Ask an Expert about Alzheimer's Disease

Familial Alzheimer's disease (FAD) or early-onset Alzheimer's is an inherited, rare form of the disease, affecting less than 10 percent of Alzheimer's disease patients. FAD develops before age 65, in people as young as 35. It is caused by one of three gene mutations on chromosomes 1, 14 and 21. If even one of these mutated genes is inherited from a parent, the person will almost always develop FAD. All offspring in the same generation have a 50/50 chance of developing FAD if one parent has it.

The majority of Alzheimer's disease cases are late-onset, usually developing after age 65. Late-onset Alzheimer's disease has no known cause and shows no obvious inheritance pattern. However, in some families, clusters of cases are seen. Although a specific gene has not been identified as the cause of late-onset Alzheimer's disease, genetic factors do appear to play a role in the development of this form of the disease. A gene called Apolipoprotein E (ApoE) appears to be a risk factor for the late-onset form of AD. There are three forms of this gene: ApoE2, ApoE3 and ApoE4. Roughly one in four Americans has ApoE4 and one in twenty has ApoE2. While inheritance of ApoE4 increases the risk of developing AD, ApoE2 substantially protects against the disease.

Scientists believe that several other genes may influence the development of Alzheimer's disease. Two of these genes, UBQLN1 and SORL1, are located on chromosomes 9 and 11. Researchers have also identified three genes on chromosome 10, one of which produces an insulin degrading enzyme that may contribute to the disease. A gene, called TOMM40, appears to significantly increase one's susceptibility to developing Alzheimer's when other risk factors are present, such as having the ApoE-4 gene. Several recently discovered genes that influence Alzheimer's disease risk are CLU (also called APOJ) on chromosome 8, which produces a protein called clusterin, PICALM on chromosome 11 and CR1 on chromosome 1.

Genetic risk factors alone are not enough to cause the late-onset form of Alzheimer's disease, so researchers are actively exploring education, diet and environment to learn what role they might play in the development of this disease.

Dementia is a decline in thinking, reasoning, and/or remembering. People with dementia have difficulty carrying out daily tasks they have performed routinely and independently throughout their lives. Vascular dementia, a hardening of the arteries in the brain that causes blockage in blood flow, is one of the two most common forms of dementia; the other is Alzheimer's disease. These two conditions account for the vast majority of cases; both are irreversible, although sometimes their symptoms can be managed.

A doctor can accurately determine whether a person is suffering from Alzheimer's disease or another form of dementia. If a person appears to be losing mental abilities to a degree that interferes with daily activities and social interactions, consult a doctor.

BrightFocus’ Alzheimer's Disease Research website goes into greater depth on many topics and covers additional areas of concern, both medical and social. You can learn where to get help and access to resources, as well as download free publications. And explore our Ask an Expert section where you can read or post queries to doctors.

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Medicare is a federal health insurance program for people age 65 or older who receive Social Security retirement benefits. To receive assistance from Medicare, a person must meet specific eligibility requirements. Medicare covers some, but not all, of the services a person with Alzheimer's disease may require. For example, the program does not cover long term healthcare. Medicaid is a federal program for certain individuals and families with low incomes and resources, typically administered by state agencies; eligibility and benefits vary from state to state. Medicaid can cover all or a portion of nursing home costs. A person with Alzheimer's can qualify for long term care only if there are minimal income and cash assets. Medicaid may be applied for by calling each state's Department of Human Services or Medicaid Assistance Program.

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.

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.

This is worrisome. If the bed sores are infected, this could be the source of the confusion. It is great that she is now eating well, and hopefully this will stabilize her weight. For her sake though, please contact her physician immediately and bring this to his/her attention. They may want to see her in the office, or if they have already seen her recently, perhaps they could schedule home health for wound care.

Regarding your father’s fatigue, this is completely normal and understandable. Is there someone who can give him a daily break? Everyone needs respite, especially from the demands of caregiving. Are there funds available to pay for a home health aide a few times per week? Depending on where they live, contact the local Area Agency on Aging. They are a good resource and can help direct you toward services in the area.

Changes in environment for someone with Alzheimer’s can be very disorienting and confusing. It is possible that returning to her home will be comforting for her and will help her return to her previous level or close to it. However, it is difficult to know without going ahead and moving her back. If it is safe to do so, and your parents have appropriate support at home, moving them back would be a good step. Maintaining a calm and supportive environment is very important for your mom to remain at her optimum.

That said, caring for two people with different needs is challenging. Obviously, your father’s needs have to be considered as well. If you find it difficult to determine your options, it would be wise to reach out to their physicians, or a local senior specialist who could assist you to determine the best course of action.