What is Alzheimer's disease?

Alzheimer's disease destroys brain cells. It causes a decline in mental function that affects:

• memory
• thinking
• language
• behavior

The disease can occur in people in their 40s and 50s, but it most often affects those 65 and older. About 1 in every 10 people over age 65 is diagnosed with Alzheimer's disease. For every 10 years of life after age 65, the numbers double (2 out of 10 over age 75, 4 out of 10 after 85, and so on).

Dementia, a general decline in mental ability, is the most common reason people are placed in nursing homes. Alzheimer's, the most common cause of dementia, affects more than 4 million people in this country.

How does it occur?

Studies show that changes in the chemistry and structures of the brain occur in people with Alzheimer's. These changes hinder the ability to process, store, and retrieve information. No one knows why these changes happen.

Between 5% and 10% of people with Alzheimer's have a family history of the disease and show signs of the disease earlier in life, before age 65. In a small number of these families, genes have been found that cause some of these so-called familial forms of the disease.

What are the symptoms?

The symptoms of Alzheimer's vary from person to person and change as the disease gets worse.

The first symptom is being forgetful. Almost all people begin to have some memory problems as they get older. For a person in the early stages of Alzheimer's, however, these problems are more obvious than in others of the same age. Forgetting people's names or the location of familiar items is common. The attention span becomes shorter. The person has a harder time concentrating. But at this stage of the disease, being forgetful still has little impact on lifestyle or work.

Over time the memory loss becomes more severe. Co-workers and friends notice the memory loss and that the person has problems dealing with written matter. He or she may misplace or lose important objects. As the disease gets worse the person can forget even major recent events and personal history. He or she cannot handle money. In general, recent memory is affected more than is long-term memory.

In later stages of Alzheimer's the person becomes disoriented and confused. The person can no longer recall major facts about him- or herself and others. Objects and people that once were familiar become unfamiliar. Changes in emotions and personality may occur. The person may have false beliefs (delusions) or see or hear things that aren't there (hallucinations). He or she may be anxious and often restless and active at night.

Someone with Alzheimer's may not see the need for care and may resist help. At first, he or she can go to the bathroom and eat without help. But in time, brain function declines and the ability to talk, move, or do any self-care is lost.

How is it diagnosed?

A definite diagnosis of Alzheimer's can be made only by examining brain tissue after death. However, probable Alzheimer's disease can be diagnosed with a careful medical history and physical exam.

While there is no one test to diagnose Alzheimer's, memory testing can be helpful. Blood work and brain scans can help show if there is a treatable cause of the decline in brain function. It is especially important to rule out major depression, a treatable condition that can cause symptoms similar to Alzheimer's.

How is it treated?

There is no cure. The goal of treatment is to preserve mental and physical function as much and as long as possible. The best approach seems to include control of other illnesses, a healthy diet, regular exercise, and suitable activities.

Medication is sometimes helpful. Some doctors believe medications such as tacrin (Cognex) and donepezil (Aricept) can be used early in Alzheimer's to slow memory loss. Both of these drugs are costly and have side effects. More often other medicines may be used to help treat anxiety and depression or to restore a normal wake-sleep (day-night) cycle.

Many people who have Alzheimer's are depressed, especially in the earlier stages. Most do not show sadness so much as a loss of pleasure and joy in life. When depression occurs in late stages of Alzheimer's, the person may be hostile or agitated and may often refuse food and drink. Depression makes brain function much worse than it otherwise would be. Treatment for depression is available and works well.

Community resources are very important. The following services may be coordinated through the doctor's office, the local county health department, or visiting nurses association:

• Social workers identify and organize help, including possible financial aid.

• Home health care agencies provide the services of nurses, medical social workers, and therapists. They also provide home health aides for personal care.

• Out-of-home services include adult day care centers; mental health services, including support groups for patients and family caregivers; transportation; and nursing homes.

How long will the effects last?

The brain function of a person who has Alzheimer's disease continues to get worse until he or she dies.

While still possible, the person with Alzheimer's disease should be involved in making decisions about the care he or she will get. The fear of being abandoned and embarrassment over the loss of independence are key issues for a person with Alzheimer's. He or she needs to be reassured sincerely and often.

Friends and family, as well as the person with Alzheimer's, should join support groups as soon as possible after the disease is diagnosed. A balance must be maintained between the needs of the person with Alzheimer's and those of family caregivers. The caregivers will become emotionally and physically worn out if they have no help or respite.

While the person with Alzheimer's is still able to make legal decisions, he or she should sign a power of attorney for medical and financial matters. If desired, a living will should be made out as well. Ask the doctor for more information about these documents.

For further information on coping with this disease, contact:

Alzheimer's Association
919 N. Michigan Avenue
Suite 1000
Chicago, IL 60611-1676
Phone: 800-272-3900
Web site: http://www.alz.org

What can be done to help prevent Alzheimer's disease?

It is difficult to prevent Alzheimer's until its causes are better understood. People with a family history of Alzheimer's should see their doctor regularly. Early diagnosis will allow them to take advantage of new treatments as they become available.

Developed by Clinical Reference Systems. Published by iMcKesson Clinical Reference Products.Copyright � 1991-2001 iMcKesson LLC. All rights reserved.