Alzheimer’s used to be an obscure disease, but is now the sixth leading cause of death in the United States. The reason for this increase is as puzzling as the disease itself.
- Alzheimer’s is a disease that destroys brain cells. This destruction causes problems with memory, thinking, behavior, and eventually the very functioning of the body.
- Alzheimer’s is a progressive disease that starts with mild mental and physical changes and leads to severe problems that end in death.
- It is the most common form of dementia (loss of memory and intellectual abilities).
- But despite its prevalence, scientists are still puzzled by what exactly causes the disease.
The brains of people with Alzheimer’s disease look atrophied and have damage that is visible on autopsy - called plaques and tangles. The plaques build up between nerve cells and contain a protein called beta-amyloid. The tangles are twisted fibers of another protein called tau protein.
Some plaques and tangles are found in normal brains, but Alzheimer’s disease patients develop many more than a normal person. What causes the plaques and tangles is unknown - as is just how these brain changes destroy the nerves. The disease appears to attack the outer layer of the brain known as the cortex, especially in areas of the brain responsible for memory and learning. The cells of the brain lose function and eventually die.
It is a mistake to think Alzheimer’s disease only occurs in older people. While the vast majority of people who get the disease are over 65, people in their 30s, 40s and 50s also can also get the disease. Currently, there are no cures, only treatments that stall the progression of the disease. The average life expectancy after diagnosis is 7 years.
Loss of memory is often the first sign of the disease, though changes in mood and personality are also possible first signs. Typically, it is difficult to determine if these first problems are signs of normal aging or the beginning of a disease. The disease, however, often progresses and the cognitive problems begin to affect the person’s daily life. Eventually the person - or, more likely, a family member -will seek help.
Typically, people with Alzheimer’s disease lose memory of recent events first; later in the disease, they lose older memories. While each patient with Alzheimer’s is different, the symptoms generally fall into a few major categories.
- Cognitive problems can be the most pronounced and include difficulties with memory, thinking and reasoning.
- Patients may have problems with language, such as having difficulty finding the right words, or using the wrong word.
- Changes in personality do occur and the person suffering from Alzheimer’s can become angry, abusive or even inappropriate.
- Disorientation is also common.
- And as the disease progresses, people lose the ability to perform daily tasks.
All symptoms worsen slowly over time. Driving a car may become especially difficult because it involves orientation, rapid changes in scenery, and short term memory all at the same time.
Eventually, in the later stages of the disease:
- Many people with Alzheimer’s experience severe insomnia, hallucinations, delusion, and paranoia.
- Distant past memories begin to fade.
- As the disease affects other areas of the brain, people lose the ability to walk and become incontinent, unable to swallow, eat, or even speak.
- They become bedridden and eventually die of respiratory failure or infection or some other complication.
The Alzheimer’s Association offers 10 warning signs, comparing symptoms of someone with Alzheimer’s disease to normal age-related memory changes.
While anyone over the age of 30 is at risk for getting Alzheimer’s disease, it is mostly a disease of advancing age. The largest percentage of people with the disease are over 65 years old. The disease strikes around 10 percent of people over 65, but jumps to almost 50 percent of people 85 and older.
- You are at a higher risk for Alzheimer’s disease if you have parents or siblings who have had the disease. There is a genetic test for risk for Alzheimer’s disease called apolipoprotein E-e4 (APOE-e4). This test is not perfect and simply shows that you have an increased risk for the disease if you carry this APOE-e4 gene.
- People with a history of head injury or heavy tobacco or alcohol use are also at higher risk.
- There also seems to be a strong link between heart health and Alzheimer’s disease, with people who have heart disease much more likely to then be stricken with Alzheimer’s.
On the other hand, people who are socially active, as in a church or other group, for example, are much less likely to get the disease, as are people who stay mentally challenged throughout their lives. People who exercise on a consistent basis also are much less likely to get Alzheimer’s.
The problem with diagnosing Alzheimer’s disease is to separate what is normal aging from a disease process. We have all misplaced our keys or forgotten why we walked into a room; but is this Alzheimer’s disease? The key to diagnosis is that the problems presented by the disease begin to affect a person’s work, personal, education or social activities.
While definite brain changes are seen in Alzheimer’s patients, the diagnosis is usually not made until after death when an autopsy confirms these changes in the brain. Doctors will diagnose Alzheimer’s disease on the basis of symptoms and by ruling out all other possible conditions that might be causing the problems. Typically a doctor will perform:
- A physical exam,
- Mental status tests,
- Blood tests,
- Computerized tomography (CT or CAT scan),
- And magnetic resonance imagery (MRI).
There is no definitive test for Alzheimer’s disease. Genetic testing has shown certain people have a higher risk of getting the disease. People who have the apolipoprotein E-e4 (APOE-e4) gene are more likely to have the disease. But having the APOE-e4 gene does not mean a person has the disease - only an increased risk of getting the disease.
A new test that combines a spinal fluid test along with positron emission tomography (PET) may become the definitive test for Alzheimer’s, but for now, it is only used for research purposes.
The causes of Alzheimer’s disease are a mystery. Scientists know that the brain is being destroyed by the disease, but are at a loss to explain exactly why brain cells are dying.
The scientists have determined that the brains of Alzheimer’s patients are shrinking and that there are pathological structures, known as plaques and tangles, which appear in the brains of these patients. The plaques are made up of a protein called beta-amyloid that builds up between nerve cells. The tangles are made from another protein called tau protein, and look like twisted fibers that form throughout the brain.
Scientists know that even normal brains tend to accumulate these plaques and tangles as they age, but that Alzheimer’s patients have many more of them. Plaques and tangles, however, do not explain the disease. Scientists have been unable to connect the plaques and tangles with the death of brain cells.
The cause of the disease will eventually be discovered, but for now, scientists discuss the cause of Alzheimer’s disease in terms of risk. You are more likely to have Alzheimer’s disease if you have had a head injury, heart disease, smoke cigarettes, drink excessive alcohol, are not socially active, or are not physically active.
There is currently no treatment for Alzheimer’s disease that will improve life expectancy. Many treatments employed by medical doctors will, in a sense, set the clock back and give people suffering from Alzheimer’s a return of lost abilities, but none of these extend life. Typically, medical treatments allow people to recover abilities lost four to six months prior to treatment.
- Medical treatment includes trying to increase the amount of the brain chemical called acetylcholine. The drugs that help increase acetylcholine are called cholinesterase inhibitors and only benefit about one-half of patients with Alzheimer’s disease. When the drugs work, they can slow deterioration of cognitive function and memory, but don’t slow progression of the disease.
- Memantine - a relatively new drug - also appears to slow the progression of the disease and can be used in combination with cholinesterase inhibitors.
- Some practitioners treat Alzheimer’s by using antiinflammatories such as acetaminophen, ibuprofen, or other non-steroidal antiinflammatories (NSAIDS).
- Occasionally, estrogen therapy is used in women.
Physical therapy is a good option for many people suffering from Alzheimer’s disease. Many Alzheimer’s associations suggest lifestyle changes and mental health support to help the sufferer.
Natural help for Alzheimer’s patients includes many dietary supplements and herbs with varying degrees of research to support their use. By far the best studied is the herb Ginkgo biloba. Ginkgo has performed as well as many drugs used for the treatment of Alzheimer’s disease, and sometimes much better.
Acupuncture is another natural therapy that may work well for Alzheimer’s support.
If you have a primary care physician with whom you’ve established a good rapport, discuss your concerns regarding Alzheimer’s disease. Chances are she has other patients with the same illness, but if not, provide her with information you’ve found helpful. She may or may not remain the gatekeeper in your care, but she can help you find a physician who is familiar with Alzheimer’s disease and able to help you.
As with any chronic illness, navigating your way within the medical world will require you to be your own advocate. This means being proactive about your care, staying informed and being organized about your needs during each appointment. This is not an easy road, and balancing the medical, insurance and care aspects of your health is going to require clarity and work on your part.
Patient Advocate
A patient advocate is a great idea for many people with a chronic disease. This is especially the case when the disease is a dementia like Alzheimer’s disease. A patient advocate is someone who helps the patient make appointments, and keeps track of medications, doctor’s orders and other important information.
While a patient advocate is often a family member, there are professional patient advocates whose job it is to help patients navigate the medical world. Check with your family health care provider or your local phone directory to find one who can work for you.
How Do You Choose a Doctor?
While you can use your primary care physician for advice in treating Alzheimer’s disease, you might want to consider consulting a specialist. Research into the field of Alzheimer’s is constantly changing and it is often better to go with a physician who is both keeping up with the latest research and also seeing many patients with the disease.
Alzheimer’s patients and those who are attempting to assist or care for someone with Alzheimer’s should consider the following types of physicians. You may want to use more than one of these specialists:
- Geriatricians are physicians who specialize in the care of older adults. While they cover a wide variety of conditions, a large part of their practice is usually people with Alzheimer’s disease.
- Neurologists are physicians who focus on diseases that have to do with the brain. They employ special diagnostic tools and are usually up to date on the latest research. They are often helpful resources to turn to for a diagnosis, as many conditions present very similar to Alzheimer’s disease.
- Psychiatrists are doctors who specialize in mental and emotional diseases. It might be a good idea to consult a psychiatrist because of the difficulty the patient might have when diagnosed. Depression is a common reaction to a diagnosis. Later in the disease, many people with Alzheimer’s disease experience severe psychiatric episodes that include hallucinations, delusions, agitation and changes in behavior, all of which can be supported by a psychiatrist. Additionally, caregivers often have a thankless job and experience many of the same mood disorders as the patient, such as helplessness and depression. Consulting a psychiatrist can be helpful.
- Alzheimer’s specialists are certain physicians who specialize in the treatment of Alzheimer’s disease. Ask your primary care physician for help finding one, or check your local phone directory.
Choosing a Care Facility
While some patients with Alzheimer’s disease may be able to stay at home through their entire illness, for most patients, a move to a care facility is not only good, but a necessary step. With the changes in mental function, loss of ability to perform daily tasks, and dramatic personality and mood changes, caring for a person with Alzheimer’s is a extremely difficult challenge that may be best left to professionals with a large staff and experience to handle these changes.
Searching for a potential care facility can be difficult and time-consuming. You should ask your friends and family doctor, check your local phone directory, or use the Alzheimer’s Association’s Care Finder .
If you need help, there are plenty of associations that can help you:
Alzheimer's Association
National Office
225 N. Michigan Ave., Fl. 17
Chicago, Ill. 60601-7633
Toll free: 1-800-272.3900
http://www.alz.org/index.asp
National Institute on Aging:
Alzheimer's Disease Education and Referral (ADEAR)
PO Box 8250
Silver Spring, MD 20907
Toll free: 1-800-438-4380
http://www.nia.nih.gov/Alzheimers/
Fisher Center for Alzheimer’s Research Foundation
1 Intrepid Square
West 46th Street and 12th Avenue
New York, NY 10036
Toll free: 1-800-259-4636 (1-800-ALZ-INFO)
http://www.alzinfo.org/
Alzheimer’s disease is rarely just about losing memory. People with Alzheimer’s suffer from a wide range of mental and emotional problems including:
- Depression,
- Cognitive and thinking problems,
- And later in the disease, problems such as insomnia, hallucinations, delusions, and agitation.
Each of these should be addressed as it arises.
Since Alzheimer’s disease is diagnosed by symptoms, this can lead to mistakes in diagnosis. There are other closely related dementias that could also be causing the problems. These include:
- Frontotemporal dementia (such as Pick's disease),
- Vascular dementia,
- Lewy-body dementia, and others.
Patients can also have more than one type of dementia at the same time.
Other diseases that can be mistaken as, or are closely related to, Alzheimer’s disease are the following:
- Brain damage, from a head injury or a tumor
- Huntington's disease
- Parkinson's disease
- Creutzfeldt-Jakob disease or other so-called prion diseases
- Progressive supranuclear palsy
- Radiation therapy to the head
- Neuro-cognitive Lyme disease.
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