What Is Alzheimer’s Disease
Alzheimer’s disease is the most common cause of dementia, a loss of brain function that affects memory, thinking, language, judgment and behavior. In Alzheimer’s disease, large numbers of neurons stop functioning, lose connections with other neurons, and die.
Irreversible and progressive, Alzheimer’s disease slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks of daily living.
The stages of the disease typically progress from mild to moderate to severe. Symptoms usually develop slowly and gradually worsen over a number of years however, progression and symptoms vary from person to person. The first symptom of Alzheimer’s disease usually appears as forgetfulness.
Mild cognitive impairment is a stage between normal forgetfulness due to aging and the development of Alzheimer’s disease. People with MCI have mild problems with thinking and memory that do not interfere with everyday activities. Not everyone with MCI develops Alzheimer’s disease.
Other early symptoms of Alzheimer’s include language problems, difficulty performing tasks that require thought, personality changes and loss of social skills.
People with severe Alzheimer’s disease are unable to recognize family members or understand language.
Iirationale For Studying Amyloid Deposition
Definitive diagnosis of AD relies on the demonstration of sufficient amounts of A plaques and NFT in autopsy brains . Imaging A thus has many potential clinical benefits: early or perhaps preclinical detection of disease and accurately distinguishing AD from non-A causes of dementia in patients with mild or atypical symptoms or confounding comorbidities . From a research perspective, imaging A allows us to study relationships between amyloid, cognition, and brain structure, and function across the continuum from normal aging to AD and to monitor the biological effects of anti-A drugs and relate them to effects on neurodegeneration and cognition. Here, we will discuss the application of one of the most broadly studied and widely used agents, Pittsburgh Compound-B .
Morley D. Glicken DSW, in, 2009
Mild Impairment Or Decline
The symptoms of Alzheimers are less clear during stage 3. While the entire stage lasts about 7 years, the symptoms will slowly become clearer over a period of 2 to 4 years. Only people close to someone in this stage may notice the signs. Work quality will decline, and they may have trouble learning new skills.
Other examples of stage 3 signs include:
- getting lost even when traveling a familiar route
- finding it hard to remember the right words or names
- being unable to remember what you just read
- not remembering new names or people
- misplacing or losing a valuable object
Your doctor or clinician may also have to conduct a more intense interview than usual to discover cases of memory loss.
Caregiver support: At this stage, someone with Alzheimers may need counseling, especially if they have complex job responsibilities. They may experience mild to moderate anxiety and denial.
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How Alzheimer’s Disease Is Diagnosed
An accurate, early diagnosis of Alzheimer’s disease allows appropriate treatment to begin sooner, which is why it’s important to schedule an evaluation if you or someone you know is showing some of the signs and symptoms. The healthcare provider will do screening assessments as well as review symptoms and medical history, but may also consider imaging to rule out other possible explanations for what one is experiencing.
While you can’t diagnose yourself or someone else with Alzheimer’s disease, you can perform a clinically supported at-home check that may point to the possibility and give the practitioner useful information to use in their assessment.
How Does Alzheimer’s Lead To Death
Alzheimers disease is a degenerative brain disorder in which brain cells destruct. The condition results in a decline in memory, behavior, and mental capabilities.
It is not Alzheimer’s disease that kills a person. Death typically results from an inability to carry out routine activities, such as eating, taking care while walking, visiting the bathroom and toilet. This inability to take care of oneself makes the affected person fall prey to problems, such as malnutrition, dehydration, falls, and infections , which lead to death.
Pneumonia is a common cause of death in people with Alzheimers disease. Problems while swallowing make ingested food particles enter the respiratory tract and the lungs instead of the esophagus. This ingested food causes pneumonia in the lungs.
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How Is Alzheimers Diagnosed And Treated
Doctors may ask questions about health, conduct cognitive tests, and carry out standard medical tests to determine whether to diagnose a person with Alzheimers disease. If a doctor thinks a person may have Alzheimers, they may refer the person to a specialist, such as a neurologist, for further assessment. Specialists may conduct additional tests, such as brain scans or lab tests of spinal fluid, to help make a diagnosis. These tests measure signs of the disease, such as changes in brain size or levels of certain proteins.
There is currently no cure for Alzheimers, though there are several medicines approved by the U.S. Food and Drug Administration that can help manage some symptoms of the disease along with coping strategies to manage behavioral symptoms. In 2021, FDA provided accelerated approval for a new medication, aducanumab, that targets the protein beta-amyloid, which accumulates abnormally in the brains of people with Alzheimers. The new medication helps to reduce amyloid deposits, but has not yet been shown to affect clinical symptoms or outcomes, such as progression of cognitive decline or dementia.
Most medicines work best for people in the early or middle stages of Alzheimers. Researchers are exploring other drug therapies and nondrug interventions to delay or prevent the disease as well as treat its symptoms.
What Are Some Complications Of Alzheimers Disease
Alzheimers disease is an irreversible form of dementia. The rate of progression differs between people: some people have it only in the last 5 years of their life, while others may have it for as long as 20 years. Alzheimers disease eventually leads to complete dependence and increasing frailty. This means a secondary illness, such as pneumonia, may eventually cause death.
Other complications of Alzheimers disease may include:
- an inability to complete daily tasks such as planning meals and managing money
- a tendency to wander from home
- personality changes such as anxiety, depression and irritability that make relationships more difficult
- delusions and hallucinations in advanced stages of the disease
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Loss Of Neural Circuits And Brain Plasticity
refers to the brain’s ability to change structure and function. This ties into the common phrase, “if you don’t use it, you lose it,” which is another way of saying, if you don’t use it, your brain will devote less somatotopic space for it. One proposed mechanism for the observed age-related plasticity deficits in animals is the result of age-induced alterations in calcium regulation. The changes in our abilities to handle calcium will ultimately influence neuronal firing and the ability to propagate , which in turn would affect the ability of the brain to alter its structure or function . Due to the complexity of the brain, with all of its structures and functions, it is logical to assume that some areas would be more vulnerable to aging than others. Two circuits worth mentioning here are the and neocortical circuits. It has been suggested that age-related cognitive decline is due in part not to neuronal death but to synaptic alterations. Evidence in support of this idea from animal work has also suggested that this cognitive deficit is due to functional and factors such as changes in enzymatic activity, chemical messengers, or gene expression in cortical circuits.
How Is Alzheimer’s Disease Diagnosed And Evaluated
No single test can determine whether a person has Alzheimer’s disease. A diagnosis is made by determining the presence of certain symptoms and ruling out other causes of dementia. This involves a careful medical evaluation, including a thorough medical history, mental status testing, a physical and neurological exam, blood tests and brain imaging exams, including:
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Advancements In Alzheimers Research
Recent advancements in neuroimaging technology and biochemical analysis have made tests much more accurate when detecting Alzheimers. Still, because there is a possibility for error, doctors must also rely on the combined results of other tests and evaluations.
Doctors can also gain important information about your health and possibly confirm or rule out other causes for your symptoms. For example, if youre experiencing memory changes, Alzheimers may not be the cause. Parkinsons disease and side effects from some medications can also cause memory issues.
Doctors can also examine if another kind of major neurocognitive disorder is present besides Alzheimers that might be the cause.
What Are The Benefits Of An Early Alzheimer’s Diagnosis
Alzheimers disease slowly worsens over time. People living with this disease progress at different rates, from mild Alzheimers, when they first notice symptoms, to severe, when they are completely dependent on others for care.
Early, accurate diagnosis is beneficial for several reasons. While there is no cure, there are several medicines available to treat Alzheimers, along with coping strategies to manage behavioral symptoms. Beginning treatment early in the disease process may help preserve daily functioning for some time. Most medicines work best for people in the early or middle stages of the disease. Learn more about Alzheimers medications.
In addition, having an early diagnosis helps people with Alzheimers and their families:
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Key Features Of Dementia
A person having dementia means that all five of the following statements are true:
- A person is having difficulty with one or more types of mental function. Although its common for memory to be affected, other parts of thinking function can be impaired. The 2013 DSM-5 manual lists these six types of cognitive function to consider: learning and memory, language, executive function, complex attention, perceptual-motor function, social cognition.
- The difficulties are a decline from the persons prior level of ability. These cant be lifelong problems with reading or math or even social graces. These problems should represent a change, compared to the persons usual abilities as an adult.
- The problems are bad enough to impair daily life function. Its not enough for a person to have an abnormal result on an office-based cognitive test. The problems also have to be substantial enough to affect how the person manages usual life, such as work and family responsibilities.
- The problems are not due to a reversible condition, such as delirium, or another reversible illness. Common conditions that can cause or worsen dementia-like symptoms include hypothyroidism, depression, and medication side-effects.
- The problems arent better accounted for by another mental disorder, such as depression or schizophrenia.
What Are The Symptoms Of Early
For most people with early-onset Alzheimer disease, the symptoms closely mirror those of other forms of Alzheimer disease.
Withdrawal from work and social situations
Changes in mood and personality
Severe mood swings and behavior changes
Deepening confusion about time, place, and life events
Suspicions about friends, family, or caregivers
Trouble speaking, swallowing, or walking
Severe memory loss
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What A Doctor May Check And Ask
Most people with suspected dementia will go to a doctors surgery to see their GP. Some doctors, however, will prefer to make a home visit to observe and assess someones behaviour in their own environment. A GP will check a persons blood pressure, temperature and pulse, listen to their heart and lungs and collect blood and urine samples for further tests to be carried out. The doctor will ask what potential signs of dementia have been noticed and when they began, how often they occur and whether they are getting worse.
The GP may ask a series of questions designed to test the persons memory and reasoning skills. The doctor is also likely to carry out a detailed review of any medication taken and ask about personal and family medical history, diet, smoking, intake of alcohol and exercise. The doctor will welcome notes perhaps kept by the patient, a partner, close family member or a care worker that outline when any symptoms or changes first happened. The GP may feel able to make a diagnosis at the conclusion of the assessment or may refer the person to a memory clinic or specialist.
Cultural diversity is an important consideration in the assessment process. Dementia assessments need to be culturally appropriate and recognise the impact of culture on individual behaviour. An interpreter may be vital for a proper assessment.
Medicines For Behavior Problems
Other medicines may be tried to treat anxiety, agitated or hostile behavior, sleep problems, frightening or disruptive false beliefs , suspicion of others , or hallucinations .
Before deciding to use medicine for behavior problems, try to see what is causing the behavior. If you know the cause, you may be able to find better ways of dealing with that behavior. You may be able to avoid treatment with medicine and the side effects and costs that come with it.
Medicines generally are used only for behavior problems when other treatments have failed. They may be needed if:
- A behavior is severely disruptive or harmful to the person or to others.
- Efforts to manage or reduce disruptive behavior by making changes in the person’s environment or routines have failed.
- The behavior is making the situation intolerable for the caregiver.
- The person has trouble telling the difference between what is and is not real . Psychosis means the person has false beliefs or hears or sees things that aren’t there .
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What Causes Alzheimer’s Disease
Alzheimer’s disease happens because of changes in the brain. Some of the symptoms may be related to a loss of chemical messengers in the brain, called neurotransmitters, that allow nerve cells in the brain to communicate properly.
People with Alzheimer’s disease have two things in the brain that are not normal: amyloid plaques and neurofibrillary tangles. Experts don’t know if amyloid plaques and neurofibrillary tangles are side effects of Alzheimer’s disease or part of the cause.
What Is Terminal Dementia
It provides information on what to expect as dementia progresses to an advanced stage. Late-stage dementia may also be called advanced or severe dementia. This usually means that a person has had dementia for some time and therefore there is now significant damage to their brain. This means that high levels of support and care are needed.
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Preclinical Alzheimers Or No Impairment
You may only know about your risk of Alzheimers disease due to your family history. Or, your doctor may identify biomarkers that indicate your risk.
If youre at risk of Alzheimers, your doctor will interview you about memory problems. However, there will be no noticeable symptoms during the first stage, which can last for years or decades.
Abnormal accumulation of a type of protein called tau in the fluid around your brain and spinal cord is associated with the development of Alzheimers disease. Changes in the levels of this protein can occur about 15 years before symptoms start.
Caregiver support: Someone in this stage is fully independent. They may not even know they have the disease.
How Does Alzheimer’s Disease Progress
The rate of progression of the disease varies from person to person.
However, the disease does lead eventually to complete dependence and finally death, usually from another illness such as pneumonia. A person may live from three to twenty years with Alzheimer’s disease, with the average being seven to ten years.
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What Causes Alzheimers
The causes of Alzheimers disease are not yet fully understood, but probably include a combination of:
- Age-related changes in the brain, like shrinking, inflammation, blood vessel damage, and breakdown of energy within cells, which may harm neurons and affect other brain cells.
- Changes or differences in genes, which may be passed down by a family member. Both types of Alzheimer’s the very rare early-onset type occurring between age 30 and mid-60s, and the most common late-onset type occurring after a persons mid-60s can be related to a persons genes in some way. Many people with Down syndrome, a genetic condition, will develop Alzheimers as they age and may begin to show symptoms in their 40s.
- Health, environmental, and lifestyle factors that may play a role, such as exposure to pollutants, heart disease, stroke, high blood pressure, diabetes, and obesity.
Watch this video to see how Alzheimers disease changes the brain.
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Thinning Of The Cortex
Advances in MRI technology have provided the ability to see the brain structure in great detail in an easy, non-invasive manner in vivo. Bartzokis et al., has noted that there is a decrease in volume between adulthood and old age, whereas volume was found to increase from age 19â40, and decline after this age. Studies using have identified areas such as the and superior parietal gyri as being especially vulnerable to age-related losses in grey matter of older adults. Sowell et al., reported that the first 6 decades of an individual’s life were correlated with the most rapid decreases in grey matter density, and this occurred over dorsal, frontal, and on both interhemispheric and lateral brain surfaces. It is also worth noting that areas such as the , and surrounding the appear exempt from this decrease in grey matter density over time. Age effects on grey matter density in the posterior temporal cortex appear more predominantly in the left versus right hemisphere, and were confined to posterior language cortices. Certain language functions such as word retrieval and production were found to be located to more anterior language cortices, and deteriorate as a function of age. Sowell et al., also reported that these anterior language cortices were found to mature and decline earlier than the more posterior language cortices. It has also been found that the width of not only increases with age, but also with cognitive decline in the elderly.