Q. What is Alzheimer's disease?
A. Alzheimer's disease is the most common cause of dementia among older people. It involves parts of the brain that control thought, memory, and language. Alzheimer's damages a person's ability to reason, remember, speak, perform simple calculations, and carry out routine tasks. Over time, patients also may become anxious or aggressive or wander away from home. In the later stages, they may forget how to do basic tasks, like brushing their teeth or dressing themselves. Eventually, patients need total care.
Q. What is dementia?
A. Dementia is a brain disorder that seriously affects a person's memory, thinking, and reasoning skills. People with dementia often have trouble thinking and speaking clearly, remembering recent events, and learning new things. Over time, it becomes hard for them to handle everyday activities and take care of themselves. There are many causes of dementia, but Alzheimer's disease is the most common cause of dementia in older persons. The second most common type of dementia is multi-infarct dementia, which is caused by a series of strokes. Dementia can also develop from other diseases affecting the nervous system, including Parkinson's disease and AIDS.
Q. What is senile dementia?
A. Senile dementia is an outdated term once used to refer to any form of dementia that occurred in older people.
Q. What is mild cognitive impairment?
A. Mild cognitive impairment, or MCI, is a change in memory that is different from both Alzheimer's disease and age-related memory change. People with MCI have ongoing memory problems but do not have noticeable problems in other areas like confusion, attention problems, and difficulty with language.
Q. How many people suffer from Alzheimer's disease?
A. It is estimated that up to 4.5 million people currently suffer from Alzheimer's disease in the United States.
Q. What is the age of most people with Alzheimer's disease?
A. The risk of Alzheimer's increases with age. In most people with Alzheimer's disease, symptoms first appear after age 65. About 3 percent of men and women ages 65 to 74 have the disease, but nearly half of those age 85 and older may have the disease. It is not uncommon for individuals to have mild symptoms for some time before a diagnosis is made. It is important to note that Alzheimer's disease is not a normal part of aging.
Q. How long do people with Alzheimer's disease live after developing the disease?
A. People with Alzheimer's disease often live for years with the disease, eventually dying from pneumonia or other diseases. The time from diagnosis to end of life varies. It can be as little as 3 years if the person is over 80 when diagnosed. Or, it may be as long as 10 years or more if the person is younger.
Q. What are the stages in the development of Alzheimer's disease?
A. Alzheimer's develops slowly, starting with mild memory problems and ending in death. The course the disease takes and how fast changes occur vary from person to person. The symptoms often progress through these stages: mild, moderate, and severe.
Signs of mild Alzheimer's can include:
- memory loss
- confusion about the location of familiar places
- taking longer to accomplish normal daily tasks
- trouble handling money and paying bills
- poor judgment leading to bad decisions
- loss of spontaneity and sense of initiative
- mood and personality changes
- increased anxiety
- increasing memory loss and confusion
- shortened attention span
- problems recognizing friends and family members
- difficulty with language, including problems with reading and writing
- difficulty working with numbers
- difficulty organizing thoughts and thinking logically
- inability to learn new things or cope with new or unexpected situations
- restlessness, agitation, anxiety, tearfulness
- wandering -- especially in the late afternoon or at night
- repetitive statements or movement, occasional muscle twitches
- hallucinations and delusions, suspiciousness or paranoia, irritability
- loss of impulse control
- perceptual-motor problems
Symptoms of severe Alzheimer's include
- Inability to recognize family or loved ones
- Inability to communicate
- loss of sense of self
- weight loss
- seizures, skin infections, difficulty swallowing
- groaning, moaning, or grunting
- increased sleeping
- lack of bladder and bowel control
- total dependence on the caregiver
Q. What other conditions have symptoms like Alzheimer's disease?
A. Tumors, strokes, severe depression, thyroid problems, medication side effects, nutritional disorders, and certain diseases can all have effects that mimic those of Alzheimer's disease. Early diagnosis increases the chances of treating these conditions successfully.
Q. Is misplacing your keys a normal part of aging or could it be a symptom of Alzheimer's disease?
A. Problems with memory may be due to a variety of factors. It is normal for people of all ages occasionally to forget names, appointments, or where they put their keys. Such memory problems may result from stress, distractions, grief, fatigue, poor vision or hearing, use of alcohol, an illness, or trying to remember too many details at once. Depression also may cause poor concentration, sleep disturbance, or other symptoms that lead to forgetfulness in people who do not have Alzheimer's disease. A decline in short-term memory that sometimes accompanies aging is called age-associated memory loss. In many people, it does not lead to Alzheimer's disease. People with early-stage Alzheimer's disease often experience forgetfulness. They may have constant trouble remembering recent events, activities, or the names of familiar people or things. Memory loss that is associated with Alzheimer's disease interferes with activities of daily living.
Q. Do we know what causes Alzheimer's disease?
A. Scientists do not yet fully understand what causes Alzheimer's disease. However, it is clear that Alzheimer's disease develops when a complex series of events in the brain gradually causes nerve cells in the brain to stop working and die. Age is the most important known risk factor for Alzheimer's disease.
Q. Are there any steps I can take to prevent Alzheimer's?
A. There are no treatments, drugs, or pills that can prevent Alzheimer's disease, but people can take some steps that may reduce their risk. These include:
A healthy diet is important. Although no special diets or nutritional supplements have been found to prevent or reverse Alzheimer's disease, a balanced diet helps maintain overall good health. Research hasn't proven that these steps will lower the risk for Alzheimer's, and studies designed to directly test their ability to do so are currently in progress. However, all of these things are good to do anyway because they lower the risk for other diseases and help maintain and improve your overall health and well-being.
Q. If a member of my family has Alzheimer's disease, am I at increased risk for developing it?
A. Two types of Alzheimer's disease exist: early-onset familial Alzheimer's disease or FAD, and late-onset Alzheimer's disease. Early-onset FAD is a rare, inherited form of the disease that occurs between age 30 and 60. Several members of the same generation of a family are often affected. In late-onset Alzheimer's disease, which most often occurs after age 65, there is no obvious family pattern in most cases. Late-onset Alzheimer's disease develops for reasons that scientists are still trying to determine. Age is the most important known risk factor for Alzheimer's disease. Having a family member with Alzheimer's disease does increase the risk for developing late-onset Alzheimer's disease, but by no means guarantees that you will develop the disease.
Q. What other risk factors, beside genetics, may contribute to developing Alzheimer's disease?
A. Scientists still need to learn a lot more about causes and risk factors. In addition to genetics, they are studying education, diet, environment, and molecular changes in the brain to learn what role they might play in the development of this disease. Scientists are finding more clues that some of the risk factors for heart disease and stroke -- such as high blood pressure, high cholesterol, and low levels of the vitamin folate -- may also increase the risk of Alzheimer's. Researchers are also investigating the possibility that physical, mental and social factors may protect against Alzheimer's.
Q. Do men or women have a higher risk of developing Alzheimer's disease?
A. Age is the most important known risk factor for Alzheimer's disease. This means the longer people live, the more likely they are to develop the disease. Since women have longer life spans than men, they have a higher lifetime risk of developing Alzheimer's.
Q. How does a head injury affect the development of Alzheimer's disease?
A. Some studies have shown that people who have suffered previous head injuries with loss of consciousness from which they recovered have an increased risk for Alzheimer's disease. However, other studies show no link between head injury and the risk of developing Alzheimer's disease.
Q. Does educational level affect the development of Alzheimer's disease?
A. Research suggests that there is a connection between the more years of formal education a person has and a reduced likelihood of Alzheimer's disease later in life. Some studies suggest that there is a connection between keeping an active mind by engaging in activities such as crossword puzzles and maintaining mental function.
Q. Do mentally stimulating activities protect against Alzheimer's disease?
A. Studies have shown that keeping the brain active may be associated with a reduced risk of Alzheimer's disease. In a study with nuns, priests, and brothers known as the Religious Orders Study, researchers asked more than 700 participants to describe the amount of time they spent in seven mentally stimulating activities. These activities included listening to the radio, reading newspapers, playing puzzle games, and going to museums.
Q. What is the relationship between aluminum and the development of Alzheimer's disease?
A. When researchers found traces of this metal in the brains of people with Alzheimer's disease, some thought it might play a role in causing the disease. However, many studies since then have not shown aluminum to be associated with Alzheimer's disease.
Q. How is Alzheimer's disease diagnosed?
A. At specialized centers, doctors can diagnose "possible" or "probable" Alzheimer's disease correctly up to 90 percent of the time. Doctors use several tools to diagnose "probable" Alzheimer's disease. These tools include a complete medical history and tests that measure memory, problem solving, attention, counting, and language abilities. Medical tests such as analysis of blood, urine, or spinal fluid are used to determine if the dementia has another cause. Brain scans allow the doctor to look at a picture of the brain to see if there is anything unusual -- such as evidence of strokes -- that could account for the dementia. However, the only definite way to diagnose Alzheimer's disease is to find out whether there are plaques and tangles in brain tissue. To look at brain tissue, doctors must wait until they do an autopsy, which is an examination of the body done after a person dies.
Q. How accurate are tests for Alzheimer's disease?
A. Doctors in specialized Alzheimer's disease treatment centers can now diagnose Alzheimer's disease with up to 90 percent accuracy in a living person.
Q. How important is a diagnosis of Alzheimer's disease?
A. The earlier an accurate diagnosis of Alzheimer's disease is made, the greater the gain in managing symptoms and allowing the person to take part in future life course decisions.
Q. How is Alzheimer's disease treated?
A. No treatment is yet available that can stop Alzheimer's disease. However, for some people in the early and middle stages of the disease, the drugs Aricept®, Exelon®, or Razadyne® -- also known as Reminyl® -- may help prevent some symptoms from becoming worse for a limited time. Aricept® is also approved for severe symptoms of Alzheimer's. Memantine, also known by its brand name Namenda®, is approved for use in moderate to severe forms of the disease. Also, some medicines may help control behavioral symptoms of Alzheimer's disease such as sleeplessness, agitation, wandering, anxiety, and depression. Treating these symptoms often makes people with Alzheimer's more comfortable and makes their care easier.
Q. Will a vaccine one day prevent Alzheimer's disease?
A. Early vaccine studies in mice successfully reduced beta-amyloid plaques in the brain and improved the way mice performed on memory tests. But when the studies were conducted in humans, they had to be stopped because some participants experienced side effects. However, scientists are continuing to study variations in the vaccine approach in the hope that they will reduce the beta-amyloid in the brain while minimizing harmful side effects.
Q. Is vitamin E effective against Alzheimer's?
A. Researchers funded by the National Institute on Aging recently completed a clinical trial focusing on the use of vitamin E in people with mild cognitive impairment, or MCI. MCI is a type of memory change that is different from both Alzheimer's and age-related memory change. People with MCI have ongoing memory problems, but do not have noticeable problems in other areas like confusion, attention problems, and difficulty with language. This 3-year trial compared the drug donepezil or vitamin E to a placebo in people with mild cognitive impairment to see if the drug or vitamin might delay or prevent the development of Alzheimer's. The study found that taking vitamin E did not prevent or delay Alzheimer's disease in persons with MCI. It is possible that vitamin E may not help after memory loss has already started. However, donepezil, also known as Aricept®, did seem to delay the onset of Alzheimer's but only during the first year of treatment, providing no clear guidance to doctors about prescribing donepezil for people with MCI.
Q. Can estrogen be used to treat Alzheimer's disease?
A. Some studies have suggested that estrogen used by women to treat the symptoms of menopause also protects the brain. Experts also wondered whether using estrogen could reduce the risk of Alzheimer's or slow the disease. Clinical trials to test estrogen, however, have not shown that it can slow the progression of Alzheimer's in women who have already been diagnosed with the disease. And one study found that women over the age of 65 who used estrogen with a progestin were at greater risk for dementia, including Alzheimer's. The study also showed that older women who used only estrogen could increase their risk of developing dementia. Scientists believe that more research is needed to find out if estrogen may play some role in Alzheimer's. They would like to know whether starting estrogen therapy around the time of menopause, rather than at age 65 or older, will protect memory or prevent Alzheimer's disease, and an NIH trial is testing that possibility.
Q. Are non-steroidal anti-inflammatory drugs like ibuprofen effective against Alzheimer's disease?
A. There is evidence that inflammation in the brain may contribute to the damage caused by Alzheimer's disease. Some studies have suggested that drugs such as nonsteroidal anti-inflammatory drugs, or NSAIDs, might help slow the progression of Alzheimer's. So far, however, clinical trials have not shown a benefit from these drugs.
Q. Does being physically active help prevent Alzheimer's?
A. Although there is no evidence that exercise can prevent Alzheimer's disease, there is growing evidence that being physically active may improve mental function. In one recent study, researchers used magnetic resonance imaging, or MRI, to measure changes in the brain activity of healthy older adults before and after a six-month program of brisk walking. They found that the group of walkers was able to pay attention better and focus more clearly on goals without becoming distracted compared to a group that was not physically active. In another study of 6,000 healthy women 65 years and older, researchers found that women who were more physically active were less likely to experience mental decline than women who were inactive.
Q. What options are there for people who want to help test new treatments for Alzheimer's disease?
A. People with Alzheimer's disease and mild cognitive impairment or even healthy people who want to help scientists test possible treatments may be able to take part in clinical trials. Clinical trials are research studies with people to find out whether a new drug or treatment is both safe and effective. New therapies are tested on people only after laboratory and animal studies show promising results. The Food and Drug Administration, or FDA, sets strict rules to make sure that people who agree to be in the studies are treated as safely as possible. To make it easier for people to find out about studies, the National Institute on Aging, or NIA, maintains the Alzheimer's Disease Clinical Trials Database. It lists clinical studies for Alzheimer's disease that are sponsored by the federal government and private companies.