Can’t remember where you put your car keys? Have you ever walked into a room and forgot why you went in? Do you occasionally forget everyday words? Everyone forgets things now and then. It’s a normal part of life. Is your forgetfulness normal or is it Alzheimer’s disease?

 Alzheimer’s disease is not a normal part of aging. It is estimated that 4.5 million Americans have Alzheimer’s disease. This number has alarmingly doubled since 1980.

 What is Alzheimer’s Disease?

Alzheimer’s disease is a disease of the nerve cells in the brain. Normally, nerve cells (called neurons) transmit impulses to and from the brain, enabling us to carry out mental and physical activities. When Alzheimer’s disease is present, the spaces between the neurons clog up with protein deposits called plaques. Normally these proteins are broken down and eliminated, but in Alzheimer’s disease they accumulate. These proteins get tangled up inside the neuron. These are called tangles. The presence of plaques and tangles prevents the normal transmission of impulses in the neurons, thereby affecting learning and memory cells.

 Alzheimer’s disease impairs our cognitive ability, or the mental processes by which we think. Degeneration of the brain’s nerve cells begins years before symptoms appear. Nerve cell damage begins in our learning and memory cells. Over time, it spreads to the brain cells that are responsible for our judgment and behavior, and then coordination and physical movement. The average length of time from diagnosis to death is eight years; however an Alzheimer’s patient can live from three to twenty years.

 Signs and Symptoms of Alzheimer’s Disease

1. Memory loss- Short term memory loss is usually the first and most common symptom. Mild memory loss progresses to severe memory loss over the course of the disease. Forgetting something on the stove or what you had for lunch an hour ago would be common in an Alzheimer’s patient.
2. Difficulty performing familiar tasks- Tasks that have been done almost every day (sometimes for years) become difficult to do because the person with Alzheimer’s disease forgets the steps. Cooking a meal, sewing a button on a shirt, or getting gas for your car become impossible to do because the Alzheimer’s patient can not remember how to do them.
3. Language problems- Everyone forgets familiar words now and then, but the Alzheimer’s patient has difficulty finding words frequently. They may forget the word for “brush” and refer to it as “the thing I comb my hair with”.
4. Disorientation/confusion- Getting lost in familiar surroundings or forgetting the date or time is common in Alzheimer’s disease.
5. Poor judgment- Judgment is affected in the daily decisions of Alzheimer’s patients. They may go to the store wearing pajamas over the clothes they wore yesterday or put their shoes on the wrong feet.
6. Problems with abstract thinking- Numbers are difficult for the patient with Alzheimer’s disease to deal with because they don’t know what they are for or what to do with them. Balancing a checkbook or keeping financial records is impossible.
7. Misplacing things- Items of value can often be misplaced or lost. It is common for money, jewelry or checkbooks to be misplaced.
8. Changes in mood or behavior- Mood swings, withdrawn personality and a decreased interest in social activities are common in a patient with Alzheimer’s disease.
9. Changes in personality- An Alzheimer’s patient may exhibit an entirely different personality than they have in the past. An outgoing, energetic person may become timid and suspicious.
10. Loss of initiative- Alzheimer’s patients loses interest in hobbies, social activities and the things they were interested in before. They need encouragement to do even the simplest of daily tasks.

 Diagnosing Alzheimer’s Disease

It takes an average of thirty months from the time a family notices symptoms of Alzheimer’s disease to the actual diagnosis. Researchers at the Oregon Health Sciences University in Portland interviewed 244 caregivers and family members of people with Alzheimer’s disease. The April 1999 issue of the American Journal of Alzheimer's Disease published their report. It listed the following reasons as the cause of delay in diagnosing Alzheimer’s disease.

• Family did not know about Alzheimer’s and didn’t know it was a disease- 72%

• The family thought changes in person were normal part of aging- 50%

• Did not know what kind of doctor to see- 44%

• Did not know how to explain the problem to the doctor- 38%

• Not able to see the doctor in private- 27%

• Doctor did not take concerns seriously- 29%

• Doctor said problem was due to normal aging- 25%

Diagnosing Alzheimer’s disease is not always easy. There is no test that shows the plaques and tangles in the brain. Doctors use several methods to diagnose Alzheimer’s disease.

• Medical history- Your doctor will take a complete medical history. The medical history will include questions and information about present health, past medical problems, family history of disease and illness, present symptoms and problems.
• Physical Exam- A physical exam is important to rule out any other possible causes of the symptoms the patient is having.
• Mental Status Exam- The doctor will ask the patient several questions to assess mental functioning, orientation, memory and language skills.
• Neurological Exam- A visit to the neurologist is very important. Neurologists are the experts in Alzheimer’s disease. He will test coordination, eye movements, muscle tone, speech and sensory ability. The neurologist can accurately assess the possibility of another disease causing the symptoms, such as a stroke or brain tumor.
• Brain Imagining- Brain imaging tests such as Cat scans or MRI can be performed to see if the brain looks normal. Other tests might include an EEG (tests brain waves) or PET scan.
• Laboratory tests- It is prudent to look at lab values in the blood to rule out imbalances and infections as the cause of symptoms.
• Psychological/psychiatric testing- Your doctor may want you to visit a psychiatrist to rule out any psychiatric problems you may be having. They will assess you for depression, memory problems, and reasoning.

An early diagnosis of Alzheimer’s disease is important. Early diagnosis allows for planning while the Alzheimer’s patient can still make decisions. Care options can be discussed and financial matters can be taken care of. Early diagnosis also offers the best chance at treating the disease symptoms.

Treatment of Alzheimer’s Disease

Alzheimer’s disease is not curable; however there are treatments to help relieve the symptoms. There are FDA approved drugs that can help slow the progression of Alzheimer’s disease. These drugs are effective for some patients so you should talk with your doctor about them. Your doctor will evaluate the benefits, risks and side effects of the medication before deciding to treat you.

Medications to help relieve agitation, psychotic symptoms and depression are also available and useful for Alzheimer’s patients. Usually medications for these symptoms are considered when other methods of controlling the behavior or anxiety are not working.    

Some reports state that families of Alzheimer’s patients are trying herbal treatments. The results of these treatments are not favorable and show little to no improvement in the patient.

There is no one treatment plan that works for all Alzheimer’s patients. Symptoms must be evaluated and treated on an individual basis. The best method of controlling symptoms is to discuss them with your doctor so medication or other methods of treatment can be explored.

Risk Factors

• A family history of Alzheimer’s disease
• As you age, the likelihood of developing Alzheimer’s disease increases.
• Heart disease risk factors
• Obesity
• A previous head injury
• Being female
•  Environmental exposures
• There is debate about the possibility of aluminum causing Alzheimer’s disease. This assertion has not been proven however.

There are things you can do to help prevent Alzheimer’s disease. Developing good strategies for healthy aging can reduce the risk of developing Alzheimer’s disease.

These include:

• Maintaining a good blood pressure
• Weight control
• Maintaining good cholesterol levels
• Exercising your mind and body
• Staying socially active

Living a healthy life into your later years will help prevent heart disease, stroke, dementia-like diseases and numerous illnesses that go along with unhealthy lifestyles.

 Caring For a Person with Alzheimer’s Disease

There is no greater challenge, fulfillment and stress than caring for a person with Alzheimer’s disease. There will be good days and bad days. Throughout the disease process caregivers will need to assess and evaluate the needs of the patient because the needs of Alzheimer’s patients change constantly. Knowing what stage of the disease a person is in can help with care decisions.

Dr. Barry Reisberg, Clinical Director of New York University of Medicine’s Silberstein Aging & Dementia Research Center, developed a framework of stages that outlines the progression of Alzheimer’s disease. Progressing through the stages can be different for everyone. Being familiar with the stages of Alzheimer’s disease can help families, caregivers and medical professionals understand what to expect and how to provide better care to the patient.

Stages of Alzheimer’s Disease

Stage One: No Impairment

Although Alzheimer’s disease has already begun, there are usually no symptoms in this stage.

Care: Self

 Stage Two: Very Mild Cognitive Decline

This stage involves minor memory lapses, forgetting familiar words, names or locations of everyday objects. These symptoms are not usually evident to family or friends.

Care: Self. If Alzheimer’s disease has been diagnosed, the family member or caregiver should frequently evaluate how the person is doing with daily tasks, if they are in a safe environment, and how the disease is progressing. Decisions about future care and financial matters should be discussed while the Alzheimer’s patient can verbalize his wishes. 

Stage Three: Mild Cognitive Decline

Stage three is usually when Alzheimer’s disease is diagnosed. Family and friends begin to notice that the person with Alzheimer’s disease is having difficulty remembering things like appointments, names, or recent events. They may lose their checkbook, valuable items or common everyday objects. There may be performance issues at work. The person with Alzheimer’s disease retains little of read material and has difficulty planning and organizing. They may get lost in familiar places, spend less time doing favorite hobbies or avoid social situations.

Care: In this stage the Alzheimer’s patient can generally take care of their daily needs. They are independent with dressing, feeding (although they may forget to eat), and using the toilet. Care involves close supervision and direction. Many Alzheimer’s patients are aware of their confusion or get frustrated easily because they are unable to do the things they have done for years. Try to keep them connected by going for walks, listening to music or doing small tasks they have the ability to do.

Stage Four: Moderate Cognitive Decline

Clear deficiencies mark this stage. Decreased ability to perform challenging cognitive functions and to perform complex tasks is common in this stage. The person with Alzheimer’s disease has difficulty paying bills and balancing their checkbook. Decreased memory of their personal history and recent events is common. They may seem withdrawn or subdued and have difficulty expressing themselves.

Care: Increased supervision and assistance with dressing, bathing and daily activities will be needed. Communication may be frustrating for the Alzheimer’s patient. Tell them you understand that it is difficult for them to verbalize their feelings. Touch is important in any stage, and should be used frequently.  

Stage Five: Moderately Severe Cognitive Decline

A person with Alzheimer’s disease has more difficulty taking care of themselves and may need assistance with day to day living in this stage. They have major memory gaps. They know their own name and usually the names of their children and spouse, but have poor recall for remembering their address, phone number or friend’s names. Assistance with choosing appropriate clothing is needed. They do not need assistance with eating or toileting in this stage.

Care: Sometimes it is impossible for family members to provide full time care to the Alzheimer’s patient. Long term placement may be necessary. The patient will need direction and assistance with dressing and all daily activities. They can usually still feed and toilet themselves. Caregivers should plan and schedule time off. Full time care of an Alzheimer’s patient in this stage is stressful and requires a lot of energy.  

Stage Six: Severe Cognitive Decline

The person’s memory continues to worsen in this stage and although they may know their own name, they occasionally forget the names of their children or spouse. They can distinguish between familiar and unfamiliar faces, however. A person with Alzheimer’s disease in this stage can have significant personality changes. Some people become very suspicious or delusional. They may think you are trying to poison them or are not who you say you are. Compulsive, repetitive behavior is common, such as wringing hands, tearing tissues into shreds for hours, or beating a spoon against the table. They need extensive assistance with showering, eating and dressing. Frequently, they will put their shoes on the wrong feet, pajamas over the clothing they wore that day or forget to eat. Most awareness of recent events is lost. Incontinence (loss of bowel and bladder control) increases. They will need assistance with toileting.

Care: Alzheimer’s patients in this stage require full time, total care. The patient is usually still mobile and needs extensive supervision. The patient may exhibit aggressive behavior or cry a lot. The role of caregiver is very demanding. Many patients are up throughout the night, requiring the caregiver to stay up. The emotional and physical demands of taking care of an Alzheimer’s patient in this stage are tremendous. Usually, more than one caregiver is needed. It is important to have a good, solid support system during this stressful time.  

Stage Seven: Very Severe Cognitive Decline

This is the final stage of Alzheimer’s disease. People in this stage of Alzheimer’s disease lose their ability to communicate, respond to their environment, and control movement. They may occasionally utter words but no real speech is formed. They need assistance with eating, toileting, walking and sitting. Frequently they can not hold their heads up without assistance or sit without support. Swallowing is impaired and their muscles become rigid. Patients in this stage sleep more often and are prone to pneumonia and infections. This stage eventually leads to death.

Care: In this stage, total care is required for the Alzheimer’s patient. Total bathing, dressing, feeding, and changing of adult diapers is needed. Food may have to be pureed (ground into thick liquid), and medicine ground up. Careful attention should be paid to the skin of the bedfast patient. Caregivers experience great physical demand because the patient is no longer mobile in any way. The patient does not know the people once familiar to him and can not communicate. The physical and emotional toll for family members caring for the patient is high.

Knowing the stages of Alzheimer’s disease can aid in understanding what to expect and how to plan. Taking care of the caregiver should be included in your plans.

Alzheimer’s disease changes the way of life for those families affected. Knowing the signs and symptoms can alert a family to the possibility of a loved one having Alzheimer’s. Early diagnosis and treatment may help delay some of the symptoms and allow for time to plan for the future. Although there is no cure for Alzheimer’s disease, taking care of your health may help in preventing it. When Alzheimer’s disease affects your family, knowing the stages of the disease and what to expect can help decrease stress and plan for future care of your loved one.

External Links:

• Support - Support for Alzheimers patients and family
• Alzheimers.org - Information