Who should I go to if I suspect I may have Alzheimer's disease? [ 11/04/14 ]
First, visit your regular family physician. The physician will probably do a variety of tests to determine the probability of Alzheimer's. Specialists such as neurologists, gerontologists and geriatric psychiatrists may also be involved in the evaluation process.
Are there treatments available for Alzheimer’s disease? [ 11/04/14 ]
Yes, while there is no cure for Alzheimer's disease as yet, there are medications that can help control its symptoms and to help manage conditions such as agitation, depression, or psychosis (hallucinations or delusions), which may occur as the disease progresses:
Cholinesterase inhibitors: People with Alzheimer's disease have low levels of a key nerve messenger, called acetylcholine, believed to be important for memory and thinking. Four drugs called cholinesterase inhibitors make more of that messenger available by slowing its breakdown, enabling greater cell-to-cell communication and slowing the progress of cognitive impairment in some patients with early- to middle-stage Alzheimer's disease. The four cholinesterase inhibitors are:
- Razadyne® (galantamine)
- Exelon® (rivastigmine)
- Aricept® (donepezil)
- Cognex® (tacrine)
All four have been approved by the Food and Drug Administration (FDA) for early- to middle-state Alzheimer's disease; Aricept® is also approved for severe-stage symptoms. Cognex® was the first approved cholinesterase inhibitor but is rarely prescribed today due to safety concerns.
Namenda® (memantine) The first FDA-approved drug for moderate to severe Alzheimer's disease, Namenda is thought to protect brain cells by regulating a nerve communication chemical, called glutamate, that is released in great quantities by Alzheimer's-damaged cells. Glutamate is normally involved with learning and memory, but when released in excess by damaged cells, it attaches to “docking sites” called NMDA receptors that in turn accelerate cell damage.
Treatment for mental illnesses People with the later stages of Alzheimer's disease often experience depression, agitation, paranoia, delusions, and/or hallucinations, which can in turn cause screaming, repetitive questions, hoarding, pacing, hyperactivity, and aggressive behavior.
These symptoms can arise from non-medical triggers as well as medical causes. The former could take the form of a change in the person's environment (a new place to live, a new caretaker, a change in routine) or from frustration at the inability to communicate. If the trigger can be identified, the environment can be modified to change the behavior.
If non-medical intervention doesn't work, or the patient becomes a danger to himself or others, a physician should be asked to evaluate the need for medical treatment.
Sources for financial assistance for Alzheimer's disease prescription drugs can be found at www.brightfocus.org/alzheimers/resources/alzheimers-disease.html. Always consult a physician before taking any medications.
How is Alzheimer’s disease diagnosed? [ 11/04/14 ]
While an autopsy can confirm the presence of the disease, skilled physicians can correctly diagnose Alzheimer's disease about 90 percent of the time based on mental and behavioral symptoms, a physical examination, and neuropsychological and laboratory tests. Scientists have recently developed a number of new biomarker and brain scanning techniques that may help to improve diagnosis.
Mentally, having trouble following instructions, losing one's orientation, displaying poor judgment, and having difficulty managing money, shopping, or driving are all possible symptoms of Alzheimer's disease.
The physical exam will usually include a general physical, blood tests, and urinalysis. The doctor can use such test results to eliminate other forms of dementia—for instance, certain vitamins and hormones can provoke symptoms of dementia if they are present in too little a quantity. Brain scans can rule out non-Alzheimer's disease dementia and can reveal structural changes present in Alzheimer's disease.
The physician will determine whether neuropsychological testing is called for to examine memory, attention, math calculations, language and other intellectual functions.
The place to start is with one's own physician, who may then suggest specialists to do further testing.
How long does Alzheimer's disease last on average? [ 11/04/14 ]
On average, patients with Alzheimer's disease live for 8 to 10 years after diagnosis. However, this terminal disease can last for as long as 20 years.
What are the stages of Alzheimer's disease? [ 11/04/14 ]
The following stages represent the general course the disease follows, but moving from one stage to another may not be perceptable due to the fact that the symptoms are on a gradual continuum of severity.
Physical conditions connected to Alzheimer’s disease exist in a person’s body long before symptoms are evident. These conditions are normally defined through the use of “biomarker” tests, like those searching for beta-amyloid and tau proteins in blood and cerebrospinal fluid, and specialized PET and MRI scans. Currently, this stage is only defined in research settings and clinical trials and is unlikely to be given as an official clinical diagnosis by a health professional.
Mild Cognitive Impairment (MCI) Due To Alzheimer’s Disease/Prodromal Stage:
Recently, scientists have identified a condition between normal age-related memory loss and dementia called mild cognitive impairment (MCI). Individuals with MCI have persistent memory problems (for example, difficulty remembering names and following conversations and marked forgetfulness) but are able to perform routine activities without more than usual assistance. MCI often leads to Alzheimer’s, but while all those who progress to some form of dementia go through a period of MCI, not all patients exhibiting MCI will develop Alzheimer’s disease. An official clinical diagnosis of MCI can be given by a health professional.
Dementia Due To Alzheimer’s Disease (Mild, Moderate, Severe Stages):
Mild (Stage 1)
Early in the illness, people with Alzheimer’s tend to lose energy and spontaneity, though often no one notices anything unusual. They exhibit minor memory loss and mood swings and are slow to learn and react. After a while they start to shy away from anything new and prefer the familiar. In this stage, Alzheimer’s patients can still perform basic tasks independently but may need assistance with more complicated activities. Speech and understanding become slower, and patients often lose their train of thought in midsentence. They may also get lost while traveling or forget to pay bills. As they become aware of this loss of control, they may become depressed, fearful, irritable, and restless.
Moderate (Stage 2)
Eventually, people with the illness begin to be disabled by it. Though the distant past may be recalled, recent events become difficult to remember. Advancing Alzheimer’s affects the ability to comprehend location, the day, and the time. Caregivers must give clear instructions and repeat them often. As Alzheimer’s patients’ minds continue to slip away, they may invent words and not recognize formerly familiar faces.
Severe (Stage 3)
During the final stage, patients become more and more unresponsive. Memory becomes so poor that no one is recognizable. Patients lose bowel and bladder control and eventually need constant care. They lose the ability to chew and swallow and become bedridden and vulnerable to pneumonia, infection, and other illnesses. Respiratory problems worsen, particularly when the patient becomes bedridden. This terminal stage eventually leads to coma and death.
Is there a test to detect a predisposition to Alzheimer's? [ 11/04/14 ]
There is a test currently available that can identify which forms of apolipoprotein (ApoE) are present in the blood. One form, ApoE4, is associated with an already well-studied condition, heart disease, and appears to increase the risk of developing Alzheimer's as well. However, this blood can only detect whether ApoE4 is present, not if and when the person will develop Alzheimer's.
In 2007, researchers at Stanford University published some promising study results in which 18 blood proteins (and resultant chemical signals) were tested to determine the risk of advancement from mild cognitive impairment (MCI) to Alzheimer's disease. In the study, the scientists were able to predict whether the subjects would progress to Alzheimer's with 90% accuracy. However, this study tested a relatively small number of people, and larger studies will need to be undertaken.
Who is at risk for developing Alzheimer’s disease? [ 11/04/14 ]
Familial or early-onset Alzheimer's disease is inherited and develops in people between the ages of 30 and 60. If even one of three gene mutations that causes the disease is inherited from a parent, the child will almost certainly develop Alzheimer's disease. However, less than five percent of patients have early-onset Alzheimer's disease.
Late-onset is usually developed after age 60; this is the most common form of the disease. Its cause is not known and no pattern of inheritance has yet been discovered, although clusters of cases are seen in some families. One particular gene carried by about 25 percent of the American population increases the risk of developing Alzheimer's disease, while another carried by a small proportion of the population substantially protects against the disease. Scientists have identified other genes that may influence the risk of contracting the disease, and further research is ongoing.
Since genetic risk factors are not enough to cause late-onset Alzheimer's disease, researchers are also studying education, diet, and other factors to see if they play a role in developing the disease.
What kind of information should I bring to my first visit to the doctor? [ 11/04/14 ]
If you visit a new doctor, bring your medical records; for any doctor, bring a list of over the counter and prescription medicines you are currently taking. If you don't know the names of the drugs, bring the pill bottles with you. A medication or a combination of medications can sometimes cause symptoms that resemble Alzheimer's disease. Also make a list of current medical problems. It's a good idea to show the doctor a list of symptoms, behaviors and any problems carrying out routine activities (for example, paying bills) in yourself or your loved one that concern you.