Alzheimer's Disease

It's normal for people to forget things occasionally. But the symptoms of Alzheimer's disease are different.

Alzheimer's disease (AD) produces a steady loss of - not just memory - but a number of thought processes like reasoning and judgment. For example, according to the Alzheimer's Association, it's not unusual to forget where you put the house keys. But someone with Alzheimer's may forget how to use the keys or what the keys are for. Eventually the loss can become severe enough to interfere with everyday life.

And the number of people affected by Alzheimer's is on the rise. The American Medical Association says that Alzheimer's disease or some related form of dementia (Read about "Dementia") affects 5 percent to 6 percent of all older Americans. According to the American Academy of Neurology, over five million Americans now have Alzheimer's disease, and that number is expected to continue climbing.

Causes and symptoms of Alzheimer's

We don't really know what causes Alzheimer's, though there are several apparent things that may increase your risk. According to the National Institute on Aging (NIA), family history (Read about "Family Health History") may be one factor. Age is another. Although Alzheimer's can strike people as young as 30, the vast majority of people with the disease are over age 65.

One of the hallmarks of Alzheimer's, according to the Alzheimer's Disease Education and Referral (ADEAR) Center, is the presence in the brain of abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary tangles). The plaques consist of largely insoluble deposits of a protein called beta-amyloid. The ADEAR Center (which is a part of the National Institutes of Health) says scientists also have found other brain changes in people with AD, such as a loss of nerve cells in areas of the brain (Read about "The Brain") that are vital to memory and other mental abilities. There also are lower levels of chemicals in the brain that carry complex messages back and forth between nerve cells. Whether these changes cause AD, or result from it, is under research.

Warning signs

Alzheimer's starts gradually in most cases. Initially, a person may forget recent events or have problems doing everyday things. In more advances stages there can also be:

• mental confusion
• poor judgment
• behavioral changes
• depression
• problems communicating

Although memory lapses can become more frequent as we get older, they are not by themselves a sign of Alzheimer's.

Ruling out other conditions

If a loved one starts to show signs of impaired mental functioning or dementia, it's important to seek medical help. Remember too, that while Alzheimer's is the leading cause of dementia in seniors, other conditions can result in similar symptoms.

For example, the American Academy of Neurology says a variety of brain disorders (Read about "The Brain") can lead to impaired thinking. Depression can also cause symptoms of dementia in older people. (Read about "Depression and Seniors") Hypothyroidism, vitamin B12 deficiency, hydrocephalus, cerebral vasculitis, neurosyphilis, AIDS and stroke can also cause dementia, as can alcohol and some medications. (Read about "Thyroid" "Vitamins & Minerals" "Hydrocephalus" "HIV / AIDS" "Stroke" "Drug Interaction Precautions")

Because of this, a diagnosis of Alzheimer's is usually made by ruling out these other causes first, then following up with lab or psychiatric exams. At specialized centers, doctors can diagnose AD correctly up to 90 percent of the time, according to the ADEAR Center. The Center says there are several tools that can diagnose "probable" AD:

• A complete medical history including information about the person's general health, past medical problems, and any difficulties the person has carrying out daily activities.
• Medical tests such as tests of blood, urine or spinal fluid help the doctor find other possible diseases causing the symptoms.
• Neuropsychological tests measure memory, problem solving, attention, counting and language.
• Brain scans allow the doctor to look at a picture of the brain to see if anything does not look normal.

Information from the medical history and test results help the doctor rule out other possible causes of the person's symptoms.

Treatment and research

Although AD has no cure, there is a great deal of research being conducted into drugs that can ease the symptoms.

Currently, medications are available to treat the more problematic behaviors of AD such as aggression or delusions. The National Institute of Mental Health (NIMH) says a class of drugs called cholinesterase inhibitors can help enhance memory and improve cognitive functioning in some patients with Alzheimer's. These drugs are generally used in the early to middle stages of the disease, though some have been approved for more severe dementia. Another class of drugs - NMDA receptor antagonists - is also being used to treat moderate to severe Alzheimer's. In addition, the Alzheimer's Association says studies of antioxidants such as vitamin E have shown promise with Alzheimer's. Always ask a doctor before using any kind of supplements. In excessively high doses (above 2,000 International Units daily, or IU/d), for example, vitamin E may be associated with increased risk of bleeding, and patients taking anti-coagulant medications may be especially at risk. Interactions with other medications commonly taken by older people are also of potential concern. People are advised to consult with their physicians before taking high doses of supplemental vitamin E or other antioxidants. In addition, because people with Alzheimer's may have problems noting any medication's side effects, the Alzheimer's Association says caregivers should pay close attention for potential problems and ask their doctor about the warning signs of possible drug interactions. (Read about "Drug Interaction Precautions" "Medicine Safety")

Research continues into additional forms of therapy. The Alzheimer's Association says scientists are also beginning to learn more about the plaques and tangles in the brains of people with Alzheimer's. Plaques and tangles may play a role in the onset and progression of the disease, so an understanding of how and when they form may lead to the development of treatments to slow the effects of the disease.

In addition, a study funded by the National Institutes of Health has tied high levels of a protein called homocysteine to an increased risk of developing AD. (Read about "Homocysteine") Homocysteine is an amino acid produced by the body. B-vitamins, including folic acid, help to break it down in the body, and studies are also considering the role of folic acid in helping to slow or prevent the development of AD.

Caregiving

Caring for someone with Alzheimer's can be extremely stressful. (Read about "Stress") The Alzheimer's Association has some suggestions to help cope:

• Talk with a doctor early on if you suspect a loved one has Alzheimer's.
• See what resources are available in your community to help. These can include support groups for caregivers as well as in-house assistance, adult day care and visiting nurse services.
• Plan ahead for legal and financial changes.

It's also important for caregivers to take time to care for themselves and not be afraid to seek professional help if they need it. (Read about "Alzheimer's and the Caregiver")