Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills and, eventually even the ability to carry out the simplest tasks of daily living. In most people with Alzheimer’s, symptoms first appear after age 60 but it can precent itself sooner. Alzheimer’s disease is the most common cause of dementia among older people.The 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 tangles).Plaques and tangles in the brain are two of the main features of Alzheimer’s disease. The third is the loss of connections between nerve cells (neurons) in the brain.
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What happens to the brain in Alzheimer's disease?
Although we still don’t know how the Alzheimer’s disease process begins, it seems likely that damage to the brain starts a decade or more before problems become evident. During the preclinical stage of Alzheimer’s disease, people are free of symptoms, but toxic changes are taking place in the brain. Abnormal deposits of proteins form amyloid plaques and tau tangles throughout the brain, and once-healthy neurons begin to work less efficiently. Over time, neurons lose the ability to function and communicate with each other, and eventually they die. Before long, the damage spreads to a nearby structure in the brain called the hippocampus, which is essential in forming memories. As more neurons die, affected brain regions begin to shrink. By the final stage of Alzheimer’s, damage is widespread, and brain tissue has shrunk significantly.
How many Americans have Alzheimer’s disease? Estimates vary, but experts suggest that as many as 5.1 million Americans have Alzheimer’s disease. Unless the disease can be effectively treated or prevented, the number of people with it will increase significantly if current population trends continue. That’s because the risk of Alzheimer’s increases with age, and the U.S. population is aging. The number of people with Alzheimer’s doubles for every 5-year interval beyond age 65.
How long can a person live with Alzheimer’s disease?
Alzheimer’s is a slow disease that progresses in three stages—an early, preclinical stage with no symptoms, a middle stage of mild cognitive impairment, and a final stage of Alzheimer’s dementia. The time from diagnosis to death varies—as little as 3 or 4 years if the person is older than 80 when diagnosed to as long as 10 or more years if the person is
Not everyone will experience the same symptoms or progress at the same rate the 7 stages that I will be going over was developed by Dr.Barry Reisberg clinical director of the New York University of Medicine Silberstein Aging and Dementia Research Center.
Stage 1: | No impairment (normal function)
The person does not experience any memory problems. An interview with a medical professional does not show any evidence of symptoms of dementia. |
Stage 2: | Very mild cognitive decline (may be normal age-related changes or earliest signs of Alzheimer's disease)
The person may feel as if he or she is having memory lapses — forgetting familiar words or the location of everyday objects. But no symptoms of dementia can be detected |
| Stage 3: Mild cognitive decline (early-stage Alzheimer's can be diagnosed in some, but not all, individuals with these symptoms)
Friends, family or co-workers begin to notice difficulties. During a detailed medical interview, doctors may be able to detect problems in memory or concentration. Common stage 3 difficulties include: * Noticeable problems coming up with the right word or name * Trouble remembering names when introduced to new people * Having noticeably greater difficulty performing tasks in social or work settings Forgetting material that one has just read * Losing or misplacing a valuable object * Increasing trouble with planning or organizing |
Stage 4: |
Moderate cognitive decline
(Mild or early-stage Alzheimer's disease)
At this point, a careful medical interview should be able to detect clear-cut symptoms in several areas: * Forgetfulness of recent events * Impaired ability to perform challenging mental arithmetic — for example, counting backward from 100 by 7s * Greater difficulty performing complex tasks, such as planning dinner for guests, paying bills or managing finances * Forgetfulness about one's own personal history * Becoming moody or withdrawn, especially in socially or mentally challenging situations | Stage 5: | Moderately severe cognitive decline
(Moderate or mid-stage Alzheimer's disease)
Gaps in memory and thinking are noticeable, and individuals begin to need help with day-to-day activities. At this stage, those with Alzheimer's may: * Be unable to recall their own address or telephone number or the high school or college from which they graduated * Become confused about where they are or what day it is * Have trouble with less challenging mental arithmetic; such as counting backward from 40 by subtracting 4s or from 20 by 2s * Need help choosing proper clothing for the season or the occasion * Still remember significant details about themselves and their family * Still require no assistance with eating or using the toilet | Stage 6: | Severe cognitive decline
(Moderately severe or mid-stage Alzheimer's disease)
Memory continues to worsen, personality changes may take place and individuals need extensive help with daily activities. At this stage, individuals may: * Lose awareness of recent experiences as well as of their surroundings * Remember their own name but have difficulty with their personal history | Remember:It is difficult to place a person with Alzheimer's in a specific stage as stages may overlap. | | | * Distinguish familiar and unfamiliar faces but have trouble remembering the name of a spouse or caregiver * Need help dressing properly and may, without supervision, make mistakes such as putting pajamas over daytime clothes or shoes on the wrong feet * Experience major changes in sleep patterns — sleeping during the day and becoming restless at night * Need help handling details of toileting (for example, flushing the toilet, wiping or disposing of tissue properly) * Have increasingly frequent trouble controlling their bladder or bowels * Experience major personality and behavioral changes, including suspiciousness and delusions (such as believing that their caregiver is an impostor)or compulsive, repetitive behavior like hand-wringing or tissue shredding * Tend to wander or become lost |
Stage 7: | Very severe cognitive decline
(Severe or late-stage Alzheimer's disease)
In the final stage of this disease, individuals lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement. They may still say words or phrases.At this stage, individuals need help with much of their daily personal care, including eating or using the toilet. They may also lose the ability to smile, to sit without support and to hold their heads up. Reflexes become abnormal. Muscles grow rigid. Swallowing impaired. |
Treatment & Care
Alzheimer's treatment and Alzheimer's care go hand in hand. There's no cure -- yet.
Alzheimer's Disease Medications
Several different types of medications are used to treat the memory loss, behavior changes, sleep problems, and other symptoms of Alzheimer's disease. These medications won't stop the disease, but they can slow down the progression of symptoms for a few months or even years. All of these medications can have side effects, which can be even more pronounced in older people.
Four medications in two classes are FDA-approved specifically for Alzheimer's therapy.
Cholinesterase inhibitors help with the cognitive symptoms of Alzheimer's. They work by preventing the breakdown of a chemical messenger in the brain called acetylcholine, which is important for learning, memory, and attention.
Three cholinesterase inhibitors are approved for Alzheimer's disease therapy: Donepezil (Aricept) is approved to treat mild, moderate, and severe Alzheimer's. Rivastigmine (Exelon) and galantamine (Razadyne) are approved to treat mild to moderate Alzheimer's. Exelon is now also available in a skin patch, which is easier for some patients to use, because it is applied to the skin and the medication is slowly released throughout the day.
Side effects of the cholinesterase inhibitors include nausea, vomiting, diarrhea, weight loss, and dizziness.
Memantine (Namenda) works by regulating the amount of another chemical messenger in the brain, called glutamate. Namenda is approved for moderate to severe Alzheimer's disease. Side effects include dizziness, confusion, headache, constipation, nausea, and agitation. Because Namenda does not work the same way as a cholinesterase inhibitor, it may be used in combination with one.
It's difficult to tell whether one drug is more effective than another for a given person. Alzheimer's patients (with the help of their doctors) should choose whichever drug works best for them.
A few Alzheimer's disease therapies treat the behavioral and psychiatric symptoms that may be related to the disease, including hallucinations, agitation, and sleep problems. However, none of these drugs is FDA-approved as an Alzheimer's therapy. * Antidepressants, such as citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) treat irritability and mood. * Anxiolytics, such as lorazepam (Ativan) and oxazepam (Serax) treat anxiety and restlessness. * Antipsychotic medications, such as aripiprazole (Abilify), haloperidol (Haldol), and olanzapine (Zyprexa) treat hallucinations, delusions, agitation, and aggression. It's important to note that antipsychotic drugs have been linked to increased risk of death in patients with dementia, and currently carry the FDA's "black box" warning about their use in older patients with dementia. They can, however, still be necessary and helpful to many patients. * Other Alzheimer's Therapies * It has been suggested that some non-drug therapies also can help Alzheimer's patients cope with the symptoms of the condition. * Vitamin E . Vitamin E has been researched as a therapy for Alzheimer's disease, because it is an antioxidant that was thought to protect nerve cells from damage. However, many doctors no longer recommend vitamin E, because there is little scientific evidence that it is effective. * Hormone replacement therapy (HRT). Some studies have suggested that postmenopausal women who are taking hormone replacement therapy have a lower risk of developing Alzheimer's disease. The female hormone, estrogen, is thought to help nerve cells make connections, and interfere with the production of beta amyloid -- a protein that is the main component in the plaques that lead to Alzheimer's disease. However, more recent research has found no improvement with HRT, and one study even suggested that estrogen use might actually increase the risk of developing Alzheimer's rather than protect against it. HRT also may increase the risk for heart attack, stroke, and breast cancer. * Sensory therapies. There is some evidence that sensory therapies such as music therapy and art therapy can improve Alzheimer's patients' mood, behavior, and day-to-day function. By stimulating the senses, these therapies may help trigger memory recall and enable Alzheimer's patients to reconnect with the world around them. * Alternative therapies. Some people have tried alternative remedies, including coenzyme Q10, coral calcium, huperzine A, and omega-3 fatty acids to prevent or treat Alzheimer's disease. However, there is not yet enough research on these treatments to recommend using any of them as an Alzheimer's therapy. The FDA does not regulate supplements as it does medications and there is not standard to prove efficacy. Supplements may cause dangerous side effects or interact with other medications patients are taking. Just because it is sold over the counter without a prescription does not guarantee that it will be safe for you. * Researchers are looking into several new treatment options for Alzheimer's. One of the most promising Alzheimer's therapies in development focuses on beta amyloid. Researchers are trying to develop new therapies that prevent beta amyloid from forming, or break it down before it leads to Alzheimer's.
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