Alzheimer disease

Alzheimer disease is a progressive disease that destroys memory and other important mental functions.

It is the most common cause of dementia; a group of brain disorders that can result in the loss of intellectual and social skills. These changes are severe enough to interfere with day to day life.
In Alzheimer disease, the connections between brain cells and the brain cells themselves degenerate and die, causing a steady decline in memory and mental function.

Current Alzheimer disease medications and management strategies may temporarily improve symptoms. This can sometimes help people with Alzheimer disease maximize function and maintain independence.
But because there is no cure for Alzheimer disease, it is important to seek supportive services and tap into your support network as early as possible.


At first, increasing forgetfulness or mild confusion may be the only symptoms of Alzheimer disease that you notice. But over time, the disease robs you of more of your memory, especially recent memories. The rate at which symptoms worsen varies from person to person. If you have Alzheimer, you may be the first to notice that you are having unusual difficulty remembering things and organizing your thoughts. Or you may not recognize that anything is wrong, even when changes are noticeable to your family members, close friends or coworkers.

Brain changes associated with Alzheimer disease lead to growing trouble with:


Everyone has occasional memory lapses. It's normal to lose track of where you put your keys or forget the name of an acquaintance. But the memory loss associated with Alzheimer's disease persists and worsens, affecting your ability to function at work and at home. People with Alzheimer's may:

Repeat statements and questions over and over, not realizing that they have asked the question before
Forget conversations, appointments or events, and not remember them later
Routinely misplace possessions, often putting them in illogical locations
Eventually forget the names of family members and everyday objects
Disorientation and misinterpreting spatial relationships

People with Alzheimer disease may lose their sense of what day it is, the season, where they are or even their current life circumstances. Alzheimer may also disrupt your brains ability to interpret what you see, making it difficult to understand your surroundings. Eventually, these problems may lead to getting lost in familiar places.
Speaking and writing

Those with Alzheimer may have trouble finding the right words to identify objects, express thoughts or take part in conversations. Over time, the ability to read and write also declines.

Thinking and reasoning

Alzheimer disease causes difficulty concentrating and thinking, especially about abstract concepts like numbers. It may be challenging to manage finances, balance checkbooks, and keep track of bills and pay them on time. These difficulties may progress to inability to recognize and deal with numbers.

Making judgments and decisions

Responding effectively to everyday problems, such as food burning on the stove or unexpected driving situations, becomes increasingly challenging.

Planning and performing familiar tasks

Once routine activities that require sequential steps; such as planning and cooking a meal, or playing a favorite game, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer may forget how to perform basic tasks such as dressing and bathing.

Changes in personality and behavior

Brain changes that occur in Alzheimer disease can affect the way you act and how you feel. People with Alzheimer may experience:

Social withdrawal
Mood swings
Distrust in others
Irritability and aggressiveness
Changes in sleeping habits
Loss of inhibitions
Delusions, such as believing something has been stolen


Scientists believe that for most people, Alzheimer disease results from a combination of genetic, lifestyle and environmental factors that affect the brain over time.

Less than 5 percent of the time, Alzheimer is caused by specific genetic changes that virtually guarantee a person will develop the disease.

Although the causes of Alzheimer are not yet fully understood, its effect on the brain is clear. Alzheimer disease damages and kills brain cells. A brain affected by Alzheimer disease has many fewer cells and many fewer connections among surviving cells than does a healthy brain.

As more and more brain cells die, Alzheimer leads to significant brain shrinkage. When doctors examine Alzheimer brain tissue under the microscope, they see two types of abnormalities that are considered hallmarks of the disease:

Plaques. These clumps of a protein called beta amyloid may damage and destroy brain cells in several ways, including interfering with cell to cell communication. Although the ultimate cause of brain cell death in Alzheimer is not known, the collection of beta amyloid on the outside of brain cells is a prime suspect.

Tangles. Brain cells depend on an internal support and transport system to carry nutrients and other essential materials throughout their long extensions. This system requires the normal structure and functioning of a protein called tau. In Alzheimer, threads of tau protein twist into abnormal tangles inside brain cells, leading to failure of the transport system. This failure is also strongly implicated in the decline and death of brain cells.

Risk Factors and Complications

Increasing age is the greatest known risk factor for Alzheimer. Alzheimer is not a part of normal aging, but your risk increases greatly after you reach age 65. Nearly half of those older than age 85 have Alzheimer.

People with rare genetic changes that virtually guarantee they'll develop Alzheimer often begin experiencing symptoms in their 40s or 50s.

Family history and genetics

Your risk of developing Alzheimer appears to be somewhat higher if a first degree relative; your parent or sibling, has the disease. Scientists have identified rare changes (mutations) in three genes that virtually guarantee a person who inherits them will develop Alzheimer. But these mutations account for less than 5 percent of Alzheimer disease. Most genetic mechanisms of Alzheimer among families remain largely unexplained. The strongest risk gene researchers have found so far is apolipoprotein e4 (APOE e4). Other risk genes have been identified but not conclusively confirmed.


Women may be more likely than are men to develop Alzheimer disease, in part because they live longer.

Mild cognitive impairment

People with mild cognitive impairment (MCI) have memory problems or other symptoms of cognitive decline that are worse than might be expected for their age, but not severe enough to be diagnosed as dementia. Those with MCI have an increased risk; but not a certainty, of later developing dementia. Taking action to develop a healthy lifestyle and strategies to compensate for memory loss at this stage may help delay or prevent the progression to dementia.

Past head trauma

People who have had a severe head trauma or repeated head trauma appear to have a greater risk of Alzheimer disease.

Lifestyle and heart health

There is no lifestyle factor that is been conclusively shown to reduce your risk of Alzheimer disease.

However, some evidence suggests that the same factors that put you at risk of heart disease may also increase the chance that you'll develop Alzheimer. Examples include:

Lack of exercise
High blood pressure
High blood cholesterol
Poorly controlled diabetes
A diet lacking in fruits and vegetables
Lack of social engagement

These risk factors are also linked to vascular dementia, a type of dementia caused by damaged blood vessels in the brain. Working with your health care team on a plan to control these factors will help protect your heart; and may also help reduce your risk of Alzheimer disease and vascular dementia.

Lifelong learning and social engagement

Studies have found an association between lifelong involvement in mentally and socially stimulating activities and reduced risk of Alzheimer disease.

Factors that may reduce your risk of Alzheimer include:

Higher levels of formal education
A stimulating job
Mentally challenging leisure activities, such as reading, playing games or playing a musical instrument
Frequent social interactions

Scientists can not yet explain this link. One theory is that using your brain develops more cell to cell connections, which protects your brain against the impact of Alzheimer related changes. Another theory is that it may be harder to measure cognitive decline in people who exercise their minds frequently or who have more education. Still another explanation is that people with Alzheimer disease may be less inclined to seek out stimulating activities years before their disease can be diagnosed.

Memory loss, impaired judgment and other cognitive changes caused by Alzheimer can complicate treatment for other health conditions. A person with Alzheimer disease may not be able to:
Communicate that he or she is experiencing pain; for example, from a dental problem
Report symptoms of another illness
Follow a prescribed treatment plan
Notice or describe medication side effects

As Alzheimer disease progresses to later stages, brain changes begin to affect physical functions, such as swallowing, balance, and bowel and bladder control. These effects can increase vulnerability to additional health problems such as:

Pneumonia and other infections. Difficulty swallowing may cause people with Alzheimer to inhale (aspirate) food or liquid into their airways and lungs, which can lead to pneumonia. Inability to control emptying of the bladder (urinary incontinence) may require placement of a tube to drain and collect urine (urinary catheter). Having a catheter increases your risk of urinary tract infections, which can lead to more-serious, life threatening infections.

Injuries from falls. People with Alzheimer become increasingly vulnerable to falling. Falls can lead to fractures. In addition, falls are a common cause of serious head injuries.

Western Treatment and Drugs

Two types of drugs are currently used to treat cognitive symptoms:
Cholinesterase inhibitors. These drugs work by boosting levels of a cell to cell communication chemical depleted in the brain by Alzheimer disease. Most people can expect to keep their current symptoms at bay for a time. Less than half of those taking these drugs can expect to have any improvement. Commonly prescribed cholinesterase inhibitors include donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon). The main side effects of these drugs include diarrhea, nausea and sleep disturbances.

Memantine (Namenda). This drug works in another brain cell communication network and slows the progression of symptoms with moderate to severe Alzheimer disease. It is sometimes used in combination with a cholinesterase inhibitor.

Creating a safe and supportive environment

Adapting the living situation to the needs of a person with Alzheimer is an important part of any treatment plan. You can take these steps to support a person's sense of well being and continued ability to function:

Remove excess furniture, clutter and throw rugs.
Install sturdy handrails on stairways and in bathrooms.
Ensure that shoes and slippers are comfortable and provide good traction.
Reduce the number of mirrors. People with Alzheimer may find images in mirrors confusing or frightening.

Regular exercise is an important part of everybodys wellness plan; and those with Alzheimer are no exception. Activities like a daily 30 minute walk can help improve mood and maintain the health of joints, muscles and your heart. Exercise can also promote restful sleep and prevent constipation. Make sure that the person with Alzheimer carries identification if she or he walks unaccompanied.

People with Alzheimer who develop trouble walking may still be able to use a stationary bike or participate in chair exercises. You may be able to find exercise programs geared to older adults on TV or on DVDs.


People with Alzheimer may forget to eat, lose interest in preparing meals or not eat a healthy combination of foods. They may also forget to drink enough, leading to dehydration and constipation.


High-calorie, healthy shakes and smoothies. You can supplement milkshakes with protein powders (available at grocery stores, drugstores and discount retailers) or use your blender to make smoothies featuring your favorite ingredients.

Water, juice and other healthy beverages. Try to ensure that a person with Alzheimer drinks at least several full glasses of liquids every day. Avoid beverages with caffeine, which can increase restlessness, interfere with sleep and trigger frequent need to urinate.

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