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Alzheimer’s / Dementia
Defined: Also called: Senile Dementia
Alzheimer's is the most common cause of dementia, a general term for memory loss and other cognitive abilities serious enough to interfere with daily life. Alzheimer's disease accounts for 60-80% of dementia cases.
Learn more: What is the Difference Between Dementia and Alzheimer's?, What is Dementia, Research and Progress
Alzheimer's is not a normal part of aging. The greatest known risk factor is increasing age, and the majority of people with Alzheimer's are 65 and older. But Alzheimer's is not just a disease of old age. Approximately 200,000 Americans under the age of 65 have younger-onset Alzheimer’s disease (also known as early-onset Alzheimer’s).
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Alzheimer's worsens over time. Alzheimer's is a progressive disease, where dementia symptoms gradually worsen over a number of years. In its early stages, memory loss is mild, but with late-stage Alzheimer's, individuals lose the ability to carry on a conversation and respond to their environment. Alzheimer's is the sixth leading cause of death in the United States. On average, a person with Alzheimer's lives four to eight years after diagnosis, but can live as long as 20 years, depending on other factors.
Learn more: 10 Warning Signs, Stages of Alzheimer's Disease
Alzheimer's has no current cure, but treatments for symptoms are available and research continues. Although current Alzheimer's treatments cannot stop Alzheimer's from progressing, they can temporarily slow the worsening of dementia symptoms and improve quality of life for those with Alzheimer's and their caregivers. Today, there is a worldwide effort under way to find better ways to treat the disease, delay its onset, and prevent it from developing.
Learn more: Treatments, Treatment Horizon, Prevention, Clinical Trials
Diagnosis
Diagnosing Alzheimer's: How Alzheimer's is diagnosed
To diagnose Alzheimer's dementia, doctors conduct tests to assess memory impairment and other thinking skills, judge functional abilities, and identify behavior changes. They also perform a series of tests to rule out other possible causes of impairment.
To diagnose Alzheimer's dementia, doctors evaluate your signs and symptoms and conduct several tests.
An accurate diagnosis of Alzheimer's dementia is an important first step to ensure you have appropriate treatment, care, family education and plans for the future.
Early signs and symptoms of Alzheimer's dementia
Early signs and symptoms of Alzheimer's dementia include:
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Memory impairment, such as difficulty remembering events
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Difficulty concentrating, planning or problem-solving
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Problems finishing daily tasks at home or at work
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Confusion with location or passage of time
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Having visual or space difficulties, such as not understanding distance in driving, getting lost or misplacing items
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Language problems, such as word-finding problems or reduced vocabulary in speech or writing
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Using poor judgment in decisions
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Withdrawal from work events or social engagements
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Changes in mood, such as depression or other behavior and personality changes
Alzheimer's dementia can affect several aspects of your daily life.
When warning signs of Alzheimer's dementia appear, it's important that you get a prompt and accurate diagnosis.
Diagnosing Alzheimer's dementia
To diagnose Alzheimer's dementia, your primary doctor, a doctor trained in brain conditions (neurologist) or a doctor trained to treat older adults (geriatrician) will review your medical history, medication history and your symptoms. Your doctor will also conduct several tests.
During your appointment, your doctor will evaluate:
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Whether you have impaired memory or thinking (cognitive) skills
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Whether you exhibit changes in personality or behaviors
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The degree of your memory or thinking impairment or changes
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How your thinking problems affect your ability to function in daily life
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The cause of your symptoms
Doctors may order additional laboratory tests, brain-imaging tests or send you for memory testing. These tests can provide doctors with useful information for diagnosis, including ruling out other conditions that cause similar symptoms.
Ruling out other conditions
Doctors will perform a physical evaluation and check that you don't have other health conditions that could be causing or contributing to your symptoms, such as signs of past strokes, Parkinson's disease, depression or other medical conditions.
Assessing memory problems and other symptoms
To assess your symptoms, your doctor may ask you to answer questions or perform tasks associated with your cognitive skills, such as your memory, abstract thinking, problem-solving, language usage and related skills.
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Mental status testing. Your doctor may conduct mental status tests to test your thinking (cognitive) and memory skills. Doctors use the scores on these tests to evaluate your degree of cognitive impairment.
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Neuropsychological tests. You may be evaluated by a specialist trained in brain conditions and mental health conditions (neuropsychologist). The evaluation can include extensive tests to evaluate your memory and thinking (cognitive) skills.
These tests help doctors determine if you have dementia, and if you're able to safely conduct daily tasks such as driving and managing your finances. They provide as much information on what you can still do as well as what you may have lost.
These tests can also evaluate if depression may be causing your symptoms.
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Interviews with friends and family. Doctors may ask your family member or friend questions about you and your behavior.
Doctors look for details that don't fit with your former level of function. Your family member or friend often can explain how your thinking (cognitive) skills, functional abilities and behaviors have changed over time.
This series of clinical assessments, the physical exam and the setting (age and duration of progressive symptoms) often provide doctors with enough information to make a diagnosis of Alzheimer's dementia. However, when the diagnosis isn't clear, doctors may need to order additional tests.
Laboratory tests
You may have laboratory tests to rule out other disorders that cause some symptoms similar to those of Alzheimer's dementia, such as a thyroid disorder or vitamin B-12 deficiency.
Brain-imaging tests
Alzheimer's dementia results from the progressive loss (degeneration) of brain cells. This degeneration may show up in a variety of ways in brain scans.
However, these scans alone aren't enough to make a diagnosis. Scans aren't used to diagnose the condition because there is overlap in what doctors consider normal age-related change in the brain and abnormal change.
However, brain imaging can help:
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Rule out other causes, such as hemorrhages, brain tumors or strokes
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Distinguish between different types of degenerative brain disease
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Establish a baseline about the degree of degeneration
The brain-imaging technologies most often used are:
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Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a detailed view of your brain.
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Computerized tomography (CT). A CT scan uses X-rays to obtain cross-sectional images of your brain.
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Positron emission tomography (PET). A PET scan uses a radioactive substance known as a tracer to detect substances in the body. There are different types of PET scans. The most commonly used PET scan is a fluorodeoxyglucose (FDG) PET scan, which can identify brain regions with decreased glucose metabolism. The pattern of metabolism change can distinguish between different types of degenerative brain disease.
PET scans have recently been developed that detect clusters of amyloid proteins (plaques), which are associated with Alzheimer's dementia, but this type of PET scan is typically used in the research setting.
Future of diagnosis
Researchers are working on new diagnostic tools that may enable doctors to diagnose Alzheimer's dementia earlier in the course of the disease, when symptoms are very mild or before symptoms even appear. One such tool is a PET scan that can detect tau, the other hallmark abnormal protein in Alzheimer's dementia.
Scientists are investigating a number of disease markers and diagnostic tests, such as genes, disease-related proteins and imaging procedures, which may accurately and reliably indicate whether you have Alzheimer's dementia and how much the disease has progressed. However, more research on these tests is necessary.
Benefit of an early diagnosis
Reluctance to go to the doctor when you or a family member has memory problems is understandable. Some people hide their symptoms, or family members cover for them. That's easy to understand, because Alzheimer's dementia is associated with loss, such as loss of independence, loss of a driving privileges and loss of self. Many people may wonder if there's any point in a diagnosis if there's no cure for the disease.
It's true that if you have Alzheimer's dementia or a related disease, doctors can't offer a cure. But getting an early diagnosis can be beneficial. Knowing what you can do is just as important as knowing what you can't do. If a person has another treatable condition that's causing the cognitive impairment or somehow complicating the impairment, then doctors can start treatments.
For those with Alzheimer's dementia, doctors can offer drug and nondrug interventions that may ease the burden of the disease. Doctors often prescribe drugs that may slow the decline in memory and other cognitive skills. You may also be able to participate in clinical trials.
Also, doctors can teach you and your caregivers about strategies to enhance your living environment, establish routines, plan activities and manage changes in skills to minimize the effect of the disease on your everyday life.
Importantly, an early diagnosis also helps you, your family and caregivers plan for the future. You'll have the chance to make informed decisions on a number of issues, such as:
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Appropriate community services and resources
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Options for residential and at-home care
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Plans for handling financial issues
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Expectations for future care and medical decisions
When a doctor tells you and your family members about an Alzheimer's diagnosis, he or she will help you understand Alzheimer's dementia, answer questions and explain what to expect. Doctors will explain what capacities are preserved and how to limit future disabilities, and look to keep you as healthy and safe as possible with the least disruption in your daily activities.
https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048075
Treatment
The more you know about Alzheimer's medications, the better prepared you will be to discuss them with your physician and make informed choices about your treatment plan. Although current medications cannot cure Alzheimer’s, some drugs may help lessen symptoms, such as memory loss and confusion, for a limited time.
FDA-approved drugs for Alzheimer’s
The U.S. Food and Drug Administration (FDA) has approved medications that may temporarily mitigate some symptoms of Alzheimer’s disease.
When considering any treatment, it is important to have a conversation with a health care professional to determine whether it is appropriate. A physician who is experienced in using these medications should monitor people who are taking them and ensure that the recommended guidelines are strictly observed.
Drugs that may change or delay progression of the disease
Drugs in this category may delay clinical decline with benefits to both cognition and function in people living with Alzheimer’s disease. While there are currently no approved drugs in this category, there are several under review by the U.S. Food and Drug Administration (FDA) and being tested in clinical trials. These drugs aim to change the underlying biology of the disease, with a goal of slowing down or stopping its progression.
Drugs that treat symptoms
Cognitive (memory and thinking) symptoms
These medications are prescribed to treat symptoms related to memory and thinking. While these drugs cannot stop the damage Alzheimer’s causes to brain cells, they may help lessen or stabilize symptoms for a limited time by affecting certain chemicals involved in carrying messages between the brain's nerve cells.
The drugs currently approved to treat cognitive symptoms are cholinesterase inhibitors and glutamate regulators.
Name
(Generic/Brand)
Approved For
Side Effects
Donepezil
Aricept®
Mild to severe dementia due to Alzheimer’s
Nausea, vomiting, loss of appetite, muscle cramps and increased frequency of bowel movements.
Galantamine
Razadyne®
Mild to moderate dementia due to Alzheimer’s
Nausea, vomiting, loss of appetite and increased frequency of bowel movements.
Rivastigmine
Exelon®
Mild to moderate dementia due to Alzheimer’s or Parkinson’s
Nausea, vomiting, loss of appetite and increased frequency of bowel movements.
Memantine
Namenda®
Moderate to severe dementia due to Alzheimer’s
Headache, constipation, confusion and dizziness.
Memantine + Donepezil
Namzaric®
Moderate to severe dementia due to Alzheimer’s
Nausea, vomiting, loss of appetite, increased frequency of bowel movements, headache, constipation, confusion and dizziness.
Learn more: Medications for Memory, Cognition and Dementia-Related Behaviors
Non-cognitive (behavioral and psychological) symptoms:
Alzheimer’s affects more than just memory and thinking. A person’s quality of life may be impacted by a variety of behavioral and psychological symptoms that accompany dementia.
A person living with dementia may experience sleep changes such as difficulty sleeping, taking daytime naps and/or experiencing other shifts in sleep pattern. Suvorexant (Belsomra®) is the first medication approved specifically to treat insomnia in people living with Alzheimer’s. It works by blocking the activity of a chemical messenger involved in the sleep-wake cycle. It is important to try non-drug strategies to manage non-cognitive symptoms — like sleep changes — before adding medications.
Name
(Generic/Brand)
Approved For
Side Effects
Suvorexant
Belsomra®
Insomnia in people living with mild to moderate Alzheimer’s disease
Impaired alertness and motor coordination, worsening of depression or suicidal thinking, complex sleep behaviors, sleep paralysis, compromised respiratory function.
Learn more: Medications for Memory, Cognition and Dementia-Related Behaviors
Tips from people living with Alzheimer's: Medication safety
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Keep a calendar and check off each dose as it's taken.
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Set up a pill box each night for use the next day.
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Set the alarm on your cell phone or schedule dosing around meal times.
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Before beginning a new medication, make sure your physician, pharmacist and care team are aware of any of all medications, alternative remedies, products and dietary supplements currently being taken (including over-the-counter and alternative preparations). This is important to ensure that medications will not interact with one another, causing side effects. Be sure to discuss all medications you take with your doctor to understand why they were prescribed and how to take them.
Alternative treatments and supplements
Research suggests that modifiable factors, such as eating a healthy diet, may reduce a person’s risk for cognitive decline and dementia. However, there isn’t a single food, ingredient or supplement that has been shown through rigorous scientific research to prevent, treat or cure Alzheimer’s or other dementias.
There are remedies, supplements and “medical foods” that are often referred to as alternative treatments. Alternative treatments are not regulated and do not need to adhere to the same standards as FDA-approved treatments. Claims about their safety and effectiveness are based largely on testimonials, tradition or a small body of scientific research.
It’s important that individuals living with Alzheimer’s or other dementia, and their caregivers, have conversations with their physicians about all medications, any dietary concerns and dietary supplements they are taking. This enables the doctor to provide the best advice possible regarding nutrition, and to consider how dietary supplements may interact with one’s medications and evaluate their potential to cause any unintended side effects.
Here is a list of questions to ask when considering an alternative treatment or supplement:
Has the FDA approved this product for the treatment of Alzheimer’s or dementia symptoms?
The FDA may have reviewed the data on a product, but found it to be ineffective for the intended purpose. In this instance, the company may still release the product as a medical food, either with or without changes. In the United States, a product can only be considered a medical food if it is designed to treat a condition that has a “distinctive nutritional requirement.” According to the FDA, Alzheimer’s, as currently understood, does not have distinctive nutritional requirements, and therefore, in the United States, no product can legitimately be described as a medical food for Alzheimer’s.
Is there independent research to support the safety and effectiveness of this product for treating Alzheimer's or other dementia?
If the testing entity has a vested interest in the outcome (e.g., testing done by the company developing the product), the results may not be reliable.
To best serve individuals living with Alzheimer’s and their families, the Alzheimer’s Association strongly encourages makers of products that claim to be beneficial for those with Alzheimer’s or other dementia to conduct definitive clinical trials.
Does the developer of the product or the person recommending it to you have a potential financial gain from the use of the medication?
If so, use extreme caution. Check with your care team to see if they have any questions or concerns with your plan to use it.
Does the FDA oversee how dietary supplements are manufactured?
No. It is up to each manufacturer and distributer of dietary supplements to meet all safety and labeling requirements of the Dietary Supplement Health and Education Act of 1994 (DSHEA) and the FDA. Most in the industry act responsibly, but some adulterated or misbranded products have made it to market. Therefore, people with Alzheimer’s and their families have no absolute guarantee that supplements contain the ingredients listed on the label in the specified amounts.
Is the product compatible with the other medications you are taking or with your diagnoses?
Be sure to check with your doctor or pharmacist to find out whether the product could cause negative outcomes given your diagnoses and any FDA-approved medications you are taking.
The lack of rigorous research for these products means little (or nothing) is known about the effects, both when taken alone or in combination with approved drugs. We often don’t know whether the products will interact with, and possibly decrease, the effectiveness of approved drugs taken for Alzheimer’s and other dementia.
https://www.alz.org/help-support/i-have-alz/treatments-research
Drugs
etanercept Off-label
Current research & peer reviewed journals
https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet
https://alz-journals.onlinelibrary.wiley.com/journal/15525279
Support Groups
Patient /Family Stories
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