Alzheimer's Disorder


Fact: Alzheimer's is the sixth leading cause of death in the United States

Overview
Alzheimer’s disease is a progressive brain disorder that impacts memory, thinking and language skills, and the ability to carry out the simplest tasks. Alzheimer’s disease is the most common cause of dementia. Dementia itself is not a disease, but a term used to describe symptoms such as loss of memory, loss of judgment and other intellectual functions. Alzheimer’s disease can cause dementia.

It is important to note that Alzheimer’s disease is not a normal part of aging, and it is important to look for signs like these that might indicate Alzheimer’s disease versus basic forgetfulness or other conditions. With Alzheimer’s disease, these symptoms gradually increase and become more persistent.

Symptoms
​At first, increasing forgetfulness or mild confusion may be the only symptoms of Alzheimer's disease that you notice. But over time, the disease robs you of more of your memory, especially recent memories. The rate at which symptoms worsen varies from person to person.

If you have Alzheimer's, you may be the first to notice that you're having unusual difficulty remembering things and organizing your thoughts. Or you may not recognize that anything is wrong, even when changes are noticeable to your family members, close friends or co-workers.

Brain changes associated with Alzheimer's disease lead to growing trouble with:

Memory
Everyone has occasional memory lapses. It's normal to lose track of where you put your keys or forget the name of an acquaintance. But the memory loss associated with Alzheimer's disease persists and worsens, affecting your ability to function at work and at home.

People with Alzheimer's may:

  • Repeat statements and questions over and over, not realizing that they've asked the question before
  • Forget conversations, appointments or events, and not remember them later
  • Routinely misplace possessions, often putting them in illogical locations
  • Get lost in familiar places
  • Eventually forget the names of family members and everyday objects
  • Have trouble finding the right words to identify objects, express thoughts or take part in conversations

Thinking and reasoning
Alzheimer's disease causes difficulty concentrating and thinking, especially about abstract concepts like numbers.

Multitasking is especially difficult, and it may be challenging to manage finances, balance checkbooks and pay bills on time. These difficulties may progress to inability to recognize and deal with numbers.

Making judgments and decisions
Responding effectively to everyday problems, such as food burning on the stove or unexpected driving situations, becomes increasingly challenging.

Planning and performing familiar tasks
Once-routine activities that require sequential steps, such as planning and cooking a meal or playing a favorite game, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer's may forget how to perform basic tasks such as dressing and bathing.

Changes in personality and behavior
Brain changes that occur in Alzheimer's disease can affect the way you act and how you feel. People with Alzheimer's may experience:

  • Depression
  • Apathy
  • Social withdrawal
  • Mood swings
  • Distrust in others
  • Irritability and aggressiveness
  • Changes in sleeping habits
  • Wandering
  • Loss of inhibitions
  • Delusions, such as believing something has been stolen

Many important skills are not lost until very late in the disease. These include the ability to read, dance and sing, enjoy old music, engage in crafts and hobbies, tell stories, and reminisce.

This is because information, skills and habits learned early in life are among the last abilities to be lost as the disease progresses; the part of the brain that stores this information tends to be affected later in the course of the disease. Capitalizing on these abilities can foster successes and maintain quality of life even into the moderate phase of the disease.

Stages of Alzheimer's
Alzheimer’s Foundation of America follows the National Institutes of Health’s  National Institute on Aging in describing the disease in three stages early (mild), middle (moderate) and  late (severe).

Early (Mild)
In this stage, people may:

  • Forget words or misplace objects
  • Forget something they just read
  • Ask the same question over and over
  • Have increasing trouble making plans or organizing
  • Not remember names when meeting new people


Middle (Moderate)
In this stage, people may have:

  • Increased memory loss and confusion
  • Problems recognizing family and friends
  • Continuously repeating stories, favorite wants (e.g., foods, places, songs, etc.), or motions
  • Decreased ability to perform complex tasks (e.g., planning dinner) or handle personal finances (e.g., paying bills)
  • Lack of concern for hygiene and appearance
  • Requiring assistance in choosing proper clothing to wear for day, season, or occasion  


​Late (Severe)

In this stage, there is almost total memory loss. The individual may:

  • Recognize faces but forget names
  • Mistake a person for someone else
  • Delusions—such as thinking he/she needs to go to work — may set in, even though he/she no longer has a job
  • There is a strong need for holding something close for tactile stimulation, nurturing, companionship and comfort
  • Basic abilities such as eating, walking, and sitting up fade during this period; the individual may no longer recognize when he is thirsty or hungry and will need help with all basic activities of daily living

Complications
Memory and language loss, impaired judgment, and other cognitive changes caused by Alzheimer's can complicate treatment for other health conditions. A person with Alzheimer's disease may not be able to:

  • Communicate that he or she is experiencing pain — for example, from a dental problem
  • Report symptoms of another illness
  • Follow a prescribed treatment plan
  • Notice or describe medication side effects

As Alzheimer's disease progresses to its last stages, brain changes begin to affect physical functions, such as swallowing, balance, and bowel and bladder control. These effects can increase vulnerability to additional health problems such as:

  • Inhaling food or liquid into the lungs (aspiration)
  • Pneumonia and other infections
  • Falls
  • Fractures
  • Bedsores
  • Malnutrition or dehydration


Causes
Scientists believe that for most people, Alzheimer's disease is caused by a combination of genetic, lifestyle and environmental factors that affect the brain over time.

Less than 5 percent of the time, Alzheimer's is caused by specific genetic changes that virtually guarantee a person will develop the disease.
Although the causes of Alzheimer's aren't yet fully understood, its effect on the brain is clear.

Alzheimer's disease damages and kills brain cells. A brain affected by Alzheimer's disease has many fewer cells and many fewer connections among surviving cells than does a healthy brain.


Risk factors

Age
Increasing age is the greatest known risk factor for Alzheimer's. Alzheimer's is not a part of normal aging, but your risk increases greatly after you reach age 65. The rate of dementia doubles every decade after age 60.

People with rare genetic changes linked to early-onset Alzheimer's begin experiencing symptoms as early as their 30s.

Family history and genetics
Your risk of developing Alzheimer's appears to be somewhat higher if a first-degree relative — your parent or sibling — has the disease. Scientists have identified rare changes (mutations) in three genes that virtually guarantee a person who inherits them will develop Alzheimer's. But these mutations account for less than 5 percent of Alzheimer's disease.

Most genetic mechanisms of Alzheimer's among families remain largely unexplained. The strongest risk gene researchers have found so far is apolipoprotein e4 (APoE4), though not everyone with this gene goes on to develop Alzheimer's disease. Other risk genes have been identified but not conclusively confirmed.

Down syndrome
Many people with Down syndrome develop Alzheimer's disease. Signs and symptoms of Alzheimer's tend to appear 10 to 20 years earlier in people with Down syndrome than they do for the general population. A gene contained in the extra chromosome that causes Down syndrome significantly increases the risk of Alzheimer's disease.

Sex
Women seem to be more likely than are men to develop Alzheimer's disease, in part because they live longer.

Mild cognitive impairment
People with mild cognitive impairment (MCI) have memory problems or other symptoms of cognitive decline that are worse than might be expected for their age, but not severe enough to be diagnosed as dementia.

Those with MCI have an increased risk — but not a certainty — of later developing dementia. Taking action to develop a healthy lifestyle and strategies to compensate for memory loss at this stage may help delay or prevent the progression to dementia.

Past head trauma
People who've had a severe head trauma seem to have a greater risk of Alzheimer's disease.

Lifestyle and heart health
There's no lifestyle factor that's been definitively shown to reduce your risk of Alzheimer's disease.
However, some evidence suggests that the same factors that put you at risk of heart disease also may increase the chance that you'll develop Alzheimer's. Examples include:

  • Lack of exercise
  • Obesity
  • Smoking or exposure to secondhand smoke
  • High blood pressure
  • High blood cholesterol
  • Poorly controlled type 2 diabetes
  • A diet lacking in fruits and vegetables

These risk factors are also linked to vascular dementia, a type of dementia caused by damaged blood vessels in the brain. Working with your health care team on a plan to control these factors will help protect your heart — and may also help reduce your risk of Alzheimer's disease and vascular dementia.

Lifelong learning and social engagement
Studies have found an association between lifelong involvement in mentally and socially stimulating activities and a reduced risk of Alzheimer's disease. Low education levels — less than a high school education — appear to be a risk factor for Alzheimer's disease.

Steps to diagnosis
There is no single test that shows a person has Alzheimer's. While physicians can almost always determine if a person has dementia, it may be difficult to determine the exact cause. Diagnosing Alzheimer's requires careful medical evaluation, including:

  • A thorough medical history
  • Mental status and mood testing
  • A physical and neurological exam
  • Tests (such as blood tests and brain imaging) to rule out other causes of dementia-like symptoms

People with memory loss or other possible warning signs of Alzheimer's may find it hard to recognize they have a problem and may resist following up on their symptoms. Signs of dementia may be more obvious to family members or friends.

Having trouble with memory does not mean you have Alzheimer's. Many health issues can cause problems with memory and thinking. When dementia-like symptoms are caused by treatable conditions — such as depression, drug interactions, thyroid problems, excess use of alcohol or certain vitamin deficiencies — they may be reversed.

Treatment

​Drugs
Current Alzheimer's medications can help for a time with memory symptoms and other cognitive changes. Two types of drugs are currently used to treat cognitive symptoms:

  • Cholinesterase inhibitors. These drugs work by boosting levels of a cell-to-cell communication by providing a neurotransmitter (acetylcholine) that is depleted in the brain by Alzheimer's disease. The improvement is modest. Cholinesterase inhibitors can improve neuropsychiatric symptoms, such as agitation or depression, as well.
    Commonly prescribed cholinesterase inhibitors include donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon). The main side effects of these drugs include diarrhea, nausea, loss of appetite and sleep disturbances. In people with cardiac conduction disorders, serious side effects may include a slow heart rate and heart block.
  • Memantine (Namenda). This drug works in another brain cell communication network and slows the progression of symptoms with moderate to severe Alzheimer's disease. It's sometimes used in combination with a cholinesterase inhibitor. Side effects may include constipation, dizziness and headache.

Sometimes other medications such as antidepressants are used to help control the behavioral symptoms associated with Alzheimer's disease. But some medications should only be used with great caution. For example, some common sleep medications — zolpidem (Ambien), eszopiclone (Lunesta) and others — may increase confusion and the risk of falls.

Anti-anxiety medications — clonazepam (Klonopin) and lorazepam (Ativan) — increase the risk of falls, confusion and dizziness. Always check with your doctor before taking any new medications.

Creating a safe and supportive environment
Adapting the living situation to the needs of a person with Alzheimer's is an important part of any treatment plan. For someone with Alzheimer's, establishing and strengthening routine habits and minimizing memory-demanding tasks can make life much easier.

You can take these steps to support a person's sense of well-being and continued ability to function:

  • Always keep keys, wallets, mobile phones and other valuables in the same place at home, so they don't become lost.
  • See if your doctor can simplify your medication regimen to once-daily dosing, and arrange for your finances to be on automatic payment and automatic deposit.
  • Develop the habit of carrying a mobile phone with location capability so that you can call in case you are lost or confused and people can track your location via the phone. Also, program important phone numbers into your phone, so you don't have to try to recall them.
  • Make sure regular appointments are on the same day at the same time as much as possible.
  • Use a calendar or whiteboard in the home to track daily schedules. Build the habit of checking off completed items so that you can be sure they were completed.
  • Remove excess furniture, clutter and throw rugs.
  • Install sturdy handrails on stairways and in bathrooms.
  • Ensure that shoes and slippers are comfortable and provide good traction.
  • Reduce the number of mirrors. People with Alzheimer's may find images in mirrors confusing or frightening.
  • Keep photographs and other meaningful objects around the house.

Exercise
Regular exercise is an important part of everybody's wellness plan — and those with Alzheimer's are no exception. Activities such as a daily walk can help improve mood and maintain the health of joints, muscles and the heart.

Exercise can also promote restful sleep and prevent constipation. Make sure that the person with Alzheimer's carries identification or wears a medical alert bracelet if she or he walks unaccompanied.

People with Alzheimer's who develop trouble walking may still be able to use a stationary bike or participate in chair exercises. You may be able to find exercise programs geared to older adults on TV or on DVDs.

Nutrition
People with Alzheimer's may forget to eat, lose interest in preparing meals or not eat a healthy combination of foods. They may also forget to drink enough, leading to dehydration and constipation.
Offer:

  • High-calorie, healthy shakes and smoothies. You can supplement milkshakes with protein powders (available at grocery stores, drugstores and discount retailers) or use your blender to make smoothies featuring your favorite ingredients.
  • Water, juice and other healthy beverages. Try to ensure that a person with Alzheimer's drinks at least several full glasses of liquids every day. Avoid beverages with caffeine, which can increase restlessness, interfere with sleep and trigger a frequent need to urinate.

Certain nutritional supplements are marketed as "medical foods" specifically to treat Alzheimer's disease. The Food and Drug Administration (FDA) does not approve products marketed as medical foods. Despite marketing claims, there's no definitive data showing that any of these supplements is beneficial or safe.

Alternative medicine
Various herbal mixtures, vitamins and other supplements are widely promoted as preparations that may support cognitive health or prevent or delay Alzheimer's. Currently, there's no strong evidence that any of these therapies slow the progression of cognitive decline.

Some of the treatments that have been studied recently include:

  • Omega-3 fatty acids. Omega-3 fatty acids in fish may help prevent cognitive decline. Studies done on fish oil supplements haven't shown any benefit, however.
  • Curcumin. This herb comes from turmeric and has anti-inflammatory and antioxidant properties that might affect chemical processes in the brain. So far, clinical trials have found no benefit for treating Alzheimer's disease.
  • Ginkgo. Ginkgo is a plant extract containing several substances. A large study funded by the NIH found no effect in preventing or delaying Alzheimer's disease.
  • Vitamin E. Although vitamin E isn't effective for preventing Alzheimer's, taking 2,000 international units daily may help delay the progression in people who already have the disease. However, study results have been mixed, with only some showing this benefit. Further research into the safety of 2,000 international units daily of Vitamin E in a dementia population will be needed before it can be routinely recommended.

Supplements promoted for cognitive health can interact with medications you're taking for Alzheimer's disease or other health conditions.
Work closely with your health care team to create a treatment plan that's right for you. Make sure you understand the risks and benefits of everything it includes.




Information on this page taken directly from:
Alzheimer's Association
Alzheimer's Foundation of America
Mayo Clinic

 

Want to learn more?
The following are organizations and/or websites dedicated to providing information and education surrounding 
Alzheimer's Disorder. These organizations are dedicated to research, education, awareness, and/or support. They are listed in Alphabetical order without any preference or prejudice. Listing these organizations is not a recommendation or referral in any regard for seeking treatment or consultation or support for treatment.

Alzheimer's Association
Alzheimer's Foundation of America
Mayo Clinic

National Institute On Aging
WebMD