Definition

Alzheimer disease is a disorder of the brain. It leads to a loss of the ability to think, reason, and remember. It worsens over time and will lead to severe impairment. Alzheimer dementia is when the disorder has made it impossible for people to care for themselves.

Areas of the Brain Affected by Alzheimer Disease

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Causes

For reasons that are not yet clear, brain cells stop working well and begin to die. It may be due to a complex mix of genes, environment, and overall health. Two known factors that play a role include:

• Plaques—protein called beta amyloid builds up between nerve cells
• Neurofibrillary tangles—twisted fibers of a protein called tau fibers inside nerve cells

These changes often begin in areas of the brain that store memory. This damage may start several years before the first symptoms appear.

Risk Factors

There are a number of factors that my increase your risk for Alzheimer . Some factors cannot be changed such as:

• Age—more common in people over 65 years of age
• Family history
• Genetics—especially presence of APOE-e4 protein

Medical or health conditions that can increase your risk include:

• Previous serious head injury
• Depression
• Elevated levels of homocysteine
• Conditions of heart and blood vessels including:
  • Coronary artery disease
  • Atherosclerosis
  • High blood pressure
  • High cholesterol
• Diabetes
• Down syndrome (or down syndrome in parent, sibling, or offspring)

Lifestyle factors that may increase risk include:

• Smoking
• Lower level of education

Symptoms

General symptoms include a gradual decline in :

• Memory
• Ability to find right words
• Visual and spatial skills
• Reasoning or judgement

There are no signs in the earliest stages. At this point there are changes in the brain but not enough to cause signs or symptoms. The speed of progression will vary from person to person but can happen over several years.

Mild Disease (also called early-stage) signs include:

• Repeating yourself or losing things
• Trouble with more complex tasks like finances
• Personality changes, mood swings, increased anxiety
• Basic care tasks start to become more challenging, take longer to do
• Getting lost even when going to familiar areas

Moderate disease signs include:

• Difficulty with logic and organization
• Trouble doing care steps like getting dressed
• May not recognize family and friends
• Inappropriate behavior, outbursts, agitation, and anxiety
• Difficulty walking, moving with shuffle
• Need for regular supervision and care

Severe disease (late-stage) signs may include:

• Increased loss of physical abilities
• Difficulty swallowing
• No longer able to communicate
• Loss of bowel and bladder control

Diagnosis

There are no tests to confirm Alzheimer. Instead, your doctor will ask about your symptoms and medical history. Tests will help to rule out other issues that can cause dementia. These may include:

• Physical exam
• Tests of cognitive process—can be done with verbal tests in office
• Examination of nervous system
• Blood tests
• Urine tests
• Lumbar puncture to test the cerebrospinal fluid that surrounds the brain and spinal cord

The doctor may need images of the brain. It will show how much damage has occurred. This can be done with:

• MRI scan
• CT scan
• PET/CT scan

Treatment

There is no cure for Alzheimer disease. The goal of most care is support and safety. Options include:

Prevention

There are no known ways to prevent Alzheimer disease. However, the following factors may reduce your risk of Alzheimer disease:

• Healthful diet that includes fish (examples DASH or Mediterranean diet)
• Regular physical activity
• Continued learning or mental stimulation through life
• Strong social connections
• Decrease risk of head trauma:
  • Use seat belt
  • Wear helmet