What Are The Warning Signs Of Alzheimers Disease
Watch this video play circle solid iconMemory Loss is Not a Normal Part of Aging
Alzheimers disease is not a normal part of aging. Memory problems are typically one of the first warning signs of Alzheimers disease and related dementias.
In addition to memory problems, someone with symptoms of Alzheimers disease may experience one or more of the following:
- Memory loss that disrupts daily life, such as getting lost in a familiar place or repeating questions.
- Trouble handling money and paying bills.
- Difficulty completing familiar tasks at home, at work or at leisure.
- Misplacing things and being unable to retrace steps to find them.
- Changes in mood, personality, or behavior.
Even if you or someone you know has several or even most of these signs, it doesnt mean its Alzheimers disease. Know the 10 warning signs .
Preventing Alzheimer’s Disease: What Do We Know
As they get older, many people worry about developing Alzheimer’s disease or a related dementia. If they have a family member with Alzheimer’s, they may wonder about their family history and genetic risk. As many as 5.5 million Americans age 65 and older live with Alzheimer’s. Many more are expected to develop the disease as the population agesunless ways to prevent or delay it are found.
Although scientists have conducted many studies, and more are ongoing, so far nothing has been proven to prevent or delay dementia caused by Alzheimer’s disease. But researchers have identified promising strategies and are learning more about what mightand might notwork.
We know that changes in the brain can occur many years before the first symptoms of Alzheimer’s appear. These early brain changes point to a possible window of opportunity to prevent or delay debilitating memory loss and other symptoms of dementia. While research may identify specific interventions that will prevent or delay the disease in some people, it’s likely that many individuals may need a combination of treatments based on their own risk factors.
Researchers are studying many approaches to prevent or delay Alzheimer’s. Some focus on drugs, some on lifestyle or other changes. Let’s look at the most promising interventions to date and what we know about them.
Fdas Accelerated Approval Program
Aducanumab was approved through the FDAs Accelerated Approval Program, which provides a path for earlier approval of drugs that treat certain serious conditions. This helps people living with the disease gain earlier access to the treatment. The approval of aducanumab was based on the ability of the drug to reduce amyloid in the brain. When using the accelerated approval pathway, drug companies are required to conduct additional studies to determine whether there is in fact clinical benefit after the drug is approved. If the follow-up trial fails to verify clinical benefit, the FDA may withdraw approval of the drug. Results of the phase 4 clinical trial for aducanumab are expected to be available by early 2030.
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How These Drugs Work
These drugs may work for some people but not others, and they do not stop the progression of Alzheimers disease. Instead, the drugs may delay it or help with symptom control for a period of time, particularly in the earlier stages of the disease. This action, in turn, may help patients with their attention and focus, cognitive abilities, memory, and communication skills.
Treatment For Mild To Moderate Alzheimers
Treating the symptoms of Alzheimers can provide people with comfort, dignity, and independence for a longer period of time and can encourage and assist their caregivers as well. Galantamine, rivastigmine, and donepezil are cholinesterase inhibitors that are prescribed for mild to moderate Alzheimers symptoms. These drugs may help reduce or control some cognitive and behavioral symptoms.
Scientists do not yet fully understand how cholinesterase inhibitors work to treat Alzheimers disease, but research indicates that they prevent the breakdown of acetylcholine, a brain chemical believed to be important for memory and thinking. As Alzheimers progresses, the brain produces less and less acetylcholine, so these medicines may eventually lose their effect. Because cholinesterase inhibitors work in a similar way, switching from one to another may not produce significantly different results, but a person living with Alzheimers may respond better to one drug versus another.
Before prescribing aducanumab, doctors may require PET scans or an analysis of cerebrospinal fluid to evaluate whether amyloid deposits are present in the brain. This can help doctors make an accurate diagnosis of Alzheimers before prescribing the medication. Once a person is on aducanumab, their doctor or specialist may require routine MRIs to monitor for side effects such as brain swelling or bleeding in the brain.
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Emotion And Behavior Treatments
The emotional and behavioral changes linked with Alzheimers disease can be challenging to manage. People may increasingly experience irritability, anxiety, depression, restlessness, sleep problems, and other difficulties.
Treating the underlying causes of these changes can be helpful. Some may be side effects of medications, discomfort from other medical conditions, or problems with hearing or vision.
Identifying what triggered these behaviors and avoiding or changing these things can help people deal with the changes. Triggers may include changing environments, new caregivers, or being asked to bathe or change clothes.
It is often possible to change the environment to resolve obstacles and boost the persons comfort, security, and peace of mind.
The Alzheimers Association offer a list of helpful coping tips for caregivers.
In some cases, a doctor may recommend medications for these symptoms, such as:
- antidepressants, for low mood
A Recent Disappointment And Renewed Hope
That is why so many patients, caregivers, researchers, and pharmaceutical executives groaned with disappointment in March of this year, when an especially hopeful new medication, aducanumab, was deemed a failure. Plans were made to shut down the two large trials investigating its potential after a few additional months. Aducanumab belongs to the class of drugs known as the anti-amyloid monoclonal antibodies. These molecules, manufactured biologically and injected into research subjects with early Alzheimers disease, are like magic bullets targeted at toxic amyloid similar to the way that our own antibodies attack infectious bacteria. In early trials, aducanumab appeared to have disease-modifying properties. When administered to people in an early stage of Alzheimers disease, it not only reduced brain amyloid content, it also appeared to delay cognitive decline. No wonder its apparent failure was soupsetti ng.
Using additional data gathered during the final months of study, Biogen revised its earlier assessment. In 2020, an application for approval of aducanumab was submitted to the FDA, seeking permission to market it as an Alzheimers disease treatment. In November of 2020, a panel of experts concluded that the clinical data did not support the approval of aducanumab. The FDAs final decision is anticipated late in March of 2021.
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Home Remedies And Lifestyle
Non-drug approaches focus on treating the behavioral, psychological, and emotional symptoms of Alzheimer’s by changing the way you understand and interact with the person with the disease.
These approaches recognize that behavior is often a way of communicating for those with Alzheimer’s. The goal of non-drug approaches is to understand the meaning of the challenging behaviors and why they are present.
Non-drug approaches should generally be attempted before using psychotropic medications since they do not have the potential for side effects or medication interactions.
Whats New In The Alzheimers Treatment Pipeline
The search for new medications that are both safe and effective weapons in the fight against Alzheimers disease has already demanded the collaboration of thousands of researchers and hundreds of thousands of willing subjects. But it is far from over! Since 1998, 146 drugs have been tested and rejected. Only four drugs have made it through the rigorous clinical trial process that precedes approval by the Food and Drug Administration . The approved drugs have modest symptom-reducing effects, but they do not alter the eventual course of Alzheimers disease.
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What Are Some Of The Newer Treatments For Alzheimers
A monoclonal antibody called aducanumab has been approved by the Food and Drug Administration for the treatment of early Alzheimers. It works by targeting a protein called amyloid that causes the formation of plaques in the brains of people with Alzheimers. It is hoped that the drug, delivered by monthly injection, may help prevent the build-up of these plaques.
How Is Alzheimers Disease Diagnosed
These tests are used to diagnose Alzheimers disease or to rule out other medical conditions that cause symptoms similar to Alzheimers disease:
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Us Approves First New Alzheimer’s Drug In 20 Years
The first new treatment for Alzheimer’s disease for nearly 20 years has been approved by regulators in the United States, paving the way for its use in the UK.
Aducanumab targets the underlying cause of Alzheimer’s, the most common form of dementia, rather than its symptoms.
Charities have welcomed the news of a new therapy for the condition.
But scientists are divided over its potential impact because of uncertainty over the trial results.
At least 100,000 people in the UK with a mild form of the disease could be suitable for the drug if it were to be approved by the UK regulator.
The US Food and Drug Administration said there was “substantial evidence that aducanumab reduces amyloid beta plaques in the brain” and that this “is reasonably likely to predict important benefits to patients”.
Natural Alzheimers Treatment #1: Nutrition
There have been extensive studies in recent decades, as well as centuries-old wisdom across the globe, that shows how many aspects of nutrition work to help those with memory impairment and dementia. Improving some symptoms of dementia may be as simple as adding a supplement to your daily vitamin regimen, but it could also involve making drastic changes to your diet like eliminating white sugar. The effectiveness of nutrition therapy varies from person to person, but its likely that you may see some benefit.
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Treatment For Moderate To Severe Alzheimers
A medication known as memantine, an N-methyl D-aspartate antagonist, is prescribed to treat moderate to severe Alzheimers disease. This drugs main effect is to decrease symptoms, which could enable some people to maintain certain daily functions a little longer than they would without the medication. For example, memantine may help a person in the later stages of the disease maintain his or her ability to use the bathroom independently for several more months, a benefit for both the person with Alzheimer’s and caregivers.
Memantine is believed to work by regulating glutamate, an important brain chemical. When produced in excessive amounts, glutamate may lead to brain cell death. Because NMDA antagonists work differently from cholinesterase inhibitors, the two types of drugs can be prescribed in combination.
The FDA has also approved donepezil, the rivastigmine patch, and a combination medication of memantine and donepezil for the treatment of moderate to severe Alzheimers.
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What’s The Bottom Line On Alzheimer’s Prevention
Alzheimer’s disease is complex, and the best strategy to prevent or delay it may turn out to be a combination of measures. In the meantime, you can do many things that may keep your brain healthy and your body fit.
You also can help scientists learn more by volunteering to participate in research. Clinical trials and studies are looking for all kinds of peoplehealthy volunteers, cognitively normal participants with a family history of Alzheimer’s, people with MCI, and people diagnosed with Alzheimer’s disease or a related dementia.
To find study sites near you, contact NIA’s Alzheimer’s and related Dementias Education and Referral Center at 1-800-438-4380 or . Or, visit the Alzheimers.gov Clinical Trials Finder to search for trials and studies.
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What Is The Outlook For People With Alzheimers Disease
Alzheimers disease gets worse over time and is ultimately fatal. Persons with Alzheimers disease live, on average, four to eight years after diagnosis. Some patients can live as long as 20 years after diagnosis. The course of the disease varies from person to person.
Last reviewed by a Cleveland Clinic medical professional on 03/18/2019.
Can Cognitive Training Prevent Alzheimer’s Disease
Cognitive training involves structured activities designed to enhance memory, reasoning, and speed of processing. There is encouraging but inconclusive evidence that a specific, computer-based cognitive training may help delay or slow age-related cognitive decline. However, there is no evidence that it can prevent or delay Alzheimer’s-related cognitive impairment.
Studies show that cognitive training can improve the type of cognition a person is trained in. For example, older adults who received 10 hours of practice designed to enhance their speed and accuracy in responding to pictures presented briefly on a computer screen got faster and better at this specific task and other tasks in which enhanced speed of processing is important. Similarly, older adults who received several hours of instruction on effective memory strategies showed improved memory when using those strategies. The important question is whether such training has long-term benefits or translates into improved performance on daily activities like driving and remembering to take medicine.
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Natural Alzheimers Treatment #2: Exercise
The relationship between exercise and dementia has been studied extensively. It is estimated that reducing physical inactivity by as little as 25% in all elders could reduce as many as one million cases of dementia worldwide.
Exercise is particularly helpful in the management of vascular dementia, where brain cell death occurs due to the blood flow being restricted somewhere along the way due to plaque build-up. Studies show that regular exercise is a great strategy to combat this plaque build-up, as well as to maintain the bodys muscle mass. According to recent research, 150 minutes of aerobic exercise a week is shown to protect cognitive health in those over age 65.
There are many ways to reach your 150 minutes at home if you arent the gym-going type.
See our guide to the best 25 videos and exercise equipment for staying fit at home if youd like some ideas. There are also many ways to get your blood pumping at home without ever picking up a dumbbell, simply incorporate your lifelong hobbies into aerobic activity. Gardening is a great activity that keeps elders active, as is walking around the neighborhood, yard work, and dancing.
Can Increasing Physical Activity Prevent Alzheimer’s Disease
Physical activity has many health benefits, such as reducing falls, maintaining mobility and independence, and reducing the risk of chronic conditions like depression, diabetes, and high blood pressure. Based on research to date, there’s not enough evidence to recommend exercise as a way to prevent Alzheimer’s dementia or mild cognitive impairment , a condition of mild memory problems that often leads to Alzheimer’s dementia.
Years of animal and human observational studies suggest the possible benefits of exercise for the brain. Some studies have shown that people who exercise have a lower risk of cognitive decline than those who don’t. Exercise has also been associated with fewer Alzheimer’s plaques and tangles in the brain and better performance on certain cognitive tests.
While clinical trials suggest that exercise may help delay or slow age-related cognitive decline, there is not enough evidence to conclude that it can prevent or slow MCI or Alzheimer’s dementia. One study compared high-intensity aerobic exercise, such as walking or running on a treadmill, to low-intensity stretching and balance exercises in 65 volunteers with MCI and prediabetes. After 6 months, researchers found that the aerobic group had better executive functionthe ability to plan and organizethan the stretching/balance group, but not better short-term memory.
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What Is The Burden Of Alzheimers Disease In The United States
- Alzheimers disease is one of the top 10 leading causes of death in the United States.2
- The 6th leading cause of death among US adults.
- The 5th leading cause of death among adults aged 65 years or older.3
In 2020, an estimated 5.8 million Americans aged 65 years or older had Alzheimers disease.1 This number is projected to nearly triple to 14 million people by 2060.1
In 2010, the costs of treating Alzheimers disease were projected to fall between $159 and $215 billion.4 By 2040, these costs are projected to jump to between $379 and more than $500 billion annually.4
Death rates for Alzheimers disease are increasing, unlike heart disease and cancer death rates that are on the decline.5 Dementia, including Alzheimers disease, has been shown to be under-reported in death certificates and therefore the proportion of older people who die from Alzheimers may be considerably higher.6
Support For Family And Friends
Currently, many people living with Alzheimers disease are cared for at home by family members. Caregiving can have positive aspects for the caregiver as well as the person being cared for. It may bring personal fulfillment to the caregiver, such as satisfaction from helping a family member or friend, and lead to the development of new skills and improved family relationships.
Although most people willingly provide care to their loved ones and friends, caring for a person with Alzheimers disease at home can be a difficult task and may become overwhelming at times. Each day brings new challenges as the caregiver copes with changing levels of ability and new patterns of behavior. As the disease gets worse, people living with Alzheimers disease often need more intensive care.
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Challenges To Finding A Cure
The path towards a cure is not going to be easy, and even if these theories do lead to the development of drugs, these drugs may fail for a host of other reasons.
Alzheimers is a very long, chronic disease, probably present 20 to 30 years before the first symptoms become obvious. Giving the drug when a person becomes symptomatic may be too late for it to make any difference. But we do not have the ability to diagnose it 30 years before the first symptoms, and even if we could, we would need to consider the ethics of giving a potentially toxic drug long-term to someone who may or may not get a disease in three decades.
Also, unlike developing antibiotics in which the researchers know within days if the drug works, the chronic nature of Alzheimers requires long, expensive trials years in duration before an answer can be attained. Such time and expense is a further impediment to drug development.
One final problem is that Alzheimers may not simply be one disease. It may in fact be a collection of similar diseases. A 52-year-old with early onset Alzheimers certainly has a clinical course distinct and different from an 82-year-old with late onset Alzheimers. Will a drug that works in an 82-year-old also work in a 52-year-old persons disease? Maybe, or maybe not.
How Is Alzheimer’s Disease Treated
Alzheimers disease is complex, and it is therefore unlikely that any one drug or other intervention will ever successfully treat it in all people living with the disease. Still, in recent years, scientists have made tremendous progress in better understanding Alzheimers and in developing and testing new treatments, including several medications that are in late-stage clinical trials.
Several prescription drugs are already approved by the U.S. Food and Drug Administration to help manage symptoms in people with Alzheimers disease. And, on June 7, 2021, FDA provided accelerated approval for the newest medication, aducanumab, which helps to reduce amyloid deposits in the brain and may help slow the progression of Alzheimers, although it 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. However, it is important to understand that none of the medications available at this time will cure Alzheimers.
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Fda Approves Alzheimers Drug Despite Fierce Debate Over Whether It Works
Aducanumab, or Aduhelm, is the first new Alzheimers treatment in 18 years and the first to attack the disease process. But some experts say theres not enough evidence it can address cognitive symptoms.
The Food and Drug Administration on Monday approved the first new medication for Alzheimers disease in nearly two decades, a contentious decision made despite opposition from the agencys independent advisory committee and some Alzheimers experts who said there was not enough evidence that the drug can help patients.
The drug, aducanumab, which will go by the brand name Aduhelm, is a monthly intravenous infusion intended to slow cognitive decline in people with mild memory and thinking problems. It is the first approved treatment to attack the disease process of Alzheimers instead of just addressing dementia symptoms.
Biogen, its manufacturer, announced Monday afternoon that the list price would be $56,000 a year. In addition, there will most likely be tens of thousands of dollars in costs for diagnostic testing and brain imaging.
Recognizing that clinical trials of the drug had provided incomplete evidence to demonstrate effectiveness, the F.D.A. granted approval for the drug to be used but required Biogen to conduct a new clinical trial.
If the new trial, called a Phase 4 trial, fails to show the drug is effective, the F.D.A. can but is not required to rescind its approval.
New Alzheimers Disease Treatment Approved
Treatment Of Alzheimer Disease
BRADFORD T. WINSLOW, MD, Swedish Family Medicine Residency, Littleton, Colorado
CHRISTIAN M. STOB, DO, Denver Health Medical Center, Denver, Colorado
KATHLEEN A. HAZLEWOOD, PharmD, University of Wyoming School of Pharmacy, Laramie, Wyoming
Am Fam Physician. 2011 Jun 15;83:1403-1412.
Patient information: See related handout on Alzheimer disease, written by the authors of this article.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Acetylcholinesterase inhibitors are modestly effective in patients with mild to moderate Alzheimer disease, although limited by their adverse effects.
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Combination therapy with an acetylcholinesterase inhibitor and memantine should be considered in patients with moderate to severe Alzheimer disease.
Atypical antipsychotic agents can improve some behavioral manifestations of Alzheimer disease but are associated with increased mortality in older patients.
Nonsteroidal anti-inflammatory drugs, vitamin E, testosterone, estrogen, statins, and insulin sensitizers are not recommended for the treatment of Alzheimer disease.
Physicians should consider discontinuing treatment for Alzheimer disease in patients who continue to decline despite maximal therapy.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Acetylcholinesterase inhibitors are modestly effective in patients with mild to moderate Alzheimer disease, although limited by their adverse effects.
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