Alzheimer’s Disease

What Is Alzheimer’s Disease?

Alzheimer’s disease is a neurodegenerative disease and the most common type of dementia. This type of memory loss is associated with other cognitive defects that can significantly impact a person’s brain health, quality of life, and ability to perform basic activities of daily living.

Alzheimer’s disease affects almost 6 million Americans. According to projections by the Centers for Disease Control and Prevention (CDC), the number is projected to reach nearly 14 million people by 2060.

Alzheimer’s disease is associated with abnormal protein buildup in the brain called amyloid plaques. The protein buildup interferes with the normal function of neurons in the brain. These plaques cause the loss of neurons, leading to progressive memory loss. Eventually, this progression can increase the risk of other health complications and death.

What Is the Difference Between Alzheimer’s and Dementia?

Dementia includes progressive memory loss and decline in cognitive functions, including thinking, remembering, and reasoning. Dementia isn’t a specific disease; it’s a general term for a group of illnesses that cause this cognitive decline.

So, while all Alzheimer’s disease is dementia, not all dementia is Alzheimer’s disease.

Who Does Alzheimer’s Disease Affect?

There are many risk factors for Alzheimer’s disease, including:

• Age
• Family history
• Obesity
• Diabetes
• Cardiovascular disease
• Traumatic head injury
• Depression
• Smoking

In addition to these risk factors, some populations are at a higher risk of developing Alzheimer’s disease.

• It is estimated that Hispanics and African Americans will see a larger increase in Alzheimer’s disease compared to other ethnic groups. These differences may be related to an increased incidence of health conditions and a greater disparity in healthcare for these minority groups.
• Women are also at an increased risk of Alzheimer’s disease across all ethnic groups. This is believed to be due to women having a longer life expectancy than men.

What Are the Stages of Alzheimer’s Disease?

Alzheimer’s disease has several stages. These stages may not be completely discrete; a lot of overlap can occur. It’s difficult to predict how long each stage may last, and it can be difficult to tell which stage you or your loved one is in because of the overlap. These stages are frequently categorized into mild, moderate, and severe disease.

Pre-Clinical Stage

The pre-clinical period is the period before symptoms start. Prior to the onset of noticeable changes in memory, the brain accumulates amyloid plaques and tau tangles. Tau tangles are another type of protein buildup in the brain similar to amyloid plaques. While amyloid plaques are made of amyloid proteins, tau tangles are made of tau proteins. Tau proteins create thin fibers that intertwine with the neurons and interfere with their actions. Currently, there is no treatment available for pre-clinical disease.

Basic Forgetfulness

Basic forgetfulness occurs in the earliest noticeable stages of Alzheimer’s disease. Forgetfulness can be present in anyone, so the earliest noticeable stages of Alzheimer’s can look like normal age-related forgetfulness. However, forgetting things like the names of new people or where they parked the car is common in people in this stage of Alzheimer’s disease.

Noticeable Memory Problems

As Alzheimer’s advances, it becomes more apparent that the associated memory loss is not strictly age-related. Memory loss begins to be more disruptive to daily life. People in this stage of memory loss may start:

• Having difficulty remembering plans and organizing things
• Having difficulty coming up with words
• Having more challenges in social settings or work

Cognitive Decline

As Alzheimer’s disease progresses, more than just the memory becomes affected. It becomes difficult to perform daily tasks because of difficulty with language, ability to organize, and even calculations. People with the disease may:

• Wander or get lost because they forget how to get home
• Become more confused about the date or their location
• Start experiencing sleep disruptions
• Have difficulty making decisions about things like appropriate clothing for the weather

Mood also starts to get affected, and people may withdraw from friends and other social settings due to frustration.

Loss of Independence

As the ability to complete daily tasks worsens, it becomes more difficult for people with Alzheimer’s disease to live independently. Many times, it becomes necessary for people to move in with a family member, have a caregiver, or even go to a facility that specializes in caring for people with Alzheimer’s disease.

In this level of advanced Alzheimer’s disease, your loved one may forget who you are and struggle with simple things like dressing or feeding themselves. It is also common to see changes in mental health, such as paranoia, delusions, or hallucinations.

Advanced Disease

Advanced Alzheimer’s disease is usually associated with a loss of ability to communicate and perform basic self-care. People in this stage of Alzheimer’s disease often have no awareness of their surroundings. They have difficulty communicating thoughts and needs. Personality changes are also very common.

Loss of Physical Function

End-stage Alzheimer’s disease usually results in the need for round-the-clock care and help with even the most basic needs, such as sitting and swallowing. People at this stage usually have minimal to no ability to communicate. They are also at an increased risk of infections.

What Are the Signs and Symptoms of Alzheimer’s Disease?

There are several signs and symptoms associated with Alzheimer’s disease. The symptoms and severity of the symptoms vary depending on the stage of the disease.

Signs of mild Alzheimer’s disease include:

• Memory loss severe enough to disrupt life
• Poor judgment
• Increased time to complete tasks
• Loss of spontaneity
• Difficulty with managing household needs such as paying bills
• Difficulty with problem solving
• Repeating questions or easily forgetting things
• Increased anxiety
• Mood changes

Signs of moderate Alzheimer’s disease include:

• Worsening memory problems
• Withdrawal from social situations
• Trouble with language and numbers
• Trouble learning new things
• Difficulty paying attention
• Occasional difficulty recognizing loved ones
• Changes in sleeping patterns
• Impulsive behavior
• Wandering
• Hallucinations, delusions, or paranoia

Signs of severe Alzheimer’s disease include:

• Trouble communicating
• Lack of awareness
• Weight loss and decreased appetite
• Seizures
• Physical decline
• Loss of control of bodily functions
• Somnolence
• Loss of ability to swallow

Alzheimer’s patients frequently die from pneumonia related to aspiration of food or fluids into the lungs as a result of the loss of ability to swallow safely.

What Causes Alzheimer’s Disease?

There are many theories as to the exact cause of Alzheimer’s disease. The basic understanding is that Alzheimer’s disease is caused by the accumulation of abnormal amyloid plaques and tau tangles in the brain. There are two prominent thoughts about how Alzheimer’s disease occurs.

The Amyloid hypothesis is the most accepted proposed mechanism for how Alzheimer’s disease occurs. This theory suggests that the abnormal function of enzymes in the brain results in abnormal protein formation. These proteins then build up and form plaques and tangles that cause toxicity to the neurons in the brain.

The cholinergic hypothesis is another proposed mechanism for the development of Alzheimer’s disease. This hypothesis suggests that reduced levels of a chemical in the brain called acetylcholine occur due to the loss of neurons. Acetylcholine is a neurotransmitter that is involved in several functions, including the ability to form new memories and learn new things. In the cholinergic hypothesis, it is believed that the amyloid plaques and tau tangles disrupt the function of the neurons in the brain responsible for the production of acetylcholine and decrease the amount of this important neurotransmitter.

Is Alzheimer’s Hereditary?

A family history of Alzheimer’s disease does increase your risk of developing the disease. That said, there is no single genetic cause for Alzheimer’s disease. Genes, lifestyle, and environmental factors can all influence Alzheimer’s disease.

Several genes are known to be associated with Alzheimer’s disease. In fact, researchers have identified over 80 genetic areas associated with the disease. This is an ongoing area of research.

How Is Alzheimer’s Disease Diagnosed?

The diagnosis of Alzheimer’s disease starts with a thorough history and physical exam. Your healthcare provider may recommend tests to rule out other causes of the symptoms. These tests may include mental status testing, neuropsychological testing, interviews with family members, labs, or imaging of your brain. There are newer tests to look at genetic markers or the proteins associated with Alzheimer’s disease, but they are still in development.

What Is the Treatment for Alzheimer’s Disease?

There is currently no cure for Alzheimer’s disease, but there are medications that can slow down the progression of symptoms over time.

• Cholinesterase inhibitors block the enzymes that break down acetylcholine and increase the amount of this important chemical in the brain.
• Immunotherapy medications can also target the beta-amyloid protein and reduce amyloid plaque formation.
• N-methyl-D-aspartate (NMDA) antagonists are used in more advanced cases to reduce symptoms. Memantine is thought to work by regulating glutamate levels in the brain to reduce brain cell death.
• Donepezil and rivastigmine are additional medications used for moderate to severe Alzheimer’s disease.

Other medications may help control some of the behavioral symptoms of Alzheimer’s disease, such as anxiety and agitation. These medications may increase the risk of death from any cause in patients with advanced dementia.

Can I Reduce My Risk of Developing Alzheimer’s Disease?

There is no current therapy that can prevent Alzheimer’s disease, but there are things that you can do to reduce your risk. Controlling chronic conditions such as high blood pressure or diabetes can improve your overall health and also reduce your risk of developing Alzheimer’s disease. Increased physical activity has also been shown to reduce the risk of age-related cognitive decline, but there is no specific known link between physical activity and Alzheimer’s prevention.

There is some evidence that cognitive training may slow age-related cognitive decline. This type of training involves specific activities that are structured and designed to improve memory, decision-making, and brain processing speeds.

One of the many benefits of getting good sleep is that it may also lower your risk of Alzheimer’s disease by allowing your brain more time to clean up. Sleep is the period your brain uses to remove excess plaque and protein buildup. Inadequate sleep increases the risk of dementia development.

What Can I Expect If My Loved One Has Alzheimer’s Disease?

Every patient is different, so if a loved one is diagnosed with Alzheimer’s disease, it can be difficult to know what to expect. Some people with the disease decline rapidly, while others slowly lose their function and independence. If someone you love has been diagnosed with Alzheimer’s disease, there are local and national support groups that can offer you support in this transition.

Your loved one’s healthcare team can also help guide you through the challenges and trials of this condition.

How Do I Care for a Loved One with Alzheimer’s Disease?

Caring for a loved one with Alzheimer’s disease is challenging. Early in the course of the disease, your loved one may only need a little bit of help. Some tips for caring for a loved one early in the course of the disease include:

• Helping them keep a routine
• Helping them keep lists and reminders
• Using a system for medication reminders
• Allowing them to do as much for themselves as they safely can
• Looking at ways to prevent falls around the house
• Being gentle and respectful
• Allowing them extra time to do tasks such as eating
• Helping them get loose-fitting clothing that is easy to put on, such as clothing with elastic waistbands and fabric fasteners
• Planning for the future by discussing care options while they can still participate in the discussion
• Getting written permission to talk to their healthcare team

Planning ahead allows your loved one to have a say in the decisions that will need to be made for your care.

Caring For the Caregiver

One of the most important things you can do as the caregiver of someone with Alzheimer’s disease is to take care of yourself.

Caregiver fatigue is a significant concern for people who care for a loved one with any chronic disease, and caring for a loved one with Alzheimer’s disease is no different. Caring for yourself is the best and most important thing you can do for your loved one with Alzheimer’s disease.