Alzheimer’s disease is a brain disorder that causes problems with memory, thinking (cognition), and behavior. All 3 of these areas worsen with time as damage to brain cells accumulates, which is why this is considered a neurodegenerative disease.
Almost 1 in 5 people over age 65 have some problems with memory, called mild cognitive impairment. This is usually normal aging but can also be an early sign of Alzheimer’s disease. It is a good idea for people having memory problems to talk to their doctor about it. When problems with memory and thinking interfere with a person’s ability to handle daily activities on their own, they have dementia. Alzheimer’s disease is the most common cause of long-term, or chronic, dementia.
There is no simple test for Alzheimer’s disease yet. New tests using brain imaging or certain proteins in the brain and body fluids are being researched. Even though we know that certain proteins are present in higher amounts in the brains of people with Alzheimer’s disease, we don’t know if those proteins cause the disease or are a result of it. We don’t know exactly what causes Alzheimer’s yet.
Other causes and types of dementia exist but these are less common than Alzheimer’s disease. Usually, people with these other types of dementia have other symptoms that help determine if the problem is Alzheimer’s or something else. For example, in dementia with Lewy bodies, people have hallucinations or are “seeing things” before memory problems develop. To identify the cause of dementia, a doctor will ask about all symptoms and how they developed over time. This is why it can be important to bring a family member or close friend who has known you for some time to a doctor visit if you are worried about memory problems.
If you, your family members, or your family doctor are concerned that forgetfulness is interfering with your daily life, it is a good idea to have an evaluation. A family doctor may use screening tests including the Mini-Mental State Exam, the Animal Naming Test, the Montreal Cognitive Assessment, or other tests to show you don’t have a problem. Some studies suggest results are more accurate when at least 2 screening tools are used.
If after screening, a doctor is not able to reassure you that you don’t have dementia, it is a good idea to see a neurologist. The neurologist will do a physical exam plus tests of neurologic function, including testing your reflexes, eye movements, walking, and more. A neurologist will ask questions about your memory problems and how those interfere with your life. She or he may also order imaging of your brain with CT or MRI and recommend a neuropsychologic evaluation.
The neuropsychologic evaluation measure several areas of cognition. It can be used to determine if a person is slower than the average person in understanding or using information. If the evaluation shows that cognitive problems are present, the neurologist may order more tests to determine if any other problem is causing them. If no other cause can be found, Alzheimer’s disease is accepted as the cause.
There are many treatment options to help with the symptoms of Alzheimer’s disease.
Memory and Thinking Problems
There are two classes of drugs that can decrease or stabilize memory loss, confusion, and problems with thinking and reasoning. The first is the cholinesterase (ko-lin-est-er-ase) inhibitors and the second is memantine, which is used in the later stages of disease. How well these treatments work is different in every person. There is some evidence that taking a cholinesterase inhibitor with memantine is beneficial and a combination of these medications is available.
Sleep problems are more common in people with Alzheimer’s disease and treating these improves quality of life for patient and caregiver. Evidence is also emerging that getting regular sleep may support brain health in people with Alzheimer’s disease. Sleep researchers have shown the best ways to maintain healthy sleep are to:
These methods may not be enough to achieve healthy and satisfying sleep for people with Alzheimer’s. Bright light therapy and use of melatonin before bedtime may be helpful. Sleep-inducing medications are used only when all else fails because they can increase confusion and are known to increase the risk of falling.
Mood and Behavior Changes
In the early stages of Alzheimer’s disease, people may have increased irritability, anxiety, and depression. These behavior changes are not just a reaction to the disease; they are part of the disease. Patients and caregivers should discuss these symptoms with their health care team. Usually the team can determine why the problems are happening and offer an appropriate choice from the many existing therapies available.
Later in Alzheimer’s disease, people may become aggressive, agitated and angry. They may be very emotional and have outbursts. Sometimes they have hallucinations (seeing, hearing, or feeling things that are not real) and delusions. Help is available for caregivers and patients when these symptoms occur, including reminiscence therapy (using photos to engage in pleasant memories), social groups, support groups, support groups, art therapy, music, and movement therapy. If problems with confusion, aggression, agitation, hallucinations, and delusions become severe enough, a physician may consider prescribing antipsychotic medications.
Stopping or Curing Alzheimer’s Disease
Treatments for memory and thinking, sleep, and behavior do not slow or stop Alzheimer’s disease and there is no cure yet. There is an enormous amount of research happening and there are many opportunities for patients and caregivers to help themselves and others by taking part in this research.
Most of us forget to take care of ourselves sometimes. Because Alzheimer’s interferes with memory, it is even likelier that people with Alzheimer’s will forget to take care of themselves. Most people with Alzheimer’s disease eventually need others to care for them. Needing care doesn’t mean not living well. Similarly, being able to give care doesn’t mean the caregiver is doing well or doesn’t need care too.
There is evidence that exercise can help people with Alzheimer’s disease with cognitive symptoms. Exercise is also beneficial for all other areas of health. Other evidence shows that remaining socially connected is beneficial for people with Alzheimer’s and for their caregivers. Some studies suggest that a Mediterranean-like diet can support cognitive abilities.
Care plans for people with Alzheimer’s can include nutrition, exercise, social activities, medication, and safety. It is important that people take their medicines as directed and not make changes without talking to the doctor who prescribed them.
A group of patients and patient advocates also made seven recommendations for caring for people with Alzheimer’s to help them live well:
Tips for caregivers are also useful and include:
09.21.20Sumifilam May Improve Episodic and Spatial Memory for People With Alzheimer Disease
09.15.20NIH Provides Funding for Large-Scale Study of Alzheimer Disease Biomarkers
09.08.20Kidney Problems as a Young Adult May Affect Cognitive Function in Midlife
09.02.20Tauroursodeoxycholic Acid /Sodium Phenylbutyrate Decreased Rate of Decline in ALS
09.02.20Anticholinergics May be Associated With Increased Risk of Mild Cognitive Impairment
08.25.20Music and Memory Program Decreased Need for Antipsychotic Treatment in Dementia
08.19.20Possible Association Between Risk of Alzheimer Disease and Disturbed Sleep Patterns
08.07.20FDA Agrees to Review Aducanumab--First Potential Treatment for Alzheimer Disease in Decades
07.31.20Alzheimer Disease Risk May Be Measurable in Adolescence and Early Adulthood
07.29.20Survey Shows Significant Burden of Visual Hallucinations and Paranoid Delusions for People With Dementia
07.29.20Flu and Pneumonia Vaccination Correlates With Reduced Incidence of Alzheimer Disease
07.28.20Plasmapheresis With Albumin Delays Cognitive and Functional Declines in Clinical Trial for Alzheimer Disease
07.21.20FDA Accepts Supplemental New Drug Application for Pimavanserin for Dementia-Related Psychosis Symptoms
Neurologists need to have a palliative care skill set.
Jessica M. Baker, MD
Dementia Insights: Language and Dementia
Who can take us seriously when we are so far from who we once were?; Everything she did and loved, everything she was, required language. -Lisa Genova, Still Alice.
Farhat Husain, MD; Divya Singhal, MD; and Sergio Ramirez Salazar, MD
07.17.20Dopamine Improves Cognitive Function in Mild-to-Moderate Alzheimer Disease
07.15.20Phase 3 Clinical Trial for Antiamyloid Beta Treatment of Preclinical Alzheimer Disease Initiated
07.08.20Aducanumab for Alzheimer Disease Treatment Submitted to FDA for Approval
07.06.20The Women Neurologist Group and the Alliance for Advancement of Neuroscience Advocate for Continued use of Telemedicine
David Z. Rose, MD
Jakai D. Nolan, DO, MPH, and Jacqueline A. Nicholas, MD, MPH
Danielle S. Shpiner, MD; Crystal Dixon, MD; Melissa R. Ortega, MD; and Henry Moore, MD