Definition

Alzheimer's disease is a progressive condition that destroys brain cells. It is the most common cause of dementia. People with this disease slowly lose the ability to learn, function, and remember.

Areas of the Brain Affected by Alzheimer's Disease

© 2009 Nucleus Medical Media, Inc.

Causes

The cause is not yet known. Studies suggest that two main mechanisms are involved with the development of Alzheimer's disease:

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

Risk Factors

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

  • Age: 65 and older
  • Previous serious, traumatic brain injury
  • Lower educational achievement
  • Down's syndrome
  • Down's syndrome in a first-degree relative
  • Women under 35 who give birth to a child with Down's syndrome
  • Smoking
  • Family history of Alzheimer's disease
  • Presence of a certain variety type of protein (APOE-e4)
  • Depression
  • Elevated levels of homocysteine
  • Heart disease

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 moves to profound loss of memory and function. Alzheimer's disease is divided into three stages:

  • Early—memory and cognition loss are noticeable but still able to function independently
  • Intermediate—mental loss, personality changes more dependent on others for basic needs
  • Severe—loss of personality and bodily functions; total dependence 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, bathing, etc.
  • Having difficulty concentrating on tasks
  • Having difficulty completing sentences due to lost/forgotten words (may progress to complete inability to speak)
  • Forgetting the date, time of day, 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  • Being withdrawn, losing interest in usual activities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 definitively diagnose this disease. The doctor will ask about your symptoms and medical history. A physical exam will be done. The doctor will ask many questions. This will help to rule out other causes.

Tests to rule out other medical conditions may include:

  • Neurological exam
  • Psychological and mental status testing
  • CT scan —a type of x-ray that uses a computer to make pictures of the brain
  • MRI scan —a test that uses magnetic waves to make pictures of the brain
  • Electroencephalogram (EEG) —a test that measures electrical currents in the brain
  • Blood tests and urine tests
  • Lumbar puncture —to test for levels of certain brain proteins that increase with Alzheimer’s disease and to rule out other disorders

Treatment

There is no cure for Alzheimer's disease. There are also no certain ways to slow its progression. Four medicines have received approval for the treatment of some symptoms. Various drugs are being studied to see if they can manage the symptoms or slow the condition's course.

Medications for Symptoms and Disease Progression

Only two types of medicines have been approved to reduce the symptoms of Alzheimer's disease:

  • Cholinesterase inhibitors—approved and recommended for mild to moderate Alzheimer's disease (eg, donepezil [Aricept], rivastigmine [Exelon], galantamine [Reminyl])
  • N-methyl-D-aspartate (NMDA) receptor antagonist—approved for moderate to severe Alzheimer's disease (eg, memantine)

Treatments that are being studied include:

  • Gamma-secretase inhibitors
  • Tau fiber aggregation inhibitors
  • Herbs and supplements (eg, vitamin E, ginkgo biloba)—The evidence is mixed as to the effectiveness of these natural remedies.

Lifestyle Management

Managing the disease includes:

  • Creating an environment in which you can receive the care you need
  • Optimizing your quality of life
  • 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, easy-to-read clocks and calendars
  • Playing quiet music
  • 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 medicine to treat:

  • Depression
  • Anxiety
  • Confusion, paranoia, and hallucinations

Caregiver Support

Caring for a person with Alzheimer's disease is extremely difficult and exhausting. The primary caregiver needs emotional support, as well as regular respite.

If you are diagnosed with Alzheimer's disease, follow your doctor's instructions.

Prevention

There are no guidelines for preventing Alzheimer's disease because the cause is unknown.