Alzheimer's Disease

What is Alzheimer's disease?

Alzheimer's disease is a progressive, neurodegenerative disease that occurs when nerve cells in the brain die and often results in the following:

• Impaired memory, thinking, and behavior

• Confusion

• Restlessness

• Personality and behavior changes

• Impaired judgment

• Impaired communication

• Inability to follow directions

• Language deterioration

• Impaired thought processes that involve visual and spatial awareness

• Emotional apathy

With Alzheimer's disease, motor function is often preserved.

When Alzheimer's was first identified by German physician, Alois Alzheimer, in 1906, it was considered a rare disorder. Today Alzheimer's disease is recognized as the most common cause of dementia (a disorder in which mental functions deteriorate and break down).  An estimated 5.3 million Americans have Alzheimer's disease. According to the Alzheimer's Association, this number includes 5.1 million people over the age of 65, as well as 200,000 to 500,000 people younger than 65 who have early-onset Alzheimer's and other types of dementias.

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How is Alzheimer's different from other forms of dementia?

Alzheimer's disease is distinguished from other forms of dementia by characteristic changes in the brain that are visible only upon microscopic examination during autopsy. Brains affected by Alzheimer's disease often show presence of the following:

• Fiber tangles within nerve cells (neurofibrillary tangles)

• Clusters of degenerating nerve endings (neuritic plaques)

Another characteristic of Alzheimer's disease is the reduced production of certain brain chemicals necessary for communication between nerve cells, especially acetylcholine, as well as norepinephrine, serotonin, and somatostatin.

What causes Alzheimer's disease?

Although intense investigation has been underway for many years, the causes of Alzheimer's disease are not entirely known. Suspected causes often include the following:

• Age and family history

• Certain genes

• Abnormal protein deposits in the brain

• Other risk and environmental factors

• Immune system problems

What are the warning signs or symptoms of Alzheimer's disease?

According to the Alzheimer's Association, the following are the most common symptoms of Alzheimer's disease. However, each individual may experience symptoms differently. Symptoms may include:

• Memory loss that affects job skills, especially short-term memory loss

• Difficulty performing familiar tasks

• Problems with language

• Disorientation to time and place

• Poor or decreased judgment

• Problems with abstract thinking

• Misplacing things

• Changes in mood or behavior

• Changes in personality

• Loss of initiative

• Loss of ability to recognize who people are, even people well known to the individual, such as his or her child or spouse, when the disease progresses to a severe stage

The symptoms of Alzheimer's disease may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is Alzheimer's diagnosed?

There is not a single, comprehensive test for diagnosing Alzheimer's disease. By ruling out other conditions through a process of elimination, physicians, or other specialists, can obtain a diagnosis of probable Alzheimer's disease with approximately 90 percent accuracy. However, the only way to confirm a diagnosis of Alzheimer's disease is through autopsy.

Examination and evaluation are essential in determining whether the dementia is the result of a treatable illness. In addition to a complete medical history and extensive neurological motor and sensory exam, diagnostic procedures for Alzheimer's disease may include the following:

• Mental status test - this is a brief and simple test of memory and some other common cognitive or thinking skills; it is usually part of a complete neurological exam

• Neuropsychological testing

• Blood tests

• Lumbar puncture (spinal tap) - a procedure performed by inserting a hollow needle into the lower back (lumbar spine)

• Urinalysis - laboratory examination of urine for various cells and chemicals, such as red blood cells, white blood cells, infection, or excessive protein

• Chest x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film

• Electroencephalogram (EEG) - a procedure that records the brain's continuous electrical activity by means of electrodes attached to the scalp

• Computed tomography scan (also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

• Magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body

• Genetic testing - some genetic testing is available, especially in some research settings; Because there is no cure or effective treatment for Alzheimer's, the decision to undergo genetic testing is one that requires careful consideration and counseling with a specialist in genetics.

Prevention of Alzheimer's

Because the cause of the disease is unknown, there are no prevention protocols to follow at this time. And, because the controllable risk factors for Alzheimer's disease are unknown, it is not yet possible to reduce the chances of developing the disease.

Treatment for Alzheimer's

Specific treatment for Alzheimer's disease will be determined by your physician based on:

• Your age, overall health, and medical history

• Extent of the disease

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

At this time, there is no cure for Alzheimer's, no way of slowing down the progression of this disease, and no treatment available to reverse the deterioration of Alzheimer's disease. New research findings give reason for hope, and several drugs are being studied in clinical trials to determine if they can slow the progress of the disease or improve memory for a period of time.

There are some medications available to assist in managing some of the most troubling symptoms of Alzheimer's disease, including the following:

• Depression

• Behavioral disturbance

• Sleeplessness

In managing the disease, physical exercise and social activity are important, as are proper nutrition, health maintenance, and a calm and well-structured environment.

Alzheimer's rehabilitation

The rehabilitation program for persons with Alzheimer's differs depending upon the symptoms, expression, and progression of the disease, and the fact that making a diagnosis of Alzheimer's is so difficult. These variables determine the amount and type of assistance needed for the Alzheimer's individual and family.

With Alzheimer's rehabilitation, it is important to remember that, although any skills lost will not be regained, the caregiving team must keep in mind the following considerations:

• In managing the disease, physical exercise and social activity are important, as are proper nutrition and health maintenance.

• Plan daily activities that help to provide structure, meaning, and accomplishment for the individual.

• As functions are lost, adapt activities and routines to allow the individual to participate as much as possible.

• Keep activities familiar and satisfying.

• Allow the individual to complete as many things by himself or herself as possible. The caregiver may need to initiate an activity, but allow the individual to complete it as much as he or she can.

• Provide "cues" for desired behavior (i.e., label drawers/cabinets/closets according to their contents).

• Keep the individual out of harm's way by removing all safety risks (i.e., car keys, matches).

• As a caregiver (full-time or part-time), it is important to understand your own physical and emotional limitations.