Alzheimer's Disease

What is Alzheimer's disease?

Alzheimer's disease (AD) affects brain cells. It slowly destroys memory and thinking skills. Over time the ability to speak, remember, control emotions, and make decisions may be lost.

AD is one cause of dementia. Dementia is a gradual loss of mental functions such as the ability to think, remember, reason, and plan. It is the most common reason that people are in nursing facilities.

How does it occur?

There are changes in the chemistry and structures of the brain in people with Alzheimer's disease. These changes keep the person from being able to process, store, and retrieve information. No one knows why these changes happen.

AD may start between the ages of 30 and 60, but it most often affects people 65 and older. Age is the most important known risk factor for AD. The number of people with the disease doubles every 5 years after age 65.

Scientists have found genes that increase the risk for AD in some families. Members of these families who have AD usually show signs of the disease before age 65. This is a rare type of AD, affecting less than 10% of the people who have Alzheimer's. Most people with AD do not have symptoms until after age 65.

What are the symptoms?

The symptoms of Alzheimer's disease vary from person to person and change as the illness gets worse.

The first symptom is forgetfulness. Almost all people begin to have some memory problems as they get older. For a person in the early stages of AD, however, these problems are more obvious than in others of the same age. He or she has trouble remembering recent events, activities, or the names of familiar people or things. The attention span becomes shorter. The person has a harder time focusing. But at this stage, being forgetful does not have a big effect on lifestyle or work.

Over time the memory loss gets worse. Co-workers and friends notice the memory loss. The person has problems reading, writing, and understanding. He or she may misplace or lose things. The person may get lost while driving or even at home. As the disease gets worse the person forgets things that happened recently and even things that happened in the person's own life. He or she cannot handle money. In general, recent memory is affected more than long-term memory.

In later stages of AD the person gets disoriented and confused. The person can no longer recall major facts about self or others. Things and people that were once familiar become unfamiliar. There may be mood and personality changes. The person may have false beliefs (delusions) or see or hear things that are not there (hallucinations). He or she may be anxious and restless, and wander late in the day (sundowning).

Someone with Alzheimer's may not see the need for care and may resist help. At first, he or she can go to the bathroom and eat without help. But as the disease progresses, bowel and bladder control is lost, as is the ability to walk and speak. The person may be bedbound and unable to swallow food, liquids, or saliva.

How is it diagnosed?

There is no one test to diagnose Alzheimer's disease. The only way to be 100% sure that someone has AD is to examine brain tissue after death. However, healthcare providers can tell if Alzheimer's disease is a likely cause of someone's symptoms.

The first step in diagnosis is a careful medical history and physical exam. Several other kinds of tests may be done to check for other illnesses. Blood and urine tests can check for problems such as thyroid disease. A CT scan of the brain may help rule out problems such as brain tumors and blood vessel disease. Tests of mental abilities (memory, problem solving, counting, and language) are often done. It is also important to rule out major depression, which can cause many of the same symptoms as Alzheimer's disease.

How is it treated?

There is no cure for Alzheimer's disease. The goal of treatment is to control symptoms and improve quality of life as much as possible. This includes treating other illnesses, eating a healthy diet, and getting regular exercise.

Medicine may help. Some doctors believe medicines such as donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon) can be used early in Alzheimer's disease to slow memory loss. Other medicines, such as memantine (Namenda), may help slow memory loss in later stages of the disease. These drugs are costly and have side effects. Vitamin E and other medicines continue to be studied to see whether they might be helpful.

Many people who have Alzheimer's disease are depressed, especially in the earlier stages. Most do not show sadness as much as a loss of pleasure and joy in life. When depression occurs in late stages of Alzheimer's disease, the person may be hostile or agitated. They may refuse food and drink. Depression makes brain function much worse than it otherwise would be. Medicines may help treat depression, anxiety, or difficult behaviors.

Community resources are very important. To find these services, talk with your healthcare provider, county health department, or visiting nurses association:

• Social workers find and organize help, including possible financial aid.
• Home healthcare agencies provide the services of nurses, medical social workers, and therapists. They also provide home health aides for personal care.
• Out-of-home services include adult day care centers; mental health services, including support groups for patients and family caregivers; transportation; and nursing homes.

How long will the effects last?

The brain function of a person who has Alzheimer's disease continues to get worse until he or she dies.

How can I help take care of someone with this disease?

While still possible, involve the person with Alzheimer's in decisions about the care he or she will get. Someone with Alzheimer's fears embarrassment from the loss of independence. He or she needs to be reassured sincerely and often.

Friends and family, as well as the person with Alzheimer's, should join support groups as soon as possible after the disease is diagnosed. Everyone's needs must be considered and balanced. The caregivers will become emotionally and physically worn out if they have no help or time away from caregiving.

Before the person with Alzheimer's becomes unable to make legal decisions, he or she should sign a power of attorney for medical and financial matters. If desired, a living will should be made out as well. Ask the healthcare provider for more information about these documents.

For more information on coping with this disease, contact:

Alzheimer's Association
Phone: 800-272-3900
Web site: http://www.alz.org.

What can be done to help prevent Alzheimer's disease?

We cannot prevent Alzheimer's disease until its causes are better understood. People with a family history of Alzheimer's should see their healthcare provider regularly. Early diagnosis will allow them to take advantage of new treatments as they become available.