Alzheimer’s Disease (Dementia) Basics


What is Alzheimer’s disease?

Dementia is a brain disorder that seriously affects a person’s ability to carry out daily activities. The most common form of dementia among older people is Alzheimer’s disease (AD), which initially involves the parts of the brain that control thought, memory, and language. Although scientists are learning more every day, right now they still do not know what causes Alzheimer’s disease, and there is no cure.

Abnormal clumps in the brain (called amyloid plaques) and tangled bundles of fibers (called neurofibrillary tangles) are considered signs of Alzheimer’s disease.

Scientists also have found other brain changes in people with Alzheimer’s disease. Nerve cells die in areas of the brain that are vital to memory and other mental abilities, and connections between nerve cells are disrupted. There also are lower levels of some of the chemicals in the brain that carry messages back and forth between nerve cells. Alzheimer’s disease may impair thinking and memory by disrupting these messages.

How long can a person live with Alzheimer’s disease?

Alzheimer’s disease is a slow disease, starting with mild memory problems and ending with severe brain damage. The course the disease takes and how fast changes occur vary from person to person. On average, people with Alzheimer’s disease live from 8 to 10 years after they are diagnosed, though the disease can last for as many as 20 years.

What causes Alzheimer’s disease?

Physicians do not yet fully understand what causes Alzheimer’s disease. There probably is not one single cause, but several factors that affect each person differently. Age is the most important known risk factor for Alzheimer’s disease. The number of people with the disease doubles every 5 years beyond age 65.

Family history is another risk factor. Scientists believe that genetics may play a role in many Alzheimer’s disease cases. For example, “early-onset familial” Alzheimer’s disease, a rare form of Alzheimer’s disease that usually occurs between the ages of 30 and 60, is inherited.

The more common form of Alzheimer’s disease is known as “late-onset”. It occurs later in life, and no obvious inheritance pattern is seen in most families. However, several risk factor genes may interact with each other and with non-genetic factors to cause the disease. The only risk factor gene identified so far for late-onset Alzheimer’s disease is a gene that makes one form of a protein called apolipoprotein E (ApoE). Everyone has ApoE, which helps carry cholesterol in the blood. Only about 15 percent of people have the form that increases the risk of Alzheimer’s disease. It is likely that other genes also may increase the risk of Alzheimer’s disease or protect against Alzheimer’s disease, but they remain to be discovered.

What are the symptoms of Alzheimer’s disease?

Alzheimer’s disease begins slowly. At first, the only symptom may be mild forgetfulness, which can be confused with age-related memory change. Most people with mild forgetfulness do not have Alzheimer’s disease. In the early stage of Alzheimer’s disease, people may have trouble remembering recent events, activities, or the names of familiar people or things. They may not be able to solve simple math problems. Such difficulties may be a bother, but usually they are not serious enough to cause alarm.

The Seven Warning Signs of Alzheimer’s Disease

  • Asking the same question over and over again.
  • Repeating the same story, word for word, again and again.
  • Forgetting how to cook, or how to make repairs, or how to play cards—activities that were previously done with ease and regularity.
  • Losing one’s ability to pay bills or balance one’s checkbook.
  • Getting lost in familiar surroundings, or misplacing household objects.
  • Neglecting to bathe, or wearing the same clothes over and over again, while insisting that they have taken a bath or that their clothes are still clean.
  • Relying on someone else, such as a spouse, to make decisions or answer questions they previously would have handled themselves.

As the disease goes on, symptoms are more easily noticed and become serious enough to cause people with Alzheimer’s disease or their family members to seek medical help. Forgetfulness begins to interfere with daily activities. People in the middle stages of Alzheimer’s disease may forget how to do simple tasks like brushing their teeth or combing their hair. They can no longer think clearly. They can fail to recognize familiar people and places. They begin to have problems speaking, understanding, reading, or writing. Later on, people with Alzheimer’s disease may become anxious or aggressive, or wander away from home. Eventually, patients need total care.

What happens during each stage of Alzheimer’s disease?

Alzheimer’s disease develops slowly and causes changes in the brain long before there are obvious changes in a person’s memory, thinking, use of words or behavior. Stages and changes the person will go through are outlined below.

Common Changes in Mild Alzheimer’s disease

  • Loses spark or zest for life–does not start anything.
  • Loses recent memory without a change in appearance or casual conversation.
  • Loses judgment about money.
  • Has difficulty with new learning and making new memories.
  • Has trouble finding words–may substitute or make up words that sound like or mean something like the forgotten word.
  • Takes longer to do routine chores and becomes upset if rushed or if something unexpected happens.
  • Forgets to pay, pays too much, or forgets how to pay–may hand the checkout person a wallet instead of the correct amount of money.
  • Loses or misplaces things by hiding them in odd places or forgets where things go, such as putting clothes in the dishwasher.
  • Constantly checks, searches or hoards things of no value.

Common Changes in Moderate Alzheimer’s disease

  • Changes in behavior, concern for appearance, hygiene, and sleep become more noticeable.
  • Mixes up identity of people, such as thinking a son is a brother or that a wife is a stranger.
  • Poor judgment creates safety issues when left alone–may wander and risk exposure, poisoning, falls, self-neglect or exploitation.
  • Has trouble recognizing familiar people and own objects; may take things that belong to others.
  • Continuously repeats stories, favorite words, statements, or motions like tearing tissues.
  • Has restless, repetitive movements in late afternoon or evening, such as pacing, trying doorknobs, fingering draperies.
  • Makes up stories to fill in gaps in memory. For example might say, “Mama will come for me when she gets off work.”

Common Changes in Severe Alzheimer’s disease

  • Doesn’t recognize self or close family.
  • Speaks in gibberish, is mute, or is difficult to understand.
  • Loses control of bowel and bladder.
  • Loses weight and skin becomes thin and tears easily.
  • Forgets how to walk or is too unsteady or weak to stand alone.
  • May groan, scream or mumble loudly.
  • Sleeps more.
  • Needs total assistance for all activities of daily living.

How is Alzheimer’s disease diagnosed?

At specialized centers, the diagnosis of Alzheimer’s disease can be made correctly up to 90 percent of the time. Doctors use several tools to diagnose “probable Alzheimer’s disease”, including:

  • Questions about the person’s general health, past medical problems, and ability to carry out daily activities.
  • Tests to measure memory, problem solving, attention, counting, and language.
  • Medical tests, such as tests of blood, urine, or spinal fluid, and brain scans.

Sometimes these test results help the doctor find other possible causes of the person’s symptoms. For example, thyroid problems, drug reactions, depression, brain tumors, and blood vessel disease in the brain can cause Alzheimer’s disease-like symptoms. Some of these other conditions can be treated successfully.

The most accurate way to diagnose Alzheimer’s disease is to find out whether there are plaques and tangles in brain tissue. However, this requires an evaluation of the brain during autopsy after the person has died. Alzheimer’s disease research continues to develop on ways diagnosing Alzheimer’s disease while the person is still alive.

Why is early diagnosis important?

An early, accurate diagnosis of Alzheimer’s disease helps patients and their families plan for the future. It gives them time to discuss care options while the patient can still take part in making decisions. Early diagnosis also offers the best chance to treat the symptoms of the disease.

What medication are currently available to treat Alzheimer’s disease?

No treatment has been proven to stop Alzheimer’s disease. However, for some people in the early and middle stages of the disease, Aricept® (donepezil), Exelon® (rivastigmine), Exelon patch® (rivastagmine patch) or Razadyne® (galantamine), formerly known as Reminyl®, may help prevent some symptoms from becoming worse for a limited time in some patients.

In addition, Namenda® (mematine), has been approved to treat moderate to severe Alzheimer’s disease.

Also, some medicines may help control behavioral symptoms of Alzheimer’s disease such as sleeplessness, agitation, wandering, anxiety, and depression. Treating these symptoms often makes patients more comfortable and makes their care easier for caregivers.

What is the outlook for someone diagnosed with Alzheimer’s disease?

The course the disease takes and how fast changes occur vary from person to person. On average, people with Alzheimer’s disease live from 8 to 10 years after they are diagnosed, though the disease can last for as many as 20 years.

Where can I learn more?

To request an evaluation of your loved one request an appointment at Metro Medical Direct (NYC Manhattan Medical House Calls and Elder care).

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