About

• Alzheimer’s is a type of dementia, a term that’s used to describe brain disorders where gradual decline in memory or other thinking skills interferes with daily life.
• The disease starts forming in the brain 5–10 years before symptoms appear.
• Abnormal clumps (amyloid plaques) and tangled fibers (tau tangles) start spreading in the brain.
• The connections between nerve cells (neurons) stop working.
• The brain tissue shrinks over time.
• Although genetics and age play a large role in causing Alzheimer’s, it is not a normal part of aging.

FYI

• Alzheimer’s is the 6th leading cause of death in the United States.
• Men represent approximately 45% of all caregivers in the United States.
• An estimated 1 in 9 Americans ages 65 and over have Alzheimer’s.
• Today, more than five 5 million Americans have Alzheimer’s disease; by 2050, that number is expected to grow to 16 million.

Symptoms

Signs and Symptoms of Alzheimer’s

• Stage 1: Normal. No difficulties with memory, judgment, communication, or conducting daily activities. People remember their name, where they live, and what time of day it is.

• Stage 2: Normal Aged Forgetfulness. Your loved one may have some “senior moments” – occasional difficulties remembering things. Friends and family aren’t usually aware of these cognitive problems.

• Stage 3. Mild cognitive Impairment. Small changes in memory, behavior, communication, personality, or mood. For many, symptoms never get any worse. But for most, symptoms become more severe within two to four years.
  • Trouble remembering names (people and things).
  • Repeating questions and stories.
  • Difficulty remembering something recently read.
  • Misplacing important items.

• Stage 4. Mild Alzheimer’s. Symptoms become more obvious now. Treatments are available that may make the disease advance more slowly. May last about two years.
  • Difficulty remembering recent events/personal details.
  • Withdrawing from social interaction.
  • Depression and moodiness.
  • Confusion about where commonly used household items typically go.

• Stage 5. Moderate Alzheimer’s. Memory worsens and everyday activities become difficult. Your loved one needs 24/7 monitoring and cannot live alone. She or he should definitely not be cooking anymore and will need help with everyday tasks (cleaning, dressing, feeding, bathing, and so on). May last 1 ½ years.
  • Severe memory loss; remembering some things but not others.
  • Difficulty remembering the date/season/country.
  • Wandering around (may get lost).
  • Difficulty bathing, cleaning, and dressing oneself.

• Stage 6. Moderately Severe Alzheimer’s. Can’t recognize people or do basic, everyday activities. Family, friends, and loved ones typically find this stage to be the most painful.
  • Continued severe memory loss.
  • Inability to identify friends/family.
  • Confusing one person for another.
  • Restlessness, agitation, and frustration when the sun goes down into evening (called sundowning).
  • Inability to use the toilet; may have accidents and require adult diapers.
  • Threatening/violent verbal outbursts.

• Stage 7. Severe Alzheimer’s. This is the final, most severe stage. Your loved one can’t move, can’t communicate, and depends on a caretaker for everything. She or he has little muscle control and spends all day in bed. Body functions slowly shut down.
  • Losing the ability to talk.
  • Decrease in vocabulary – forgetting words.
  • Inability to walk, smile, sit, swallow, and hold head up.
  • Mouth sucking reflex.
  • Inability to move joints, or it could be too painful to move or movement could be too painful.
  • Gets sick easily. May develop pneumonia or ulcerated infections.

Prevention

One way to reduce the impact that cognitive aging can have—as well as to possibly slow the advance of Alzheimer’s symptoms—is to make “healthy aging” a regular part of your life. Healthy aging is really nothing more than maintaining an active, healthy lifestyle. Besides being good for your brain, healthy aging will help improve your overall health. Here’s what you and your loved one need to do:

• Visit the doctor regularly.
• Be active. Exercise at least 30 minutes every day.
• Eat healthy foods (fruits, vegetables, whole grains, and those rich in Vitamin C, E, and folic acid).
• Get enough sleep.
• Limit alcohol consumption.
• Find ways to reduce stress (meditation, yoga, etc.).
• Take part in mentally stimulating activities (puzzles, games, cards, books, etc.).
• Have a social network of family and friends. Besides keeping you emotionally healthy, this may prevent mental health issues, such as depression.
• Manage medications that can have cognitive health effects.

Diagnosis

If you suspect that someone you love might be suffering from Alzheimer’s, you may want to explore some of the available, non-invasive screening tests. The Alzheimer’s Foundation of America (contact info is in the Caregiver Resources and Tools section) has a National Memory Screening Program that uses a number of those tests. Keep in mind that these tests are not intended to (nor are they able to) diagnose Alzheimer’s or any other illness. If the results of the screen are troubling, schedule an appointment with your loved one’s healthcare provider right away. He or she may be able to administer additional tests and make a diagnosis in the office.

Questions to Ask Your Health Care Provider

Here are some questions you may want to ask:

• What’s the actual diagnosis?
• Is it certain that this is Alzheimer’s?
• What tests are needed and why?
• What medications are available?
• What’s the best treatment option and why?
• What non-drug therapies are available for us?
• What are the possible side effects of medications and how common are they?
• What signs and symptoms should I expect in the upcoming stages?
• How will this diagnosis affect my loved one’s overall health?
• Will we need to see other doctors or specialists?
• How can I best prepare for each visit to the doctor’s office?
• Do you have any tools that I can use to monitor my loved one’s daily activities and symptoms?
• Who should we talk to about Alzheimer’s care?
• Are there any life-threatening situations I should be aware of where I need to act quickly?
• Are there any clinical trials my loved one can be a part of?
• Are there any caregiver training classes or support groups near where I live?
• Do you have any brochures or other educational materials I can take home?
• How do I talk to my kids and other family members about this?
• How can I include family into the caregiving process?

Treatments

NON-DRUG TREATMENTS
Managing your loved one’s behavior and/or finding ways to provide comfort and a sense of security can be very effective. You’ll find more information on managing behaviors in the Caregiving Tips & Understanding Behaviors: Tips on Everyday Things section.

MEDICATIONS
The Food and Drug Administration (FDA) has approved treatments that may improve your loved one’s quality of life. These treatments help maintain memory, learning, awareness, information processing, thinking, and speaking skills.
They may also control some of the common behavioral symptoms, such as depression, agitation, hallucinations, and delusions. It’s important to understand that these drug treatments do not stop the changes that are caused by Alzheimer’s, or prevent brain cells from dying. But they may temporarily slow the symptoms, which, in turn, may help your loved one perform everyday life functions for a longer period of time.

ALZHEIMER’S DRUGS FALL INTO TWO BROAD CATEGORIES:

• Cholinesterase inhibitors, which help prevent the breakdown of a brain chemical (acetylcholine) that is important for memory and thinking. These drugs are donepezil, galantamine, and rivastigmine.

• N-methyl-D-aspartate (NMDA) receptor antagonists, which block the activity of a different brain chemical (glutamate) by binding to NMDA receptors on brain cells. When the body overproduces glutamate, brain cells may die. If it doesn’t produce enough glutamate, cognitive problems can develop. Memantine is an NMDA receptor.

Common Alzheimer’s Drugs Based on Severity:

Mild to Moderate = Galantamine
Moderate to Severe = Memantine
Moderate to Severe = Memantine + Donepezil
All Stages = Donepezil
All Stages = Rivastigmine

Resources

National Institute on Aging:
www.nia.nih.gov/alzheimers

National Institutes of Health:
www.clinicaltrials.gov

Alzheimer’s Association:
www.alz.org/trialmatch

Alzheimer’s Foundation of America:
www.alzfdn.org/ClinicalTrials/findatrial.html

The Center For Information & Study on Clinical Research
Participation (CISCRP):
www.searchclinicaltrials.org or 1-888-CISCRP3

ResearchMatch:
www.ResearchMatch.org/roar