Alzheimer's Disease

Alzheimer's Disease

Alzheimer's Disease, named after Alois Alzheimer, the German physician who first described the disease in 1906, is a brain disorder in which healthy brain tissue degenerates.  Alzheimer's causes memory loss and problems with thinking and behavior severe enough to affect work, lifelong hobbies or social life.  It is the most common cause of dementia and has no current cure.  Alzheimer's is not a part of normal aging, but the risk of the disease increases with age, and as it worsens over time, is fatal.

Alzheimer's Facts

  • As many as 5.3 million Americans are living with Alzheimer's disease.
  • Alzheimer’s is the seventh-leading cause of death in the United States.
  • About five percent of people between the ages of 65 and 74 have Alzheimer's disease, while nearly half the people over the age of 85 have Alzheimer's.
  • Every 70 seconds, someone in America develops Alzheimer's.  By mid-century, someone will develop the disease every 33 seconds.
  • Projections for new cases of Alzheimer's: in 2010, 454,000 new cases; by 2030, 615,000; and by 2050, 959,000.
  • When the first wave of baby boomers reaches age 85 years (2031), an estimated 3.5 million people aged 85 and older will have Alzheimer's.  The number of people aged 65 and older with Alzheimer's disease is estimated to reach 7.7 million.
  • In 2030, more than a 50 percent increase from the 5.1 million aged 65 and older currently affected.
  • By 2050, the number of individuals aged 65 and older with Alzheimer’s is projected to be between 11 million and 16 million.
  • Alzheimer's disease accounts for 50 to 80 percent of dementia cases.
  • More women than men have dementia, primarily because women live longer, on average, than men. This longer life expectancy increases the time during which women can develop Alzheimer’s or other dementia.

Stages of Alzheimer's

Stage 1: No Impairment (normal function):  Unimpaired individuals experience no memory problems – their brains are functioning normally.

Stage 2: Very Mild Cognitive Decline (may be normal age-related changes or earliest signs of Alzheimer's disease):  Individuals may feel as if they have memory loss and lapses, especially in forgetting familiar words or names or the location of keys, eyeglasses or other everyday objects.  These problems are not evident during a medical examination or apparent to friends, family or co-workers.

Stage 3: Mild Cognitive Decline: Friends, family or co-workers begin to notice deficiencies.  Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical interview.

Stage 4: Moderate Cognitive Decline (mild or early-stage of Alzheimer's disease) characterized by:

  • A decreased knowledge of recent occasions or current events.
  • Impaired ability to perform challenging mental arithmetic-for example, to count backward from 75 by 7s.
  • Decreased capacity to perform complex tasks, such as planning dinner for guests, paying bills and managing finances.
  • Reduced memory of personal history.
  • Appear subdued and withdrawn, especially in socially or mentally challenging situations.

Stage 5: Moderately Severe Cognitive Decline (moderate or mid-stage Alzheimer's disease):  Major gaps in memory and deficits in cognitive function emerge.  Some assistance with day-to-day activities becomes essential.

  • Unable to recall details, such as current address, telephone number or the name of the college or high school from which they graduated.
  • Become confused about where they are or about the date, day of the week or season.
  • Have trouble with less challenging mental arithmetic, such as counting backward from 40 by 4s or from 20 by 2s.
  • Need help choosing proper clothing for the season or the occasion.
  • Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children.

Stage 6: Severe Cognitive Decline (moderately severe or mid-stage Alzheimer's disease):   Memory difficulties continue to worsen, significant personality changes may emerge and affected individuals need extensive help with customary daily activities.

  • Lose most awareness of recent experiences and events as well as of their surroundings.
  • Recollect their personal history imperfectly, although they generally recall their own name.
  • Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces.
  • Need help getting dressed properly; without supervision, may make such errors as putting pajamas over daytime clothes or shoes on wrong feet.
  • Experience disruption of their normal sleep/waking cycle.
  • Need help with handling details of toileting (flushing toilet, wiping and disposing of tissue properly).
  • Have increasing episodes of urinary or fecal incontinence.
  • Experience significant personality changes and behavioral symptoms, including suspiciousness and delusions (for example, believing that their caregiver is an impostor); hallucinations (seeing or hearing things that are not really there); or compulsive, repetitive behaviors such as hand-wringing or tissue shredding.
  • Tend to wander and become lost

Stage 7:  Very severe cognitive decline (severe or late-stage Alzheimer's disease): This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak and, ultimately, the ability to control movement.

  • Frequently individuals lose their capacity for recognizable speech, although words or phrases may occasionally be uttered.
  • Individuals need help with eating and toileting and there is general incontinence of urine.
  • Individuals lose the ability to walk without assistance, then the ability to sit without support, the ability to smile, and the ability to hold their head up.
  • Reflexes become abnormal and muscles grow rigid. Swallowing is impaired.

Causes of Alzheimer's

No one factor appears to cause Alzheimer's disease.  Instead, it’s believed that it may take a combination of genetic, lifestyle and environmental factors to trigger the onset of Alzheimer's symptoms.  While the causes of Alzheimer's are poorly understood, its effect on brain tissue is clear – it damages and kills brain cells.

Symptoms of Alzheimer's

Alzheimer's disease can affect different people in different ways.  The most common symptom is difficulty in remembering new information. 

Warning signs of Alzheimer's include:

  • Memory loss that disrupts daily life
  • Challenges in planning or solving problems
  • Difficulty completing familiar tasks at home, at work or at leisure
  • Confusion with time or place
  • Trouble understanding visual images and spatial relationships
  • New problems with words in speaking or writing
  • Misplacing things and losing the ability to retrace steps
  • Decreased or poor judgment
  • Withdrawal from work or social activities
  • Changes in mood and personality

Risk Factors for Alzheimer's

The following are risk factors that increase the likelihood of developing Alzheimer's:

  1. Age:  Alzheimer's usually affects people older than 65, but can, rarely, affect those younger than 40.  Less than 5 percent of people between 65 and 74 have Alzheimer's.  For people 85 and older, that number jumps to nearly 50 percent.

2. Family History:  The risk is slightly higher if a first-degree relative (parent, sister or brother) has the disease. 

3. Heredity:  Two genes play a role in determining the likelihood of developing Alzheimer's:

  • Apolipoprotein E-e4 (APOE-e4), an Alzheimer's "risk gene," only increases the likelihood of developing a disease.
  • Deterministic genes directly cause a disease, guaranteeing that anyone who inherits them will develop the disorder.  There are rare genes that directly cause Alzheimer's in only a few hundred extended families worldwide.  When Alzheimer’s disease is caused by deterministic genes, it is called "familial Alzheimer's disease," and many family members in multiple generations are affected.  True familial Alzheimer's accounts for less than 5 percent of cases.

4. Gender:  Women are more likely than men are to develop the disease, in part because they live longer.

5. Mild Cognitive Impairment:  People with memory problems that are worse than what might be expected for people of their age, yet not bad enough to be classified as dementia.

6. Lifestyle: The same factors that increase the risk of heart disease may also increase the likelihood that of developing Alzheimer's, such as high blood pressure, high cholesterol and poorly controlled diabetes.

Diagnosing Alzheimer's

Doctors can accurately diagnose 90 percent of Alzheimer's cases. To help distinguish Alzheimer's disease from other causes of memory loss, doctors obtain medical and family history and rely on the following types of tests:

  • Lab tests
  • Neuropsychological testing
  • Brain scans, including magnetic resonance imaging (MRI), computerized tomography (CT) and positron emission tomography (PET)

Treating Alzheimer’s

Although there's no cure, treatments may improve the quality of life for people with Alzheimer's disease.   

There are two varieties of medications which have been proven to slow the cognitive decline associated with Alzheimer's:

  • Cholinesterase inhibitors, which work by improving the levels of neurotransmitters in the brain
  • Memantine, the first drug approved to treat moderate to severe stages of Alzheimer's.  There are also medications that can improve symptoms, such as sleeplessness, wandering, anxiety, agitation and depression.

Alzheimer’s Myths

A few myths and misconceptions about Alzheimer’s…

  • Memory loss is a natural part of aging.
  • Alzheimer's disease is not fatal.
  • Only older people can get Alzheimer’s
  • Drinking out of aluminum cans or cooking in aluminum pots and pans can lead to Alzheimer’s disease.
  • Aspartame causes memory loss.
  • Flu shots increase the risk of Alzheimer's.
  • Silver dental filings increase the risk of Alzheimer's.
  • There are treatments available to stop the progression of Alzheimer's disease.

For more information on caring for someone with Alzheimer's disease, please click on

Caring for Someone with Alzheimer's [link].

Sources:

1Alzheimer's Association, www.alz.org

2Alzheimer's, Mayoclinic.com

32010 Alzheimer's Disease Facts and Figures, Alzheimer's Association, www.alz.org