Overview
When was Alzheimer’s disease discovered?
What causes Alzheimer’s?
Will my children inherit Alzheimer’s disease?
What are the current treatment for Alzheimer’s disease?
What is the difference between Alzheimer’s disease and dementia?
What does an evaluation include?
What are other causes of dementia symptoms?
What is frontotemporal dementia?
What is vascular dementia?
What is Lewy body dementia?
Are there reversible causes of dementia?
How fast does Alzheimer’s disease progress?
Overview
Alzheimer’s disease (AD) is a progressive brain disease that causes memory loss and other cognitive changes. Initially the memory loss is mild, but because of the progressive nature of the disease, memory declines gradually over time. In the early stage of AD people have problems with their recent memory keeping track of appointments, remembering to take their medications, managing finances and preparing adequate meals. In the early stage of Alzheimer’s long term memory is not impaired. People with early Alzheimer’s disease can easily remember many details about their childhood and other earlier phases of their life.
Cognitive functions other than memory are affected by AD. People often have difficulty with making decisions, paying attention or they may become disorientated to time or place. Some people may be unable to “find the word” they are looking for or they may have trouble understanding what they hear. Other people with AD may have perfect vision, but their brain has trouble interpreting what they see.
In the middle stage of Alzheimer’s disease short term memory is significantly impaired and people become repetitive. Problems with long term memory become more evident. Families begin to notice changes in their loved ones ability to do daily activities such as grooming and dressing. While they are still physically capable of dressing they often begin to change clothes less frequently or wear the same clothes over and over again. At about the same time people with Alzheimer’s disease may begin to bathe less frequently than has been their life long pattern. Sometimes these changes have been so gradual that families have been compensating without realizing the significance of these changes.
During the middle stage of AD people often begin to have changes in personality and behavior. Some of these changes present major challenges to the family and require the family to learn new skills to cope with the changes.
When was Alzheimer's disease discovered?
Alzheimer’s was first described in 1907 by a German physician, Alois Alzheimer. He described a woman in her 50’s with the disease and for many years Alzheimer’s was diagnosed only in people under 65. Dr. Alzheimer found plaques and tangles in the brain of the woman he described and even today these are the hallmark signs of AD when brain autopsy is done after death. The diagnosis of AD is still rare in people under 65, but becomes more prevalent with each decade of life. 10% of those over 65 and almost 50% of those over the age of 85 have Alzheimer’s. It is estimated that 4 million Americans have Alzheimer’s. Clearly you are not alone if you are facing this disease.
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What causes Alzheimer's?
Scientists are trying hard to unravel the cause of Alzheimer’s. They are hard at work trying to understand the biological events that cause the brain cell and tissue changes of AD. Although a great deal has been learned over the last 100 years, Dr. Alzheimer’s discoveries in 1907 are still relevant. The two abnormal structures he described, plaques and tangles, continue to be studied. Amyloid plaques are clumps of protein fragments that accumulate outside of cells in the brain. Neurofibrillary tangles are clumps of altered proteins inside cells. Research about these structures has provided clues about why cells die, but scientists have not determined the exact role plaques and tangles play in the disease process.
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Will my children inherit Alzheimer's disease?
Two types of Alzheimer’s disease risk have been identified. Familial AD clearly follows an inheritance pattern. Most known Familial AD has an early onset (occurring in people younger than 65). These families usually know from their family history that they may be at risk. The vast majority of AD cases are sporadic AD, with no obvious inheritance patterns. For further information on this issue see the Emory Alzheimer’s Disease Center publication entitled “The Role of Genetics in Alzheimer’s Disease” which is available in our clinic or on our website.
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What are the current treatments for Alzheimer's disease?
Research has led to the development of treatments for Alzheimer’s disease. Current treatments for Alzheimer’s disease include a class of medications called cholinesterase inhibitors. There are three medications in this class: Aricept, Exelon and Razadyne. Your physician will determine which of these three medications may be appropriate for you. Although these medications do not stop the disease progression, brain functions, including memory, thinking, and behavior may improve in many people who take these drugs.
A medication called Namenda (Memantine) became available January 2004. This medication can be taken along with one of the cholinesterase inhibitors and may benefit people in the moderate to severe stage of Alzheimer’s disease.
Vitamin E is known for its antioxidant properties and in a clinical trial has been shown to delay the progression of Alzheimer’s disease. Talk with your physician about the risks and benefits of Vitamin E.
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What is the difference between Alzheimer's disease and dementia?
Many people use the terms dementia and Alzheimer’s interchangeably however they have different meanings. Dementia is a collection of symptoms such as memory loss, confusion, problems thinking, etc. When someone has dementia symptoms they go to a physician to seek a diagnosis. Alzheimer’s disease is a specific diagnosis. When a person receives a diagnosis of Alzheimer’s disease the physician has ruled out reversible causes of the problem and has concluded that Alzheimer’s is the cause of the dementia. Alzheimer’s is only one possible diagnosis when someone has dementia symptoms.
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What does an evaluation include?
An evaluation of memory and thinking may take several appointments. Initially a complete history of the onset of the dementia symptoms is gathered from the person and their family. Cognitive tests are administered that take from 30 minutes to three hours. Blood work is completed to look for potential causes of the cognitive changes such as hormonal or metabolic problems. An MRI or CT scan is completed to look for structural changes in the brain such as strokes, brain tumors or hydrocephalus that could be causing the cognitive changes. After the neurologist has reviewed the results of all of the tests and completed the neurological exam s/he is able diagnose the cause of the memory and cognitive changes.
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What are other causes of dementia symptoms?
Alzheimer’s disease is found to be the cause of dementia 52% of the time after a complete evaluation. Other possible causes of dementia include vascular dementia (also called multi-infarct dementia), frontotemporal dementia, lewy body dementia and Creutzfeldt-Jakob disease to name a few possibilities.
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What is frontotemporal dementia?
This form of dementia generally begins with changes in personality, behavior or language. While memory may also be affected it is not the most significant change noted by patients and their families. The areas of the brain associated with decision-making and control of behavior (frontal lobes) and emotion and language (temporal lobe) are affected in frontotemporal dementia. This form of dementia results in gradual, but definite progressive decline in behavior and/or language that often results in inappropriate social behavior.
One form of frontotemporal dementia is Pick’s disease, named for Dr. Arnold Pick who described the abnormal changes found in the brain. Another form of frontotemporal dementia is corticobasal degeneration which begins with problems with coordination or language changes.
Currently there is no treatment specifically for frontotemporal dementia although the treatments for Alzheimer’s disease may be given a trial to determine if they are helpful. There are also medications that treat some of the behavioral symptoms that develop in these disorders.
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What is vascular dementia?
Vascular dementia is caused by changes in the brain due to strokes. These changes may be due to mini strokes sometimes called “silent strokes” or “vascular erosion” as they produce no obvious symptoms and are only identified when a CT or MRI scan of the brain is completed. Most people are not aware they have “mini strokes” or “vascular erosion” occurring. Treatment for vascular dementia includes managing blood pressure, cholesterol, diabetes and heart disease. Your physician will determine if any of the treatments for Alzheimer’s disease should be given a trial.
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What is Lewy body dementia?
Lewy body dementia is a neurodegenerative disorder in which abnormal structures called “Lewy bodies” are found in the brain. People with Lewy body dementia frequently have symptoms of both Alzheimer’s disease and Parkinson’s disease. These symptoms can include traditional parkinsonian symptoms, such as loss of spontaneous movement (bradykinesia), rigidity (muscles feel stiff and resist movement), tremor, and shuffling gait. Symptoms of Alzheimer's disease include confusion, loss of memory, and fluctuating cognition. In addition many people with Lewy body dementia experience visual hallucinations, delusions and depression. Medications to treat symptoms are available, but there is no medication developed specifically for Lewy body dementia. The medications for Alzheimer’s disease may be initiated by your physician.
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Are there reversible causes of dementia?
Yes, some causes of dementia are reversible if they are detected early. Some of the reversible causes of dementia include thyroid problems, dietary deficiencies, and B12 deficiencies. During an evaluation the physician always looks for reversible causes of dementia. Generally reversible dementia’s begin rather suddenly. This is different than Alzheimer’s and other neurodegenerative diseases which progress gradually over time.
Depression can also cause memory problems. Evaluation and treatment for depression may be recommended. Memory problems may be reversible if depression is the only cause of the symptom. However many people with Alzheimer’s disease also have depression. When depression is treated mood may improve, however memory problems do not improve.
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How fast does Alzheimer's disease progress?
Alzheimer’s disease progresses at different rates in each person with the disease. Life expectancy from diagnosis to death can be from three to 20 years. There is no way to predict the life expectancy of a specific individual with the disease.
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