Alzheimer disease
Senile dementia - Alzheimer type (SDAT); SDAT; Dementia - Alzheimer; Alzheimer's disease
Dementia is a loss of brain function that occurs with certain diseases. Alzheimer disease (AD) is the most common form of dementia. It affects memory, thinking, and behavior.
Dementia may also be referred to as major neurocognitive disorder.
Aged nervous tissue is less able to rapidly communicate with other neural tissues.
Imagine waking up this morning, and not being able to remember your own name, or recognize your spouse? While Alzheimer disease is a more gradual process, over time it can destroy memory to the point where people can't even remember the simplest and most important details of their lives. Let's talk more about Alzheimer disease. Alzheimer disease is a type of dementia, a loss of brain function that makes it harder and harder to think and speak. To understand what causes Alzheimer, we need to look inside the brain. In a normal brain, nerves send messages to one another. In people with Alzheimer disease, abnormal proteins clump in the brain, damaging nerve cells so they can no longer send the messages needed to think clearly. So, why do some people get Alzheimer, and others do not? Getting older itself doesn't cause Alzheimer disease. It's not a part of the normal aging process. Alzheimer does seem to run in families, though. So if you have a close relative, like a sister or parent, with Alzheimer, you may be more likely to get the disease. Usually when Alzheimer disease starts, people have trouble remembering simple things, like their phone number, or where they put their car keys. But, as the disease progresses, memory loss gets worse. People with Alzheimer find it hard to have conversations or complete simple tasks, like getting dressed. They can also become angry or depressed. Those in the later stages of the disease can no longer care for themselves. They lose the ability to recognize even close family members. To diagnose Alzheimer disease, doctors prescribe tests of mental ability. They also prescribe medical tests to rule out diseases that can make it harder to think clearly, such as a brain tumor or stroke. As far as treatments for Alzheimer disease, right now, there isn't a cure. A few drugs can slow memory loss and control depression and aggressiveness from the disease. Despite what you may have read, there isn't any proof that vitamins or other supplements can prevent or treat Alzheimer. However, eating a low-fat diet that's high in vitamin E and C, and rich in omega-3 fatty acids may keep your brain healthier. Alzheimer disease is different in each person. Some people decline quickly and die within just a few years, while others can live for two decades with the disease. If you have a family member with Alzheimer, talk to your doctor about ways to protect your own memory. And, call right away if you have any significant memory loss. Though it may be normal forgetfulness that comes with getting older, the sooner you get it checked out, the earlier you can start treatment if you need it.
Causes
The exact cause of Alzheimer disease is not known. Research shows that certain changes in the brain are associated with Alzheimer disease. This leads to structures called neuritic plaques and neurofibrillary tangles. Most experts believe that this is the cause of Alzheimer disease but why this happens to some people is not known.
You are more likely to develop Alzheimer disease if you:
- Are older -- Developing Alzheimer disease is not a part of normal aging.
- Have a close relative, such as a brother, sister, or parent with Alzheimer disease.
- Have certain genes linked to Alzheimer disease.
The following may also increase the risk:
- Being female
- Having heart and blood vessel problems due to high cholesterol
- History of head trauma
There are two types of Alzheimer disease:
- Early onset Alzheimer disease -- Symptoms appear before age 60. This type is much less common than late onset. It tends to get worse quickly. Early onset disease can run in families. Several genes have been identified.
- Late onset Alzheimer disease -- This is the most common type. It occurs in people age 60 and older. It may run in some families, but the role of genes is less clear.
Symptoms
Alzheimer disease symptoms include difficulty with many areas of mental function, including:
- Emotional behavior or personality
- Language
- Memory
- Perception
- Thinking and judgment (cognitive skills)
Alzheimer disease usually first appears as forgetfulness.
Mild cognitive impairment (MCI) is a condition in which a person has more memory and thinking problems than other people their age. People with MCI have mild problems with thinking and memory that do not interfere with daily activities. They are often aware of the forgetfulness. Not everyone with MCI develops Alzheimer disease.
Symptoms of MCI include:
- Difficulty doing more than one task at a time
- Difficulty solving problems or making decisions
- Forgetting names of familiar people, recent events, or conversations
- Taking longer to do more difficult mental activities
Early symptoms of Alzheimer disease can include:
- Difficulty performing tasks that take some thought, but used to come easily, such as balancing a checkbook, playing complex games (bridge), and learning new information or routines
- Getting lost on familiar routes
- Language problems, such as trouble remembering the names of familiar objects
- Losing interest in things previously enjoyed and being in a flat mood
- Misplacing items
- Personality changes and loss of social skills
- Mood changes leading to aggressive behavior
- Poor performance of job duties
As Alzheimer disease becomes worse, symptoms are more obvious and interfere with the ability to take care of oneself. Symptoms may include:
- Change in sleep patterns, often waking up at night
- Delusions, depression, and agitation
- Difficulty doing basic tasks, such as preparing meals, choosing proper clothing, and driving
- Difficulty reading or writing
- Forgetting details about current events
- Forgetting events in one's life history and losing self-awareness
- Hallucinations, arguments, striking out, and violent behavior
- Poor judgment and loss of ability to recognize danger
- Using the wrong word, mispronouncing words, or speaking in confusing sentences
- Withdrawing from social contact
People with severe Alzheimer disease can no longer:
- Recognize family members
- Perform basic activities of daily living, such as eating, dressing, and bathing
- Understand language
Other symptoms that may occur with Alzheimer disease:
- Problems controlling bowel movements or urine
- Swallowing problems
Exams and Tests
A skilled health care provider can often diagnose Alzheimer disease with the following steps:
- Performing a complete physical exam, including a nervous system exam
- Asking about the person's medical history and symptoms
- Mental function tests (mental status examination)
- Neuropsychological testing
A diagnosis of Alzheimer disease is made when certain symptoms are present, and by making sure other causes of dementia are not present.
Tests may be done to rule out other possible causes of dementia, including:
- Anemia
- Brain tumor
- Long-term (chronic) infection
- Intoxication from medicines
- Severe depression
- Increased fluid on the brain (normal pressure hydrocephalus)
- Stroke
- Thyroid disease
- Vitamin deficiency
CT or MRI of the brain may be done to look for other causes of dementia, such as a brain tumor or stroke. Sometimes, a PET scan can be used to rule out Alzheimer disease.
The only way to know for certain that someone has Alzheimer disease is to examine a sample of their brain tissue after death.
Treatment
There is no cure for Alzheimer disease. The goals of treatment are:
- Slow the progression of the disease (although this is difficult to do)
- Manage symptoms, such as behavior problems, confusion, and sleep problems
- Change the home environment to make daily activities easier
- Support family members and other caregivers
Medicines are used to:
- Slow the rate at which symptoms worsen, though the benefit from using these medicines may be small
- Lower the amount of beta amyloid protein in the brain
- Control problems with behavior, such as loss of judgment or confusion
Before using these medicines, ask your provider:
- What are the side effects? Is the medicine worth the risk?
- When is the best time, if any, to use these medicines?
- Do medicines for other health problems need to be changed or stopped?
Someone with Alzheimer disease will need support in the home as the disease gets worse. Family members or other caregivers can help by helping the person cope with memory loss and behavior and sleep problems. It is important to make sure the home of a person who has Alzheimer disease is safe for them.
Support Groups
Having Alzheimer disease or caring for a person with the condition may be a challenge. You can ease the stress of illness by seeking support through Alzheimer disease resources. Sharing with others who have common experiences and problems can help you not feel alone.
Outlook (Prognosis)
How quickly Alzheimer disease gets worse is different for each person. If Alzheimer disease develops quickly, it is more likely to worsen quickly.
People with Alzheimer disease often die earlier than normal, although a person may live anywhere from 3 to 20 years after diagnosis.
Families will likely need to plan for their loved one's future care.
The final phase of the disease may last from a few months to several years. During that time, the person becomes totally disabled. Death usually occurs from an infection or organ failure.
When to Contact a Medical Professional
Contact your provider if:
- Alzheimer disease symptoms develop or a person has a sudden change in mental status
- The condition of a person with Alzheimer disease gets worse
- You are unable to care for a person with Alzheimer disease at home
Prevention
Although there is no proven way to prevent Alzheimer disease, there are some measures that may help prevent or slow the onset of Alzheimer disease:
- Stay on a low-fat diet and eat foods high in omega-3 fatty acids.
- Get plenty of exercise.
- Stay mentally and socially active.
- Wear a helmet during risky activities to prevent brain injury.
References
Alzheimer's Association website. Press release: First practice guidelines for clinical evaluation of Alzheimer's disease and other dementias for primary and specialty care.
Budson AE, Solomon PR. Alzheimer’s disease. In: Budson AE, Solomon PR, eds. Memory Loss, Alzheimer's Disease, and Dementia. 3rd ed. Philadelphia, PA: Elsevier; 2022:chap 4.
Knopman DS. Cognitive impairment and dementia. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 371.
Peterson R, Graff-Radford J. Alzheimer disease and other dementias. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 95.
Wilamowska K, Knoefel J. Alzheimer's disease. In: Kellerman RD, Rakel DP, eds. Conn's Current Therapy 2022. Philadelphia, PA: Elsevier 2022:711-718.
Version Info
Last reviewed on: 1/23/2022
Reviewed by: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Internal review and update on 02/23/24 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
