Alzheimer's Disease

The term “dementia” describes any decrease in mental ability that interferes with a person’s daily life. Dementia is an umbrella term for symptoms related to loss of cognitive function, including memory loss, impaired reasoning, and behavioral changes.

There are several types of dementia, with Alzheimer’s disease as the most common. It accounts for approximately 65% of all new dementia diagnoses.

Other types of dementia include:

• Vascular dementia, the second most common type of dementia after Alzheimer’s, caused by conditions that block or reduce blood flow to the brain, resulting in loss of function.

• Lewy body dementia, the third most common cause of dementia, marked by brain abnormalities called Lewy bodies, discovered in the early 20th century by a neurologist named Dr. Frederich H. Lewy.

• Frontotemporal dementia (FTD), a term that comprises a number of conditions that affect the frontal and temporal lobes of the brain, causing progressive nerve cell loss.

• Creutzfeldt-Jakob disease, a rare, rapidly progressing form of dementia in which prion proteins in the brain fold into abnormal shapes.

• Mixed dementia, which describes changes in brain function caused by multiple types of dementia at the same time.

Dementia can also be induced by head trauma, adverse effects from medications, poorly controlled chronic conditions like diabetes and hypertension, substance abuse, and malnutrition. People with other neurological and genetic conditions, such as Huntington’s disease, Parkinson’s disease, and Down syndrome, can also experience dementia in the course of their disease.

The onset of Alzheimer’s is most commonly associated with memory loss, particularly the inability to recall newly learned information. This is because the disease first affects the area of the brain focused on learning.

Everyone can experience moments of forgetfulness as we age. However, chronic or disruptive memory loss is not a normal sign of aging. If you notice any of these symptoms in yourself or a loved one, see a doctor right away. The sooner you can get an accurate diagnosis—which may or may not be Alzheimer’s disease—the sooner you can begin treatment to slow the progression of symptoms.

Early signs of Alzheimer’s disease include:

• Memory loss that interferes with daily life, such as repeating questions or stories, forgetting important dates, or more frequently relying on reminder notes or other memory aids

• Difficulty planning ahead or solving problems, which may include challenges with paying and tracking monthly bills, loss of concentration, or taking longer to complete a task than previously needed

• Challenges completing familiar tasks, including the inability to remember directions to a longtime grocery store or forgetting the rules to a favorite board game

• Date, time and place confusion, marked by losing track of the day of the week, the seasons, or how much time has passed. People with Alzheimer’s may not know where they are or how they got there.

• Vision problems, including spatial relationships and depth perception. Reading may become more difficult, as can the ability to judge distance, which can cause problems with driving.

• New problems with language, both written and oral, which can include difficulty following or participating in a conversation, challenges with vocabulary, or inability to correctly name a familiar object (e.g., saying “thing you eat with” instead of “fork”)

• Losing or misplacing objects in odd places, such as putting milk away in the cabinet instead of the refrigerator. When an object is lost, someone with Alzheimer’s may not be able to retrace his or her steps to find it, which can lead to accusing others of theft.

• Poor judgment, including making irresponsible decisions with money, not keeping up with cleaning house, or forgetting proper grooming habits

• Withdrawing from social interactions, often as a result of the inability to follow or partake in a conversation

• Noticeable personality changes or mood swings, such as becoming anxious, confused, depressed, fearful, or easily upset. Unfamiliar situations or changes in environment may cause distress, restlessness, or agitation.

It is important to note that Alzheimer’s disease is not the only possible cause of memory loss or any of the above symptoms. Other types of dementia, including vascular dementia, Lewy body disease, and frontotemporal dementia (FTD), can result in loss of cognitive function. Non-dementia conditions, such as brain tumor, minor head trauma, substance abuse, and even some medications can cause memory loss, confusion, and other dementia-like symptoms. That is why it is important to see a doctor as soon as you notice these types of symptoms, so you can get an accurate diagnosis and begin treatment.

Alzheimer’s disease symptoms worsen as the disease progresses. But the timing of progression varies from person to person. As it advances, people move through three broad Alzheimer’s disease stages. These stages are general guidelines for what to expect with symptoms. They do not have concrete definitions and can overlap.

Early-stage Alzheimer’s disease usually starts with mild symptoms. People are still able to function independently and continue driving, working, and other daily activities. There is growing evidence that weight loss later in life can be an early warning sign of mental decline and the development of Alzheimer's disease. The most common symptoms of mild Alzheimer’s disease are forgetfulness and memory lapses including:

• Difficulty planning, organizing, or performing tasks at work or in social situations

• Forgetting familiar words

• Losing or misplacing objects

• Problems recalling information recently read

• Trouble remembering names

Middle-stage Alzheimer’s is typically the longest stage. People require more care during this stage and are less able to function independently. Symptoms become more pronounced and may include:

• Behavioral problems, changes in sleep patterns, and problems with wandering off or getting lost

• Confusion with words, dates and places, which can lead to outbursts of anger or frustration

• Difficulty with tasks, such as paying bills and other household duties

• Forgetting events or details about their personal history, such as their high school, college, or home address

• Moodiness, personality changes, or social withdrawal

• Problems choosing appropriate clothing and completing other personal care tasks

Late-stage Alzheimer’s disease requires 24-hour supervision and assistance. Symptoms may include:

• Difficulty communicating and talking

• Disability requiring extensive help with daily activities and personal care

• Inability to respond to the environment

• Loss of awareness of experiences and surroundings

• Problems moving and controlling movements including sitting, walking, swallowing, and bladder and bowel control

• Significant personality changes

The physical difficulties in late-stage Alzheimer’s lead to an increased risk of dehydration, physical wasting, and pneumonia and other infections. These are often the cause of death.

Alzheimer’s disease results from abnormal changes in the brain. The main features of these changes are abnormal clumps and nerve fiber tangles. The ‘clumps’ are deposits, or plaques, of a protein called beta-amyloid. These plaques are in between neurons (nerve cells). The ‘tangles’ of nerve fibers are tau, a protein inside neurons. The tangles and plaques cause neurons to stop working, lose connection with each other, and die.

Experts do not know why these changes happen or how they start. Experts believe these changes begin at least a decade before symptoms appear. The hippocampus is the first part of the brain damaged. It is responsible for memory. As the disease progresses, other areas of the brain begin to deteriorate. In the final stage, there is damage throughout the brain.

Several factors increase the risk of developing Alzheimer’s disease. Not all people with risk factors will get Alzheimer’s disease.

Risk factors include:

• Age: Most people are 65 or older at diagnosis. However, about 200,000 Americans have early-onset disease, which strikes before age 65.

• Down syndrome: People with Down syndrome have an extra copy of the gene that makes the protein in the amyloid plaques. They tend to develop the disease 10 to 20 years earlier than the general population.

• Education: Having less than a high school education seems to increase the risk.

• Family history: Having a first-degree relative with the disease increases the risk. You can be tested for one of the genes that have been linked to Alzheimer’s, APOE-e4; but, even if you have the gene, it’s not certain you will develop Alzheimer’s.

• Health: Past head injuries, heart disease, high blood pressure, diabetes, and obesity may all play a role in developing Alzheimer’s disease.

• Sex: More females than males have Alzheimer’s disease. However, this is likely due to increased longevity in females.

Alzheimer’s is not preventable. However, research is providing insight into ways to keep your brain healthy and reduce your risk of the disease. You may be able to lower your risk of Alzheimer’s disease by:

• Avoiding tobacco and excess alcohol

• Eating a healthy diet that includes antioxidants

• Engaging in mentally stimulating activities, such as reading, playing board games, playing a musical  instrument, or creating art or other hobbies

• Getting regular physical exercise

• Staying socially active

• Treating chronic diseases, such as diabetes and high blood pressure

If you are concerned about Alzheimer’s disease, talk with your doctor about your risks. There are simple screening examinations that can be performed in the clinic. Ask about specific ways to keep your brain engaged and healthy as you age.

No specific foods can help treat or definitively prevent Alzheimer’s disease, and studies of the link between diet and cognitive abilities are not conclusive. However, some research indicates that smart eating habits—as part of an overall healthy lifestyle—may help lower your risk of developing Alzheimer’s or other forms of cognitive decline later in life, such as vascular dementia.

Two diets in particular have been noted for their potential benefits in maintaining cognitive function:

• DASH (Dietary Approaches to Stop Hypertension), designed to help treat and prevent high blood pressure by reducing sodium intake. The DASH diet focuses on whole grains, fresh fruits and vegetables, and low-fat dairy products, along with small amounts of poultry, fish, nuts and seeds. By maintaining strong cardiovascular health, you may also be able to reduce your risk of dementia.

• Mediterranean diet, which emphasizes fresh fruits and vegetables, lean proteins like chicken and fish, and healthy fats, like those found in nuts, legumes and olive oil. This diet limits red meat, dairy, butter or margarine, and sugar. The Mediterranean diet is known for its anti-inflammatory and antioxidant benefits, which could play a key role in maintaining brain function.

A third option growing in popularity is the MIND Diet (Mediterranean-DASH Intervention for Neurodegenerative Delay), which combines elements of the Mediterranean and DASH diets. In one study, participants who adhered to a diet focused on whole grains, leafy greens, lean meats, berries, and olive oil and avoided high-fat and high-sugar foods showed a slower rate of cognitive decline following a stroke. Another study showed that the MIND diet was associated with lower rates of Alzheimer’s disease than the Mediterranean or DASH diets alone.

The cognitive decline associated with the middle and late stages of Alzheimer’s disease can make meals difficult for many reasons. As the condition progresses, swallowing can become difficult (a condition known as dysphagia), which increases the risk of choking and can lead to weight loss due to decreased appetite. Loss of ability to use utensils, decreased sense of smell or taste, and loss of recognition of certain foods also can contribute to challenging mealtimes.

Because proper nutrition is essential to maintaining good physical, emotional and cognitive health, people with Alzheimer’s—and their caregivers—benefit from eating a balanced diet. This includes fresh fruits and vegetables, lean proteins, low-fat dairy products, and whole grains, while avoiding or limiting foods high in fat, sugar and salt. Experts recommend seasoning foods with herbs and spices rather than salt. In later stages of Alzheimer’s, it may be helpful to add some sugar to foods if it encourages eating over no food intake at all.

It is also important for people with Alzheimer’s to avoid dehydration. Caregivers can offer small amounts of water throughout the day, or serve foods with high water content, such as fresh fruit, smoothies, or soups.

Creating a calm, soothing environment for meals can help make eating easier for someone with Alzheimer’s. Caregivers can try these tips to encourage their loved one to eat nutritious meals and maintain a healthy weight:

• Design a simple table setting: People with Alzheimer’s disease can have difficulty with vision and spatial perception. Avoid busy patterns and stick to solid colors, with strong contrasts between the plate and the table. Similarly, use light-colored dishes (preferably white) to help the food stand out from the plate.

• Reduce distractions: Have mealtime in a quiet setting where the person can focus on the meal and the people at the table. Turn off TVs, radios, or other potential distractions.

• Serve one food at a time: Too many choices can confuse a person with Alzheimer’s, so it may be helpful to break up meal components into their own individual “courses.”

• Don’t rush meals: Encourage independence by allowing a loved one with Alzheimer’s to do as much as possible on his or her own, even if it means taking extra time or making a mess.

• Serve easy-to-eat foods: If using utensils has become too difficult, opt for foods that are easy for the person to pick up and eat with their hands, such as sandwiches, chicken nuggets, fruit pieces, or steamed cauliflower. For people who have difficulty swallowing, cut foods into bite-size pieces or opt for soft, smooth foods like applesauce or scrambled eggs. You may need to purée food in a blender to help with swallowing.

• Check food temperature: Someone with Alzheimer’s disease may not remember to check if a food or drink is too hot to consume. Test anything you prepare before you serve it.

• Recognize that food preferences may change: A long-time favorite recipe may suddenly fall out of favor, or a new craving may develop. Be willing to adapt to changes in what your loved one finds appetizing.

• Prepare for someone not remembering when he or she ate: Your loved one might finish lunch, then a few minutes later ask when it will be time to eat lunch. It may help to break up one large meal into several small portions, so you have something to serve when the person repeats a request.

If you are concerned that your loved one is not eating well or not getting proper nutrition, talk to your specialist about meeting with a registered dietitian. Together, you can develop a plan for preparing and serving meals that meet your loved one’s needs while taking into consideration the limitations caused by Alzheimer’s. A speech or swallowing therapist may also be able to help manage dysphagia (difficulty swallowing) and improve a person’s ability to eat and drink.

Alzheimer’s disease is one type of dementia, an umbrella term for symptoms that affect mental ability to a point that they disrupt daily life. These include memory loss, confusion, impaired cognitive function, language difficulty, and disabling changes in personality and/or behavior.

Other conditions that cause dementia or include dementia-related symptoms include:

• Creutzfeldt-Jakob disease

• Down syndrome

• Frontotemporal dementia (FTD)

• Huntington’s disease

• Korsakoff syndrome

• Lewy body dementia

• Normal pressure hydrocephalus

• Parkinson’s disease

• Posterior cortical atrophy

• Vascular dementia

There is not a single, comprehensive test for diagnosing Alzheimer’s disease. By ruling out other conditions through a process of elimination, doctors can diagnose probable Alzheimer’s disease with about 90% accuracy. However, the only way to confirm the diagnosis is through an autopsy of the brain.

When someone shows signs of dementia, it is essential to determine whether symptoms are the result of a treatable illness. In addition to a complete medical history and extensive neurological motor, cognitive and sensory exams, diagnostic procedures for Alzheimer’s disease may include the following:

• Blood tests

• Chest X-ray

• Computed tomography scan (CT scan)

• Electrocardiogram (ECG or EKG)—a test that records the electrical activity of the heart

• Electroencephalogram (EEG)—a procedure that records the brain’s continuous electrical activity using electrodes attached to the scalp

• Lumbar puncture (spinal tap)

• Mental status test

• Neuropsychological testing

• Urinalysis

There is no cure for Alzheimer’s disease. It is eventually fatal. However, Alzheimer’s disease treatment can help slow the progression of dementia and improve quality of life.

Currently, there are five drugs with FDA approval to treat the memory and cognitive problems of Alzheimer’s disease:

• Donepezil (Aricept)

• Galantamine (Razadyne)

• Memantine (Namenda)

• Memantine/donepezil (Namzaric)

• Rivastigmine (Exelon)

Doctors may also use antidepressants to help manage behavioral problems in people with Alzheimer’s. The FDA has also approved one drug, suvorexant (Belsomra), to treat Alzheimer’s-related insomnia in people who have not found effective relief through lifestyle or sleep routine changes.

Along with medications, treatment involves adapting the environment to meet the needs of the person with Alzheimer’s. This means establishing strong habits and minimizing tasks that rely on memory. Examples include:

• Automating finances and using daily schedule tools, such as calendars or whiteboards

• Keeping appointments consistent on the same days and times

• Maintaining the familiar placement of furniture and removing clutter, rugs, and other tripping hazards

• Making a place for everything and keeping it there, including wallets, keys, and other valuables

• Removing mirrors, which can cause confusion, but keeping photos and other familiar objects around the house

• Securing medications and using a system to track dosages

• Using a mobile phone or other location tracker and wearing medical identification

The later stages of the disease will require more extensive assistance and constant supervision.

Social interaction, activities, and exercise are important aspects of treatment as well. These pursuits help nurture the abilities the person has, contribute to mental and emotional health, and improve quality of life.

Alzheimer’s disease is a life-altering diagnosis, both for the people with the condition and—perhaps especially—for the people around them. Family members suddenly find themselves as caregivers, a job that is both physically and mentally demanding, at the same time they are coping with the emotional pain of losing their loved one to memory loss, personality changes, and other forms of cognitive decline.

For the person with Alzheimer’s disease, it can be difficult to lose independence and increasingly rely on others in daily life. As a spouse or partner shifts into the role of caregiver, the sense of being “equals” in the relationship may start to feel lost, and both people may grieve the loss of their previous life together.

When the caregiver is an adult child, the parent with Alzheimer’s may have a hard time accepting that he or she is now the one in need of care, versus the parent being in the carer role when children were younger. Conversely, adults in their 40s or 50s with early-onset Alzheimer’s disease may find themselves back in the care of their parents, which can create stress on both sides of the relationship.

As the disease progresses, activities of daily living (ADL) become more difficult. This can lead to a lack of proper grooming, difficulty eating and drinking, issues with dental hygiene, and problems with incontinence, among other issues.

Caregivers should work with their loved one’s medical team to learn how best to provide support for daily tasks such as:

• Bathing or showering, including washing hair

• Brushing teeth and, when applicable, cleaning dentures

• Dressing

• Eating and drinking

• Exercising

• Paying bills

• Preventing bed sores

• Reducing risk of falls

• Remembering to take medications

• Sleeping through the night

• Toileting

In the later stages of Alzheimer’s, it can be helpful to hire outside professionals to assist with ADL. (The Administration for Community Living’s Elder Care site is a good place to start.) This helps ensure the person is receiving proper care and can provide much-needed respite for caregivers.

Communication becomes more difficult as Alzheimer’s disease progresses, due to loss of memory and increased issues with following a conversation. This can make it tempting for people to withdraw from someone with Alzheimer’s, but socializing with friends and family is an important way for someone with Alzheimer’s to stay engaged and cognitively alert. Plus, during this challenging experience, spending time with loved ones is more important than ever.

Here are some tips to make talking to someone with Alzheimer’s easier for the people on both sides of the conversation:

• Speak in short, simple sentences. This is less likely to cause confusion in the person and makes it easier for him or her to follow the conversation.

• Find a quiet place to talk. Minimize distractions like TVs or background chatter. Find good lighting, as Alzheimer’s can cause declines in vision.

• Take advantage of “clear” moments. If there is a time of day when a person is more alert, use this window for conversations, particularly if there is something specific you need to discuss.

• Avoid pointing out when someone is repeating himself or herself. A person with Alzheimer’s does not realize when they have already told a story, and calling attention to repetition or inability to remember facts may only cause further distress.

• Let someone walk down memory lane. While someone with Alzheimer’s struggles with short-term memory, oftentimes distant memories remain very clear. Ask questions about the person’s childhood, or follow his or her lead if the conversation turns to reminiscing about younger days.

• Don’t rush it. Take pauses to give the person time to comprehend what you just said and formulate a response. Be patient if it takes someone a long time to find the right words.

• Find a translator, if necessary. If someone speaks more than one language, as Alzheimer’s progresses, the person may revert to speaking the first language he or she learned. If you do not speak the language, try using a translation app through your phone, or reach out to the person’s medical team or care facility for help finding an interpreter.

Caring for someone with Alzheimer’s disease can be overwhelming. Caregivers are often balancing their own careers, families and daily lives while also tending to the very challenging needs of someone with Alzheimer’s. Add to that the emotional burden of watching a loved one’s mental abilities and memories fade—potentially even forgetting who family members are—and it is understandable why Alzheimer’s is such a dreaded diagnosis for both patients and families alike.

In one survey of more than 500 caregivers conducted by the Center to Advance Palliative Care (CAPC) and the Gary and Mary West Health Institute (WHI), Alzheimer’s disease caregivers pointed to these symptoms in their loved ones as the most challenging to manage:

• Agitation or aggression

• Repetitive speech or actions

• Wandering or restlessness

• Incontinence or constipation

• Late-day confusion, also known as “sundowning”

• Sleeplessness or insomnia

• Refusal to eat, bathe or take medicine

• Paranoia

• Hallucinations or delirium

• Choking on foods or liquids

In the same survey, Alzheimer’s caregivers identified their top personal challenges as:

• Coping with memory loss and cognitive decline in your loved one

• Managing the stress and emotional impact on yourself

• Having patience with the person who has Alzheimer’s

• Dealing with the person’s mood swings or changes in behavior

• Assisting with activities of daily living

• Keeping their loved one motivated and optimistic 

The collective toll of these responsibilities can lead to caregiver burnout, which makes it more difficult to provide quality care to the person with Alzheimer’s. That’s why it is essential for caregivers to make time for themselves and recharge, both physically and emotionally. Caregivers must schedule adequate time for rest, health maintenance and personal needs. They should not attempt to soldier on by themselves. During the lengthy course of Alzheimer’s, the death rate for caregivers exceeds that of the Alzheimer’s patient. Consider third-party respite care if other family members are unable to fill in.

Families can take advantage of resources that offer financial and caregiving assistance. General support can be found at the National Institute of Aging Trusted Source National Institute on Aging Governmental authority Go to source , Alzheimer’s Association, Alzheimer’s Foundation of America, and Family Caregiver Alliance. Financial help may be available through Medicare, Medicaid, and the U.S. Department of Veterans Affairs. Finally, federal and state benefit programs can offer help with meal programs, household expenses, prescription drugs, and legal services.

Because the progression of Alzheimer’s disease means the person with the condition will require increasingly demanding levels of care, it is important to plan ahead so loved ones with Alzheimer’s can maintain their desired quality of life and have a voice in determining how their wishes will be met. Procrastination will cause catastrophic and expensive problems if the affected individual loses legal capacity before completing necessary medical, legal, and financial affairs.

As an Alzheimer’s caregiver, talk with your care team about resources that may be available, such as counselors, social workers, or legal representatives, to help you discuss and plan for decisions related to:

• When a loved one should stop driving

• What to do if a loved one has walked away from home and is missing

• Drafting legal documents, including power of attorney, living will, and guardianship or conservatorship, to determine a person’s wishes for late-stage and end-of-life care

• How to handle situations in which the person refuses to take medication

• When to move a loved one into a full-time care facility

• How to prepare if a loved one wishes to remain at home

• Whether the person wants to receive artificial feeding or hydration during late-stage or end-of-life care

• How to handle the person’s finances after he or she is no longer capable, or after the person’s death

An Alzheimer’s disease diagnosis changes nearly every aspect of a person’s life, and the lives of his or her loved ones. The challenges can seem insurmountable, but it is important to remember that help is available. Millions of families have traveled this path before you. If you have Alzheimer’s disease, or care for someone who does, consider seeking the expertise of a counselor, therapist, or other mental health professional to help you navigate the most difficult aspects of living with Alzheimer’s. It can also help to find local or online support groups where you can share your experience and receive guidance from others like you.

As the disease progresses, it becomes difficult to communicate problems and symptoms. It may not be possible for someone with Alzheimer’s to tell you when they are in pain or feel ill. They may also have trouble following a treatment plan by themselves.

People with Alzheimer’s disease may forget to eat or drink during the day. This can lead to malnutrition and dehydration. Over time, the disease will also cause problems moving and controlling movements. This can lead to complications including falls, fractures, bedsores, physical wasting, difficulty swallowing, and pneumonia and other infections. Eventually, one or more of these factors are often what leads to the person’s death.

Knowing how long a person can be expected to live with Alzheimer’s helps families plan accordingly for long-term care. However, each case of Alzheimer’s disease is unique to the person who has it, with the prognosis influenced by individual medical history, level of caregiving, and the rate of disease progression.

Generally, Alzheimer’s disease shortens a person’s life expectancy by half, compared to someone of the same age who does not have Alzheimer’s disease or another form of dementia.

On average, someone with Alzheimer’s disease will live between 4 and 5 years past diagnosis. It is important to note that many people are diagnosed at an advanced age, often in their 80s or 90s. People diagnosed at a younger age, on average, can live 10 or even 20 years past diagnosis.

Although progress has been made in recent years in the study of Alzheimer’s disease, there is still much experts have to learn about this and other forms of dementia. Advocacy groups like the Alzheimer’s Association work to increase awareness of Alzheimer’s disease in hopes of inspiring further research and funding to one day find a cure.

June is Alzheimer’s & Brain Awareness month, signified by the color purple.