About alzheimer's disease
What is alzheimer's disease?
Alzheimer's disease is a progressive neurologic disorder that causes the brain to shrink (atrophy) and brain cells to die. Alzheimer's disease is the most common cause of dementia — a continuous decline in thinking, behavioral and social skills that affects a person's ability to function independently.
Approximately 5.8 million people in the United States age 65 and older live with Alzheimer's disease. Of those, 80% are 75 years old and older. Out of the approximately 50 million people worldwide with dementia, between 60% and 70% are estimated to have Alzheimer's disease.
The early signs of the disease include forgetting recent events or conversations. As the disease progresses, a person with Alzheimer's disease will develop severe memory impairment and lose the ability to carry out everyday tasks.
Medications may temporarily improve or slow progression of symptoms. These treatments can sometimes help people with Alzheimer's disease maximize function and maintain independence for a time. Different programs and services can help support people with Alzheimer's disease and their caregivers.
There is no treatment that cures Alzheimer's disease or alters the disease process in the brain. In advanced stages of the disease, complications from severe loss of brain function — such as dehydration, malnutrition or infection — result in death.
What are the symptoms for alzheimer's disease?
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:
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:
- Social withdrawal
- Mood swings
- Distrust in others
- Irritability and aggressiveness
- Changes in sleeping habits
- 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 success and maintain quality of life even into the moderate phase of the disease.
What are the causes for alzheimer's disease?
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.
As more and more brain cells die, Alzheimer's leads to significant brain shrinkage. When doctors examine Alzheimer's brain tissue under the microscope, they see two types of abnormalities that are considered hallmarks of the disease:
- Plaques. These clumps of a protein called beta-amyloid may damage and destroy brain cells in several ways, including interfering with cell-to-cell communication. Although the ultimate cause of brain-cell death in Alzheimer's isn't known, the collection of beta-amyloid on the outside of brain cells is a prime suspect.
Tangles. Brain cells depend on an internal support and transport system to carry nutrients and other essential materials throughout their long extensions. This system requires the normal structure and functioning of a protein called tau.
In Alzheimer's, threads of tau protein twist into abnormal tangles inside brain cells, leading to failure of the transport system. This failure is also strongly implicated in the decline and death of brain cells.
What are the treatments for alzheimer's disease?
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 cell-to-cell communication by preserving a chemical messenger that is depleted in the brain by Alzheimer's disease. These are usually the first medications tried, and most people see modest improvements in symptoms.
Cholinesterase inhibitors may also improve neuropsychiatric symptoms, such as agitation or depression. Commonly prescribed cholinesterase inhibitors include donepezil (Aricept), galantamine (Razadyne ER) and rivastigmine (Exelon).
The main side effects of these drugs include diarrhea, nausea, loss of appetite and sleep disturbances. In people with certain heart disorders, serious side effects may include cardiac arrhythmia.
- 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. Relatively rare side effects include dizziness and confusion.
In June 2021, the Food and Drug Administration (FDA) approved aducanumab (Aduhelm) for the treatment of some cases of Alzheimer's disease. This is the first drug approved in the United States to treat the underlying cause of Alzheimer's by targeting and removing amyloid plaques in the brain. The approved the drug on the condition that further studies be conducted to confirm the drug's benefit. Experts also need to identify which patients may benefit from the drug.
Sometimes other medications such as antidepressants may be prescribed to help control the behavioral symptoms associated with Alzheimer's disease.
Trying to communicate with a person who has Alzheimer's disease can be a challenge. Both understanding and being understood may be difficult.
- Choose simple words and short sentences and use a gentle, calm tone of voice.
- Avoid talking to the person with Alzheimer's like a baby or talking about the person as if he or she weren't there.
- Minimize distractions and noise—such as the television or radio—to help the person focus on what you are saying.
- Make eye contact and call the person by name, making sure you have his or her attention before speaking.
- Allow enough time for a response. Be careful not to interrupt.
- If the person with Alzheimer's is struggling to find a word or communicate a thought, gently try to provide the word he or she is looking for.
- Try to frame questions and instructions in a positive way.
- Be open to the person's concerns, even if he or she is hard to understand.
Creating a safe and supportive environment
Adapting the living situation to the needs of a person with Alzheimer's disease 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.
- Keep medications in a secure location. Use a daily checklist to keep track of dosages.
- Arrange for finances to be on automatic payment and automatic deposit.
- Have the person with Alzheimer's carry a mobile phone with location capability so that a caregiver can track its location. Program important phone numbers into the phone.
- Install alarm sensors on doors and windows.
- 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.
- 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.
- Make sure that the person with Alzheimer's carries identification or wears a medical alert bracelet.
- Keep photographs and other meaningful objects around the house.
What are the risk factors for alzheimer's disease?
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.
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.
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
- 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.
Is there a cure/medications for alzheimer's disease?
Life expectancy varies for each person with AD. The average life expectancy after diagnosis is eight to 10 years. In some cases, however, it can be as short as three years or as long as 20 years.
AD can go undiagnosed for several years, too. In fact, the average length of time between when symptoms begin and when an AD diagnosis is made is 2.8 years.
Treatment will not prevent the progression of AD. It is also unclear if treatment can add time to a person’s life. Ultimately, AD will progress and take its toll on the brain and body. As it progresses, symptoms and side effects will get worse.
However, a few medications may be able to slow the progression of AD at least for a short time. Treatment can also improve your quality of life and help treat symptoms. Talk with your doctor about your treatment options.
Talk with your doctor about how your risk factors and lifestyle may affect your life expectancy. Work with your doctor to find the best treatments and lifestyle changes for you.
If you are a caretaker for a person with AD, work with their doctor to learn about the treatments and lifestyle changes that may help slow the progression. Alzheimer’s disease is not curable, but there are measures you can take to ease its toll.