Answers to your questions about Alzheimer's disease
Alzheimer's disease is the most common form of dementia, and this terminal, progressive brain disorder has no known cause or cure. It slowly steals the minds of its victims, leading to memory loss, confusion, impaired judgment, personality changes, disorientation, and the inability to communicate. More than 5 million Americans have Alzheimer's disease, and by 2050, as the U.S. population ages, this could increase to approximately 14 million. Nearly 47 million people are living with Alzheimer's disease or other dementias worldwide, and this is likely to increase to more than 131.5 million by 2050.
What is the difference between Alzheimer's disease and dementia?
Alzheimer's disease is a type of dementia. Generally, 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. The two most common forms of dementia-Alzheimer's disease and vascular dementia-are irreversible, although sometimes their symptoms can be managed. Alzheimer's disease accounts for 60 to 80 percent of cases of dementia. The lesser known vascular dementia is a hardening of the arteries in the brain that causes blockage in blood flow.
If a person appears to be losing mental abilities to a degree that interferes with daily activities and social interactions, consult a doctor to determine if the person is suffering from Alzheimer's disease or another form of dementia.
What are the stages of Alzheimer's disease?
Physical conditions connected to Alzheimer's disease exist in a person's body long before symptoms are evident. State-of-the-art equipment is being developed to detect subtle signs of Alzheimer's prior to noticeable memory loss.
Mild (Stage 1):
In addition to minor memory loss and difficulty learning, first-stage Alzheimer's disease may cause a loss of energy and spontaneity, as well as mood swings, confusion, trouble communicating, and difficulty organizing. Those with mild Alzheimer's may become withdrawn, avoiding new people and places, preferring the familiar. Understandably, they can also become angry and frustrated.
Moderate (Stage 2):
During the second stage of Alzheimer's disease, the patient begins to need help carrying out anything but simple tasks. Recent events and personal histories may be lost and the present confused with the past. There may be difficulty recognizing familiar people, as well as in speaking, reading, writing, dressing, and sleeping. A person with moderate Alzheimer's disease is clearly becoming disabled.
Severe (Stage 3):
Third-stage Alzheimer's disease brings full-blown disability, with possible loss of the ability to feed oneself, to speak, to recognize people, and to control bodily functions. Memory weakens still further and may nearly disappear. The patient's weakened physical state creates vulnerability to other diseases and breathing problems, especially for those confined to bed.
What are the genetic risk factors for developing Alzheimer's disease?
Familial or early-onset Alzheimer's disease is inherited and develops in people before age 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. However, fewer than five percent of patients have early-onset Alzheimer's disease.
Late-onset usually develops 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 genetic factors do appear to play a role in its development. 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.
How is Alzheimer's disease diagnosed?
Only an autopsy can positively confirm the presence of the disease. Knowledgeable physicians however, can correctly diagnose Alzheimer's 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.
Having trouble following instructions, losing one's orientation, displaying poor judgment, and having difficulty managing money, shopping, or driving are all possible mental symptoms of Alzheimer's disease.
When a person experiencing such declines visits the doctor, the medical 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.
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.
Are there treatments available for Alzheimer's disease?
Yes, while there is no cure for Alzheimer's disease as yet, there are medications that can help control or slow its symptoms for a time, and help manage some conditions. These include agitation, depression, sleep problems, wandering, or psychosis (hallucinations or delusions), which may occur as the disease progresses. For more detailed information on the treatments listed below, visit www.brightfocus.org/alzheimerstreatments.
People with Alzheimer's disease have low levels of a key nerve messenger, called acetylcholine, which is important for memory and thinking. Cholinesterase inhibitors drugs 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.
- Razadyne® (galantamine)
- Exelon® (rivastigmine)
- Aricept® (donepezil)
- Cognex® (tacrine)
All four cholinesterase inhibitors have been approved by the Food and Drug Administration (FDA) for early-stage to middle-stage 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.
Some drugs 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.
- Namenda® (memantine)
Namenda® is the first FDA-approved drug for moderate to severe Alzheimer's.
There is one FDA-approved drug that combines cholinesterase inhibitors and glutamate inhibitors. It both prevents the breakdown of acetylcholine in the brain, and appears to protect the brain's nerve cells against excess amounts of glutamate.
- Namzaric® (donepezil and memantine)
Treatment for mental illness:
People in 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 themselves or others, a physician should be asked to evaluate the need for medical treatment.
FINANCIAL ASSISTANCE FOR ALZHEIMER'S MEDICATIONS:
Financial aid resources for Alzheimer's disease prescription drugs can be found at www.brightfocus.org/alzheimersdrugassistance. Always consult a physician before taking any medications.
Are resources available for caregivers for people with Alzheimer's?
There are many great resources available. For instance, every state has a state agency on aging. You may find it in the phone book, online, or with the help of a librarian or friend.
The Alzheimer's Disease Research section of BrightFocus' website provides caregivers with a great deal of useful information on living with and caring for a person with Alzheimer's disease while also taking care of oneself.
Caregivers are often under tremendous pressure and stress, and it is important that they take advantage of the support and assistance available to them.
To find caregiver support, information about your rights as a caregiver, how to manage stress, and more, visit BrightFocus' Caregiver Support page at www.brightfocus.org/alzheimers/caregiving.
Where can I find more information?
BrightFocus Alzheimer's Disease Research website at www.brightfocus.org/alzheimers goes into greater depth on many topics and covers additional areas of concern, both medical and social. You can learn where to get help, how to access resources, and download free BrightFocus publications. Publications are available in both English and Spanish. Explore our Experts & Advice section where you can read tips, insights, and advice written by experts.
For a list of helpful resources for Alzheimer's patients and caregivers, visit our website at www.brightfocus.org/alzresources or call our toll-free number at 855-345-6237 for a print version.
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