Alzheimer's Disease

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Alzheimer's disease is a progressive disease that causes problems with memory, thinking and behavior. These symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily life.

Alzheimer’s is the most common form of dementia, a general term for brain disorders that result in the loss of intellectual and social skills. Alzheimer’s disease accounts for 50 to 80 percent of dementia cases.

Unfortunately, there is no cure yet for Alzheimer’s disease however treatments, such as medications and management strategies, may temporarily improve the symptoms.

How Does Alzheimer’s Disease Occur?

Alzheimer’s disease damages and kills brain cells that are responsible for specific functions such as thinking, learning and remembering. Compared with a healthy brain, a brain affected by Alzheimer’s disease has many fewer cells and many fewer connections among surviving cells.

Although the ultimate cause of brain cell death in Alzheimer’s is not known, there are two types of abnormalities found in the brain of those with the disease that are strongly implicated in damaging and killing brain cells:

  • Plaques: These clumps of a protein, called beta-amyloid, build up in the spaces between nerve cells and may damage and destroy brain cells in several ways, including interfering with cell-to-cell communication.
  • Tangles: Tangles are twisted fibers of another protein, called tau, that build up inside cells. In Alzheimer's, threads of tau protein twist into abnormal tangles inside brain cells, leading to failure of the transport system. This failure is also associated with the decline and death of brain cells.

What are the Causes of Alzheimer’s Disease?

While a specific cause of Alzheimer’s is not known, there are factors that can increase your risk of developing the disease. These include:

  • Age: Increasing age is the greatest known risk factor for Alzheimer's disease. Most individuals with the disease are 65 years or older. The likelihood of developing Alzheimer’s doubles around every five years after age 65 and nearly half of those older than age 85 have Alzheimer's.
  • Family history: Your risk of developing Alzheimer's is higher if a first-degree relative (your parent, sibling or child) has the disease.
  • Genetics: Another risk factor involved in Alzheimer’s is genetics. Scientists have identified rare changes in three genes that almost guarantee a person who inherits them will develop Alzheimer's. However, these mutations occur in less than 5 percent of those who have Alzheimer's disease.
  • Sex: Women are more likely than men to develop Alzheimer's disease.
  • Past head trauma: People who have experienced severe head trauma appear to have a greater risk of Alzheimer's disease.
  • Lifestyle and health factors: There is some evidence to suggest that factors such as inadequate exercise, smoking, alcohol abuse and lack of social engagement can increase the chance of developing Alzheimer’s.

 

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Regardless of age, everyone experiences occasional episodes of forgetfulness. But sometimes, when your memory loss occurs more and more frequently, this could mean a more serious condition. If you find yourself struggling to find the right word, having difficulty with tasks that once came easily and feeling like your memory problems are affecting your daily life, then you may be experiencing the early signs of Alzheimer’s disease.

Alzheimer’s is not a normal part of aging, so it is important to be aware of the symptoms and what you can do to address the disease. In 2006, there were 26.6 million people with Alzheimer’s disease worldwide. By 2050, this is estimated to quadruple, by which time 1 in 85 people worldwide will be living with the disease.

As there is no cure for Alzheimer’s disease, this section includes in-depth information on diagnosing Alzheimer’s and treating its symptoms. Being a progressive condition, there is also information to guide you on what to expect at different stages of the disease, as well as tips for coping with daily routines and challenges.

For the family and friends of those suffering with the disease, there is a detailed explanation of the causes and risk factors associated with the disease

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There is no one test that confirms you have Alzheimer’s disease. As memory loss and other symptoms of Alzheimer’s can be caused by many different factors, your doctor will run various tests to help clarify the diagnosis and make a judgment about whether Alzheimer’s is the most likely cause of your symptoms.

Doctors can almost always determine whether you have dementia, including whether your dementia is due to Alzheimer’s disease.

These are some of the tests conducted to diagnose Alzheimer’s and rule out other conditions:

  • Medical history assessment: During a review of your medical history, your doctor will want to know about any current or past illnesses, as well as any medications you are taking. They will also ask about related medical conditions affecting other family members, including whether any family members have suffered from Alzheimer's disease or other forms of dementia.
  • Cognitive and neuropsychological tests: In these tests, doctors will evaluate your thinking (cognitive) function. A number of tests measure thinking skills such as memory, orientation, reasoning and judgment, language skills, and attention.
  • Neurological evaluation: In a neurological evaluation, doctors will assess your movement, senses, speech, balance and reflexes. This evaluation can sometimes help to diagnose other conditions.
  • Brain scans: Doctors may order brain scans, such as a CT or MRI scan, to check for evidence of a stroke, damage from severe head trauma or a buildup of fluid in the brain. Such scans are also used to rule out the possibility of a tumor.
  • Laboratory tests: Simple blood and/or urine tests can detect whether physical problems, such as vitamin B-12 deficiency or an underactive thyroid gland, are affecting your brain function and causing similar symptoms to Alzheimer’s.
  • Psychiatric evaluation: You may be referred to meet with a psychologist or psychiatrist who will evaluate whether depression or another psychological condition may be causing your symptoms.

Coping with an Alzheimer’s diagnosis

If your symptoms have been diagnosed as Alzheimer’s disease, this can mean an enormous adjustment for both you and your loved ones. While there is currently no cure for Alzheimer’s disease, there are treatments available for the symptoms. It may also help to understand more about the progressive nature of the disease by learning about the 7 stages of Alzheimer’s.

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This seven-stage framework below gives a general outline of how abilities change during the course of the disease. It is based on a system developed by Barry Reisberg, M.D., Clinical Director of the New York University School of Medicine's Silberstein Aging and Dementia Research Center.

  • Stage 1 – No Impairment: Memory and cognitive abilities appear normal.
  • Stage 2 – Minimal Impairment/Normal Forgetfulness: Memory lapses and changes in thinking are rarely noticed by friends, family or doctors.
  • Stage 3 – Early Confusional/Mild Cognitive Impairment: Subtle difficulties begin occur including trouble with retrieving words, planning, misplacing objects and forgetting recent learning. Depression and other changes in mood can also arise.
  • Stage 4 – Late Confusional/Mild Alzheimer’s: While most people in this stage still know themselves and their family, recent conversations and events are increasingly forgotten. There can be difficulty carrying out sequential tasks, including cooking, driving and shopping. Withdrawing from social situations, becoming defensive, and denying problems is also likely. Accurate diagnosis of Alzheimer’s disease is possible at this stage.
  • Stage 5 – Early Dementia/Moderate Alzheimer’s disease: Decline is more severe and requires assistance. People in this stage are unable to recall personal history details and contact information. They are no longer able to manage independently and are frequently disoriented regarding place and/or time. Basic daily living tasks like feeding and dressing require increased supervision.
  • Stage 6 – Middle Dementia/Moderately Severe Alzheimer’s disease: This stage is characterised by a total lack of awareness of present events, as well as the inability to accurately remember the past. People in this stage progressively lose the ability to take care of daily living activities like dressing, going to the toilet and eating but are still able to respond to nonverbal stimuli. Agitation and hallucinations are common. Dramatic personality changes, including suspicion of family members, occur often. Many can’t remember close family members, but know they are familiar.
  • Stage 7 – Late or Severe Dementia and Failure to Thrive: In this final stage, speech becomes severely limited, as well as the ability to walk or sit. Care and support is required 24 hours a day for day-to-day living. 
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While there is no cure for Alzheimer’s disease, doctors can offer a range of treatments to help you reduce or delay the symptoms.

Medications

  • Cholinesterase inhibitors: These medications – including donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) – work by boosting levels of a chemical messenger involved in memory and judgment. These medications are generally well tolerated and delay worsening of symptoms by an average of 6 to 12 months, for approximately half of the people who take them. Potential side effects include nausea, vomiting, diarrhea and loss of appetite. 
  • Memantine: Memantine (Namenda) works by regulating the activity of glutamate. Glutamate is another chemical messenger involved in brain functions, such as learning and memory. Memantine delays the worsening of symptoms for some people temporarily. There is some evidence that suggests individuals with moderate to severe Alzheimer’s who are taking a cholinesterase inhibitor might benefit by also taking Memantine. Potential side effects include dizziness, headache, constipation and confusion.
  • Other medications: Your doctor may prescribe other medications to treat related symptoms, such as sleep disorder and depression.

Lifestyle adjustments

  • Modifying the environment at home: Getting rid of unnecessary furniture and clutter can reduce confusion, and make it easier for someone with Alzheimer’s to function. Consider installing handrails through the house for extra support, as well as reducing the number of mirrors to avoid confusion.

  • Adjusting a caregiver’s responses: Despite best intentions, sometimes a caregiver’s response to a behaviour can actually make the behaviour worse. It's best to avoid correcting and quizzing a person with Alzheimer’s disease. Reassuring the person and validating his or her concerns can defuse most situations.

  • Simplify tasks: Break tasks into easier steps and focus on completing them successfully. Creating structure and routine throughout the day can also help reduce confusion in people with Alzheimer’s.

Alternative Medicine

  • Herbal mixtures, vitamins and supplements can support cognitive function and be used to delay or prevent Alzheimer’s. While some alternative treatments such as Vitamin E, Omega-3 fatty acids, Co-enzyme Q10 and Gingko bilboa are recommended for this use, there are concerns about the use of alternative medicine, especially when taken together with other drugs. It is best to speak with your doctor to create a treatment plan that’s right for you. 
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Currently, there’s no proven way to prevent Alzheimer’s disease. But you may be able to lower your risk of developing the disease by keeping physically and mentally active and making lifestyle changes such as those below:

  • Keep your mind active: Mentally stimulating activities such as memory training games, puzzles and cross words may delay the onset of Alzheimer’s and help decrease its effects.
  • Exercise regularly: Regular physical activity not only improves a person’s overall wellbeing, but may also delay the onset of Alzheimer’s disease and reduce its symptoms. Research suggests that exercise can directly benefit brain cells by increasing blood and oxygen flow. Staying physically active may also protect brain health through its proven benefits to the cardiovascular system.
  • Avoid smoking and limit drinking: Some studies have shown smoking in middle age and older may increase your risk of Alzheimer’s. People who consume large amounts of alcohol also have a higher risk of developing the disease.
  • Social connections and intellectual activity: A number of studies indicate that maintaining strong social connections and keeping mentally active as we age might lower the risk of mental decline. Researchers believe that intellectual activity may help your brain develop a strong nerve cell network that compensates for nerve cell damage caused by Alzheimer's disease.
  • Maintain a heart healthy diet: Having a healthy diet is important for many reasons, but a diet rich in whole grains, fruits, vegetables and healthy fats, may promote overall health and lower your risk of developing dementia or Alzheimer’s.
  • Get regular and restful sleep: Your brain needs regular, restful sleep in order to function at optimum capacity. This is critical for memory formation and retention. Sleep deprivation not only slows your thinking and affects your mood, it can also put you at greater risk of developing symptoms of Alzheimer’s disease. Aim for the recommended 8 hours of sleep per night.
  • Avoid head trauma: There appears to be a strong link between future risk of Alzheimer's and serious head trauma. Protect your head by always wearing a seat belt and using protective head gear when playing sports.
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