Alzheimer's Disease

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KEY POINTS

• Alzheimer’s disease results in a gradual loss of the ability to think, remember, reason, and plan.
• 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.
• Treatment may include treating other illnesses, eating a healthy diet, getting regular exercise, and medicines.

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What is Alzheimer's disease?

Alzheimer's disease (AD) is a form of dementia that gets worse over time. AD results in a loss of the ability to think, remember, reason, and plan that is usually gradual. The disease affects brain cells and slowly causes the loss of memory and thinking skills. Over time, it can also cause the loss of the ability to speak, walk, remember, control emotions, and make decisions.

AD cannot be cured. Brain function keeps getting worse until death. From the start of memory problems, AD can cause death in 5 to 15 years.

What is the cause?

The exact cause of AD is not well understood. It might be a number of things, like genes, the environment, or lifestyle. When you have AD, there are changes in your brain. Abnormal pieces and clusters of protein start to build up in the brain. Some nerve cells in the brain stop working and die. This causes parts of the brain start to shrink. It is not clear if these changes cause AD or if they are the result of AD.

Age is the most important known risk factor for AD. The earliest changes in the brain from AD may start between the ages of 30 and 65. However, most people don’t have signs of the disease until after the age of 65.

Scientists have found genes that increase the risk for AD at an early age in some families. Members of these families may start showing signs of the disease as early as their 30s. This is a rare type of AD. Other genes may increase the risk for having the disease at an older age.

What are the symptoms?

The symptoms of AD are different from person to person. They also change as the illness gets worse.

Often the first symptom is forgetfulness. Almost everyone starts to have some memory problems as they get older, but these problems do not usually affect everyday life. Being forgetful does not always mean that you have AD since your ability to function is not affected. If you are in the early stages of AD, however, these memory problems are more obvious and important than they are in others of the same age. They start to affect everyday life. 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 often, in the early stages of the disease, memory problems may not have a big effect on your lifestyle or work.

Over time, the memory loss gets worse. There are more problems with reading, writing, and understanding. You may have trouble knowing how to pay for things with money. You may misplace or lose things more often. You may get lost while driving or even at home.

As the disease gets worse, you may forget more of your past as well as recent events. However, in general, recent memory is affected more than long-term memory.

In later stages of AD, you will often be confused. It will be hard to recall major facts about yourself or others. Things and people that were once familiar become unfamiliar. There may be mood and personality changes. Some people may have false beliefs (delusions). Other people may see or hear things that are not there (hallucinations). You may be anxious. You may be restless and tend to wander.

How is it diagnosed?

No specific test confirms AD while someone is alive. A test of brain tissue after death is the only way to know if you had AD.

• Your provider will ask about your symptoms and medical history, and examine you.
• Your provider will test your memory, problem solving, counting, and language skills.

Several tests may be done to see if other illnesses are causing the symptoms. For example, blood and urine tests can check for problems such as thyroid disease, diabetes, or kidney disease. CT or MRI scans may be done to see if other problems in the brain are causing symptoms. Your provider will also ask about depression.

How is it treated?

There is no cure for AD. 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. Making your home safe is also important.

Some medicines may help slow down the loss of memory and decrease in function, but they do not cure AD. These medicines may help your memory so that you can stay active for a longer period of time. If you have severe AD these medicines may not help. Talk to your healthcare provider about the risks and benefits of these medicines.

Other medicines are being studied to see if they might be helpful. The Alzheimer’s Association runs a service to help people take part in ongoing research studies.

Many people who have AD are depressed, especially in the earlier stages. Instead of sadness, you may lose the ability to feel pleasure and joy. In the late stages of AD, depression may cause you to feel angry and restless. You may lose interest in eating or drinking. Depression can make brain function worsen. Medicines that treat depression or anxiety may help.

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

If possible, people who have AD should be involved in decisions about the care they need or want to have in the future. A durable power of attorney for medical and financial matters should be signed before a person becomes unable to make legal or healthcare decisions. The power of attorney should be someone who can be trusted to make decisions that the person with AD would make if they could. If desired, a living will should be made out as well.

A living will is a legal document that states your wishes for your medical care if you have a serious or terminal illness. You can complete this document at any time and it is best to do it when you are healthy and able to ask questions so you can make these important decisions about your care. A living will is not used to say who you want to make decisions for you when you cannot make them yourself.

States are different in the forms they use and recognize. You need to know the laws in your state and fill out the forms your state recognizes. Ask your healthcare provider or lawyer for more information about these documents.

The prospect of living a long time with the need for a lot of care and supervision may be overwhelming to the person with AD as well as for their loved ones. Care giving can be a 24/7 job. As a caregiver, you can get emotionally and physically worn out if you have no help or no time for yourself. Support groups for caregivers, family, friends, and the person with AD can help provide emotional support and help you learn about the disease.

Community resources are very important. To find these services, talk with your healthcare provider, county health department, or visiting nurses association. Some services may be covered by health insurance, long term care insurance, or local and state agencies. You may need to pay for other services yourself. Other sources of help include:

• Social workers who can find and organize help, including possible financial aid
• Home healthcare agencies that can provide services such as nurses, medical social workers, dietitians, and therapists. They also provide home health aides for personal care such as bathing.
• Training programs to help family and friends learn how to care for a person with AD
• Out-of-home services such as adult day care centers, mental health services, transportation, and nursing facilities

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

• Alzheimer's Association
  http://www.alz.org
  800-272-3900 (TDD: 1-866-403-3073)

Many Web sites offer information and products for AD. Talking with people in support groups and with caregivers and a trusted healthcare provider can help you sort through all of the information.

How can I help prevent Alzheimer's disease?

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

Many researchers think that you may be able to lower your risk of getting AD by following a healthy lifestyle. Steps you can take include:

• Keep a healthy weight.
• Eat a healthy diet that is low in sodium and saturated and trans fat.
• Stay fit with the right kind of exercise for you.
• Decrease stress.
• Don’t smoke.
• Limit your use of alcohol.