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.

Alzheimer's is one cause of dementia. Dementia is a gradual loss of mental functions such as the ability to think, remember, reason, and plan. Dementia 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 when you have Alzheimer's disease. These changes keep you 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 diagnosed with the disease doubles every 5 years after age 65.

Scientists have found genes that increase the risk for Alzheimer's 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 are different from person to person, and they change as the illness gets worse.

The first symptom is forgetfulness. Almost all people begin to have some memory problems as they get older. When you are in the early stages of AD, however, these problems are more obvious than in others of the same age. You have trouble remembering recent events, activities, or the names of familiar people or things. Your attention span gets shorter. It's harder to focus. But, at this stage, being forgetful does not have a big effect on your lifestyle or work.

Over time your memory loss gets worse. Co-workers and friends notice the memory loss. You have problems reading, writing, and understanding. You have trouble knowing how to pay for things with money. You may misplace or lose things. You may get lost while driving or even at home. As the disease gets worse, you completely forget things that happened recently. You may forget parts of your past life as well. In general, recent memory is affected more than long-term memory.

In later stages of AD you will be often disoriented and confused. You will no longer be able to recall major facts about yourself or others. Things and people that were once familiar will become unfamiliar. You may have mood and personality changes. You may have false beliefs (delusions) or see or hear things that are not there (hallucinations). You may be anxious. You may be restless and tend to wander late in the day (a problem called sundowning).

How is it diagnosed?

There is no specific test for Alzheimer's disease except for a test of brain tissue after death. However, healthcare providers can determine if Alzheimer's disease is a likely cause of your 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, diabetes, or kidney disease.

Brain imaging is controversial. MRI scans may be done to take pictures of the brain. MRI shows a lot of detail about the brain, but it does not show Alzheimer's disease directly. Some experts say that brain imaging is needed to rule out other brain problems that would require different treatment. Other experts say that the brain imaging is not needed unless something specific shows up in the person's history or from a careful physical exam. These experts say that if someone has symptoms of Alzheimer's, they should be treated, so scanning everyone is not necessary.

More important than MRI scans are tests of mental abilities (memory, problem solving, counting, and language). 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. Donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon) are drugs that may slow memory loss early in the disease. Memantine (Namenda) may help slow memory loss in later stages of the disease. These drugs are costly and have side effects. None of these medicines can cure or reverse Alzheimer's disease. You should not expect big improvements when these medicines are given. Not all people with dementia should take these medicines. Those whose disease is very severe will not benefit. Talk to your healthcare provider about these issues. 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. Depression during the late stages of Alzheimer's disease may cause feelings of hostility or agitation and a loss of interest in eating or drinking. Depression makes brain function much worse than it otherwise would be. Medicines for depression or anxiety may help.

How long will the effects last?

Alzheimer's disease causes brain function to keep getting worse until death. The time from when memory problems begin until death from Alzheimer's disease varies a lot--from 5 to 15 years. Many people have other major medical problems like heart disease or cancer, and those illnesses often cause death earlier than would happen just due to Alzheimer's disease. The prospect of living a long time with the need for total care and supervision is one of the most troubling parts of coping with Alzheimer's disease.

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

Sometimes people who have Alzheimer's do not think they need help and may resist it. But as the disease progresses, bowel and bladder control is lost, as is the ability to walk, speak, and even swallow food or liquids.

While still possible, people who have AD should be involved in decisions about the care they will get. Someone with AD fears embarrassment from the loss of independence and needs to be reassured sincerely and often.

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

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 facilities.

Is a power of attorney needed?

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

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

Alzheimer's disease cannot be prevented until its causes are better understood. However, if you have a family history of Alzheimer's, tell your healthcare provider. Early diagnosis can allow you to take advantage of new treatments as they become available.

How can I get more information/

For more information on coping with this disease, talk to the healthcare provider. Another good source of information is:

Alzheimer's Association
Web site: http://www.alz.org
24-hour helpline: 1-800-272-3900 (TDD: 1-866-403-3073).