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Alzheimer's disease (AD) is an age-related, non-reversible brain disorder that develops over a period of years. Initially, people experience memory loss and confusion, which may be mistaken for the kinds of memory changes that are sometimes associated with normal aging. However, the symptoms of AD gradually lead to behavior and personality changes, a decline in cognitive abilities such as decision-making and language skills, and problems recognizing family and friends. AD ultimately leads to a severe loss of mental function. These losses are related to the worsening breakdown of the connections between certain neurons in the brain and their eventual death. AD is one of a group of disorders called dementias that are characterized by cognitive and behavioral problems. It is the most common cause of dementia among people age 65 and older. There are three major hallmarks in the brain that are associated with the disease processes of AD.
Amyloid plaques, which are made up of fragments of a protein called betaamyloid peptide mixed with a collection of additional proteins, remnants of neurons, and bits and pieces of other nerve cells. Neurofibrillary tangles (NFTs), found inside neurons, are abnormal collections of a protein called tau. Normal tau is required for healthy neurons. However, in AD, tau clumps together. As a result, neurons fail to function normally and eventually die. Loss of connections between neurons responsible for memory and learning. Neurons can't survive when they lose their connections to other neurons. As neurons die throughout the brain, the affected regions begin to atrophy, or shrink. By the final stage of AD, damage is widespread and brain tissue has shrunk significantly.
What is the prognosis? In very few families, people develop AD in their 30s, 40s, and 50s. This is known as "early onset" AD. These individuals have a mutation in one of three different inherited genes that causes the disease to begin at an earlier age. More than 90 percent of AD develops in people older than 65. This form of AD is called "late-onset" AD, and its development and pattern of damage in the brain is similar to that of early-onset AD. The course of this disease varies from person to person, as does the rate of decline. In most people with AD, symptoms first appear after age 65. We don't yet completely understand the causes of late-onset AD, but they probably include genetic, environmental, and lifestyle factors. Although the risk of developing AD increases with age, AD and dementia symptoms are not a part of normal aging. There are also some forms of dementia that aren't related to brain diseases such as AD, but are caused by systemic abnormalities such as metabolic syndrome, in which the combination of high blood pressure, high cholesterol, and diabetes causes confusion and memory loss. What is dementia? Dementia is a syndrome characterized by: 1. impairment in memory, 2. impairment in another area of thinking such as the ability to organize thoughts and reason, the ability to use language, or the ability to see accurately the visual world (not because of eye disease), and 3. these impairments are severe enough to cause a decline in the patient's usual level of functioning. Although some kinds of memory loss are normal parts of aging, the changes due to aging are not severe enough to interfere with the level of function. Many different diseases can cause dementia, but Alzheimer's disease is by far the most common cause for dementia in the United States and in most countries in the world.
the number of individuals with Alzheimer's disease in the United States is expected to be 14 million by the year 2050. Common forms of certain genes increase the risk of developing Alzheimer's disease. no genetic risk factor has yet been found. The apoE4 form of the gene has been associated with increased risk of Alzheimer's disease in most (but not all) populations studied. All patients with Down syndrome will develop the brain changes of Alzheimer's disease by 40 years of age. but is always less than 30% and frequently 8%-15%. The frequency of the apoE4 version of the gene in the general population varies. the children of a patient with early onset Alzheimer's disease who has one of these gene mutations has a 50% risk of developing Alzheimer's disease. As a population ages. The best-studied "risk" gene is the one that encodes apolipoprotein E (apoE). Other risk factors for Alzheimer's disease include high blood pressure (hypertension). Ten percent of people over 65 years of age and 50% of those over 85 years of age have Alzheimer's disease. In the majority of Alzheimer's disease cases. diabetes. The apoE gene has three different forms (alleles) -apoE2. Alzheimer's disease is not a normal part of aging and is not something that inevitably happens in later life. Whereas only 1%-2% of individuals 70 years of age have Alzheimer's disease. Most patients develop Alzheimer's disease after age 70. Who develops Alzheimer's disease? The main risk factor for Alzheimer's disease is increased age. and possibly elevated blood cholesterol. A relatively common form of a gene located on chromosome 19 is associated with late onset Alzheimer's disease. For example. Nonetheless. At least half of these early onset patients have inherited gene mutations associated with their Alzheimer's disease. Unless new treatments are developed to decrease the likelihood of developing Alzheimer's disease. even persons with two copies of the E4 gene don't always get Alzheimer's disease. Persons with two copies of the E4 gene (usually around 1% of the population) have about a nine-fold increase in risk. Nonetheless. 2%-5% of patients develop the disease in the fourth or fifth decade of life (40s or 50s). but do not invariably cause Alzheimer's disease. Most experts do not recommend that adult children of patients with . These factors increase the risk of Alzheimer's disease. There are also genetic risk factors for Alzheimer's disease. Nonetheless. This fact was also a clue to the "amyloid hypothesis of Alzheimer's disease" What are risk factors for Alzheimer's disease? The biggest risk factor for Alzheimer's disease is increased age. However. Moreover. The likelihood of developing Alzheimer's disease doubles every 5. at least half of people who live past the 95 years of age do not have Alzheimer's disease. the frequency of Alzheimer's disease continues to increase. Individuals who have completed less than eight years of education also have an increased risk for Alzheimer's disease. apoE3. This means that in majority of patients with Alzheimer's disease. many people live to over 100 years of age and never develop Alzheimer's disease.The likelihood of having Alzheimer's disease increases substantially after the age of 70 and may affect around 50% of persons over the age of 85. and apoE4. in some studies around 40% of individuals 85 years of age have Alzheimer's disease. no specific genetic risks have yet been identified. At least one copy of the E4 gene is found in 40% of patients with sporadic or late-onset Alzheimer's disease. Persons with one copy of the E4 gene usually have about a two to three fold increased risk of developing Alzheimer's disease. however. but by no means do they mean that Alzheimer's disease is inevitable in persons with these factors.5 years from 65 to 85 years of age. coronary artery disease. There is also a genetic risk for late onset cases.
usually less than eight years . you can maximize independence. have demonstrated that persons with limited formal education . While some Alzheimer's behaviors can be managed with special medications prescribed by a doctor. Many. It is more effective to change the environment than to change most behaviors. General Safety Concerns People with Alzheimer's disease become increasingly unable to take care of themselves. studies have found that women have a higher risk for Alzheimer's disease than men.Alzheimer's disease should have genetic testing for the apoE4 gene since there is no treatment for Alzheimer's disease. Avoid the use of flammable and volatile compounds near gas appliances. Therefore. many cannot. Throughout the Home • • • • • Display emergency numbers and your home address near all telephones. A safe environment can be a less restrictive environment where the person with Alzheimer's disease can experience increased security and more mobility. the role of estrogen in Alzheimer's disease remains an area of research focus. Tack extension cords to the baseboards of a room to avoid tripping. you face the ongoing challenge of adapting to each change in the person's behavior and functioning. The following general principles may be helpful. . As a caregiver. genetic testing may be recommended for adult children of patients with Alzheimer's disease so that they may be treated. It is very difficult to predict what a person with Alzheimer's might do. but age alone does not seem to explain the increased frequency in women. checking the safety of your home will help you take control of some of the potential problems that may create hazardous situations. Minimize danger. but not all. Do not store these materials in an area where a gas pilot light is used. The apparent increased frequency of Alzheimer's disease in women has led to considerable research about the role of estrogen in Alzheimer's disease. Recent studies suggest that estrogen should not be prescribed to post-menopausal women for the purpose of decreasing the risk of Alzheimer's disease. 3. It is certainly true that women live longer than men. accidents can happen. but not all studies. Install secure locks on all outside doors and windows. Hide a spare house key outside in case the person with Alzheimer's disease locks you out of the house. When medical treatments that prevent or decrease the risk of developing Alzheimer's disease become available. However. Just because something has not yet occurred does not mean it should not be cause for concern. Even with the best-laid plans. Adapt the environment. It is not known whether this reflects a decreased "cognitive reserve" or other factors associated with a lower educational level. Some studies have found that Alzheimer's disease occurs more often among people who suffered significant traumatic head injuries earlier in life. In addition. 1.are at increased risk for Alzheimer's disease. particularly among those with the apoE 4 gene. By minimizing danger. Nonetheless. many. Think prevention. the disease progresses differently in each person. 2. Avoid the use of extension cords if possible by placing lamps and appliances close to electrical outlets. You can make changes in an environment to decrease the hazards and stressors that accompany these behavioral and functional changes.
Remove matches. This reduces fire hazards. radiators. knives. store them in a locked cabinet. If possible. and potentially poisonous aquatic life could be harmful to a curious person with Alzheimer's disease. If smoking is permitted. Drinking alcohol can increase confusion. Each bottle of prescription medicine should be clearly labeled with the person's name. Keep all medications (prescription and over-the-counter) locked. water. blades. Do not use or store flammable liquids in the kitchen. monitor the person with Alzheimer's while he or she is smoking. • • • • . Remove scatter rugs and foam pads from the floor. stairways should be carpeted or have safety grip strips. A person with Alzheimer's disease may choke or suffocate. small appliances. Install safety knobs and an automatic shut-off switch on the stove. • • • • • • • • • Outside Approaches to the House Kitchen • Install childproof door latches on storage cabinets and drawers designated for breakable or dangerous items. which can create confusion and danger. dosage frequency. Throw out or recycle newspapers and magazines regularly. If prescription or nonprescription drugs are kept in the kitchen. Installing safety locks on guns or remove ammunition and firing pins. Avoid clutter. Keep all areas where people walk free of furniture. cigarettes. Lock all power tools and machinery in the garage. Place red tape around floor vents. and expiration date. lighters. workroom. Lock them in the garage or in an outside storage unit. matches. Keep plastic bags out of reach.• • • • • Cover unused electrical outlets with childproof plugs. ashtrays. Place light switches at the top and the bottom of stairs. and anything valuable. Check all rooms for adequate lighting. The combination of glass. or basement. Child-resistant caps are available if needed. electrical pumps. drug strength. Stairways should have at least one handrail that extends beyond the first and last steps. Lock away all household cleaning products. Keep fish tanks out of reach. Keep all alcohol in a locked cabinet or out of reach of the person with Alzheimer's. the person may forget the desire to smoke. Remove all guns and other weapons from the home or lock them up. name of the drug. and other means of smoking from view. Remove all poisonous plants from the home. Put a gate across the stairs if the person has balance problems. and other heating devices to deter the person with Alzheimer's from standing on or touching them when hot. and with these reminders out of sight. Check with local nurseries or contact the for a list of poisonous plants. scissors.
people with Alzheimer's may no longer be able to interpret accurately what they see because of brain changes. • • • • • Create color contrast between floors and walls to help the person see depth. or mats in the tub and shower. The person with Alzheimer's should be evaluated periodically by a physician for any such changes that may be correctable with glasses. Remove the lock from the bathroom door to prevent the person with Alzheimer's from getting locked inside. Use a plastic shower stool and a hand-held shower head to make bathing easier. Smell . hear.Bedroom • Anticipate the reasons a person with Alzheimer's disease might get out of bed. For example. • • Impairment of the Senses Alzheimer's disease can cause changes in a person's ability to interpret what he or she can see. Use a raised toilet seat with handrails. for example) for easier identification. thirst. Also. Vision People with Alzheimer's may experience a number of changes in visual abilities. Place brightly colored signs or simple pictures on important rooms (the bathroom. and sink. be sure that objects cannot be placed in the blades. consider placing these strips next to the tub. Be aware that a small pet that blends in with the floor or lies in walkways may be a hazard. These changes can cause safety concerns. they may lose their ability to comprehend visual images. If you use portable fans. taste. or other devices. going to the bathroom. Use a night-light. toilet. If the bathroom is uncarpeted. Although there is nothing physically wrong with their eyes. or smell. Try to meet these needs by offering food and fluids and scheduling ample toileting. or install grab bars beside the toilet. hearing aids. dentures. Remove portable space heaters. decals. Use a monitoring device (like those used for infants) to alert you to any sounds indicating a fall or other need for help. feel. Floor coverings are less visually confusing if they are a solid color. The person with Alzheimer's disease may trip over the pet. restlessness. This also is an effective device for bathrooms. • • • • Bathroom • • • Do not leave a severely impaired person with Alzheimer's alone in the bathroom. their sense of perception and depth may be altered. Mark the edges of steps with brightly colored strips of tape to outline changes in height. Place nonskid adhesive strips. and pain. Remove scatter rugs and throw rugs. such as hunger. Use dishes and placemats in contrasting colors for easier identification.
and close windows or doors. Remove or lock up medicine cabinet items such as toothpaste. • • • • Avoid excessive noise in the home such as having the stereo and the TV on at the same time. Consider a childproof latch on the refrigerator. Taste People with Alzheimer's may lose taste sensitivity. with red for hot and blue for cold. This loss may result in confusion or overstimulation. • • • • • Hearing People with Alzheimer's disease may have normal hearing. but they may lose their ability to interpret what they hear accurately. or discomfort. keep a spare set of dentures. Be sensitive to the amount of noise outside the home. shampoos. . If the person keeps removing dentures. Touch People with Alzheimer's may experience loss of sensation or may no longer be able to interpret feelings of heat. • Keep all condiments such as salt. The person with Alzheimer's disease may not smell smoke or may not associate it with danger. Remove furniture or other objects with sharp corners or pad the corners to reduce potential for injury. Learn the Heimlich maneuver or other techniques to use in case of choking. if necessary. • • • • • • • Install smoke detectors and check them frequently. Use a thermometer to tell you if bath water is too hot or too cold. or spices hidden if you see the person with Alzheimer's using excess amounts. or spice can be irritating to the stomach or cause other health problems. Too much salt. check the batteries and functioning frequently. they also may place dangerous or inappropriate things in their mouths. If possible. if necessary. check for correct fit. sugar. Do not store pet food in the refrigerator. Check with your local Red Cross chapter for more information and instruction. If the person wears a hearing aid. lotions. Keep refrigerators clear of spoiled foods. rubbing alcohol. and soap. sugar. Keep pet litter boxes inaccessible to the person with Alzheimer's disease. As their judgment declines. Avoid large gatherings of people in the home if the person with Alzheimer's shows signs of agitation or distress in crowds.A loss of or decrease in smell often accompanies Alzheimer's disease. which may look and smell like food to the person with Alzheimer's. cold. Color code separate water faucet handles. perfume.
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