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Alzheimer's Disease

Alzheimer's disease is caused by the destruction of nerve cells (neurons) in the brain. The destruction of neurons also reduces neurotransmitters, substances made by neurons responsible for message transmission in the brain. Because Alzheimer's causes both structural and chemical deficits, the disease interferes with the way parts of the brain work together. As a result, a person with Alzheimer's has a steady loss of memory and other cognitive abilities. For more information about Alzheimer's disease or to schedule an appointment, call (206) 341-0420.

Risk Factors for Alzheimer's Disease

The exact cause of Alzheimer's is not known but it may involve both genetic and environmental factors. Early onset disease, which is defined as appearing before age 60, can run in families and involves inherited gene mutations that can lead to the disease. Early onset Alzheimer's is much less common than late onset; however, early onset tends to progress rapidly.

Late onset Alzheimer's is the most common form of the disease, developing in people 60 and older. While late onset Alzheimer's may run in families, the role of genetics is less definitive. One possibility is that certain genes may increase the likelihood that tissues in the brain will degenerate, leading to the onset of Alzheimer's disease.

Other risk factors for Alzheimer's disease include:

  • Age - Usually people who develop Alzheimer's are older than 65. The risk of the disease increases with age. Up to 50 percent of people 85 and older have or will develop Alzheimer's disease.
     
  • Gender -In general women have longer lifespans, and are more likely to develop Alzheimer's disease.
     
  • Cognitive impairment - People with some level of cognitive impairment, such as memory problems not severe enough to be called dementia, can later develop Alzheimer's disease. A history of head trauma can also be a precursor to the disease.
      
  • Lifestyle - Some of the same factors that increase the risk of heart disease may also contribute to developing Alzheimer's. These factors include high blood pressure, high cholesterol and poorly controlled diabetes. 

Symptoms of Alzheimer's Disease

Depending on how quickly the disease progresses, Alzheimer's usually starts with slight memory loss and confusion, eventually leading to serious mental impairment that affects a person's ability to remember, reason, learn and exercise judgment.

Signs and symptoms of Alzheimer's disease include:

  • Progressive memory loss - While everyone has occasional lapses in memory, those associated with Alzheimer's persist and get worse. Common memory problems caused by the disease include repeating things, forgetting conversations, routinely misplacing things or putting them in odd locations and eventually forgetting the names of family members or everyday objects.
     
  • Difficulty performing familiar tasks - Routine tasks that used to come easily, such as cooking or balancing a checkbook, become confusing or difficult.
     
  • Loss of judgment - Activities that require planning or decision making become more difficult or impossible. People with Alzheimer's have trouble solving everyday problems.
     
  • Personality changes - Mood swings are common in those with Alzheimer's, as is increased stubbornness, social withdrawal, anxiety and sometimes aggressiveness.

As Alzheimer's disease progresses, symptoms become more pronounced and interfere with managing daily life, including:

  • Difficulty doing basic tasks, such as dressing properly.
  • Forgetting key life events and losing a sense of one's own identity.
  • Difficulty reading or writing.
  • Having delusions, sometimes leading to aggressive behavior and striking out.
  • Loss of ability to judge situations, including recognizing danger.

In the most advanced stages of Alzheimer's disease, people no longer recognize family members, understand language or are able to perform the most basic life tasks. The final phase of the disease may last from a few months to several years.

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Diagnosing Alzheimer's Disease

While Alzheimer's disease is the most common cause of dementia, diagnosing it requires ruling out other potential causes. A definitive Alzheimer's diagnosis can only be made after death when a sample of brain tissue can be examined. Careful medical evaluation helps exclude other conditions linked to dementia such as thyroid and vascular disorders. The diagnostic process for Alzheimer's usually includes:

  • A physical exam and medical history -A health care provider will take a history with a review of the patient's prescription drugs, conduct a physical exam (including a neurological exam to test reflexes and coordination), and perform a mental status examination. Laboratory testing of blood, urine or other samples can help rule out other possible causes of symptoms.
     
  • Neuropsychological testing - Testing of cognitive function, including memory, perception, language and other skills can shed light on the type of impairment present and possible source of the dementia.
     
  • Brain imaging - Brain imaging tests help rule out structural abnormalities in the brain brought on by blood clots, brain tumor or stroke. Types of studies used most often are magnetic resonance imaging (MRI) and computed tomography (CT).

Treatment of Alzheimer's Disease

Currently there is no cure for Alzheimer's disease. The goals of treatment are to slow the progression of the disease while supporting family and caregivers. Some medications are used on a short-term basis to slightly improve or stabilize symptoms and slow cognitive decline. Other drugs can be used to help with behavioral symptoms, such as sleeplessness and agitation.

Because medications can have disruptive side effects and may not offer noticeable improvement, patients and caregivers should discuss the appropriateness and timing of using medications with the patient's health care provider.

Types of drugs used to treat Alzheimer's disease:

  • Memantine (Namenda) is currently the only drug approved for the treatment of moderate-to-severe Alzheimer's disease. Anxiety and agitation are possible side effects.
     
  • Neurotransmitters are the message carrying chemicals in the brain. Drugs that affect the levels of the neurotransmitter acetylcholine are Donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne, formerly called Reminyl). Side effects in the form of flu-like symptoms can result.

Other types of drugs are sometimes needed to control aggressive or dangerous behaviors.

It also may be necessary to stop taking medications suspected of making confusion worse. These drugs can include painkillers, antihistamines, sleeping pills and others. However a patient should never change or stop taking any medicines without first talking to their health care provider.

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Supplements

Vitamins such as folate (vitamin B9), vitamin B12, and vitamin E are known to support the nervous system and possibly affect the rate of cell damage. However, there is no clear evidence that taking these vitamins prevents Alzheimer's or slows the disease once it occurs.

The herb ginkgo biloba has been used by those who believe it prevents or slows the development of dementia. However, studies to date have failed to show that the herb lowers the chance of developing dementia, or improves the cognitive abilities of those who already have Alzheimer's. DO NOT use ginkgo if you take blood-thinning medications like warfarin (Coumadin) or a class of antidepressants called monoamine oxidase inhibitors (MAOIs).

It is important to talk to a health care provider before taking any supplements. These products are available over the counter and are NOT regulated by the FDA.