When To See A Gp
If you’re worried about your memory or think you may have dementia, it’s a good idea to see a GP.
If you’re worried about someone else’s memory problems, encourage them to make an appointment and perhaps suggest that you go along with them.
Memory problems are not just caused by dementia they can also be caused by depression, stress, medicines or other health problems.
A GP can carry out some simple checks to try to find out what the cause may be, and they can refer you to a specialist for more tests if necessary.
Read more about diagnosing Alzheimer’s disease.
Page last reviewed: 05 July 2021 Next review due: 05 July 2024
Symptoms Of Mild Cognitive Impairment
Some people have a condition called mild cognitive impairment, or MCI. It can be an early sign of Alzheimers. But, not everyone with MCI will develop Alzheimers disease. People with MCI can still take care of themselves and do their normal activities. MCI memory problems may include:
- Losing things often
- Forgetting to go to events or appointments
- Having more trouble coming up with words than other people the same age
Learn more about Alzheimer’s disease from MedlinePlus.
Disproportionate Impact On Women
Globally, dementia has a disproportionate impact on women. Sixty-five percent of total deaths due to dementia are women, and disability-adjusted life years due to dementia are roughly 60% higher in women than in men. Additionally, women providethe majority of informal care for people living with dementia, accounting for 70% of carer hours.
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Neurofibrillary Tangles And Senile Plaques
Plaques are dense, mostly insoluble deposits of protein and cellular material outside and around the neurons. Plaques are made of beta-amyloid , a protein fragment snipped from a larger protein called amyloid precursor protein . These fragments clump together and are mixed with other molecules, neurons, and non-nerve cells .
In AD, plaques develop in the hippocampus, a structure deep in the brain that helps to encode memories, and in other areas of the cerebral cortex that are used in thinking and making decisions. Plaques may begin to develop as early as the fifth decade of life. Whether Ab plaques themselves cause AD or whether they are a by-product of the AD process is still unknown. It is known that changes in APP structure can cause a rare, inherited form of AD.
Tangles are insoluble twisted fibers that build up inside the nerve cell. Although many older people develop some plaques and tangles, the brains of people with AD have them to a greater extent, especially in certain regions of the brain that are important in memory. There are likely to be significant age-related differences in the extent to which the presence of plaques and tangles are indicative of the presence of dementia.
SPs also accumulate primarily in association cortices and in the hippocampus. Plaques and tangles have relatively discrete and stereotypical patterns of laminar distribution in the cerebral cortex, which indicate predominant involvement of corticocortical connections.
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.
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What To Do If You Suspect Alzheimers Disease
Getting checked by your healthcare provider can help determine if the symptoms you are experiencing are related to Alzheimers disease, or a more treatable conditions such as a vitamin deficiency or a side effect from medication. Early and accurate diagnosis also provides opportunities for you and your family to consider financial planning, develop advance directives, enroll in clinical trials, and anticipate care needs.
Cholinergic Neurotransmission And Alzheimer Disease
The cholinergic system is involved in memory function, and cholinergic deficiency has been implicated in the cognitive decline and behavioral changes of AD. Activity of the synthetic enzyme choline acetyltransferase and the catabolic enzyme acetylcholinesterase are significantly reduced in the cerebral cortex, hippocampus, and amygdala in patients with AD.
The nucleus basalis of Meynert and diagonal band of Broca provide the main cholinergic input to the hippocampus, amygdala, and neocortex, which are lost in patients with AD. Loss of cortical CAT and decline in acetylcholine synthesis in biopsy specimens have been found to correlate with cognitive impairment and reaction-time performance. Because cholinergic dysfunction may contribute to the symptoms of patients with AD, enhancing cholinergic neurotransmission constitutes a rational basis for symptomatic treatment.
Warning Signs Of Alzheimer’s
Memory often changes as people grow older. Some people notice changes in themselves before anyone else does. For other people, friends and family are the first to see changes in memory, behavior, or abilities. Memory loss that disrupts daily life is not a typical part of aging. People with one or more of these 10 warning signs should see a doctor to find the cause. Early diagnosis gives them a chance to seek treatment and plan for the future.
1. Memory loss that disrupts daily life: forgetting events, repeating yourself or relying on more aids to help you remember .
2.Challenges in planning or solving problems: having trouble paying bills or cooking recipes you have used for years.
3.Difficulty completing familiar tasks at home, at work, or at leisure: having problems with cooking, driving places, using a cell phone, or shopping.
4.Confusion with time or place: having trouble understanding an event that is happening later, or losing track of dates.
5.Trouble understanding visual images and spatial relations: having more difficulty with balance or judging distance, tripping over things at home, or spilling or dropping things more often.
The Centers for Disease Control and Prevention and the Alzheimers Association have created the Healthy Brain Initiatives State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map.
8. being a victim of a scam, not managing money well, paying less attention to hygiene, or having trouble taking care of a pet.
What Are The Signs And Symptoms Of Alzheimers
Memory problems are often one of the first signs of Alzheimers. Symptoms vary from person to person, and may include problems with:
- Word-finding, or having more trouble coming up with words than other people the same age.
- Vision and spatial issues, like awareness of the space around them.
- Impaired reasoning or judgment, which can impact decisions.
Other symptoms may be changes in the persons behavior, including:
- Taking longer to complete normal daily tasks.
- Repeating questions.
- Trouble handling money and paying bills.
- Wandering and getting lost.
- Losing things or misplacing them in odd places.
- Mood and personality changes.
- Increased anxiety and/or aggression.
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What Is Known About Reducing Your Risk Of Alzheimers Disease
The science on risk reduction is quickly evolving, and major breakthroughs are within reach. For example, there is growing evidence that people who adopt healthy lifestyle habits like regular exercise and blood pressure management can lower their risk of dementia. There is growing scientific evidence that healthy behaviors, which have been shown to prevent cancer, diabetes, and heart disease, may also reduce risk for subjective cognitive decline. To learn more about the current state of evidence on dementia risk factors and the implications for public health, please read the following summaries on Cardiovascular Health, Exercise, Diabetes and Obesity, Traumatic Brain Injury , Tobacco and Alcohol, Diet and Nutrition, Sleep, Sensory Impairment, and Social Engagement or the Compiled Report .
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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Can Alzheimer’s Disease Be Prevented
As the exact cause of Alzheimer’s disease is not clear, there’s no known way to prevent the condition.
But there are things you can do that may reduce your risk or delay the onset of dementia, such as:
- staying physically fit and mentally active
These measures have other health benefits, such as lowering your risk of cardiovascular disease and improving your overall mental health.
Read more about preventing Alzheimer’s disease.
Facts About Alzheimer Disease
Alzheimer disease is becoming more common as the general population gets older and lives longer. Alzheimer disease usually affects people older than 65. A small number of people have early-onset Alzheimer disease, which starts when they are in their 30s or 40s.
People live for an average of 8 years after their symptoms appear. But the disease can progress quickly in some people and slowly in others. Some people live as long as 20 years with the disease.
No one knows what causes Alzheimer disease. Genes, environment, lifestyle, and overall health may all play a role.
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Who Gets Alzheimers Disease
Anyone can develop Alzheimers disease, but it is more common in older age.
Genetics, lifestyle and health factors are associated with an increased risk of developing dementia.
In a few cases, Alzheimers disease is inherited, caused by a genetic mutation. This is called familial Alzheimers disease, with symptoms occurring at a relatively young age. This is usually when someone is in their 50s, but sometimes younger.
Difficulty Completing Familiar Tasks
Some people may experience a greater problem with concentration. Routine day-to-day tasks requiring critical thought may take longer as the disease progresses.
The ability to drive safely may also be called into question. If you or a loved one gets lost while driving a commonly traveled route, this may be a symptom of AD.
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Stages Of Alzheimer Disease
The stages of Alzheimer disease usually follow a progressive pattern. But each person moves through the disease stages in his or her own way. Knowing these stages helps healthcare providers and family members make decisions about how to care for someone who has Alzheimer disease.
Preclinical stage. Changes in the brain begin years before a person shows any signs of the disease. This time period is called preclinical Alzheimer disease and it can last for years.
Mild, early stage. Symptoms at this stage include mild forgetfulness. This may seem like the mild forgetfulness that often comes with aging. But it may also include problems with concentration.
A person may still live independently at this stage, but may have problems:
Remembering a name
The person may be aware of memory lapses and their friends, family or neighbors may also notice these difficulties.
Moderate, middle stage. This is typically the longest stage, usually lasting many years. At this stage, symptoms include:
Increasing trouble remembering events
Problems learning new things
Trouble with planning complicated events, like a dinner
Trouble remembering their own name, but not details about their own life, such as address and phone number
Problems with reading, writing, and working with numbers
As the disease progresses, the person may:
Physical changes may occur as well. Some people have sleep problems. Wandering away from home is often a concern.
Where To Get Help
- Your local community health centre
- National Dementia Helpline Dementia Australia Tel. 1800 100 500
- Aged Care Assessment Services Tel. 1300 135 090
- My Aged Care 1800 200 422
- Cognitive Dementia and Memory Service clinics Tel. 1300 135 090
- Carers Victoria Tel. 1800 242 636
- Commonwealth Carelink and Respite Centres Australian Government Tel. 1800 052 222
- Dementia Behaviour Management Advisory Service Tel. 1800 699 799 for 24-hour telephone advice for carers and care workers
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Assessing Your Mental Abilities
A specialist will usually assess your mental abilities using a special series of questions.
One widely used test is the mini mental state examination . This involves being asked to carry out activities such as memorising a short list of objects correctly and identifying the current day of the week, month and year. Different memory clinics may also use other, longer tests.
The MMSE isn’t used to diagnose Alzheimer’s disease, but it’s useful to initially assess areas of difficulty that a person with the condition may have. This helps specialists to make decisions about treatment and whether more tests are necessary.
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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The Brain And Body Connection
Though the cause of Alzheimerâs is not known, doctors think the symptoms of the disease are caused by a buildup of harmful proteins in your brain called amyloid and tau. These proteins form large clumps, called tangles and plaques. They get in the way of normal brain function and kill healthy cells.
The damage usually starts in the area of your brain that forms memories. People with early-stage Alzheimer’s disease often have trouble remembering things. As the disease gets worse, the plaques and clusters also appear in the parts of the brain in charge of bodily behaviors.
Everyday activities like walking, eating, going to the bathroom, and talking become harder.
The effects of the disease will differ for each person as it gets worse. The pace can be slow. Some people live up to 20 years after a diagnosis. The average life expectancy, though, is 4 to 8 years.
Ps1 And Ps2 Mutations
Approximately 50-70% of early-onset autosomal-dominant AD cases appear to be associated with a locus mapped by genetic linkage to the long arm of chromosome 14 . Numerous missense mutations have been identified on a strong candidate gene, called PS1.
At the same time, another autosomal dominant locus responsible for early-onset AD was localized to chromosome 1. Two mutations were identified on the candidate gene, designated PS2. The physiological role of presenilins and the pathogenic effects of their mutations are not yet well understood.
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Impact On Families And Carers
In 2019, informal carers spent on average 5 hours per day providing care for people living with dementia. This can be overwhelming . Physical, emotional and financial pressures can cause great stress tofamilies and carers, and support is required from the health, social, financial and legal systems. Fifty percent of the global cost of dementia is attributed to informal care.
Medications For Cognitive Symptoms
No disease-modifying drugs are available for Alzheimers disease, but some options may reduce the symptoms and help improve quality of life.
Drugs called cholinesterase inhibitors can ease cognitive symptoms, including memory loss, confusion, altered thought processes, and judgment problems. They improve neural communication across the brain and slow the progress of these symptoms.
Three common drugs with Food and Drug Administration approval to treat these symptoms of Alzheimers disease are:
- donepezil , to treat all stages
- galantamine , to treat mild-to-moderate stages
- rivastigmine , to treat mild-to-moderate stages
Another drug, called memantine , has approval to treat moderate-to-severe Alzheimers disease. A combination of memantine and donepezil is also available.
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Treatment And Management Options
At present there is no cure for Alzheimers disease and no treatment can stop the condition progressing. However, medications can help stabilise or slow the decline in memory and thinking abilities. Drugs may also be prescribed for secondary symptoms such as agitation or depression, or to improve sleep. Non-drug therapies can be beneficial, such as staying active and socially connected, and managing stress.
Talking to a counsellor or psychologist is important to help manage changes in behaviour and mood.
Occupational therapy can help improve everyday functioning at home.
At all stages of Alzheimers disease, treatments and support services are available to reduce the impact of symptoms, to ensure the best possible quality of life for every person living with the condition.
Treatment For Alzheimer’s Disease Symptoms At Bwh
There is no known cure for the disease, but Alzheimer’s disease symptoms may be treated in a number of ways.
- Medications may be prescribed by a neurologist and to help enhance memory and attention, or to address mood and behavioral disorders.
- Education for patients and their families helps everyone affected by the disease better understand the illness and its symptoms and plan more effectively for the future.
- Treating other conditions is an important part of the treatment of Alzheimer’s disease symptoms. The BWH team carefully reviews medication that patients may be taking for other conditions and assesses whether side effects may be contributing to their Alzheimer’s disease symptoms.
Dennis Selkoe, MD, Co-director of the Ann Romney Center for Neurologic Diseases, discusses progress in the development of Alzheimer’s disease treatments that target the amyloid beta protein. Read the Research Updates on Amyloid Beta and Alzheimer’s Disease video transcript.
Patients may also visit the Neurology Services Department for sleep disorders, migraine treatment, or an EMG test, and consult with the Neurosurgery Department about conditions that include tumors, and epilepsy, spinal surgery and other conditions.
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