Dementia describes a brain disorder that seriously impairs a person’s ability to carry out normal, daily activities. Alzheimer’s Disease (AD) is the most common form of dementia. Alzheimer's Disease involves the parts of the brain that control thought, memory and language. Great advances are being made in the diagnosis and treatment of Alzheimer's, but there is presently no cure. Other forms of dementia include: Frontotemporal Dementia (FTD), also called “Pick’s Disease”; Vascular Dementia, associated with strokes; Lewy body Dementia; Parkinson’s Disease with Dementia (PDD) and others.

Longevity with Alzheimer’s Disease

Alzheimer's Disease evolves slowly, usually starting with mild memory problems. Final stages of the disease involve severe brain damage. The course the disease takes and how fast changes occur vary from person to person. On average, people with Alzheimer's Disease live from 8-10 years after they are diagnosed, though some people can survive for decades.

Causes

Physicians do not yet fully understand what causes Alzheimer's Disease. There probably is not one single cause, but several factors that affect each person differently. The brain undergoes changes that are signs of Alzheimer's Disease. These changes include the development of abnormal clumps called “amyloid plaques” and bundles of fibers called “neurofibrillary tangles”. Researcher have found other brain changes in people with Alzheimer's Disease. Nerve cells die in areas of the brain that are vital to memory and other mental abilities, and connections between nerve cells are disrupted. There also are lower levels of some of the chemicals in the brain that carry messages back and forth between nerve cells. Alzheimer's Disease may impair thinking and memory by disrupting these messages.

Risk Factors

Age is the most important known risk factor for Alzheimer's Disease. The number of people with the disease doubles every 5 years beyond age 65. The most common form of Alzheimer's Disease is known as “late-onset”. It occurs later in life, and does not appear to be inherited. However, there is evidence that genetics may play a role in some cases. For example, “early-onset familial” Alzheimer's Disease, a rare form of Alzheimer's Disease that usually occurs between the ages of 30 and 60, is inherited.

One risk factor gene identified so far for late-onset Alzheimer's Disease is a gene that makes one form of a protein called apolipoprotein E (ApoE). Everyone has ApoE, which helps carry cholesterol in the blood. Only about 15% of people have the form that increases the risk of Alzheimer's Disease. It is likely that other genes also may increase the risk of Alzheimer's Disease or protect against Alzheimer's Disease, but they remain to be discovered.

Symptoms

Alzheimer's Disease begins slowly. At first, the only symptom may be mild forgetfulness, which can be confused with age-related memory change. Most people with mild forgetfulness do not have Alzheimer's Disease. In the early stage, people may have trouble remembering recent events, activities, or the names of familiar people or things. They may not be able to solve simple math problems. Such difficulties may be a bother, but usually they are not serious enough to cause alarm.

The Seven Warning Signs of Alzheimer's Disease:

  • Asking the same question over and over again.
  • Repeating the same story, word for word, again and again.
  • Forgetting how to cook, or how to make repairs, or how to play cards—activities that were previously done with ease and regularity.
  • Losing one's ability to pay bills or balance one's checkbook.
  • Getting lost in familiar surroundings, or misplacing household objects.
  • Neglecting to bathe, or wearing the same clothes over and over again, while insisting that they have taken a bath or that their clothes are still clean.
  • Relying on someone else, such as a spouse, to make decisions or answer questions they previously would have handled themselves.

As the disease goes on, symptoms are more easily noticed and become serious enough to cause people or their family members to seek medical help. Forgetfulness begins to interfere with daily activities. People in the middle stages may forget how to do simple tasks like brushing their teeth or combing their hair. They can no longer think clearly. They can fail to recognize familiar people and places. They begin to have problems speaking, understanding, reading or writing. Later on, people may become anxious or aggressive, or wander away from home. Eventually, patients need total care.

Stages of Alzheimer’s Disease

Alzheimer's Disease develops slowly and causes changes in the brain long before there are obvious changes in a person's memory, thinking, use of words or behavior. Stages and changes the person will go through are outlined below.

Common Changes in Mild Alzheimer's Disease

  • Loses spark or zest for life--does not start anything.
  • Loses recent memory without a change in appearance or casual conversation.
  • Loses judgment about money.
  • Has difficulty with new learning and making new memories.
  • Has trouble finding words--may substitute or make up words that sound like or mean something like the forgotten word.
  • Takes longer to do routine chores and becomes upset if rushed or if something unexpected happens.
  • Forgets to pay, pays too much, or forgets how to pay--may hand the checkout person a wallet instead of the correct amount of money.
  • Loses or misplaces things by hiding them in odd places or forgets where things go, such as putting clothes in the dishwasher.
  • Constantly checks, searches or hoards things of no value.

Common Changes in Moderate Alzheimer's Disease

  • Changes in behavior, concern for appearance, hygiene and sleep become more noticeable.
  • Mixes up identity of people, such as thinking a son is a brother or that a wife is a stranger.
  • Poor judgment creates safety issues when left alone--may wander and risk exposure, poisoning, falls, self-neglect or exploitation. 
  • Has trouble recognizing familiar people and own objects; may take things that belong to others.
  • Continuously repeats stories, favorite words, statements or motions like tearing tissues.
  • Has restless, repetitive movements in late afternoon or evening, such as pacing, trying doorknobs, fingering draperies.
  • Makes up stories to fill in gaps in memory. For example might say, “Mama will come for me when she gets off work.”

Common Changes in Severe Alzheimer's Disease

  • Doesn't recognize self or close family.
  • Speaks in gibberish, is mute or is difficult to understand.
  • Loses control of bowel and bladder.
  • Loses weight and skin becomes thin and tears easily.
  • Forgets how to walk or is too unsteady or weak to stand alone.
  • May groan, scream or mumble loudly.
  • Sleeps more.
  • Needs total assistance for all activities of daily living.

Diagnosis

The diagnosis of Alzheimer's Disease can be made correctly most of the time. Doctors use several tools to diagnose “probable Alzheimer's Disease”, including: a detailed medical history, mental function tests to measure a person's memory, problem-solving ability, attention, numerical counting ability and language skills; and medical tests, such as tests of blood, urine or spinal fluid, and brain scans. Sometimes these test results help the doctor find other possible causes of the person's change in mental function. For instance, thyroid problems, drug reactions, depression, brain tumors, and blood vessel disease in the brain can cause Alzheimer's Disease-like symptoms. These other medical conditions may be uncovered during an evaluation for possible Alzheimer's dementia and successfully treated. The most accurate way to diagnose Alzheimer's Disease is to find out whether there are plaques and tangles in the brain tissue. However, this requires an evaluation of the brain that can only be performed during a biopsy or an autopsy.

The Importance of Early Diagnosis

An early, accurate diagnosis of Alzheimer's Disease helps patients and their families plan for the future. It gives them time to discuss care options while the patient can still take part in making decisions. Early diagnosis also offers the best chance to treat the symptoms of the disease.

Current Medications

No treatment has been proven to stop Alzheimer’s Disease. However, for some people in the early and middle stages of the disease, Aricept®, Exelon® or Razadyne® may help prevent some symptoms from becoming worse for a limited time in some patients. Namenda® has been approved to treat moderate to severe Alzheimer’s Disease. Also, some medicines may help control behavioral symptoms of Alzheimer’s Disease such as sleeplessness, agitation, wandering, anxiety and depression. Treating these symptoms often makes patients more comfortable and makes their care easier for caregivers.