Alzheimer's Disease

Alzheimer's disease is a progressive degenerative disorder that affects the brain, causing cognitive problems and behavioral changes. It is the most common cause of dementia and the fourth leading cause of death in the United States. Almost 4 million Americans have Alzheimer's disease.

More information about Alzheimer's disease

• What are the symptoms of Alzheimer's disease?
• Who gets Alzheimer's, and how is it diagnosed?
• What causes Alzheimer's disease?
• What is the course of the disease, and what are the treatment options?

What are the symptoms of Alzheimer's disease?

Symptoms usually begin with memory problems, especially short-term memory. As time continues, patients become increasingly confused and disoriented. Here are some of the most common symptoms:

• Memory loss that affects job skills and daily life at home
• Significant problems with using and understanding language
• Confusion about time and place
• Problems with abstract thinking
• Personality changes, such as apathy and a tendency to withdraw from social situations
• Mood swings

A variety of disorders, including depression, vitamin deficiencies, hypothyroidism and chronic subdural hematoma, can cause symptoms that mimic Alzheimer's. Many of these conditions can be treated or even cured. For that reason, it's important to get a comprehensive diagnostic evaluation from a doctor as soon as possible.

Who gets Alzheimer's, and how is it diagnosed?

Alzheimer's and other forms of dementia affect less than one out of 1,000 people under the age of 65. The chances of developing dementia increase with age - two percent of people between 65 and 75 suffer from a dementia disorder, rising to 20 percent of those over 80. However, it's hard to tell exactly how many people with dementia have Alzheimer's, because there is no definitive test for the disease. Currently, Alzheimer's is diagnosed through the process of elimination - that is, the doctor concludes that the patient has Alzheimer's after other possible sources of dementia have been ruled out.

To determine the cause of dementia, the doctor will take a detailed medical history, perform a complete physical and neurological examination and administer some neuropsychological and mental status tests.

Computerized tomography (CT) or magnetic resonance imaging (MRI), positron emission tomography (PET) and electroencephalography (EEG) may be used to examine the brain.

What causes Alzheimer's disease?

Doctors aren't sure what causes Alzheimer's disease. Autopsies on the brains of Alzheimer's patients have shown some structural abnormalities in areas important to cognitive function, including protein fiber tangles within nerve cells (neurofibrillary tangles) and clusters of degenerating nerve endings (neuritic plaques). Also, the production of several brain chemicals, especially acetycholine, that help brain cells communicate with each other is reduced. These abnormalities help explain some of the symptoms of the disease - however, no one knows exactly what causes them.

Current research is focusing on solving these mysteries and finding treatments that will slow or reverse the disease's progress.

What is the course of the disease, and what are the treatment options?

The course of the disease can vary significantly from one person to another, and not all Alzheimer's patients will exhibit all symptoms. The disease's onset is gradual and seems to progress in three loosely defined stages. They are:

• Early stage: This stage generally lasts from two to four years. This stage is characterized by confusion about names and places, difficulty handling money, poor decision-making and anxiety about symptoms.
• Moderate stage: This stage of Alzheimer's is often the longest, lasting from two to 10 years after diagnosis. Symptoms become more pronounced, and new symptoms such as decreased perceptual and motor skills appear. The patient may have hallucinations and delusions.
• Terminal stage: This stage of the disease can last from one to three years, sometimes longer. Symptoms typical of this late stage include difficulty recognizing loved ones, inability to care for oneself or communicate, mood changes, seizures and bowel or bladder incontinence. In this stage, patients can no longer function independently on any level - they require full-time care. They usually die from pneumonia or other conditions that commonly affect chronically ill, bedridden patients.

There is no cure for Alzheimer's, and treatment options are limited. Drugs like tacrine and donepezil have shown promise in temporarily improving the memory skills of some patients with mild to moderate Alzheimer's, but no known treatment can stop or reverse the progress of the disease. On the other hand, medications that can help manage some symptoms, such as depression, behavioral disturbances and sleeplessness, are available.

Proper nutrition, physical exercise and a calm, well-structured environment can improve the quality of life for Alzheimer's patients.

Practical ways to help Alzheimer's patients include posting easy-to-read calendars, lists of routine tasks and step-by-step directions for daily activities. Major changes in routine should be avoided, and the patient should be encouraged to socialize and exercise.