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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 5.4 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 amyloid plaques and twisted fibers in brain cells called neurofibrillary tangles. Over time, this destruction erodes the most vital human abilities: language, learning, memory and judgment. Personality and behavior also are dramatically affected by Alzheimer's disease.
Alzheimer's disease is the most common cause of dementia in older people. The terms Alzheimer's disease and dementia are often used interchangeably, but they are not the same. Dementia is a medical term used to describe deterioration in thinking ability severe enough to disrupt a person's normal activities and relationships. Alzheimer's disease is only one of several dozen diseases that cause dementia. Alzheimer's usually begins in people 65 or older, but in rare instances it can affect individuals as young as 30. An estimated one in nine people over 65 have Alzheimer's disease, and about one-third of people age 85 and older have the disease.
Women are more likely to develop Alzheimer's disease than men, and women are more likely to bear the major responsibility for caring for family members with Alzheimer's disease. More than twice as many women as men die of Alzheimer's each 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. Human memory is always fallible. We compensate by writing things down and keeping a calendar. As we age there is so much more we try to remember, and this increases the demands on our memory.
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. Distinguishing normal aging from concerning memory loss is not easy and may require medical advice and testing.
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 disease often are divided into mild cognitive impairment, mild, moderate, severe and very severe dementia. Though these disease phases are not distinct and symptoms often overlap, they help us understand disease progression.
The phases roughly correspond to periods when individuals have memory problems yet remain able to perform their usual activities (mild cognitive impairment); can be relatively independent and need only supervision (mild dementia); need assistance throughout the day (moderate dementia); become dependent on others for daily activities (severe dementia); and motor functions are compromised (very severe dementia).
Not everyone with Alzheimer's disease will reach the most severe phases. Most people with the disease do not require nursing home care.
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. People with Alzheimer's may be disturbed by delusions—serious misunderstandings and false beliefs—such as believing family members are strangers. Mood swings and irritability are common and can escalate if not treated early. These behavioral patterns typically change as the disease progresses.
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), occurs in up to 20 percent of people age 65 and older. And among the people who visit a health care professional due to MCI symptoms, recent studies show up to 38 percent will develop dementia symptoms within five years. 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.
In some cases and in research studies, it is possible to perform spinal fluid or amyloid PET scan testing in patients with MCI to determine whether the cause is Alzheimer's disease pathology.
Mild Alzheimer's symptoms include:
Moderate Alzheimer's symptoms often add:
Severe Alzheimer's includes symptoms listed above plus:
Very severe Alzheimer's includes:
The major risk factor for Alzheimer's disease is age. According to the Alzheimer's Association, one in nine people age 65 and older and about one-third of people 85 and older have Alzheimer's disease.
Although researchers still don't know for sure what typically 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 cause damage to brain cells and 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, young onset Alzheimer's disease, a rare form of the disease that strikes people between the ages of 30 and 60, is often inherited. Only about 5 percent of Alzheimer's disease is the true familial inherited form. Genetic mutations causing young onset Alzheimer's disease have been identified in some of these families.
So far, only one genetic factor has been identified that makes late-life Alzheimer's disease more likely—a gene that makes the APOE epsilon 4 (APOE-e4) form of the apolipoprotein E (ApoE) protein. APOE-e4 is one of three common forms of the APOE gene. The other two forms are APOE-e2 and APOE-e3. Scientists believe there are numerous additional Alzheimer's risk genes, but others haven't yet been convincingly shown to have a major effect on risk
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, there is evidence that risk factors for cardiovascular disease, such as a sedentary lifestyle, smoking, diabetes and obesity, may increase risk for 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.
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 determine whether other medical conditions are causing the 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 end-of-life decisions. Alzheimer's disease is a serious illness that usually requires lifestyle changes and major adjustments for both the person with Alzheimer's and the family members. Early planning and involving all family members can avoid crises and can use financial resources optimally for quality of life.
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.
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, a physician experienced in cognitive evaluations using validated clinical criteria can diagnose Alzheimer's during life with more than 90 percent accuracy.
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:
The list of warning signs above departs significantly from signs considered a part of the normal aging process. These include:
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 person'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 person 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. Often standardized neuropsychological testing consisting of answering questions and drawing pictures will be performed to better understand the nature and severity of cognitive problems and provide clues to the cause. A psychiatric evaluation also may be performed to assess mood and behavior.
You will undergo a neurological examination and tests of the brain. Computerized tomography (CT) and magnetic resonance imaging (MRI) scans give a picture of the brain that enables your doctor to see any abnormalities within your brain including stroke; however, these results are often inconclusive since the loss of brain cells may be mild early in the disease and the plaques and tangled neuron fibers don't show up on these scans. But a brain scan can identify other neurological problems that might cause symptoms like Alzheimer's, such as stroke.
Position emission tomography (PET) scanning, another scanning procedure, can sometimes help physicians distinguish Alzheimer's from other causes of dementia. The test may be covered under Medicare, but only in certain situations.
Even when the doctor makes a diagnosis of Alzheimer's disease, there are varying degrees of certainty:
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.
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. While the drugs can't restore dead brain cells, they can provide modest benefit that slow or temporarily forestall the inevitable decline. Three drugs 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 people with Alzheimer's.
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. Only one of the medications in this class should be taken at one time. Approved drugs in this class are:
A fourth drug, memantine (Namenda), is in a class of its own and is an N-methyl-D-aspartate receptor agonist. It is approved for 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. 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:
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 should include:
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:
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. There are some that have been tested in clinical trials and found not to be effective. 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.
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:
For more information, go to https://www.alz.org/care/alzheimers-dementia-medicare.asp or www.medicare.gov.
Researchers suspect a healthy lifestyle, including controlling blood pressure, cholesterol and weight and getting moderate exercise, may help prevent or delay the onset of Alzheimer's disease symptoms.
For instance, results of a recent study done at the University of Maryland and published in the November 2015 issue of the Journal of the International Neuropsychological Society found exercise can improve thickness of the outer layer of the brain called the cortex, possibly offering protection against dementia. The researchers found the amount of moderate intensity exercise recommended by the United States Centers for Disease Control and Prevention—150 minutes per week—can significantly improve memory after only three months.
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 done at the University of California Berkeley and published in the Archives of Neurology found the more often seniors engaged in mentally demanding activities like reading newspapers, writing letters, or playing games, the less buildup of beta-amyloid they were likely to have in their brains. Beta-amyloid is a toxic protein that builds up in the brains of people with Alzheimer's and is thought to be the biggest component of the plaques that cause Alzheimer's disease.
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. The Memory Improvement with DHA study (MIDAS) found that older adults with normal age-related cognitive decline who took 900 milligrams of the omega-3 fatty acid docosahexaenoic acid (DHA) did better on a computerized memory test than those who took a placebo. 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 people experience.
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.
Alzheimer's is a degenerative disease of the brain, initially characterized by gradual loss of short-term memory and then increasing difficulty performing simple, routine tasks. The disease progresses at different speeds for every individual, but eventually most people experience disorientation and personality and behavior changes. Communicating with others becomes difficult, 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 eventually become entirely dependent on others. Symptoms of natural aging, such as difficulties with short-term memory, do not progress into more serious symptoms as they do with Alzheimer's.
About 5.4 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 nine people over 65 have Alzheimer's, and about one-third of people age 85 and older 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
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 the best 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.
While examining the brain after death is the most definitive way to diagnose Alzheimer's disease, a physician experienced in cognitive evaluations using validated clinical criteria can diagnose Alzheimer's during life with more than 90 percent accuracy. 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.
An evaluation for Alzheimer's disease includes a history and examination, assessment of cognitive abilities, blood tests and brain scans. The physician will need to get information from the patient and also individuals (often family members) who know and have observed the patient.
There are no treatments that can cure or reverse the effects of Alzheimer's or slow its progression. A handful of drugs approved by the U.S. Food and Drug Administration (FDA) can alleviate some of the cognitive and behavioral symptoms, particularly 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 person's home environment or creating a routine and staying active—since some medications can contribute to increased problems with dementia.
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.
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 https://www.alz.org/help-support.
For information and support on coping with Alzheimer's Disease, please see the recommended organizations and Spanish-language resources listed below.
Alzheimer's Disease Education and Referral Center (ADEAR)
Website: https://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: https://www.alzdiscovery.org
Address: 1414 Avenue of the Americas
Suite 1502
New York, NY 10019
Alzheimer's Foundation of America
Website: https://www.alzfdn.org
Address: 322 8th Ave., 7th Floor
New York, NY 10001
Hotline: 1-866-AFA-8484 (1-866-232-8484)
BrightFocus Foundation
Website: https://www.ahaf.org
Address: 22512 Gateway Center Drive
Clarksburg, MD 20871
Hotline: 1-800-437-AHAF (2423)
Email: info@brightfocus.org
Eldercare Locator
Website: https://eldercare.acl.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: https://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: https://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: https://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: https://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: https://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
Spanish-language resources
Medline Plus
US National Library of Medicine and the National Institutes of Health
Alzheimer's Disease
Website: https://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 Institute on Aging
National Institute of Health
Website: https://www.nia.nih.gov/health/spanish/alzheimer
Address: Instituto Nacional Sobre el Envejecimiento
Building 31, Room 5C27
31 Center Drive, MSC 2292
Bethesda, MD 20892
Phone: 1-800-222-2225
HealthyWomen content is for informational purposes only. Please consult your healthcare provider for medical advice, diagnosis or treatment.
African Americans have higher rates of dementia and Alzheimer's disease than white Americans.