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Alzheimer's and Dementia

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Overview

Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills and, eventually even the ability to carry out the simplest tasks of daily living. In most people with Alzheimer’s, symptoms first appear after age 60. Alzheimer’s disease is the most common cause of dementia among older people.

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Symptoms

The cause of Alzheimer's disease is not the same in every person, but symptoms seem to develop over the same general stages. In most people with Alzheimer's, symptoms first appear after age 60.

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Symptoms

Scientists now know that Alzheimer’s progresses on a spectrum with three stages—an early, preclinical stage with no symptoms; a middle stage of mild cognitive impairment (MCI); and a final stage of Alzheimer’s dementia. At this time, doctors cannot predict with any certainty which people with MCI will or will not develop Alzheimer’s.

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Symptoms

As AD spreads through the brain, the number of plaques and tangles grows, shrinkage progresses, and more and more of the cerebral cortex is affected. Memory loss continues and changes in other cognitive abilities begin to emerge. The clinical diagnosis of AD is usually made during this stage. Signs of mild AD can include:

-- Memory loss

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Symptoms

-- Confusion about the location of familiar places (getting lost begins to occur)

-- Taking longer than before to accomplish normal daily tasks

-- Trouble handling money and paying bills

-- Poor judgment leading to bad decisions

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Symptoms

-- Loss of spontaneity and sense of initiative

-- Mood and personality changes, increased anxiety and/or aggression

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Symptoms

In mild AD, a person may seem to be healthy but is actually having more and more trouble making sense of the world around him or her. The realization that something is wrong often comes gradually to the person and his or her family. Accepting these signs as something other than normal and deciding to go for diagnostic tests can be a big hurdle for people and families. Once this hurdle is overcome, many families are relieved to know what is causing the problems. They also can take comfort in the

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Symptoms

AD Spreads Through the Brain

**MODERATE AD**

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Symptoms

By this stage, AD damage has spread to the areas of the cerebral cortex that control language, reasoning, sensory processing, and conscious thought. Affected regions continue to shrink, ventricles enlarge, and signs and symptoms of the disease become more pronounced and widespread. Behavioral problems, such as wandering and agitation, can occur. More intensive supervision and care become necessary, which can be difficult for many spouses and families. The symptoms of this stage can include:

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Symptoms

-- Increasing memory loss and confusion

-- Shortened attention span

-- Inappropriate outbursts of anger

-- Problems recognizing friends and family members

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Symptoms

-- Difficulty with language and problems with reading, writing, and working with numbers

-- Difficulty organizing thoughts and thinking logically

-- Inability to learn new things or to cope with new or unexpected situations

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Symptoms

-- Restlessness, agitation, anxiety, tearfulness, wandering—especially in the late afternoon or at night

-- Repetitive statements or movement, occasional muscle twitches

-- Hallucinations, delusions, suspicion or paranoia, irritability

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Symptoms

-- Loss of impulse control (shown through undressing at inappropriate times or places or vulgar language)

-- An inability to carry out activities that involve multiple steps in sequence, such as dressing, making a pot of coffee, or setting the table

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Symptoms

Behavior is the result of complex brain processes, all of which take place in a fraction of a second in the healthy brain. In AD, many of those processes are disturbed, and these disrupted communications between neurons are the basis for many distressing or inappropriate behaviors. For example, a person may angrily refuse to take a bath or get dressed because he does not understand what his caregiver has asked him to do. If he does understand, he may not remember how to do it. The anger can be a

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Symptoms**SEVERE AD**

In the last stage of AD, plaques and tangles are widespread throughout the brain, most areas of the brain have shrunk further, and ventricles have enlarged even more. People with AD cannot recognize family and loved ones or communicate in any way. They are completely dependent on others for care. Other symptoms can include:

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Symptoms**SEVERE AD**

-- Weight loss

-- Seizures

-- Skin infections

-- Difficulty swallowing

-- Groaning, moaning, or grunting

-- Increased sleeping

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Symptoms**SEVERE AD**

-- Lack of bladder and bowel control

Near the end, the person may be in bed much or all of the time. The most frequent cause of death for people with AD is aspiration pneumonia. This type of pneumonia develops when a person is not able to swallow properly and takes food or liquids into the lungs instead of air.

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Diagnosis

A definitive diagnosis of Alzheimer’s disease can be made only through autopsy after death, by linking clinical measures with an examination of brain tissue. However, doctors have several methods and tools to help them determine fairly accurately whether a person who is having memory problems has “possible Alzheimer’s disease” (symptoms may be due to another cause), “probable Alzheimer’s disease” (no other cause for the symptoms can be found), or some other problem.

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Diagnosis

To diagnose Alzheimer’s, doctors may:

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Treatment

Alzheimer's disease is complex, and it is unlikely that any one intervention will be found to delay, prevent, or cure it. That’s why current approaches in treatment and research focus on several different aspects, including helping people maintain mental function, managing behavioral symptoms, and slowing or delaying the symptoms of the disease.

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Treatment

Four medications are approved by the U.S. Food and Drug Administration to treat Alzheimer's. Donepezil (Aricept®), rivastigmine (Exelon®), or galantamine (Razadyne®) are used to treat mild to moderate Alzheimer's (donepezil can be used for severe Alzheimer's as well). Memantine (Namenda®), is used to treat moderate to severe Alzheimer's.

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Treatment

These drugs work by regulating neurotransmitters, the chemicals that transmit messages between neurons. They may help maintain thinking, memory, and speaking skills, and may help with certain behavioral problems. However, these drugs don’t change the underlying disease process, are effective for some but not all people, and may help only for a limited time.

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Causes

Scientists don’t yet fully understand what causes Alzheimer's disease, but it has become increasingly clear that it develops because of a complex series of events that take place in the brain over a long period of time. It is likely that the causes include some mix of genetic, environmental, and lifestyle factors. Because people differ in their genetic make-up and lifestyle, the importance of any one of these factors in increasing or decreasing the risk of developing Alzheimer's differs from p

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Causes**Age**

One of the great mysteries of Alzheimer’s disease is why it largely strikes older adults. Research on how the brain changes normally with age is shedding light on this question. For example, scientists are learning how age-related changes in the brain may harm neurons and contribute to Alzheimer’s damage.

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Causes**Genetics**

The more researchers learn about Alzheimer's disease, the more they realize that genes play an important role in its development.

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Causes**Genetics**

Early-onset Alzheimer’s is a rare form of the disease. It occurs in people age 30 to 60 and represents less than 5 percent of all people who have Alzheimer’s disease. Most cases of early-onset Alzheimer’s are familial Alzheimer’s disease, caused by changes in one of three known genes inherited from a parent.

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Causes**Genetics**

Most people with Alzheimer’s disease have “late-onset” Alzheimer’s, which usually develops after age 60. Many studies have linked the apolipoprotein E (APOE) gene to late-onset Alzheimer’s. This gene has several forms. One of them, APOE ?4, seems to increase a person’s risk of getting the disease. However, carrying the APOE ?4 form of the gene does not necessarily mean that a person will develop Alzheimer’s disease, and people carrying no APOE ?4 can also develop the disease.

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Causes**Genetics**

Most experts believe that additional genes may influence the development of late-onset Alzheimer’s. Scientists around the world are searching for these genes, and have identified a number of common genes in addition to APOE ?4 that may increase a person’s risk for late-onset Alzheimer’s.

**Environmental/lifestyle factors**

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Causes**Genetics**

Research also suggests that a host of factors beyond basic genetics may play a role in the development and course of Alzheimer’s disease. There is a great deal of interest, for example, in associations between cognitive decline and vascular and metabolic conditions such as heart disease, stroke, high blood pressure, diabetes, and obesity. Understanding these relationships and testing them in clinical trials will help us understand whether reducing risk factors for these conditions may help wit

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Prevention

Since the root cause of Alzheimer's and Dementia is not yet known there is no scientifically proven way to prevent Alzheimer's.

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Additional Resources

National Institute on Aging

PubMed Health

Alzheimer's Association