Understanding Alzheimers & Dementia: General Info
The chance of an elderly person becoming confused, forgetful, and developing severe memory problems increases with each passing year. Alzheimer’s disease, one of the most common forms of dementia, is thought to affect 5 percent of people over age 65 and 20 percent of people over age 80. Below is some general information to help answers questions you may have about Alzheimers and Dementia.What is dementia?
Dementia is an impairment in brain functioning resulting in problems with memory and judgment. It is often accompanied by confusion.In all dementias there is a loss of intellectual abilities. This means losing the ability to use information once known or learned, as well as basic abilities to think and to understand. There are also memory deficits or losses-with recent memory being the first area affected.
Memory loss and loss of intellectual abilities can result in:
- the person no longer being aware of social niceties, such as how to behave in public
- confusion and disorientation
- changes in abstract thinking (such as being unable to understand humor or discern the passage of time)
- severe problems in what is called “higher order functioning” (such as language use and the ability to do numerical calculations)
- a change or exaggeration in the personality of the individual, for example, becoming more stubborn or suspicious
- problems with personal hygiene
What is Alzheimer’s disease?
Alzheimer’s disease is a progressive, irreversible brain disease that affects the central nervous system. Alzheimer’s disease, which is the most common form of dementia, is not part of normal aging. It is caused by factors that are largely unknown and result in a slow, gradual decline of intellectual functioning, memory, and judgment. It can occur as early as 40 years of age or as late as 100 years of age.Return to top
What Alzheimer’s disease is NOT:
Alzheimer’s disease is not contagious. Alzheimer’s is not insanity or “craziness.” Alzheimer’s is not an inevitable result of aging.Return to top
What is physically happening in Alzheimer’s disease?
Several major changes are occurring in the brain:- the nerve cells important in memory and cognition are dying
- microscopic changes called plaques and tangles are developing
- there is a loss of certain brain chemicals, in particular, acetylcholine, which is needed for communication between nerve cells
What are the causes?
Alzheimer’s disease affects men and women of all races and socioeconomic backgrounds. The cause is currently unknown. Possible causes may include:- genetic factors–In families where Alzheimer’s occurs in several generations, genetic causes are suspected. In a very small number of these families, gene mutations have been found. For the large majority of families with a history of Alzheimer’s disease, however, the genetic causes have yet to be determined. Genetic causes appear to be more likely in families where there is an early onset of the disease (before age 65).
- possible non-genetic factor–These include environmental toxins (such as exposure to aluminum), infectious or transmittable agents, and traumas (such as severe head injuries). Research to date is inconclusive as to the effects of these conditions.
- a combination of the effects of genes, the environment, and the aging process–Most cases of Alzheimer’s disease are thought to be a result of these three factors.
Is there a cure?
Some dementias do have cures. Alzheimer’s dementia does not. However, there is both medical and non-medical treatment available to help manage symptoms.Medical treatment can include medications that may help improve symptoms.
Non-medical treatment may help the patient become more adjusted to the limitations of the disease. It may also help caregivers manage the sometimes bizarre and difficult behavior patients exhibit.
Over the years there have been a number of articles about the use of Lecithin, vitamins, chelating agents, special diets, and removing dental fillings as a way to “cure” Alzheimer’s disease. There is no consistent proof that these treatments work. Caregivers should be wary of expensive treatments that claim to be cures.
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How long will the disease last?
The course of Alzheimer’s varies tremendously. The life expectancy for people with the disease can range anywhere from 3 to 25 years. It appears, however, that the average duration of the disease may be 8 to 10 years. Alzheimer’s disease is a terminal illness. There are not periods of “remission” or improvement that can occur with other illnesses, like cancer.Return to top
Is a diagnosis of Alzheimer’s disease usually accurate?
A definitive diagnosis can only be made by examining the brain tissue after the patient’s death. However, if the patient is given a thorough assessment, the diagnosis can be almost 90 percent accurate.Return to top
Are there other kinds of dementia besides Alzheimer’s?
Although Alzheimer’s disease is the most common form of dementia, there are other progressive dementing illnesses. These include the following:- Vascular dementia (also known as multi-infarct dementia) is the second most common form of dementia; individuals often experience sudden deterioration, which may progress over time; sometimes only very specific areas of functioning are affected, such as speech
- Parkinson’s disease, in which individuals develop severe problems of movement and balance, and other problems, including dementia
- Huntington’s disease, a hereditary disease usually appearing when the individual approaches 40 years of age, passed on from parent to child, whose symptoms include quick jerky movements of the face, limbs, and trunk, and eventually a dementia
- dementias associated with physical disorders such as diabetes, thyroid disease, brain tumors, or Acquired Immune Deficiency Syndrome (AIDS)
- dementias of alcohol or substance abuse; these may be a combination of direct chemical damage to the brain combined with nutritional or vitamin deficiencies
Are some dementias reversible?
Certain dementias can be reversed or improved. These include dementias associated with metabolic disorders such as diabetes, or dementias associated with alcohol or substance abuse.Also, there are a number of physical problems which can have dementia-like secondary symptoms. These include vitamin deficiencies, reactions to medications, physical illnesses, delirium, anemia, and hearing or vision problems. Often, once the physical problem is treated, the dementia-like symptoms will subside.
Two treatable conditions commonly confused with dementia are delirium and depression.
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What are the tests needed to diagnose Alzheimer’s?
Assessment may consist of:
1. A physical examination
Families or others knowledgeable about the patient must be interviewed to obtain accurate information about past and current problems including:
An environmental assessment may also be included as part of the
evaluation. This assessment determines:
- a comprehensive physical examination to find any treatable medical conditions like high blood pressure or anemia
- laboratory studies including a blood count, urinalysis and blood chemistry screening; assessment of liver, kidney and thyroid functioning
- X-rays of the head, such as CAT scans
- hearing and vision exams
Families or others knowledgeable about the patient must be interviewed to obtain accurate information about past and current problems including:
- drug and alcohol use
- medication use
- a history and progression of cognitive and behavioral problems
- a medical and family history
- cognitive tests to determine whether the patient is actually having memory problems and how severe these problems are
- a psychological exam to rule out depression or other emotional illnesses
- if the patient’s home is safe and secure enough given their current level of functioning
- if changes need to be made to allow the patient to remain at home
- how well the patient is able to perform “activities of daily living” (such as bathing or dressing)
What are some examples of cognitive tests?
Two commonly used cognitive tests are:- the Mini Mental State Examination (MMSE) (Folstein, Folstein, and McHugh, 1975)
- the Blessed Dementia Rating Scale (Blessed, Tomlinson, and Roth, 1968)
If these tests show that some memory impairment exists, it is important that the patient undergo more detailed cognitive testing. More detailed tests can determine what areas the patient is having difficulty with (such as judgment, abstraction, reasoning, orientation, attention, or calculation).
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Are there stages to Alzheimer’s disease?
Every person reacts differently to the disease. Some people may have a slow, gradual decline; some a rapid decline; and some periods of slow or relatively little decline interspersed with periods of rapid decline. Despite this variation among individuals, there are sets of symptoms commonly seen in the beginning, middle, and end phases of the disease.
Early phase
In this phase, something appears to be wrong with the patient but it is hard to pinpoint the problem. The patient may:
Everyone has memory lapses-not remembering a name, forgetting where you left your keys-but with Alzheimer’s disease these problems occur frequently and worsen over time.
In this phase, something appears to be wrong with the patient but it is hard to pinpoint the problem. The patient may:
- have difficulty concentrating
- avoid new situations
- have difficulty understanding abstract concepts (that is, not understand humor as readily, or have difficulty understanding concepts such as the past and the future)
- mix up words or be unable to recall words
- forget recent events or cover up forgetfulness (that is, give vague answers or make up answers)
- have problems with mathematical calculations
- have a personality change (act in unusual or extreme ways)
- be unable to deal with ordinary problems such as managing finances, paying bills, keeping clothes clean, tending to personal hygiene, or doing necessary household tasks
Middle phase
Impairments in memory and functioning become more obvious in this phase. Although memory from the distant past is often still clear (such as remembering stories from young adulthood), the patient may forget more recent events such as what they did earlier in the day or yesterday. Sometimes they won’t recognize friends or neighbors.
They may also:
The patient’s abilities have declined dramatically by the final phase. The patient may:
In the very end phases, the patient is unable to eat or walk without assistance.
Impairments in memory and functioning become more obvious in this phase. Although memory from the distant past is often still clear (such as remembering stories from young adulthood), the patient may forget more recent events such as what they did earlier in the day or yesterday. Sometimes they won’t recognize friends or neighbors.
They may also:
- experience worsening judgment
- need help making decisions, performing tasks, or planning for the future
- become less sociable and less aware of the feelings of others
- have difficulty sleeping at night
- have difficulty using language or remembering common words
- get lost when visiting unfamiliar places
- need assistance with bathing or complex tasks
- experience personality changes (such as sudden mood shifts, outbursts of anger, extreme worry or fearfulness, or crying spells)
The patient’s abilities have declined dramatically by the final phase. The patient may:
- become unable to use language
- get lost easily
- be incontinent of urine or stool
- need assistance with simple tasks
- show minimal emotional response
- walk with a shuffle
- fail to recognize familiar objects and people
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What is delirium?
Because many of the symptoms of delirium are similar to Alzheimer’s disease, the two are commonly confused. Delirium, however, is a treatable condition which can be reversed when the problems causing it are corrected. In delirium there is often a rapid onset of symptoms related to a sudden change in the patient’s health. Common delirium symptoms include:- fluctuation in consciousness
- visual or auditory hallucinations
- sudden onset of incoherent speech
- sleep-wake cycle reversals (awake at night and very sleepy during the day)
- medications-new dosage, sudden sensitivity or reaction with another medication
- vitamin deficiencies associated with chronic alcohol intake
- physical illness
- surgery and anesthesia-effects of surgery and anesthesia on the patient’s system may produce delirium in patients as they are recovering
- location or living changes
- has a medical condition which becomes unstable (their diabetes gets out of control)
- has surgery
- is hospitalized or relocated
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What are the signs of depression?
Like delirium, depression is a treatable condition that is commonly confused with dementia (especially the early stages of dementia). Because medication and psychotherapy can have a very positive outcome on depression, it is important not to let depression go untreated. Symptoms of depression include:- loss of interest and pleasure in usual activities
- appetite change
- sleep disturbance (too much or too little)
- fatigue and inactivity
- trouble concentrating
- feelings of sadness
- feelings of worthlessness or guilt
- thoughts of death or suicide
- feeling discouraged about the future
Remember that depression and dementia can co-exist:
- one-third of individuals with early stage dementia are depressed
- depression is common after a stroke
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Are there any medications that can help with Alzheimer’s symptoms?
Currently, no cure for Alzheimer’s disease exists. All medication treatment for Alzheimer’s disease is supportive, not curative. New medications appear with some regularity and time can change what medications are and are not used. No medication is always effective with Alzheimer’s patients and no medication always creates the side effects listed below. When considering or continuing a medication, a close relationship with your physician is critical. Only he or she can suggest what is best and monitor the patient adequately.Drugs to treat behavior problems
A. Antipsychotic drugs
Brand names: Haldol, Navane, Prolixin, Stelazine, Trilafon, Loxitane, Moban, Thorazine, Mellaril.
These medications are often prescribed to manage symptoms of agitation, anxiety, delusions, hallucinations, hostile behavior, uncooperativeness, and psychosis. Often, these drugs have a sedating effect on behavior. They are not always effective with Alzheimer’s disease patients and they need to be closely monitored to avoid oversedation.
Side effects can include shakiness, muscle rigidity (can lead to falls), drowsiness, constipation, increased confusion, stiffness, dry mouth, blurred vision, muscle spasms, dizziness, difficulty urinating, restlessness, fast heartbeat, and a shuffling walk.
B. Antianxiety drugs
Brand names: Valium, Tranxene, Halcion, Ativan, Librium, Xanax, Restoril, Centrax, Buspar.
These medications are often used to treat anxiety and agitation and insomnia when psychotic features are not present. These drugs can build up in the body over time.
Side effects can include oversedation, drowsiness, nervousness, dizziness, headache, unsteady gait (can lead to falls), depression, blurred vision, and breathing problems. Sometimes these drugs can produce a paradoxical reaction of increased restlessness or aggression. Withdrawal from these medications needs to be monitored, especially if the patient has been on them for a long time.
C. Antidepressants
Brand names: Prozac, Elavil, Sinequan, Adapin, Tofranil, Norpramin, Vivactil, Ludiomil, Asendin, Desyrel, Aventyl/Pamelor, Wellbutrin, Zoloft, Paxil.
These medications are often used to decrease depressed mood, improve appetite and sleep, and increase energy and functioning. When they are prescribed, it may take several weeks to a month for them to take effect.
Side effects can include drowsiness, dry mouth, urinary retention, congestion, delirium, blurred vision, constipation, tremors, weight gain, nausea, and dizziness. Patients on these drugs should have their blood pressure checked routinely in both the lying and standing positions. High doses can lead to cardiac irregularities.
Drugs to improve memory and thinking
Brand names: Haldol, Navane, Prolixin, Stelazine, Trilafon, Loxitane, Moban, Thorazine, Mellaril.
These medications are often prescribed to manage symptoms of agitation, anxiety, delusions, hallucinations, hostile behavior, uncooperativeness, and psychosis. Often, these drugs have a sedating effect on behavior. They are not always effective with Alzheimer’s disease patients and they need to be closely monitored to avoid oversedation.
Side effects can include shakiness, muscle rigidity (can lead to falls), drowsiness, constipation, increased confusion, stiffness, dry mouth, blurred vision, muscle spasms, dizziness, difficulty urinating, restlessness, fast heartbeat, and a shuffling walk.
B. Antianxiety drugs
Brand names: Valium, Tranxene, Halcion, Ativan, Librium, Xanax, Restoril, Centrax, Buspar.
These medications are often used to treat anxiety and agitation and insomnia when psychotic features are not present. These drugs can build up in the body over time.
Side effects can include oversedation, drowsiness, nervousness, dizziness, headache, unsteady gait (can lead to falls), depression, blurred vision, and breathing problems. Sometimes these drugs can produce a paradoxical reaction of increased restlessness or aggression. Withdrawal from these medications needs to be monitored, especially if the patient has been on them for a long time.
C. Antidepressants
Brand names: Prozac, Elavil, Sinequan, Adapin, Tofranil, Norpramin, Vivactil, Ludiomil, Asendin, Desyrel, Aventyl/Pamelor, Wellbutrin, Zoloft, Paxil.
These medications are often used to decrease depressed mood, improve appetite and sleep, and increase energy and functioning. When they are prescribed, it may take several weeks to a month for them to take effect.
Side effects can include drowsiness, dry mouth, urinary retention, congestion, delirium, blurred vision, constipation, tremors, weight gain, nausea, and dizziness. Patients on these drugs should have their blood pressure checked routinely in both the lying and standing positions. High doses can lead to cardiac irregularities.
Many experimental drugs with the potential to improve memory and other basic thinking deficits in Alzheimer’s disease are currently being investigated. Some of the medications that have been approved by the FDA are: Cognex (tacrine), Aricept (donepezil), Exelon (rivastigmine) and Reminyl (galantamine). Cognex was the first to be approved, but is no longer widely used because of troublesome side effects. All of these medications have similar actions, so only one is prescribed at a time, and response is usually modest. They do not stop the progression of Alzheimer’s disease, but may improve some of its symptoms.
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