The Financial Implications Of Early
People with early-onset Alzheimers disease may be facing a daunting financial future, particularly if their job is their main source of income.
Those who are still working may be eligible for disability benefits or may be able to use benefits offered under the federal Family and Medical Leave Act, which allows up to 12 weeks of unpaid, job-protected leave each year for family and medical reasons with continuation of group health insurance coverage.
People who need to leave their jobs may be able to retain employer-sponsored healthcare coverage for as long as 36 months under the federal law COBRA.
The Health Insurance Marketplace in each state, created by the Affordable Care Act , is another option for healthcare coverage. ACA health plans cannot refuse coverage to people with preexisting conditions, meaning no one can be denied insurance because of an Alzheimers diagnosis.
The Social Security Administration has added early-onset Alzheimers disease to its list of conditions under theCompassionate Allowances initiative.
This means people younger than 65 who qualify have expedited access to Social Security Disability Insurance and Supplemental Security Income.
Talking with a financial planner who is familiar with elder care or long-term-care planning may be helpful in understanding the choices and taking a proactive approach.
What Are The Symptoms Of Alzheimers
Recognizing the signs of Alzheimers early in the course of the disease can sometimes be difficult. Weve all misplaced our keys or forgotten someones name. Thats common and shouldnt necessarily be a cause for concern. The first symptoms of Alzheimers vary from person to person. For many, decline in non-memory aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment may signal the very early stages of the disease.2 This disease affects all sorts of things, from memory and mood swings, to the ability to complete everyday tasks. Signs of Alzheimers include:3
- Forgetfulness
- Getting lost in familiar places
- Having trouble finding words to describe objects or express thoughts
- Difficulty concentrating and thinking
- Making poor or uncharacteristic choices
- Forgetting how to carry out basic tasks, like dressing or bathing
- Personality changes
If youve noticed some of these behaviors in yourself or a loved one, schedule a visit with your doctor. These symptoms can reflect signs of early Alzheimers or signs of early dementia.
Stage : Moderate Dementia
Patients in stage 5 need some assistance in order to carry out their daily lives. The main sign for stage 5 dementia is the inability to remember major details such as the name of a close family member or a home address. Patients may become disoriented about the time and place, have trouble making decisions, and forget basic information about themselves, such as a telephone number or address.
While moderate dementia can interfere with basic functioning, patients at this stage do not need assistance with basic functions such as using the bathroom or eating. Patients also still have the ability to remember their own names and generally the names of spouses and children.
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Stage 4 Late Confusional/mild Alzheimers Disease
Mathematical challenges can cause problems handling finances. Increasingly, the person will forget recent events and conversations, although most people in this stage still know themselves and their family.
Problems carrying out sequential tasks, including cooking, driving, ordering food at restaurants, and shopping are common. The person often withdraws from social situations, becomes defensive, and denies any problems.
Duration: roughly 2 years.
Sexual Differences In Incidence
Some studies have reported a higher risk of AD in women than in men other studies, however, including the Aging, Demographics, and Memory Study, found no difference in risk between men and women. Almost two thirds of Americans with AD are women. Among AD patients overall, any sexual disparity may simply reflect womens higher life expectancy. Among those who are heterozygous for the APOE E4 allele, however, Payami et al found a twofold increased risk in women.
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What Is Alzheimer Disease
Alzheimer disease, which affects some older people, is different from everyday forgetting. It is a condition that permanently affects the brain. Over time, the disease makes it harder to remember even basic stuff, like how to tie a shoe.
Eventually, the person may have trouble remembering the names and faces of family members or even who he or she is. This can be very sad for the person and his or her family.
It’s important to know that Alzheimer disease does not affect kids. It usually affects people over 65 years of age. Researchers have found medicines that seem to slow the disease down. And there’s hope that someday there will be a cure.
The Basics Of Alzheimers Disease
Scientists are conducting studies to learn more about plaques, tangles, and other biological features of Alzheimers disease. Advances in brain imaging techniques allow researchers to see the development and spread of abnormal amyloid and tau proteins in the living brain, as well as changes in brain structure and function. Scientists are also exploring the very earliest steps in the disease process by studying changes in the brain and body fluids that can be detected years before Alzheimers symptoms appear. Findings from these studies will help in understanding the causes of Alzheimers and make diagnosis easier.
One of the great mysteries of Alzheimers disease is why it largely affects older adults. Research on normal brain aging is exploring this question. For example, scientists are learning how age-related changes in the brain may harm neurons and affect other types of brain cells to contribute to Alzheimers damage. These age-related changes include atrophy of certain parts of the brain, inflammation, blood vessel damage, production of unstable molecules called free radicals, and mitochondrial dysfunction .
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When Someone You Love Has Alzheimer Disease
You might feel sad or angry or both if someone you love has Alzheimer disease. You might feel nervous around the person, especially if he or she is having trouble remembering important things or can no longer take care of himself or herself.
You might not want to go visit the person, even though your mom or dad wants you to. You are definitely not alone in these feelings. Try talking with a parent or another trusted adult. Just saying what’s on your mind might help you feel better. You also may learn that the adults in your life are having struggles of their own with the situation.
If you visit a loved one who has Alzheimer disease, try to be patient. He or she may have good days and bad days. It can be sad if you can’t have fun in the same ways together. Maybe you and your grandmother liked to go to concerts. If that’s no longer possible, maybe bring her some wonderful music and listen together. It’s a way to show her that you care and showing that love is important, even if her memory is failing.
Amyloid Hypothesis Versus Tau Hypothesis
A central but controversial issue in the pathogenesis of AD is the relationship between amyloid deposition and NFT formation. Evidence shows that abnormal amyloid metabolism plays a key pathogenic role. At high concentrations, the fibrillar form of Ab has been shown to be neurotoxic to cultured neurons.
Cultured cortical and hippocampal neurons treated with Ab protein exhibit changes characteristic of apoptosis , including nuclear chromatin condensation, plasma membrane blebbing, and internucleosomal DNA fragmentation. The fibrillar form of Ab has also been shown to alter the phosphorylation state of tau protein.
The identification of several point mutations within the APP gene in some patients with early-onset familial AD and the development of transgenic mice exhibiting cognitive changes and SPs also incriminate Ab in AD. The apolipoprotein E E4 allele, which has been linked with significantly increased risk for developing AD, may promote inability to suppress production of amyloid, increased production of amyloid, or impaired clearance of amyloid with collection outside of the neuron.
Autopsies have shown that patients with 1 or 2 copies of the APOE E4 allele tend to have more amyloid. Additional evidence comes from recent experimental data supporting the role of presenilins in Ab metabolism, as well as findings of abnormal production of Ab protein in presenilin-mutation familial Alzheimer disease.
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Age And Immune Response In Ad
What seemed like a farfetched idea a few years ago is now a well established fact in AD: inflammatory and immune responses have a significant role in its development and progression. Several of the genetic loci associated with AD risk contain genes with known roles in inflammation, the complement system and the immune response in general . Pathway analyses of GWAS data have identified the immune response as important in AD, and an integrated network analysis of genome and transcriptome data identified the immune and microglia module as significant for AD and TYROBP as the driver gene for this module .
Microglial activation and monocyte/macrophage-mediated inflammatory responses are currently particularly interesting areas of research on AD. To evaluate the relationship between known AD risk loci, Chan et al. recently conducted a protein quantitative trait analysis in monocytes and showed that the NME8 risk allele influences protein tyrosine kinase 2 , the CD33 risk allele influences triggering receptor expressed on myeloid cells 2 and the TREM1 risk allele is associated with a decreased TREM1/TREM2 ratio. Interestingly, the authors also uncovered potential differences associated with age in the expression of genes in the TREM locus. TREM1 expression was found to increase with advancing age in younger but not in older individuals, and TREM1 variants were found to affect TREM2 expression in younger but not older people .
Problems With Vision And Spatial Awareness
Alzheimers disease can sometimes cause vision problems, making it difficult for people to judge distances between objects. The person may find it hard to distinguish contrast and colors or judge speed or distance.
These vision problems combined can affect the persons ability to drive.
Normal aging also affects eyesight, so it is essential to have regular checkups with an eye doctor.
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What Causes Alzheimer’s Disease To Progress So Quickly
The progression of Alzheimers disease varies widely between individuals, with most people living with the condition for between 3 and 11 years after the initial diagnosis. In some cases, people may survive for more than 20 years. When Alzheimers is detected early, there are possible treatments that can help to slow the progression of the disease and contribute to a longer life expectancy.
It is therefore crucial to plan for the future and follow the progression of the disease through each stage. Alzheimers disease first begins with physical changes in the brain. This can happen at a gradual pace before any noticeable symptoms appear. In fact, this pre-clinical Alzheimers disease stage can begin 10 to 15 years before any symptoms appear.
Slowing The Progression Of Symptoms
The same healthy lifestyle changes that are used to prevent Alzheimers disease can also be useful in slowing the advancement of symptoms.
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Genetic Testing And Alzheimers Disease
Testing can show whether you have a version of a gene that increases your risk of Alzheimers. Testing can also uncover the rare cases when an inherited genetic change, or mutation, causes Alzheimers.
At OHSU, we generally do not recommend routine genetic testing for Alzheimers because:
- Many factors can lead to the disease.
- Most people who develop Alzheimers do not have a related genetic variant.
- Most people who have a variant do not develop the disease.
Talk with your primary care doctor or to a medical geneticist to learn more or to better understand your risk if youve taken a test on your own.
Genetic testing can show whether you carry an inherited gene mutation that causes early-onset Alzheimers. In some cases, we may recommend testing to confirm a diagnosis in someone who has signs or symptoms of early-onset Alzheimers.
Some family members, after careful discussion with a genetic counselor, may also want testing to find out whether they carry the mutation.
At-home tests from DNA analysis companies can give consumers access to limited genetic testing, without guidance from a genetic counselor. An at-home test can detect variants that increase the risk of late-onset Alzheimers disease.
Stage : Very Mild Changes
You still might not notice anything amiss in your loved one’s behavior, but they may be picking up on small differences, things that even a doctor doesn’t catch. This could include forgetting words or misplacing objects.
At this stage, subtle symptoms of Alzheimer’s don’t interfere with their ability to work or live independently.
Keep in mind that these symptoms might not be Alzheimer’s at all, but simply normal changes from aging.
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Stages Of Alzheimers Disease: 7
In addition to the three stages of Alzheimers, your doctor may also use a diagnostic framework with five, six, or seven levels. Progression through these stages usually lasts from 8 to 10 years, but again, differs from person to person and can stretch out for as long as 20 years.
Sample 7-stage model of Alzheimers disease:
Stage 3 Early Confusional/mild Cognitive Impairment
While subtle difficulties begin to impact function, the person may try to cover up their problems. They may have difficulty with retrieving words, planning, organization, misplacing objects, and forgetting recent learning, which can affect life at home and work. Depression and other changes in mood can also occur.
Duration: 2 to 7 years.
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Signs Of Mild Alzheimers Disease
In mild Alzheimers disease, a person may seem to be healthy but has more and more trouble making sense of the world around him or her. The realization that something is wrong often comes gradually to the person and his or her family. Problems can include:
- Memory loss
- Poor judgment leading to bad decisions
- Loss of spontaneity and sense of initiative
- Taking longer to complete normal daily tasks
- Repeating questions
- Increased sleeping
- Loss of bowel and bladder control
A common cause of death for people with Alzheimers disease is aspiration pneumonia. This type of pneumonia develops when a person cannot swallow properly and takes food or liquids into the lungs instead of air.
There is currently no cure for Alzheimers, though there are medicines that can treat the symptoms of the disease.
Key Points About Early
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Alzheimer disease commonly affects older people, but early-onset Alzheimer disease can affect people in their 30s or 40s.
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It affects memory, thinking, and behavior.
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Although there is no known cure, early diagnosis and treatment can lead to better quality of life.
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Stay healthy with a good diet and regular exercise.
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Avoid alcohol and other substances that may affect memory, thinking, and behavior.
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Difficulty Finding The Right Words
Another early symptom of dementia is struggling to communicate thoughts. A person with dementia may have difficulty explaining something or finding the right words to express themselves. Having a conversation with a person who has dementia can be difficult, and it may take longer than usual to conclude.
How Is Alzheimers Diagnosed
Doctors rely on medical history, mental status tests, brain imaging, exams, and diagnostic tests for an accurate Alzheimers diagnosis. Its important to see your doctor early if you notice cognitive changes in yourself or a loved one. Your primary doctor will check your overall health, address concerns and usually oversee the diagnosis process themselves. .8 To make the most of your appointment, consider bringing information on the following:9
- Changes in your health
- Medical history
- Medications including vitamins and supplements youre taking
- Questions you want to ask your doctor
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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.
Types Of Alzheimer’s Disease
Nearly everyone with Alzheimerâs disease will eventually have the same symptoms — memory loss, confusion, trouble with once-familiar tasks, and making decisions. While the manner of the disease development remains unclear, all forms of Alzheimer’s appear to share overproduction and/or decreased clearance of a type of protein called amyloid beta peptides. Though the effects of the disease are similar, there are two main types.
- Early-onset Alzheimer’s. This type happens to people who are younger than age 65. Often, theyâre in their 40s or 50s when theyâre diagnosed with the disease. Itâs rare — up to 5% of all people with Alzheimer’s have early-onset. People with Down syndrome have a higher risk for it.Scientists have found a few ways in which early-onset Alzheimerâs is different from other types of the disease. People who have it tend to have more of the brain changes that are linked with Alzheimerâs. The early-onset form also appears to be linked with a defect in a specific part of a personâs DNA: chromosome 14. A form of muscle twitching and spasm, called myoclonus, is also more common in early-onset Alzheimer’s.
- Late-onset Alzheimer’s. This is the most common form of the disease, which happens to people age 65 and older. It may or may not run in families. So far, researchers havenât found a particular gene that causes it. No one knows for sure why some people get it and others donât.
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