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Alzheimer's disease is the
most common cause of mental decline, or
dementia. But dementia also has many other causes. For
more information, see the topic
brain. It causes a steady loss of memory and of how
well you can speak, think, and do your daily activities.
Alzheimer's disease gets worse over time, but how quickly this
happens varies. Some people lose the ability to do daily activities in the first few years. Others may do fairly well until much later in the disease.
Mild memory loss is common in people older than 60. It may not mean that you
have Alzheimer's disease. But if your memory is getting worse, see your doctor.
If it is Alzheimer's, treatment may help.
disease happens because of changes in the brain. Some of the deterioration may be related to a
loss of chemical messengers in the brain, called neurotransmitters, that allow nerve cells in the brain to communicate
People with Alzheimer's disease have two things in the brain that are not normal: amyloid plaques and neurofibrillary
tangles. Experts don't know if amyloid plaques and neurofibrillary tangles are side effects of Alzheimer's disease or part of
the cause. These plaques and tangles are not found in people who do not have the disease.
For most people, the first
symptom of Alzheimer's disease is memory loss. Often the person who has a
memory problem doesn't notice it, but family and friends do. But the person
with the disease may also know that something is wrong.
The symptoms of Alzheimer's get worse slowly over time. You may:
A person who gets these symptoms over a few hours or days or whose symptoms
suddenly get worse needs to see a doctor right away, because there may be
Your doctor will ask about your past health and do a physical
exam. He or she may ask you to do some simple things that test your memory and
other mental skills. Your doctor may also check how well you can do daily
The exam usually includes blood tests to look for another
cause of your problems. You may have tests such as
CT scans and
MRI scans, which look at your brain. By themselves,
these tests can't show for sure whether you have Alzheimer's.
There is no cure for
Alzheimer's disease. But there are medicines that may slow symptoms down for a while
and make the disease easier to live with. These medicines may not work for everyone or have a big
effect. But most experts think they are worth a try.
disease gets worse, you may get
depressed or angry and upset. The doctor may also
prescribe medicines to help with these problems.
If you are or will be taking care of a loved one with
Alzheimer's, start learning what you can expect. This can help you make the
most of the person's abilities as they change. And it can help you deal with
new problems as they arise.
Work with your loved one to make
decisions about the future before the disease gets worse. It's important to
living will and a
durable power of attorney.
Your loved one will need more and
more care as the disease gets worse. You may be able to give this care at home. Or
you may want to think about using assisted living or a nursing home.
Ask your doctor about
local resources such as support groups or other groups that can help as you
care for your loved one. You can also search the Internet for online support
groups. Help is available.
Learning about Alzheimer's disease:
Living with Alzheimer's disease:
Health Tools help you make wise health decisions or take action to improve your health.
Alzheimer's disease causes loss of brain cells in areas of the brain. Some of the deterioration may be related to a loss
of chemical messengers in the brain, called neurotransmitters, that
allow nerve cells in the brain to communicate properly.
People with Alzheimer's disease have two things in the brain that are not normal: amyloid plaques and neurofibrillary tangles.
Experts don't know if
amyloid plaques and neurofibrillary tangles are side effects of Alzheimer's disease or part of the cause. These plaques and tangles are not found in people who do not have the disease.
Memory loss is usually the first sign of
Alzheimer's disease. Having some
short-term memory loss in your 60s and 70s is common, but this doesn't mean it's Alzheimer's disease.
Compare these examples of normal memory problems and the types of memory problems that may be caused by Alzheimer's disease.
In normal forgetfulness, the person may forget:
In Alzheimer's disease, the person may forget:
Alzheimer's disease also causes changes in thinking,
behavior, and personality. Close family members and friends may first notice these symptoms, although the person may also realize that something is
Following are some of the symptoms of the different stages of Alzheimer's disease. They vary as the disease progresses. Talk to your doctor if a friend or family member has any of the signs.
Usually, a person with mild Alzheimer's disease:
These symptoms often are more obvious when the person is
in a new and unfamiliar place or situation.
Some people have memory loss called mild cognitive impairment. People with this condition are at risk for Alzheimer's disease or another type of dementia. But not all people with mild cognitive impairment progress to dementia.
With moderate Alzheimer's disease, a person
With severe Alzheimer's disease, a person
Early in the disease, Alzheimer's usually doesn't affect a
person's fine motor skills (such as the ability to button or unbutton clothes
or use utensils) or sense of touch. So a person who develops motor symptoms (such
as weakness or shaking hands) or sensory symptoms (such as numbness) probably
has a condition other than Alzheimer's disease. Conditions such as
Parkinson's disease, for instance, may cause motor
symptoms along with dementia.
Other conditions with symptoms
similar to those of Alzheimer's disease may include:
Researchers have discovered
changes that take place in the brains of people who have
Alzheimer's disease. These brain changes may cause the memory loss and decline
in other mental abilities that occur with Alzheimer's disease. It's not fully
understood why these brain changes occur in some people but not in
Alzheimer's disease gets worse over time, but the
course of the disease varies from person to person. Some people may still be
able to function relatively well until late in the course of the disease.
Others may lose the ability to do everyday activities very early on.
A person with severe dementia becomes more vulnerable to other illnesses, such as pneumonia.
Certain things make getting a disease more likely. These are called risk factors. Risk factors for Alzheimer's disease include:
Alzheimer's disease tends to develop slowly over time. If confusion and other
changes in mental abilities come on suddenly, within hours or days, the problem
delirium. Delirium needs treatment right away.
Seek care right away if:
Call your doctor to schedule an appointment if:
If memory loss isn't rapidly becoming worse or
interfering with work, social life, or the ability to function, it may be
normal age-related memory loss. Talk to your doctor if you are concerned about
The following health professionals can evaluate
symptoms of memory loss or confusion:
A family member or friend will need to go with the person
who needs to be evaluated.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Alzheimer's disease is diagnosed after other
conditions are ruled out. Your doctor will use a variety of tests to do this.
is helpful to have a family member or someone in close contact with the person
present at the appointment. A family member may be able to provide the best
information about how a person's day-to-day functioning, memory, and
personality have changed.
The doctor will use a medical history and physical exam to help find out if a physical problem may be causing the person's
symptoms. Sometimes another problem can cause the same symptoms as Alzheimer's.
The person will also have a functional status exam and a
mental health assessment. During these exams, he or she will be asked to perform simple tasks.
Lab tests may be done to rule out other possible causes of a person's
symptoms, such as levels of certain minerals or chemicals in the blood, liver disease, abnormal thyroid levels, or nutritional
problems, such as folate or vitamin B12 deficiencies. Treatment for these
conditions may slow or reverse mental decline.
Blood tests that may be done include:
Other tests include:
In some cases, examining the brain after death is done if the family wants to confirm
that the person had Alzheimer's disease.
While there is not yet a cure for
Alzheimer's disease, you can create a care plan to
maintain quality of life and help the person stay active.
As you get started, ask yourself, other family members, and your doctor these questions:
Care plans may include any of the following:
See Home Treatment to learn more about helping the person remain independent, making the most of the person's abilities, and dealing with new problems as they arise.
An important part of treatment is
finding and treating other medical problems the person may have.
At this time, there is no known way to
Alzheimer's disease. But there are things that may make it less likely.
Adults who are physically active may be less likely than adults who aren't physically
active to get
Alzheimer's disease or another type of dementia. Moderate activity is safe for most people, but it's always a good idea to talk to your doctor before starting an exercise
Older adults who stay
mentally active may be at lower risk for Alzheimer's
disease. Reading, playing cards and other games, working
crossword puzzles, and
even watching television or listening to the radio may help them avoid
symptoms of the disease. So can going out and remaining as socially active as possible. Although this "use it or lose it" approach hasn't been proved, no harm can come from regularly putting the brain to work.
People who eat more fruits and
vegetables, high-fiber foods, fish, and omega-3 rich oils (sometimes known as
the Mediterranean diet) and who eat less red meat and dairy may have some
protection against dementia.
Most people who have
Alzheimer's disease are cared for at home by family members and friends. Taking
care of someone with the disease can be physically and emotionally
draining, but there are ways to make it easier.
Home treatment involves teamwork among health professionals and caregivers to create a safe and comfortable environment and to make tasks of daily living as easy as possible. Some people with early or mild Alzheimer's disease can be involved in planning for the future and organizing the home and daily tasks.
One of the keys to successful
home care is educating yourself. You can do a lot to make the most of the
person's remaining abilities, manage the problems that develop, and improve the
quality of his or her life as well as your own. Also remember that caregiving
can be a positive experience for you and the person you are caring for.
Work with the team of health professionals to:
The team can also help you learn how to manage behavior problems. For example, you can learn ways to:
Caregivers should remember to
seek support from other family and friends. Groups
such as the Alzheimer's Association and the Dementia Advocacy and Support
Network can provide not only educational materials but also information on
support groups and services. For more
information, see the topic
Alzheimer's disease progresses, you have decisions to make about medical care and legal issues.
There are no medicines that
can prevent or cure
Alzheimer's disease. Medicine may help some people function better by temporarily
reducing memory loss and thinking problems. Other medicines may be needed to manage behaviors or symptoms that are causing strain for the person
who has Alzheimer's disease and/or for his or her caregivers.
Because these medicines work differently, they are sometimes used together (for example, memantine and donepezil).
These medicines may temporarily help improve memory and daily
functioning in some people who have Alzheimer's disease. The improvement varies
from person to person. These medicines don't prevent the disease from getting
worse. But they may slow down symptoms of mental decline.
decision about using these usually isn't
whether to try a medicine but when to begin and stop treatment.
Treatment can be started as soon as Alzheimer's disease is diagnosed.
If the medicines are effective, they are
continued until the side effects outweigh the benefits or until the person no
longer responds to the medicines.
Other medicines may be tried to treat anxiety,
agitated or hostile behavior, sleep problems, frightening or disruptive false
beliefs (delusions), suspicion of others (paranoia), or hallucinations (seeing
or hearing things that aren't there).
to use medicine for behavior problems, try to see what is causing
the behavior. If you know the cause, you may be able to find better ways of dealing with that behavior. You may be able to avoid treatment with
medicine and the side effects and costs that come with it.
Medicines generally are
used only for behavior problems when other treatments have failed. They may be needed if:
Close monitoring and regular
reevaluation of the person who has Alzheimer's disease are very important during
treatment with medicine. As the disease progresses and symptoms change, the
person's medicine needs often change. If you are a caregiver for someone with
Alzheimer's disease, be alert for adverse drug reactions or side effects that
further impair the person's ability to function.
Other therapies, such as light therapy,
aromatherapy, and exercise, may help reduce behaviors such as agitation. But they should only be done with supervision.
Another way a caregiver can try to reduce agitation in a person who has Alzheimer's disease is to
play soothing music during meals
and when the caregiver is helping with bathing.
Other treatments for Alzheimer's disease need further study. Their effectiveness and possible side effects aren't yet
fully known. Talk to your doctor before you decide to try any
herbal therapies, supplements, or nonprescription
The Alzheimer's Association is a national organization that
provides educational materials, support groups, and community services for
people dealing with Alzheimer's disease. It has more than 200 local chapters
throughout the United States. The organization publishes a newsletter as well
as a wide range of brochures and videos. The Web site includes a lot of useful
information for people with Alzheimer's and other dementias, as well as for
Part of the National Institute on Aging, ADEAR is a
government-funded agency that prepares computer searches on educational and
library resources as well as information on clinical drug trials.
Care Crossroads is the Alzheimer's Foundation of America's community for caregivers. Using online support groups, teleconferences, discussion boards and more, people who are caring for someone with Alzheimer's disease can learn about the disease and connect with people who can help.
Alzinfo.org was created by the Fisher Center for
Alzheimer's Research Foundation to educate people about Alzheimer's disease.
The mission of the Web site is to build an online community with
24-hours-a-day/7-days-a-week access to information and support via online
chats, message boards, and resource databases.
This organization supports and assists
people who are providing long-term care at home. It also provides education,
research, services, and advocacy.
This website for older adults offers aging-related
health information. The website's senior-friendly features include large
print, simple navigation, and short, easy-to-read segments of information. A
visitor to this website can click special buttons to hear the text aloud, make
the text larger, or turn on higher contrast for easier viewing.
site was developed by the National Institute on Aging and the National
Library of Medicine, both part of the National Institutes of Health
(NIH). NIHSeniorHealth features up-to-date health information from NIH. Also,
the American Geriatrics Society provides independent review of some of the
material found on this website.
Other Works Consulted
Albert MS, et al. (2011). The diagnosis of mild cognitive impairment due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's and Dementia, 7 (3): 270–279.
American Psychiatric Association (2007). Practice Guideline for the Treatment of Patients With Alzheimer's Disease and Other Dementias. Arlington, VA: American Psychiatric Association. Available online: http://psychiatryonline.org/guidelines.aspx.
California Workgroup on Guidelines for Alzheimer's Disease Management (2008). Guideline for Alzheimer's Disease Management. Chicago: Alzheimer's Association. Available online: http://www.alz.org/socal/images/professional_guidelinefullreport.pdf.
Marder K (2012). Dementia and memory loss. In JCM Brust, ed., Current Diagnosis and Treatment Neurology, 2nd ed., pp. 78–101. New York: NcGraw-Hill.
McKhann GM, et al. (2011). The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's and Dementia, 7 (3): 263–269.
National Center for Health Statistics (2010). Alzheimer's Disease. Available online: www.cdc.gov/nchs/fastats/alzheimr.htm.
Qaseem A, et al. (2008). Current pharmacologic treatment of dementia: A clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Annals of Internal Medicine, 148: 370–378.
Remig VM, Weeden A (2012). Medical nutrition therapy and neurologic disorders. In LK Mahan et al., eds., Krause's Food and the Nutrition Care Process, 13th ed., pp. 923–955. St Louis, MO: Saunders.
Small SA, Mayeux R (2010). Alzheimer disease. In LP Rowland, TA Pedley, eds., Merritt's Neurology, 12th ed., pp. 713–718. Philadelphia: Lippincott Williams and Wilkins.
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October 29, 2012
Anne C. Poinier, MD - Internal Medicine & Myron F. Weiner, MD - Psychiatry, Neurology
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