Alzheimer’s disease causes a decline in memory, thinking, learning and organizing skills over time. It’s the most common cause of dementia and usually affects people over the age of 65. There’s no cure for Alzheimer’s, but certain medications and therapies can help manage symptoms temporarily.
What is Alzheimer’s disease?
Alzheimer’s disease is a progressive form of dementia. Dementia is a broader term for conditions that negatively affect memory, thinking, and behavior. The changes interfere with daily living. Dementia can have a range of causes, such as brain injuries or diseases. Sometimes the cause is unknown.
Alzheimer’s facts
Although many people have heard of Alzheimer’s disease, it’s helpful to know the facts. Here are some key details about this condition:
- Alzheimer’s disease is a chronic (long-term), ongoing condition. It is not a typical sign of aging.
- Alzheimer’s and dementia aren’t the same thing. Alzheimer’s disease is a type of dementia.
- Its symptoms come on gradually, and the effects on the brain are degenerative, meaning they cause slow decline.
- Anyone can get Alzheimer’s disease, but certain people are at higher risk for it. This includes people over age 65 and those with a family history of the condition.
- There’s no single expected outcome for people with Alzheimer’s. Some people live a long time with mild cognitive damage, while others experience a more rapid onset of symptoms and quicker disease progression.
- There’s no cure for Alzheimer’s yet, but treatment can help slow the progression of the disease and may improve quality of life.
Each person’s journey with Alzheimer’s disease is different.
What is the difference between Alzheimer’s and dementia?
Dementia describes the state of a person’s mental function. It’s not a specific disease. It’s a decline in mental function from a previously higher level that’s severe enough to interfere with daily living.
A person with dementia has two or more of these specific difficulties, including a change or decline in:
- Memory.
- Reasoning and handling of complex tasks.
- Language.
- Understanding visual form and space relationship.
- Behavior and personality.
Dementia ranges in severity. In the mildest stage, you may notice a slight decline in your mental functioning and require some assistance on daily tasks. At the most severe stage, a person depends completely on others for help with simple daily tasks.
Dementia develops when infections or diseases impact the parts of your brain involved with learning, memory, decision-making or language. Alzheimer’s disease is the most common cause of dementia, accounting for at least two-thirds of dementia cases in people 65 and older.
Other common causes of dementia include:
- Vascular dementia.
- Dementia with Lewy bodies.
- Frontotemporal dementia.
- Dementia due to Parkinson’s disease.
Who does Alzheimer’s disease affect?
Alzheimer’s disease mainly affects people over age 65. The higher your age over 65, the more likely you’ll develop Alzheimer’s.
Some people develop Alzheimer’s disease before age 65 — typically in their 40s or 50s. This is called early-onset Alzheimer’s disease. It’s rare. Less than 10% of AD cases are early-onset.
How common is Alzheimer’s disease?
Alzheimer’s disease is common. It affects approximately 24 million people across the world. One in 10 people older than 65 and nearly a third of people older than 85 have the condition.
Symptoms of Alzheimer’s disease
Everyone has episodes of forgetfulness from time to time. But people with Alzheimer’s disease display certain ongoing behaviors and symptoms that worsen over time. These can include:
- memory loss affecting daily activities, such as keeping appointments
- trouble with familiar tasks, such as using a microwave
- difficulties with problem-solving
- trouble with speech or writing
- becoming disoriented about times or places
- decreased judgment
- decreased personal hygiene
- mood and personality changes
- withdrawal from friends, family, and community
These signs don’t always mean that a person has Alzheimer’s. It’s important to see a doctor to determine the cause.
Symptoms change according to the stage of the disease. In later stages, people with Alzheimer’s often have significant trouble with talking, moving, or responding to what’s happening around them.
What causes Alzheimer’s disease?
An abnormal build-up of proteins in your brain causes Alzheimer’s disease. The build-up of these proteins — amyloid protein and tau protein — causes brain cells to die.
The human brain contains over 100 billion nerve cells and other cells. The nerve cells work together to fulfill all the communications needed to perform functions such as thinking, learning, remembering and planning.
Scientists believe that amyloid protein builds up in your brain cells, forming larger masses called plaques. Twisted fibers of another protein called tau form into tangles. These plaques and tangles block the communication between nerve cells, which prevents them from carrying out their processes.
The slow and ongoing death of the nerve cells results in the symptoms of Alzheimer’s disease. Nerve cell death starts in one area of your brain (usually in the area of your brain that controls memory — the hippocampus) and then spreads to other areas.
Despite ongoing research, scientists still don’t know what exactly causes these proteins to build up. So far, they believe that a genetic mutation may cause early-onset Alzheimer’s. They think that late-onset Alzheimer’s happens due to a complex series of brain changes that may occur over decades. A combination of genetic, environmental and lifestyle factors likely contribute to the cause.
Is Alzheimer’s hereditary?
Researchers don’t know why some people get Alzheimer’s disease and others don’t. But they’ve identified several factors that increase your risk for Alzheimer’s, including genetic (hereditary) factors.
Having a form of the apolipoprotein E (APOE) gene increases your risk. This gene has several forms, and one of those, APOE ε4, increases your risk of developing Alzheimer’s and is also associated with an earlier age of disease onset. However, having the APOE ε4 form of the gene doesn’t guarantee that you’ll develop the condition. Some people with no APOE ε4 may also develop Alzheimer’s.
If you have a first-degree relative (biological parent or sibling) with Alzheimer’s disease, your risk of developing the condition increases by 10% to 30%. People with two or more siblings with late-onset Alzheimer’s disease are three times more likely to develop the condition than the general population.
Having trisomy 21 (Down syndrome) also increases your risk for early-onset Alzheimer’s.
Diagnosing Alzheimer’s disease
The only definitive way to diagnose someone with Alzheimer’s disease is to examine their brain tissue after death. But a doctor can use other examinations and tests to assess your mental abilities, diagnose dementia, and rule out other conditions.
The doctor will likely start by taking a medical history. They may ask about your:
- symptoms
- family medical history
- other current or past health conditions
- current or past medications
- diet, alcohol intake, and other lifestyle habits
From there, your doctor will likely request several tests to help determine if you have Alzheimer’s disease.
Alzheimer’s tests
There’s no definitive test for Alzheimer’s disease. However, mental, physical, neurological, and imaging tests can help your doctor reach a diagnosis.
Your doctor may start with a mental status test. This can help them assess your:
- short-term memory
- long-term memory
- orientation to place and time
For example, they may ask you:
- what day it is
- who the president is
- to remember and recall a short list of words
Next, they’ll likely conduct a physical exam. For example, they may:
- check your blood pressure
- assess your heart rate
- take your temperature
- request urine or blood tests, in some cases
Your doctor may also conduct a neurological exam to rule out other possible diagnoses, such as acute medical issues like infection or stroke. During this exam, they will check your:
- reflexes
- muscle tone
- speech
Your doctor may also order brain imaging studies. These studies, which will create pictures of your brain, can include:
- Magnetic resonance imaging (MRI) scan. MRIs can help pick up key markers, such as inflammation, bleeding, and structural issues.
- Computed tomography (CT) scan. CT scans take X-ray images, which can help your doctor look for abnormal characteristics in your brain.
- Other tests your doctor may do include blood tests to check for genes that may indicate you have a higher risk of Alzheimer’s disease.
Alzheimer’s medication
There’s no known cure for Alzheimer’s disease. However, your doctor can recommend medications and other treatments to help ease your symptoms and delay the progression of the disease for as long as possible.
For early to moderate Alzheimer’s, your doctor may prescribe medications such as donepezil (Aricept) or rivastigmine (Exelon). These drugs can help maintain high levels of acetylcholine in your brain. This can help the nerve cells in your brain send and receive signals better. In turn, this may ease some symptoms of Alzheimer’s.
A newer medication called aducanumab (Aduhelm) is recommended only for those with early Alzheimer’s. It is thought to reduce the protein plaques that build up in the brain with Alzheimer’s. However, there are some concerns about whether the drug’s potential benefits outweigh its risks.
To treat moderate to late stage Alzheimer’s, your doctor may prescribe donepezil (Aricept) or memantine (Namenda). Memantine can help block the effects of excess glutamate. Glutamate is a brain chemical that’s released in higher amounts in Alzheimer’s disease and damages brain cells.
Your doctor may also recommend antidepressants, anti-anxiety medications, or antipsychotics to help treat symptoms related to Alzheimer’s. These symptoms vary based on the progression of the disease, and can include:
- depression
- difficulty sleeping at night
- agitation
- hallucinations
Although the care needs of a person with Alzheimer’s will increase over time, the exact symptoms will be different from person to person.
Other Alzheimer’s treatments
In addition to medication, lifestyle changes can help you manage your condition. For example, your doctor might develop strategies to help you or your loved one:
- simplify tasks
- limit confusion
- get enough rest every day
- use relaxation techniques
- create a calming environment
Along with your doctor, a team of healthcare professionals can help you maintain your quality of life at all stages along the Alzheimer’s journey. A care team for Alzheimer’s may include a:
- physical therapist, to help with staying active
- dietician, to maintain a balanced, nutritious diet
- pharmacist, to help with monitoring medications
- mental health professional, who may work with the person with Alzheimer’s as well as their caregivers
- social worker, to help with accessing resources and support
- respite care center, to provide short-term care for someone with Alzheimer’s when their caregivers are temporarily unavailable
- hospice care center, to manage symptoms in a comfortable and supportive setting at the end of life
Some studies have suggested that vitamin E could help slow the loss of functioning in Alzheimer’s, especially when taken with medications like donepezil that increase acetylcholine in the brain. But other research found no benefits when taking vitamin E for Alzheimer’s disease. Overall, more evidence is needed.
Be sure to ask your doctor before taking vitamin E or any other supplements. It can interfere with some of the medications used to treat Alzheimer’s disease.
In addition to lifestyle changes, there are several alternative and complementary therapies you can ask your doctor about.
Alzheimer’s disease causes and risk factors
Experts haven’t determined a single cause of Alzheimer’s disease, but they have identified certain risk factors, including:
- Age. Most people who develop Alzheimer’s disease are 65 years of age or older.
- Family history. If you have an immediate family member who has developed the condition, you’re more likely to get it.
- Genetics. Certain genes have been linked to Alzheimer’s disease.
Having one or more of these risk factors doesn’t mean that you’ll develop Alzheimer’s disease. It simply raises your risk level.
Other possible risk factors include a history of:
- depression
- smoking
- cardiovascular disease
- previous traumatic brain injury
To learn more about your personal risk of developing Alzheimer’s, talk with your doctor.
Alzheimer’s stages
Alzheimer’s is a progressive disease, which means the symptoms will gradually increase over time. There are seven main stages:
Stages 1–3: Pre-dementia and mild cognitive impairment
Stage 1. There are no symptoms at this stage. If you have a family history of Alzheimer’s and no symptoms, you may wish to talk to a doctor about strategies for healthy aging.
Stage 2. The earliest symptoms appear, such as forgetfulness.
Stage 3. Mild physical and cognitive impairments appear, such as reduced memory and concentration. Learning new skills may become harder. These changes may only be noticeable by someone very close to the person.
Stages 4–7: Dementia
Stage 4. Alzheimer’s is often diagnosed at this stage, but it’s still considered mild. It’s common to notice memory loss and to have difficulty managing everyday tasks.
Stage 5. Moderate to severe symptoms will require help from loved ones or caregivers. This is necessary to ensure that daily needs are being met, such as eating meals and managing the home.
Stage 6. At this stage, a person with Alzheimer’s will need help with basic tasks, such as eating, dressing, and toileting.
Stage 7. This is the most severe and final stage of Alzheimer’s. There is usually a progressive loss of speech and facial expressions. Movement is likely to become limited.
As a person progresses through these stages, they’ll need increasing support from their caregivers.
Talk with your doctor about strategies to help you manage these changes. Appropriate care can help you maintain comfort and quality of life for as long as possible.
It’s also important to discuss your care plan with your loved ones. People with Alzheimer’s will need more assistance with medical decisions as the disease progresses.
People with Alzheimer’s typically live for 4 to 8 years after diagnosis, though some live for up to 20 years.
Younger onset Alzheimer’s
Alzheimer’s typically affects people ages 65 and older. However, it can occur in people as early as in their 30s, 40s, or 50s. This is called younger onset, or early onset Alzheimer’s. This type of Alzheimer’s affects fewer than 10 percent of all people with the condition.
Because doctors aren’t always looking for signs of Alzheimer’s in younger adults, getting a diagnosis can take a long time. Symptoms of early onset Alzheimer’s depend on the stage of the disease. Early signs can include mild memory loss and trouble concentrating or finishing everyday tasks. It can be hard to find the right words, and you may lose track of time.
Some studies have found that certain vision and eye changes could indicate early stage Alzheimer’s disease for people in their 50s and older.
People with a family history of younger onset Alzheimer’s are at greater risk of developing this condition. There are several rare genes that, together, cause groups of cases in some families. People with a family history of Alzheimer’s should talk with their doctor.
Preventing Alzheimer’s
Just as there’s no known cure for Alzheimer’s, there are no foolproof preventive measures. For now, health-promoting lifestyle habits are the best tools we have to prevent cognitive decline.
The following steps may help:
- Try to quit smoking. If you smoke, quitting benefits your health both immediately and in the long term.
- Exercise regularly. Getting active reduces the risk of many conditions, such as cardiovascular disease and diabetes.
- Keep your brain active. Try some cognitive training exercises.
- Eat well. Eat a balanced diet with plenty of fruits and vegetables.
- Maintain an active social life. Friendships, volunteering, and hobbies are likely to benefit your overall health.
Be sure to talk with your doctor before making any big changes in your lifestyle.
How long do people with Alzheimer’s live?
The prognosis (outlook) for Alzheimer’s disease is generally poor. The course of the disease varies from person to person. But on average, people with AD over 65 die within four to eight years of the diagnosis. However, some people may live up to 20 years after the first symptoms appear.
Common causes of death include:
- Pneumonia.
- Malnutrition and dehydration.
- Other infections.
Alzheimer’s care
As Alzheimer’s progresses, the tasks of daily living require more support. If you have a loved one with Alzheimer’s, it’s important to start learning about what to expect and what your role may be in your loved one’s future care. Caregiving is a role that’s typically not easy, but it can also be very rewarding.
If your loved one has Alzheimer’s, here are some ways to plan and prepare for caregiving:
- Educate yourself about Alzheimer’s, its stages, and its typical symptoms. By reading this article, you’re already on the right track.
- Connect with family members who can step in to help.
- Consider joining a support group for dementia caregivers.
- Look up professional home care, respite care, and adult day care programs in your area.
- Remember that you’ll need support too. Reach out to the people you’re close to, and be open to accepting help.
As a caregiver, it’s important to take care of yourself as well as your loved one. Caregiving has its difficult moments, and the strain of ongoing responsibilities can start to negatively affect your health. As much as possible, a robust care plan should include support for you, too.
Final Thought
Alzheimer’s is a complicated disease, and scientists are working on unlocking its secrets. Living a healthy lifestyle may help prevent it. If you have a family history of Alzheimer’s, it’s important to discuss it with your doctor.
By the time Alzheimer‘s is diagnosed, the progression of the disease can’t be stopped. But treatment can help delay symptoms and improve your quality of life.
If you think you or a loved one may have Alzheimer’s, talk with a doctor. They can help make a diagnosis, discuss what you can expect, and help connect you with services and support.
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