Alzheimer's disease

Alzheimer's disease is a form of dementia marked by impaired memory, thinking and behavior. It's thought to be the most common cause of dementia in elderly adults.

A person who has Alzheimer's disease loses the ability to perform vital mental and physical functions. A decline in intellectual and social abilities can interfere with daily activities. The person may also experience personality and behavior changes.

Alzheimer's disease is progressive, degenerative and currently irreversible. Life expectancy after being diagnosed with Alzheimer's disease is usually between eight and 10 years.


Causes/associated factors
Alzheimer's disease typically develops after age 65, although it can begin as early as age 40. About 4 million Americans are affected by Alzheimer caused by the degeneration of brain cells that are responsible for memory and other thought processes. Despite ongoing research, the cause of this degeneration remains unknown. Currently, genetic researchers are analyzing the link between Alzheimer's disease and a gene called apolipoprotein E4 (apo-E4).
Risk factors may include:

age
prior head injury
Down syndrome
a family history of Alzheimer's disease
genetic predisposition
low level of education
In addition, a large study on hormone replacement therapy conducted by the Women's Health Initiative found that women older than age 65 taking the combination hormone replacement therapy (HRT) of estrogen and progestin (Prempro, for example) have twice the risk of developing dementia, including Alzheimereeded to determine the significance of this relationship.


Signs/symptoms
Symptoms of Alzheimer's disease typically develop over many years. The disease may not be apparent to family members, neighbors, friends or even doctors for quite some time. At first, symptoms may include:
gradual memory loss, especially for recent or short-term events
difficulty remembering the names of familiar objects
difficulty learning new information
a tendency to repeat things, misplace items, and become lost or confused
shortened attention span
decreased ability to concentrate
depression and personality changes
As the disease progresses, symptoms become more serious. A slow disintegration of personality, judgment and social graces affects the person's ability to function. Symptoms of advancing Alzheimer's disease often include:

complete inability to learn or recall new information
needing help to bathe, eat or dress
wandering away
agitation, hostility and lack of cooperation
physical or sexual aggression
getting lost, even in the person's own home
paranoia and hallucinations
Symptoms of the most advanced stage of Alzheimer's disease may include:

inability to walk
inability to swallow food or liquids
loss of bowel and bladder control
refusal to speak
complete inability to care for oneself

Diagnosis
There's no single test to diagnose Alzheimer's disease. Instead, the diagnosis is based on a variety of factors, including:
the person's medical history, including past and current medical problems
a series of medical tests, including blood tests, electrolyte panels, thyroid function tests, vitamin levels, urinalysis, chest X-rays and electrocardiograms (recordings of the electrical activity of the heart)
psychological testing to check memory, attention span and problem-solving, math and language skills
imaging studies of the brain when symptoms are new, such as computed tomography or magnetic resonance imaging
Diagnosing Alzheimer's disease can be stressful and time-consuming for both patients and their families. Proper diagnosis is the key to treatment and planning, however.


Treatment
There's no cure for Alzheimer's disease. Treatment can help control symptoms, manage behavior, improve mental ability or delay further brain degeneration.
Medication
Medications such as donepezil (Aricept, for example), tacrine (Cognex, for example), rivastigmine (Exelon, for example) and galantamine (Reminyl, for example) may be used to treat the symptoms of mild to moderate Alzheimer's disease. A new medication, memantine (Namenda, for example), was recently approved by the U.S. Food and Drug Administration (FDA) to treat the symptoms of moderate to severe Alzheimer's. In clinical trials, memantine was found to delay cognitive and functional deterioration. Dizziness, headache and constipation are the most common side effects from memantine.

In some cases, certain types of antidepressants, antipsychotics or sedatives may be needed to help control symptoms. These medications are used only in small doses with close monitoring because they may cause lethargy or excessive drowsiness. It's best to avoid tricyclic antidepressants and antihistamines due to the same side effects.

More effective medication therapies, including combination treatment therapies, are emerging rapidly. It's now thought that treatment will be most beneficial if it's started earlier and continued long-term.

Daily life
Depending on the person's condition and available resources, family members or professional health care providers may need to care for the person. Adult day care centers, elder care programs and respite care can provide occasional relief for the primary caregiver. Eventually, the person may be admitted to a nursing home or extended care facility. In some cases, hospice care may be appropriate.

If you're caring for someone who has Alzheimer's disease, keep the following suggestions in mind:

Maintain the person's personal hygiene.
Make sure the person gets enough sleep and exercise.
Pay close attention to memory aids, such as repeating instructions and establishing routines.
Avoid dramatic changes in normal routines and settings.
Offer clear instructions on how to accomplish tasks.
Make the person's surroundings as safe as possible to prevent or minimize the risk of injury.
Take time to care for yourself.
If you'll be visiting someone who has Alzheimer's disease, keep the following suggestions in mind:

Bring photos. The past may be more familiar to the person than the present.
If the person is hostile or suspicious, use diversion to redirect the behavior.
Try hand-holding or hugging as a form of compassionate touch if the person exhibits inappropriate sexual behavior.
Avoid expectations.
Be flexible.
Allow independence when possible.
If the person will be coming to your home, create a safe wandering area.
Communication
Here are some tips to help you improve communication with someone who has Alzheimer's disease:

Listen closely and pay attention to verbal and nonverbal cues.
Don't quiz or criticize the person.
Use short, simple sentences.
Avoid open-ended questions.
Decrease distraction.
Avoid using a harsh tone of voice.
Avoid arguing or contradicting the person.
Above all, do your best to remain patient.

Seeking support
Alzheimer's disease is a challenging condition for the patient, as well as family members and other loved ones. The disease affects the person physically, socially, emotionally and financially. If a loved one develops Alzheimer's disease, find a concerned, compassionate doctor. Take advantage of community services and support groups. If the disease causes depression for you or your loved one, seek treatment. The benefits may impact the entire family.

Planning for the future
It's important for families to participate in the development of a care plan. The plan should be based on the person's wishes for things such as comfort and dignity, rather than complex medical interventions. A living will or a durable power of attorney for health care (which gives another person the ability to make health care decisions for someone who no longer has capacity to make such decisions) should be designated while the person is still able to make decisions. Finally, financial planning for someone who has Alzheimer's may be crucial.


Complications
Alzheimer's disease can lead to:
dehydration
malnutrition
infections
injuries
falls
contractures (the permanent contraction of a muscle)
permanent bedrest
incontinence
self-neglect
Infections are the most common cause of death for people who have Alzheimer's disease.


Prevention
There are no proven ways to prevent or reduce the risk of Alzheimer's disease. Researchers are studying the impact of various factors, such as:
a vaccine
nonsteroidal anti-inflammatory medications
cholesterol-lowering medications
certain nutritional supplements (specifically vitamin E and ginkgo biloba)
maintaining mental fitness
antioxidant and hormone therapies