What is Alzheimer's disease?

Alzheimer's disease is a disease that destroys brain cells. The destruction of cells causes a decline in mental functions that affects memory, thinking, language, and behavior. While the disease can occur in people in their 40s and 50s, it most commonly affects those 65 and older. In fact, about 1 in every 10 people over age 65 is diagnosed with Alzheimer's disease. For every 10 years of life after age 65, the frequency doubles (2 out of 10 over age 75, 4 out of 10 after 85, and so on).

At any one time, about half of those with Alzheimer's are mildly impaired and the other half are severely impaired. Dementia is the most common cause of nursing home placement. Studies estimate that over 4 million Americans have Alzheimer's.

How does it occur?

Brain studies show that chemical and structural changes occur in the brain tissue of people with Alzheimer's disease. These changes interfere with a person's ability to process, store, and retrieve information. It is not known why these changes occur.

Between 5% and 10% of people with Alzheimer's have forms of the disease called familial Alzheimer's. These people have a family history of the disease and show signs of the disease earlier in life, before age 65. Researchers have identified genes that are responsible for some of these forms of Alzheimer's in a small number of these families.

What are the symptoms?

The symptoms of Alzheimer's vary from person to person and change as the disease progresses.

The first symptom is forgetfulness. Everyone begins to have some memory problems as they get older. For a person in the early stages of Alzheimer's, however, these problems are more noticeable than in others of the same age. Forgetting people's names or the location of familiar items is typical. The person's attention span becomes shorter and he or she has more difficulty concentrating. But at this stage of the disease, forgetfulness still has little impact on lifestyle or employment.

After a while memory loss becomes more severe. Coworkers and friends notice the person's memory loss and difficulty understanding written material. The person may misplace or lose valuable objects. As the disease progresses the person can forget even major recent events and personal history and cannot handle financial matters. In general, recent memory is more severely affected than long-term memory.

In later stages of Alzheimer's the person becomes disoriented and confused and can no longer remember major facts about him- or herself and others. Once-familiar objects and people become unfamiliar. Personality and emotional changes may occur. There may be delusions, hallucinations, anxiety, and loss of motivation. The person is often restless and active at night.

Someone with Alzheimer's may not recognize the need for care and may resist help. At first, he or she can go to the bathroom and eat without help. But as brain function decreases, the ability to talk, move, or do any self-care is eventually lost.

How is it diagnosed?

A definite diagnosis of Alzheimer's disease can be made only after death by an examination of the brain tissue. However, the diagnosis of probable Alzheimer's disease can be made after a careful medical history and physical exam.

While there is no diagnostic test for Alzheimer's disease, formal memory testing can be helpful. Blood work and brain scans can help determine if there is a cause of the decline in brain function that can be treated.

It is especially important to rule out the existence of a major depression, a treatable condition that can cause symptoms similar to Alzheimer's.

How is it treated?

There is no cure for Alzheimer's. The goal of treatment is to preserve mental and physical function as much and as long as possible.

The best approach seems to include control of other illnesses, good nutrition, regular exercise, and appropriate activities.

Medication is sometimes helpful. Some doctors believe medications such as tacrin (Cognex) and donepezil (Aricept) can be used early in Alzheimer's to slow the progression of memory loss. Both of these medications are expensive and have side effects that can be difficult to tolerate. More often other medicines may be used to help treat anxiety, depression, and misperceptions, or to restore a normal wake-sleep (day-night) cycle.

Many people who have Alzheimer's are depressed, especially in the earlier stages. Most do not show sadness but more often show loss of pleasure and joy in life. When depression occurs in late stages of Alzheimer's, the person may be combative or agitated and may often refuse food and drink. Depression makes brain function much worse than it otherwise would be. Treatment for the depression is available and effective.

Community resources are very important. The following services may be coordinated through the doctor's office or through the local county health department or visiting nurses association:

• Social workers identify and coordinate help, including possible financial aid.

• Home health care agencies provide the services of skilled professionals, such as nurses, medical social workers, and therapists (physical, occupational, speech, and respiratory). They also provide home health aides for personal care.

• Out-of-home services include adult day care centers; mental health services, including support groups for patients and family caregivers; transportation; and nursing homes.

How long will the effects last?

The brain function of a person who has Alzheimer's disease continues to get worse until the person dies. Death may occur after as few as 3 years or as long as 20 years after the disease is diagnosed.

What can be done to help take care of a person with this disease?

While still possible, the person with Alzheimer's disease should be involved in decision-making about the type and location of care he or she will receive. The fear of abandonment and embarrassment due to the loss of independence and ability to care for oneself are major issues for a person with Alzheimer's. He or she needs frequent, sincere reassurance.

Caregivers, friends, and family, as well as the person with Alzheimer's, should join support groups as soon as possible after diagnosis of the disease. A delicate balance must be maintained between the needs of the person with Alzheimer's and the needs of the family caregivers. The caregivers will become emotionally and physically exhausted if no help or respite is available.

In time, while the person with Alzheimer's is still competent to make legal decisions, he or she should execute a power of attorney for medical and financial matters, including a living will, if desired. A family attorney or doctor may have information or forms for these.

For further information on coping with this disease, contact the Alzheimer's Association National Headquarters at (800) 272-3900.

What can be done to help prevent Alzheimer's disease?

Because the cause of Alzheimer's disease is unknown, there are no known ways to prevent it. However, major advances have been made recently in identifying the brain chemistry and cellular processes that appear to be involved. These discoveries raise hopes that a specific treatment or prevention strategy can be developed. Active research continues in the areas of early diagnosis and early treatment of mental decline. People who have a family history of Alzheimer's should see their doctor on a regular basis. Early diagnosis of the disease will allow them to take advantage of medical advances as they become available.