Brochure Basicsofalz Low
Brochure Basicsofalz Low
Brochure Basicsofalz Low
ALZHEIMER’S
DISEASE
WHAT IT IS AND WHAT YOU CAN DO
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1.
ALZHEIMER’S DISEASE
AND OTHER TYPES OF
DEMENTIA
Alzheimer’s disease
More than 5 million Americans have Alzheimer’s
disease, the most common form of dementia.
Alzheimer’s accounts for 60 to 80 percent of all
dementia cases. That includes 11 percent of those
age 65 and older and one-third of those 85 and
older. The disease also impacts more than 15
million family members, friends and caregivers.
Dementia
Dementia is a general term for the loss of
memory and other cognitive abilities serious
enough to interfere with daily life.
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mental functions, including memory and
the ability to pay attention, make sound
judgments and plan the steps needed to
complete a task.
» Dementia with Lewy bodies is a type of
progressive dementia that leads to a decline in
thinking, reasoning and independent function
due to abnormal microscopic deposits that
damage brain cells.
» Huntington’s disease dementia is a
progressive brain disorder caused by a
defective gene. It causes changes in the
central area of the brain, which affect
movement, mood and thinking skills.
» Creutzfeldt-Jakob disease is the most
common human form of a group of rare,
fatal brain disorders known as prion diseases.
Misfolded prion protein destroys brain
cells, resulting in damage that leads to rapid
decline in thinking and reasoning as well as
involuntary muscle movements, confusion,
difficulty walking and mood changes.
» Frontotemporal dementia (FTD) is a group
of disorders caused by progressive cell
degeneration in the brain’s frontal lobes (the
areas behind the forehead) or its temporal
lobes (the regions behind the ears).
» Normal pressure hydrocephalus is a brain
disorder in which excess cerebrospinal fluid
accumulates in the brain’s ventricles, causing
thinking and reasoning problems, difficulty
walking and loss of bladder control.
» Down syndrome dementia develops in
people born with extra genetic material
from chromosome 21, one of the 23 human
chromosomes. As individuals with Down
syndrome age, they have a greatly increased
risk of developing a type of dementia
that’s either the same as or very similar to
Alzheimer’s disease.
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» Korsakoff syndrome is a chronic memory
disorder caused by severe deficiency of
thiamine (vitamin B-1). It is most commonly
caused by alcohol misuse, but certain other
conditions can also cause the syndrome.
» Posterior cortical atrophy (PCA) is the
gradual and progressive degeneration of the
outer layer of the brain (the cortex) located
in the back of the head (posterior). It is not
known whether PCA is a unique disease or a
possible variant form of Alzheimer’s disease.
2. HOW ALZHEIMER’S
AFFECTS THE BRAIN
The changes that take place in the brain begin at
the microscopic level long before the first signs
of memory loss.
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TAKE A CLOSER LOOK
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experts believe that they disable or block
communication among nerve cells and disrupt
processes the cells need to survive.
The destruction and death of nerve cells causes
memory failure, personality changes, problems in
carrying out daily activities and other symptoms
of Alzheimer’s disease.
Illustrations:
Alzheimer’s Disease Education and Referral Center, a service of
the National Institute on Aging
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3. CAUSES AND
RISK FACTORS
While scientists know that Alzheimer’s disease
involves the failure of nerve cells, it’s still
unknown why this happens. However, they have
identified certain risk factors that increase the
likelihood of developing Alzheimer’s.
Age
The greatest known risk factor for Alzheimer’s is
increasing age. Most individuals with the disease
are 65 and older. One in nine people in this age
group and nearly one-third of people age 85 and
older have Alzheimer’s.
Family history
Another risk factor is family history. Research
has shown that those who have a parent, brother
or sister with Alzheimer’s are more likely to
develop the disease than individuals who do
not. The risk increases if more than one family
member has the illness.
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Rare deterministic genes cause Alzheimer’s in a
few hundred extended families worldwide. These
genes are estimated to account for less than 1
percent of cases. Individuals with these genes
usually develop symptoms in their 40s or 50s.
LATINOS AND
AFRICAN-AMERICANS
Research shows that older Latinos are
about one-and-a-half times as likely as
older whites to have Alzheimer’s and
other dementias, while older African-
Americans are about twice as likely to
have the disease as older whites. The
reason for these differences is not well
understood, but researchers believe that
higher rates of vascular disease in these
groups may also put them at greater risk
for developing Alzheimer’s.
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Some of the strongest evidence links brain
health to heart health. The risk of developing
Alzheimer’s or vascular dementia appears to be
increased by many conditions that damage the
heart and blood vessels. These include heart
disease, diabetes, stroke, high blood pressure
and high cholesterol. Work with your doctor
to monitor your heart health and treat any
problems that arise.
Studies of donated brain tissue provide additional
evidence for the heart-head connection. These
studies suggest that plaques and tangles are
more likely to cause Alzheimer’s symptoms if
strokes or damage to the brain’s blood vessels
are also present.
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» Psychologist with special training in testing
memory and other mental functions.
There is no single test that proves a person has
Alzheimer’s. The workup is designed to evaluate
overall health and identify any conditions that
could affect how well the mind is working. When
other conditions are ruled out, the doctor can
then determine if it is Alzheimer’s or another
dementia.
Experts estimate that a skilled physician can
diagnose Alzheimer’s with more than 90
percent accuracy. Physicians can almost always
determine that a person has dementia, but it
may sometimes be difficult to determine the
exact cause.
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Reviewing medical history
The doctor will interview the person being
tested and others close to him or her to gather
information about current and past mental and
physical illnesses. It is helpful to bring a list of all
the medications the person is taking.
The doctor will also obtain a history of key
medical conditions affecting other family
members, especially whether they may have or
had Alzheimer’s disease or other dementias.
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The physician will collect blood and urine
samples and may order other laboratory
tests. Information from these tests can help
identify disorders such as anemia, infection,
diabetes, kidney or liver disease, certain vitamin
deficiencies, thyroid abnormalities, and problems
with the heart, blood vessels or lungs. All of
these conditions may cause confused thinking,
trouble focusing attention, memory problems or
other symptoms similar to dementia.
Neurological exam
A doctor will closely evaluate the person for
problems that may signal brain disorders other
than Alzheimer’s.
The physician will also test:
» Reflexes
» Coordination
» Muscle tone and strength
» Eye movement
» Speech
» Sensation
The doctor is looking for signs of small or large
strokes, Parkinson’s disease, brain tumors, fluid
accumulation on the brain, and other illnesses
that may impair memory or thinking.
The neurological exam may also include a brain
imaging study. The most common types are
magnetic resonance imaging (MRI) or computed
tomography (CT). MRIs and CTs can reveal
tumors, evidence of small or large strokes,
damage from severe head trauma or a buildup
of fluid. Researchers are studying other imaging
techniques so they can better diagnose and track
the progress of Alzheimer’s.
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5. WHEN THE DIAGNOSIS
IS ALZHEIMER’S
Once testing is complete, the doctor will make
an appointment to review results and share his
or her conclusions. A diagnosis of Alzheimer’s
reflects a doctor’s best judgment about the
cause of a person’s symptoms, based on the
testing performed.
You may want to ask the doctor:
» Why the diagnosis is Alzheimer’s.
» Where the person may be in the course of
the disease.
» What to expect in the future.
Find out if the doctor will manage care going
forward and, if not, who will be the primary
doctor. The doctor can then schedule the next
appointment or provide a referral.
Alzheimer’s disease is life-changing for both
the diagnosed individual and those close to
him or her. While there is currently no cure,
treatments are available that may help relieve
some symptoms. Research has shown that taking
full advantage of available treatment, care and
support options can improve quality of life.
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Consider:
» H ow to provide increasing levels of care as
the disease progresses.
» How the individual and family members will
cope with changes in the person’s ability
to drive, cook and perform other daily
activities.
» H ow to ensure a safe environment.
It is also important to begin making legal and
financial plans. A timely diagnosis often allows
the person with dementia to participate in this
planning. The person can also decide who will
make medical and financial decisions on his or
her behalf in later stages of the disease.
6. STAGES OF
THE DISEASE
Alzheimer’s disease typically progresses slowly in
three general stages: early, middle and late
(sometimes referred to as mild, moderate and
severe in a medical context). Since Alzheimer’s
affects people in different ways, each person may
experience symptoms — or progress through
the stages — differently.
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Overview of disease progression
The symptoms of Alzheimer’s worsen over
time, but because the disease affects people in
different ways, the rate of progression varies. On
average, a person with Alzheimer’s lives four to
eight years after diagnosis, but can live as long as
20 years, depending on other factors.
Changes in the brain related to Alzheimer’s begin
years before any signs of the disease. This period
is referred to as preclinical Alzheimer’s disease.
The following stages provide an overall idea of
how abilities change once symptoms appear and
should be used as a general guide. Stages may
overlap, making it difficult to place a person with
Alzheimer’s in a specific stage.
Early-stage Alzheimer’s
In the early stage of Alzheimer’s, a person may
function independently. He or she may still drive,
work and be part of social activities. Despite
this, the person may feel as if he or she is having
memory lapses, such as forgetting familiar words
or the location of everyday objects.
Friends, family or others close to the individual
begin to notice difficulties. During a detailed
medical interview, doctors may be able to detect
problems in memory or concentration. Common
difficulties include:
» Problems coming up with the right word
or name.
» Trouble remembering names when
introduced to new people.
» Challenges performing tasks in social or
work settings.
» Forgetting material that was just read.
» Losing or misplacing a valuable object.
» Increasing trouble with planning
or organizing.
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Middle-stage Alzheimer’s
Middle-stage Alzheimer’s is typically the longest
stage and can last for many years. As the disease
progresses, the person with Alzheimer’s will
require a greater level of care.
You may notice the person with Alzheimer’s
confusing words, getting frustrated or angry, or
acting in unexpected ways, such as refusing to
bathe. Damage to nerve cells in the brain can
make it difficult to express thoughts and perform
routine tasks.
At this point, symptoms will be noticeable to
others and may include:
» Forgetfulness of events or about one’s own
personal history.
» Feeling moody or withdrawn, especially in
socially or mentally challenging situations.
» Being unable to recall their address or
telephone number or the high school or
college from which they graduated.
» Confusion about where they are or what
day it is.
» The need for help choosing proper clothing
for the season or the occasion.
» Trouble controlling bladder and bowels in
some individuals.
» Changes in sleep patterns, such as sleeping
during the day and becoming restless
at night.
» An increased risk of wandering and
becoming lost.
» Personality and behavioral changes,
including suspiciousness and delusions or
compulsive, repetitive behavior like hand
wringing or tissue shredding.
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WANDERING
Six out of 10 people with Alzheimer’s
will wander and become lost. People can
wander or become confused about their
location at any stage of the disease. If not
found within 24 hours, up to half of those
who get lost risk serious injury or death.
Late-stage Alzheimer’s
In the final stage of the disease, individuals lose
the ability to respond to their environment,
carry on a conversation and, eventually, control
movement. They may still say words or phrases,
but communicating pain becomes difficult. As
memory and cognitive skills worsen, significant
personality changes may occur and extensive
help with daily activities may be required.
At this stage, individuals may:
» Need round-the-clock assistance with
daily activities and personal care.
» Lose awareness of recent experiences as
well as of their surroundings.
» Experience changes in physical abilities,
including the ability to walk, sit and,
eventually, swallow.
» Have greater difficulty communicating.
» Become increasingly vulnerable to
infections, especially pneumonia.
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7. TREATING THE
SYMPTOMS
Currently, there is no cure for Alzheimer’s and no
way to stop the underlying death of brain cells.
But drugs and non-drug treatments may help with
both cognitive and behavioral symptoms.
A comprehensive care plan for Alzheimer’s disease:
» Considers appropriate treatment options.
» Monitors treatment effectiveness as the
disease progresses.
» Changes course and explores alternatives
as necessary.
» Respects individual and family goals for
treatment and tolerance for risk.
Cognitive symptoms
Three types of drugs are currently approved
by the FDA to treat cognitive symptoms of
Alzheimer’s disease.
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The first, cholinesterase (KOH-luh-NES-ter-ays)
inhibitors, prevents the breakdown of
acetylcholine (a-SEA-til-KOH-lean), a chemical
messenger important for memory and learning.
By keeping levels of acetylcholine high, these
drugs support communication among nerve cells.
Three cholinesterase inhibitors are commonly
prescribed:
» Donepezil (Aricept®), approved in 1996 to
treat mild-to-moderate Alzheimer’s and in
2006 for the severe stage.
» Rivastigmine (Exelon®), approved in 2000
for mild-to-moderate Alzheimer’s.
» Galantamine (Razadyne®), approved in 2001
for mild-to-moderate stages.
The second type of drug works by regulating
the activity of glutamate, a different messenger
chemical involved in information processing:
» Memantine (Namenda®), approved in 2003
for moderate-to-severe stages, is the only
drug in this class currently available.
The third type is a combination of cholinesterase
inhibitor and a glutamate regulator:
» Donepezil and memantine (Namzaric®),
approved in 2014 for moderate-to-severe
stages.
The effectiveness of these treatments varies
from person to person. While they may
temporarily help symptoms, they do not slow or
stop the brain changes that cause Alzheimer’s to
become more severe over time.
Behavioral symptoms
Many find behavioral changes, like anxiety,
agitation, aggression and sleep disturbances, to
be the most challenging and distressing effect of
Alzheimer’s disease. These changes can greatly
impact the quality of life for individuals.
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As with cognitive symptoms of Alzheimer’s,
the chief underlying cause of behavioral and
psychiatric symptoms is the progressive damage
to brain cells. Other possible causes of behavioral
symptoms include:
» Drug side effects
Side effects from prescription medications
may be at work. Drug interactions may occur
when taking multiple medications for several
conditions.
» Medical conditions
Symptoms of infection or illness, which may
be treatable, can affect behavior. Pneumonia
or urinary tract infections can bring
discomfort. Untreated ear or sinus infections
can cause dizziness and pain.
» Environmental influences
Situations affecting behavior include moving
to a new private residence or residential
care facility; misperceived threats; or fear
and fatigue from trying to make sense of a
confusing world.
There are two types of treatments for behavioral
symptoms: non-drug treatments and prescription
medications.
Non-drug treatments
Steps to developing non-drug treatments include:
» Identifying the symptom.
» Understanding its cause.
» Changing the caregiving environment to
remove challenges or obstacles.
Pinpointing what has triggered behaviors can
often help guide the best approach. Often the
trigger is a change in the person’s environment,
such as:
» New caregivers.
» Different living arrangements.
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» Travel.
» Admission to a hospital.
» Presence of houseguests.
» Being asked to bathe or change clothes.
Because people with Alzheimer’s gradually lose
the ability to communicate, it is important to
regularly monitor their comfort and anticipate
their needs.
Prescription medications
Medications can be effective in managing some
behavioral symptoms, but they must be used
carefully and are most effective when combined
with non-drug treatments. Medications should
target specific symptoms so that response to
treatment can be monitored.
Prescribing any drug for a person with
Alzheimer’s is medically challenging. Use of
drugs for behavioral and psychiatric symptoms
should be closely supervised.
Some medications, called psychotropic
medications (antipsychotics, antidepressants,
anti-convulsants and others), are associated
with an increased risk of serious side effects.
These drugs should only be considered when
non-pharmacological approaches are
unsuccessful in reducing dementia-related
behaviors that are causing physical harm to the
person with dementia or his or her caregivers.
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KEY TERMS
SYMPTOMS
Cognitive: Symptoms that affect
memory, awareness, language, judgment,
and an individual’s ability to plan, organize
and carry out other thought processes.
TREATMENTS
FDA-approved: Medication approved by
the U.S. Food and Drug Administration
(FDA) that treats symptoms of
Alzheimer’s disease.
Non-drug: A treatment other than
medication that helps relieve symptoms
of Alzheimer’s disease.
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8. HOPE FOR THE
FUTURE
The Alzheimer’s Association is the world’s
largest nonprofit funder of Alzheimer’s
research. Since 1982, we have awarded over
$350 million to more than 2,300 research
investigations worldwide.
When Dr. Alois Alzheimer first described the
disease in 1906, a person in the United States
lived an average of about 50 years. Few people
reached the age of greatest risk. As a result, the
disease was considered rare and attracted little
scientific interest. That attitude changed as the
average life span increased and scientists began
to realize how often Alzheimer’s strikes people
in their 70s and 80s. The Centers for Disease
Control and Prevention recently estimated the
average life expectancy to be 78.8 years.
Today, Alzheimer’s is at the forefront of
biomedical research, with 90 percent of what
we know discovered in the last 20 years. Some
of the most remarkable progress has shed light
on how Alzheimer’s affects the brain. Better
understanding of the disease’s impact may lead
to better treatments.
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I don't have a laboratory.
I have Alzheimer's disease.
And I'm helping to
discover a cure.
You can too.
alz.org/TrialMatch
800.272.3900
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While there is no known way to prevent
Alzheimer’s disease, emerging research
suggests that the steps people take to maintain
heart health may also reduce the risk of
cognitive decline.
This connection makes sense, because the
brain is nourished by one of the body’s richest
networks of blood vessels, and the heart
is responsible for pumping blood through
these blood vessels to the brain. It’s especially
important for people to do everything they
can to keep weight, blood pressure, cholesterol
and blood sugar within recommended ranges
to reduce the risk of heart disease, stroke and
diabetes. Eating a diet low in saturated fats
and rich in fruits and vegetables, exercising
regularly, and staying mentally and socially
active may all help protect the brain.
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alz.org
Access reliable information and resources, such as:
» Alzheimer’s Navigator® – Assess your needs and
create customized action plans.
» Community Resource Finder – Find
local resources.
» ALZConnected® – Connect with other
caregivers or people with dementia.
» Alzheimer’s and Dementia Caregiver Center –
Get information for all stages of the disease.
» Safety Center – Access information and tools.
alz.org/education
Free online workshops, including:
» The Basics: Memory Loss, Dementia and
Alzheimer's Disease.
alz.org/findus
We’re in communities across the country.
800.272.3900
24/7 Helpline – Available all day, every day.
(TTY: 866.403.3073)
800.272.3900 | alz.org®
This is an official publication of the Alzheimer’s Association but may be distributed
by unaffiliated organizations and individuals. Such distribution does not constitute
an endorsement of these parties or their activities by the Alzheimer’s Association.
© 2016 Alzheimer’s Association®. All rights reserved. Rev. Oct16 770-10-0003