Alzheimer's disease

1. What is Alzheimer's disease?
2. What is the difference between Alzheimer's disease and dementia?
3. How can one distinguish Alzheimer's disease from normal memory loss or ordinary forgetfulness?
4. Are there warning signs for Alzheimer's disease? What is typically the first sign?
5. How is Alzheimer's disease diagnosed?
6. What treatments are there for Alzheimer's disease?
7. Are there side-effects from the medication prescribed for Alzheimer's disease?
8. What vitamins and herbal supplements are protective against Alzheimer's disease?
9. Is there anything that I can do to prevent myself from getting Alzheimer's disease?
10. Are people with Alzheimer's disease aware of their symptoms?
11. Can people with Alzheimer's disease live alone?
12. If an individual has been diagnosed with Alzheimer's disease, should they continue to drive?
13. Should a person tell friends and family that they have been diagnosed with Alzheimer's disease?
14. Do all people with Alzheimer's disease wander? Do all get irritable?
15. Where can I receive instruction or help in dealing with Alzheimer's disease?
16. Is Alzheimer's disease hereditary? Does having a parent who has the disease increase my chances of developing it? If so, are there any tests that clarify my risk?

What is Alzheimer's disease?

Alzheimer's disease is the most common cause of dementia. It is characterized by protein abnormalities that lead to death of nerve cells in the brain. The earliest and main symptom of AD is progressive memory problems. The symptoms usually start gradually, and may, at first be attributed to old age or ordinary forgetfulness. Over time, memory and other thinking abilities become worse and interfere more and more with the patient's ability to do daily activities. For example, patients often develop difficulty with planning and organizing their behavior, with problem solving, and in making decisions. It may become hard for them to find the right words and the content of their speech may wander. Eventually, the ability to do routine or everyday tasks such as cooking and dressing is affected and personality changes can develop. In its late stage, there is global cognitive and functional impairment and eventually death.

Approximately four million people nationwide have been diagnosed with AD. The condition is most common in individuals who are over 65 and the risk of having it increases with age; however, it can also occur in people much younger. People with Alzheimer's live an average of eight years after diagnosis, although some people may live for as many as 20 years after being diagnosed. A diagnosis of Alzheimer's disease is based on a combination of tests including a thorough medical evaluation followed by neurological and neuropsychological testing.

The exact causes of Alzheimer's disease (AD) are still uncertain, and presently there is no way to prevent or cure the disease. However, in recent years several medications have been developed to help reduce some of the common symptoms of early- to mid-stage AD. Currently, four drugs have been approved by the FDA. The first one, approved in 1993, tacrine (Cognex) has many side effects, including potential liver damage and has shown disappointing memory results. For these reasons it is seldom prescribed. Three newer drugs, donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl), have proved beneficial in improving memory and slowing cognitive decline, and have fewer side effects. Unfortunately, these drugs are not effective for everyone, and their effectiveness is limited to the early and middle stages of AD. Additionally, it currently is possible to reduce some of the common emotional and behavioral symptoms associated with AD. For example, a doctor may prescribe medications such as tranquilizers to reduce agitation, anxiety and unpredictable behavior. Medications are also available to improve sleeping patterns and treat depression.

Research on Alzheimer s disease is currently being conducted at a number of institutions. The National Institute of Neurological Disorders and Stroke (NINDS), the National Institute on Aging, the National Institute of Mental Health, and the Alzheimer's Association are just some of the organizations that support AD research. New medications for the treatment of AD are tested on an ongoing basis. People interested in participating in clinical trials of these medications should discuss the pros and cons with their physician and family.

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What is the difference between Alzheimer's disease and dementia?

Dementia refers to a category of disorders that involve memory loss while Alzheimer's disease is a specific disease. Alzheimer's disease causes dementia, however, several other diseases or conditions, such as stroke, Parkinson's disease, head injury, and vitamin deficiency can also cause dementia.

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How can one recognize Alzheimer's disease from normal memory loss or ordinary forgetfulness?

Everyone experiences memory lapses and forgetfulness from time to time and some decline in memory ability is a normal part of aging. For example, as an individual approaches middle age, his or her ability to recall newly learned information may begin to slip such as recalling people's names or specific words. These memory problems do not get worse over short periods of time and do not interfere much with the ability to do daily activities. People may compensate for these normal memory changes by repeatedly going over things to be remembered, linking them in their mind with something already well known, or keeping lists of things to do. In contrast, the memory loss in Alzheimer's disease is much greater than expected for age. The memory lapses are more frequent and severe and interfere with the ability to manage daily activities.

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Are there warning signs for Alzheimer's disease? What is typically the first sign?

A. Memory loss that affects day-to-day function
It is normal to occasionally forget appointments or phone numbers. However, a person with Alzheimer's disease may forget things more often and not remember them later. The disease prevents the person from making new memories. Memories of things from long ago often remain after the ability to learn new information is lost.

B. Difficulty performing familiar task
Busy people can be so distracted from time to time that they may forget what they are doing such as serving vegetables during dinner, but they will remember to serve them at the end of the mea. A person with Alzheimer's disease may be unable to prepare any part of a meal or forget they ate it.

C. Problems with language
Everyone has trouble finding the right words sometimes, but a person with Alzheimer's disease may forget simple words or substitute the wrong words, making his or her sentences difficult to understand. The conversation of a person with Alzheimer's disease may wander excessively.

D. Disorientation of time and place
It is normal to forget the day of the week or your destination-for a moment. But a person with Alzheimer's disease can have persistent problems remembering the date, day of the week, or time. They may have more trouble finding their way while driving and may occasionally get lost.

E. Poor or decreased judgment
People may sometimes put off going to the doctor if they have an infection but eventually will seek medical attention. A person with Alzheimer's disease may not recognize the need for a doctor at all. Another example of poor judgment is that a person with Alzheimer's disease may dress inappropriately, wearing heavy clothing on a hot day, or two shirts. People with Alzheimer's disease may become distracted and unsafe while doing routine activities such as cooking or driving.

F. Problems with abstract thinking
Trouble balancing a checkbook may be the first sign that there is a serious problem.

G. Misplacing Things
We all misplace things from time to time. Frequently misplacing items may be an underlying memory disorder. Later in th eillness, a person with Alzheimer's disease may put things in inappropriate places: an iron in the freezer or a watch in the sugar bowl and forget that they put them there. They may also accuse others of stealing when they are unable to find things they need.

H. Changes in Mood or Behavior
Everyone becomes sad or moody from time to time. Depression may be the first sign of an underlying memory disorder in an older person. Someone with Alzheimer's disease can exhibit a wide range of mood or behavioral changes. For example, they may display rapid mood swings - from calm to tears to anger - for no apparent reason, become abnormally irritable, depressed, or agitated. They may have changes in their eating, sleeping, and hygiene and may engage in repetitive purposeless behaviors as rummargin through closets and drawers.

I. Changes in Personality
People's personalities can change somewhat with age. But a person with Alzheimer's disease can change dramatically, becoming, suspicious, or withdrawn. Changes may also include apathy or indifference, fearfulness or anxiety, or acting inappropriately.

J. Loss of Initiative
It is normal to lose interest and motivation in housework, business activities, or social obligations, but most people regain their initiative. A person with Alzheimer's disease may become very passive, and require cues and prompting to become involved in daily activities. The symptoms of apathy are not distressing to the patient but can be very disturbing for the caregiver and family.

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How is Alzheimer's disease diagnosed?

There is no single test that can determine if someone has Alzheimer's disease, and the diagnosis requires a full physical and neurological examination to rule out other causes of dementia. Screenings include blood tests to measure thyroid function, vitamin B12 levels. A MRI or CT scan of the brain helps to exclude other causes of dementia such as large or small strokes, tumors, or hydrocephalus (excessive fluid build-up in the brain). In addition, cognitive testing for memory, language, and other cognitive difficulties may be helpful.

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What treatments are there for Alzheimer's disease?

There is no medical treatment currently available to cure or stop the progression of Alzheimer's disease. However the Food & Drug Administration (FDA) has approved four drugs that may temporarily relieve some symptoms of the disease or slow its progression. These are tacrine (Cognex®), donepezil (Aricept®), rivastigmine (Exelon®), and galantamine (Reminyl®).

Many other new promising drugs are now being developed - some which may be available within the next few years. Medication and non-drug therapies are also available to reduce some of the changes in behavior associated with Alzheimer's disease, such as depression, sleeplessness, and agitation.

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Are there side-effects from the medication prescribed for Alzheimer's disease?

Generally, donepezil (Aricept®), rivastigmine (Exelon®), and galantamine (Reminyl®) are well tolerated. Symptoms such as nausea, vomiting, loss of appetite, and loose stools might occur but are usually transient. It is recommended to take Reminyl® and Exelon®with a full meal. Because of side effects associated with tacrine, including possible liver damage, it is very rarely prescribed. There is no evidence or reason to believe that combining the drugs would be any more beneficial than taking either one alone, and it is likely that combining the drugs would result in greater side effects.

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What vitamins and herbal supplements are protective against Alzheimer's disease?

Research into the production of free radicals in the brain in Alzheimer's disease have suggested that antioxidants, such as vitamin E, vitamin C, and Ginko biloba may be useful in treating or slowing the progression of the disease. However, more research needs to be done in this area before the effectiveness or lack thereof of these supplements can be verified.

Vitamin E
An article published in the New England Journal of Medicine demonstrated that Vitamin E can slow the disease course in patients with moderate-severe Alzheimer's disease.

An article published recently in the Journal of the American Medical Association suggested that high levels of dietary vitamin E might be protective against the development of Alzheimer's disease. This study found a benefit when patients ate vitamin E in the form of natural foods, but found no benefit when it was taken as a vitamin supplement. More studies need to be done to understand the protective role that this vitamin may play. Vitamin E supplements are frequently prescribed and have become a part of a standard treatment regimen for most people with Alzheimer's disease.

Vitamin C
Vitamin C, like Vitamin E, plays an antioxidant role by neutralizing free radicals and preventing cell death. More studies need to be done to investigate whether Vitamin C can limit Alzheimer's disease progression.

Ibuprofen and other Nonsteroidal anti-inflammatories (NSAIDS)

There is evidence that NSAIDS may play a preventative role in the development of AD but have no benefit on disease course in people diagnosed with AD, more research is needed. The role of NSAIDs in Alzheimer's disease is an active area in AD research, and its benefits, if any, are unclear.

Ibuprofen and other Nonsteroidal anti-inflammatories (NSAIDS)
There is evidence that NSAIDS may play a preventative role in the development of AD but have no benefit on disease course in people diagnosed with AD, more research is needed. The role of NSAIDS in Alzheimer's disease is an active area in AD research and its benefits, if any, are unclear.

Gingko biloba

Gingko biloba has anti-oxidant and vasodilating properties. Several clinical trials have suggested that gingko is effective in the treatment of Alzheimer's disease (AD). There have been some contraindications of gingko when using anti-coagulants, so you should speak with your physician before starting on this, or any supplement.

A recent study in Journal of the American Medical Association showed no benefit for gingko in patients with AD and we do not currently recommend it.

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Is there anything that I can do to prevent myself from getting Alzheimer's disease?

Eating foods high in Vitamin E has recently been shown to have a protective effect against Alzheimer's disease. However, for the most part, scientists are still not certain about what causes Alzheimer's disease. Age and family history have been identified as potential risk factors. Researchers are exploring the role of genetics in the development of Alzheimer's disease, but most agree the disease is likely caused by a variety of factors. Each year, scientists are uncovering important new clues about potential causes of the disease, which is helping to generate more accurate diagnostic tests and better treatment options for affected individuals. Stay active physically and mentally. There is evidence that people who have lot of mental, physical, and social stimulation have lower rates of AD.

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Are people with Alzheimer's disease aware of their symptoms?

Patients in the early stages of Alzheimer's disease may have awareness of their memory and other deficits. However, awareness of memory and other problems generally decreases as the disease progresses.

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Can people with Alzheimer's disease live alone?

Approximately 25 percent of Americans with Alzheimer's disease live alone. However, as the condition progresses, patients may need more help and it is especially important for family and friends to provide supervision for tasks that the person with AD can no longer do for themselves. Family members, friends, and community services can help. Imfornation is available on home care services, meals, transportations, and day care from the Alzheimer's Association or a primary care physician. Arrangements can be made for direct deposit of checks such as retirement pensions and/or Social Security benefits. Home-delivered meals are available. At some point people with AD will need to live in a supervised seeting either with family, an assisted living facility, or a nursing home.

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If an individual has been diagnosed with Alzheimer's disease, should they continue to drive?

Whether or not a person with Alzheimer's disease can continue to drive is dependent on the progression of the disease and their remaining functional abilities. Individuals who still drive should be encouraged to limit their driving to short distances in areas that are familiar to them. Caregivers should try to guage whether they feel that the person is driving safely. After evaluation in the Memory Clinic, our staff can advise patients and their families regarding driving saftey, and refer patients for driving safetey evlautions if indicated.

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Should a person tell friends and family that they have been diagnosed with Alzheimer's disease?

People with Alzheimer's disease will need support and assistance from others as they experience changes brought on by the disease. While telling friends and family may cause some emotional stress, it is important to tell people early on so that an effective and caring support network of family and friends can be established.

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Do all people with Alzheimer's disease wander? Do all get irritable?

Behavior problems are common in AD, especially as the disease progresses. Depression and irritability may occur early. Suspiciousness is common. Apathy is th emost common behavioral symptom. Restlessness, wandering, agitation, impulsiveness, delusions, and hallucinations may occur later. These behavioral symptoms can be very distressing to caregivers and family members. It is important to have the support of family and friends. Support groups may help. Medications may help. Your family doctor may refer you to a geriatric psychiatrist who specializes in managing behavioral problems in demential.

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Where can I receive instruction or help in dealing with Alzheimer's disease?

You can contact your local chapter of the Alzheimer's Association for information and support in areas ranging from day-to-day living to cutting edge medical research. The address is as follows:

Alzheimer' s Association
Rhode Island Chapter
245 Waterman Street, Suite 306
Providence, RI 02906
800-244-1428
401-421-0008

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Is Alzheimer's disease hereditary? Does having a parent who has the disease increase my chances of developing it? If so, are there any tests that clarify my risk?

The average worldwide lifetime risk of developing any type of Alzheimer’s disease is about 5 percent by age 65, 10 to 15 percent by age 75, and 20 to 40 percent by age 85. Individuals who have a parent with Alzheimer’s disease have about twice the average risk of getting the disease, that is, among 65-year-olds with an affected parent, about 10 percent will develop Alzheimer’s disease. Having a brother or sister with Alzheimer’s disease also doubles the risk. The likelihood of developing the disease continues to increase as the number of affected relatives increases, and having more than one affected sibling appears to cause the greatest increase in risk.

This increased risk occurs because children and parents may share certain genes, the basic units of heredity that provide a blueprint for many biological and behavioral characteristics. The influence of a gene may be large or small.

Tests are available that can determine whether a person carries Alzheimer’s disease genes. It is important to understand, however, that even people with Alzheimer’s disease genes may not develop the disease. In addition, an Alzheimer's disease diagnosis approaches 90 percent accuracy without genetic testing. Therefore, genetic testing is usually not essential, but is recommended in those patients with early onset of symptoms (early onset AD is associated with greater likelihood of a genetic link) and a positive family history.

Most experts regard genetic testing as an acceptable part of clinical trials as long as participants give informed consent and understand the procedure’s purpose and limitations thoroughly. Most experts recommend that the complex analysis involved in characterizing such one-of-a-kind gene mutations be carried out at a major academic center and that individuals receive genetic counseling as part of the testing process. Genetic counselors help people explore emotional and legal implications as well as scientific and technical issues before testing proceeds; after testing is completed, they explain and interpret results and help people accept the outcome.

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