• Alzheimer's Disease

    (Alzheimer's Dementia)

    Definition

    Alzheimer's disease is a condition that destroys brain cells. People with this disease slowly lose the ability to learn, function, and remember. It is the most common cause of dementia. Dementia is a loss in mental abilities that is great enough to interfere with daily life.
    Areas of the Brain Affected by Alzheimer's Disease
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Causes

    The cause of Alzheimer's is not yet known. Two factors that may play a role in the development of Alzheimer's disease are:
    • Plaques—Abnormal deposits of a substance called beta amyloid in different areas of the brain
    • Neurofibrillary tangles—Twisted fibers (called tau fibers) within the nerve cells

    Risk Factors

    Factors that may increase your chance of Alzheimer's disease include:
    • Age: 65 and older
    • Previous serious, traumatic brain injury
    • Lower educational achievement
    • Down's syndrome
    • Down's syndrome in a first-degree relative
    • Women under age 35 who give birth to a child with Down's syndrome
    • Smoking
    • Family history of Alzheimer's disease
    • Presence of a certain type of protein (APOE-e4)
    • Depression
    • Elevated levels of homocysteine
    • Heart disease
    Researchers are studying the following to see if they are related to Alzheimer's disease:
    • Poor nutrition and vitamin deficiency in childhood
    • Excess metal in the blood, especially zinc, copper, aluminum, and iron
    • Certain viral infections
    • Diabetes
    • High cholesterol

    Symptoms

    The disease begins as mild memory lapses. It will continue toward a profound loss of memory and function. Alzheimer's disease is divided into three stages:
    • Early—Loss of memory, reasoning, understanding, or learning, but does not interfere with independence
    • Intermediate—Increased mental loss, personality changes, and increased dependence on others for basic needs
    • Severe—Loss of personality and bodily functions with total dependence on others for care
    Symptoms include:
      Increasing trouble remembering things, such as:
      • How to get to familiar locations
      • What the names of family and friends are
      • Where common objects are usually kept
      • How to do simple math
      • How to do usual tasks, such as cooking, dressing, bathing, etc.
    • Having difficulty concentrating on tasks
    • Having difficulty completing sentences due to lost or forgotten words (may progress to complete inability to speak)
    • Forgetting the date, time of day, or season
    • Getting lost in familiar surroundings
    • Having mood swings
    • Being withdrawn, losing interest in usual activities
    • Having personality changes
    • Walking in a slow, shuffling way
    • Having poor coordination
    • Losing purposeful movement

    Diagnosis

    There are no tests to confirm Alzheimer's. The doctor will ask about your symptoms and medical history. A physical exam will be done. The doctor will ask many questions. This will help to rule out other causes.
    Tests to rule out other medical conditions may include:
    • Neurological exams—Tests of your nervous system
    • Psychological and mental status testing
    • CT scan—A type of x-ray that uses a computer to make pictures of your brain
    • MRI scan—A test that uses magnetic waves to make pictures of your brain
    • Electroencephalogram (EEG)—A test that measures electrical currents in your brain
    • Blood tests and urine tests
    • Lumbar puncture—To test for levels of certain brain proteins that increase with Alzheimer’s disease and to rule out other disorders
    • Positron emission tomography (PET) scan of the brain—A test that makes images showing activity in your brain

    Treatment

    There is no cure for Alzheimer's disease. There are no certain ways to slow its progression. Four medicines are available to treat some of the symptoms. Other drugs are being studied. The goal is to find a medicine that can manage the symptoms or slow the condition's course.

    Medications for Symptoms and Disease Progression

    Only two types of medicines have been approved to reduce the symptoms of Alzheimer's disease:
    • Cholinesterase inhibitors—Recommended for mild-to-moderate Alzheimer's disease (may be called donepezil [Aricept], rivastigmine [Exelon], galantamine [Reminyl])
    • N-methyl-D-aspartate (NMDA) receptor antagonist—For moderate-to-severe Alzheimer's disease (may be called memantine)
    Treatments that are being studied include:
    • Gamma-secretase inhibitors
    • Tau fiber aggregation inhibitors
    • Herbs and supplements (such as vitamin E, ginkgo biloba)

    Lifestyle Management

    Managing the disease includes:
    • Creating an environment in which you can receive the care you need
    • Keeping your quality of life as high as possible
    • Keeping yourself safe
    • Helping yourself learn to deal with the frustration of your uncontrollable behavior
    • Providing a calm, quiet, predictable environment
    • Providing appropriate eyewear and hearing aids, and easy-to-read clocks and calendars
    • Playing quiet music
    • Doing light, appropriate exercise to reduce agitation and relieve depression
    • Encouraging family and close friends to visit frequently

    Psychiatric Medication

    Psychiatric symptoms may occur with Alzheimer’s disease. Your doctor may prescribe medicine to treat:
    • Depression
    • Anxiety
    • Confusion, paranoia, and hallucinations

    Caregiver Support

    Caring for a person with Alzheimer's disease is extremely difficult and exhausting. The primary caregiver needs emotional support, rest, and regular breaks.
    If you are diagnosed with Alzheimer's disease, follow your doctor's instructions.
    If you are diagnosed with Alzheimer's disease, follow your doctor's instructions.

    Prevention

    There are no guidelines for preventing Alzheimer's disease because the exact cause is unknown. However, the following factors may help you reduce your risk of Alzheimer's disease:
    • Eat a healthy diet that includes fish.
    • Drink alcohol, but in moderation. This means no more than two drinks per day for a man, and one drink per day for a woman.
    • Exercise regularly.
    • Engage in mentally stimulating activities.

    RESOURCES

    Alzheimer's Association http://www.alz.org

    Alzheimer's Disease Education and Referral Center http://www.nia.nih.gov/alzheimers

    CANADIAN RESOURCES

    Alzheimer Society http://www.alzheimer.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Albanese E, Dangour AD, et al. Dietary fish and meat intake and dementia in Latin America, China, and India: a 10/66 Dementia Research Group population-based study. Am J Clin Nutr. 2009;90(2):392-400.

    Alzheimer's disease. Activity based prevention strategies. EBSCO DynaMed website. Available at: http://dynamed.ebscohost.com/about/about-us. Updated July 11, 2012. Accessed August 22, 2012.

    Alzheimer's disease and non-Alzheimer’s dementia. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary. Updated July 7, 2012. Accessed August 22, 2012.

    Alzheimer's disease. EBSCO DynaMed website. Available at: http://dynamed.ebscohost.com/about/about-us. Updated July 11, 2012. Accessed August 22, 2012.

    Alzheimer's disease medications fact sheet. National Institute on Aging website. Available at: http://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-medications-fact-sheet. Updated July 2010. Accessed August 22, 2012.

    American Academy of Neurology website. Available at: http://patients.aan.com/disorders/index.cfm?event=viewampdisorder%5Fid=844. Accessed August 22, 2012.

    Anstey KJ, Mack HA, et al. Alcohol consumption as a risk factor for dementia and cognitive decline: meta-analysis of prospective studies. Am J Geriatr Psychiatry. 2009;17(7):542-555.

    Carillo MC, Blackwell A, et al. Early risk assessment for Alzheimer's disease. Alzheimers dementia. 2009;5(2):182-196.

    Deweerdt S. Prevention: activity is the best medicine. Nature. 2011;475:S16-S17.

    Gidoni R, et al. Cerebrospinal fluid biomarkers in Alzheimer’s disease: the present and the future. Neurodegen Dis. 2011;8:413-420.

    Goetz CG. Textbook of Clinical Neurology. Philadelphia, PA: WB Saunders Company; 1999.

    Green RC, Cupples LA, et al. Risk of dementia among white and African-American relatives of patients with Alzheimer disease. JAMA. 2002;287:329-336.

    Hampel H, Frank R, et al. Biomarkers for Alzheimer’s disease: academic, industry and regulatory perspectives. Nat Rev Drug Discov. 2010;9:560-574.

    Hayden KM, Welsh-Bohmer KA. Epidemiology of cognitive aging and Alzheimer’s disease: contributions of the Cache County Utah study of memory, health, and aging. Curr Top Behav Neurosci. 2011 Aug 2.

    Kasper DL, Braunwald E, et al. Harrison's Principles of Internal Medicine. 16th ed. New York, NY: The McGraw-Hill Companies; 2005.

    Neugroschl J, Sano M. An update on treatment and prevention strategies for Alzheimer’s disease. Curr Neurol Neurosci Rep. 2009;9:368-376.

    Rakel RE, Bope ET. Conn's Current Therapy. 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.

    Rowland LP, Merritt HH. Alzheimer's disease and related dementias. Merritt's Neurology. Philadelphia, PA: Lippincott Williams and Wilkins; 2000: chap 106.

    Ruitenberg A, van Swieten JC, et al. Alcohol consumption and risk of dementia: the Rotterdam Study. Lancet. 2002;359(9303):281-286.

    1/8/2010 DynaMed's Systematic Literature Surveillance. Available at: http://dynamed.ebscohost.com/about/about-us: Snitz BE, O'Meara ES, et al. Ginkgo biloba for preventing cognitive decline in older adults: a randomized trial. JAMA. 2009;302:2663-2670.

    5/4/2012 DynaMed's Systematic Literature Surveillance. Available at: http://dynamed.ebscohost.com/about/about-us: Buchman AS, Boyle PA, et al. Total daily physical activity and the risk of AD and cognitive decline in older adults. Neurology. 2012;78(17):1323-1329.

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