Alzheimer’s & Dementia
Alzheimer’s is a type of dementia that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks.
Symptoms of Alzheimer’s
The most common early symptom of Alzheimer’s is difficulty remembering newly learned information.
Just like the rest of our bodies, our brains change as we age. Most of us eventually notice some slowed thinking and occasional problems with remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work may be a sign that brain cells are failing.
The most common early symptom of Alzheimer’s is difficulty remembering newly learned information because Alzheimer’s changes typically begin in the part of the brain that affects learning. As Alzheimer’s advances through the brain it leads to increasingly severe symptoms, including disorientation, mood and behavior changes; deepening confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more serious memory loss and behavior changes; and difficulty speaking, swallowing and walking.
People with memory loss or other possible signs of Alzheimer’s may find it hard to recognize they have a problem. Signs of dementia may be more obvious to family members or friends. Anyone experiencing dementia-like symptoms should see a doctor as soon as possible. If you need assistance finding a doctor with experience evaluating memory problems, your local Alzheimer’s Association can help. Early diagnosis and intervention methods are improving dramatically, and treatment options and sources of support can improve quality of life. Two helpful support resources you can tap into are ALZ Connected, our messages boards and online social networking community, and Alzheimer’s Navigator, a web tool that creates customized action plans, based on answers you provide through short, online surveys.
The role of plaques and tangles
Two abnormal structures called plaques and tangles are prime suspects in damaging and killing nerve cells.
- Plaques are deposits of a protein fragment called beta-amyloid (BAY-tuh AM-uh-loyd) that build up in the spaces between nerve cells.
- Tangles are twisted fibers of another protein called tau (rhymes with “wow”) that build up inside cells
- Alzheimer’s and the brain
- Microscopic changes in the brain begin long before the first signs of memory loss.
- The brain has 100 billion nerve cells (neurons). Each nerve cell connects with many others to form communication networks. Groups of nerve cells have special jobs. Some are involved in thinking, learning and remembering. Others help us see, hear and smell.
- To do their work, brain cells operate like tiny factories. They receive supplies, generate energy, construct equipment and get rid of waste. Cells also process and store information and communicate with other cells. Keeping everything running requires coordination as well as large amounts of fuel and oxygen.
- Scientists believe Alzheimer’s disease prevents parts of a cell’s factory from running well. They are not sure where the trouble starts. But just like a real factory, backups and breakdowns in one system cause problems in other areas. As damage spreads, cells lose their ability to do their jobs and, eventually die, causing irreversible changes in the brain.
Physical and neurological exam
Your doctor will perform a physical exam, and is likely to check your overall neurological health by testing your:
- Reflexes
- Muscle tone and strength
- Ability to get up from a chair and walk across the room
- Sense of sight and hearing
- Coordination
- Balance
Lab tests
Blood tests may help your doctor rule out other potential causes of memory loss and confusion, such as thyroid disorders or vitamin deficiencies.
Mental status and neuropsychological testing
Your doctor may conduct a brief mental status test to assess your memory and other thinking skills. In addition, your doctor may suggest a more extensive assessment of your thinking and memory. Longer forms of neuropsychological testing may provide additional details about your mental function compared with others’ of a similar age and education level.
Brain imaging
Images of the brain are now used chiefly to pinpoint visible abnormalities related to conditions other than Alzheimer’s disease — such as strokes, trauma or tumors — that may cause cognitive change. New imaging applications — currently used primarily in major medical centers or in clinical trials — may enable doctors to detect specific brain changes caused by Alzheimer’s.
Brain-imaging technologies include:
- Magnetic resonance imaging (MRI).An MRI uses radio waves and a strong magnetic field to produce detailed images of your brain. MRIs are used to rule out other conditions that may account for or be adding to cognitive symptoms. In addition, they may be used to assess whether shrinkage in brain regions implicated in Alzheimer’s disease has occurred.
- Computerized tomography (CT).A CT scan produces cross-sectional images (slices) of your brain. It’s currently used chiefly to rule out tumors, strokes and head injuries.
- Positron emission tomography (PET).During a PET scan, you’ll be injected in a vein with a low-level radioactive tracer. The tracer may be a special form of glucose (sugar) that shows overall activity in various brain regions.
This can show which parts of your brain aren’t functioning well. New PET techniques are able to detect your brain level of plaques (amyloid) and tangles (tau), the two hallmark abnormalities linked to Alzheimer’s. However, these new PET techniques are generally found in research settings or in clinical trials.
- Cerebrospinal fluid.In special circumstances such as rapidly progressive dementia or very young onset dementia, a cerebrospinal fluid examination may be performed. The spinal fluid can be tested for biomarkers that indicate the likelihood of Alzheimer’s disease.
Treatment
Drugs
Current Alzheimer’s medications can help for a time with memory symptoms and other cognitive changes. Two types of drugs are currently used to treat cognitive symptoms:
- Cholinesterase inhibitors.These drugs work by boosting levels of a cell-to-cell communication by providing a neurotransmitter (acetylcholine) that is depleted in the brain by Alzheimer’s disease. The improvement is modest. Cholinesterase inhibitors can improve neuropsychiatric symptoms, such as agitation or depression, as well.
Commonly prescribed cholinesterase inhibitors include donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon). The main side effects of these drugs include diarrhea, nausea, loss of appetite and sleep disturbances. In people with cardiac conduction disorders, serious side effects may include a slow heart rate and heart block.
- Memantine (Namenda).This drug works in another brain cell communication network and slows the progression of symptoms with moderate to severe Alzheimer’s disease. It’s sometimes used in combination with a cholinesterase inhibitor. Side effects may include constipation, dizziness and headache.
Sometimes other medications such as antidepressants are used to help control the behavioral symptoms associated with Alzheimer’s disease. But some medications should only be used with great caution. For example, some common sleep medications — zolpidem (Ambien), eszopiclone (Lunesta) and others — may increase confusion and the risk of falls.
Anti-anxiety medications — clonazepam (Klonopin) and lorazepam (Ativan) — increase the risk of falls, confusion and dizziness. Always check with your doctor before taking any new medications.
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