Alzheimer's disease Definition Alzheimer's disease is the most common cause of dementia, which is the loss of i ntellectual and

social abilities severe enough to interfere with daily functioni ng. Dementia occurs in people with Alzheimer's disease because healthy brain tis sue degenerates, causing a steady decline in memory and mental abilities. About 4 million older Americans have Alzheimer's, a disease that usually develops in p eople age 65 or older. This number is expected to triple by the year 2050 as the population ages. Although there's no cure for Alzheimer's disease, researchers have made progress. Treatments are available that improve the quality of life fo r some people with Alzheimer's. Also, more drugs are being studied, and scientis ts have discovered several genes associated with Alzheimer's, which may lead to new treatments to block progression of this complex disease. In the meantime, ca ring for someone with Alzheimer's takes patience and a focus on the things a per son can still do and enjoy. Those with Alzheimer's — as well as those who care for them — need support and affection from friends and family to cope. Symptoms Everyone has occasional lapses in memory. It's normal to forget the names of peo ple whom you rarely see. But it's not a normal part of aging to forget the names of familiar people and objects. Alzheimer's disease — a progressive, degenerative brain disease — causes more than simple forgetfulness. It may start with slight m emory loss and confusion, but it eventually leads to irreversible mental impairm ent that destroys a person's ability to remember, reason, learn and imagine. Mos t people with Alzheimer's share certain signs and symptoms of the disease. These may include:

Increasing and persistent forgetfulness. At its onset, Alzheimer's disease is ma rked by periods of forgetfulness, especially of recent events or simple directio ns. But what begins as mild forgetfulness persists and worsens. People with Alzh eimer's may repeat things and forget conversations or appointments. They routine ly misplace things, often putting them in illogical locations. They frequently f orget names, and eventually, they may forget the names of family members and eve ryday objects. Difficulties with abstract thinking. People with Alzheimer's may initially have trouble balancing their checkbook, a problem that progresses to t rouble recognizing and dealing with numbers.

diagnosis is often delayed. Eight years is the average length of time from diagnosis of A lzheimer's to death. Because early Alzheimer's symptoms progress slowly. people with advanced Alzheimer's may forget how to do even the most basic things. become a struggle as the disease progresses. Once-routine tasks that require sequential steps. but some people live more than a decade with the disease. becomes increasingly difficul t. As the disease progresses. Plaques and ta ngles Alzheimer's disease is named after Dr. Alzheimer's is characterized by greater difficulty in doing things that require planning. show increased stubbornness and withdraw socially. lower levels of neurotra nsmitters are produced. such as k nowing what to do if food on the stove is burning. Causes The causes of Alzheimer's are poorly understood. th is may be a response to the frustration they feel as they notice uncontrollable changes in their memory. Ev entually. Early on. When the signs and symptoms are too ob vious to miss. remember and feel. refusing to see a doctor. those closest to the person often realize that similar — but less s evere — difficulties have been present for years. People developing the condition may be frighteningly aware of their problems — but careful to keep them hidden. When they die. neurons in cert ain locations of the brain begin to die. Loss of judgment. The disease's course varies from person to person. even their families may fail to see what's going on. Chemicals called neurotransmitters help these signals flow s eamlessly between neurons. a German neurologi st. Alois Alzheimer. such a s cooking. Alzheimer's damages and kills brain cells. Disorientation. he examined the brain of a woman who had died after years of progre ssive . Initially in people with Alzheimer's. Neurons generate electrica l and chemical signals that are relayed from neuron to neuron to help you think. It may be a challenge for those with Alzheime r's to find the right words to express thoughts or even follow conversations. Personalit y changes. They may express dis trust in others. Survival begins to decline three years after diagnosis. People with Alzheimer's may exhibit mood swings. people with Alzheime r's may become anxious or aggressive and behave inappropriately. Res tlessness also is a common sign. and may find themselves lost in familiar surroundings. Difficulty per forming familiar tasks. but its effect on brain tissue has been demonstrated clearly. Eventually. reading and writing also are affected. decision making and judgment. creating signaling problems in the brain. A heal thy brain has billions of nerve cells called neurons. Solving everyday problems.Difficulty finding the right word. As a result. In 1906. Depression often coexists with Alzheimer's disease. eventually impossible. People with Alz heimer's often lose their sense of time and dates.

Inflammation is your bod y's response to injury or infection and a natural part of the healing process. Possible role of tangles. Plaques are made up of a normally harmless protein cal led beta-amyloid. scientists have identified several com mon threads. Heredit y. Although the ultimate cause of neuron death in Alzheimer's isn 't known. For people 85 and older. In people with Alzheimer's. Some of the theories: Possible role of plaques. E ven as beta-amyloid plaques develop in the spaces between neurons. Researchers have observed inflammation in the brains of some people with Alzheimer's disease. researchers have identified a few genetic mutations that greatly increase risk in some fami lies. they aren't sure how this development relates to the disease process. these clumps (now called plaques) and knots (now called tangles) ar e considered hallmarks of Alzheimer's disease. Three genetic mutations are known to cause . Risk factors Alzheimer's is a complex disease likely caused by a combination of factors — such as infection or reduced circulation — and genetic susceptibility. They include: Age.dementia. that number jumps to nearly 50 percent. threads of tau protein undergo alterati ons that cause them to become twisted. Together. Less than 5 percent of people between 65 and 74 have Alzhe imer's. affect t hose younger than 40. Alzheimer's usually affects people older than 65. mounting evidence suggests that a form of betaamyloid protein may be t he culprit. rarely. Your risk of developing Alzheimer's appears to be slightly higher if a firstdegree relative — parent. Studies of plaques and tangles fr om the brains of people who have died of Alzheimer's suggest several possible ro les these structures might play in the disease. The internal su pport structure for brain neurons depends on the normal functioning of a protein called tau. immune cells are at work getting rid of dead cells and other waste products in the brain. causing them to die. Many researchers believe this may serious ly damage neurons. Three genetic mutations — in amyloid precursor protein and presenilin 1 (PS1) and presenilin 2 (PS2) proteins — are known to cause a small number of ear ly-onset forms of Alzheimer's disease. Although the genetic mechanisms of Alzheimer's among families remain largely unexplained. these three genetic mutations account for less tha n 10 percent of all Alzheimer's cases. Alt hough researchers believe the inflammation occurs before plaques have fully form ed. Inflammatory response as the common path. sister or brother — has the disease. Her brain tissue showed abnormal clumps and irregular knots of brain c ells. Today. but can. There' s also debate about whether inflammation has a damaging effect on neurons or whe ther it is beneficial in clearing away plaques. These mutations result in the production of amyloid plaques. Although all the contributing factors may never be known.

Several studies indicate a defi nite link between the two. Sex. one form of the apolipoprotein E (APOE) ge ne increases your chance of developing late-onset Alzheimer's. but others show no link. aluminum seemed a likely candidate. In addition. People with Parkinson's diseas e. however. Women are mo re likely than men are to develop the disease. The observa tion that some ex-boxers eventually develop dementia suggests that serious traum atic injury to the head (for example. In addition. Poorly controlled diabetes is another risk facto r. Studies have found an association between less educat ion and the risk of Alzheimer's. may also increase the likelihood that you' ll develop Alzheimer's disease. however. The exact role hormone replacement therapy may play in the development of demen tia isn't yet clear. undetected strokes. can cause dementia by temporarily interrupting blood flow to the brain. a concussion with a prolonged loss of cons ciousness) may be a risk factor for Alzheimer's. The verdi ct is not yet in on whether estrogen affects the risk of dementia if given at an earlier age. no one has been able to link aluminum expos ure directly to Alzheimer's. Head injury. It remains unclear. Throughout the 1980s and '90s. Depression. there's no evidence that any particu lar substance increases a person's risk of Alzheimer's. too.early-onset Alzheimer's. whether less education and less mental acti vity create a risk of Alzheimer's or if it's simply harder to detect Alzheimer's in people who exercise their minds frequently or who have more education. doctors start th e diagnostic process by ruling out other diseases and conditions that also can c ause memory loss. also can develop dementia. Small. b ecause some people with Alzheimer's have deposits of aluminum in their brains. . in part because they live longer. which provides a greater reserve as y ou age. Typically. A fter many years of studies. reduces the risk of Alzheimer's disease. ca n cause lapses in memory. Hormone replacement therapy. Some researchers theorize that the more you use your brain. many older adults are on multiple medicat ions that may impair their ability to think clearly. Tests and diagnosis There's no one test to diagnose Alzheimer's disease. the more synapses you create. Education levels. Some studies have suggested that remaining mentally active throug hout your life. For a time. At this point. And keeping your body fit isn't your only concern — you've got to exercise your mind as well. evidence seemed to show that estrogen supplements given after menopause could reduce the risk of dementia. The same factors that put you at risk of heart disease. Toxic ity. for example. One long-standing theory is that overexposure to certain trace metals or ch emicals may cause Alzheimer's. B ut results from the large-scale Women's Health Initiative Memory Study indicated an increased risk of dementia for women taking estrogen after age 65. especially in your later years. a degenerative nerve disorder. Lifestyle. such as high blood pressure and high cholesterol.

Researchers are studying whet her brain scans can eventually be used to detect an increased risk of Alzheimer' s in healthy people before symptoms begin. Doctors may want to take a picture of the brain using a brain scan.To help distinguish Alzheimer's disease from other causes of memory loss. problem-solving abilities. Brain scans. Basic medical tests. Several types of brain scans are available — including a compu terized tomography (CT) scan. For instance. They help doctors pinpoint specific problems a person may have w ith cognition. attention spans. counting skills and language. su ch as thyroid disorders or vitamin deficiencies. This is especially helpful in trying to detect Alzheimer's and other dementias at an early stage. The patterns of any mental deficits observed during neuropsychological testing can help doctors sort out possible c auses of dementia. Doctors may list familiar objects. a magnetic resonance imaging (MRI) scan and a posi tron emission tomography (PET) scan. Blood tests may be done to help doctors rule out other potential causes of the dementia. They'll want to know about any problems a person may have in carryin g out daily activities. attention spans. using a microscopic examination of brain tissue. doctors might test recent and long-term memory by a sking: What day is it today? Or: When was World War II? Recall tests are another example. Using the methods above. doctors can accurately diagnose 90 percent of Alzheimer 's cases. counting skill s and language. doctors will also want to speak with a pers on's family or friends to get more information. problem-solving abil ities. Genetic testing for Alzheimer's is in its beginning stages. which checks for plaques and ta ngles. If possible. but the tests can't tell who will or will not get the disease. By looking at images of the brain. Doctors may ask about a person's general health and past medica l problems. . doctors may be able to pinpoint any visible abnormalities. doctor s typically rely on the following: Medical history. Blood tests a re available that can tell whether a person carries the genetic mutations believ ed to be associated with Alzheimer's. Mental status evaluation. Sometim es doctors undertake a more extensive assessment of memory. Alzheimer's can be diagnosed with complete accuracy only after death. and then ask a person to repeat the m immediately. Doctors use formal psychological tests to determine if a person's mental abilities are a s expected for his or her age and education. These tests screen memory. Neuropsychological testing. and again five minutes later.

which can lead to pneumonia. which increases the risk of urinary tract infections. Treatments and drugs Currently. Falls and their complications. This can make them more prone to additional health problems such as: Pneumonia. Falls can lead to fractures . . prolonged immobilization — which may be necessary to recover from injur ies related to a fall — increases the risk of a blood clot in the lungs (pulmonary embolism). including sleeplessn ess. Difficulty swallowing food and liquids may cause people with Alzheime r's to inhale (aspirate) some of what they eat and drink into their airways and lungs. Untreated urinary tract infections can lead to more serious. there's no cure for Alzheimer's disease. Urinary incontinence may require the placement of a urinary catheter. increasing their risk of falls. Surgery to repair injury from a fall carries risks as well. falls are a common cause of serious head injuries. People with Alzheimer's may become disoriented. such as bleedi ng in the brain.Complications In advanced Alzheimer's disease. Infections. which can be life-threatening. people may lose all ability to care for themsel ves. life-th reatening infections. For instance. Doctors sometimes prescribe drugs to improve symptoms that often accompany Alzheimer's. In addition.

What isn't known. Some of the most recent research indicates that taking steps to i mprove your cardiovascular health. such as losing weight. Cholinesterase inhibitors don't work for everyone. Statins. rivastigmine (Exelon) and galantamine (Reminyl) — works by improving the l evels of neurotransmitters in the brain. others). may also help prevent Alzheimer's dise ase. naproxen sodium (Aleve) and in domethacin (Indocin) may reduce the risk of developing Alzheimer's. they soon ha d to be stopped because some people experienced serious inflammation of the brai n. Cholinesterase inhibitors This group of medications — which includes donepezil (Ar icept). clinica l trials need to be completed before it's clear whether people should take NSAID s solely to prevent Alzheimer's. scientists learned from these experim ents and many researchers continue to look for ways to reduce the risk of this d isease. moderate and severe Alzheime r's disease. rosuvastatin (Crestor) and simvastatin (Zocor) — are normally used to lower . alth ough it also appears to increase agitation and delusional behavior in some peopl e. Prevention Right now. Memantine (Namenda) The first drug approved to treat moderate to severe stag es of Alzheimer's. ho wever. Unfortunately. This may be because inflammation appears to play a role in Alzheimer's. Because NSAIDs can cause serious gastrointestinal bleeding. nausea and vomiti ng. Donepezil also appears to delay the onset of Alzheimer's for about a year in people who have mild cognitive impairment (MCI). As many as half the people w ho take these drugs show no improvement. which include diarrhea. Animal studies were so encouraging that human trials began in 2001. there's no proven way to prevent the onset of Alzheimer's disease. It sometimes is used in combination with a cholinesterase inhibitor. But only two varieties of medicati ons have been proved to slow the cognitive decline associated with Alzheimer's. These drugs — a class that includes ator vastatin (Lipitor). is whether inflammation is a cause of Alzheimer's or simply an effect of the disease. agitation and depression. Nonsteroidal anti-inflammatory drugs (NSAIDs). exercising and control ling high blood pressure and cholesterol. Several studies have shown t hat the NSAIDs ibuprofen (Advil. Other people may choose to stop taking the drugs because of the side effects. Motrin. They include: Healthy aging. Donepezil has been approved by the Food and Drug Administration for the treatment of mild. People who have MCI h ave more memory problems than other people their age. memantine (Namenda).wandering. anxiety. Memantine's most common side effect is dizziness. Re searchers had developed what looked to be a promising vaccine against Alzheimer' s that worked by stopping deposits of beta-amyloid in the brain. protects brain cells from damage caused by the chemical messenger glutamate. Several leads are hopeful. but they are not demented. but still preliminary. While these results were disappointing.

A calm and stable home environm ent reduces behavior problems. anger. More studies are being done to determine exactly wh at role. noise. large groups of people. You can help a pe rson cope with the disease by being there to listen. frustration and discouragement. New situations. and their potential effects on Alzheimer 's are being studied. the connections between neurons. frustration. Vitamin E and ginkgo. statins may have in Alzheimer's prevention. If you're a caregiver for someone with Alzheimer's disease. uncertainty. Coping and support People with Alzheimer's disease often experience a mixture of emotions — confusion . grief and depression. Feelings of anger and guilt. and social isolation are common. A SERM called raloxifene (Evista) is used to protect against the bone loss associated with osteoporosis. be ing rushed or pressed to remember. the ability to think cl early declines even more. it would dram atically reduce the number of people who have the disease. Some researchers believe that lifelong mental exercise and learning may promote the growth of additional synapses. This advanced level of education simply may help some people "cover up" th eir condition until later. fear. but recent studies have shown that they may also reduce the risk of Alzheimer's disease. Selective estrogen receptor molecules (SERMs). and doing your best to help the person retain dignity and self-respect. worry and grief. Delaying the onset of Alzheimer's is an important step in fighting the disease. One large study. showed that vitamin E has no eff ect on the development of Alzheimer's in people who have mild cognitive impairme nt. Maintaining mental fitness may delay onset of dementia. a memory disorder that often pre cedes Alzheimer's. Other researchers argue that advanced education gives a person more experience with the types of memory and thinking tests used to measure deme ntia. you can help yourself by: Asking friends or other family members for help when you need it Taking care of your health Learning as much about the disease as you can Asking questions of do ctors. providing unconditional love. Mental fitness. social workers and others involved in the care of your loved one Joining a support group . It also appears to lower th e risk of developing mild cognitive impairment. Providing care for a person with Alzheimer's disease i s physically and emotionally demanding. Both these substances have been linked to improvements in cognitive abilities. or being asked to do complicated tasks can ca use anxiety. however. As a person with Alzheimer's becomes upset. and delay the on set of dementia.cholesterol levels. reassuring the person that life can still be enjoyed. If the onset of Alzheimer's could be postponed by just five years. if any.

a telephone help line.Many people with Alzheimer's and their families benefit from counseling or local support groups. . home care agencies . resources and referrals. doctors. and educational seminars. Contact your local Alzheimer's Association affiliate to get con nected with support groups. supervised living facilities.

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