Alzheimer’s Disease

Alzheimer’s disease is a form of dementia. It

is the most common form of dementia.
Dementia is a term used to describe memory
loss and loss of other intellectual capabilities,
like reasoning and thinking, that are severe
enough to cause problems in daily life.
Alzheimer’s disease is named after Dr. Alois
Alzheimer, who discovered the disease in
1906.

Alzheimer’s largest risk factor is aging. However, it is not a normal part of aging. While
the majority of people who have Alzheimer’s are over the age of 65, it can happen in
someone younger. Early-onset Alzheimer’s is when the disease becomes noticeable in
someone in their 40s or 50s. About 5 percent of people with this disease are in this age
group.

This is a disease that progressively gets worse over time. In late stages, someone with
Alzheimer’s may not be able to communicate or reason with those around them. They
will also eventually need full-time care for everyday life. According to the Alzheimer’s
Association, it is the 6th leading cause of death in the United States. The average life
span of someone with the disease is eight years after diagnosis, but they can live up to
20 years depending on other health conditions. There is no cure at this time. However,
there are treatments that can slow the progression and improve the quality of life for
those with the disease.

Symptoms

Memory problems are usually the first symptoms of Alzheimer’s. Remembering things
that have been recently learned is especially difficult. Some other symptoms are:

 confusion about places or times (may be mild at first)

 unable to find words with speaking
 misplacing objects you use regularly
 changes to personality
 new irritability
 making bad decisions
 difficulty organizing thoughts
 repeating things over and over
 forgetting things and not remembering them later
 difficulty with numerical calculations
 difficulty responding to everyday problems
 mood swings
 paranoia and distrust of others (including immediate family or close friends)
This disease does not affect everyone in the same way, so individuals may experience
symptoms at different times. If you or a loved one has any of these symptoms and they
are causing problems with everyday life, you should talk to your doctor.

Causes

The exact cause of Alzheimer’s is not clear, but there are a number of genetic,
environmental, and lifestyle factors that can contribute. However, what is known is that
Alzheimer’s damages the brain and its brain cells. This leads to the brain shrinking. The
brain of someone with Alzheimer’s usually has two types of abnormalities: plaques and
tangles.

What Is Tay-Sachs Disease?

Tay-Sachs is a disease of the central

nervous system. It is a neurodegenerative
disorder that most commonly affects
infants. In infants, it is a progressive
disease that is unfortunately always fatal.
Tay-Sachs can also occur in teens and
adults, causing less severe symptoms,
although this occurs more rarely.

Symptoms of Infantile Tay-Sachs

Most affected infants have nerve damage starting in utero (before birth), with symptoms
appearing from age 3 to 6 months, in most cases. Progression is rapid, and the child will
typically pass away by 4 or 5 years old.

Symptoms of Tay-Sachs in infants include:

 deafness
 progressive blindness
 decreased muscle strength
 increased startle response
 paralysis or loss of muscle function
 seizure
 muscular stiffness (spasticity)
 delayed mental and social development
 slow growth
 red spot on the macula (an oval-shaped area near the center of the retina in the
eye)
Emergency Symptoms

If your child has a seizure or has trouble breathing, go to the emergency room or call
911 immediately.

Symptoms of Other Forms of Tay-Sachs

There are also late-onset juvenile, chronic, and adult forms of the disease, which are
much more rare, but tend to be milder in severity.

People with the juvenile form of Tay-Sachs typically display symptoms between the
ages of 2 and 10 and usually pass away by age 15.

Those with the chronic form of Tay-Sachs develop symptoms by the age of 10, but the
disease progresses slowly. Symptoms may include slurred speech, muscle cramps, and
tremors. Life expectancy varies with this form of the disease, and some people have a
normal lifespan.

Adult Tay-Sachs is the mildest form. Symptoms appear during adolescence or

adulthood. People with the adult form of Tay-Sachs disease usually have these
symptoms:

 muscle weakness
 slurred speech
 unsteady gait
 memory problems
 tremors

The severity of symptoms and life expectancy varies.

What Causes Tay-Sachs?

A defective gene on chromosome 15 (HEX-A) causes Tay-Sachs disease. This

defective gene causes the body to not make a protein called hexosaminidase A.
Without this protein, chemicals called gangliosides build up in nerve cells in the brain,
destroying brain cells.

The disease is hereditary, which means it is passed down through families. You have to
receive two copies of the defective gene — one from each parent — to become
affected. If only one parent passes down the defective gene, the child becomes a
carrier. They will not be affected, but may pass the disease down to their own children.
What Is Huntington’s Disease?

Huntington’s disease is a hereditary condition in

which your brain’s nerve cells gradually break down.
This affects your physical movements, emotions, and
cognitive abilities. There is no cure, but there are
ways to cope with this disease and its symptoms.

Huntington’s disease is much more common in

people with European ancestry, affecting about three
to seven out of every 100,000 people of European
descent.

What Are the Symptoms of Huntington’s Disease?

There are two types of Huntington’s disease: adult onset and early onset.

Adult Onset

Adult onset is the most common type of Huntington’s disease. Symptoms usually begin
when people are in their 30s or 40s. Initial signs often include:

 depression
 irritability
 hallucinations
 psychosis
 minor involuntary movements
 poor coordination
 difficulty understanding new information
 trouble making decisions

Symptoms that may occur as the disease progresses include:

 uncontrolled twitching movements, called chorea

 difficulty walking
 trouble swallowing and speaking
 confusion
 memory loss
 personality changes
 speech changes
 decline in cognitive abilities
Early Onset

This type of Huntington’s disease is less common. Symptoms usually start to appear in
childhood or adolescence. Early-onset Huntington’s disease causes mental, emotional,
and physical changes, such as:

 drooling
 clumsiness
 slurred speech
 slow movements
 frequent falling
 rigid muscles
 seizures
 sudden decline in school performance

What Causes Huntington’s Disease?

A defect in a single gene causes Huntington’s disease. It’s considered an autosomal

dominant disorder. This means that one copy of the abnormal gene is enough to cause
the disease. If one of your parents has this genetic defect, you have a 50 percent
chance of inheriting it. You can also pass it on to your children.

The genetic mutation responsible for Huntington’s disease is different from many other
mutations. There isn’t a substitution or a missing section in the gene. Instead, there is a
copying error. An area within the gene is copied too many times. The number of
repeated copies tends to increase with each generation.

In general, symptoms of Huntington’s disease show up earlier in people with a larger

number of repeats. The disease also progresses faster as more repeats build up.

How Is Huntington’s Disease Diagnosed?

Family history plays a major role in the diagnosis of Huntington’s disease. However, a
variety of clinical and laboratory testing can be done to assist in diagnosing the problem.

Neurological Tests
A neurologist will do tests to check your:

 reflexes
 coordination
 balance
 muscle tone
 strength
 sense of touch
 hearing
 vision
Brain Function and Imaging Tests

If you’ve had seizures, you may need an electroencephalogram (EEG). This test
measures the electrical activity in your brain.

Brain-imaging tests can also be used to detect physical changes in your brain.

 Magnetic resonance imaging (MRI) scans use magnetic fields to record brain
images with a high level of detail.
 Computed tomography (CT) scans combine several X-rays to produce a cross-
sectional image of your brain.

Psychiatric Tests

Your doctor might ask you to undergo a psychiatric evaluation. This evaluation checks
your coping skills, emotional state, and behavioral patterns. A psychiatrist will also look
for signs of impaired thinking.

You may be tested for substance abuse to see if drugs might explain your symptoms.

Genetic Testing

If you have several symptoms associated with Huntington’s disease, your doctor might
recommend genetic testing. A genetic test can definitively diagnose this condition.

Genetic testing may also help you decide whether or not to have children. Some people
with Huntington’s do not want to risk passing the defective gene to the next generation.

What Are the Treatments for Huntington’s Disease?

Medications

Medications can provide relief from some of your physical and psychiatric symptoms.
The types and amounts of drugs needed will change as your condition progresses.

 Involuntary movements may be treated with tetrabenazine and antipsychotic

drugs.
 Muscle rigidity and involuntary muscle contractions can be treated with
diazepam.
 Depression and other psychiatric symptoms can be treated with antidepressants
and mood-stabilizing drugs.

Therapy

Physical therapy can help improve your coordination, balance, and flexibility. With this
training, your mobility is improved, and falls may be prevented.
Occupational therapy can be used to evaluate your daily activities and recommend
devices that help with:

 movement
 eating and drinking
 bathing
 getting dressed

Speech therapy may be able to help you speak clearly. If you can’t speak, you will be
taught other types of communication. Speech therapists can also help with swallowing
and eating problems.

Psychotherapy can help you work through emotional and mental problems. It can also
help you develop coping skills.

What Is ALS?

Amyotrophic lateral sclerosis (ALS) is a

degenerative disease that affects the brain and
spinal cord. ALS is a chronic disorder that causes a
loss of control of voluntary muscles. The nerves
controlling speech, swallowing, and limb
movements are often affected. Unfortunately, a
cure has not yet been found for it.

The famous baseball player Lou Gehrig was diagnosed with the disease in 1939. ALS is
also known as Lou Gehrig’s disease.

What Are the Symptoms of ALS?

Both sporadic and familial ALS are associated with a progressive loss of motor neurons.
The symptoms of ALS depend on what areas of the nervous system are affected. These
will vary from person-to-person.

The medulla is the lower half of the brainstem. It controls many of the body’s autonomic
functions. These include breathing, blood pressure, and heart rate. Damage to the
medulla can cause:

 slurred speech
 hoarseness
 difficulty swallowing
 emotional lability, which is characterized by excessive emotional reactions such
as laughing or crying
 a loss of tongue muscle contour, or tongue atrophy
  excess saliva
 difficulty breathing

The corticospinal tract is a part of the brain made up of nerve fibers. It sends signals
from your brain to your spinal cord. ALS damages the corticospinal tract and causes
spastic limb weakness.

The anterior horn is the front part of the spinal cord. Degeneration here can cause:

 limp muscles, or flaccid weakness

 muscle wasting
 twitching
 breathing problems caused by weakness in the diaphragm and other respiratory
muscles

Early signs of ALS may include problems performing everyday tasks. For example, you
may have difficulty climbing stairs or getting up from a chair. You might also have
difficulty speaking or swallowing, or weakness in your arms and hands. Early symptoms
are usually found in specific parts of the body. They also tend to be asymmetrical, which
means they only happen on one side.

As the disease progresses, the symptoms generally spread to both sides of the body.
Bilateral muscle weakness becomes common. This can lead to weight loss from muscle
wasting. The senses, the urinary tract, and bowel function usually remain intact.

Does ALS Affect Thinking?

Cognitive impairment is a common symptom of ALS. Behavioral changes can also

occur without mental decline. Emotional lability can occur in all ALS sufferers, even
those without dementia.

Inattention and slowed thinking are the most common cognitive symptoms of ALS. ALS-
related dementia can also occur if there’s cell degeneration in the frontal lobe. ALS-
related dementia is most likely to occur when there’s a family history of dementia.

How Is ALS Diagnosed?

ALS is usually diagnosed by a neurologist. There’s no specific test for ALS. The process
of establishing a diagnosis can take anywhere from weeks to months.

Your doctor may start to suspect you have ALS if you have progressive neuromuscular
decline. They’ll watch for increasing problems with symptoms such as:

 muscle weakness  cramps

 wasting  contractures
 twitching
These symptoms can also be caused by a number of conditions. Therefore, a diagnosis
requires your doctor to rule out other health problems. This is done with a series of
diagnostic tests including:

 an EMG to evaluate the electrical activity of your muscles

 nerve conduction studies to test your nerve function
 an MRI that shows which parts of your nervous system are affected
 blood tests to evaluate your general health and nutrition

Genetic tests may also be useful for people with a family history of ALS.

How Is ALS Treated?

As ALS progresses, it becomes more difficult to breathe and digest food. The skin and
subcutaneous tissues are also affected. Many parts of the body deteriorate, and all of
them must be treated appropriately.

Because of this, a team of doctors and specialists often work together to treat people
with ALS. Specialists involved in the ALS team might include:

 a neurologist who is skilled in the management of ALS

 a physiatrist
 a nutritionist
 a gastroenterologist
 an occupational therapist
 a respiratory therapist
 a speech therapist
 a social worker
 a mental health professional
 a pastoral care provider

Family members should talk to people with ALS about their care. People with ALS may
need support when making medical decisions.

What Are the Complications of ALS?

The complications of ALS include:

 choking
 pneumonia
 malnutrition
 bed sores
What is Parkinson’s disease?

Parkinson’s disease (Parkinsonism) is marked by

the presence of certain recognizable symptoms.
These include uncontrollable shaking or tremor,
lack of coordination, and speaking difficulties.
However, symptoms vary and may worsen as the
disease progresses.

The main symptoms of Parkinson’s include:

 uncontrollable shaking and tremors

 slowed movement (bradykinesia)
 balance difficulties and eventual problems standing up
 stiffness in limbs

Many doctors who diagnose this brain disorder rely on the Hoehn and Yahr rating scale
to classify the severity of symptoms. The scale is broken into five stages based on
disease progression. The five stages help doctors evaluate how far the disease has
advanced.

Stage 1

Stage 1 is the mildest form of Parkinson’s. At this stage, there may be symptoms, but
they’re not severe enough to interfere with daily tasks and overall lifestyle. In fact, the
symptoms are so minimal at this stage that they’re often missed. But family and friends
may notice changes in your posture, walk, or facial expressions.

A distinct symptom of stage 1 Parkinson’s is that tremors and other difficulties in

movement are generally exclusive to one side of the body. Prescribed medications can
work effectively to minimize and reduce symptoms at this stage.

Stage 2

Stage 2 is considered a moderate form of Parkinson’s, and the symptoms are much
more noticeable than those experienced in stage 1. Stiffness, tremors, and trembling
may be more noticeable, and changes in facial expressions can occur.

While muscle stiffness prolongs task completion, stage 2 does not impair balance.
Difficulties walking may develop or increase, and the person’s posture may start to
change.

People at this stage feel symptoms on both sides of the body (though one side may only
be minimally affected) and sometimes experience speech difficulties.
The majority of people with stage 2 Parkinson’s can still live alone, though they may find
that some tasks take longer to complete. The progression from stage 1 to stage 2 can
take months or even years. And there is no way to predict individual progression.

Stage 3

Stage 3 is the middle stage in Parkinson’s, and it marks a major turning point in the
progression of the disease. Many of the symptoms are the same as those in stage 2.
However, you’re now more likely to experience loss of balance and decreased reflexes.
Your movements become slower overall. This is why falls become more common in
stage 3.

Parkinson’s significantly affects daily tasks at this stage, but people are still able to
complete them. Medication combined with occupational therapy may help decrease
symptoms.

Stage 4

Independence separates people with stage 3 Parkinson’s from those with stage 4.
During stage 4, it’s possible to stand without assistance. However, movement may
require a walker or other type of assistive device.

Many people are unable to live alone at this stage of Parkinson’s because of significant
decreases in movement and reaction times. Living alone at stage 4 or later may make
many daily tasks impossible, and it can be extremely dangerous.

Stage 5

Stage 5 is the most advanced stage of Parkinson’s disease. Advanced stiffness in the
legs can also cause freezing upon standing, making it impossible to stand or walk.
People in this stage require wheelchairs, and they’re often unable to stand on their own
without falling. Around-the-clock assistance is required to prevent falls.

Up to 30 percent of people at stage 4 and 5 experience confusion, hallucinations, and

delusions. Hallucinations occur when you see things that aren’t there. Delusions happen
when you believe things that aren’t true, even when you have been presented with
evidence that your belief is wrong. Dementia is also common, affecting up to 75 percent
of people with Parkinson’s. Side effects from medications at these later stages can often
outweigh the benefitsTrusted Source.

Non motor symptoms

The progression of Parkinson’s disease is most commonly evaluated by motor

symptoms such as muscle stiffness and tremors. However, nonmotor symptoms are
also common. Some people will develop these symptoms years before developing
Parkinson’s, and some will develop them after. Anywhere from 80 to 90 percent of
people with Parkinson’s disease will also experience nonmotor symptoms.

Nonmotor symptoms include:

 cognitive changes, such as difficulties with memory or planning, or slowing of

thought
 mood disorders such as anxiety and depression
 sleep disorders such as insomnia
 fatigue
 constipation
 vision problems
 speech and swallowing problems
 difficulties with sense of smell

Is Parkinson’s disease fatal?

Parkinson’s disease itself doesn’t cause death. However, symptoms related to

Parkinson’s can be fatal. For example, injuries that occur because of a fall or problems
associated with dementia can be fatal.

Some people with Parkinson’s experience difficulty swallowing. This can lead to
aspiration pneumonia. This condition is caused when foods, or other foreign objects, are
inhaled into the lungs.

The Stages of Dementia

What is dementia?

Dementia refers to a category of diseases that cause loss

of memory and deterioration in other mental functions.
Dementia occurs due to physical changes in the brain and
is a progressive disease, meaning it gets worse over time.
For some people, dementia progresses rapidly, while it
takes years to reach an advanced stage for others. The
progression of dementia depends greatly on the
underlying cause of the dementia. While people will experience the stages of dementia
differently, most people with dementia share some of the symptoms.

Types of dementia

The symptoms and progression of the disease depend on the type of dementia a
person has. Some of the most commonly diagnosed forms of dementia are:
Alzheimer’s disease

Alzheimer’s disease is the most common form of dementia. It accounts for 60 to 80

percent of cases. It’s usually a slowly progressing disease. The average person lives
four to eight years after receiving the diagnosis. Some people may live as many as 20
years after their diagnosis.

Alzheimer’s occurs due to physical changes in the brain, including a buildup of certain
proteins and nerve damage.

Dementia with Lewy bodies

Dementia with Lewy bodies is a form of dementia that occurs due to clumps of a protein
in the cortex. In addition to memory loss and confusion, dementia with Lewy bodies can
also cause:

 sleep disturbances  imbalance

 hallucination  other movement difficulties
Vascular dementia

Vascular dementia, also known as post-stroke or multi-infarct dementia, accounts for

about 10 percent of all cases of dementia. It’s caused by blocked blood vessels. These
occur in strokes and other brain injuries.

Parkinson’s disease

Parkinson’s disease is a neurodegenerative condition that can produce dementia similar

to Alzheimer’s in its later stages. The disease more commonly leads to problems with
movement and motor control, but it also can cause dementia in some people.

Frontotemporal dementia

Frontotemporal dementia refers to a group of dementias that often cause changes in

personality and behavior. It can also cause language difficulty. Frontotemporal dementia
can occur due to a range of conditions, including Pick’s disease and progressive
supranuclear palsy.

Mixed dementia

Mixed dementia is dementia in which multiple types of dementia-causing brain

abnormalities are present. This is most commonly Alzheimer’s and vascular dementia,
but it can include other forms of dementia as well.
How is dementia diagnosed?

No single test can determine whether you have dementia. Diagnosis is based on a
range of medical tests and your medical history. If you exhibit symptoms of dementia
your doctor will perform:

 a physical exam
 a neurological exam
 a mental status tests
 other laboratory tests to rule out other causes of your symptoms

Mini-mental state examination (MMSE)

The MMSE is a questionnaire for measuring cognitive impairment. The MMSE uses a
30-point scale and includes questions that test memory, language use and
comprehension, and motor skills, among other things. A score of 24 or higher indicates
normal cognitive function. While scores 23 and below indicate that you have some
degree of cognitive impairment.

Mini-Cog test

This is a short test for helping your doctor diagnose dementia. It involves these three
steps:

1. They’ll name three words and ask you to repeat them back.
2. They’ll ask you to draw a clock.
3. They’ll ask you to repeat back the words from the first step.

Clinical dementia rating (CDR)

If your doctor diagnoses you with dementia, they’ll also likely assign a CDR score. This
score is based on your performance in these and other tests, as well as your medical
history. The scores are as follows:

 A score of 0 is normal.
 A score of 0.5 is very mild dementia.
 A score of 1 is mild dementia.
 A score of 2 is moderate dementia.
 A score of 3 is severe dementia.

What are the stages of dementia?

Dementia progresses differently in everyone. Many people will experience the

symptoms associated with the following stages of Alzheimer’s disease:
Mild cognitive impairment (MCI)

MCI is a condition that can affect older people. Some of these people will go on to
develop Alzheimer’s disease. MCI is characterized by losing things often, forgetfulness,
and having trouble coming up with words.

Mild dementia

People may still be able to function independently in mild dementia. However, they’ll
experience memory lapses that affect daily life, such as forgetting words or where
things are. Common symptoms of mild dementia include:

 memory loss of recent events

 personality changes, such as becoming more subdued or withdrawn
 getting lost or misplacing objects
 difficulty with problem-solving and complex tasks, such as managing finances
 trouble organizing or expressing thoughts

Moderate dementia

People experiencing moderate dementia will likely need more assistance in their daily
lives. It becomes harder to perform regular daily activities and self-care as dementia
progresses. Common symptoms during this stage include:

 increasing confusion or poor judgment

 greater memory loss, including a loss of events in the more distant past
 needing assistance with tasks, such as getting dressed, bathing, and grooming
 significant personality and behavior changes, often caused by agitation and
unfounded suspicion
 changes in sleep patterns, such as sleeping during the day and feeling restless
at night

Severe dementia

People will experience further mental decline as well as worsening physical capabilities
once the disease progresses to the point of severe dementia. Severe dementia often
can cause:

 a loss of the ability to communicate

 a need for full-time daily assistance with tasks, such as eating and dressing
 a loss of physical capabilities, such as walking, sitting, and holding one’s head up
and, eventually, the ability to swallow, to control the bladder, and bowel function
 an increased susceptibility to infections, such as pneumonia