Alzheimers Disease Vs Other Types Of Dementia
Dementia is an umbrella term for a range of conditions that involve a loss of cognitive functioning.
Alzheimers disease is the most common type of dementia. It involves plaques and tangles forming in the brain. Symptoms start gradually and are most likely to include a decline in cognitive function and language ability.
To receive a diagnosis of Alzheimers, a person will be experiencing memory loss, cognitive decline, or behavioral changes that are affecting their ability to function in their daily life.
Friends and family may notice the symptoms of dementia before the person themselves.
There is no single test for Alzheimers disease. If a doctor suspects the presence of the condition, they will ask the person and sometimes their family or caregivers about their symptoms, experiences, and medical history.
The doctor may also carry out the following tests:
- cognitive and memory tests, to assess the persons ability to think and remember
- neurological function tests, to test their balance, senses, and reflexes
- blood or urine tests
- a CT scan or MRI scan of the brain
- genetic testing
A number of assessment tools are available to assess cognitive function.
In some cases, genetic testing may be appropriate, as the symptoms of dementia can be related to an inherited condition such as Huntingtons disease.
Some forms of the APOE e4 gene are associated with a higher chance of developing Alzheimers disease.
Icipating In Alzheimer’s Disease Clinical Trials
Everybody those with Alzheimers disease or MCI as well as healthy volunteers with or without a family history of Alzheimers may be able to take part in clinical trials and studies. Participants in Alzheimers clinical research help scientists learn how the brain changes in healthy aging and in Alzheimers. Currently, at least 270,000 volunteers are needed to participate in more than 250 active clinical trials and studies that are testing ways to understand, diagnose, treat, and prevent Alzheimers disease.
Volunteering for a clinical trial is one way to help in the fight against Alzheimers. Studies need participants of different ages, sexes, races, and ethnicities to ensure that results are meaningful for many people.
NIA leads the federal governments research efforts on Alzheimers. NIA-supported Alzheimers Disease Research Centers throughout the U.S. conduct a wide range of research, including studies of the causes, diagnosis, and management of the disease. NIA also sponsors the Alzheimers Clinical Trials Consortium, which is designed to accelerate and expand studies and therapies in Alzheimers and related dementias.
To learn more about Alzheimers clinical trials and studies:
- Talk to your health care provider about local studies that may be right for you.
Watch videos of participants in Alzheimers disease clinical trials talking about their experiences.
Overview Of Alzheimer’s Disease
Alzheimer’s disease is a type of brain disease, just as coronary artery disease is a type of heart disease. It is also a degenerative disease, meaning that it becomes worse with time. Alzheimer’s disease is thought to begin 20 years or more before symptoms arise,- with changes in the brain that are unnoticeable to the person affected. Only after years of brain changes do individuals experience noticeable symptoms such as memory loss and language problems. Symptoms occur because nerve cells in parts of the brain involved in thinking, learning and memory have been damaged or destroyed. As the disease progresses, neurons in other parts of the brain are damaged or destroyed. Eventually, nerve cells in parts of the brain that enable a person to carry out basic bodily functions, such as walking and swallowing, are affected. Individuals become bed-bound and require around-the-clock care. Alzheimer’s disease is ultimately fatal.
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Medications For Vascular Dementia
Because vascular dementia is caused by the death of brain tissue and atherosclerosis, there is no standard drug treatment for it. Drugs used to treat other atherosclerotic vascular diseases such as cholesterol medications, blood pressure medications, and anti-blood clotting medications, may be used to slow the progression of vascular dementia. In some cases, cholinesterase inhibitors and antidepressants may help improve symptoms associated with vascular dementia.
How Does Alzheimer’s Disease Affect The Brain
Scientists continue to unravel the complex brain changes involved in Alzheimers disease. Changes in the brain may begin a decade or more before symptoms appear. During this very early stage of Alzheimers, toxic changes are taking place in the brain, including abnormal buildups of proteins that form amyloid plaques and tau tangles. Previously healthy neurons stop functioning, lose connections with other neurons, and die. Many other complex brain changes are thought to play a role in Alzheimers as well.
The damage initially appears to take place in the hippocampus and the entorhinal cortex, which are parts of the brain that are essential in forming memories. As more neurons die, additional parts of the brain are affected and begin to shrink. By the final stage of Alzheimers, damage is widespread and brain tissue has shrunk significantly.
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Racial And Ethnic Differences In The Prevalence Of Alzheimer’s And Other Dementias
Although there are more non-Hispanic whites living with Alzheimer’s and other dementias than any other racial or ethnic group in the United States , older black/African Americans and Hispanics/Latinos are disproportionately more likely than older whites to have Alzheimer’s or other dementias., , – Most studies indicate that older black/African Americans are about twice as likely to have Alzheimer’s or other dementias as older whites., , Some studies indicate older Hispanics/Latinos are about one and one-half times as likely to have Alzheimer’s or other dementias as older whites.,, , However, Hispanics/Latinos comprise a very diverse group in terms of cultural history, genetic ancestry and health profiles, and there is evidence that prevalence may differ from one specific Hispanic/Latino ethnic group to another .,
There is evidence that missed diagnoses of Alzheimer’s and other dementias are more common among older black/African Americans and Hispanics/Latinos than among older whites., Based on data for Medicare beneficiaries age 65 and older, it has been estimated that Alzheimer’s or another dementia had been diagnosed in 10.3% of whites, 12.2% of Hispanics/Latinos and 13.8% of black/African Americans. Although rates of diagnosis were higher among black/African Americans than among whites, according to prevalence studies that detect all people who have dementia irrespective of their use of the health care system, the rates should be even higher for black/African Americans.
Estimates Of The Number Of People With Alzheimer’s Dementia By State
Table lists the estimated number of people age 65 and older with Alzheimer’s dementia by state for 2020, the projected number for 2025, and the projected percentage change in the number of people with Alzheimer’s between 2020 and 2025.,
|Projected Number with Alzheimer’s||Percentage Increase|
- Created from data provided to the Alzheimer’s Association by Weuve et al.,
As shown in Figure , between 2020 and 2025 every state across the country is expected to experience an increase of at least 6.7% in the number of people with Alzheimer’s. These projected increases in the number of people with Alzheimer’s are due solely to projected increases in the population age 65 and older in these states. Because risk factors for dementia such as midlife obesity and diabetes can vary dramatically by region and state, the regional patterns of future burden may be different than reported here. Based on these projections, the West and Southeast are expected to experience the largest percentage increases in people with Alzheimer’s dementia between 2020 and 2025. These increases will have a marked impact on statesâ health care systems, as well as the Medicaid program, which covers the costs of long-term care and support for many older residents with dementia, including more than a quarter of Medicare beneficiaries with Alzheimer’s or other dementias.
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From Frankfurt To Munich Via Heidelberg
Apart from his very intensive clinical work, Alzheimer – together with Sioli – organized the establishment of a special branch hospital for mental patients close to Frankfurt in the Taunus mountains. In addition, he began to write a so-called Habilitationssdirift as a basis for an application at a medical faculty of a German university. He was in possession of the clinical and the postmortem findings of 320 patients with the diagnosis of Progressive Paralyse , investigated at the Frankfurt Hospital since 1888.
In the summer of 1902, little more than one year after the death of Alzheimer’s wife, Emil Kraepelin invited him to join the Heidelberg research team as assistant to the Heidelberg Hospital. This was a great honor because Kraepelin was at the time one of the most, prominent and influential psychiatrists in Germany. In addition, Alzheimer’s great friend Nissl had then been working in the Heidelberg Hospital for 7 years. In spite of many reasons in favor of Heidelberg, Alzheimer refused Kraepelin’s invitation and applied – unsuccessfully – for the leading position in a Hessian state hospital.
When Nissl heard about, this, he persuaded Kraepelin to repeat his offer of a position at the Heidelberg Hospital to Alzheimer. Kraepelin did so and Alzheimer accepted he moved to Heidelberg at the end of 1902.
Use And Costs Of Health Care Services
6.2.1 Use of health care services
People with Alzheimer’s or other dementias have twice as many hospital stays per year as other older people. Moreover, the use of health care services by people with other serious medical conditions is strongly affected by the presence or absence of dementia. In particular, people with coronary artery disease, diabetes, chronic kidney disease, chronic obstructive pulmonary disease , stroke or cancer who also have Alzheimer’s or other dementias have higher use and costs of health care services than people with these medical conditions but no coexisting dementia.
- * This table does not include payments for all kinds of Medicare services, and as a result the average per-person payments for specific Medicare services do not sum to the total per-person Medicare payments.
- Created from unpublished data from the National 5% Sample Medicare Fee-for-Service Beneficiaries for 2014.
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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.
The First Use Of Alzheimers Disease
Alzheimer later published his descriptions of several similar patients in 1909 and Kraepelin included Ms. Deters case in the 1910 edition of his widely respected psychiatry textbook. It was Kraepelin who named this dementia after his junior colleague.Auguste Deter was not an elderly woman at the onset of her illness, and Alzheimers disease was therefore regarded as a presenile dementia to distinguish it from the familiar senile dementia thought to result from aging-related vascular disease. Further investigation, however, showed that plaques and tangles were present in the brains of the majority of older adults with symptoms of dementia.
In the late 1960s, the British psychiatrists Tomlinson and Roth described the importance of these plaques in older adults, and in 1970 Dr. Roth questioned the meaningfulness of the age criterion that distinguished AD from senile dementia of the Alzheimers type.
Alzheimers Disease Redefined As A Major Killer
It was not until the second half of the 20th century that Alzheimers disease become redefined as affecting late as well as early onset patients. This shift in thinking accompanied a transformation in the conceptualization of senile dementia and normal ageing. The British psychiatrist Martin Roth made a seminal contribution with his study, in which he argued that mental disorders in the elderly could be split into distinct categories, which carried very different prognoses . With senile dementia increasingly viewed as a pathological condition and distinguished from other psychiatric disorders of the elderly it could be studied in its own right, and it soon became apparent that the historical distinction from Alzheimers disease no longer seemed valid. In the late 1960s, Roth and his colleagues Blessed and Tomlinson demonstrated that the majority of cases of senile dementia had neurofibrillary tangles and amyloid plaques and the latter correlated with severity of cognitive impairment . Roth concluded in 1970 that:
Insights Into The Biology And Genetics Underlying Alzheimers Disease
Although autosomal dominant mutations account for a very small proportion of cases of Alzheimers disease, the discoveries from these young onset families had, and continue to have, profound implications. The amyloid cascade hypothesis was proposed, which posits that accumulation of amyloid- is the initiating event in Alzheimers disease pathogenesis . This hypothesis has had a major influence on research and motivated the development of therapies that aim to reduce production of amyloid- or increase its clearance from the brain. Identification of familial Alzheimers disease mutations also provided the information necessary to make transgenic animals in which these therapies could be tested, some with dramatic effect, before going in to a series of trials in humans. Ironically, these initial clinical trials tended to exclude the familial patients that had contributed to the ideas and models on the basis of their young age.
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Risk Factors For Alzheimer’s Dementia
The vast majority of people who develop Alzheimer’s dementia are age 65 or older. This is called late-onset Alzheimer’s. Experts believe that Alzheimer’s, like other common chronic diseases, develops as a result of multiple factors rather than a single cause. Exceptions are cases of Alzheimer’s related to uncommon genetic changes that increase risk.
2.7.1 Age, genetics and family history
The greatest risk factors for late-onset Alzheimer’s are older age,, genetics, and having a family history of Alzheimer’s.-
Age is the greatest of these three risk factors. As noted in the Prevalence section, the percentage of people with Alzheimer’s dementia increases dramatically with age: 3% of people age 65-74, 17% of people age 75-84 and 32% of people age 85 or older have Alzheimer’s dementia. It is important to note that Alzheimer’s dementia is not a normal part of aging, and older age alone is not sufficient to cause Alzheimer’s dementia.
- One in 10 people age 65 and older has Alzheimer’s dementia.,,
- The percentage of people with Alzheimer’s dementia increases with age: 3% of people age 65-74, 17% of people age 75-84, and 32% of people age 85 and older have Alzheimer’s dementia. People younger than 65 can also develop Alzheimer’s dementia, but it is much less common and prevalence is uncertain.
3.1.1 Underdiagnosis of Alzheimer’s and other dementias in the primary care setting
3.1.2 Prevalence of subjective cognitive decline
Exercise And Dementia Treatment
An active lifestyle can have a significant impact on the well-being of dementia patients. Not only does exercise benefit the patient physically, but mentally as well. Patients throughout all stages of dementia can benefit from physical activities such as walking, gardening, or dancing. It is important to ease into exercise if the patient does not take part in regular exercise. Exercise for dementia patients is important for the following reasons:
- Improves the heath of the heart and blood vessels
- Reduces the risk of some types of cancer, stroke, and type 2 diabetes
- Improves ability to complete daily tasks
- Reduces the risk of osteoporosis
- Reduces the risk of falling
- Improves cognition
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Alzheimer Auguste D And The Defining Of A Disease
. Reprinted from The Lancet, 349, Maurer et al., Auguste D and Alzheimer’s disease, 1546-9, 1997, with permission from Elsevier.
Alzheimer presented the clinical and pathological findings from Auguste D.s case at the meeting of Southwest German Psychiatrists held in Tübingen, in 1906 and his lecture was published under the title A Characteristic Disease of the Cerebral Cortex the following year. He described and beautifully recorded characteristic changes in the neurofibrils revealed by the Bielschowsky silver stain at autopsy. Thick fibrils accumulated in apparently normal-appearing cells until eventually, the nucleus and cytoplasm disappeared, and only a tangled bundle of fibrils indicated the site where once the neuron had been located. Severe neuronal loss was observed and over the entire cortex, and in large numbers especially in the upper layers, miliary foci could be found which represented the sites of deposition of a peculiar substance. Many years later, hyperphosphorylated tau was found to be the key component of the tangles and amyloid- the peculiar substance that formed the core of the plaques. Psychoanalytic studies presented at the meeting received more attention than Alzheimers paper and were the ones to get reported in the local press. However, in 1910 Kraepelin coined the term Alzheimers disease in the eighth edition of his Handbook of Psychiatry, declaring it to be a specific clinical-pathological disease entity.
What Are The Symptoms
The warning signs can be mild at first, but worsen with time. They include:
Problems with cognitive ability, attention, alertness, memory, judgment and concentration
Slow movement, tremors, difficulty walking, or rigidity
Sleep problems, including acting out dreams
Problems with autonomic body functions, such as bladder and bowel function
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Health Environmental And Lifestyle Factors
Research suggests that a host of factors beyond genetics may play a role in the development and course of Alzheimers. There is a great deal of interest, for example, in the relationship between cognitive decline and vascular conditions such as heart disease, stroke, and high blood pressure, as well as conditions such as diabetes and obesity. Ongoing research will help us understand whether and how reducing risk factors for these conditions may also reduce the risk of Alzheimers.
A nutritious diet, physical activity, social engagement, and mentally stimulating pursuits have all been associated with helping people stay healthy as they age. These factors might also help reduce the risk of cognitive decline and Alzheimers. Researchers are testing some of these possibilities in clinical trials.