basics of alzheimer's disease - Alzheimer's Association

28 Pages·2016·5.53 MB·English

BASICS OF
ALZHEIMER’S
DISEASE
WHAT IT IS AND WHAT YOU CAN DO
Geri T., living with Alzheimer's, and her
husband and care partner, Jim T.
WHAT IS ALZHEIMER’S
DISEASE?
Alzheimer’s (AHLZ-high-merz) is a disease
of the brain that causes problems with
memory, thinking and behavior. It is not a
normal part of aging.
Alzheimer’s gets worse over time. Although
symptoms can vary widely, the first problem
many people notice is forgetfulness that’s
severe enough to affect their ability to
function at home or at work, or to enjoy
hobbies.
The disease may cause a person to become
confused, get lost in familiar places, misplace
things or have trouble with language.
It can be easy to explain away unusual
behavior as part of normal aging, especially
for someone who seems physically healthy.
However, any concerns about memory loss
should be discussed with a doctor.
CONTENTS
1. Alzheimer’s and other dementias .......... p.2
2. How Alzheimer’s affects the brain ....... p.4
3. Causes and risk factors .............................. p.7
4. How to find out if it’s
Alzheimer’s disease ....................................... p.9
5. When the diagnosis is Alzheimer’s ....... p.13
6. Stages of the disease. .................................. p.15
7. Treating the symptoms............................... p.18
8. Hope for the future ..................................... p.23
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1. ALZHEIMER’S AND mental functions, including memory and
the ability to pay attention, make sound
OTHER DEMENTIAS
judgments and plan the steps needed to
complete a task.
Alzheimer’s
More than 5 million Americans have Alzheimer’s, » Dementia with Lewy bodies is a type of
the most common form of dementia. Alzheimer’s progressive dementia that leads to a decline in
accounts for 60 to 80 percent of all dementia thinking, reasoning and independent function
cases. That includes 10 percent of those age 65 due to abnormal microscopic deposits that
and older and one-third of those 85 and older. damage brain cells.
Alzheimer’s also impacts the more than 15 million
» Huntington’s disease dementia is a
Americans who provide these individuals with
progressive brain disorder caused by a
unpaid care.
defective gene. It causes changes in the
central area of the brain, which affect
Dementia movement, mood and thinking skills.
Dementia is a general term for the loss of
» Creutzfeldt-Jakob disease is the most
memory and other cognitive abilities serious
common human form of a group of rare,
enough to interfere with daily life.
fatal brain disorders known as prion diseases.
Misfolded prion protein destroys brain
Other types of dementia
cells, resulting in damage that leads to rapid
» Vascular dementia is a decline in thinking
decline in thinking and reasoning as well as
skills caused by conditions that block or
involuntary muscle movements, confusion,
reduce blood flow to the brain, depriving
difficulty walking and mood changes.
brain cells of vital oxygen and nutrients.
These changes sometimes occur suddenly » Frontotemporal dementia (FTD) is a group
following strokes that block major brain of disorders caused by progressive cell
blood vessels. It is widely considered the degeneration in the brain’s frontal lobes (the
second most common cause of dementia areas behind the forehead) or its temporal
after Alzheimer’s disease. lobes (the regions behind the ears).
» Mixed dementia is a condition in which » Normal pressure hydrocephalus is a brain
abnormalities characteristic of more than disorder in which excess cerebrospinal fluid
one type of dementia occur simultaneously. accumulates in the brain’s ventricles, causing
Symptoms may vary, depending on the thinking and reasoning problems, difficulty
types of brain changes involved and the walking and loss of bladder control.
brain regions affected, and may be similar
» Down syndrome dementia develops in
to or even indistinguishable from those of
people born with extra genetic material
Alzheimer’s or another dementia.
from chromosome 21, one of the 23 human
» Parkinson’s disease dementia is an chromosomes. As individuals with Down
impairment in thinking and reasoning that syndrome age, they have a greatly increased
many people with Parkinson’s disease risk of developing this type of dementia
eventually develop. As brain changes that’s either the same as or very similar to
gradually spread, they often begin to affect Alzheimer’s disease.
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» Korsakoff syndrome is a chronic memory
disorder caused by severe deficiency of TAKE A CLOSER LOOK
thiamine (vitamin B-1). It is most commonly
caused by alcohol misuse, but certain other
conditions can also cause the syndrome.
» Posterior cortical atrophy (PCA) is the
gradual and progressive degeneration of the
outer layer of the brain (the cortex) located
in the back of the head (posterior). It is not
known whether PCA is a unique disease or a
possible variant form of Alzheimer’s disease.
2. HOW ALZHEIMER’S
AFFECTS THE BRAIN
The changes that take place in the brain begin at
the microscopic level long before the first signs Explore our Inside the Brain: An Interactive
of memory loss. This period is referred to as Tour at alz.org/brain to learn how Alzheimer’s
preclinical Alzheimer’s. affects the brain and its functions.
What goes wrong in the brain
like a real factory, backups and breakdowns in one
The brain has 100 billion nerve cells (neurons).
system cause problems in other areas. As damage
Each nerve cell connects to many others to form
spreads, cells lose their ability to do their jobs and,
communication networks. In addition to nerve
eventually, die.
cells, the brain has specialized cells that support
and nourish other cells.
The role of plaques and tangles
Groups of nerve cells have special jobs. Some The brains of individuals with Alzheimer’s have an
are involved in thinking, learning and memory. abundance of plaques and tangles. Plaques are
Others help us see, hear, smell and tell our deposits of a protein fragment called beta-amyloid
muscles when to move. that build up in the spaces between nerve cells.
Tangles are twisted fibers of another protein
Brain cells operate like tiny factories. They
called tau that build up inside cells.
receive supplies, generate energy, construct
equipment and get rid of waste. Cells also process Though autopsy studies show that most people
and store information and communicate with develop some plaques and tangles as they age,
other cells. Keeping everything running requires those with Alzheimer’s tend to develop far more
coordination as well as large amounts of fuel and develop them in a predictable pattern,
and oxygen. beginning in the areas important for memory
before spreading to other regions.
Scientists believe Alzheimer’s disease prevents
parts of a cell’s factory from running well. They Scientists do not know exactly what role plaques
are not sure where the trouble starts. But just and tangles play in Alzheimer’s disease. Most
4 5
experts believe that they disable or block 3. CAUSES AND
communication among nerve cells and disrupt
RISK FACTORS
processes the cells need to survive.
While scientists know that Alzheimer’s disease
The destruction and death of nerve cells causes
involves the failure of nerve cells, it’s still
memory failure, personality changes, problems in
unknown why this happens. However, they have
carrying out daily activities and other symptoms
identified certain risk factors that increase the
of Alzheimer’s disease.
likelihood of developing Alzheimer’s.
How Alzheimer’s spreads in the brain
Age
The greatest known risk factor for Alzheimer’s is
increasing age. Most individuals with the disease
are 65 and older. One in 10 people in this age
group and nearly one-third of people age 85 and
older have Alzheimer’s.
Plaques and tangles begin Family history
in brain areas involved in Another risk factor is family history. Research
memory.
has shown that those who have a parent, brother
or sister with Alzheimer’s are more likely to
develop it than individuals who do not. The risk
increases if more than one family member has
the disease.
Genetics
Two categories of genes influence whether
a person develops a disease: risk genes and
They gradually spread to
deterministic genes. Risk genes increase the
other areas.
likelihood of developing a disease but do not
guarantee it will happen. Deterministic genes
cause a disease, meaning anyone who inherits
one will develop a disorder.
Researchers have found several genes that
increase the risk of Alzheimer’s. APOE-e4 is the
first risk gene identified and remains the one
with the strongest impact. Other common forms
of the APOE gene are APOE-e2 and APOE-e3.
Eventually much of the brain
is affected Everyone inherits a copy of some form of APOE
from each parent. Those who inherit one copy of
Illustrations: APOE-e4 have an increased risk of developing
Alzheimer’s Disease Education and Referral Center, a service of Alzheimer’s; those who inherit two copies have
the National Institute on Aging
an even higher risk, but not a certainty.
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Rare deterministic genes cause Alzheimer’s in a Some of the strongest evidence links brain
few hundred extended families worldwide. These health to heart health. The risk of developing
genes are estimated to account for less than Alzheimer’s or vascular dementia appears to be
1 percent of cases. Individuals with these genes increased by many conditions that damage the
usually develop symptoms in their 40s or 50s. heart and blood vessels. These include heart
disease, diabetes, stroke, high blood pressure
and high cholesterol. Work with your doctor
to monitor your heart health and treat any
LATINOS AND
problems that arise.
AFRICAN-AMERICANS
Studies of donated brain tissue provide additional
Research shows that older Latinos are
evidence for the heart-head connection. These
about one-and-a-half times as likely as
studies suggest that plaques and tangles are
older whites to have Alzheimer’s and
more likely to cause Alzheimer’s symptoms if
other dementias, while older African-
strokes or damage to the brain’s blood vessels
Americans are about twice as likely to are also present.
have the disease as older whites. The
reason for these differences is not well 4. HOW TO FIND OUT IF IT’S
understood, but researchers believe that
ALZHEIMER’S DISEASE
higher rates of vascular disease in these
Not everyone experiencing memory loss or
groups may also put them at greater risk
other Alzheimer’s warning signs recognizes that
for developing Alzheimer’s.
they have a problem. Signs of dementia are
sometimes more obvious to family members
or friends.
Other risk factors The first step in following up on symptoms is
Age, family history and genetics are all risk
finding a doctor with whom the person feels
factors we can’t change. However, research is
comfortable. There is no single type of doctor
beginning to reveal clues about other risk factors
that specializes in diagnosing and treating
that we may be able to influence. There appears
memory symptoms or Alzheimer’s. Many people
to be a strong link between serious head injury
contact their regular primary care physician
and future risk of Alzheimer’s. It’s important to
about their concerns. Primary care doctors often
protect your head by buckling your seat belt,
oversee the diagnostic process themselves.
wearing a helmet when participating in sports
In some cases, the doctor may refer the
and proofing your home to avoid falls.
individual to a specialist, such as a:
One promising line of research suggests that
» Neurologist, who specializes in diseases of
strategies for overall healthy aging may help
the brain and nervous system.
keep the brain healthy and may even reduce the
risk of developing Alzheimer’s. These measures » Psychiatrist, who specializes in disorders
include eating a healthy diet, staying socially that affect mood or the way the mind works.
active, avoiding tobacco and excess alcohol, and
» Psychologist with special training in testing
exercising both the body and mind.
memory and other mental functions.
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There is no single test that proves a person has Reviewing medical history
Alzheimer’s. The workup is designed to evaluate The doctor will interview the person being
overall health and identify any conditions that tested and others close to him or her to gather
could affect how the mind is working. When information about current and past mental and
other conditions are ruled out, the doctor physical illnesses. It is helpful to bring a list of all
can determine if it is Alzheimer’s or another the medications the person is taking.
dementia.
The doctor will also obtain a history of key
Experts estimate that a skilled physician is able medical conditions affecting other family
to diagnose Alzheimer’s with more than members, especially whether they may have or
90 percent accuracy. Physicians can almost had Alzheimer’s or other dementias.
always determine that a person has dementia,
but it may sometimes be difficult to determine Evaluating mood and mental status
the exact cause. Mental status testing evaluates memory, the
ability to solve simple problems and other
STEPS TO DIAGNOSIS INCLUDE: thinking skills.
Understanding the problem This testing gives an overall sense of whether
Be prepared for the doctor to ask: a person:
» What kind of symptoms have occurred. » Is aware of symptoms.
» When they began. » Knows the date, time and where he or she is.
» How often they happen. » Can remember a short list of words, follow
instructions and do simple calculations.
» If they have gotten worse.
The doctor may ask the person his or her
address, what year it is or who is serving as
president. The individual may also be asked to
spell a word backward, draw a clock or copy a
design. Mood and sense of well-being will also be
assesed to detect depression or other illnesses
that can cause memory loss and confusion.
Physical exam and diagnostic tests
A physician will:
» Evaluate diet and nutrition.
» Check blood pressure, temperature
and pulse.
» Listen to the heart and lungs.
» Perform other procedures to assess
overall health.
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The physician will collect blood and urine 5. WHEN THE DIAGNOSIS
samples and may order other laboratory
IS ALZHEIMER’S
tests. Information from these tests can help
Once testing is complete, the doctor will make
identify disorders such as anemia, infection,
an appointment to review results and share his
diabetes, kidney or liver disease, certain vitamin
or her conclusions. A diagnosis of Alzheimer’s
deficiencies, thyroid abnormalities, and problems
reflects a doctor’s best judgment about the
with the heart, blood vessels or lungs. All of
cause of a person’s symptoms, based on the
these conditions may cause confused thinking,
testing performed.
trouble focusing attention, memory problems or
other symptoms similar to dementia. You may want to ask the doctor:
» Why the diagnosis is Alzheimer’s.
Neurological exam
A doctor will closely evaluate the person for » Where the person may be in the course of
problems that may signal brain disorders other the disease.
than Alzheimer’s.
» What to expect in the future.
The physician will also test:
Find out if the doctor will manage care going
» Reflexes. forward and, if not, who will be the primary
doctor. The doctor can then schedule the next
» Coordination.
appointment or provide a referral.
» Muscle tone and strength.
Alzheimer’s disease is life-changing for both
» Eye movement. the diagnosed individual and those close to him
or her. While there is currently no cure and no
» Speech.
way to stop the underlying death of brain cells,
» Sensation. treatments are available that may help relieve
The doctor is looking for signs of small or large some symptoms.
strokes, Parkinson’s disease, brain tumors, fluid
Research has shown that taking full advantage of
accumulation on the brain and other illnesses
available treatment, care and support options can
that may impair memory or thinking.
improve quality of life.
The neurological exam may also include a brain
Consider:
imaging study. The most common types are
» How to provide increasing levels of care as
magnetic resonance imaging (MRI) or computed
the disease progresses.
tomography (CT). MRIs and CTs can reveal
tumors, evidence of small or large strokes, » How the individual and family members will
damage from severe head trauma or a buildup cope with changes in the person’s ability
of fluid. Researchers are studying other imaging to drive, cook and perform other daily
techniques so they can better diagnose and track activities.
the progress of Alzheimer’s.
» How to ensure a safe environment.
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It is also important to begin making legal and 6. STAGES OF
financial plans. A timely diagnosis often allows
THE DISEASE
the person with dementia to participate in this
Alzheimer’s typically progresses slowly in
planning. The person can also decide who will
three general stages: early, middle and late
make medical and financial decisions on his or
(sometimes referred to as mild, moderate
her behalf as the disease progresses.
and severe).
Medicare coverage of care planning The symptoms of Alzheimer’s worsen over
People with cognitive impairment, including time, but because the disease affects people in
Alzheimer’s and other dementias, now different ways, the rate of progression varies.
have access to care planning with a medical On average, a person with Alzheimer’s lives four
professional through Medicare. This detailed care to eight years after diagnosis, but can live as long
planning includes: as 20 years, depending on other factors.
» Measuring neuropsychiatric symptoms. The following stages provide an overall idea
of how abilities change and should be used as
» Medication reconciliation.
a general guide. Stages may overlap, making it
» Evaluating safety (including driving ability).
difficult to place a person with Alzheimer’s in a
» Identifying caregivers and caregiver needs. specific stage.
» Identifying and assessing care directives.
Early-stage Alzheimer’s
» Planning for palliative care needs. In the early stage, a person may function
independently. He or she may still drive, work and
» Referrals to community services.
be social. However, the person may experience
Check with your health care provider for more
memory lapses, such as forgetting familiar words
information.
or the location of everyday objects.
Those close to the individual begin to notice
difficulties. During a detailed medical interview,
CREATE AN ACTION PLAN
doctors may be able to detect problems in memory
Alzheimer’s Navigator® helps guide or concentration. Common difficulties include:
individuals facing dementia when » Problems coming up with the right word
planning for the future. This interactive or name.
tool evaluates needs, outlines action
» Trouble remembering names when
steps and links the user to local
introduced to new people.
services and Association programs.
» Challenges performing tasks in social or
Visit alz.org/alzheimersnavigator to
work settings.
start planning.
» Forgetting material that was just read.
» Losing or misplacing a valuable object.
» Increasing trouble with planning
or organizing.
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Middle-stage Alzheimer’s
Middle-stage Alzheimer’s is typically the longest WANDERING
stage and can last for many years. As the disease
Six out of 10 people with Alzheimer’s
progresses, the person with Alzheimer’s will
will wander and become lost. People can
require a greater level of care.
wander or become confused about their
You may notice the person with Alzheimer’s
location at any stage of the disease. If not
confusing words, getting frustrated or angry, or
found within 24 hours, up to half of those
acting in unexpected ways, such as refusing to
who get lost risk serious injury or death.
bathe. Damage to nerve cells in the brain can
make it difficult to express thoughts and perform
Visit alz.org/safety to learn about
routine tasks.
MedicAlert® + Alzheimer’s Association
At this point, symptoms will be noticeable to Safe Return®, a 24-hour emergency
others and may include: response service that provides assistance
when a person with dementia becomes
» Forgetfulness of events or about one’s own
lost or has a medical emergency.
personal history.
» Feeling moody or withdrawn, especially in
socially or mentally challenging situations.
Late-stage Alzheimer’s
» Being unable to recall their address or
In the final stage of the disease, individuals lose
telephone number, or the high school or
the ability to respond to their environment,
college from which they graduated.
carry on a conversation and, eventually, control
» Confusion about where they are or what movement. They may still say words or phrases,
day it is. but communicating pain becomes difficult. As
memory and cognitive skills worsen, significant
» The need for help choosing proper clothing
personality changes may occur and extensive
for the season or the occasion.
help with daily activities may be required.
» Trouble controlling bladder and bowels.
At this stage, individuals may:
» Changes in sleep patterns, such as sleeping
» Need around-the-clock assistance with
during the day and restlessness at night.
daily activities and personal care.
» An increased risk of wandering and
» Lose awareness of recent experiences as
becoming lost.
well as of their surroundings.
» Personality and behavioral changes,
» Experience changes in physical abilities,
including suspiciousness and delusions or
including the ability to walk, sit and,
compulsive, repetitive behavior like hand
eventually, swallow.
wringing or tissue shredding.
» Have greater difficulty communicating.
» Become increasingly vulnerable to
infections, especially pneumonia.
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