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Information About Alzheimer's Disease and Related Dementias for Patients & Caregivers

Below are answers to some of the more commonly asked questions and topics related to Alzheimer's disease and dementia. The information has been adapted from the National Institute on Aging, Alzheimer's Disease Education & Referral Center (ADEAR). We encourage you to follow the links included to other sources for further information on topics of interest to you.

 

 

For further information on any of the topics below, visit the websites of the National Institute on Aging, Alzheimer's Disease Education & Referral Center (ADEAR) (www.nia.nih.gov/alzheimers) and the Alzheimer's Association (www.alz.org).

 

 

When to Be Concerned About Memory Loss

Forgetfulness can be a normal part of aging. As people get older, changes occur in all parts of the body, including the brain. As a result, some people may notice that it takes longer to learn new things, they don't remember information as well as they did, or they lose things like their glasses. These usually are signs of mild forgetfulness, not serious memory problems. In fact, as people age, healthy adults may actually improve in some areas of mental ability because of all of their life experiences.

 

If forgetfulness interferes with a person's ability to function, to take care of him or her self, to be safe or to work, then it is more serious and a physician should be consulted.

 

There are a number of clinics in Wisconsin and beyond staffed by providers who are well-informed in the diagnosis and treatment of dementia and Alzheimer's disease. Visit our Memory Clinics page to find a clinic near you.

JEANNE'S STORY

Jeanne couldn't find her car keys. She looked on the hook just inside the front door. They weren't there. She searched in her purse. No luck. Finally, she found them on her desk. Yesterday, she forgot her neighbor's name. Her memory was playing tricks on her. She was starting to worry about it. She decided to see her doctor. After a complete check-up, her doctor said that Jeanne was fine. Her forgetfulness was just a normal part of getting older. The doctor suggested that Jeanne take a class, play cards with friends, or help out at the local school to sharpen her memory.

 

The story above was featured in Understanding Memory Loss, Alzheimer's Disease Education and Referral Center (www.nia.nih.gov/Alzheimers/Publications/UnderstandingMemoryLoss/).

 

 

What is Dementia?

Dementia is a general term that refers to a decline in cognitive function so extensive that it interferes with daily life and activities. This loss in the ability to think, remember, and reason is not a disease itself, but a group of symptoms that often accompanies a disease or condition.


Many conditions and diseases cause dementia. Some of them can be reversed, but others cannot. Alzheimer's disease is the most common cause of dementia in older people. Vascular dementia, caused by cognitive impairment from a stroke or other damage to the brain's blood vessels, is the second most common form of dementia.

 

Other conditions that cause dementia include:

  • medication side effects
  • depression
  • certain brain tumors
  • blood clots pressing on the brain
  • poor nutrition
  • dehydration
  • high fever
  • thyroid, kidney, or liver disorders

Many of these conditions are temporary and reversible, but they can be serious and should be treated by a doctor as soon as possible.

Sometimes older people have emotional problems that can be mistaken for dementia. They may feel sad, lonely, worried, or bored when facing retirement or coping with the death of a spouse, relative, or friend. Adapting to these changes leaves some people feeling confused or forgetful. These symptoms should be discussed with a physician. Counseling and/or medication can help.

 

 

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What is Mild Cognitive Impairment?

Mild cognitive impairment (MCI) is a condition in which a person has memory problems greater than those expected for his or her age. However, they are still able things that they have always done.

 

Research has shown that people with MCI have an increased risk of developing Alzheimer's disease over the next few years, especially when their main problem is memory but not everyone diagnosed with MCI does develop Alzheimer's disease. We do not know why some people do and others do not. At present there is no treatment.

 

 

What is Alzheimer's Disease?

Alzheimer's disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks of daily living. In most people with Alzheimer's disease, symptoms first appear after age 60. It can occur at an earlier age.

 

Alzheimer's disease is the most common cause of dementia among older people, but it is not a normal part of aging. It is in a region of the brain that affects recent memory, then gradually spreads to other parts of the brain. Although treatment can slow the progression of Alzheimer's disease and help manage its symptoms in some people, currently there is no cure for this devastating disease.

 

Alzheimer's disease is named after Dr. Alois Alzheimer, a German doctor. In 1906, Dr. Alzheimer described changes in the brain tissue of a woman who had died of an unusual mental illness. He found abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary tangles).

 

Today, these plaques and tangles in the brain are considered hallmarks of Alzheimer's disease. The third main feature of Alzheimer's disease is the gradual loss of connections between nerve cells (neurons) in the brain. This loss leads to diminished cell function and cell death.

We don't know what starts the Alzheimer's disease process, but we do know that damage to the brain begins as many as 10 to 20 years before any obvious signs of forgetfulness appear. As nerve cells die throughout the brain, affected regions begin to shrink. By the final stage of Alzheimer's disease, damage is widespread, and brain tissue has shrunk significantly.

 

The Suncoast Alzheimer's & Gerontology Center at the University of South Florida gives us 7 warning signs of Alzheimer's disease:

  1. Asking the same question over and over again.
  2. Repeating the same story, word for word, again and again.
  3. Forgetting how to cook, or how to make repairs, or how to play cards; activities that were previously done with ease and regularity.
  4. Losing one's ability to pay bills or balance one's checkbook.
  5. Getting lost in familiar surroundings, or misplacing household objects.
  6. Neglecting to bathe, or wearing the same clothes over and over again, while insisting that they have taken a bath or that their clothes are still clean.
  7. Relying on someone else, such as a spouse, to make decisions or answer questions they previously would have handled themselves.

 

 

What is Lewy Body Disease?

Lewy body disease, also known as dementia with Lewy bodies, is one of the most common causes of irreversible dementia in the elderly. Dementia is the loss of mental functions severe enough to affect normal activities and relationships. Lewy body disease happens when abnormal structures, called Lewy bodies, build up in areas of the brain. The disease may cause a wide range of symptoms, including:

  • Changes in alertness and attention
  • Hallucinations
  • Problems with movement and posture
  • Frequent falls
  • Muscle stiffness
  • Confusion
  • Loss of memory

Lewy body disease can be hard to diagnose, because Parkinson's disease and Alzheimer's disease cause similar symptoms. Scientists think that Lewy body disease might be related to these diseases, or that they sometimes happen together.

 

Lewy body disease usually begins between the ages of 50 and 85. The disease gets worse over time. There is no cure. Treatment focuses on drugs to help symptoms.

 

For further information, visit the Lewy Body Disease Association (www.lbda.org) website.

 

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What is Frontotemporal Dementia?

Frontotemporal Dementia (FTD) is a group of related conditions that share many clinical features and all result from progressive degeneration of the anterior temporal and frontal lobes of the brain. These areas of the brain are associated with decision-making and control of behavior (frontal lobe) and emotion and language (temporal lobe).

 

The hallmark of FTD is a gradual, progressive decline in behavior and/or language. Patients may suffer from a decline in one or both of these areas, but they are always characterized by a gradual onset at a relatively young age, and a continuing decline after onset. As the disease progresses, these deficits cause significant impairment in social and/or occupational functioning and result in an increasing dependency on caregivers.

 

The behavioral changes are typically witnessed as a change in personality, characterized by increasingly inappropriate social behavior. Examples of this include swearing, overeating or drinking, impulsivity, shoplifting, hypersexual behavior, and a deterioration in personal hygiene habits.

Accompanying this inappropriate behavior is a decreasing self-awareness: the patient displays little insight into how inappropriate his or her behavior is, and little or no concern for its effect on other people, including family and friends. Patients may also display repetitive, stereotyped behaviors, such as hand clapping, humming the same song over and over, or walking to the same place day after day.

 

The language deficits experienced by patients range from problems with expression of language (generating meaningful, grammatical sentences), to problems with word meaning or a severe difficulty in finding the correct name for common, familiar objects.

 

The onset of FTD symptoms typically occurs in the 50's to early 60's, but has been seen as early as 21 and as late as 80 years. The average age of onset is about 60. FTD occurs equally in men and women.

 

For more information, visit The Association of Frontotemporal Dementias (www.ftd-picks.org) website.

 

 

What is Multi-Infarct Dementia?

Multi-infarct dementia is the most common form of vascular dementia, and accounts for 10-20% of all cases of progressive, or gradually worsening, dementia. It usually affects people between the ages of 60-75, and is more likely to occur in men than women.

 

Multi-infarct dementia is caused by a series of strokes that disrupt blood flow and damage or destroy brain tissue. A stroke occurs when blood cannot get to part of the brain. Strokes can be caused when a blood clot or fatty deposit (called plaque) blocks the vessels that supply blood to the brain. A stroke also can happen when a blood vessel in the brain bursts.

 

Some of the main causes of strokes are:

  • untreated high blood pressure (hypertension)
  • diabetes
  • high cholesterol
  • heart disease

Of these, the most important risk factor for multi-infarct dementia is high blood pressure.

 

Because strokes occur suddenly, loss of thinking and remembering skills (the symptoms of dementia) also occur quickly and often in a step-wise pattern. People with multi-infarct dementia may even appear to improve for short periods of time, then decline again after having more strokes.

 

Sudden onset of any of the following symptoms may be a sign of multi-infarct dementia:

  • confusion and problems with recent memory
  • wandering or getting lost in familiar places
  • moving with rapid, shuffling steps
  • loss of bladder or bowel control
  • laughing or crying inappropriately
  • difficulty following instructions
  • problems handling money

Multi-infarct dementia is often the result of a series of small strokes. Some of these small strokes produce no obvious symptoms and are noticed only on brain imaging studies, so they are sometimes called "silent strokes." A person may have several small strokes before noticing serious changes in memory or other signs of multi-infarct dementia.

SAM'S STORY

Sam feels good for a guy his age. He's an active 70 year old. So, he couldn't believe it when, all of a sudden, he couldn't remember what somebody told him 5 minutes ago. He went for a check up. The doctor told him that his forgetfulness was caused by small strokes. These strokes had damaged some of his brains cells. She said his problem was called multi-infarct dementia. She said that she couldn't cure his memory problems, but that she would give him medicine to lower his high blood pressure. This medicine also would lower his chances of having more strokes. Sam wasn't happy to find out that his doctor couldn't fix everything. Even so, he agreed to take his medication. At least then he'd be doing something to keep from having more strokes.

Even active people can have memory problems.

 

Transient ischemic attacks, or TIA's, are caused by a temporary blockage of blood flow. Symptoms of TIA's are similar to symptoms of stroke and include mild weakness in an arm or leg, slurred speech, and dizziness. Symptoms generally do not last for more than 20 minutes. A recent history of TIAs greatly increases a person's chance of suffering permanent brain damage from a stroke.

 

 

The story and photo above were featured in Understanding Memory Loss, Alzheimer's Disease Education and Referral Center (www.nia.nih.gov/Alzheimers/Publications
/UnderstandingMemoryLoss/).

 

 

 

 

Diagnosis and Treatment of Alzheimer's Disease

Doctors can determine fairly accurately whether a person who is having memory problems has "possible Alzheimer's disease" (the symptoms may be due to another cause) or "probable Alzheimer's disease" (no other cause for the symptoms can be found). The only definite way to diagnose Alzheimer's disease is with an autopsy, which is an examination of the body done after a person dies. Following specific guidelines, physicians can make an accurate diagnosis, confirmed on autopsy, 90% of the time.

 

To diagnose Alzheimer's disease, doctors:

  • ask questions about a person's overall health, past medical problems, ability to carry out daily activities, and changes in behavior and personality
  • conduct tests of memory, problem solving, attention, counting, and language skills
  • carry out medical tests, such as tests of blood, urine, or spinal fluid
  • perform brain scans, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) test

These tests may be repeated to give doctors information about how the person's memory is changing over time. Sometimes these tests help doctors find other possible causes of the person's symptoms. For example, thyroid problems, drug reactions, depression, brain tumors, and blood-vessel disease in the brain can cause Alzheimer's disease-like symptoms. Some of these other conditions can be treated successfully.

 

 

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Why Early Diagnosis is Important

Early diagnosis is beneficial for several reasons.

 

Having an early diagnosis and starting treatment in the early stages of the disease can help preserve function for months to years, even though the underlying Alzheimer's disease process cannot be changed.

 

Having an early diagnosis also helps families plan for the future, make living arrangements, take care of financial and legal matters, and develop support networks.

 

Early diagnosis gives the person with Alzheimer's disease and their family more time to learn about the disease and the best way for them to live with the disease. Knowledge is power.

FAMILY STORY

Mom had been losing weight, she wasn't interested in going to church or cooking anymore, things she'd always enjoyed and looked forward to. She didn't bathe regularly and always wore the same clothes. We didn't know what was wrong and were afraid that it might be Alzheimer's disease. When we finally got her to the doctor, we learned that it was early Alzheimer's disease. She's on medication now and is back to going to church with Dad. My brother and I are going to a support group with Dad and we're learning how to take care of Mom. We aren't quite so afraid anymore.

 

 

How Alzheimer's Disease Is Treated

Alzheimer's disease is a complex disease, and no single "magic bullet" is likely to prevent or cure it. That's why current treatments focus on several different aspects, including helping people maintain mental function; managing behavioral symptoms; and slowing, delaying, or preventing Alzheimer's disease.

 

Helping People with Alzheimer's Disease Maintain Mental Function

Four medications are approved by the U.S. Food and Drug Administration to treat Alzheimer's disease.

 

Medications used to treat mild to moderate Alzheimer's disease:

  • Donepezil (Aricept®)
  • Rivastigmine (Exelon®)
  • Galantamine (Razadyne®)

Medications used to treat moderate to severe Alzheimer's disease:

  • Memantine (Namenda®)
  • Donepezil can be used for severe Alzheimer's disease.

These drugs work by regulating neurotransmitters (the chemicals that transmit messages between neurons). They may help maintain thinking, memory, and speaking skills, and help with certain behavioral problems. However, these drugs don't change the underlying disease process and may help only for a few months to a few years.

Managing Behavioral Symptoms

Common behavioral symptoms of Alzheimer's disease include sleeplessness, agitation, wandering, anxiety, anger, depression and many others. Scientists are learning more about why these symptoms occur and are studying new treatments, drug and non-drug, to manage them. Treating behavioral symptoms often makes people with Alzheimer's disease more comfortable and makes their care easier for caregivers. Tips for Caregivers: Caring for a Person with Alzheimer's Disease.

 

You can also learn more about non-drug treatments from your local Alzheimer's Association Chapter. Call 1-800-272-3900 or visit the Alzheimer's Association (www.alz.org) website to find a Chapter near you.

 

Slowing, Delaying, or Preventing Alzheimer's Disease

Alzheimer's disease research has developed to a point where scientists can look beyond treating symptoms to think about addressing the underlying disease process. In ongoing Alzheimer's disease clinical trials, scientists are looking at many possible interventions, such as cardiovascular treatments, antioxidants, immunization therapy, cognitive training, and physical activity.

 

 

Family and Caregiver Support

Caring for a person with Alzheimer's disease can have high physical, emotional, and financial costs. The demands of day-to-day care, changing family roles, and difficult decisions about placement in a care facility can be hard to handle. Researchers are learning a lot about Alzheimer's disease caregiving, and studies are helping experts develop new ways to support caregivers.

 

Becoming well-informed about Alzheimer's disease is one important long-term strategy. Programs that teach families about the various stages of Alzheimer's disease and about flexible and practical strategies for dealing with difficult caregiving situations provide vital help to those who care for people with Alzheimer's disease.

 

Developing good coping skills and a strong support network of family and friends also are important ways that caregivers can help themselves handle the stresses of caring for a loved one with Alzheimer's disease. For example, staying physically active provides physical and emotional benefits. Some Alzheimer's disease caregivers have found that participating in an Alzheimer's disease support group is a critical lifeline. These support groups allow caregivers to find respite, express concerns, share experiences, get tips, and receive emotional comfort. The Alzheimer's Association, Alzheimer's Disease Centers, and many other organizations sponsor in-person and online Alzheimer's disease support groups across the country.

There are a growing number of groups for people in the early stage of Alzheimer's disease and their families. Support networks can be especially valuable when caregivers face the difficult decision of whether and when to place a loved one in a nursing home.

 

 

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For further information on any of the above topics, visit the websites of the National Institute on Aging, Alzheimer's Disease Education & Referral Center (ADEAR) (www.nia.nih.gov/alzheimers) or the Alzheimer's Association (www.alz.org).

 

 

 

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