| What is alzheimer's disease? |
Alzheimer's disease is the most common cause of dementia, which is the loss of intellectual and social abilities severe enough to interfere with daily functioning. Dementia occurs in people with Alzheimer's disease because healthy brain tissue degenerates, causing a steady decline in memory and mental abilities.
More than 4 million older Americans have Alzheimer's, a disease that usually develops in those age 65 or older. This number is expected to quadruple by the year 2050 as more people live into their 80s and 90s.
Although there's no cure for Alzheimer's disease, researchers have made progress. Treatments are available that help improve the quality of life for people with Alzheimer's. Also, more drugs are being studied, and scientists have discovered several genes associated with Alzheimer's, which may lead to new treatments to block progression of this complex disease.
In the meantime, caring for someone with Alzheimer's takes patience and a focus on the things a person can still do and enjoy. Those with Alzheimer's — as well as those who care for them — need support and affection from friends and family to cope.
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| Signs and symptoms |
Everyone has occasional lapses in memory. It's often quite normal to forget the names of people whom you rarely see. But it's not a normal part of aging to forget the names of familiar people and objects.
Alzheimer's disease — which is a progressive (degenerative) brain disease — goes beyond simple forgetfulness. It may start with slight memory loss and confusion, but it eventually leads to irreversible mental impairment that destroys a person's ability to remember, reason, learn and imagine.
Most people with Alzheimer's share certain signs and symptoms of the disease. These may include:
- Increasing and persistent forgetfulness. At its onset, Alzheimer's disease is marked by
periods of forgetfulness, especially of recent events or simple directions. But what begins as mild
forgetfulness persists and worsens. People with Alzheimer's may repeat things and forget
conversations or appointments. They routinely misplace things, often putting them in illogical
locations. They frequently forget names, and eventually, they may forget the names of family members
and everyday objects.
- Difficulties with abstract thinking. People with Alzheimer's may initially have trouble
balancing their checkbook, a problem that progresses to trouble recognizing and understanding
numbers.
- Difficulty finding the right word. It may be a challenge for those with Alzheimer's to
find the right words to express thoughts or even follow conversations. Eventually, reading and
writing also are affected.
- Disorientation. People with Alzheimer's may lose a sense of time and dates. They may find
themselves lost in familiar surroundings. Eventually, they may even wander from home.
- Loss of judgment. Solving everyday problems, such as knowing what to do if food on the
stove is burning, becomes increasingly difficult, eventually impossible. Alzheimer's is
characterized by greater difficulty in doing things that require planning, decision making and
judgment.
- Difficulty performing familiar tasks. Once-routine tasks that require sequential steps,
such as cooking, become a struggle as the disease progresses. Eventually, people with advanced
Alzheimer's may forget how to do the most basic things.
- Personality changes. People with Alzheimer's may exhibit mood swings. They may express distrust in others, show increased stubbornness and withdraw socially. Early on, this may be a response to the frustration they feel as they notice uncontrollable changes in their memory. Depression often coexists with Alzheimer's disease. Restlessness also is a common sign. As the disease progresses, people with Alzheimer's may become anxious or aggressive and behave inappropriately.
The course the disease takes and how rapidly changes occur vary from person to person. For some, the progression from simple forgetfulness to severe dementia takes five years. For others, it can take a decade or longer.
Alzheimer's generally progresses from mild to moderate to severe to, finally, profound impairment. People with mild Alzheimer's can usually live alone and function fairly well. Those with moderate Alzheimer's may have greater difficulty coping without supervision. People with advanced Alzheimer's generally can no longer care for themselves.
Researchers have identified a state of memory loss called mild cognitive impairment that could potentially be known as a pre-Alzheimer's period. This memory loss falls somewhere between what's associated with normal aging and what's common in Alzheimer's disease. People with mild cognitive impairment may experience forgetfulness beyond what's typical for their age, yet they don't have the dementia of Alzheimer's. Identification of this category of memory loss could help doctors more accurately diagnose, advise and treat these people. It could also alert these people to a greater risk of developing Alzheimer's disease.
In the past, people called dementia senility and considered it an inevitable part of aging. Doctors now know that dementia isn't a normal part of aging and that it's caused by some underlying condition affecting the brain.
Many different conditions can cause dementia. Alzheimer's disease accounts for more than half of all dementia cases. However, as many as 50 other conditions may cause dementia. Some are treatable, such as depression. That makes it important to diagnose the particular signs and symptoms of a dementia and attempt to identify its underlying cause.
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| Causes |
The causes of Alzheimer's aren't well understood. But researchers have found that people with Alzheimer's have brain cells that become damaged and die for unknown reasons.
A healthy brain has about 100 billion nerve cells called neurons. Neurons generate electrical and chemical signals that are relayed from neuron to neuron to help you think, remember and feel. Chemicals called neurotransmitters help these signals flow seamlessly between neurons.
Initially in people with Alzheimer's, neurons in certain locations of the brain begin to die. As they die, lower levels of neurotransmitters are produced, creating signaling problems in the brain.
Using the methods above, doctors can accurately diagnose 90 percent of Alzheimer's cases. Alzheimer's can be diagnosed with 100-percent accuracy only after a microscopic examination of brain tissue, which checks for plaques and tangles.
Genetic testing for Alzheimer's is in its infancy stages. Blood tests are available that can tell whether a person carries genetic mutations believed associated with Alzheimer's, but the tests can't tell who will or will not get the disease.
| Complications |
Most people with Alzheimer's don't die of the disease itself but of a secondary illness, such as pneumonia or another infection.
In advanced Alzheimer's disease, people may lose all ability to care for themselves. They may have difficulty eating, become incontinent, or be unable to take a walk and find their way back home.
These inabilities can increase the risk of complicating health problems such as:
- Pneumonia. Difficulty swallowing food and liquids may cause people with Alzheimer's to
inhale some of what they eat and drink into their airways and lungs, which can lead to pneumonia.
- Infections. Urinary incontinence may require the placement of a urinary catheter, which
increases the risk of urinary tract infections. Untreated urinary tract infections can lead to more
serious, life-threatening infections.
- Falls and their complications. People with Alzheimer's may become disoriented, increasing their risk of falls. Falls can lead to bone fractures. In addition, falls are a common cause of serious head injuries, such as bleeding in the brain. Surgery to repair injury from a fall carries risks as well. For instance, prolonged immobilization — which may be necessary to recover from injuries related to a fall — increases the risk of a blood clot in the lungs (pulmonary embolism), which can be life-threatening.
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| Treatment |
Currently, there's no cure for Alzheimer's disease. Medications and caregiving are the primary treatments.
Medications
Current medications for Alzheimer's can't stop or reverse the underlying disease process. But they may slow it down, lessening signs and symptoms. Medications commonly recommended for people with Alzheimer's include:
- Donepezil (Aricept). This medication decreases mild to moderate symptoms of Alzheimer's
by improving levels of neurotransmitters in the brain.
- Rivastigamine (Exelon). Like donepezil, rivastigamine blocks the breakdown of
neurotransmitters in the brain, lessening symptoms.
- Galantamine (Reminyl). Galantamine is a newer medication to treat Alzheimer's. It improves both cognition and behavior.
Doctors also sometimes prescribe drugs to improve behavioral symptoms that often accompany Alzheimer's, including sleeplessness, wandering, anxiety, agitation and depression.
Today, treatment of Alzheimer's disease is still in its infancy. But researchers are confident that in the not-too-distant future, new medications should be available that do more than treat the symptoms of Alzheimer's. Mayo Clinic researchers continue to study a breed of mice with Alzheimer's-like symptoms. This research is expected to accelerate the study of drugs that can delay or slow the progression of Alzheimer's.
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Caregiving
Until there's a cure for Alzheimer's, people with the disease will need caregiving. According to the Alzheimer's Association, approximately one in 10 families have a relative with Alzheimer's disease. Of the 4 million people with Alzheimer's disease in the United States, the majority live at home — often receiving part- or full-time care from family members.
Caregiving can be a challenge. The slow and unpredictable decline that may last more than a decade requires caregivers to exercise patience, understanding, compassion, and often, creativity.
The key to caregiving is focusing on things that the person with Alzheimer's can still do and enjoy. In fact, learning ways to reduce the impact of impaired abilities and behavior problems can help avoid some of the most difficult aspects of the disease.
Each person with Alzheimer's disease experiences its symptoms and progression differently. Consequently, the techniques to care for each person should vary. You may have to adapt the following tips to your specific caregiving situation:
- Use memory aids. Memory aids may help a friend or family member remain independent. Write
out a list of the day's activities, the phone numbers that can be used to call for help and
instructions on how to do simple tasks, such as make a cup of tea or use the telephone.
- Provide structure. A home environment that provides serenity and stability reduces
behavior problems. New situations, noise, large groups of people, being rushed or pressed to
remember, or being asked to do a task that's too difficult can cause anxiety. As a person with
Alzheimer's becomes upset, the ability to think clearly declines even more.
- Monitor wandering. Wandering is a common problem. In some cases, a pocket card with
simple instructions, such as "Call home" (with a phone number below), may help. Make sure your loved
one wears a bracelet with his or her name, phone number and a notation such as "Memory impaired."
The Alzheimer's Association offers this resource through its national Safe Return Program. Also try
to determine the cause of wandering. It may simply be a signal that the person with Alzheimer's is
looking for something, such as a bathroom, or is seeking a meaningful activity or reassurance. Some
experts believe taking your loved one for a vigorous daily walk helps reduce wandering.
- Establish a nighttime ritual. Behavior is often worse at night. Try to establish
going-to-bed rituals that are calming and away from the noise of television, meal cleanup and active
family members. Leave night lights on to prevent disorientation. Limiting caffeine during the day,
discouraging daytime napping and offering opportunities for exercise during the day may help prevent
nighttime restlessness.
- Enhance communication. When talking with your loved one, stand where you can be seen and
touch his or her arm or shoulder to focus attention. Speak slowly, in simple sentences and don't
rush the response. Present only one idea or instruction at a time. Use gestures and cues, such as
pointing to objects. Avoid asking questions or offering difficult choices because trying to come up
with answers may prove frustrating.
- Create a safe environment. Make your home familiar and safe. Keep furniture in the same
place to avoid clutter and help prevent falls. Install locks on cabinets containing medicines,
alcohol, guns, toxic substances, and dangerous utensils and tools. Remove electrical appliances from
your bathroom to prevent shocks, set your water heater no higher than 120 F to prevent scalding, and
install grab rails to prevent falls.
- Encourage exercise. Exercise carries many benefits for someone with Alzheimer's disease. The fact that these benefits often are the same for people without Alzheimer's disease doesn't lessen their importance. In fact, it just makes exercise a more important activity for caregivers and people with Alzheimer's to engage in together. The main benefits of exercise include improved strength, endurance and cardiovascular health. Exercise can also improve energy, sleep, circulation, stamina and mood. For people with Alzheimer's disease, exercise can help retain motor skills, impart a sense of meaning or purpose, create a calming effect, and sustain strength, flexibility and balance — lessening the risk of serious injury from a fall.
- How long can a person with Alzheimer's safely drive, work or live alone?
- Can family or friends provide the care necessary for the current phase and during later
progression of the disease?
- Is money available for professional in-home care or a care facility now or in the future if the need arises?
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| Prevention |
Right now, there's no way to prevent the onset of Alzheimer's disease. But researchers continue to look for ways to reduce risk of the disease. Several leads are hopeful, but preliminary. They include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). A study released in 1996 showed that the
NSAIDs ibuprofen (Advil, Motrin, others), naproxen sodium (Aleve) and indomethacin (Indocin) reduced
the risk of developing Alzheimer's. Doctors believe brain inflammation occurs as one part in the
development of Alzheimer's. Investigators were uncertain why aspirin, which also is an
anti-inflammatory drug, and acetaminophen (Tylenol, others), which is not, had no effect. NSAIDs can
cause gastrointestinal bleeding. For this reason, clinical trials need to be completed before it's
clear whether doctors should recommend that people take NSAIDs solely to prevent Alzheimer's.
- Vitamin E and selegiline. Researchers are studying whether vitamin E and selegiline
(Eldepryl), a drug used to treat Parkinson's disease, may hold a possible protective effect against
the progression of Alzheimer's. These substances may slow the rate of decline in people with
moderately severe Alzheimer's. Vitamin E and selegiline are antioxidants and may help prevent brain
cell damage by destroying toxic free radicals. Free radicals are byproducts of normal cell function.
Some scientists believe free radicals are discharged by immune cells that are in the brain
responding to chronic brain inflammation from Alzheimer's. The free radicals may attach to molecules
in brain cells and disrupt brain cell function. Findings of the only large clinical trial to date,
with regard to these antioxidants, were published in the April 24, 1997, issue of the New England
Journal of Medicine. In the trial, people with moderate Alzheimer's who were given selegiline or
high doses of vitamin E, or a combination of both, experienced a seven-month delay in the
progression of the disease.
- Estrogen. Alzheimer's disease in older women may be related to estrogen deficiency.
Estrogen helps keep the brain healthy by boosting production of a key neurotransmitter, helping
prevent deposits of plaque and improving blood flow to the brain. Studies show that hormone
replacement therapy after menopause can reduce a woman's risk of developing Alzheimer's by 40
percent to 50 percent. However, the results of the largest and longest trial to date involving
estrogen and women with Alzheimer's, published in 2000, showed no differences between the women who
received estrogen replacement therapy and those who didn't after one year. A smaller trial also
showed no benefit in administering estrogen for preventing Alzheimer's. Because the impact of
estrogen still isn't proved, women shouldn't begin hormone replacement therapy solely to prevent
Alzheimer's without the approval of their doctor.
- Mental fitness. Maintaining mental fitness may delay onset of dementia. Some researchers believe that lifelong mental exercise and learning may promote the growth of additional synapses, the connections between neurons, and delay the onset of dementia. Other researchers argue that advanced education gives a person more experience with the types of memory and thinking tests used to measure dementia. This advanced level of education simply may help some people "cover up" their condition until later.
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| Coping skills |
People with Alzheimer's disease often experience a mixture of emotions — confusion, frustration, anger, fear, uncertainty, grief and depression. You can help a person cope with the disease by being there to listen, reassuring the person that life can still be enjoyed, providing unconditional love and doing your best to help the person retain dignity and self-respect.
Caring for a person with Alzheimer's disease can be an all-absorbing experience. The physical and emotional demands of caregiving can be exhausting. Feelings of anger and guilt, frustration and discouragement, worry and grief, and social isolation are common. If you're a caregiver for someone with Alzheimer's disease, you can help yourself and help prevent caregiver burnout by:
- Asking friends or other family members for help when you need it.
- Taking care of your health.
- Learning as much about the disease as you can. Ask questions of doctors, social workers and
others involved in the care of your loved one.
- Joining a support group.
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| Complementary and alternative medicine |
Some alternative medicines may benefit a person with Alzheimer's. The herb ginkgo continues to be studied for its brain-enhancing effects both in healthy people and people with Alzheimer's. For now, however, ginkgo isn't proved to improve memory or prevent Alzheimer's.
Vitamin E, an antioxidant being studied as a treatment for Alzheimer's, doesn't require a prescription. You can purchase vitamin E over-the-counter. But it's best taken under a doctor's supervision to monitor for possible side effects such as bleeding and gastrointestinal problems.
Some limited studies suggest that aromatherapy — using fragrant plant oils to relax and affect the body — and massage can play a supportive role in Alzheimer's treatment.
— June 4, 2003 —