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.
- aging
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
Aging
Why Early Detection Can Be Difficult
Alzheimers disease usually is not diagnosed in the early stages, even in people who visit their primary care doctors with memory complaints.
- People and their families generally underreport the symptoms.
- They may confuse them with normal signs of aging.
- The symptoms may emerge so gradually that the person affected doesnt recognize them.
- The person may be aware of some symptoms but go to great lengths to conceal them.
Recognizing symptoms early is crucial because medication to control symptoms is most effective in the early stages of the disease and early diagnosis allows the individual and his or her family members to plan for the future. If you or a loved one is experiencing any of the following symptoms, contact a physician.
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What Are The Symptoms Of Alzheimers Disease
Symptoms of Alzheimers disease vary from person to person and worsen over time. Symptoms of the disease include:
- Memory loss. This is usually one of the first symptoms of Alzheimers disease.
- Putting objects in odd places
- Confusion about events, time and place
- Repeating questions
For more information on the stage of disease, click here.
Tips For Caregivers: Taking Care Of Yourself
Being a caregiver can be extremely rewarding, but it can also be overwhelming. Caring for a person with Alzheimer’s or a related dementia takes time and effort. It can feel lonely and frustrating. You might even feel angry, which could be a sign you are trying to take on too much. It is important to find time to take care of yourself. Here are some tips that may offer some relief:
- Ask for help when you need it. This could mean asking family members and friends to help or reaching out to for additional care needs.
- Eat nutritious foods, which can help keep you healthy and active for longer.
- Join a caregiver’s support group online or in person. Meeting other caregivers will give you a chance to share stories and ideas and can help keep you from feeling isolated.
- Take breaks each day. Try making a cup of tea or calling a friend.
- Spend time with friends and keep up with hobbies.
- Get exercise as often as you can. Try doing yoga or going for a walk.
- Try practicing meditation. Research suggests that practicing meditation may reduce blood pressure, anxiety and depression, and insomnia.
- Consider seeking help from mental health professionals to help you cope with stress and anxiety. Talk with your doctor about finding treatment.
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Mental Activity To Support Cognition
Many patients with normal cognition or those with mild impairment are concerned that they may develop AD. Many experts believe that mentally challenging activities, such as doing crossword puzzles and brainteasers, may reduce the risk in such patients. Whether such activities might slow the rate of disease progression in patients who already have AD is not known. Clinical trials are under way to determine the effect these cognitive activities have on AD progression.
Mental activities should be kept within a reasonable level of difficulty. Activities should preferably be interactive, and they should be designed to allow the patient to recognize and correct mistakes. Most important, these activities should be administered in a manner that does not cause excessive frustration and that ideally motivates the patient to engage in them frequently. Unfortunately, little standardization or rigorous testing has been done to validate this treatment modality.
Some investigators have attempted various forms of cognitive retraining, also known as cognitive rehabilitation. The results of this approach remain controversial, and a broad experimental study needs to be performed to determine whether it is useful in AD.
Supportive Measures And Treatments
In addition to medication, treatment for Alzheimer’s disease involves a wide range of other measures and treatments to help people with dementia live as independently as possible.
For example, an occupational therapist can identify problems or unsafe areas in your everyday life and help you to develop strategies or use alternative tools to manage these. They may suggest:
- ways of prompting and reminding yourself of important tasks such as using diaries or calendars
- assistive technology devices or systems to help maintain the independence and safety of people living with dementia
- adding grab bars and handrails to your home to help you move around safely
- other professionals visiting you at home and assisting with daily tasks to maintain your independence in the community
Psychological treatments, such as cognitive stimulation, may be offered to help improve your memory, problem solving skills and language ability.
Medication, other psychological therapies, such as cognitive behavioural therapy , music and art therapy, reminiscence and relaxation therapies may also be offered. These may help with managing depression, anxiety, agitation, hallucinations, delusions and challenging behaviour that can occur with Alzheimer’s disease.
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Helping An Alzheimer’s Patient In A Facility
Reminiscence And Life Story Work
Reminiscence work involves talking about things and events from your past. It usually involves using props such as photos, favourite possessions or music.
Life story work involves a compilation of photos, notes and keepsakes from your childhood to the present day. It can be either a physical book or a digital version.
These approaches are sometimes combined. Evidence shows they can improve mood and wellbeing.
Find out how to live well with dementia and more useful information in the NHS Dementia Guide.
Page last reviewed: 05 July 2021 Next review due: 05 July 2024
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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 Medications Can Help
The FDA has approved the drug aducanumab-avwa as the first therapy that targets the fundamental pathophysiology of the disease by reducing amyloid beta plaques in the brain. It is not without controversy because of concerns it may cause swelling of bleeding in the brain.
Some drugs curb the breakdown of a chemical in the brain, called acetylcholine, thatâs important for memory and learning. They may slow down how fast symptoms get worse for about half of people who take them. The effect lasts for a limited time, on average 6 to 12 months. Common side effects are usually mild for these medications and include diarrhea, vomiting, nausea, fatigue, insomnia, loss of appetite, and weight loss. There are three drugs of this type: donepezil , galantamine , and rivastigmine .
Doctors can also prescribe medicines for other health problems that happen along with the disease, including depression, sleeplessness, and behavior problems like agitation and aggression.
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What Is Known About Alzheimers Disease
Scientists do not yet fully understand what causes Alzheimers disease. There likely is not a single cause but rather several factors that can affect each person differently.
- Age is the best known risk factor for Alzheimers disease.
- Family historyresearchers believe that genetics may play a role in developing Alzheimers disease. However, genes do not equal destiny. A healthy lifestyle may help reduce your risk of developing Alzheimers disease. Two large, long term studies indicate that adequate physical activity, a nutritious diet, limited alcohol consumption, and not smoking may help people. To learn more about the study, you can listen to a short podcast.
- Changes in the brain can begin years before the first symptoms appear.
- Researchers are studying whether education, diet, and environment play a role in developing Alzheimers disease.
- 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. Heres 8 ways.
Can Controlling High Blood Pressure Prevent Alzheimer’s Disease
Controlling high blood pressure is known to reduce a person’s risk for heart disease and stroke. The NASEM committee of experts concluded that managing blood pressure when it’s high, particularly for middle-aged adults, also might help prevent or delay Alzheimer’s dementia.
Many types of studies show a connection between high blood pressure, cerebrovascular disease , and dementia. For example, it’s common for people with Alzheimer’s-related changes in the brain to also have signs of vascular damage in the brain, autopsy studies show. In addition, observational studies have found that high blood pressure in middle age, along with other cerebrovascular risk factors such as diabetes and smoking, increase the risk of developing dementia.
Clinical trialsthe gold standard of medical proofare underway to determine whether managing high blood pressure in individuals with hypertension can prevent Alzheimer’s dementia or cognitive decline.
One large clinical trialcalled SPRINT-MIND found that lowering systolic blood pressure to less than 120 mmHg, compared to a target of less than 140 mmHg, did not significantly reduce the risk of dementia. Participants were adults age 50 and older who were at high risk of cardiovascular disease but had no history of stroke or diabetes.
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Early Onset Alzheimers Disease
Although age is the main risk factor for Alzheimers disease, this is not just a condition that affects older adults.
According to the Alzheimers Association, early onset Alzheimers disease affects around 200,000 U.S. adults under the age of 65 years. Many people with this condition are in their 40s or 50s.
In many cases, doctors do not know why younger people develop this condition. Several rare genes can cause the condition. When there is a genetic cause, it is known as familial Alzheimers disease.
Whats A Neuropsychological Test
These tests assist the physician in diagnosing Alzheimers by identifying behavioral and mental symptoms associated with brain injury or abnormal brain function. Your doctor will recommend specific tests depending on symptoms and how far the dementia has advanced. Usually, physicians start with a brief screening tool such as the Mini-Mental Status Examination to help confirm that the patient is experiencing problems with intellectual functions.
The MMSE includes tests of:
- Attention
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What Are Some Risk Factors For Alzheimers Disease
Risk factors for the development of Alzheimers disease include:
- Age. Increasing age is the primary risk factor for developing Alzheimers disease.
- Genetics . There is a certain gene, apolipoprotein E that is associated with late-onset Alzheimers disease. Other genes have been associated with early-onset Alzheimers disease.
- Smoking
- Obesity
Researchers believe the presence of the last five risk factors mentioned above might reduce the clearance of amyloid protein from the brain, which then increases the risk of developing Alzheimers disease. In particular, the presence of a number of these risk factors at the same time and while the person is in his or her 50s is associated with a higher risk of Alzheimers disease.
There may be some ways to reduce the risk of mental decline. In general, living a healthy lifestyle protects the body from strokes and heart attacks and is believed to also protect the brain from cognitive decline. Scientists cant absolutely prove the cause and effect of the following factors, but studies have shown a positive association.
Pillar #: Social Engagement
Human beings are highly social creatures. We dont thrive in isolation, and neither do our brains. Staying socially engaged may even protect against symptoms of Alzheimers disease and dementia in later life, so make developing and maintaining a strong network of friends a priority.
You dont need to be a social butterfly or the life of the party, but you do need to regularly connect face-to-face with someone who cares about you and makes you feel heard. While many of us become more isolated as we get older, its never too late to meet others and develop new friendships:
- Volunteer.
- Join a club or social group.
- Visit your local community center or senior center.
- Take group classes .
- Get to know your neighbors.
- Make a weekly date with friends.
- Get out .
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Treatment Of Secondary Symptoms
A variety of behavioral and pharmacologic interventions can alleviate clinical manifestations of AD, such as anxiety, agitation, depression, psychotic behavior, and sleep problems. The effectiveness of such interventions ranges from modest and temporary to excellent and prolonged. No specific agent or dose of individual agents is unanimously accepted for the wide array of clinical manifestations. At present, the FDA has not approved any psychotropic agent for the treatment of AD.
How To Cope With Side Effects
What to do about:
- diarrhoea â drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark strong-smelling pee. Do not take any other medicines to treat diarrhoea, including rehydration salts, without first speaking to a pharmacist or doctor
- feeling sick â it may help to avoid eating very rich, fatty or spicy food
- headache â make sure you rest and drink plenty of fluids. If it’s bothering you, ask a pharmacist to recommend a painkiller. Talk to a doctor if your headaches last longer than a week or are severe
- feeling sleepy in the daytime or feeling dizzy â try taking your medicine at night. If you feel dizzy or tired do not drive or ride a bike until you feel more alert. Talk to a doctor if these effects bother you, or do not get better
As your body gets used to donepezil, these side effects should wear off. If you are still bothered by them after a week or two, speak to a doctor. They may want to adjust your dose or recommend a different medicine.
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