Alzheimer’s Disease: A Quick Guide

Most people have probably heard of Alzheimer’s disease. However, very few have a clear understanding of the disease—what it really is and how it affects those who have been diagnosed with it. Alzheimer’s is an irreversible disease that involves difficulties with thinking, problem-solving, or language and eventually leads to inability to carry out even the most simple of tasks. It is also known to be a subset of dementia. About 75% of all dementia cases are diagnosed as being Alzheimer’s, making it the most prevalent type of dementia.


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WHO DOES ALZHEIMER’S AFFECT?

One of the greatest risk factors for Alzheimer’s is increasing age. While a normal part of aging involves some slowed thinking and occasional lapses in memory, patients suffering from Alzheimer’s become increasingly worse over time. A large number of those affected tend to be in their mid-60s when the symptoms start to appear. There are also cases, although rare, of early onset where individuals as young as in their 40s are diagnosed. 

 

HOW DOES IT HAPPEN?

Named after the doctor who first discovered it (Alois Alzheimer), the disease is one that directly affects the brain and consequently its normal functioning. During the course of the disease, there is a buildup of proteins that form structures in the brain known as amyloid plaques and neurofibrillary tangles. These plaques and tangles, considered to be some of the main features of Alzheimer’s disease, leads to the loss of connections between nerve cells. Eventually, it causes the death of nerve cells and loss of brain tissue.

Another feature is that there tends to be a shortage of certain important chemicals in the brain that help to transmit signals around the brain. This, together with the death and damage of neurons in the brain causes less than ideal functioning of the brain.

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STAGES & SYMPTOMS OF ALZHEIMER'S - HOW CAN YOU TELL IF SOMEONE HAS ALZHIEMER’S?

Being a progressive disease, Alzheimer’s gradually, over time, destroys the brain’s capacity to functional normally. As more parts of the brain are damaged, more severe symptoms develop. In the initial stages, the disease begins to affect a person’s daily life and functioning and eventually progresses to a stage where the person becomes completely dependent on others for basic care and daily living.

 It is important to remember that while there are general symptoms for Alzheimer’s, no two individuals experience the conditions in the same way. The progress of Alzheimer’s can be roughly categorized into four stages:


Stages of Alzheimer's Disease

Stage 1: Cognitive Impairment

One of the first parts of the brain that is affected is the hippocampus, which is the center for emotions and memories. This is why for most people, the very first signs of Alzheimer’s are memory loss, especially difficulty remembering new information and recalling recent events as well as mood changes. Usually at this point of the disease, patients may simply attribute these symptoms to the natural progression of old age. However, observers such as friends and family may be able to detect the changes more effectively.
 

Stage 2: Early Stages

Although the disease is still at an early stage at this point, individuals with Alzheimer’s tend to suffer from an increased frequency in memory lapses. For example, they may:
  • Misplace items—unable to find keys, glasses, and other items around the house
  • Unable to recall recent conversations or events—forgetting appointments and dates
  • Have trouble recalling words, names, places, or objects
  • Repeat themselves regularly, such as repeating a task or question
  • Find it more difficult to make decisions
  • Become more hesitant and less willing to try new things
 
The mood changes also can become heightened, where the person may often be agitated, confused, or depressed. They may become withdrawn and lose interest in activities and hobbies that they used to find exciting.

 

Stage 3: Middle Stages

By this stage of Alzheimer’s, people begin to lose the ability to care for themselves and would need support to accomplish daily tasks such as eating, dressing, washing, and even using the toilet. This is mainly caused by their worsening memory problems. Some of the obvious symptoms at this stage are:
  • Not being able to remember names of people they know, including family and friends
  • Getting lost or wandering or losing track of time due to increased confusion and disorientation
  • Repetitive behavior—forgetting that they’ve eaten a short while ago and start to eat again
  • Hallucinations and becoming suspicious of family members or having delusions about them
  • Speech and language difficulties
  • Frequent changes in mood—may go from being excited to depressed in a short time
  • Reduced spatial recognition
 

Stage 4: Late Stages

During the final stages of the disease, the symptoms become severe and causes much distress for both the person with the condition as well as their caretakers, family, and friends. In some cases, they may become extremely violent and suspicious of those around them. Hallucinations and delusions also tend to be severe at this point. Other extreme symptoms in this stage include:
  • Inability of difficulty eating and swallowing
  • Inability to change position or move around without assistance
  • Either considerable weight loss or weight gain - some people eat too much because they forget that they've had their meals while others eat too little because they think they've already eaten
  • Loss of control over urinary and bowel movements
  • Gradual loss of speech
  • Severe memory problems—both short term and long term memory

At this stage, most people would require full time caretakers to assist them with their daily activities such as eating, moving, and using the toilet. 

It is important to note that the rate of progression of Alzheimer’s in each person is different. No two people’s symptoms develop the same way or within the same time frame. Therefore it is difficult to predict exactly how quickly or slowly a person may deteriorate. In general, people diagnosed with Alzheimer’s live an average of eight years after their symptoms become noticeable. However, depending on the rate of progress, survival can range from as little as four years to a couple of decades. This also depends on the age of onset and other health factors.


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THE PROCESS OF DIAGNOSING ALZHEIMER’S

If you suspect that you or a loved one are showing one or more of the symptoms of Alzheimer’s, the first thing to do is to consult with a physician. Symptoms such as memory loss or mood changes can also be due to a variety of other treatable conditions such as depression, thyroid problems, or certain vitamin deficiencies. Your physician will run a careful medical evaluation, including:

  • A thorough medical history—including family medical history
  • Mental status testing
  • Memory testing
  • Physical exam
  • Neurological exam
  • Blood tests
  • Brain imaging

All these items will then be used to rule out other treatable conditions, which may be causing the symptoms, or diagnose the person with Alzheimer’s. It is estimated that a skilled physician can diagnose Alzheimer’s with more than 90% accuracy.

 In the News: Alzheimer's Disease Detection & Diagnosis

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THE SIMILARITIES AND DIFFERENCES BETWEEN ALZHEIMER’S AND DEMENTIA

To the average person, Alzheimer’s and dementia often seem like the same thing. Sometimes, the two terms are even used interchangeably. However, although the two are somewhat related, each condition has its own distinct differences.

Firstly, dementia is categorized as a ‘syndrome’, which means that it is a set of symptoms that occur together consistently. These symptoms include memory loss, difficulty with thinking and problem solving, and/or issues with language. Alzheimer’s is similar to dementia in that they share these symptoms and progresses in severity over time. This is why it is accepted to be one type of dementia among several others.

However, what sets these two conditions apart is that Alzheimer’s is a disease that destroys the brain while dementia can be caused by a number of other things that damages brain cells. Diseases such as Huntington’s, Parkinson’s, Creutzfeldt-Jacob, and other types of brain damage can also cause dementia. Another major difference between the two conditions is that dementia is often diagnosed based the symptoms rather than the actual cause. Whereas, Alzheimer’s is diagnosed based on the exact cause of the symptoms. Also, in patients with Alzheimer’s it is not possible to reverse the symptoms, but some types of dementia can be reversed, such as those caused by nutritional deficiencies and drug problems.

 

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AVAILABILITY OF TREATMENTS FOR ALZHEIMER’S

At the moment, there is no cure available for Alzheimer’s. However, there are a number of drug and non-drug related treatments available to help patients alleviate or delay the progress of their symptoms.

Common Medications Given to Alzheimer’s Patient

There are several drugs that are normally prescribed as treatment for Alzheimer’s. These medicines help to temporarily slow down their progress for some people. For patients in the early or middle stages of the disease, they are often given donepezil, galantamine, or rivastigmine. These are mainly targeted at helping with their memory problems and to improve their concentration. As a result it allows patients to go through their day fairly normally. For those in the severe stages of Alzheimer’s, memantine might be of better help. It may ease their agitations and delusions. Other medications such as antipsychotics to deal with behavioral changes, antidepressants to treat depression, and sleeping medication may be prescribed depending on the specific person’s condition. 
In the News: Alzheimer's Drugs

Non-Medicinal Treatments

Being a disease of the brain, there are also various means of keeping the brain active without medication that can keep people diagnosed with Alzheimer’s to keep their symptoms at bay. For example, during the initial stages, the person may benefit from counselling in order to psychologically adjust to their diagnosis.
Experts also recommend that people with Alzheimer’s keep up with their regular activities and hobbies in order to keep their minds exercised. Reading, doing different types of puzzles, playing instruments, and having meaningful social interactions can all benefit the person greatly.
In today’s world of constant scientific advancements, researchers are always on the lookout for new and improved methods of treatment for Alzheimer’s—to give them an improved quality of life while managing their progression better and to even prevent it from developing.
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CHALLENGES OF CARING FOR ALZHEIMER’S PATIENTS

Stage 1: Cognitive Impairment

During this early stage of the disease, symptoms such as memory lapses and mood changes can be easily attributed to an ‘off day’ or the natural progression of old age. However, it is extremely important for close friends and family to remain alert and keep a watchful eye for consistent symptoms. Early detection and diagnosis can benefit the person tremendously in terms of managing and delaying the progression. Attending counselling and therapy sessions can also help in terms of mentally coping with their diagnosis.

What can you expect to feel or worry about if you suspect a loved one may be in this phase of the disease?

  • You may be confused or frustrated at first at your loved ones irregular behavior. For example, they may repeat things more than once. This is especially true when there is no diagnosis and nothing specific to attribute these erratic behaviors. 
  • You may be nervous about what the progression of the disease will look like. Speaking with your loved one about long-term planning, financial or legal decisions while they are still able to is extremely important and will help ease decisions down the line. Find out what their wishes are and go through the different scenarios of care arrangements potential medical scenarios. 

Stage 2: Early Stages

At this stage, it is important for the person to have a sense of independence remain within them. Developing routines, setting reminders, and using calendar clocks can help. For example, using weekly pill boxes or written instructions allow them to continue with their daily activities without much interference from outside. Family and friends should always remain supportive, patient, and not dismiss them as this can cause them to feel more isolated and suspicious.

Stage 3: Middle Stages

By this point, a person with Alzheimer’s will usually need some support to help them with their daily activities. Family members caring for the patient would need to monitor and help them with eating, washing, dressing, and even using the toilet. During their mood swings, it is important to treat them normally and patiently help them understand their surroundings. You can also opt for professional caregivers to watch over and assist the person.

Stage 4: Late Stages

In the final stage of the disease’s progression, a person most likely will require full time care and assistance. This stage often can be very stressful for family members as they may not be fully able to care for the person. In this case, it might be best to opt for permanent home health aides or an assisted living facility.

 

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CARE ARRANGEMENTS FOR ALZHEIMER’S PATIENTS

Normally, when a person is diagnosed with Alzheimer’s, a family member or loved one becomes the primary caregiver. However, caring for the person can be physically and emotionally taxing, especially without any training or experience in dealing with the condition. There are many types of care arrangement options that you can opt for the person instead, to support and ease the burden of the primary caregiver. Below are some of the options available:

Adult Day Care

Provides a safe environment for patients with Alzheimer’s and other forms of dementias to participate in activities and interact socially with people. This type of care is desirable when the primary caregiver works during the day or a full time caregiver needs a break or has to run errands without having to worry about the patient’s safety. In addition, these care centers may have counseling, health services, meal services, personal care, behavior management, and therapy available.

In-Home Care

This type of care arrangement allows the patient to stay in their homes. Receiving care while in a familiar setting may be beneficial for many people as it provides a sense of comfort. It can also be seen as a helping hand for full-time primary caregivers. There are several types of in-home services such as:

  • Companion services—to provide help with supervision and recreational activities.
  • Personal care services—to help with various personal care such as bathing, dressing, eating, and exercising.
  • Homemaker services—to help with housekeeping, cooking, or shopping.
  • Skilled care—to help with medical need such as wound care, injections, physical therapy, and more.

Residential Care

In a situation where the patient prefers to be in a communal living environment or when their disease progression requires more care than that provided at home, residential care is a good option. In this situation, the patient living within a facility that is designed to provide care and support for them. There are several types of residential care including, retirement housing, assisted living, nursing homes, and special care units. Each of these type of facilities offer different levels of care, depending on the patient’s needs and progression of Alzheimer’s.

When it comes to each patient, there is no one-size-fits all type of care arrangement. The choice must be made based on the progression of the disease and its corresponding symptoms as well as the patient’s and their loved ones’ preferences.

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RESEARCH & CLINICAL TRIALS FOR ALZHEIMER’S 

Alzheimer’s is an illness that has many facets to it, which both doctors and scientists around the world are still in the process of unveiling. Various research and clinical trials are done every day. Below are some examples of clinical research and their aims:

  • Treatment trials—to test new treatments for the purpose of reducing symptoms, slowing or stopping the progression entirely.
  • Diagnostic studies—to find new tests and methods for diagnosing Alzheimer’s
  • Prevention trials—to investigate methods to prevent the onset of Alzheimer’s
  • Quality of life studies—to look at different ways and how to improve the quality of life for individuals with Alzheimer’s, their caregivers, and family members.

For more information on research currently being conducted on Alzheimer's Disease, the following are great resources and tools that can help shine light on progress being made.

Alzheimer's Society: Research
Alzheimer's Association: Research

A great resource is the Alzheimer's Association's TrialMatch system. 

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RESOURCES AND SUPPORT FOR ALZHEIMER’S

Please know that you are NOT alone in this even if it feels lonely at times. Rest assured, there are many out there who have been in your shoes and who want to help you through this tough time. Here are a couple of resources available to connect with others who are going through what you are going through:

  • Seek your local Alzheimer's Association chapter for support groups.
  • Online Forums & Chat Rooms:

For family members and friends who would like to educate themselves further on the details of Alzheimer’s, its symptoms, treatments, and challenges, you should seek the assistance of local or national Alzheimer’s Association.

Alzheimer’s Association
1-800-272-3900 (toll-free)
1-866-403-3073 (TTY/toll-free)
info@alz.org
www.alz.org
Alzheimer’s Foundation of America
1-866-232-8484 (toll-free)
info@alzfdn.org
www.alzfdn.org

Other websites to obtain more detailed information on Alzheimer’s:

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