(AD) is a neurologic disease that affects the brain. A
gradual loss of memory is one of the main symptoms
that a person experiences. However, memory problems
are not the only issues that people with AD experience.
They may also have problems with language and
changes in behavior, mood, or personality. The loss
of neurologic function usually occurs very gradually
over a period of 5 to 20 years. At some point, if the disease becomes severe, a person with AD will need help
with daily tasks such as eating, grooming, and proper
hygiene. In other words, AD affects patients and the
people around them.
About 4 million Americans have AD. It is estimated that more than 360,000 new cases occur each year. This number will probably increase as the population ages because aging itself is a major risk factor for the development of AD. AD is the fourth leading cause of death for adults. It kills more than 100,000 Americans each year.
To make the diagnosis of AD, a person needs to meet specific diagnostic criteria (see below). Generally, the diagnosis of AD is made when a person meets these criteria, and when the disease affects his or her ability to perform usual daily activities. However, before a person is impaired by the illness, he or she may experience very mild symptoms such as mild memory loss (without any other symptoms). The “in-between” stage is called mild cognitive impairment (MCI).
The Mayo Clinic defines mild cognitive impairment as “an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia [AD is one kind of dementia]. It can involve problems with memory, language, thinking and judgment that are greater than normal age-related changes.” Having MCI increases the risk of developing a dementia like AD. However, having MCI does not automatically mean that a person will develop AD (or another kind of dementia). In fact, there are people who develop MCI that never go on to having a more serious illness.
Loss of recent memories (also called Short-term memory) is usually the earliest warning. For instance, the person will repeat stories in the same conversation. They may forget the details of the previous day; for instance, they may not recall what they had for lunch. Other features include:
- Misplacing belongings
- Difficulty doing familiar tasks
- Increasing confusion and disorientation to time and place
- Trouble finding the right words, not following conversations
- Changes in mood or behavior
- Changes in personality
- Poor or impaired judgment
- Loss of initiative (no “get-up-and-go”)
When AD is suspected, it is important to have a complete medical and neurologic workup. The purpose of this evaluation is to uncover other causes of dementia that must be treated in very specific ways. This may include:
- A complete health history and physical examination
- Screening for depression
- Neurologic and mental status testing
- Blood and urine tests
- Positron emission testing (PET)
- Computerized tomography scan (CAT) or magnetic resonance imaging (MRI)
- Single photon emission computed tomography (SPECT)
The cause of AD is not fully known. It is not contagious. Although genetic forms have been identified, the most common form of AD does not run in families. Aging and inherited or genetic factors seem to play an important role.
Although there is currently no cure for AD, there are treatments that may help.
- Treat memory symptoms. The cognitive symptoms of AD should be treated as early as possible to slow the progression of the disease. Drugs called cholinesterase inhibitors may be considered in patients with mild to moderate disease. Vitamin E may also slow the progression, but should only be used if prescribed by the doctor.
- Treat behavioral problems. Suspiciousness, aggression, or resistance to care may be treated first by understanding what triggers these behaviors. Caregivers may learn how to change things in the environment to improve cooperation. Some examples include providing low lighting and music to improve behaviors, taking regular walks, scheduling toileting, and following consistent routines. Certain medications may also help, including drugs to treat depression.
- Caregivers need caring too. Caregiver training programs to learn more about the disease and how to manage it help delay the time to nursing home placement. Support systems (adult day care, computer support networks, telephone support programs, and other respite programs) may also help.
Although there is no known way to prevent AD, researchers believe there are several things that will help to keep your brain healthy:
- Avoid harmful substances—excessive drinking and drug abuse are thought to damage brain cells.
- Challenge yourself—read frequently, do crossword puzzles. Keep mentally active. Learn new skills. This strengthens the brain connections and promotes new ones.
- Exercise regularly—even low- to moderate-level activity such as walking or gardening 3 to 5 times per week can make you feel better.
- Stay socially active—family, friends, church, and a sense of community may all contribute to better brain health
Families and friends can help by recognizing that AD affects not only the patient, but also the primary caregiver. To take the best care of the patient with AD, the primary caregiver must take care of himself or herself. Primary caregivers should be encouraged to learn more about the disease, avoid isolation, and seek support from family, friends, and professionals. Do not be afraid to ask your doctor questions!