Alzheimer's Disease
Overview
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Alzheimer's disease is a progressive disease that destroys memory and other important mental functions. It's the most common cause of dementia These changes are severe enough to interfere with day-to-day life. In Alzheimer's disease, the connections between brain cells and the brain cells themselves degenerate and die, causing a steady decline in memory and mental function.
Causes and Symptoms
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Causes:
Scientists believe that for most people, Alzheimer's disease results from a combination of genetic, lifestyle and environmental factors that affect the brain over time. Alzheimer's is caused by specific genetic changes that virtually guarantee a person will develop the disease. Although the causes of Alzheimer's are not yet fully understood, its effect on the brain is clear. Alzheimer's disease damages and kills brain cells. A brain affected by Alzheimer's disease has a lot less cells and a lot less connections among surviving cells than a healthy brain. As more and more brain cells die, significant brain shrinkage occurs. When doctors examine Alzheimer's brain tissue under the microscope, they see two types of abnormalities that are considered hallmarks of the disease:
Symptoms:
At first, increasing forgetfulness or mild confusion may be the only symptoms of Alzheimer's disease that you notice. But over time, the disease causes the person to lose more and more of their memory, especially recent memories. If you have Alzheimer's, you may be the first to notice that you're having unusual difficulty remembering things and organizing your thoughts. Brain changes associated with Alzheimer's disease lead to growing trouble with:
Memory: The memory loss associated with Alzheimer's disease persists and worsens, affecting your ability to function at work and at home. People with Alzheimer's may:
Disorientation and misinterpreting spatial relationships: People with Alzheimer's disease may lose their sense of their current life circumstances, dates, etc. Alzheimer's may also disrupt your brain's ability to interpret what you see, making it difficult to understand your surroundings. Eventually, these problems may lead to getting lost in familiar places.
Speaking and writing: Those with Alzheimer's may have trouble finding the right words to identify objects, expressing their thoughts or taking part in conversations. Over time, the ability to read and write also declines.
Thinking and reasoning: Alzheimer's disease causes difficulty concentrating and thinking, especially about abstract concepts like numbers. These difficulties may progress to the inability to recognize and deal with numbers.
Making judgments and decisions: Responding effectively to everyday problems, such as food burning on the stove, becomes increasingly challenging.
Planning and performing familiar tasks: Once-routine activities that require sequential steps, such as planning and cooking a meal, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer's may forget how to perform basic tasks such as dressing and bathing.
Changes in personality and behavior: Brain changes that occur in Alzheimer's disease can affect the way you act and how you feel. People with Alzheimer's may experience:
Scientists believe that for most people, Alzheimer's disease results from a combination of genetic, lifestyle and environmental factors that affect the brain over time. Alzheimer's is caused by specific genetic changes that virtually guarantee a person will develop the disease. Although the causes of Alzheimer's are not yet fully understood, its effect on the brain is clear. Alzheimer's disease damages and kills brain cells. A brain affected by Alzheimer's disease has a lot less cells and a lot less connections among surviving cells than a healthy brain. As more and more brain cells die, significant brain shrinkage occurs. When doctors examine Alzheimer's brain tissue under the microscope, they see two types of abnormalities that are considered hallmarks of the disease:
- Plaques: These clumps of a protein may damage and destroy brain cells in several ways, including interfering with cell-to-cell communication. Although the ultimate cause of brain-cell death in Alzheimer's isn't known, the collection of this protein on the outside of brain cells is a prime suspect.
- Tangles: Brain cells depend on an internal support and transport system to carry nutrients and other essential materials throughout their long extensions. This system requires the normal structure and functioning of a protein called tau. In Alzheimer's, threads of tau protein twist into abnormal tangles inside brain cells, leading to failure of the transport system.
Symptoms:
At first, increasing forgetfulness or mild confusion may be the only symptoms of Alzheimer's disease that you notice. But over time, the disease causes the person to lose more and more of their memory, especially recent memories. If you have Alzheimer's, you may be the first to notice that you're having unusual difficulty remembering things and organizing your thoughts. Brain changes associated with Alzheimer's disease lead to growing trouble with:
Memory: The memory loss associated with Alzheimer's disease persists and worsens, affecting your ability to function at work and at home. People with Alzheimer's may:
- Repeat statements and questions over and over, not realizing that they've asked the question before
- Forget conversations, appointments or events, and not remember them later
- Routinely misplace possessions, often putting them in illogical locations
- Eventually forget the names of family members and everyday objects
Disorientation and misinterpreting spatial relationships: People with Alzheimer's disease may lose their sense of their current life circumstances, dates, etc. Alzheimer's may also disrupt your brain's ability to interpret what you see, making it difficult to understand your surroundings. Eventually, these problems may lead to getting lost in familiar places.
Speaking and writing: Those with Alzheimer's may have trouble finding the right words to identify objects, expressing their thoughts or taking part in conversations. Over time, the ability to read and write also declines.
Thinking and reasoning: Alzheimer's disease causes difficulty concentrating and thinking, especially about abstract concepts like numbers. These difficulties may progress to the inability to recognize and deal with numbers.
Making judgments and decisions: Responding effectively to everyday problems, such as food burning on the stove, becomes increasingly challenging.
Planning and performing familiar tasks: Once-routine activities that require sequential steps, such as planning and cooking a meal, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer's may forget how to perform basic tasks such as dressing and bathing.
Changes in personality and behavior: Brain changes that occur in Alzheimer's disease can affect the way you act and how you feel. People with Alzheimer's may experience:
- Depression
- Social withdrawal
- Mood swings
- Distrust in others
- Irritability and aggressiveness
- Changes in sleeping habits
- Wandering
- Loss of inhibitions
- Delusions, such as believing something has been stolen
Diagnosis and Cures
Diagnosis:
There's no specific test today that confirms you have Alzheimer's disease. Doctors can nearly always determine whether you have dementia, and they can often identify whether your dementia is due to Alzheimer's disease. Alzheimer's disease can be diagnosed with complete accuracy only after death, when microscopic examination of the brain reveals the characteristic plaques and tangles. To help distinguish Alzheimer's disease from other causes of memory loss, doctors now typically rely on the following types of tests:
Physical and neurological exam: Your doctor will perform a physical exam, and is likely to check your overall neurological health by testing your:
Lab tests: Blood tests may help your doctor rule out other potential causes of memory loss and confusion, such as thyroid disorders or vitamin deficiencies.
Mental status testing: Your doctor may conduct a brief mental status test to assess your memory and other thinking skills.
Neuropsychological testing: Longer forms of neuropsychological testing may provide additional details about your mental function compared with other people's of a similar age and education level.
Brain imaging: Images of the brain are now used to pinpoint visible abnormalities related to conditions other than Alzheimer's disease — such as strokes, trauma or tumors — that may cause change. New imaging applications may enable doctors to detect specific brain changes caused by Alzheimer's. Brain-imaging technologies include:
Cures:
As of now, there are no cures for Alzheimer's. However, there are many things that one can do to reduce the symptoms of Alzheimer's:
Drugs: Current Alzheimer's medications can help for a time with memory symptoms and other cognitive changes. Two types of drugs are currently used to treat cognitive symptoms:
Creating a safe and supportive environment: Adapting the living situation to the needs of a person with Alzheimer's is an important part of any treatment plan. You can take these steps to support a person's sense of well-being and continued ability to function:
Exercise: Activities like a daily 30-minute walk can help improve mood and maintain the health of joints, muscles and your heart. People with Alzheimer's who develop trouble walking may still be able to use a stationary bike or participate in chair exercises.
There's no specific test today that confirms you have Alzheimer's disease. Doctors can nearly always determine whether you have dementia, and they can often identify whether your dementia is due to Alzheimer's disease. Alzheimer's disease can be diagnosed with complete accuracy only after death, when microscopic examination of the brain reveals the characteristic plaques and tangles. To help distinguish Alzheimer's disease from other causes of memory loss, doctors now typically rely on the following types of tests:
Physical and neurological exam: Your doctor will perform a physical exam, and is likely to check your overall neurological health by testing your:
- Reflexes
- Muscle tone and strength
- Ability to get up from a chair and walk across the room
- Sense of sight and hearing
- Coordination
- Balance
Lab tests: Blood tests may help your doctor rule out other potential causes of memory loss and confusion, such as thyroid disorders or vitamin deficiencies.
Mental status testing: Your doctor may conduct a brief mental status test to assess your memory and other thinking skills.
Neuropsychological testing: Longer forms of neuropsychological testing may provide additional details about your mental function compared with other people's of a similar age and education level.
Brain imaging: Images of the brain are now used to pinpoint visible abnormalities related to conditions other than Alzheimer's disease — such as strokes, trauma or tumors — that may cause change. New imaging applications may enable doctors to detect specific brain changes caused by Alzheimer's. Brain-imaging technologies include:
- Computerized tomography (CT): X-rays pass through your body from various angles, and a computer uses this information to create slices of your brain. It's mainly used to rule out tumors, strokes and head injuries.
- Magnetic resonance imaging (MRI): An MRI uses radio waves and a strong magnetic field to produce detailed images of your brain. MRIs are mainly used to rule out other conditions that may account for cognitive symptoms.
- Positron emission tomography (PET): During a PET scan, you'll be injected in a vein with a low-level radioactive tracer. An overhead scanner tracks the tracer's flow through your brain. The tracer may be a special form of glucose that shows overall activity in various brain regions. This can show which parts of your brain aren't functioning well.
Cures:
As of now, there are no cures for Alzheimer's. However, there are many things that one can do to reduce the symptoms of Alzheimer's:
Drugs: Current Alzheimer's medications can help for a time with memory symptoms and other cognitive changes. Two types of drugs are currently used to treat cognitive symptoms:
- Cholinesterase inhibitors: These drugs work by boosting levels of a cell-to-cell communication chemical depleted in the brain by Alzheimer's disease. Most people can expect to keep their current symptoms at bay for a time. Less than half of those taking these drugs can expect to have any improvement. Commonly prescribed cholinesterase inhibitors include donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon). The main side effects of these drugs include diarrhea, nausea and sleep disturbances.
- Memantine: This drug works in another brain cell communication network and slows the progression of symptoms with moderate to severe Alzheimer's disease. It's sometimes used in combination with a cholinesterase inhibitor.
Creating a safe and supportive environment: Adapting the living situation to the needs of a person with Alzheimer's is an important part of any treatment plan. You can take these steps to support a person's sense of well-being and continued ability to function:
- Remove excess furniture, clutter and throw rugs.
- Install sturdy handrails on stairways and in bathrooms.
- Ensure that shoes and slippers are comfortable and provide good traction.
- Reduce the number of mirrors. People with Alzheimer's may find images in mirrors confusing or frightening.
Exercise: Activities like a daily 30-minute walk can help improve mood and maintain the health of joints, muscles and your heart. People with Alzheimer's who develop trouble walking may still be able to use a stationary bike or participate in chair exercises.