Alzheimer's Disease
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(Alzheimer's Dementia)
Definition
| Areas of the Brain Affected by Alzheimer's Disease |
|
| Copyright © Nucleus Medical Media, Inc. |
Causes
- Plaques—Abnormal deposits of a substance called beta amyloid in different areas of the brain
- Neurofibrillary tangles—Twisted fibers (called tau fibers) within the nerve cells
Risk Factors
- Age: 65 and older
- Previous serious, traumatic brain injury
- Lower educational achievement
- Down's syndrome
- Down's syndrome in a first-degree relative
- Women under age 35 who give birth to a child with Down's syndrome
- Smoking
- Family history of Alzheimer's disease
- Presence of a certain type of protein (APOE-e4)
- Depression
- Elevated levels of homocysteine
- Heart disease
- Poor nutrition and vitamin deficiency in childhood
- Excess metal in the blood, especially zinc, copper, aluminum, and iron
- Certain viral infections
- Diabetes
- High cholesterol
Symptoms
- Early—Loss of memory, reasoning, understanding, or learning, but does not interfere with independence
- Intermediate—Increased mental loss, personality changes, and increased dependence on others for basic needs
- Severe—Loss of personality and bodily functions with total dependence on others for care
-
Increasing trouble remembering things, such as:
- How to get to familiar locations
- What the names of family and friends are
- Where common objects are usually kept
- How to do simple math
- How to do usual tasks, such as cooking, dressing, bathing, etc.
- Having difficulty concentrating on tasks
- Having difficulty completing sentences due to lost or forgotten words (may progress to complete inability to speak)
- Forgetting the date, time of day, or season
- Getting lost in familiar surroundings
- Having mood swings
- Being withdrawn, losing interest in usual activities
- Having personality changes
- Walking in a slow, shuffling way
- Having poor coordination
- Losing purposeful movement
Diagnosis
- Neurological exams—Tests of your nervous system
- Psychological and mental status testing
- CT scan—A type of x-ray that uses a computer to make pictures of your brain
- MRI scan—A test that uses magnetic waves to make pictures of your brain
- Electroencephalogram (EEG)—A test that measures electrical currents in your brain
- Blood tests and urine tests
- Lumbar puncture—To test for levels of certain brain proteins that increase with Alzheimer’s disease and to rule out other disorders
- Positron emission tomography (PET) scan of the brain—A test that makes images showing activity in your brain
Treatment
Medications for Symptoms and Disease Progression
- Cholinesterase inhibitors—Recommended for mild-to-moderate Alzheimer's disease (may be called donepezil [Aricept], rivastigmine [Exelon], galantamine [Reminyl])
- N-methyl-D-aspartate (NMDA) receptor antagonist—For moderate-to-severe Alzheimer's disease (may be called memantine)
- Gamma-secretase inhibitors
- Tau fiber aggregation inhibitors
- Herbs and supplements (such as vitamin E, ginkgo biloba)
Lifestyle Management
- Creating an environment in which you can receive the care you need
- Keeping your quality of life as high as possible
- Keeping yourself safe
- Helping yourself learn to deal with the frustration of your uncontrollable behavior
- Providing a calm, quiet, predictable environment
- Providing appropriate eyewear and hearing aids, and easy-to-read clocks and calendars
- Playing quiet music
- Doing light, appropriate exercise to reduce agitation and relieve depression
- Encouraging family and close friends to visit frequently
Psychiatric Medication
- Depression
- Anxiety
- Confusion, paranoia, and hallucinations
Caregiver Support
Prevention
- Eat a healthy diet that includes fish.
- Drink alcohol, but in moderation. This means no more than two drinks per day for a man, and one drink per day for a woman.
- Exercise regularly.
- Engage in mentally stimulating activities.
RESOURCES
Alzheimer's Association http://www.alz.org
Alzheimer's Disease Education and Referral Center http://www.nia.nih.gov/alzheimers
References
Albanese E, Dangour AD, et al. Dietary fish and meat intake and dementia in Latin America, China, and India: a 10/66 Dementia Research Group population-based study. Am J Clin Nutr. 2009;90(2):392-400.
Alzheimer's disease. Activity based prevention strategies. EBSCO DynaMed website. Available at: http://dynamed.ebscohost.com/about/about-us. Updated July 11, 2012. Accessed August 22, 2012.
Alzheimer's disease and non-Alzheimer’s dementia. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary. Updated July 7, 2012. Accessed August 22, 2012.
Alzheimer's disease. EBSCO DynaMed website. Available at: http://dynamed.ebscohost.com/about/about-us. Updated July 11, 2012. Accessed August 22, 2012.
Alzheimer's disease medications fact sheet. National Institute on Aging website. Available at: http://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-medications-fact-sheet. Updated July 2010. Accessed August 22, 2012.
American Academy of Neurology website. Available at: http://patients.aan.com/disorders/index.cfm?event=viewampdisorder%5Fid=844. Accessed August 22, 2012.
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Carillo MC, Blackwell A, et al. Early risk assessment for Alzheimer's disease. Alzheimers dementia. 2009;5(2):182-196.
Deweerdt S. Prevention: activity is the best medicine. Nature. 2011;475:S16-S17.
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Green RC, Cupples LA, et al. Risk of dementia among white and African-American relatives of patients with Alzheimer disease. JAMA. 2002;287:329-336.
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Hayden KM, Welsh-Bohmer KA. Epidemiology of cognitive aging and Alzheimer’s disease: contributions of the Cache County Utah study of memory, health, and aging. Curr Top Behav Neurosci. 2011 Aug 2.
Kasper DL, Braunwald E, et al. Harrison's Principles of Internal Medicine. 16th ed. New York, NY: The McGraw-Hill Companies; 2005.
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