing of normal brain proteins, particularly amyloid precursor protein and tau. For some reason, later in life these proteins, which serve a normal function, begin to be abnormally processed. When this happens, the abnormally processed proteins assemble themselves into clumps, which interfere with thinking. These clumped proteins are called neurofibrillary tangles and senile (amyloid) plaques (often simply referred to as tangles and plaques), and eventually destroy critical parts of the brain.

Family history is also a risk factor for Alzheimer's. For example, early onset Alzheimer's disease, a rare form of the disease that strikes people between the ages of 30 and 60, is often inherited. Only 5 percent of Alzheimer's disease is the true familial inherited form.

So far, only one genetic factor has been identified that makes late-stage Alzheimer's disease more likely—a gene called APOE epsilon 4 (APOE-e4) that makes a particular form of a protein called apolipoprotein E (ApoE). Scientists believe there may be as many as a dozen additional Alzheimer's risk genes, but others haven't yet been convincingly proven.

Other theories link the disease's development to the death of cells critical for maintaining levels of certain brain chemicals required for normal thought processes; vascular factors that affect the health of blood vessels in the brain; and severe head injury.

In addition, scientists are investigating the role of education, diet and environment in Alzheimer's disease. They are also looking into the link between the risk factors of heart disease—such as high blood pressure, high cholesterol and low levels of folate—and Alzheimer's disease. On the positive side, there is some evidence that higher levels of education early in life and more social, mental and physical activities in older age may help prevent the disease.

At one time, hormone therapy was thought to reduce a woman's risk of developing dementia and Alzheimer's. However, several studies have shown it may have the opposite effect. One major study published in the Journal of the American Medical Association found that estrogen plus progestin hormone therapy increased the risk of dementia, including Alzheimer's disease. Another study found that estrogen did not improve the symptoms of those who already had Alzheimer's disease.

To date, there is no cure for Alzheimer's, but there are some drug and nondrug treatments that may help with both behavioral and cognitive symptoms.

If you think you have Alzheimer's or suspect someone you know might be experiencing symptoms, it's important to consult with medical professionals as soon as possible. Early diagnosis can help rule out other medical reasons for symptoms. It is important to distinguish Alzheimer's from other diseases causing dementia and from depression and psychiatric illness. Health care professionals can make sure that medications you are taking aren't causing or worsening the problem.

Because Alzheimer's eventually affects an individual's ability to care for him or herself, short- and long-term planning is important. The earlier you can develop a support system, as well as review financial and medical management strategies, the better. Plus, the sooner someone with Alzheimer's begins taking medications to minimize or stabilize symptoms, the better.

Issues to consider include: caregiving support and establishing a power of attorney and a living will, as well as making other end-of-life decisions.

The Alzheimer's Association and the support groups it sponsors can provide additional information about Alzheimer's disease and the needs you and your family are likely to face. It's natural to feel overwhelmed by such a diagnosis. These organizations, together with your medical team, can help you cope.

Diagnosis

Diagnosis

Alzheimer's is only one of many diseases that can cause dementia. Because these diseases often cause similar symptoms, a comprehensive evaluation is essential to ensure the correct diagnosis and optimal treatment. Alois Alzheimer, a German physician, first identified Alzheimer's disease in 1906. During an autopsy of brain tissue of a woman who had suffered what was believed to be a mental illness, Dr. Alzheimer found the unique plaques and twisted fibers now considered a hallmark of the disease.

Today, a brain autopsy after death remains the only definitive way to diagnose Alzheimer's disease. Autopsy should be considered because confirming the cause of dementia can be important for the health care of future generations. Because there is no simple or single test available to diagnose the disease, Alzheimer's disease sometimes goes unrecognized and misdiagnosed in primary care settings. However, according to the Alzheimer's Association, experts estimate that a skilled physician can diagnose Alzheimer's during life with more than 90 percent accuracy.

Position emission tomography (PET) scanning, a scanning procedure that measures the activity in the brain, can sometimes help physicians distinguish Alzheimer's from other causes of dementia. The test may covered under Medicare, but only in certain situations.

Not all dementia-related problems are caused by Alzheimer's disease; some are caused by depression, unintended medication interactions, thyroid problems and other health conditions. However, any symptoms associated with memory, judgment or difficulty performing daily tasks, as well as any abnormal behavior or mood swings, should be discussed with a health care professional.

According to the Alzheimer's Association, the following 10 symptoms are warning signs of Alzheimer's disease:

• Memory loss: Forgetting recently learned information.

• Difficulty performing familiar tasks: Trouble remembering how or where to find your car even though it's parked in the same place every day; not being able to remember how or where to brush your teeth.

• Problems with language: Forgetting common and simple words used in everyday language; for example, instead of toothbrush, you might say: "that thing for my mouth." In addition, people suffering from Alzheimer's may begin to substitute inappropriate words when they talk.

• Disorientation about time and place: Getting lost frequently in familiar places. For instance, you may not recognize your own street and may wander endlessly looking for your house.

• Poor or decreased judgment: Dressing inappropriately, such as wearing pajamas to the grocery store or showing up at work in a bathrobe and slippers. Another sign is giving large sums of money to telemarketers.

• Challenges with planning and problem-solving: Basic calculations that were once easily mastered are sometimes impossible. Some people may experience changes in their ability to develop and follow a plan. They may have trouble following a once familiar recipe or managing monthly bills. They may also have trouble concentrating and take much longer to do things.

• Misplacing things: Placing things in obviously inappropriate locations. For example, someone with Alzheimer's may put a watch in the toaster but have no memory of doing this.

• Dramatic and sometimes abrupt changes in personality or mood: These changes may occur over time and are more pronounced than the mild personality or mood changes that may accompany aging. A person may go from calm to very angry for no apparent reason.

• Withdrawal from work or social activities: Someone with Alzheimer's may lose interest in one or more of their usual endeavors and fail to regain that interest.

The list of warning signs above departs significantly from signs considered a part of the normal aging process. These include:

• Benign forgetfulness: Forgetting where you put certain items is a normal part of aging. For example, you may put your keys in the wrong place, but you aren't likely to put them in the refrigerator, as someone with Alzheimer's might.

• Decreased motor skills: Many people begin to lose some agility as they age. Thus, it may take longer to perform certain motor-related functions such as walking or lacing your shoes. Other ailments such as arthritis may also play a role.

Primary care physicians as well as neurologists, psychiatrists and geriatricians typically diagnose and treat Alzheimer's disease. An evaluation usually requires two or more visits of 30 minutes or more, plus testing. The diagnostic process includes a thorough medical history and family interview, including questions about the patient's current mental and physical conditions with an emphasis on any noticeable physical, mental and emotional changes. The physician will want to get information from someone who knows the patient well, since individuals may not recognize their own limitations or symptoms. A health care professional should also ask for a list of prescription drugs and take a family health history. Routine tests, such as blood work, blood pressure screening and urine tests, will also be necessary as part of a comprehensive physical evaluation.

A mental status evaluation will help assess your sense of time and place, memory, comprehension and communication abilities. Part of the evaluation may include asking you to perform simple calculations and answer other simple memory-related questions.

You will undergo a neurological examination and tests of the brain. The most common is a brain scan to take pictures of the brain. This may be a computerized tomography (CT) scan, a magnetic resonance imaging (MRI) scan, or a positron emission tomography (PET) scan. A picture of the brain enables your doctor to see any abnormalities within your brain; however, in the earlier stages of Alzheimer's, these results are often normal since the loss of brain cells and the creation of plaques and tangled neuron fibers don't typically show up on a scan. But a brain scan can identify other neurological problems that might cause symptoms like Alzheimer's, such as stroke. A psychiatric evaluation also may be performed to assess mood and behavior.

Even when the doctor makes a diagnosis of Alzheimer's disease, there are varying degrees of certainty:

• Probable Alzheimer's. This diagnosis means your doctor has ruled out all other dementia disorders and your symptoms strongly point to Alzheimer's disease.

• Possible Alzheimer's. This diagnosis indicates Alzheimer's is the primary cause of the dementia symptoms, but another disorder or disease may be present as well and could affect the progression of Alzheimer's. This indicates a lesser degree of certainty.

• Definite Alzheimer's. This diagnosis means that there is physical evidence of plaques and tangles or that a gene mutation has been found that causes Alzheimer's. This diagnosis indicates complete certainty, but except in unusual cases, it can only be made when the brain is examined after death.

Physicians sometimes find significant memory loss that is too mild to affect daily function. This is called mild cognitive impairment. This can be an indication that Alzheimer's will develop later and should be closely monitored by a health professional.

With a diagnosis as shattering as Alzheimer's, it's a good idea to take some time to come to terms with the news. Support groups and Alzheimer's-related organizations can offer suggestions for working through the diagnosis. Once you decide to share your diagnosis with family and friends, try to be open to their concerns and offers of help. Conversely, if someone close to you tells you about an Alzheimer's diagnosis, be sensitive to his or her needs and ask what you can do to help.

Treatment

Treatment

While there is no cure for Alzheimer's disease, medical treatments can help alleviate some of the behavior and cognitive symptoms.

There is increasing evidence that optimal treatment of medical conditions such as hypertension and diabetes is critical to improve outcomes in Alzheimer's. In addition, it is important to keep physically active with regular exercise of 30 minutes or more on most days. Since people with Alzheimer's tend to withdraw from activities, it is important to encourage social interactions. These steps can improve mood, thinking abilities and quality of life.

The FDA has approved two classes of drugs to treat the cognitive symptoms of Alzheimer's disease. Four are in a class known as acetylcholinesterase inhibitors (also called cholinesterase inhibitors). They work by inhibiting an enzyme called acetylcholinesterase which normally breaks down acetylcholine, a key neurotransmitter involved in cognitive functioning. Levels of acetylcholine typically drop sharply in patients with Alzheimer's.

The fifth drug, memantine (Namenda), is an N-methyl-D-aspartate (NMDA) receptor agonist and is approved for the treatment of moderate to severe Alzheimer's. It works by blocking excess amounts of a brain chemical called glutamate that is involved in information processing, storage and retrieval.

While the drugs can't restore dead brain cells, they can slow or temporarily forestall the inevitable decline. Usually these medications are easily tolerated. However, side effects like diarrhea or loose stools, nausea, vomiting, loss of appetite and weight loss sometimes occur. Occasionally, there can be muscle cramps, increased nasal secretions or urinary incontinence. Some people may have sleep disturbances, often with strikingly vivid dreams. Approved drugs are:

• Donepezil (Aricept). This drug can help boost thinking abilities and reduce some general function and behavior problems of Alzheimer's without significant side effects. It is usually taken daily at bedtime and is approved for all stages of Alzheimer's disease.

• Rivastigmine (Exelon). This drug can help improve thinking and memory, activities of daily living and general functional abilities. It is approved for mild to moderate Alzheimer's disease.

• Galantamine (Razadyne; previously marketed as Reminyl). This drug is approved for mild to moderate Alzheimer's disease and can improve cognitive symptoms of the disease.

• Tacrine (Cognex). Tacrine was the first acetylcholinesterase inhibitor approved by the FDA, but because it is very toxic to the liver, it is not used much anymore.

• Memantine (Namenda). This is the only drug specifically approved for moderate to severe Alzheimer's. It appears to work by regulating the activity of glutamate, a brain chemical involved in information storage, processing and retrieval. Some common side effects include dizziness, headaches, constipation and confusion.

Although typical of Alzheimer's, any changes in behavior should be reported to a health care professional so any potential physical causes may be investigated. Behavioral symptoms may be influenced by a variety of factors, including:

• physical discomfort
• side effects from medication
• chronic pain
• infection
• nutritional problems
• problems with vision or hearing
• disruptive environment
• upset or unprepared caregiver

Whenever possible, health care professionals usually recommend nondrug interventions first to reverse behavioral symptoms. Some medications can make behavior-related symptoms worse. Caring for someone with memory loss can be challenging, but it can be easier if you learn the right skills. The Alzheimer's Association and other community agencies can provide family members with the education necessary to become successful caregivers.

Nondrug treatment options include:

• Change the mood of the home environment.

  The lighting in a house or apartment, colors in the decor and level of noise in the immediate living area can have a significant impact on how someone with Alzheimer's behaves and feels. Researchers found that certain types of lighting can make some people feel uneasy, while higher noise levels can induce frustration.

• Create a routine and stay active.

  Constructing a routine for everyday activities including dressing, bathing and cooking can reduce depression and help keep someone with Alzheimer's active longer. It may also reduce the chances of wandering because the person is more likely to follow the daily routine. Alzheimer's experts also recommend patients take up creative and pleasing activities that can bring more happiness into their life, such as painting, reading or singing.

Research is under way to find additional medications that can help relieve the more intense behaviors associated with Alzheimer's disease. For now, other drugs are used to treat symptoms such as agitation, aggression, delusions or depression, including:

• Antipsychotics such as olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), aripiprazole (Abilify) ziprasidone (Geodon) and haloperidol (Haldol) address delusions, hallucinations, aggression, uncooperativeness and hostility. However, because a recent analysis shows that some antipsychotic drugs are associated with an increased risk of stroke and death in older people with dementia, the FDA says these drugs should be used with extreme caution.

• Anxiolytics such as oxazepam (Serax) and lorazepam (Ativan) help calm anxiety and agitation. Only the short-acting types are typically prescribed for Alzheimer's patients and should be used intermittently, not regularly.

• Antidepressants, including citalopram (Celexa), paroxetine (Paxil), fluoxetine (Prozac), sertraline (Zoloft) and others help relieve low mood and irritability. The FDA warns that anyone who starts therapy with these drugs—particularly children and adolescents—should be watched closely for clinical worsening, suicidal tendencies or unusual changes in behavior.

• Vitamin E is sometimes prescribed for Alzheimer's patients. Vitamin E is an antioxidant, a substance that may help protect nerve cells from the wear and tear that can lead to Alzheimer's. In one large study, vitamin E slightly delayed Alzheimer's patients' loss of ability to carry out their daily activities and postponed their placement in residential care. However, other studies have shown that vitamin E has no benefit. Discuss this option with your health care professional. However, vitamin E can cause negative side effects when taken in large quantities or used with other medications, such as blood thinners.

Some people with Alzheimer's use alternative treatments such as herbal remedies and dietary supplements even though claims about the safety and effectiveness of some of these remedies are largely based on testimonials. If you're considering any alternative treatments or want to advise a friend or loved one with Alzheimer's about alternatives, it's a good idea to discuss your interest with a health care professional (or suggest your friend talk to a health care professional) who can offer advice or discuss possible side effects. Some of the more widely known alternative treatments people with Alzheimer's try include:

• Ginkgo biloba: This plant extract has been used for hundreds of years in China and is popular in Europe to help ease some neurological problems, including memory problems. It contains certain compounds that may have positive effects on cells within the brain. It is believed to be an antioxidant and may have some anti-inflammatory qualities, as well as the ability to help regulate neurotransmitters within the brain. One study found ginkgo biloba had a positive effect on patients with Alzheimer's, although researchers cautioned the results were preliminary because of the limited number of participants. And results of a large government-sponsored study on 3,000 participants published in the Journal of the American Medical Association in November 2008 showed that gingko was no more effective than a placebo in delaying changes in memory, thinking and personality and did not delay or prevent the onset of Alzheimer's or dementia

• Huperazine A: This is a moss extract that has been used in traditional Chinese therapies for centuries. This extract is emerging as a potential treatment for Alzheimer's because it contains certain properties similar to cholinesterase inhibitors used to treat the disease. Some small study results show that huperzine A may work as well as the FDA-approved drugs. However, huperazine A isn't regulated by the FDA and may not be manufactured under uniform standards. Health care professionals warn that people with Alzheimer's shouldn't take this extract without medical consultation because it could interact with other Alzheimer's medications and cause serious side effects.

Medicare Coverage for Alzheimer's Expanded

Medicare, the government health insurance program for the elderly and disabled, provides coverage for some Alzheimer's-related therapies. Specifically, the program:

• Cannot refuse to pay for any medical services for beneficiaries with Alzheimer's solely because of their diagnosis.

• Covers evaluation and reasonable and necessary management visits by physicians or other health care providers for Alzheimer's patients.

• Covers physical, occupational and speech therapy as needed for Alzheimer's patients; however, coverage is limited.

• Covers psychotherapy or other behavior management therapy provided by a mental health provider for Alzheimer's patients as needed under certain circumstances. However, Medicare pays mental health claims at 50 percent rather than the 80 percent rate for other conditions.

• Usually pays for home health care if the Alzheimer's patient is homebound and requires a skilled service, such as nursing services or physical, occupational or speech therapy. Medicare's definition of homebound is extremely strict, however, and may only apply to patients with very severe disease. It stipulates that it must be involve "considerable and taxing effort" for the individual to leave his or her home.

For more information, go to www.medicare.gov.

Prevention

Prevention

Researchers suspect a healthy lifestyle, including controlling blood pressure, cholesterol and weight, and getting moderate exercise, may help prevent the disease or delay its onset.

For instance, results of a recent study done at the University of Kansas Medical Center and published in the July 2008 issue of the journal Neurology showed that people with early Alzheimer's disease who exercised regularly and had good cardiorespiratory fitness experienced less atrophy is key areas of the brain associated with memory. In other words, good physical fitness appears to help Alzheimer's patients preserve memory.

Additionally, some population studies suggest that regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin or ibuprofen, could reduce a person's risk. However, the latest research on animals shows that NSAIDs may only help protect against Alzheimer's disease if you start taking them at a very early age. More research is necessary to prove whether this is also true in humans. Don't begin taking a daily aspirin without first checking with your health care professional.

Certain activities that stretch your mind, like chess or crossword puzzles, actually help rewire your brain, increasing the number of synapses, or connections, between brain cells. One study found activities such as listening to the radio, reading the newspaper, playing puzzle games and going to museums, could lower the risk of developing Alzheimer's disease. The study followed 700 participants for four years and found that people who spent the most time on activities involving significant information processing were 47 percent less likely to develop Alzheimer's than those who spent the least amount of time on these activities.

Eating a healthy diet may also play a role. Specifically, studies suggest that lots of fruits and vegetables high in antioxidants (the darker the better), cold-water fish high in omega-3 fatty acids, and nuts (good sources of vitamin E) can play a protective role. One study published in Neurology found that people who regularly consumed omega-3 oils such as walnut oil, canola oil and flaxseed oil lowered their risk of dementia by 60 percent compared to those who did not regularly consume omega-3-rich oils. The same study also found that those with a daily intake of fruits and vegetables reduced their risk of dementia by 30 percent compared to those who didn't regularly consume fruits and vegetables. Along the same lines, keep levels of high-fat, high-cholesterol foods low to protect the health of your blood vessels.

As with other medical conditions, any unusual symptoms you or a loved one experience should be discussed with a health care professional as soon as possible. Once you or someone you care about is diagnosed with Alzheimer's, early detection may buy more time in helping you to plan ahead for your loved one's health and welfare while FDA-approved drugs may help to ameliorate some of the cognitive and behavioral symptoms many patients experience.

Facts to Know

Facts to Know

1. Alzheimer's disease is a progressive brain disease responsible for the majority of cases of dementia in older people. Hallmark signs of Alzheimer's include memory loss, confusion, poor judgment, wandering and depression or an indifferent attitude.

2. The older someone gets, the more likely he or she is to acquire Alzheimer's. One in eight people over the age of 65 has Alzheimer's, and 50 percent of people with the disease are over age 85. A small percentage of people as young as their 30s and 40s get the disease.

3. There is some evidence that women may be at greater risk for developing Alzheimer's; certainly the fact that women live longer than men puts women at higher risk for Alzheimer's. More evidence is showing that genes are likely to play a role in determining who develops Alzheimer's.

4. What causes Alzheimer's is unknown, and so far there is no cure for the disease. However, scientists are working hard to find the cause, and some drug therapies benefit individuals with the disease. There are many effective strategies that caregivers can use to ease the burdens of the disease.

5. Some of the warning signs for Alzheimer's include the following:

   • memory loss
   • trouble performing everyday tasks
   • difficulty with language
   • disorientation
   • decreased good judgment
   • problems with abstract thinking
   • misplacing things regularly in inappropriate places
   • significant changes in mood or behavior
   • personality changes
   • loss of drive or initiative

6. Health care professionals typically use a step-by-step process to determine if you or someone you know has Alzheimer's. In some instances, some of the early symptoms can be attributed to other problems, such as fatigue, grief, depression, illness, vision or hearing loss or interactions between medications. A mental status evaluation, a comprehensive physical examination, neurological tests, brain imaging and discussions with family members about changes in behavior and mood all are part of the diagnostic process for Alzheimer's disease.

7. Despite the fact there is no cure for the disease, health care professionals can help relieve some of the behavioral and cognitive symptoms of Alzheimer's disease with a small arsenal of medical treatments.

8. Major risk factors for Alzheimer's are believed to be age-related. Other potential risk factors include a severe head injury and genetic factors. There is some evidence that environmental and dietary factors may be involved.

9. There is no set pattern as to how the disease will progress in each person who acquires it. Some may have the disease for three to five years at the end of their lives, while others might have Alzheimer's for a decade or two.

10. Local chapters of the Alzheimer's Association provide information and referrals to support groups that can help you develop short- and long-term planning for managing the disease.

Questions to Ask

Questions to Ask

Review the following Questions to Ask about Alzheimer's disease so you're prepared to discuss this important health issue with your health care professional.

1. How much experience do you have in diagnosing and treating people with Alzheimer's disease? If you haven't had much experience with Alzheimer's patients, can you recommend a specialist who has?

2. Which tests will be performed and what can I, or the person I'm worried about, expect to experience during those tests?

3. How quickly will I, or the person I'm concerned about, learn the results of those tests?

4. How can you be sure the problems I'm experiencing are really Alzheimer's and not just part of the normal aging process?

5. Am I taking any medications that could be making my symptoms worse?

6. What changes can I expect over time in behavior and mental capabilities? How quickly will these changes occur?

7. What treatments are available for these symptoms? What side effects are likely to occur?

8. Can I or the person I'm worried about make some changes in the immediate surroundings or activities that don't involve medical treatments that could possibly alleviate some of the symptoms?

9. Do you recommend any alternative treatments, such as vitamin E supplements or ginkgo biloba, to help the situation?

10. Are there clinical trials in this area that could possibly improve the situation? Do you recommend I or the person I'm concerned about participate?

11. Should coworkers and friends be told about this diagnosis? Do you have any advice about the best approaches to use in discussing Alzheimer's with them?

Key Q&A

Key Q&A

1. What is Alzheimer's disease and how is it different from the normal aging process?

   Alzheimer's is a degenerative disease of the brain characterized by gradual loss of short-term memory and increasing difficulty performing simple, routine tasks. The disease progresses at different speeds for every individual, but eventually most patients experience confusion and personality and behavior changes. Communicating with others becomes difficult, language problems become more evident and the ability to stay focused and follow directions becomes more challenging. Ultimately, people with Alzheimer's require more and more assistance with activities of daily living and become increasingly disoriented. Symptoms of the natural aging process, such as difficulties with short-term memory, do not progress into more serious symptoms, as they do with Alzheimer's.

2. How common is the disease?

   About 5.3 million Americans currently suffer from Alzheimer's, according to the Alzheimer's Association. Alzheimer's disease usually begins in people who are 65 or older, with the risk of getting the disease increasing with age. About one in eight people over 65 have Alzheimer's, and 50 percent of people with the disease are over age 85.

3. How do I know if I have the disease?

   The Alzheimer's Association has created a list of 10 warning signs that could signal the potential for the disease. If you or a loved one experiences any of these symptoms, contact a health care professional for an evaluation. The warning signs include:

   • memory loss that is significant
   • difficulty performing everyday simple tasks
   • problems with language and communication
   • disorientation of time and place
   • poor or impaired judgment
   • challenges with planning and problem-solving
   • misplacing things beyond normal forgetfulness
   • changes in mood or behavior
   • personality changes
   • withdrawal from work or social activities

4. Why is early diagnosis of Alzheimer's so important?

   An early visit to a health care professional for memory loss and thinking problems can help determine if symptoms are caused by Alzheimer's or some other condition and will help to establish a course of treatment as quickly as possible. It can help ensure that medications are not contributing to problems and can address psychosocial factors. It also helps in planning for the future, preventing complications, learning effective caregiving strategies and using financial resources effectively.

5. What kinds of tests and evaluations may be used to determine whether Alzheimer's is the problem?

   Unfortunately, a brain biopsy after death remains the only definitive way to diagnose Alzheimer's disease. Because there is no simple or single test available to diagnose the Alzheimer's, the disease sometimes goes unrecognized and misdiagnosed in primary care settings. However, according to the Alzheimer's Association, experts estimate that a skilled physician can diagnose Alzheimer's with more than 90 percent accuracy.

   Position emission tomography (PET) scanning, a noninvasive scanning procedure that measures body processes such as metabolism and blood flow in certain areas of the body, including the brain, may also be used to diagnose Alzheimer's. However, the test is covered under Medicare only when it is used to help distinguish Alzheimer's disease from a rare related disorder called frontotemporal dementia that may cause severe losses of function in the front and side areas of the brain.

   Beyond that, physicians may use a set of symptoms and warning signs to help diagnosis the disease. These symptoms include memory loss, difficulty performing tasks, problems with language, disorientation in time and place, forgetfulness and problems with motor skills.

6. What kinds of treatments are available for Alzheimer's?

   While there are no medical treatments that can reverse the effects of Alzheimer's or slow its progression, there are a handful of drugs approved by the U.S. Food and Drug Administration (FDA) that can alleviate some of the cognitive and behavioral symptoms in the disease's early or moderate stages. Medications also are available for other symptoms associated with Alzheimer's, such as agitation, delusions and depression. It's important for a health care professional to discuss some of the side effects of these drugs with you or the person you know who has Alzheimer's.

   A healthy lifestyle is important for optimal treatment of Alzheimer's. This includes a well-rounded diet, treatment of medical conditions, regular physical activity sustained over 30 minutes, social engagement and encouraging participation in daily activities to the extent possible with existing impairments.

   Whenever possible, health care professionals usually recommend nondrug options first to treat behavior disturbance—such as changing the mood of the patient's home environment or creating a routine and staying active—since some medications can contribute to increased problems with dementia.

7. Is there anything that can be done to prevent or decrease the potential for getting Alzheimer's disease?

   Yes. Numerous studies suggest that eating a healthy diet, participating in regular physical activity and maintaining healthy blood pressure, cholesterol and weight levels may all contribute to a reduced risk of Alzheimer's disease. Researchers are studying the role of genetics in the development of Alzheimer's, but most agree there are a handful of risk factors—whether individually or in combination—that could play a role in acquiring the disease. What's known for certain is the older you get, the greater the risk for acquiring Alzheimer's.

8. How can I or someone I care about get more information about the disease and the help that may be needed to cope with it?

   The Alzheimer's Association has local chapters from coast-to-coast, support groups nationwide that provide access to services and information all over the country, a toll-free 24/7 hotline and other resources. Support groups are usually a good way to make contact with others who have the disease and can offer a great way to network and find out about important services in your area. For more information on the services available through the Alzheimer's Association, go to www.alz.org/about_us_about_us_.asp.

Organizations and Support

Organizations and Support

For information and support on coping with Alzheimer's Disease, please see the recommended organizations and Spanish-language resources listed below.

Organizations

Alzheimer's Disease Education and Referral Center (ADEAR)
Website: http://www.nia.nih.gov/alzheimers
Address: P.O. Box 8250
Silver Spring, MD 20907
Hotline: 1-800-438-4380

Alzheimer's Drug Discovery Foundation
Website: http://www.alzdiscovery.org
Address: 1414 Avenue of the Americas
Suite 1502
New York, NY 10019

Alzheimer's Foundation of America
Website: http://www.alzfdn.org
Address: 322 8th Ave., 7th Floor
New York, NY 10001
Hotline: 1-866-AFA-8484 (1-866-232-8484)

American Health Assistance Foundation
Website: http://www.ahaf.org
Address: 22512 Gateway Center Drive
Clarksburg, MD 20871
Hotline: 1-800-437-AHAF (2423)

Eldercare Locator
Website: http://www.eldercare.gov
Address: Administration on Aging
One Massachusetts Avenue, Suites 4100 & 5100
Washington, DC 20201
Hotline: 1-800-677-1116
Email: eldercarelocator@n4a.org

Family Caregiver Alliance
Website: http://www.caregiver.org
Address: 180 Montgomery Street, Suite 1100
San Francisco, CA 94104
Hotline: 1-800-445-8106
Phone: 415-434-3388
Email: info@caregiver.org

Geriatric Mental Health Foundation
Website: http://www.gmhfonline.org
Address: 7910 Woodmont Ave, Suite 1050
Bethesda, MD 20814
Phone: 301-654-7850
Email: web@GMHFonline.org

National Family Caregivers Association
Website: http://www.nfcacares.org
Address: 10400 Connecticut Avenue, Suite 500
Kensington, MD 20895
Hotline: 1-800-896-3650
Phone: 301-942-6430
Email: info@thefamilycaregiver.org

National Hispanic Council On Aging
Web Site: http://www.nhcoa.org
Address: 734 15th Street, NW, Suite 1050
Washington, DC 20005
Phone: 202-347-9733
Email: nhcoa@nhcoa.org

National Institute on Aging (NIA)
Website: http://www.nia.nih.gov
Address: Building 31, Room 5C27
31 Center Drive, MSC 2292
Bethesda, MD 20892
Hotline: 800-222-4225
Phone: 301-496-1752

National Program on Women and Aging
Website: http://iasp.brandeis.edu/womenandaging
Address: The Heller School for Social Policy and Management
Institute on Assets and Social Policy, MS 035 Brandeis University
Waltham, MA 02454
Phone: 781-736-3826 or 781-736-3863

Older Women's League (OWL)
Website: http://www.owl-national.org
Address: 1828 L Street NW, Suite 801
Washington, DC 20036
Hotline: 1-800-825-3695
Phone: 202-332-2949
Email: owlinfo@owl-national.org

Spanish-language Resources

Medline Plus
US National Library of Medicine and the National Institites of Health
Alzheimer's Disease
Website: http://www.nlm.nih.gov/medlineplus/spanish/alzheimersdisease.html
Address: US National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
Email: custserv@nlm.nih.gov

National Institite on Aging
National Institute of Health
Website: http://www.nia.nih.gov/Espanol/Publicaciones/GuiaAlzheimer/
Address: Instituto Nacional Sobre el Envejecimiento
Building 31, Room 5C27
31 Center Drive, MSC 2292
Bethesda, MD 20892
Phone: 1-800-222-2225