Alzheimer's Disease

Definition

Alzheimer's disease is a condition that destroys brain cells. People with this disease slowly lose the ability to learn, function, and remember. It is the most common cause of dementia. Dementia is a loss in mental abilities that is great enough to interfere with daily life.

Areas of the Brain Affected by Alzheimer's Disease

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Causes

The cause of Alzheimer's is not yet known. Two factors that may play a role in the development of Alzheimer's disease are:
•Plaques—Abnormal deposits of a substance called beta amyloid in different areas of the brain.
•Neurofibrillary tangles—Twisted fibers (called tau fibers) within the nerve cells.

Risk Factors

People who are over 65 years of age have an increased risk of Alzheimer's disease.

Other factors that may increase your chance of Alzheimer's disease include:
 

•Previous serious, traumatic brain injury
•Lower educational achievement
•Obesity in middle-age
• Down's syndrome
•Down's syndrome in a first-degree relative
•Women under age 35 who give birth to a child with Down's syndrome
• Smoking
•Family history of Alzheimer's disease
•Presence of a certain type of protein (APOE-e4)
• Depression
•Elevated levels of homocysteine
• Coronary artery disease

Researchers are studying the following to see if they are related to Alzheimer's disease:
 

•Poor nutrition and vitamin deficiency in childhood
•Excess metal in the blood, especially zinc, copper, aluminum, and iron
•Certain viral infections
• Diabetes
• High cholesterol

 

Symptoms

The disease begins as mild memory lapses. It will continue toward a profound loss of memory and function. Alzheimer's disease is divided into 3 stages:
 

•Early—Loss of memory, reasoning, understanding, or learning, but does not interfere with independence
•Intermediate—Increased mental loss, personality changes, and increased dependence on others for basic needs
•Severe—Loss of personality and bodily functions with total dependence on others for care

Symptoms include:
• Increasing trouble remembering things, such as: ◦How to get to familiar locations
◦What the names of family and friends are
◦Where common objects are usually kept
◦How to do simple math
◦How to do usual tasks, such as cooking, dressing, and bathing

•Having difficulty concentrating on tasks
•Having difficulty completing sentences due to lost or forgotten words—may progress to complete inability to speak
•Forgetting the date, time of day, or season
•Getting lost in familiar surroundings
•Having mood swings
•Being withdrawn, losing interest in usual activities
•Having personality changes
•Walking in a slow, shuffling way
•Having poor coordination
•Losing purposeful movement

Diagnosis

There are no tests to confirm Alzheimer's. You will be asked about your symptoms and medical history. A physical exam will be done. Neurological, psychological, and mental status exams may be done.

Your bodily fluids may be tested. This can be done with:
•Blood tests
•Urine tests
• Lumbar puncture to test the cerebrospinal fluid that surrounds the brain and spinal cord

Images may be taken of your bodily structures. This can be done with:
• MRI scan
• CT scan
• PET/CT scan

Your brain's electrical activity may be measured. This can be done with electroencephalogram (EEG).

Treatment

There is no cure for Alzheimer's disease. There are no certain ways to slow its progression. Medication is available to treat some of the symptoms. The goal is to find a medication that can manage the symptoms or slow the condition's course.

Medications for Symptoms and Disease Progression

Medications that have been approved to reduce the symptoms of Alzheimer's disease include:
•Cholinesterase inhibitors—for mild-to-moderate Alzheimer's disease
•N-methyl-D-aspartate (NMDA) receptor antagonist—for moderate-to-severe Alzheimer's disease

Lifestyle Management

Managing the disease includes:
•Creating an environment in which you can receive the care you need
•Keeping your quality of life as high as possible
•Keeping yourself safe
•Helping yourself learn to deal with the frustration of your uncontrollable behavior
•Providing a calm, quiet, predictable environment
•Providing appropriate eyewear and hearing aids, and easy-to-read clocks and calendars
•Playing quiet music
•Doing light, appropriate exercise to reduce agitation and relieve depression
•Encouraging family and close friends to visit frequently

Psychiatric Medication

Psychiatric symptoms may occur with Alzheimer’s disease. Your doctor may prescribe medication to treat:
•Depression
• Anxiety
•Confusion, paranoia, and hallucinations

Caregiver Support

Caring for a person with Alzheimer's disease is difficult and exhausting. The primary caregiver needs emotional support, rest, and regular breaks. The Alzheimer’s Association is an excellent resource for families and caregivers

Prevention

There are no guidelines for preventing Alzheimer's disease because the exact cause is unknown. However, the following factors may help you reduce your risk of Alzheimer's disease:
• Eat a healthful diet that includes fish.
•Drink alcohol, but in moderation. This means no more than two drinks per day for a man, and one drink per day for a woman.
• Exercise regularly .
•Engage in mentally stimulating activities.

Resources:

Alzheimer's Association
http://www.alz.org

National Institute on Aging
http://www.nia.nih.gov

References:

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Last reviewed August 2015 by Rimas Lukas, MD
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