Alzheimer’s disease causes brain changes that gradually get worse. It’s the most common cause of dementia — a group of brain disorders that cause progressive loss of intellectual and social skills, severe enough to interfere with day-to-day life. In Alzheimer’s disease, brain cells degenerate and die, causing a steady decline in memory and mental function.
Current Alzheimer’s disease medications and management strategies can temporarily improve symptoms, maximize function and maintain independence. It’s also important to seek social services and tap into your support network to make life better. Research efforts aim to discover treatments that prevent Alzheimer’s or slow its progression.
The first symptoms of Alzheimer’s disease you may notice are increasing forgetfulness and mild confusion. Over time, the disease has a growing impact on your memory, your ability to speak and write coherently, and your judgment and problem solving. If you have Alzheimer’s, you may be the first to notice that you’re having unusual difficulty remembering things and organizing your thoughts. Or you may not recognize that anything is wrong, even when changes are noticeable to your family members, close friends or co-workers.
Brain changes associated with Alzheimer’s disease lead to growing trouble with:
Everyone has occasional memory lapses. It’s normal to lose track of where you put your keys or forget the name of an acquaintance. But the memory loss associated with Alzheimer’s disease persists and gets worse. People with Alzheimer’s may:
Disorientation and misinterpreting spatial relationships
People with Alzheimer’s disease may lose their sense of what day it is, the time of year, where they are or even their current life circumstances. Alzheimer’s may also disrupt your brain’s ability to interpret what you see, making it difficult to understand your surroundings. Eventually, these problems may lead to getting lost in familiar places.
Speaking and writing
Those with Alzheimer’s may have trouble finding the right words to identify objects, express thoughts or take part in conversations. Over time, the ability to read and write also declines.
Thinking and reasoning
Alzheimer’s disease causes difficulty concentrating and thinking, especially about abstract concepts like numbers. Many people find it challenging to manage their finances, balance their checkbooks, and keep track of bills and pay them on time. These difficulties may progress to inability to recognize and deal with numbers.
Making judgments and decisions
Responding effectively to everyday problems, such as food burning on the stove or unexpected driving situations, becomes increasingly challenging.
Planning and performing familiar tasks
Once-routine activities that require sequential steps, such as planning and cooking a meal or playing a favorite game, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer’s may forget how to perform basic tasks such as dressing and bathing.
Changes in personality and behavior
Brain changes that occur in Alzheimer’s disease can affect the way you act and how you feel. People with Alzheimer’s may experience:
Scientists believe that for most people, Alzheimer’s disease results from a combination of genetic, lifestyle and environmental factors that affect the brain over time.
Less than 5 percent of the time, Alzheimer’s is caused by specific genetic changes that guarantee a person will develop the disease.
While the causes of Alzheimer’s are not yet fully understood, its effect on the brain is clear. Alzheimer’s disease damages and kills brain cells. A brain affected by Alzheimer’s disease has many fewer cells and many fewer connections among surviving cells than does a healthy brain.
As more and more brain cells die, Alzheimer’s leads to significant brain shrinkage. When doctors examine Alzheimer’s brain tissue under the microscope, they see two types of abnormalities that are considered hallmarks of the disease:
Increasing age is the greatest known risk factor for Alzheimer’s. Alzheimer’s is not a part of normal aging, but your risk increases greatly as you grow older. After you reach age 65, your risk of developing the disease doubles about every five years. Nearly half of those over age 85 have Alzheimer’s.
People with rare genetic changes that guarantee they’ll develop Alzheimer’s often begin experiencing symptoms in their 40s or 50s.
Family history and genetics
Your risk of developing Alzheimer’s appears to be somewhat higher if a first-degree relative — your parent, sibling or child — has the disease. Scientists have identified rare changes (mutations) in three genes that guarantee a person who inherits them will develop Alzheimer’s. But these mutations account for less than 5 percent of Alzheimer’s disease. Most genetic mechanisms of Alzheimer’s among families remain largely unexplained. The strongest risk gene researchers have found so far is apolipoprotein e4 (APOE-e4). Other risk genes have been identified but not conclusively confirmed.
Women may be more likely than are men to develop Alzheimer’s disease, in part because they live longer.
Mild cognitive impairment
People with mild cognitive impairment (MCI) have memory problems or other symptoms of cognitive decline that are worse than might be expected for their age, but not severe enough to be diagnosed as dementia. Those with MCI have an increased risk — but not a certainty — of later developing dementia.
Lifestyle and heart health
There’s no lifestyle factor that’s been conclusively shown to reduce your risk of Alzheimer’s disease.
However, some evidence suggests that the same factors that put you at risk of heart disease may also increase the chance that you’ll develop Alzheimer’s. Examples include:
These risk factors are also linked to vascular dementia, a type of cognitive decline caused by damaged blood vessels in the brain. Many people with cognitive decline have brain changes characteristic of both Alzheimer’s disease and vascular dementia. Some researchers think that each condition helps fuel the damage caused by the other.
Working with your health care team on a plan to control these factors will help protect your heart — and may also help reduce your risk of dementia.
Lifelong learning and social engagement
Studies have found an association between lifelong involvement in mentally and socially stimulating activities and reduced risk of Alzheimer’s disease.
Factors that may reduce your risk of Alzheimer’s include:
Scientists can’t yet explain this link. One theory is that using your brain develops more cell-to-cell connections, which protects your brain against the impact of Alzheimer-related changes. Another theory is that it may be harder to measure cognitive decline in people who exercise their minds frequently or who have more education. Still another explanation is that people with Alzheimer’s disease may be less inclined to seek out stimulating activities years before their disease can be diagnosed.
Memory loss, impaired judgment and other cognitive changes caused by Alzheimer’s can complicate treatment for other health conditions. A person with Alzheimer’s disease may not be able to:
As Alzheimer’s disease progresses, brain changes begin to affect physical functions such as swallowing, balance, and bowel and bladder control. These effects can increase vulnerability to additional health problems such as:
You may decide you want to talk to your doctor about memory loss or other cognitive changes, or you may seek care at the urging of a family member who arranges your appointment and goes with you. You’ll probably start by seeing your family doctor or general practitioner, who may refer you to a neurologist, psychiatrist or neuropsychologist for further evaluation.
Because appointments can be brief and there’s often a lot of ground to cover, it’s a good idea to prepare ahead of time. Here are some suggestions to help you get ready for your appointment and understand what to expect from your doctor.
What you can do
Questions to ask your doctor
Because time with your doctor is limited, writing down a list of questions will help you make the most of your appointment. If you’re seeing your doctor regarding concerns about Alzheimer’s disease, some questions to ask include:
In addition to the questions you’ve prepared ahead of time, don’t hesitate to ask your doctor to clarify anything you don’t understand.
What to expect from your doctor
Your doctor is also likely to have questions for you. Being ready to respond may free up time to focus on any points you want to talk about in-depth. Your doctor may ask:
There’s no specific test today that confirms you have Alzheimer’s disease. Your doctor will make a judgment about whether Alzheimer’s is the most likely cause of your symptoms based on the information you provide and results of various tests that can help clarify the diagnosis.
Doctors can nearly always determine whether you have dementia, and they can accurately identify whether your dementia is due to Alzheimer’s disease about 90 percent of the time. Alzheimer’s disease can be diagnosed with complete accuracy only after death, when microscopic examination of the brain reveals the characteristic plaques and tangles.
To help distinguish Alzheimer’s disease from other causes of memory loss, doctors now typically rely on the following types of tests.
Physical and neurological exam
Your doctor will perform a physical exam, and is likely to check your overall neurological health by testing your:
Blood tests may help your doctor rule out other potential causes of memory loss and confusion, such as thyroid disorders or vitamin deficiencies.
Mental status testing
Your doctor may conduct a brief mental status test to assess your memory and other thinking skills. Short forms of mental status testing can be done in about 10 minutes. Commonly used tests include the following tasks and questions:
Your doctor may recommend a more extensive assessment of your thinking and memory. Longer forms of neuropsychological testing, which can take several hours to complete, may provide additional details about your mental function compared with others’ of a similar age and education level. This type of testing may be especially helpful if your doctor thinks you may have a very early stage of Alzheimer’s disease or another dementia. These tests may also help identify patterns of change associated with different types of dementia.
Images of the brain are now used chiefly to pinpoint visible abnormalities related to conditions other than Alzheimer’s disease — such as strokes, trauma or tumors — that may cause cognitive change. New imaging applications — currently used primarily in major medical centers or in clinical trials — may enable doctors to detect specific brain changes caused by Alzheimer’s.
Brain-imaging technologies include:
Future diagnostic tools
Researchers are working with doctors to develop new diagnostic tools to help clinch the diagnosis of Alzheimer’s. Another important goal is to detect the disease before it causes the symptoms targeted by current diagnostic techniques — at the stage when Alzheimer’s may be most treatable as new drugs are discovered. New tools under investigation include:
Current Alzheimer’s medications can help for a time with memory symptoms and other cognitive changes. Two types of drugs are currently used to treat cognitive symptoms:
Creating a safe and supportive environment
Adapting the living situation to the needs of a person with Alzheimer’s is an important part of any treatment plan. You can take these steps to support a person’s sense of well-being and continued ability to function:
Regular exercise is an important part of everybody’s wellness plan — and those with Alzheimer’s are no exception. Activities like a daily 30-minute walk can help improve mood and maintain the health of joints, muscles and your heart. Exercise can also promote restful sleep and prevent constipation. Make sure that the person with Alzheimer’s carries identification if she or he walks unaccompanied.
People with Alzheimer’s who develop trouble walking may still be able to use a stationary bike or enjoy chair exercises. You may be able to find exercise programs geared to older adults on TV or on DVDs.
People with Alzheimer’s may forget to eat, lose interest in preparing meals or not eat a healthy combination of foods. They may also forget to drink enough, leading to dehydration and constipation.
Certain nutritional supplements are marketed as “medical foods” specifically to treat Alzheimer’s disease. The Food and Drug Administration (FDA) does not approve products marketed as medical foods. Despite marketing claims, there’s no definitive data showing that any of these supplements is beneficial or safe.
Study results have been mixed about whether diet, exercise or other healthy lifestyle choices can prevent or reverse cognitive decline. But these healthy choices promote good overall health and may play a role in maintaining cognitive health, so there’s no harm in including these strategies in your general wellness plan:
Various herbal mixtures, vitamins and other supplements are widely promoted as preparations that may support cognitive health or prevent or delay Alzheimer’s. The National Institutes of Health (NIH) convened an expert panel that concluded current evidence doesn’t support any benefit from taking vitamin B, vitamin C, vitamin E, folic acid or beta carotene.
Omega-3 fatty acids
The NIH panel concluded there is somewhat stronger data — but not definitive evidence — that omega-3 fatty acids in fish oil may help prevent cognitive decline.
Some physicians prescribe high doses of vitamin E to help treat Alzheimer’s disease, based on a federally funded study showing that vitamin E delayed loss of ability to carry out daily activities and placement in residential care for a few months. Since that study, other research has associated taking vitamin E with an increased risk of death. No one should take vitamin E except under a doctor’s supervision.
Ginkgo is a plant extract containing several substances believed to be of possible benefit in Alzheimer’s. But a large study funded by the NIH found no effect in preventing or delaying Alzheimer’s disease.
This extract from a type of Chinese moss has effects similar to the cholinesterase inhibitors, one class of drugs approved for Alzheimer’s disease. But a large federally funded study found huperzine A didn’t help treat mild to moderate Alzheimer’s disease.
Supplements promoted for cognitive health can interact with medications you’re taking for Alzheimer’s disease or other health conditions. Work closely with your health care team to create a treatment plan that’s right for you. Make sure you understand the risks and benefits of everything it includes.
People with Alzheimer’s disease experience a mixture of emotions — confusion, frustration, anger, fear, uncertainty, grief and depression.
You can help a person cope with the disease by being there to listen, reassuring the person that life can still be enjoyed, providing support, and doing your best to help the person retain dignity and self-respect.
A calm and stable home environment can help reduce behavior problems. New situations, noise, large groups of people, being rushed or pressed to remember, or being asked to do complicated tasks can cause anxiety. As a person with Alzheimer’s becomes upset, the ability to think clearly declines even more.
Caring for the caregiver
Caring for a person with Alzheimer’s disease is physically and emotionally demanding. Feelings of anger and guilt, frustration and discouragement, worry and grief, and social isolation are common. But paying attention to your own needs and well-being is one of the most important things you can do for yourself and for the person with Alzheimer’s. If you’re a caregiver for someone with Alzheimer’s, you can help yourself by:
Many people with Alzheimer’s and their families benefit from counseling or local support services. Contact your local Alzheimer’s Association affiliate to connect with support groups, doctors, resources and referrals, home care agencies, residential care facilities, a telephone help line, and educational seminars.
Right now, there’s no proven way to prevent Alzheimer’s disease. Research into prevention strategies is ongoing. The strongest evidence so far suggests that you may be able to lower your risk of Alzheimer’s disease by reducing your risk of heart disease. Many of the same factors that increase your risk of heart disease can also increase your risk of Alzheimer’s disease and vascular dementia. Important factors that may be involved include high blood pressure, high cholesterol, excess weight and diabetes.
Keeping active — physically, mentally and socially — may make your life more enjoyable and may also help reduce the risk of Alzheimer’s disease.