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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 (AD) 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:

  • Problems controlling bowel movements or urine
  • Swallowing problems

 

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:

  • Anemia
  • Brain tumor
  • Chronic infection
  • Intoxication from medicines
  • Severe depression
  • Increased fluid on the brain (normal pressure hydrocephalus)
  • Stroke
  • Thyroid disease
  • Vitamin deficiency

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. Available at: www.alz.org/facts/downloads/facts_figures_2015.pdf. Accessed September 15, 2015.

Apostolova LG, DeKosky ST, Cummings JL. Dementias. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 66.

Ellison D, Love S, Chimelli L, et al. Dementias. In: Ellison D, Love S, Chimelli L, et al, eds. Neuropathology. 3rd ed. Philadelphia, PA: Elsevier; 2013:chap 31.

Galvin JE, Sadowsky CH; NINCDS-ADRDA. Practical guidelines for the recognition and diagnosis of dementia. J Am Board Fam Med. 2012;25:367-382. 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.

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A Closer Look

 

Talking to your MD

 

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      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. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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