Alzheimer’s disease is a progressive disease that destroys memory and other important mental functions. At first, someone with Alzheimer’s disease may notice mild confusion and difficulty remembering. Eventually, people with the disease may even forget important people in their lives and undergo dramatic personality changes.
Alzheimer’s is the most common cause of dementia among older adults. Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it interferes with a person’s daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living.
Changes in the Brain
Scientists continue to unravel the complex brain changes involved in the onset and progression of Alzheimer’s disease.
It seems likely that damage to the brainstarts a decade or more before memory and other cognitive problems appear. During this preclinical stage of Alzheimer’s disease, people seem to be symptom-free, but toxic changes are taking place in the brain.
Cross sections of the brain show atrophy or shrinking of brain tissue caused by Alzheimer’s disease.
Abnormal deposits of proteins form amyloid plaques and tau tangles throughout the brain, and once-healthy neurons stop functioning, lose connections with other neurons, and die.
The damage initially appears to take place in the hippocampus, the part of the brain essential in forming memories.
As more neurons die, additional parts of the brain are affected, and they begin to shrink. By the final stage of Alzheimer’s, damage is widespread, and brain tissue has shrunk significantly.
Stages of Alzheimer’s disease
Stage 1: Normal Outward Behavior
When one individual is in this early phase, he won’t have any symptoms that can be spot. Only a PET scan, an imaging test that shows how the brain is working, can reveal whether he’s got Alzheimer’s. As he moves into the next 6 stages, patient with Alzheimer’s will see more and more changes in his thinking and reasoning.
Stage 2: Very Mild Changes
You still might not notice anything amiss in your loved one’s behavior, but he may be picking up on small differences, things that even a doctor doesn’t catch. This could include forgetting a word or misplacing objects. At this stage, subtle symptoms of Alzheimer’s don’t interfere with his ability to work or live independently. Keep in mind that these symptoms might not be Alzheimer’s at all, but simply normal changes from aging.
Stage 3: Mild Decline
It’s at this point that you start to notice changes in your loved one’s thinking and reasoning, such as:
Forgets something he just read
Asks the same question over and over
Has more and more trouble making plans or organizing
Can’t remember names when meeting new people
You can help by being your loved one’s “memory” for him, making sure he pays bills and gets to appointments on time. You can also suggest he ease stress by retiring from work and putting his legal and financial affairs in order.
Stage 4: Moderate Decline
During this period, the problems in thinking and reasoning that you noticed in stage 3 get more obvious, and new issues appear. Your friend or family member might:
Forget details about himself
Have trouble putting the right date and amount on a check
Forget what month or season it is
Have trouble cooking meals or even ordering from a menu
You can help with everyday chores and his safety. Make sure he isn’t driving anymore, and that someone isn’t trying to take advantage of him financially.
Stage 5: Moderately Severe Decline
Your loved one might start to lose track of where he is and what time it is. He might have trouble remembering his address, phone number, or where he went to school. He could get confused about what kind of clothes to wear for the day or season. You can help by laying out his clothing in the morning. It can help him dress by himself and keep a sense of independence.
If he repeats the same question, answer with an even, reassuring voice. He might be asking the question less to get an answer and more to just know you’re there. Even if your loved one can’t remember facts and details, he might still be able to tell a story. Invite him to use his imagination at those times.
Stage 6: Severe Decline
As Alzheimer’s progresses, your loved one might recognize faces but forget names. He might also mistake a person for someone else, for instance, thinking his wife is his mother. Delusions might a set in, such as thinking he needs to go to work even though he no longer has a job. You might need to help him go to the bathroom. It might be hard to talk, but you can still connect with him through the senses. Many people with Alzheimer’s love hearing music, being read to, or looking over old photos.
Stage 7: Very Severe Decline
Many basic abilities in a person with Alzheimer’s, such as eating, walking, and sitting up, fade during this period. You can stay involved by feeding your loved one with soft, easy-to-swallow food, helping him use a spoon, and making sure he drinks. This is important, as many people at this stage can no longer tell when they’re thirsty.
History about Alzheimer’s disease
Alzheimer’s disease is named after Dr. Alois Alzheimer. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. Her symptoms included memory loss, language problems, and unpredictable behavior. After she died, he examined her brain and found many abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary, or tau, tangles).
These plaques and tangles in the brain are still considered some of the main features of Alzheimer’s disease. Another feature is the loss of connections between nerve cells (neurons) in the brain. Neurons transmit messages between different parts of the brain, and from the brain to muscles and organs in the body.
Epidemiology of Alzheimer’s in worldwide
Someone in the world develops dementia every 3 seconds. There were an estimated 46.8 million people worldwide living with dementia in 2015 and this number is believed to be close to 50 million people in 2017. This number will almost double every 20 years, reaching 75 million in 2030 and 131.5 million in 2050. Much of the increase will be in developing countries. Already 58% of people with dementia live in low and middle income countries, but by 2050 this will rise to 68%. The fastest growth in the elderly population is taking place in China, India, and their south Asian and western Pacific neighbours. There are over 9.9 million new cases of dementia each year worldwide, implying one new case every 3.2 seconds.
Age: Increasing age is the greatest known risk factor for Alzheimer’s. Alzheimer’s is not a part of normal aging, but your risk increases greatly after you reach age 65. The rate of dementia doubles every decade after age 60.
Family history and genetics: Your risk of developing Alzheimer’s appears to be somewhat higher if a first-degree relative your parent or sibling has the disease. Scientists have identified rare changes (mutations) in three genes that virtually guarantee a person who inherits them will develop Alzheimer’s. But these mutations account for less than 5 percent of Alzheimer’s disease.
Down syndrome: A gene contained in the extra chromosome that causes Down syndrome significantly increases the risk of Alzheimer’s disease.
Sex: Women seem to be more likely than are men to develop Alzheimer’s disease, in part because they live longer.
Mild cognitive impairment: Those with MCI have an increased risk but not a certainty of later developing dementia. Taking action to develop a healthy lifestyle and strategies to compensate for memory loss at this stage may help delay or prevent the progression to dementia.
Past head trauma: People who’ve had a severe head trauma seem to have a greater risk of Alzheimer’s disease.
Lifestyle and heart health: There’s no lifestyle factor that’s been definitively shown to reduce your risk of Alzheimer’s disease. However, some evidence suggests that the same factors that put you at risk of heart disease also may increase the chance that you’ll develop Alzheimer’s. Examples include:
Lack of exercise
Smoking or exposure to secondhand smoke
High blood pressure
High blood cholesterol
Poorly controlled type 2 diabetes
A diet lacking in fruits and vegetables
These risk factors are also linked to vascular dementia, a type of dementia caused by damaged blood vessels in the brain. Working with your health care team on a plan to control these factors will help protect your heart and may also help reduce your risk of Alzheimer’s disease and vascular dementia.
Lifelong learning and social engagement: Studies have found an association between lifelong involvement in mentally and socially stimulating activities and a reduced risk of Alzheimer’s disease. Low education levels which is less than a high school education is appear to be a risk factor for Alzheimer’s disease.
What Causes Alzheimer’s?
Scientists don’t yet fully understand what causes Alzheimer’s disease in most people.
In people with early-onset Alzheimer’s, a genetic mutation is usually the cause.
Late-onset Alzheimer’s arises from a complex series of brain changes that occur over decades.
The causes probably include a combination of genetic, environmental, and lifestyle factors.
The importance of any one of these factors in increasing or decreasing the risk of developing Alzheimer’s may differ from person to person.
Signs and Symptoms
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
Get lost in familiar places
Eventually forget the names of family members and everyday objects
Have trouble finding the right words to identify objects, express thoughts or take part in conversations
Thinking and reasoning
It causes difficulty in concentrating and thinking
Difficulty in multi-tasking such as to manage finances, checkbooks and pay bills on time.
Making judgments and decisions
Responding effectively to everyday problems, such as food burning on the stove or unexpected driving situations, becomes increasingly challenging.
Planning and performing familiar tasks
Once-routine activities that require sequential steps, such as planning and cooking a meal or playing a favorite game, 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:
Distrust in others
Irritability and aggressiveness
Changes in sleeping habits
Loss of inhibitions
Delusions, such as believing something has been stolen
Diagnosis and Testing
To distinguish Alzheimer’s disease from other causes of memory loss, doctors now typically rely on the following types of tests.
Physical and neurological exam
Muscle tone and strength
Ability to get up from a chair and walk across the room
Sense of sight and hearing
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 and neuropsychological testing
Your doctor may conduct a brief mental status test to assess your memory and other thinking skills. In addition, your doctor may suggest a more extensive assessment of your thinking and memory.
Brain-imaging technologies include:
Magnetic resonance imaging (MRI).
Computerized tomography (CT).
Positron emission tomography (PET).
Cerebrospinal fluid examination
Future diagnostic tests
New tools under investigation include:
Additional approaches to brain imaging
More-sensitive tests of mental abilities
Measurement of key proteins or protein patterns in blood or spinal fluid (biomarkers)
Treatment and medications
Treatment for AD affected individual includes:
Maintaining Mental Function
Caring for a person with Alzheimer’s disease
Medications for AD persons includes the following:
Drugs to treat problems with mood, depression, and irritability includes citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).
For people who have anxiety or restlessness, medicines includes alprazolam (Niravam, Xanax), buspirone (BuSpar), lorazepam (Ativan) and oxazepam (Serax).
To ease confusion, aggression, agitation or hallucinations (seeing, hearing, or feeling things that aren’t there) options include aripiprazole (Abilify), haloperidol (Haldol), and olanzapine (Zyprexa).
The U.S. Food and Drug Administration (FDA) has approved five medications (listed below) to treat the symptoms of Alzheimer’s disease.
Drug name Brand name Approved For FDA Approved
Donepezil Aricept All stages 1996
Galantamine Razadyne Mild to moderate 2001
Memantine Namenda Moderate to severe 2003
Rivastigmine Exelon All stages 2000
Donepezil and Memantine Namzaric Moderate to severe 2014
Prevention of AD
Consumption of fruit and vegetable juices was associated with decreased incidence of Alzheimer’s over seven to nine years of follow-up.
Berries contain high levels of biologically active components, including a class of compounds called anthocyanosides, which fight memory impairment associated with free radicals and beta-amyloid plaques in the brain. Eat berries each day for maximum benefit.
Levels of docosahexaenoic acid (DHA) found in fatty fish like salmon, mackerel, and tuna, measured at baseline had lower rates of Alzheimer’s over nine years of follow-up. These fish are all rich in omega-3 fatty acids.
Take folic acid supplements
Drink a glass of red wine or purple grape juice with your evening meal. Components in grape skins protect brain cells from the toxic effect of oxidative stress and beta amyloid
Control your blood pressure
Adherent to the Mediterranean style diet had a lower incidence of Alzheimer’s, compared with those who did not follow this diet.