Alzheimer's Disease

What Is It?

Alzheimer's disease damages the brain's intellectual functions (memory, orientation, calculation), but at first, it largely spares those parts of the brain that control sensation and movement. The memory often is affected early and gradually deteriorates, causing impaired judgment and other problems that may affect your ability to perform normal daily activities. Although Alzheimer's usually begins later in life, generally after age 60, it can affect people as young as age 30.

In Alzheimer's disease, deposits of proteins called amyloid and TAU distort communication between brain cells. Also, levels of a chemical called acetylcholine that helps transmit messages between brain cells begin to drop, causing more communication problems. Eventually, brain cells themselves are affected. They begin to shrivel and die, causing certain areas of the brain to shrink.

Alzheimer's disease is the most common cause of dementia, accounting for 50% to 67% of all cases in people aged 65 and older. Approximately 4 million people in the United States currently have the disease.

Everyone is born with the potential to develop Alzheimer's disease. Your lifetime risk of developing the disease is about 10% to 15%. However, several factors may increase your risk:

• Age The older you get, the greater your chance of developing Alzheimer's disease.
• Family history If members of your family, especially parents or siblings, have Alzheimer's or have died of it, your risk of developing the disease increases. Your personal risk also depends several factors, including how many family members are affected with Alzheimer's.
• Genetic factors Some genetic (inherited) factors may increase your lifetime risk of getting Alzheimer's disease.

Symptoms

In the earliest stages of Alzheimer's disease, new or recent memories are difficult to recall. You will find it hard to learn and retain new information. Eventually, older or more distant memories are gradually lost. Other symptoms may appear, including difficulty expressing thoughts as spoken words, difficulty carrying out simple instructions and difficulty interpreting familiar faces or other well-known objects.

A person with early Alzheimer's disease may not be able to plan meals, manage money, remember to keep doors locked or take medicines. You also may lose your sense of direction and get lost while driving or walking, even in a familiar neighborhood.

A person with early Alzheimer's disease usually is able to feed, bathe, dress and groom without help. Two thirds of people develop psychological problems, such as personality changes, irritability, anxiety or depression. When these types of symptoms appear before the disease is diagnosed, relationships with family members and friends can become strained.

As Alzheimer's disease progresses to its middle and late stages, you may have delusions (irrational beliefs, especially about being persecuted or having your belongings stolen) and hallucinations (seeing, hearing, smelling, tasting or being touched by something that isn't really there). You also may become aggressive or may begin to wander away from home if left alone.

Diagnosis

By interviewing both you and your family members, the doctor will determine whether you have any of the following problems: memory lapses, difficulty using language, problems learning and retaining new information, difficulty following directions or handling complex tasks, episodes of poor judgment or unusual or risky behaviors. The doctor will perform a neurological examination (to check the brain and nerves), as well as a brief mental state examination, which includes visual, writing and memory testing. The doctor will check for other illnesses that can cause symptoms that resemble Alzheimer's disease. Testing may include blood tests to make sure that blood chemistry and the levels of vitamin B-12 and thyroid hormone are normal.

In some cases, the doctor may order a brain imaging study to be more certain that there is not some other reason for the symptoms. The results of a computed tomography (CT) scan, a magnetic resonance imaging (MRI) scan and a positron emission tomography (PET) scan cannot diagnose Alzheimer's with certainty. However, the radiologist (doctor who reads the scans) can suggest that the images are consistent with the disease. If your symptoms are not typical (10% to 20% of cases) or if the neurological examination shows signs of a sensory or movement problem, the doctor may refer you to a specialist, such as a neurologist, geriatrician or a geriatric psychiatrist, to confirm the diagnosis.

Expected Duration

Alzheimer's disease is irreversible. Once the diagnosis is made, mental function usually declines over 3 to 20 years (average, 10 years) until death.

Prevention

There is no way to prevent Alzheimer's disease. Nonsteroidal anti-inflammatory drugs (NSAIDs) may offer some protection. This is being studied. Staying physically and mentally active and having a high educational level is associated with a lower risk of developing the disease.

Treatment

Four medications, tacrine (Cognex), donepezil (Aricept), rivastigmine tartrate (Exelon) and galantamine (Reminyl), may slow the intellectual decline in some people with mild to moderate Alzheimer's disease. These drugs (called cholinesterase inhibitors) increase the brain's levels of acetylcholine, which helps to restore communication between brain cells. Another medication, memantine (Namenda), has been shown to stabilize memory in people with moderate to severe Alzheimer's disease. It is the first in a new class of medications called NMDA receptor antagonists.

Other strategies used to help people with Alzheimer's include psychotherapy techniques (reality orientation and memory retraining) and medications to relieve depression and calm agitated behavior.

As much as possible, you should follow a regular exercise routine, maintain normal social contacts with family and friends and continue intellectual activities. In addition to regularly scheduled doctor visits, patients and their families should take advantage of community resources and support groups. Discuss any safety concerns, especially driving, with the doctor.

Although several nonprescription products claim to improve mental function, the scientific evidence to support this claim is weak. Check with your doctor before taking any nonprescription medication, especially if you are taking a prescription medication for heart problems, diabetes, high blood pressure or mental illness or if you have problems with your heart or liver.

When To Call a Professional

Call your doctor whenever you or a family member has any of the following problems: serious lapses in memory or judgment (forgets medication, forgets the stove is on, allows strangers into the home); disorientation (gets lost) while driving or walking, especially in a familiar neighborhood; a substantial change in personality. The affected person often is unaware of these problems and may even deny that they exist.

Prognosis

Although no medication is available to cure Alzheimer's disease, cholinesterase inhibitors may improve the ability to perform daily activities, relieve behavior problems or possibly delay the need for a nursing home.

Additional Info

Alzheimer's Association

National Office

225 N. Michigan Ave.

Floor 17

Chicago, IL 60601

Phone: 312-335-8700

Toll-Free: 1-800-272-3900

Fax: 312-335-1110

Email: info@alz.orghttp://www.alz.org/

Alzheimer's Disease Education & Referral Center (ADEAR)

National Institute on Aging

P.O. Box 8250

Silver Spring, MD 20907-8250

Toll-Free: 1-800-438-4380

Fax: 301-495-3334

Email: adear@alzheimers.org

http://www.alzheimers.org/

Fisher Center for Alzheimer's Research Foundation

One Intrepid Square

West 46th Street and 12th Avenue

New York, NY 10036

Toll-Free: 1-800-259-4636

http://www.alzinfo.org