CONDITIONS

What Is Alzheimer’s Disease

Alzheimer’s disease is a disease that damages and ultimately destroys brain cells, leading to:

  • Memory loss
  • Trouble thinking clearly
  • Loss of social skills

The condition can also lead to:

  • Poor judgment
  • Confusion and disorientation
  • Changes in personality
  • Delusions
  • Forgetting how to read or write

When these changes get severe enough to get in the way of day-to-day life, they are known as dementia. Alzheimer’s disease is the most common cause of dementia, accounting for 3 to 4 out of every 5 people with dementia—but it is not the only cause.

Other conditions that cause dementia include:

  • Parkinson’s disease and dementia with Lewy bodies, caused by buildup of a specific protein in the brain
  • Genetic conditions such as Huntington’s disease and frontotemporal dementia
  • Prion diseases, such as Creutzfeldt-Jakob disease and mad cow disease
  • Physical problems inside the brain, such as brain tumors, vascular dementia, and normal pressure hydrocephalus
  • Wernicke-Korsakoff syndrome, a memory disorder that often affects heavy drinkers

When a person has more than one of these conditions, it is called mixed dementia. Dementia can also be caused by:

  • Side effects of medication
  • Infections
  • Some toxins
  • Oxygen shortage in the brain, known as hypoxia

Many types of dementia cannot be cured, although some have treatments that can alleviate symptoms or slow the progression of the disease. Alzheimer’s disease affects more than 5 million Americans, about half of who don’t know they have the condition. Other types of dementia are harder to estimate, but may affect an additional 1.3 to 3.5 million people in the United States.

What Causes Alzheimer’s Disease

Alzheimer’s disease and other dementia are not a normal part of aging. The exact cause of Alzheimer’s disease is not known, although scientists believe it is caused by a mix of:

  • Genetics. recent evidence suggests that genetics compose 70% of the risk of developing the disease. Unfortunately, it also appears that numerous genes may play a role in Alzheimer’s onset and progression.
  • Lifestyle factors, which may include the frequency and type of intellectual activity, diet, and medications
  • Environmental factors like air pollution
  • Lack of acetylcholine, which is an abundant neurotransmitter in the brain
  • Accumulation of a plaques, from amyloid protein or tau protein deposits

Once Alzheimer’s disease begins, it kills brain cells secondary to altered biochemistry, which results in multiple proteins within the neurons “misfolding” and disrupting the intracellular mechanical support of the cell and the cell membrane itself. As a result, there is a loss of neurons, neuronal connections (referred to as synapses) and the entire brain   shrinks The brains in people with Alzheimer’s disease also develop:

  • Plaques on the brain surface
  • Tangles in the connections that deliver nutrients to your brain cells
  • Fewer connections between brain cells, which limit the pathways for information to travel and to be applied in various parts of the brain

Other types of dementia have different causes. For example:

  • Vascular dementia is caused by bleeding or blocked veins or arteries after a stroke or other brain injury.
  • Dementia with Lewy bodies is caused by buildup of a protein called alpha-synuclein in the cerebral cortex.
  • Parkinson’s disease also involves buildup of alpha-synuclein, but in a different part of the brain.
  • Frontotemporal dementia is caused by diseases damaging the front and sides of the brain.
  • Creutzfeldt-Jakob disease is caused by abnormal proteins called prions, which can develop spontaneously or enter the body during surgery, or from eating meat that contains prions.
  • Normal pressure hydrocephalus is caused by fluid buildup in the brain.
  • Huntington’s disease is an inherited genetic disorder.
  • Wernicke-Korsakoff syndrome is caused by thiamine deficiency, often caused by alcohol abuse.
  • Dementia may also be caused directly by a number of causes, such as a brain tumor, an infection, or the side effect of a medication

Risk Factors For Alzheimer’s Disease

Age is the greatest risk factor for Alzheimer’s disease and many other types of dementia. Dementia is not a normal part of aging, but it does become much more common after age 65.

Some of the known risk factors for dementia include:

•    Genes. You may be more likely to get Alzheimer’s disease or certain other types of dementia if one of your parents or siblings has it. Huntington’s disease and one rare strain of Alzheimer’s disease are dominant genetic disorders, which means that if one of your parents has the gene for the disease, you have a fifty-fifty chance of inheriting the gene, and if you inherit the gene you will almost definitely have the disease.
•    Sex. Women are at slightly higher risk than men for Alzheimer’s disease. This is especially true in women who take hormone treatment for a long time after menopause.
•    Head trauma. Injuries that affect your brain can raise your risk of Alzheimer’s disease and vascular dementia The effects of chronic head trauma in professional football players has recently been described and diagnosed as chronic traumatic encephalitis (CTE) and is the basis of a lawsuit against the National Football League (NFL).
•    Poor health. If you have unhealthy eating or exercise habits can increase your risk of Alzheimer’s disease and vascular dementia. Health problems like high blood pressure, high cholesterol, and diabetes can also increase your risk.
•    Mild cognitive impairment. Sometimes a slight decline in memory is an early sign of problems to come.
•    Down syndrome. People with Down syndrome often develop plaques and tangles like those seen in Alzheimer’s disease.
•    Alcohol abuse. Drinking to excess can lead to Wernicke-Korsakoff syndrome and other types of dementia.

The good news? Studies have also shown that keeping your mind active and interacting with other people may help reduce your risk of Alzheimer’s disease. So factors that may help protect you from dementia may include:

•    An interesting job that engages your mind
•    A college education, especially a graduate degree
•    An active social life
•    Reading
•    Playing a musical instrument
•    Other challenging hobbies
•    Playing chess, bridge, or other games

Diagnosing Alzheimer’s Disease

Dementia can be difficult to diagnose, because there are many factors that could cause the same symptoms. Alzheimer’s disease, in particular, can only be confirmed for certain by an autopsy—so any diagnosis while you are alive is based on your doctor’s best judgment. Researchers are searching for tests to identify patients at risk of developing AD before the disease commences. These biochemical tests are targeting the suspected “mis-folded” plaques of proteins (beta-amyloid and tau proteins) in the cerebrospinal fluid, or CSF, which can be obtained from a spinal tap. Your doctor or a mental health professional will also test your memory and thinking skills, and possibly give you a neuropsychological exam. Do not expect a quick diagnosis.

To start, your doctor will start by asking you questions about:

•    Your symptoms
•    Your family history
•    Your day-to-day life, such as whether you’ve stopped doing any activities you used to do

Your doctor will also review your medical history and give you a physical examination. During the physical exam, your doctor will probably test:

•    Your reflexes
•    Your balance and coordination
•    Your vision
•    Your hearing
•    Your strength and muscle tone
•    Your ability to get up from a chair and walk across the room

Symptoms of Alzheimer’s Disease

Dementia symptoms may vary, depending on the type of dementia you have. In general, symptoms of Alzheimer’s disease and other dementias may include:

 

  • Memory loss
  • Trouble concentrating, reasoning, or making decisions
  • Difficulty performing complex tasks, or even everyday tasks
  • Agitation
  • Personality changes, paranoia, or inappropriate behavior
  • Trouble communicating
  • Disorientation/getting lost
  • Clumsiness or poor coordination
  • Hallucinations or delusions

Early warning signs may include:

  • Forgetting important dates
  • Not remembering things you were just told
  • Taking longer to do routine tasks
  • Trouble following recipes or directions
  • Forgetting everyday words or having difficulty following a conversation
  • Forgetting where things are
  • Poor judgment
  • Personality changes or social withdrawal

Over time, Alzheimer’s disease may lead to:

  • Getting lost in familiar places
  • Forgetting how to read and write
  • Trouble doing basic tasks, such as eating or getting dressed

These symptoms may be different if you have a different type of dementia. For instance:

  • Vascular dementia often starts suddenly; impaired judgment and disorganization are the key symptoms, and memory loss is less likely.
  • Parkinson’s disease and dementia with Lewy bodies cause memory loss and muddled thinking like Alzheimer’s disease, but they can also cause vivid hallucinations, movement problems such as rigid muscles or tremors, and a sleep disorder that makes people act out their dreams. Dementia with Lewy bodies tends to fluctuate, so people with this condition may go back and forth between confusion and lucid thought.
  • Frontotemporal dementia usually starts between the ages of 40 and 65. There are three types of frontotemporal dementia
    • Behavioral variant frontotemporal dementia causes people to lose their inhibitions and act inappropriately
    • Primary progressive aphasia makes people forget words and may also affect behavior
    • Frontotemporal dementia movement disorders affect the way your body moves and can cause stiffness, spasms, and problems with balance and coordination
  • Creutzfeldt-Jakob disease starts off with mood changes, confusion, poor memory, and clumsiness. It can also cause problems with eyesight and movement, which worsen over time.
  • Normal pressure hydrocephalus causes walking problems, memory loss, and loss of bladder control.
  • Huntington’s disease usually starts between ages 30 and 50 and causes irritability, other mood changes, and loss of thinking skills.
  • Wernicke-Korsakoff syndrome can cause severe memory problems without many other effects.

Prognosis

The long-term outcome depends on the type of dementia you have. Sometimes dementia has a specific cause and goes away when that cause is treated. But some types of dementia are unstoppable and deadly. Others may be slowed with treatment, though are not curable. The average life expectancy for people with Alzheimer’s disease is 8 to 10 years after symptoms start, but some live with Alzheimer’s disease for as long as 20 years.

Lifespans with other types of dementia can vary widely. People with Huntington’s disease typically survive for 15 to 25 years after diagnosis, while 9 out of 10 people diagnosed with Creutzfeldt-Jacob disease die within a year.

Living With Alzheimer’s Disease

Life with dementia and Alzheimer’s disease can be a challenge, and it often worsens over time. But there are things you can do to help keep up your quality of life:

  • Take care of your health. Eat balanced meals and stay active.
  • Keep up your social life. Make the effort to spend time with friends and family. Don’t isolate yourself. You can also join a support group.
  • Get enough sleep. Dementia may affect your sleep habits, but better sleep habits can help you stay healthy and think clearly.
  • Don’t give up on the things you enjoy. Some hobbies and activities may be more challenging with dementia, but keeping your mind active can help you keep your mind sharp.

Screening

At present, there are no guidelines for routine screening for dementia. If you are concerned about memory problems, doctors have a variety of questionnaires they can use to assess you for dementia symptoms. There are also at-home tests you can use, though no self-test can take the place of a thorough exam by a doctor.

If you are concerned about inheriting a condition that causes dementia, or about passing one on to your children, genetic testing is available for the genes that cause Huntington’s disease and some types of Alzheimer’s disease and frontotemporal dementia.

Prevention

Some types of dementia can’t be prevented. But there are things you can do to reduce your overall risk of dementia. The main thing you can do? Keep your mind and your body active.

Keeping your mind engaged in challenging work or activities, such as games or puzzles, playing a musical instrument, or interacting with other people, has been shown to reduce your risk for Alzheimer’s disease.

Taking good care of your heart can also reduce your risk of Alzheimer’s disease and frontotemporal dementia. This includes:

  • Regular exercise
  • Not smoking
  • Keeping your blood pressure and cholesterol under control
  • Eating fruits, vegetables, and other healthy foods
  • Keeping your weight in balance
  • Controlling your blood sugar if you have diabetes

You can also avoid other controllable risk factors for dementia, such as:

  • Excessive drinking, which can lead to Wernicke-Korsakoff syndrome and other types of dementia.
  • Prolonged hormone replacement therapy after menopause.

Medication And Treatment

Sometimes, dementia has a clear cause, such as a hormone imbalance or a side effect of a medication. In these cases, dementia usually resolves on its own once the underlying cause is removed. Unfortunately, many types of dementia have no cure, at least not yet. Treatment for dementia focuses on slowing disease progress when possible, and keeping symptoms under control. Namenda (memantine) affects the way your brain sends and receives messages, by regulating the chemical messenger glutamate. Namenda may slow down Alzheimer’s disease and some other types of dementia, especially when combined with another type of medicine called a cholinesterase inhibitor.

Cholinesterase inhibitors help control symptoms by improving communication between your brain cells. Cholinesterase inhibitors include:

  • Aricept (donepizil)
  • Exelon (rivastigmine)
  • Razadyne (galantamine)

Unfortunately, cholinesterase inhibitors don’t work for everyone, but they can help some patients with:

  • Alzheimer’s disease
  • Parkinson’s disease
  • Dementia with Lewy bodies

Your doctor may also prescribe other treatments to help with specific symptoms, such as trouble sleeping.

Treatment may also include occupational therapy to help you adapt to living with dementia, and lifestyle changes such as exercise, nutrition, and changes to the home environment to reduce risks and simplify everyday life.

Complementary and Alternative Treatment

Relaxation techniques such as music therapy, aromatherapy, or massage can help relieve problems such as frustration and anxiety in people with dementia and Alzheimer’s.

Some herbs and supplements may help as well, but they should be used with caution:

  • Vitamin E may slow down Alzheimer’s disease progression. But be careful and talk to your doctor, because too much vitamin E can be dangerous or even lethal.
  • CoQ10, well known for its heart and vascular health benefits, may also have a beneficial impact for those with dementia or Alzheimer’s disease.
  • Gingko biloba extract may slow down memory problems, but studies have had mixed results.
  • Omega-3 fatty acids, found in fish and nuts, may help with mild cognitive decline. No benefit has yet been found for people with dementia.

Always talk with your doctor about any herbal treatment or supplement you are considering.

Care Guide

Living with dementia can be difficult and stressful, but there are things you can do to help yourself or a loved one with dementia.

To help yourself cope emotionally:

  • Learn all you can about your condition
  • Join a local support group
  • Try out relaxation techniques, such as yoga or music therapy
  • Seek help from friends, family, or a counselor
  • Keep yourself active through volunteer work
  • Find someone you can trust who can help you with important decisions now and in the future
  • Be patient, and don’t blame yourself for problems and setbacks

To help keep your independence despite day-to-day issues:

  • Arrange your home so that important things like keys, wallets, and valuables are always in the same place when you need them.
  • Keep a calendar or whiteboard in your house to track your schedule. Check things off when you do them, in case you forget.
  • Get rid of excess clutter in your home. Also remove extra mirrors and furniture you don’t use.
  • Simplify your medical regimen as much as you can. Make appointments at the same time on the same day of the week, and ask your doctor to simplify your medicines so you can take them all at the same time.
  • Arrange for your bills to pay automatically.
  • Keep a mobile phone with a tracker, so your loved ones can know where you are. Program important numbers into this phone.
  • To avoid falls, wear shoes with good traction, install handrails on all stairways, and make sure all rugs and carpets are secured to the floor.

If you are caring for a loved one with dementia, it’s important to take care of yourself as well. Caregiver burnout is a very real problem, and much more common than you might think. Don’t be afraid to ask for help when you need it, and find a caregiver support group in your area. Hiring help may not be the same as being there yourself, but a nurse or home aide can give you the relief you need to be at your best when you are there.

When To Contact A Doctor

If you have problems remembering things, or other symptoms that might be caused by dementia, see a doctor. If you see these symptoms in a loved one, encourage him or her to see a doctor. If necessary, help make the appointment and take your loved one there.

Questions For A Doctor

When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:

  • What tests do I need?
  • How long will it take to get my diagnosis?
  • Do I need to see a specialist?
  • Could my symptoms be caused by a medicine I’m already taking?
  • Do I need medications? What do you recommend?
  • Do you know of any clinical trials or experimental treatments?
  • Is there anything else I should know about?
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