Alzheimer's Disease

(Alzheimer's Dementia)

Definition

Alzheimer's disease is a condition that destroys brain cells. People with this disease slowly lose the ability to learn, function, and remember. It is the most common cause of dementia. Dementia is a loss in mental abilities that is great enough to interfere with daily life.

Areas of the Brain Affected by Alzheimer's Disease

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Causes  ^

The cause of Alzheimer's is not yet known. Two factors that may play a role in the development of Alzheimer's disease are:

  • Plaques—Abnormal deposits of a substance called beta amyloid in different areas of the brain.
  • Neurofibrillary tangles—Twisted fibers (called tau fibers) within the nerve cells.

Risk Factors  ^

People who are over 65 years of age have an increased risk of Alzheimer's disease.

Other factors that may increase your chance of Alzheimer's disease include:

  • Previous serious, traumatic brain injury
  • Lower educational achievement
  • Obesity in middle-age
  • Down syndrome
  • Down syndrome in a first-degree relative
  • Women under age 35 who give birth to a child with Down's syndrome
  • Smoking
  • Family history of Alzheimer's disease
  • Presence of a certain type of protein (APOE-e4)
  • Depression
  • Elevated levels of homocysteine
  • Coronary artery disease
  • Atherosclerosis

Researchers are studying the following to see if they are related to Alzheimer's disease:

  • Poor nutrition and vitamin deficiency in childhood
  • Excess metal in the blood, especially zinc, copper, aluminum, and iron
  • Certain viral infections
  • Diabetes
  • High cholesterol

Symptoms  ^

The disease begins as mild memory lapses. It will continue toward a profound loss of memory and function. Alzheimer's disease is divided into 3 stages:

  • Early—Loss of memory, reasoning, understanding, or learning, but does not interfere with independence
  • Intermediate—Increased mental loss, personality changes, and increased dependence on others for basic needs
  • Severe—Loss of personality and bodily functions with total dependence on others for care

Symptoms include:

  • Increasing trouble remembering things, such as:
    • How to get to familiar locations
    • What the names of family and friends are
    • Where common objects are usually kept
    • How to do simple math
    • How to do usual tasks, such as cooking, dressing, and bathing
  • Having difficulty concentrating on tasks
  • Having difficulty completing sentences due to lost or forgotten words—may progress to complete inability to speak
  • Forgetting the date, time of day, or season
  • Getting lost in familiar surroundings
  • Having mood swings
  • Being withdrawn, losing interest in usual activities
  • Having personality changes
  • Walking in a slow, shuffling way
  • Having poor coordination
  • Losing purposeful movement

Diagnosis  ^

There are no tests to confirm Alzheimer's. You will be asked about your symptoms and medical history. A physical exam will be done. Neurological, psychological, and mental status exams may be done.

Your bodily fluids may be tested. This can be done with:

  • Blood tests
  • Urine tests
  • Lumbar puncture to test the cerebrospinal fluid that surrounds the brain and spinal cord

Images may be taken of your bodily structures. This can be done with:

Your brain's electrical activity may be measured. This can be done with electroencephalogram (EEG).

Treatment  ^

There is no cure for Alzheimer's disease. There are no certain ways to slow its progression. Medication is available to treat some of the symptoms. The goal is to find a medication that can manage the symptoms or slow the condition's course.

Medications for Symptoms and Disease Progression

Medications that have been approved to reduce the symptoms of Alzheimer's disease include:

  • Cholinesterase inhibitors—for mild-to-moderate Alzheimer's disease
  • N-methyl-D-aspartate (NMDA) receptor antagonist—for moderate-to-severe Alzheimer's disease

Lifestyle Management

Managing the disease includes:

  • Creating an environment in which you can receive the care you need
  • Keeping your quality of life as high as possible
  • Keeping yourself safe
  • Helping yourself learn to deal with the frustration of your uncontrollable behavior
  • Providing a calm, quiet, predictable environment
  • Providing appropriate eyewear and hearing aids, and easy-to-read clocks and calendars
  • Playing quiet music
  • Doing light, appropriate exercise to reduce agitation and relieve depression
  • Encouraging family and close friends to visit frequently

Psychiatric Medication

Psychiatric symptoms may occur with Alzheimer’s disease. Your doctor may prescribe medication to treat:

  • Depression
  • Anxiety
  • Confusion, paranoia, and hallucinations

Caregiver Support

Caring for a person with Alzheimer's disease is difficult and exhausting. The primary caregiver needs emotional support, rest, and regular breaks. The Alzheimer’s Association is an excellent resource for families and caregivers

Prevention  ^

There are no guidelines for preventing Alzheimer's disease because the exact cause is unknown. However, the following factors may help you reduce your risk of Alzheimer's disease:

  • Eat a healthful diet that includes fish.
  • Drink alcohol, but in moderation. This means no more than two drinks per day for a man, and one drink per day for a woman.
  • Exercise regularly.
  • Engage in mentally stimulating activities.
RESOURCES:

Alzheimer's Association
http://www.alz.org

National Institute on Aging
http://www.nia.nih.gov

CANADIAN RESOURCES:

Alzheimer Society Canada
http://www.alzheimer.ca

Health Canada
http://www.hc-sc.gc.ca

REFERENCES:

Albanese E, Dangour AD, Uauy R, et al. Dietary fish and meat intake and dementia in Latin America, China, and India: A 10/66 Dementia Research Group population-based study. Am J Clin Nutr. 2009;90(2):392-400.

Alzheimer dementia. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114193/Alzheimer-dementia. Updated August 27, 2016. Accessed September 30, 2016.

Alzheimer's disease medications fact sheet. National Institute on Aging website. Available at: http://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-medications-fact-sheet. Accessed August 18, 2014.

Anstey KJ, Mack HA, Cherbuin N. Alcohol consumption as a risk factor for dementia and cognitive decline: Meta-analysis of prospective studies. Am J Geriatr Psychiatry. 2009;17(7):542-555.

Carillo MC, Blackwell A, Hampel H, et al. Early risk assessment for Alzheimer's disease. Alzheimers Dement. 2009;5(2):182-196.

Deweerdt S. Prevention: Activity is the best medicine. Nature. 2011;475(7355):S16-S17.

Gidoni R, Benussi L, Paterlini A, Albertini V, Binetti G, Emanuele E. Cerebrospinal fluid biomarkers in Alzheimer’s disease: The present and the future. Neurodegen Dis. 2011;8(6):413-420.

Green RC, Cupples LA, Go R, et al. Risk of dementia among white and African-American relatives of patients with Alzheimer disease. JAMA. 2002;287(3):329-336.

Hampel H, Frank R, Broich K, et al. Biomarkers for Alzheimer’s disease: Academic, industry, and regulatory perspectives. Nat Rev Drug Discov. 2010;9(7):560-574.

Hayden KM, Welsh-Bohmer KA. Epidemiology of cognitive aging and Alzheimer’s disease: Contributions of the Cache County Utah study of memory, health, and aging. Curr Top Behav Neurosci. 2012;10:3-31.

Neugroschl J, Sano M. An update on treatment and prevention strategies for Alzheimer’s disease. Curr Neurol Neurosci Rep. 2009;9(5):368-376.

Ruitenberg A, van Swieten JC, Wittemen JC, et al. Alcohol consumption and risk of dementia: The Rotterdam Study. Lancet. 2002;359(9303):281-286.

1/8/2010 DynaMed Plus Systematic Literature Surveillance. Available at:http://www.dynamed.com/topics/dmp~AN~T114193/Alzheimer-dementia: Snitz BE, O'Meara ES, et al. Ginkgo biloba for preventing cognitive decline in older adults: A randomized trial. JAMA. 2009;302(24):2663-2670.

5/4/2012 DynaMed Plus Systematic Literature Surveillance. Available at:http://www.dynamed.com/topics/dmp~AN~T114193/Alzheimer-dementia: Buchman AS, Boyle PA, et al. Total daily physical activity and the risk of AD and cognitive decline in older adults. Neurology. 2012;78(17):1323-1329.

9/3/2014 DynaMed Plus Systematic Literature Surveillance. Available at:http://www.dynamed.com/topics/dmp~AN~T114193/Alzheimer-dementia: Wippold FJ, Brown DC, Broderick DF, et al. American College of Radiology (ACR) Appropriateness Criteria for dementia and movement disorders. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/DementiaAndMovementDisorders.pdf. Updated 2014. Accessed September 3, 2014.

10/17/2016 DynaMed Plus Systematic Literature Surveillance. Available at:http://www.dynamed.com/topics/dmp~AN~T114193/Alzheimer-dementia: Arvanitakis Z, Capuano AW, et al. Relation of cerebral vessel disease to Alzheimer's disease dementia and cognitive function in elderly people: a cross-sectional study. Lancet Neurol. 2016 Aug;15(9):934-943.

Last reviewed September 2016 by Rimas Lukas, MD  Last Updated: 10/17/2016