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Alzheimer disease

Senile dementia - Alzheimer type (SDAT); SDAT; Dementia - Alzheimer

Dementia is a loss of brain function that occurs with certain diseases. Alzheimer disease is one form of dementia. It affects memory, thinking, and behavior.

Causes

The exact cause of Alzheimer disease (AD) is not known. Research shows that certain changes in the brain lead to AD.

You are more likely to develop AD if you:

  • Are older. Developing AD is not a part of normal aging.
  • Have a close relative, such as a brother, sister, or parent with AD.
  • Have certain genes linked to AD.

The following may also increase the risk:

  • Being female
  • Having heart and blood vessel problems due to high cholesterol
  • History of head trauma

There are two types of AD:

  • Early onset AD. Symptoms appear before age 60. This type is much less common than late onset. It tends to get worse quickly. Early onset disease can run in families. Several genes have been identified.
  • Late onset AD. This is the most common type. It occurs in people age 60 and older. It may run in some families, but the role of genes is less clear.

Symptoms

AD symptoms include difficulty with many areas of mental function, including:

  • Emotional behavior or personality
  • Language
  • Memory
  • Perception
  • Thinking and judgment (cognitive skills)

AD usually first appears as forgetfulness.

Mild cognitive impairment (MCI) is the stage between normal forgetfulness due to aging, and the development of AD. People with MCI have mild problems with thinking and memory that do not interfere with daily activities. They are often aware of the forgetfulness. Not everyone with MCI develops AD.

Symptoms of MCI include:

  • Difficulty performing more than one task at a time
  • Difficulty solving problems
  • Forgetting recent events or conversations
  • Taking longer to perform more difficult activities

Early symptoms of AD can include:

  • Difficulty performing tasks that take some thought, but used to come easily, such as balancing a checkbook, playing complex games (bridge), and learning new information or routines
  • Getting lost on familiar routes
  • Language problems, such as trouble remembering the names of familiar objects
  • Losing interest in things previously enjoyed and being in a flat mood
  • Misplacing items
  • Personality changes and loss of social skills

As AD becomes worse, symptoms are more obvious and interfere with the ability to take care of oneself. Symptoms may include:

  • Change in sleep patterns, often waking up at night
  • Delusions, depression, and agitation
  • Difficulty doing basic tasks, such as preparing meals, choosing proper clothing, and driving
  • Difficulty reading or writing
  • Forgetting details about current events
  • Forgetting events in one's life history and losing self-awareness
  • Hallucinations, arguments, striking out, and violent behavior
  • Poor judgment and loss of ability to recognize danger
  • Using the wrong word, mispronouncing words, or speaking in confusing sentences
  • Withdrawing from social contact

People with severe AD can no longer:

  • Recognize family members
  • Perform basic activities of daily living, such as eating, dressing, and bathing
  • Understand language

Other symptoms that may occur with AD:

Exams and Tests

A skilled health care provider can often diagnose AD with the following steps:

  • Performing a complete physical exam, including a nervous system exam
  • Asking about the person's medical history and symptoms
  • Mental function tests (mental status examination)

A diagnosis of AD is made when certain symptoms are present, and by making sure other causes of dementia are not present.

Tests may be done to rule out other possible causes of dementia, including:

CT or MRI of the brain may be done to look for other causes of dementia, such as a brain tumor or stroke. Sometimes, a PET scan can be used to rule out AD.

The only way to know for certain that someone has AD is to examine a sample of their brain tissue after death.

Treatment

There is no cure for AD. The goals of treatment are:

  • Slow the progression of the disease (although this is difficult to do)
  • Manage symptoms, such as behavior problems, confusion, and sleep problems
  • Change the home environment to make daily activities easier
  • Support family members and other caregivers

Medicines are used to:

  • Slow the rate at which symptoms worsen, though the benefit from using these drugs may be small
  • Control problems with behavior, such as loss of judgment or confusion

Before using these medicines, ask the provider:

  • What are the side effects? Is the medicine worth the risk?
  • When is the best time, if any, to use these medicines?
  • Do medicines for other health problems need to be changed or stopped?

Someone with AD will need support in the home as the disease gets worse. Family members or other caregivers can help by helping the person cope with memory loss and behavior and sleep problems. It is important to make sure the home of a person who has AD is safe for them.

Support Groups

Having AD or caring for a person with the condition may be a challenge. You can ease the stress of illness by seeking support through AD resources. Sharing with others who have common experiences and problems can help you not feel alone.

Outlook (Prognosis)

How quickly AD gets worse is different for each person. If AD develops quickly, it is more likely to worsen quickly.

People with AD often die earlier than normal, although a person may live anywhere from 3 to 20 years after diagnosis.

Families will likely need to plan for their loved one's future care.

The final phase of the disease may last from a few months to several years. During that time, the person becomes totally disabled. Death usually occurs from an infection or organ failure.

When to Contact a Medical Professional

Call the provider if:

  • AD symptoms develop or a person has a sudden change in mental status
  • The condition of a person with AD gets worse
  • You are unable to care for a person with AD at home

Prevention

Although there is no proven way to prevent AD, there are some measures that may help prevent or slow the onset of AD:

  • Stay on a low-fat diet and eat foods high in omega-3 fatty acids.
  • Get plenty of exercise.
  • Stay mentally and socially active.
  • Wear a helmet during risky activities to prevent brain injury.

References

Alzheimer's Association. 2015 Alzheimer's Disease Facts and Figures. Washington, DC: Alzheimer's Association. www.alz.org/facts/downloads/facts_figures_2015.pdf. Accessed September 15, 2015.

Galvin JE, Sadowsky CH; NINCDS-ADRDA. Practical guidelines for the recognition and diagnosis of dementia. J Am Board Fam Med. 2012;25(3):367-382. PMID: 22570400 www.ncbi.nlm.nih.gov/pubmed/22570400.

Knopman DS. Alzheimer disease and other dementias. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 402.

Mitchell SL. CLINICAL PRACTICE. Advanced dementia. N Engl J Med. 2015;372(26):2533-2540. PMID: 26107053 www.ncbi.nlm.nih.gov/pubmed/26107053.

Peterson R, Graff-Radford J. Alzheimer disease and other dementias. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. Philadelphia, PA: Elsevier; 2016:chap 95.

    • Alzheimer disease

      Animation

    •  

      Alzheimer disease - Animation

      In a person with Alzheimer disease, neurofibrillary tangles and plaques develop causing both structural and chemical problems in the brain. Alzheimer disease appears to disconnect areas of the brain that normally work together.

    • Alzheimer disease

      Animation

    •  

      Alzheimer disease - Animation

      Imagine waking up this morning, and not being able to remember your own name, or recognize your spouse? While Alzheimer disease is a more gradual process, over time it can destroy memory to the point where people can't even remember the simplest and most important details of their lives. Let's talk more about Alzheimer disease. Alzheimer disease is a type of dementia, a loss of brain function that makes it harder and harder to think and speak. To understand what causes Alzheimer, we need to look inside the brain. In a normal brain, nerves send messages to one another. In people with Alzheimer disease, abnormal proteins clump in the brain, damaging nerve cells so they can no longer send the messages needed to think clearly. So, why do some people get Alzheimer, and others do not? Getting older itself doesn't cause Alzheimer disease. It's not a part of the normal aging process. Alzheimer does seem to run in families, though. So if you have a close relative, like a sister or parent, with Alzheimer, you may be more likely to get the disease. Usually when Alzheimer disease starts, people have trouble remembering simple things, like their phone number, or where they put their car keys. But, as the disease progresses, memory loss gets worse. People with Alzheimer find it hard to have conversations or complete simple tasks, like getting dressed. They can also become angry or depressed. Those in the later stages of the disease can no longer care for themselves. They lose the ability to recognize even close family members. To diagnose Alzheimer disease, doctors prescribe tests of mental ability. They also prescribe medical tests to rule out diseases that can make it harder to think clearly, such as a brain tumor or stroke. As far as treatments for Alzheimer disease, right now, there isn't a cure. A few drugs can slow memory loss and control depression and aggressiveness from the disease. Despite what you may have read, there isn't any proof that vitamins or other supplements can prevent or treat Alzheimer. However, eating a low-fat diet that's high in vitamin E and C, and rich in omega-3 fatty acids may keep your brain healthier. Alzheimer disease is different in each person. Some people decline quickly and die within just a few years, while others can live for two decades with the disease. If you have a family member with Alzheimer, talk to your doctor about ways to protect your own memory. And, call right away if you have any significant memory loss. Though it may be normal forgetfulness that comes with getting older, the sooner you get it checked out, the earlier you can start treatment if you need it.

    • Alzheimer disease

      Alzheimer disease - illustration

      Aged nervous tissue is less able to rapidly communicate with other neural tissues.

      Alzheimer disease

      illustration

    • Alzheimer disease

      Animation

    •  

      Alzheimer disease - Animation

      In a person with Alzheimer disease, neurofibrillary tangles and plaques develop causing both structural and chemical problems in the brain. Alzheimer disease appears to disconnect areas of the brain that normally work together.

    • Alzheimer disease

      Animation

    •  

      Alzheimer disease - Animation

      Imagine waking up this morning, and not being able to remember your own name, or recognize your spouse? While Alzheimer disease is a more gradual process, over time it can destroy memory to the point where people can't even remember the simplest and most important details of their lives. Let's talk more about Alzheimer disease. Alzheimer disease is a type of dementia, a loss of brain function that makes it harder and harder to think and speak. To understand what causes Alzheimer, we need to look inside the brain. In a normal brain, nerves send messages to one another. In people with Alzheimer disease, abnormal proteins clump in the brain, damaging nerve cells so they can no longer send the messages needed to think clearly. So, why do some people get Alzheimer, and others do not? Getting older itself doesn't cause Alzheimer disease. It's not a part of the normal aging process. Alzheimer does seem to run in families, though. So if you have a close relative, like a sister or parent, with Alzheimer, you may be more likely to get the disease. Usually when Alzheimer disease starts, people have trouble remembering simple things, like their phone number, or where they put their car keys. But, as the disease progresses, memory loss gets worse. People with Alzheimer find it hard to have conversations or complete simple tasks, like getting dressed. They can also become angry or depressed. Those in the later stages of the disease can no longer care for themselves. They lose the ability to recognize even close family members. To diagnose Alzheimer disease, doctors prescribe tests of mental ability. They also prescribe medical tests to rule out diseases that can make it harder to think clearly, such as a brain tumor or stroke. As far as treatments for Alzheimer disease, right now, there isn't a cure. A few drugs can slow memory loss and control depression and aggressiveness from the disease. Despite what you may have read, there isn't any proof that vitamins or other supplements can prevent or treat Alzheimer. However, eating a low-fat diet that's high in vitamin E and C, and rich in omega-3 fatty acids may keep your brain healthier. Alzheimer disease is different in each person. Some people decline quickly and die within just a few years, while others can live for two decades with the disease. If you have a family member with Alzheimer, talk to your doctor about ways to protect your own memory. And, call right away if you have any significant memory loss. Though it may be normal forgetfulness that comes with getting older, the sooner you get it checked out, the earlier you can start treatment if you need it.

    • Alzheimer disease

      Alzheimer disease - illustration

      Aged nervous tissue is less able to rapidly communicate with other neural tissues.

      Alzheimer disease

      illustration

    A Closer Look

     

    Talking to your MD

     

    Review Date: 8/13/2015

    Reviewed By: Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Internal review and update on 09/01/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

    The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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