| Alzheimer | 6 items found |
What is Alzheimer's
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Alzheimer’s disease is a brain disorder named for German physician Alois Alzheimer, who first described it in 1906. Scientists have learned a great deal about Alzheimer’s disease in the century since Dr. Alzheimer first drew attention to it. Today we know that Alzheimer’s: | Is a progressive and fatal brain disease. As many as 5.3 million Americans are living with Alzheimer’s disease. Alzheimer's destroys brain cells, causing memory loss and problems with thinking and behavior severe enough to affect work, lifelong hobbies or social life. Alzheimer’s gets worse over time, and it is fatal. Today it is the seventh-leading cause of death in the United States. Learn more: Warning Signs and Stages of Alzheimer’s Disease. Is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer’s disease accounts for 50 to 70 percent of dementia cases. Other types of dementia include vascular dementia, mixed dementia, dementia with Lewy bodies and frontotemporal dementia. Learn more: Related Dementias. Has no current cure. But treatments for symptoms, combined with the right services and support, can make life better for the millions of Americans living with Alzheimer’s. There is an accelerating worldwide effort under way to find better ways to treat the disease, delay its onset, or prevent it from developing. Learn more about recent progress in Alzheimer research funded by the Alzheimer’s Association in the Research section. Alzheimer's and the brain Just like the rest of our bodies, our brains change as we age. Most of us notice some slowed thinking and occasional problems with remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work are not a normal part of aging. They may be a sign that brain cells are failing. The brain has 100 billion nerve cells (neurons). Each nerve cell communicates with many others to form networks. Nerve cell networks have special jobs. Some are involved in thinking, learning and remembering. Others help us see, hear and smell. Still others tell our muscles when to move. In Alzheimer’s disease, as in other types of dementia, increasing numbers of brain cells deteriorate and die. The role of plaques and tangles Two abnormal structures called plaques and tangles are prime suspects in damaging and killing nerve cells. Plaques and tangles were among the abnormalities that Dr. Alois Alzheimer saw in the brain of Auguste D., although he called them different names. Plaques build up between nerve cells. They contain deposits of a protein fragment called beta-amyloid (BAY-tuh AM-uh-loyd). Tangles are twisted fibers of another protein called tau (rhymes with “wow”). Tangles form inside dying cells. Though most people develop some plaques and tangles as they age, those with Alzheimer’s tend to develop far more. The plaques and tangles tend to form in a predictable pattern, beginning in areas important in learning and memory and then spreading to other regions. Scientists are not absolutely sure what role plaques and tangles play in Alzheimer’s disease. Most experts believe they somehow block communication among nerve cells and disrupt activities that cells need to survive. Early-stage and younger-onset Alzheimer's disease Early-stage is the early part of Alzheimer’s disease when problems with memory, thinking and concentration may begin to appear in a doctor’s interview or medical tests. Individuals in the early-stage typically need minimal assistance with simple daily routines. At the time of a diagnosis, an individual is not necessarily in the early stage of the disease; he or she may have progressed beyond the early stage. The term younger-onset refers to Alzheimer's that occurs in a person under age 65. Younger-onset individuals may be employed or have children still living at home. Issues facing families include ensuring financial security, obtaining benefits and helping children cope with the disease. People who have younger-onset dementia may be in any stage of dementia – early, middle or late. Experts estimate that some 500,000 people in their 30s, 40s and 50s have Alzheimer's disease or a related dementia.
Symptoms & Stages of Alzheimer’s Disease
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Some common early symptoms of Alzheimer’s disease include confusion, disturbances in short-term memory, problems with attention and spatial orientation, changes in personality, language difficulties and unexplained mood swings. Normally, these symptoms are very mild, and presence of the disease may not be apparent to the person experiencing the symptoms, loved ones or even health professionals. The three stages listed below represent the general progression of the disease. Although these symptoms will likely vary in severity and chronology, overlap and fluctuate, the overall progress of the disease is fairly predictable. On average, people live for 8 to 10 years after diagnosis, but this terminal disease can last for as long as 20 years. | Alzheimer’s generally leads to impairment of cognitive and memory function, communication problems, personality changes, erratic behavior, dependence and loss of control over bodily functions. Alzheimer’s disease doesn’t affect every person the same way, but symptoms normally progress in these stages. Stage 1 (Mild): This stage can last from 2 to 4 years. Early in the illness, those with Alzheimer’s tend to be less energetic and spontaneous. They exhibit minor memory loss and mood swings, and are slow to learn and react. They may become withdrawn, avoid people and new places and prefer the familiar. Individuals become confused, have difficulty organizing and planning, get lost easily and exercise poor judgment. They may have difficulty performing routine tasks, and have trouble communicating and understanding written material. If the person is employed, memory loss may begin to affect job performance. They can become angry and frustrated. Some specific examples of behaviors that people exhibit in this mild stage include: Getting lost Difficulty managing money and paying bills Repetitive questions and conversations Taking longer than usual to finish routine daily tasks Poor judgment Losing things or misplacing them in odd places Noticeable changes in personality or mood Stage 2 (Moderate): This is generally the longest stage and can last 2 to 10 years. In this stage, the person with Alzheimer’s is clearly becoming disabled. Individuals can still perform simple tasks independently, but may need assistance with more complicated activities. They forget recent events and their personal history, and become more disoriented and disconnected from reality. Memories of the distant past may be confused with the present, and affect the person’s ability to comprehend the current situation, date and time. They may have trouble recognizing familiar people. Speech problems arise and understanding, reading and writing are more difficult, and the individual may invent words. They may no longer be safe alone and can wander. As Alzheimer’s patients become aware of this loss of control, they may become depressed, irritable and restless or apathetic and withdrawn. They may experience sleep disturbances and have more trouble eating, grooming and dressing. Stage 3 (Severe): This stage may last 1 to 3 years. During this final stage, people may lose the ability to feed themselves, speak, recognize people and control bodily functions, such as swallowing or bowel and bladder control. Their memory worsens and may become almost non-existent. They will sleep often and grunting or moaning can be common. Constant care is typically necessary. In a weakened physical state, patients may become vulnerable to other illnesses, skin infections, and respiratory problems, particularly when they are unable to move around.
10 Signs of Alzheimer's
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1. Memory loss that disrupts daily life | One of the most common signs of Alzheimer's is memory loss, especially forgetting recently learned information. Others include forgetting important dates or events; asking for the same information over and over; relying on memory aides (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own. What's typical? Sometimes forgetting names or appointments, but remembering them later. 2. Challenges in planning or solving problems Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before. What's typical? Making occasional errors when balancing a checkbook 3. Difficulty completing familiar tasks at home, at work or at leisure People with Alzheimer's often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game. What's typical? Occasionally needing help to use the settings on a microwave or to record a television show 4. Confusion with time or place People with Alzheimer's can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there. What's typical? Getting confused about the day of the week but figuring it out later. 5. Trouble understanding visual images and spatial relationships For some people, having vision problems is a sign of Alzheimer's. They may have difficulty reading, judging distance and determining color or contrast. In terms of perception, they may pass a mirror and think someone else is in the room. They may not realize they are the person in the mirror. What's typical? Vision changes related to cataracts. 6. New problems with words in speaking or writing People with Alzheimer's may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a "watch" a "hand-clock"). What's typical? Sometimes having trouble finding the right word. 7. Misplacing things and losing the ability to retrace steps A person with Alzheimer's disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time. What's typical? Misplacing things from time to time, such as a pair of glasses or the remote control. 8. Decreased or poor judgment People with Alzheimer's may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean. What's typical? Making a bad decision once in a while. 9.Withdrawal from work or social activities A person with Alzheimer's may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced. What's typical? Sometimes feeling weary of work, family and social obligations. 10. Changes in mood and personality The mood and personalities of people with Alzheimer's can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone. What's typical? Developing very specific ways of doing things and becoming irritable when a routine is disrupted.
Standard Treatments
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Currently, there is no cure for Alzheimer's. But drug and non-drug treatments may help with both cognitive and behavioral symptoms. | Researchers are looking for new treatments to alter the course of the disease and improve the quality of life for people with dementia. Treatments for cognitive symptoms The U.S. Food and Drug Administration (FDA) has approved two types of medications to treat cognitive symptoms of Alzheimer's disease. These drugs affect the activity of two different chemicals involved in carrying messages between the brain's nerve cells. 1. Cholinesterase (KOH-luh-NES-ter-ays) inhibitors prevent the breakdown of acetylcholine (a-SEA-til-KOH-lean), a chemical messenger important for learning and memory. These drugs: Support communication among nerve cells by keeping acetylcholine levels high. On average, delay worsening of symptoms for 6 to 12 months for about half the people who take them. Some experts believe a small percentage of people may benefit more dramatically. Three cholinesterase inhibitors are commonly prescribed: Donepezil (Aricept), approved to treat all stages of Alzheimer's disease. Rivastigmine (Exelon), approved to treat mild to moderate Alzheimer's. Galantamine (Razadyne), approved to treat mild to moderate Alzheimer's. 2. Memantine (Namenda) works by regulating the activity of glutamate, a different messenger chemical involved in learning and memory. Memantine: Was approved in 2003 for treatment of moderate to severe Alzheimer's disease. Is currently the only drug of its type approved to treat Alzheimer's. Temporarily delays worsening of symptoms for some people. Many experts consider its degree of benefit is similar to the cholinesterase inhibitors. Treatments for behavioral and psychiatric symptoms For many individuals, Alzheimer's disease affects the way they feel and act in addition to its impact on memory and other thought processes. As with cognitive symptoms, the chief underlying cause is progressive destruction of brain cells. In different stages of Alzheimer's, people may experience: Physical or verbal outbursts General emotional distress Restlessness, pacing, shredding paper or tissues and yelling Hallucinations (seeing, hearing or feeling things that are not really there) Delusions (firmly held belief in things that are not real) Many diagnosed individuals and their families find these symptoms the most challenging and distressing effects of the disease. For more information about behaviors in Alzheimer's disease, please see the Behaviors section. There are two approaches to managing behavioral symptoms: using medications specifically to control the symptoms or non-drug strategies. Non-drug approaches should always be tried first. Non-drug approaches Steps to developing successful non-drug treatments include: Recognizing that the person is not just "acting mean or ornery," but is having further symptoms of the disease Understanding the cause and how the symptom may relate to the experience of the person with Alzheimer's Changing the person's environment to resolve challenges and obstacles to comfort, security and ease of mind Everyone who develops behavioral symptoms should receive a thorough medical exam, especially if symptoms appear suddenly. Even though the chief cause of behavioral symptoms is the effect of Alzheimer's disease on the brain, an exam may reveal treatable conditions that are contributing to the behavior. Treatable conditions may include: Drug side effects. Many people with Alzheimer's take prescription medications for other health problems. Drug side effects or interactions between drugs can sometimes affect behavior. Physical discomfort. As the disease gets worse, those with Alzheimer's have more and more difficulty communicating about their experience. As a result, symptoms of common illnesses may sometimes go undetected. Pain from infections of the urinary tract, ear or sinuses may lead to restlessness or agitation. Discomfort from a full bladder, constipation, or feeling too hot or too cold may also be expressed through behavior. Uncorrected problems with hearing or vision. These can contribute to confusion and frustration and foster a sense of isolation. Factors in the environment may also trigger behaviors. Events or changes in a person's surroundings may contribute to a sense of uneasiness, or increase fear or confusion. Situations affecting behavior may include: Moving to a new residence or nursing home Changes in the environment or caregiver arrangements Misperceived threats Admission to a hospital Being asked to bathe or change clothes Fear and fatigue resulting from trying to make sense out of an increasingly confusing world Potential solutions Monitor personal comfort. Check for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation. Maintain a comfortable room temperature. Avoid being confrontational or arguing about facts; instead, respond to the feeling behind what is being expressed. For example, if a person expresses a wish to go visit a parent who died years ago, don't point out that the parent is dead. Instead, say, "Your mother is a wonderful person. I would like to see her too." Redirect the person's attention. Try to remain flexible, patient and supportive. Create a calm environment. Avoid noise, glare, insecure space, and too much background distraction, including television. Simplify the environment, tasks and solutions. Allow adequate rest between stimulating events. Provide a security object or privacy. Equip doors and gates with safety locks. Remove guns. Medications for behavioral symptoms If non-drug approaches fail after they have been applied consistently, introducing medications may be appropriate when individuals have severe symptoms or have the potential to harm themselves or others. Medications can be effective in some situations, but they must be used carefully and are most effective when combined with non-drug approaches. Medications should target specific symptoms so their effects can be monitored. In general, it is best to start with a low dose of a single drug. Effective treatment of one core symptom may sometimes help relieve other symptoms. For example, some antidepressants may also help people sleep better. Individuals taking medications for behavioral symptoms must be closely monitored. People with dementia are susceptible to serious side effects, including stroke and an increased risk of death from antipsychotic medications. Sometimes medications can cause an increase in the symptom being treated. Without careful evaluation, some medical providers will increase rather than decrease the dose, putting the person at greater risk. Risk and potential benefits of a drug should be carefully analyzed for any individual.
Alternative Treatments
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A growing number of herbal remedies, vitamins and other dietary supplements are promoted as memory enhancers or treatments for Alzheimer’s disease and related diseases. | Claims about the safety and effectiveness of these products, however, are based largely on testimonials, tradition and a rather small body of scientific research. The rigorous scientific research required by the U.S. Food and Drug Administration (FDA) for the approval of a prescription drug is not required by law for the marketing of dietary supplements. Coenzyme Q10 Coenzyme Q10, or ubiquinone, is an antioxidant that occurs naturally in the body and is needed for normal cell reactions. This compound has not been studied for its effectiveness in treating Alzheimer’s. A synthetic version of this compound, called idebenone, was tested for Alzheimer’s disease but did not show favorable results. Little is known about what dosage of coenzyme Q10 is considered safe, and there could be harmful effects if too much is taken. Coral calcium “Coral” calcium supplements have been heavily marketed as a cure for Alzheimer’s disease, cancer and other serious illnesses. Coral calcium is a form of calcium carbonate claimed to be derived from the shells of formerly living organisms that once made up coral reefs. In June 2003, the Federal Trade Commission (FTC) and the Food and Drug Administration (FDA) filed a formal complaint against the promoters and distributors of coral calcium. The agencies state that they are aware of no competent and reliable scientific evidence supporting the exaggerated health claims and that such unsupported claims are unlawful. Coral calcium differs from ordinary calcium supplements only in that it contains traces of some additional minerals incorporated into the shells by the metabolic processes of the animals that formed them. It offers no extraordinary health benefits. Most experts recommend that individuals who need to take a calcium supplement for bone health take a purified preparation marketed by a reputable manufacturer. See also the FDA/FTC press release on the coral calcium complaint. Ginkgo biloba Ginkgo biloba is a plant extract containing several compounds that may have positive effects on cells within the brain and the body. Ginkgo biloba is thought to have both antioxidant and anti-inflammatory properties, to protect cell membranes and to regulate neurotransmitter function. Ginkgo has been used for centuries in traditional Chinese medicine and currently is being used in Europe to alleviate cognitive symptoms associated with a number of neurological conditions. However, results of a large, multicenter Phase III study published in the Journal of the American Medical Association (November 19, 2008) showed that gingko was no better than placebo in delaying changes in memory, thinking and personality and had no impact on the development of dementia and Alzheimer’s. The Gingko Evaluation and Memory (GEM) Study enrolled 3,000 individuals age 75 or older who either had no dementia or mild cognitive impairment. Participants were randomly assigned to receive twice daily doses of either a placebo or 120 milligrams of gingko biloba extract. They were followed up every six months for six years. Researchers found no statistical difference in dementia or Alzheimer’s rates between the groups. Among those receiving gingko, 277 developed dementia. Among those receiving placebo, 246 developed dementia. Mortality rates were also similar. According to the researchers, an effect may have been observed if the study was longer because it takes many years to progress from the initial brain changes of Alzheimer’s to the clinical symptoms of dementia. The research team intends to conduct a follow-up analysis of brain function and structure in a subset of study participants using magnetic resonance imaging and positron emission tomography scans.
Stages of Alzheimer's
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Experts have documented common patterns of symptom progression that occur in many individuals with Alzheimer’s disease and developed several methods of “staging” based on these patterns. | Staging systems provide useful frames of reference for understanding how the disease may unfold and for making future plans. But it is important to note that not everyone will experience the same symptoms or progress at the same rate. People with Alzheimer’s die an average of four to six years after diagnosis, but the duration of the disease can vary from three to 20 years. The framework for this section is a system that outlines key symptoms characterizing seven stages ranging from unimpaired function to very severe cognitive decline. This framework 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. Within this framework, we have noted which stages correspond to the widely used concepts of mild, moderate, moderately severe and severe Alzheimer’s disease. We have also noted which stages fall within the more general divisions of early-stage, mid-stage and late-stage categories. Stage 1: No impairment (normal function) Unimpaired individuals experience no memory problems and none are evident to a health care professional during a medical interview. Stage 2: Very mild cognitive decline (may be normal age-related changes or earliest signs of Alzheimer's disease) Individuals may feel as if they have memory loss and lapses, especially in forgetting familiar words or names or the location of keys, eyeglasses or other everyday objects. But these problems are not evident during a medical examination or apparent to friends, family or co-workers. Stage 3: Mild cognitive decline Early-stage Alzheimer's can be diagnosed in some, but not all, individuals with these symptoms Friends, family or co-workers begin to notice deficiencies. Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical interview. Common difficulties include: Word- or name-finding problems noticeable to family or close associates Decreased ability to remember names when introduced to new people Performance issues in social or work settings noticeable to family, friends or co-workers Reading a passage and retaining little material Losing or misplacing a valuable object Decline in ability to plan or organize Stage 4: Moderate cognitive decline (Mild or early-stage Alzheimer's disease) At this stage, a careful medical interview detects clear-cut deficiencies in the following areas: Decreased knowledge of recent occasions or current events Impaired ability to perform challenging mental arithmetic-for example, to count backward from 75 by 7s Decreased capacity to perform complex tasks, such as planning dinner for guests, paying bills and managing finances Reduced memory of personal history The affected individual may seem subdued and withdrawn, especially in socially or mentally challenging situations Stage 5: Moderately severe cognitive decline (Moderate or mid-stage Alzheimer's disease) Major gaps in memory and deficits in cognitive function emerge. Some assistance with day-to-day activities becomes essential. At this stage, individuals may: Be unable during a medical interview to recall such important details as their current address, their telephone number or the name of the college or high school from which they graduated Become confused about where they are or about the date, day of the week or season Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s Need help choosing proper clothing for the season or the occasion Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children Usually require no assistance with eating or using the toilet. Stage 6: Severe cognitive decline (Moderately severe or mid-stage Alzheimer's disease) Memory difficulties continue to worsen, significant personality changes may emerge and affected individuals need extensive help with customary daily activities. At this stage, individuals may: Lose most awareness of recent experiences and events as well as of their surroundings Recollect their personal history imperfectly, although they generally recall their own name Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces Need help getting dressed properly; without supervision, may make such errors as putting pajamas over daytime clothes or shoes on wrong feet Experience disruption of their normal sleep/waking cycle Need help with handling details of toileting (flushing toilet, wiping and disposing of tissue properly) Have increasing episodes of urinary or fecal incontinence Experience significant personality changes and behavioral symptoms, including suspiciousness and delusions (for example, believing that their caregiver is an impostor); hallucinations (seeing or hearing things that are not really there); or compulsive, repetitive behaviors such as hand-wringing or tissue shredding Tend to wander and become lost. Stage 7: Very severe cognitive decline (Severe or late-stage Alzheimer's disease) This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak and, ultimately, the ability to control movement. Frequently individuals lose their capacity for recognizable speech, although words or phrases may occasionally be uttered Individuals need help with eating and toileting and there is general incontinence of urine Individuals lose the ability to walk without assistance, then the ability to sit without support, the ability to smile, and the ability to hold their head up. Reflexes become abnormal and muscles grow rigid. Swallowing is impaired. | |||||||||||||||||||||||||||
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