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.
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.
You can find more information about caring for yourself and access a helpful care planning form.
What Happens In Alzheimer Disease
You probably know that your brain works by sending signals. Chemical messengers, called neurotransmitters , allow brain cells to talk to each other. But a person with Alzheimer disease has lower amounts of neurotransmitters.
People with Alzheimer disease also develop deposits of stuff that prevent the cells from working properly. When this happens, the cells can’t send the right signals to other parts of the brain. Over time, brain cells affected by Alzheimer disease also begin to shrink and die.
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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.
What Are The Latest Findings In Alzheimer’s Disease Research
The Wisconsin Alzheimer’s Disease Research Center is committed to educating the community about the latest updates in Alzheimer’s disease research through our outreach events, newsletters, podcast and direct discussion with our research participants. Information on research advances can also be found at Alzforum and Being Patient, both news sources for dementia and brain health research news. In addition to clinical trials conducted in partnership with the Wisconsin Alzheimer’s Disease Research Center, information on clinical trials for people both with and without memory problems can be obtained by visiting the following websites: Alzheimer’s Disease Education and Referral Center Clinical Trials, the Alzheimer’s Association TrialMatch, and ClinicalTrials.gov.
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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.
How Is Alzheimers Disease Diagnosed
Unfortunately, there is no single test that can confirm Alzheimers disease. A diagnosis comes after careful assessment. This may involve:
- a detailed medical history
- urine and blood tests
- medical imaging, such as an MRI scan to assess shrinking of the brain
After eliminating other possible causes of symptoms , a clinical diagnosis of Alzheimers can be made.
An early diagnosis allows your doctor to work out if there is another cause of your symptoms that may be treatable. If a diagnosis of Alzheimers disease is most likely, you can start to discuss medical treatment and further assistance to help slow the degenerative process.
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What Are The Signs Of Alzheimer’s Disease
Scientists continue to unravel the complex brain changes involved in the onset and progression of Alzheimers disease. It seems likely that damage to the brain starts a decade or more before memory and other cognitive problems appear. During this preclinical stage of Alzheimers disease, people seem to be symptom-free, but toxic changes are taking place in the brain.
Damage occurring in the brain of someone with Alzheimers disease begins to show itself in very early clinical signs and symptoms. For most people with Alzheimersthose who have the late-onset varietysymptoms first appear in their mid-60s. Signs of early-onset Alzheimers begin between a persons 30s and mid-60s.
The first symptoms of Alzheimers vary from person to person. Memory problems are typically one of the first signs of cognitive impairment related to Alzheimers disease. Decline in non-memory aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment, may also signal the very early stages of Alzheimers disease. And some people may be diagnosed with mild cognitive impairment. As the disease progresses, people experience greater memory loss and other cognitive difficulties.
Alzheimers disease progresses in several stages: preclinical, mild , moderate, and severe .
What Will The Doctor Do
It can be hard for a doctor to diagnose Alzheimer disease because many of its symptoms can be like those of other conditions affecting the brain. The doctor will talk to the patient, find out about any medical problems the person has, and will examine him or her.
The doctor can ask the person questions or have the person take a written test to see how well his or her memory is working. Doctors also can use medical tests to take a detailed picture of the brain. They can study these images and look for signs of Alzheimer disease.
When a person is diagnosed with Alzheimer disease, the doctor may prescribe medicine to help with memory and thinking. The doctor also might give the person medicine for other problems, such as depression . Unfortunately, the medicines that the doctors have can’t cure Alzheimer disease they just help slow it down.
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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.
Late Stages Of Alzheimers Disease Symptoms
The needs of the person with Alzheimers become much more demanding as the disease progresses. In the late stages of Alzheimers, the person with the disease loses the ability to respond appropriately and is unable to converse with others. They will also develop an inability to control movements like sitting, standing and walking.
Here are some other common symptoms of the disease that can occur:
- Catches colds and infections easily
- Day/night reversal of sleep pattern
- Difficulty communicating
- Difficulty using the toilet independently
- Eventually requires help with activities of daily living, 24 hours per day
- Eventually unable to walk
- Hoarding, rummaging
- Inability to sit and eventually to swallow
- Incontinence
- Loss of awareness of surroundings
- Needs help walking
- Needs progressively more help with personal care
- Personality changes such as aggression, anxiety, hostility, irritability or uncooperativeness
- Repetitive questioning
- Sundowners
- Verbally aggressive or demanding behavior
- Wandering
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Cognitive Changes For Dementia Patients
- Disorientation: A person with dementia becomes lost in familiar places, expresses confusion about the date or time of day, or has difficulty with directions.
- Memory loss: Failure to recognize people and faces, in later stages even family members or close loved ones. Dementia patients can also experience decreases in short term memory, such as asking the same questions repeatedly or forgetting recent events and conversations.
- Problems communicating: Loss of social skills and lack of interest in socializing, frequently forgetting words, or being unable to follow a conversation.
- Difficulty with complex tasks: Difficulty planning or organizing events, paying bills, following recipes, writing letters, or traveling to new locations.
- Difficulty staying focused and concentrating, decreased ability to learn and memorize new information.
- Problems with coordination: Decreased motor functions and coordination, sometimes manifested as trembling, shaking, or difficulty walking.
Moderate Stage Alzheimer’s Symptoms
This stage is usually the longest stage of Alzheimers disease and can last for years, although during this stage, the symptoms still progress.2 You might remain slightly independent in the beginning of this stage, but as it progresses, more and more help is needed.
In this stage, you will likely still remember important events and information about your life, but the Alzheimers symptoms become more pronounced and you have more difficulty with tasks and cognition. Symptoms are noticeable to others, not just those closest to you. These can include:1,2
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Six Tips For Caregivers
Explore pain as a trigger.
Don’t argue or try to convince.
Try to accept behaviors as a reality of the disease.
Seek help to avoid fatigue
Adapted from Alzheimer’s Association
The U.S. Food and Drug Administration has approved four medicines for Alzheimer’s disease. They may help delay or slow symptoms of the disease. Several medications called cholinesterase inhibitors , Exelon® and Aricept® ) are prescribed for mild to moderate Alzheimer’s disease. The medication Namenda® is prescribed to treat moderate to severe Alzheimer’s disease. It can help delay some symptoms of moderate to severe Alzheimer’s and allow individuals to maintain some functions a little longer than they would without the medication. A fifth medication is called Namzaric it is a combination of donepezil and memantine.
Patients and families may also benefit from support groups and counseling. Family members can learn ways to help their relative manage the illness and they can learn coping skills to lessen the stress of caring for a relative with Alzheimer’s disease.
from the Alzheimer’s Association and from APA.)
Signs And Symptoms Of Alzheimer’s Disease
Alzheimer’s disease is a progressive condition, which means the symptoms develop gradually over many years and eventually become more severe. It affects multiple brain functions.
The first sign of Alzheimer’s disease is usually minor memory problems.
For example, this could be forgetting about recent conversations or events, and forgetting the names of places and objects.
As the condition develops, memory problems become more severe and further symptoms can develop, such as:
- confusion, disorientation and getting lost in familiar places
- difficulty planning or making decisions
- problems with speech and language
- problems moving around without assistance or performing self-care tasks
- personality changes, such as becoming aggressive, demanding and suspicious of others
- hallucinations and delusions
- low mood or anxiety
Read more about the symptoms of Alzheimer’s disease.
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What Are The Warning Signs Of Alzheimers Disease
Watch this video Memory 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 .
Referral To A Specialist
Your GP may refer you to a specialist memory assessment service to help with your diagnosis. Memory clinics are staffed by professionals from multiple disciplines who are experts in diagnosing, caring for and advising people with dementia and their families.
Memory clinic staff can include the following, depending on your local area:
- a nurse usually a trained mental health nurse who specialises in diagnosing and caring for people with dementia
- a psychologist a healthcare professional who specialises in the assessment and treatment of mental health conditions
- a psychiatrist a qualified medical doctor who has training in treating mental health conditions
- a neurologist a specialist in treating conditions that affect the nervous system
- a geriatrician a physician with specialist training in the care of older people
- a social worker a trained member of staff able to advise and assist with accessing social services within the local area
- an occupational therapist a member of staff with specialist skills in assessing and supporting people with dementia and their families with adjusting to disabilities
There’s no simple and reliable test for diagnosing Alzheimer’s disease, but the staff will listen to the concerns of both you and your family about your memory or thinking. They will assess your skills and arrange more tests to rule out other conditions.
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Diagnosing Alzheimer’s Disease Symptoms At Bwh
Researchers at Brigham and Women’s Hospital have made groundbreaking discoveries in Alzheimer’s research over the past 30 years. The BWH Alzheimer Center in the Department of Neurology Services provides a comprehensive program that involves laboratory research, clinical trials, and patient care to advance the prevention of Alzheimer’s and treatment of Alzheimer’s disease symptoms.
In this video, Reisa Sperling, MD, provides an overview on Alzheimer’s disease dementia and a new groundbreaking study, the Anti-Amyloid Treatment in Asymptomatic Alzheimer’s Disease Study. The A4 Study is the first study to examine early treatment of older adults at risk for Alzheimer’s disease dementia with the hope of preventing memory loss before it begins.
What Are Final Stage Care Options For Alzheimers
Caring for someone with Alzheimers can be a monumental task. Home care may not be sufficient even with additional assistance.
Some areas that need utmost care include foods and fluids, bowel and bladder function, skin and body health, infections and pneumonia, and pain and illness.
Here are some things to keep in mind:
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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.