Facts You Should Know
Alzheimer’s disease (AD) is an often misunderstood illness. It is not just about losing your memory. Alzheimer’s slowly overtakes your brain and its functions. Sufferers gradually lose their ability to learn, reason, make decisions, communicate and perform daily activities. Symptoms of this irreversible, progressive brain disease generally appear after age 60. Although not all memory loss indicates Alzheimer’s disease, one in ten people over 65—and over half of those over 85—have fallen victim. Currently, 26 million individuals worldwide have this dementia and over 15 million Americans will be affected by 2050.
Alzheimer’s disease is the most common cause of dementia among the elderly. Dementia is the loss of cognitive functioning — thinking, remembering, and reasoning — and behavioral abilities to the extent that it interferes with your daily life and activities. Dementia ranges in severity from mild, when it is just starting to affect a person’s functioning, to the most severe stage, when an individual must depend completely on others for even the most basic of activities.
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 difficulties and irregular behavior. Following her death, he examined her brain and discovered many irregular clumps (amyloid plaques) and tangled bundles of fibers (neurofibrillary tangles). Plaques and tangles in the brain are two of the main indicators of AD. The third is the loss of connections between nerve cells (neurons) in the brain.
Popular belief is that Alzheimer’s is an “old person’s” disease. Not so. Even those in their 40s and 50s can be afflicted. Two types of Alzheimer’s have been identified: early and late onset. Late onset is more common. Affecting individuals over 60, this type of AD is less likely to be genetic. Studies have linked the apolipoprotein E (APOE) gene to late-onset Alzheimer’s. This gene has several forms. One of them, APOE ε4, seems to increase your risk of getting the disease. Carrying this form of the gene, however, doesn't necessarily mean you will develop AD and those not carrying the gene can contract the disease.
Early-onset Alzheimer’s is rare. Occurring in those ages 30 to 60, it represents less than 5 percent of all who have the disease. Most cases of early-onset Alzheimer’s are caused by changes in one of three known genes inherited from a parent. While this type of AD accounts for only 5 to 10 percent of all instances, progression is faster and it has been known to occur within families.
Forgetting where you left your car keys is probably a sign of aging. Not remembering what those keys are used for may signal a more serious problem. Unlike the expected lapses in memory that come with getting older, Alzheimer’s sufferers have more instances of forgetfulness than most persons over 60. These individuals also have trouble processing and retaining new facts or remembering the names of familiar persons and things.
- Memory loss that affects performing everyday activities
- Difficulty performing familiar acts, such as brushing your hair
- Language problems that result in forgetting words or creating new ones
- Being confused about time and place
- Impaired judgment
- Unable to think abstractly
- Difficulty placing objects in their proper location
- Sudden mood swings
- Changes in your behavior or personality
- Lack of interest in performing once-enjoyed activities
Alzheimer’s disease is divided into stages with each one having specific symptoms. Keep in mind, however, that not everybody experiences the same symptoms or progresses at the same rate. Individuals in the first stage show only a slight decline in cognitive functioning and memory and may, in fact, have no noticeable symptoms. Stage 2 sufferers also exhibit only minor cognitive decline. At the same time they might have trouble recalling common words and expressions or where they have placed things like car keys or eyeglasses.
Three and Four
Stage 3 produces difficulty concentrating. Persons aren’t able to remember words or names of people they recently met. They also misplace valuables; have limited reading comprehension; can’t make plans or organize; and act inappropriately in public. Stage 4 features moderate cognitive deterioration: individuals can’t recall recent events; have trouble solving mathematical problems; are withdrawn socially; and have few personal memories.
This stage of AD is identified by a severe decline in cognitive functioning. Sufferers need help choosing the right clothing; forget where they live and/or their telephone number; and are uncertain about where they are, the season of the year and the current day of the week and date. They can remember their name and the names of family members and can eat and use the bathroom on their own.
Six and Seven
The most serious cognitive decline occurs in Stage 6. Individuals can identify familiar faces and know their own name. They do, however, need help dressing, bathing and with some elements of personal hygiene; wander or get lost; exhibit changes in behavior; and may form irregular sleeping patterns. Stage 7—or the “late-stage”—is the most severe. Sufferers can't react to their surroundings, communicate verbally or be in command of their actions. They slowly become unable to walk, sit up or raise their head. It becomes hard to swallow, muscles stiffen and reflexes become irregular.
Early Alzheimer's Issues
- Telling others about your diagnosis is one of the most difficult steps for you and your caregivers. You may have some anxiety about who to tell and worry about social disgrace. Be open with your friends and family about the changes that are taking place. Educate them on the disease and tell them how they can be supportive.
- Even if changes are small at first, someone with early-stage Alzheimer's will have different needs than they did before their diagnosis. Support is critical. Your caregiver will need a support system in place, too. They may be worried about how your relationship may change or feel disconnected from friends and family. It is important to know that you aren't alone and that help is available.
- Plan for your future.Talk with your family about things that will need to be addressed later. One of the most important things to do is get your legal, financial and personal/medical care plans in order, including designating a durable power of attorney and health care proxy and preparing a living will. Doing so will allow you to express your wishes about future decisions and work through the issues involved in long-term care. It's also a good time discuss future safety concerns like what to do when driving is longer an option or you can't live alone anymore.
- If you have been diagnosed with early-stage Alzheimer's it is important to stay as engaged and active as possible for as long as you can. Spend time with your friends and family. Continue to participate in your favorite activities eat well and exercise regularly.
- With support and resources, many people in the early stages of Alzheimer's live independently. If you live alone, your family members and/or caregivers should stay involved. They should try to call or visit every day and make sure you get the assistance you need, such as help with housekeeping, meals, transportation, finances and other daily chores. Home safety measures should be put in place and you should be aware of any changes that would indicate you need additional supervision or care.
- Remember there will be good days and bad days.
Presently there is no known cure for Alzheimer's but there are treatments for symptoms. Research also continues to find better ways to treat it, delay its onset and prevent it from developing. Although current treatments can't keep AD from progressing, they can temporarily slow the symptoms and improve your quality of life.
Medications for Early Alzheimer's Disease
The prescription medications approved to treat early to moderate Alzheimer's are from a class of drugs called cholinesterase inhibitors. They treat symptoms related to memory, thinking, language, judgment and other thought processes.
Cholinesterase inhibitors behave in the following ways:
- Prevent the breakdown of acetylcholine, a chemical messenger critical for learning and memory
- Delay worsening of symptoms for 6 to 12 months, on average, for about one-half of those who take them
- Are generally well tolerated but side effects may occur including nausea, vomiting, decreased appetite and increased bowel movements
These are the most commonly prescribed Cholinesterase inhibitors:
- Donepezil (Aricept) is approved for all stages.
- Rivastigmine (Exelon) is approved for mild to moderate.
- Galantamine (Razadyne) is approved for mild to moderate Alzheimer's.
Here is a list of helpful resources for more information on early Alzheimer's disease for sufferers, their families and caregivers.
Alzheimer's Disease Education and Referral (ADEAR) Center
Silver Springs, MD
Administration on Aging
Visit the National Institute on Aging and the National Library of Medicine's senior-friendly website for more health information for older adults. The site's special features allow you to click on a button to have the text read out loud or to enlarge the type.
Written by home care expert Mary S. Yamin-Garone.