What is alzheimer's disease?

Alzheimer's disease is a type of dementia. It causes memory loss and affects judgment, language, and behavior. You may have trouble making decisions or may get lost in places that you used to know well. Alzheimer's disease is different than mild memory loss that occurs with aging. It's not clear what causes Alzheimer's disease. It's the most common form of dementia in older adults.

Although there is no cure at this time, medicine in some cases may slow memory loss for a while. Other medicines may help with sleep, depression, or behavior changes.

Alzheimer's disease is different for everyone. Some people can function well for a long time. In the early stage of the disease, you can do things at home to make life easier and safer. You also can keep doing your hobbies and other activities. Many people find comfort in planning now for their future needs.

Alzheimer's disease gets worse over time. But the course of the disease varies from person to person. The disease tends to get worse little by little. It usually starts with mild memory loss. Eventually, it progresses to severe mental and functional problems.

Memory loss is usually the first sign of Alzheimer's disease. Often the person who has a memory problem doesn't notice it, but family and friends do.

Having some short-term memory loss in your 60s and 70s is common, but this doesn't mean it's Alzheimer's disease.

Normal memory problems aren't the same as the kind of memory problems that may be caused by Alzheimer's disease. For example, normally you might forget:

• Parts of an experience.
• Where your car is parked.
• A person's name. (But you may remember the name later.)

With Alzheimer's disease, you might forget:

• An entire experience.
• What your car looks like.
• Having ever known a certain person.

Following are some of the symptoms of mild, moderate, and severe Alzheimer's disease. Symptoms vary as the disease progresses. Talk to your doctor if a friend or family member has any of the signs.

Mild Alzheimer's disease

Usually, a person with mild Alzheimer's disease:

• Avoids new and unfamiliar situations.
• Has delayed reactions.
• Has trouble learning and remembering new information.
• Starts speaking more slowly than in the past.
• Starts using poor judgment and making wrong decisions.
• May have mood swings and become depressed, grouchy, or restless.

These symptoms often are more obvious when the person is in a new and unfamiliar place or situation.

Some people have memory loss called mild cognitive impairment. People with this condition are at risk for Alzheimer's disease or another type of dementia. But not all people with mild cognitive impairment progress to dementia.

Moderate Alzheimer's disease

With moderate Alzheimer's disease, a person typically:

• Has problems recognizing close friends and family.
• Becomes more restless, especially in late afternoon and at night. This is called sundowning.
• Has problems reading, writing, and dealing with numbers.
• Has trouble dressing.
• Has more trouble doing daily tasks like cooking a meal or paying bills. For example, maybe the person can't use simple appliances such as a microwave.
• Has trouble making decisions.
• Is confused about what time and day it is.
• Gets lost in places that the person knows well.
• Has trouble finding the right words to say what he or she wants to say.

Severe Alzheimer's disease

With severe Alzheimer's disease, a person usually:

• Can't remember how to bathe, eat, dress, or go to the bathroom without help.
• No longer knows when to chew and swallow.
• Has trouble with balance or walking and may fall often.
• Becomes more confused in the evening (sundowning) and has trouble sleeping.
• Can't use words to communicate.
• Loses bowel or bladder control (incontinence).

Other conditions with similar symptoms

Early in the disease, Alzheimer's usually doesn't affect a person's fine motor skills (such as the ability to button or unbutton clothes or use utensils) or sense of touch. So a person who has motor symptoms (such as weakness or shaking hands) or sensory symptoms (such as numbness) probably has a condition other than Alzheimer's disease. Conditions such as Parkinson's disease, for instance, may cause motor symptoms along with dementia.

Other conditions with symptoms similar to those of Alzheimer's disease may include:

• Dementia caused by small strokes (multi-infarct dementia).
• Thyroid problems, such as hyperthyroidism or hypothyroidism.
• Depression.
• Other problems such as kidney and liver disease and some infections such as HIV (human immunodeficiency virus).

There is no cure for Alzheimer's disease. But there are medicines that may slow down the symptoms for a while and make the disease easier to live with. If you're a caregiver, there are steps you can take to help the person be independent for as long as possible.

At this time, there is no known way to prevent Alzheimer's disease. But there are things that may make it less likely.

Adults who are physically active may be less likely than adults who aren't active to get this disease or another type of dementia. Moderate activity is safe for most people. But it's always a good idea to talk to your doctor before you start an exercise program.

Older adults who stay mentally active may be at lower risk for this disease. Activities that may help include reading, playing cards and other games, and working crossword puzzles. Going out and staying as socially active as possible may also help lower the risk. Although this "use it or lose it" approach hasn't been proven, no harm can come from often putting the brain to work.

Eating a balanced diet may also help. This includes whole grains, dairy, fruits, and vegetables.

Your doctor will do a number of tests to make sure your symptoms are caused by Alzheimer's disease and not another condition. You may have to do some simple memory tests and tests that show how well you can do daily tasks. You may get blood tests and tests that look at your brain.

There are no medicines that can prevent or cure Alzheimer's disease. Medicine may help some people do daily tasks better. They do this by reducing memory loss and thinking problems for a period of time. Medicines are also used for behavior problems.

Close monitoring and regular reevaluation of the person who has Alzheimer's disease are very important during treatment with medicine. As the disease gets worse and symptoms change, the person's medicine needs often change. If you are a caregiver for someone with the disease, it's also important to watch for adverse drug reactions or side effects that make it harder for the person to function.

Medicines for memory problems

• Cholinesterase inhibitors treat symptoms of mental decline in people who have mild to moderate Alzheimer's disease. They include donepezil, galantamine, and rivastigmine. Donepezil can be used to help those who have severe Alzheimer's disease.
• Memantine (Namenda) treats more severe symptoms of confusion and memory loss from the disease.

These medicines may help improve memory and daily functioning for a period of time in some people who have Alzheimer's disease. How well they work varies. These medicines don't prevent the disease from getting worse. But they may slow down symptoms of mental decline.

Treatment can be started as soon as the disease is diagnosed. If the medicines work, they are continued until the side effects get very bad or the medicines no longer help the person.

Because these medicines work differently, they are sometimes used together.

Medicines for behavior problems

Medicines may be used if someone with Alzheimer's is agitated or disruptive and this behavior is stressful for the person and/or for his or her caregivers. The medicines used include antipsychotic, antianxiety, and anticonvulsant medicines.

Medicines generally are used only for behavior problems when other treatments have failed. They may be needed if:

• A behavior is severely disruptive or harmful to the person or to others.
• Efforts to manage or reduce disruptive behavior by making changes in the person's environment or routines have failed.
• The behavior is making things very hard for the caregiver.
• The person has trouble telling the difference between what is and isn't real (psychosis). Psychosis means the person has false beliefs (delusions) or hears or sees things that aren't there (hallucinations).

Before deciding to use medicine for behavior problems, try to see what's causing the behavior. If you know the cause, you may be able to find better ways to deal with that behavior. You may be able to avoid treatment with medicine and the side effects and costs that come with it.

• Develop a routine. The person will feel less frustrated or confused with a clear, simple daily plan. Remind him or her about important facts and events.
• Be patient. It may take longer for the person to complete a task than it used to.
• Help the person eat a balanced diet. Serve plenty of whole grains, fruits, and vegetables every day. If the person is not eating well at mealtimes, give snacks at midmorning and in the afternoon. Offer drinks such as Boost, Ensure, or Sustacal if he or she is losing weight.
• Encourage exercise. Walking and other activity may slow the decline of mental ability. Help the person keep an active mind. Encourage hobbies such as reading and crossword puzzles.
• Take steps to help if the person is sundowning. This is the restless behavior and trouble with sleeping that may occur in late afternoon and at night. Try not to let the person nap during the day. Offer a glass of warm milk or caffeine-free tea before bedtime.
• Ask family members and friends for help. You may need breaks where others can help care for the person.
• Talk to the person's doctor about what resources are available for help in your area.
• Review all of the person's medicines with his or her doctor.
• For as long as the person is able, allow him or her to make decisions about activities, food, clothing, and other choices. Let the person be independent, even if tasks take more time or are not done perfectly. Tailor tasks to the person's abilities. For example, if cooking is no longer safe, ask for other help. He or she can help set the table or make simple dishes such as a salad. When the person needs help, offer it gently.

Keeping safe

• Make your home (or the person's home) safe. Tack down rugs, and put no-slip tape in the tub. Install handrails, and put safety switches on stoves and appliances. Keep rooms free of clutter. Make sure walkways around furniture are clear. Do not move furniture around, because the person may become confused.
• Use locks on doors and cupboards. Lock up knives, scissors, medicines, cleaning supplies, and other dangerous things.
• Do not let the person drive or cook if he or she cannot do it safely. A person with Alzheimer's should not drive unless he or she is able to pass an on-road driving test. Your state driver's license bureau can do a driving test if there is any question.
• Get medical alert jewelry for the person so you can be contacted if he or she wanders away. If possible, provide a safe place for wandering, such as an enclosed yard or garden.

Alzheimer's disease is caused by changes in the brain. Some of the symptoms may be linked to a loss of chemical messengers in the brain. These messengers are called neurotransmitters. They allow nerve cells in the brain to communicate properly.

People with Alzheimer's disease have two things in the brain that aren't normal: amyloid plaques and neurofibrillary tangles. Experts don't know if these things are side effects of Alzheimer's disease or part of the cause.

Alzheimer's disease is a type of dementia that damages the brain. It causes a steady loss of memory and of how well you can speak, think, and do your daily activities.

The disease gets worse over time, but how quickly this happens varies. Some people lose the ability to do daily activities in the first few years. Others may do fairly well until much later in the disease.

Mild memory loss is common in people older than 60. It may not mean that you have Alzheimer's disease. But if your memory is getting worse, see your doctor. If it is Alzheimer's, treatment may help.