Alzheimer's Disease

Alzheimer's disease is a progressive condition that damages areas of the brain involved in memory, intelligence, judgment, language, and behavior. It is the most common form of mental decline, or dementia, in older adults.

Alzheimer's disease is more severe than the mild memory loss that many people experience as they grow older. It affects not only memory but also behavior, personality, ability to think, and the ability to function from day to day. Close family members usually notice symptoms first, although the person affected also may realize that something is wrong.

What causes Alzheimer's disease?

The causes of Alzheimer's disease are not fully known. Most experts believe there is probably more than one cause. Studies of inherited and environmental factors are beginning to provide some answers.

The symptoms of Alzheimer's disease

Typical early symptoms of Alzheimer's disease include:

• Memory loss.
• Inability to use judgment and make decisions.
• Confusion about what time and day it is.
• Getting lost in familiar places.
• Difficulty learning and remembering new information.
• Difficulty expressing himself or herself.
• Decreasing ability to perform everyday tasks like cooking a meal or paying bills.

As the disease progresses, these symptoms get worse. The person may also develop strange new behaviors and withdraw from family and friends. Hallucinations, delusions, and paranoia are common; some people may become verbally or physically aggressive or abusive. Eventually the person may forget how to perform basic tasks like eating, dressing, bathing, using the toilet, or getting up from a bed or chair and walking.

How is Alzheimer's disease diagnosed?

A diagnosis of Alzheimer's disease is made based on a careful medical history and physical exam, evaluation of the person's mental and functional status, and selected lab tests and imaging tests, such as CT and MRI scans, to rule out other possible causes of the symptoms. Imaging tests also can sometimes identify subtle changes in structures of the brain that may relate to Alzheimer's disease, but they do not provide enough evidence for a diagnosis.

How is Alzheimer's disease treated?

There is no cure for Alzheimer's disease. However, much can be done to maintain quality of life and help the person stay active. Treatment focuses on several areas, including:

• Improving memory and daily functioning. Several prescription medications, including donepezil hydrochloride (Aricept), galantamine (Reminyl), and rivastigmine (Exelon), may temporarily improve memory and thinking problems that occur with Alzheimer's. The improvement varies from person to person and may not last, but they are effective for some people.
• Dealing with new and unusual behaviors. Most of the treatment for Alzheimer's disease happens at home and is provided by the person's family or other caregivers. It consists of ensuring that the person is in a safe, healthy environment, providing basic care and assistance with eating, dressing, bathing, using the bathroom, and other daily activities, and dealing with behavior problems. The behaviors that people with Alzheimer's sometimes develop can be frustrating to deal with and hard to understand. Medications sometimes may be used to treat behavior problems when other approaches to the problem have not worked, but nondrug approaches are preferred when possible.
• Treating other conditions. People with Alzheimer's disease may have other medical problems that can make symptoms worse. For instance, depression is common in people who have Alzheimer's disease, especially in those who are aware that they are losing their memory and ability to function on their own. Treatment with medication often can improve depression and help the person cope with the disease. Hearing and vision problems can add to the person's confusion and agitation; these problems are often easy to correct.

Alzheimer's disease is becoming a more common problem for older people, who are living longer now, and for those who take care of them. The demands of caring for a spouse or parent with Alzheimer's can be physically, emotionally, and financially draining. With support, education, and planning, caregivers may find ways of making life easier for the person they take care of and for themselves.