Managing Alzheimer’s Disease Behavior
Common behavioral symptoms of Alzheimers include sleeplessness, wandering, agitation, anxiety, and aggression. Scientists are learning why these symptoms occur and are studying new treatments drug and nondrug to manage them. Research has shown that treating behavioral symptoms can make people with Alzheimers more comfortable and makes things easier for caregivers.
Who Has Alzheimers Disease
- In 2020, as many as 5.8 million Americans were living with Alzheimers disease.1
- Younger people may get Alzheimers disease, but it is less common.
- The number of people living with the disease doubles every 5 years beyond age 65.
- This number is projected to nearly triple to 14 million people by 2060.1
- Symptoms of the disease can first appear after age 60, and the risk increases with age.
Can You Prevent Alzheimers Disease
There is no sure way to prevent Alzheimers disease. However, you can reduce the risk of Alzheimers disease by caring for your health:
- your heart whats good for your heart is good for your brain so stick to a healthy diet and dont smoke
- your body regular physical activity increases blood flow to the brain so maintain an active lifestyle
- your mind an active mind helps build brain cells and strengthens their connections so socialise, do things such as puzzles and crosswords, and learn new things, such as a language
Learn more about the risk factors associated with Alzheimers and other types of dementia, and what you can do to reduce your risk:
Read the related video transcript.
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Treatment For Alzheimer’s Disease
At this stage, there is no cure and no treatment that can stop the Alzheimers disease progressing.Medications are available that can help to stabilise or slow the decline in memory and thinking abilities for a time, such as cholinesterase inhibitors and memantine. Other medications are available that might help with secondary symptoms like depression, anxiety and sleep disturbances.It is important to remember that all medications have side effects. People with Alzheimers disease may take a number of medications and your doctor can help you to understand how the different medications might interact with each other.Non-medication therapies, staying active and socially connected, as well as managing stress, can help people with Alzheimers disease. Education and professional support are important for people with Alzheimers disease and their families and carers.
Symptoms Of Alzheimers Disease
Alzheimers disease typically starts slowly and the symptoms can be very subtle in the early stages. As the disease progresses, symptoms become more noticeable and interfere with daily life. The disease affects each person differently and the symptoms vary.Common symptoms include:
- persistent and frequent memory loss, especially of recent events
- vagueness in everyday conversation
- being less able to plan, problem-solve, organise and think logically
- language difficulties such as finding the right word and understanding conversations
- apparent loss of enthusiasm for previously enjoyed activities
- taking longer to do routine tasks
- becoming disoriented, even in well-known places
- inability to process questions and instructions
- deterioration of social skills
- emotional unpredictability
- changes in behaviour, personality and mood.
Symptoms vary as the disease progresses and different areas of the brain are affected. A persons abilities may fluctuate from day to day, or even within the one day, and can become worse in times of stress, fatigue or ill health.The stages of Alzheimers disease progress from mild Alzheimers disease to moderate Alzheimers disease and then severe Alzheimers disease. During severe Alzheimers disease, people need continuous care. The rate of progression between these stages differs between people.
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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 Tel. 1800 200 422
- Cognitive Dementia and Memory Service clinics Tel. 1300 135 090
- Carers Victoria Tel. 1800 242 636
- Commonwealth Respite and Carelink Centres Tel. 1800 052 222
- Dementia Behaviour Management Advisory Service Tel. 1800 699 799 for 24-hour telephone advice for carers and care workers
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 .
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Risk To Family Members Late
Inheritance of LOFAD is thought to be and potentially involve multiple susceptibility genes . First-degree relatives of a person with LOFAD have a cumulative lifetime risk of developing AD of ~15%-25%, which is ~1.5-2 times the risk of the general population. When both parents have AD risk to their children is at least twice that of the general population risk .
Down Syndrome And Alzheimers Disease
People with Down syndrome have a third copy of chromosome 21, instead of the usual two copies. This genetic change causes a collection of characteristics, including intellectual disability and some common physical traits.The APP gene that leads to the production of the beta-amyloid protein present in Alzheimers plaques is located on chromosome 21. This means that people with Down syndrome make one and a half times the amount of APP and, as a consequence, more beta-amyloid. This appears to be the cause of the earlier appearance of the brain changes typical of Alzheimers disease in people with Down syndrome.
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Changes In Mild Dementia
The early or mild stage of ADRD begins with mild forgetfulness, especially memories of recent events. Forgetfulness might be the most obvious symptom at this stage, especially in Alzheimers disease.
Logical thinking and judgment are mildly affected, especially in frontal-temporal dementia. At this stage, you might notice a little confusion with complex tasks that take many steps to complete. People try to cover up mild confusion so friends, coworkers, and family might not notice that something is wrong.
Even when symptoms are mild, peoples behavior begins to change, especially in Alzheimers disease. People with mild dementia know something is wrong. They may begin to worry about the future or feel stress and anxiety. They may get depressed as they struggle with changes in their thinking. Mood changes might be most obvious in a person with vascular dementia.
People with mild dementia may occasionally become angry or aggressive. They might have difficulty making decisions. They will ask for help more often. They still might be able to work, drive, and live independently, but they will begin to need more help from family or coworkers.
Changes in the Brain During Mild Dementia
In the earliest stages of Alzheimers disease, before symptoms can be detected with current tests, damage begins in the areas of the brain involved in:
- Learning and memory
Use Of Potentially Inappropriate Medications
Data on medication use at or following the first assessment which subjects probable AD diagnosis was recorded in the NACC-UDS were considered. The identification of potentially inappropriate medications was deemed feasible for 3 specific subgroups within the misdiagnosed group based on prior research: those diagnosed post-mortem with either frontotemporal dementia , dementia with Lewy bodies , or cerebrovascular disease . Prior to start of the analysis, a neurologist at Eli Lilly and Company created an appropriate and potentially inappropriate medication matrix list based on the NACC-UDS medication checklist. Classification of potentially inappropriate medications was then based on clinical treatment guidelines and available research evidence.
The use of acetylcholinesterase inhibitors was considered potentially inappropriate for subjects whose true diagnosis was FTD at autopsy. A previous study evaluating donepezil in the treatment of FTD relative to matched, untreated FTD patients over six months found that a third of the treated patients experienced increased disinhibited or compulsive acts, which abated with discontinuation of the medication. These and similar observations have prompted a general recommendation to avoid acetylcholinesterase inhibitors in FTD. Recent randomized controlled trials also suggest that memantine lacks efficacy in the treatment of FTD.
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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.
How Is Alzheimers Disease Treated
Alzheimers is complex, and it is therefore unlikely that any one drug or other intervention will successfully treat it in all people living with the disease.
Scientists are exploring many avenues to delay or prevent the disease as well as to treat its symptoms. In ongoing clinical trials, scientists are developing and testing several possible interventions. Under study are drug therapies aimed at a variety of disease interventions, as well as nondrug approaches such as physical activity, diet, cognitive training, and combinations of these. Just as we have many treatments for heart disease and cancer, we will likely need many options for treating Alzheimers. Precision medicine getting the right treatment to the right person at the right time will likely play a major role.
Current approaches to treating Alzheimers focus on helping people maintain mental function, treating the underlying disease process, and managing behavioral symptoms.
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Is There Treatment Available
At present there is no cure for Alzheimer’s disease. However, one group of drugs called cholinergeric drugs appears to be providing some temporary improvement in cognitive functioning for some people with mild to moderate Alzheimer’s disease.
Drugs can also be prescribed for secondary symptoms such as restlessness or depression or to help the person with dementia sleep better.
Community support is available for the person with Alzheimer’s disease, their families and carers. This support can make a positive difference to managing dementia. Dementia Australia provides support, information and counselling for people affected by dementia. Dementia Australia also aims to provide up-to-date information about drug treatments.
For more information contact the National Dementia Helpline on 1800 100 500.
For a range of books and videos contact our Library.
For advice, common sense approaches and practical strategies on the issues most commonly raised about dementia, read our Help Sheets.
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
develops due to the death of brain cells. It is a neurodegenerative condition, which means that the brain cell death happens over time.
In a person with Alzheimers, the brain tissue has fewer and fewer nerve cells and connections, and tiny deposits, known as plaques and tangles, build up on the nerve tissue.
Plaques develop between the dying brain cells. They are made from a protein known as beta-amyloid. The tangles, meanwhile, occur within the nerve cells. They are made from another protein, called tau.
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Difficulty Determining Time Or Place
Losing track of dates and misunderstanding the passage of time as it occurs are also two common symptoms. Planning for future events can become difficult since they arent immediately occurring.
As symptoms progress, people with AD can become increasingly forgetful about where they are, how they got there, or why theyre there.
What Causes Alzheimers Disease
In recent years, scientists have made tremendous progress in better understanding Alzheimers and the momentum continues to grow. Still, scientists dont yet fully understand what causes Alzheimers disease in most people. In people with early-onset Alzheimers, a genetic mutation may be the cause. Late-onset Alzheimers arises from a complex series of brain changes that may occur over decades. The causes probably include a combination of genetic, environmental, and lifestyle factors. The importance of any one of these factors in increasing or decreasing the risk of developing Alzheimers may differ from person to person.
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What Are The Symptoms Of Alzheimer’s Disease
Memory loss is usually the first sign of Alzheimer’s disease. Often the person who has a memory problem doesn’t notice it, but family and friends do.
Having some short-term memory loss in your 60s and 70s is common, but this doesn’t mean it’s Alzheimer’s disease.
Normal memory problems aren’t the same as the kind of memory problems that may be caused by Alzheimer’s disease. For example, normally you might forget:
- Parts of an experience.
- Where your car is parked.
- A person’s name.
With Alzheimer’s disease, you might forget:
- An entire experience.
- What your car looks like.
- Having ever known a certain person.
Following are some of the symptoms of mild, moderate, and severe Alzheimer’s disease. Symptoms vary as the disease progresses. Talk to your doctor if a friend or family member has any of the signs.
Mild Alzheimer’s disease
Usually, a person with mild Alzheimer’s disease:
- Avoids new and unfamiliar situations.
- Has delayed reactions.
- Has trouble learning and remembering new information.
- Starts speaking more slowly than in the past.
- Starts using poor judgment and making wrong decisions.
- May have mood swings and become depressed, grouchy, or restless.
These symptoms often are more obvious when the person is in a new and unfamiliar place or situation.
Some people have memory loss called mild cognitive impairment. People with this condition are at risk for Alzheimer’s disease or another type of dementia. But not all people with mild cognitive impairment progress to dementia.
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Certain medications can also affect memory. A lack of sleep and an impaired thyroid function can negatively affect memory. Some of these conditions can also lead to a decreased ability to remember events. In addition to these, natural aging can affect brain function, and may lead to a slowdown in memory. Although this symptom does not necessarily mean that youre losing your memory, it could indicate a problem with your cognitive ability. If you are suffering from either, a medical evaluation is necessary to determine if youre suffering from memory loss. Characteristics of Alzheimers Disease
In addition to aging, medications can affect memory. Certain antidepressants, anxiety medications, and sleep disorders can all affect memory. A persons mental health can also contribute to memory problems. In some cases, a persons mental state may be affected by the medication they are taking. Some untreated medical conditions can lead to deterioration of the brain and affect the ability to learn and remember. It is also important to see a medical professional if your symptoms persist even after youve stopped taking certain medications.
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Loss Of Neuronal Connections And Cell Death
In Alzheimers disease, as neurons are injured and die throughout the brain, connections between networks of neurons may break down, and many brain regions begin to shrink. By the final stages of Alzheimers, this processcalled brain atrophyis widespread, causing significant loss of brain volume.
Learn more about Alzheimer’s disease from MedlinePlus.
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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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.
Clinical Characteristics Of Alzheimer Disease
Alzheimer disease is characterized by dementia that typically begins with subtle and poorly recognized failure of memory and slowly becomes more severe and, eventually, incapacitating. Other common findings include confusion, poor judgment, language disturbance, visual complaints, agitation, withdrawal, and hallucinations. Occasionally, seizures, Parkinsonian features, increased muscle tone, myoclonus, incontinence, and mutism occur. Death usually results from general inanition, malnutrition, and pneumonia. The typical clinical duration of the disease is eight to ten years, with a range from one to 25 years.
Approximately 95% of all AD is late onset and 5% is early onset .
Establishing the diagnosis of Alzheimer disease relies on clinical-neuropathologic assessment. Neuropathologic findings of -amyloid plaques, intraneuronal neurofibrillary tangles , and amyloid angiopathy remain the gold standard for diagnosis.
- The plaques should stain positively with -amyloid antibodies and negative for prion antibodies .
- The numbers of plaques and tangles must exceed those found in age-matched controls without dementia. Guidelines for the quantitative assessment of these changes exist .
- Aggregation of alpha-synuclein in the form of Lewy bodies may also be found in neurons in the amygdala frequently there is accumulation of TDP-43 protein .
Differential diagnosis of Alzheimer disease includes the following:
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