The chance of an elderly person becoming confused, forgetful, and developing severe memory problems increases with each passing year. Alzheimer's disease, one of the most common forms of dementia, is thought to affect 5 percent of people over age 65 and 20 percent of people over age 80.

What is dementia?

Dementia is an impairment in brain functioning resulting in problems with memory and judgment. It is often accompanied by confusion.

In all dementias there is a loss of intellectual abilities. This means losing the ability to use information once known or learned, as well as basic abilities to think and to understand. There are also memory deficits or losses-with recent memory being the first area affected.

Memory loss and loss of intellectual abilities can result in:

• the person no longer being aware of social niceties, such as how to behave in public
• confusion and disorientation
• changes in abstract thinking (such as being unable to understand humor or discern the passage of time)
• severe problems in what is called "higher order functioning" (such as language use and the ability to do numerical calculations)
• a change or exaggeration in the personality of the individual, for example, becoming more stubborn or suspicious
• problems with personal hygiene

What is Alzheimer's disease?

Alzheimer's disease is a progressive, irreversible brain disease that affects the central nervous system. Alzheimer's disease, which is the most common form of dementia, is not part of normal aging. It is caused by factors that are largely unknown and result in a slow, gradual decline of intellectual functioning, memory, and judgment. It can occur as early as 40 years of age or as late as 100 years of age.

What Alzheimer's disease is NOT:

Alzheimer's disease is not contagious. Alzheimer's is not insanity or "craziness." Alzheimer's is not an inevitable result of aging.

What is physically happening in Alzheimer's disease?

Several major changes are occurring in the brain:

• the nerve cells important in memory and cognition are dying
• microscopic changes called plaques and tangles are developing
• there is a loss of certain brain chemicals, in particular, acetylcholine, which is needed for communication between nerve cells

What are the causes?

Alzheimer's disease affects men and women of all races and socioeconomic backgrounds. The cause is currently unknown. Possible causes may include:

• genetic factors--In families where Alzheimer's occurs in several generations, genetic causes are suspected. In a very small number of these families, gene mutations have been found. For the large majority of families with a history of Alzheimer's disease, however, the genetic causes have yet to be determined. Genetic causes appear to be more likely in families where there is an early onset of the disease (before age 65).
• possible non-genetic factor--These include environmental toxins (such as exposure to aluminum), infectious or transmittable agents, and traumas (such as severe head injuries). Research to date is inconclusive as to the effects of these conditions.
• a combination of the effects of genes, the environment, and the aging process--Most cases of Alzheimer's disease are thought to be a result of these three factors.

Is there a cure?

Some dementias do have cures. Alzheimer's dementia does not. However, there is both medical and non-medical treatment available to help manage symptoms.

Medical treatment can include medications that may help improve symptoms.

Non-medical treatment may help the patient become more adjusted to the limitations of the disease. It may also help caregivers manage the sometimes bizarre and difficult behavior patients exhibit.

Over the years there have been a number of articles about the use of Lecithin, vitamins, chelating agents, special diets, and removing dental fillings as a way to "cure" Alzheimer's disease. There is no consistent proof that these treatments work. Caregivers should be wary of expensive treatments that claim to be cures.

How long will the disease last?

The course of Alzheimer's varies tremendously. The life expectancy for people with the disease can range anywhere from 3 to 25 years. It appears, however, that the average duration of the disease may be 8 to 10 years. Alzheimer's disease is a terminal illness. There are not periods of "remission" or improvement that can occur with other illnesses, like cancer.

Is a diagnosis of Alzheimer's disease usually accurate?

A definitive diagnosis can only be made by examining the brain tissue after the patient's death. However, if the patient is given a thorough assessment, the diagnosis can be almost 90 percent accurate.

Are there other kinds of dementia besides Alzheimer's?

Although Alzheimer's disease is the most common form of dementia, there are other progressive dementing illnesses. These include the following:

• Vascular dementia (also known as multi-infarct dementia) is the second most common form of dementia; individuals often experience sudden deterioration, which may progress over time; sometimes only very specific areas of functioning are affected, such as speech
• Parkinson's disease, in which individuals develop severe problems of movement and balance, and other problems, including dementia
• Huntington's disease, a hereditary disease usually appearing when the individual approaches 40 years of age, passed on from parent to child, whose symptoms include quick jerky movements of the face, limbs, and trunk, and eventually a dementia
• dementias associated with physical disorders such as diabetes, thyroid disease, brain tumors, or Acquired Immune Deficiency Syndrome (AIDS)
• dementias of alcohol or substance abuse; these may be a combination of direct chemical damage to the brain combined with nutritional or vitamin deficiencies

Are some dementias reversible?

Certain dementias can be reversed or improved. These include dementias associated with metabolic disorders such as diabetes, or dementias associated with alcohol or substance abuse.

Also, there are a number of physical problems which can have dementia-like secondary symptoms. These include vitamin deficiencies, reactions to medications, physical illnesses, delirium, anemia, and hearing or vision problems. Often, once the physical problem is treated, the dementia-like symptoms will subside.

Two treatable conditions commonly confused with dementia are delirium and depression.

What are the tests needed to diagnose Alzheimer's?

Assessment may consist of:

An environmental assessment may also be included as part of the evaluation. This assessment determines:

• if the patient's home is safe and secure enough given their current level of functioning
• if changes need to be made to allow the patient to remain at home
• how well the patient is able to perform "activities of daily living" (such as bathing or dressing)

What are some examples of cognitive tests?

Two commonly used cognitive tests are:

• the Mini Mental State Examination (MMSE) (Folstein, Folstein, and McHugh, 1975)
• the Blessed Dementia Rating Scale (Blessed, Tomlinson, and Roth, 1968)

These tests are screening measures that identify the existence of memory problems. They are administered by trained personnel. A number of factors can influence a patient's scores, including education, anxiety, and depression. The tests can not identify the causes of memory problems.

If these tests show that some memory impairment exists, it is important that the patient undergo more detailed cognitive testing. More detailed tests can determine what areas the patient is having difficulty with (such as judgment, abstraction, reasoning, orientation, attention, or calculation).

Are there stages to Alzheimer's disease?

Every person reacts differently to the disease. Some people may have a slow, gradual decline; some a rapid decline; and some periods of slow or relatively little decline interspersed with periods of rapid decline. Despite this variation among individuals, there are sets of symptoms commonly seen in the beginning, middle, and end phases of the disease.

Everyone has memory lapses-not remembering a name, forgetting where you left your keys-but with Alzheimer's disease these problems occur frequently and worsen over time.

In the very end phases, the patient is unable to eat or walk without assistance.

What is delirium?

Because many of the symptoms of delirium are similar to Alzheimer's disease, the two are commonly confused. Delirium, however, is a treatable condition which can be reversed when the problems causing it are corrected. In delirium there is often a rapid onset of symptoms related to a sudden change in the patient's health. Common delirium symptoms include:

• fluctuation in consciousness
• visual or auditory hallucinations
• sudden onset of incoherent speech
• sleep-wake cycle reversals (awake at night and very sleepy during the day)

Some possible causes of delirium include:

• medications-new dosage, sudden sensitivity or reaction with another medication
• vitamin deficiencies associated with chronic alcohol intake
• physical illness
• surgery and anesthesia-effects of surgery and anesthesia on the patient's system may produce delirium in patients as they are recovering
• location or living changes

Dementia and delirium can occur together when a demented person:

• has a medical condition which becomes unstable (their diabetes gets out of control)
• has surgery
• is hospitalized or relocated

When these things happen, treating the cause of the delirium will greatly improve the patient's functioning.

What are the signs of depression?

Like delirium, depression is a treatable condition that is commonly confused with dementia (especially the early stages of dementia). Because medication and psychotherapy can have a very positive outcome on depression, it is important not to let depression go untreated. Symptoms of depression include:

• loss of interest and pleasure in usual activities
• appetite change
• sleep disturbance (too much or too little)
• fatigue and inactivity
• trouble concentrating
• feelings of sadness
• feelings of worthlessness or guilt
• thoughts of death or suicide
• feeling discouraged about the future

Depression may be brought on by an upsetting experience or loss, or a change in the person's nervous system that is beyond his or her control.

Remember that depression and dementia can co-exist:

• one-third of individuals with early stage dementia are depressed
• depression is common after a stroke

Being able to recognize demented, delirious, and depressed behaviors and to obtain the necessary care for each is an important and useful skill for caregivers. Taking care of treatable disorders makes caregiving easier.

Are there any medications that can help with Alzheimer's symptoms?

Currently, no cure for Alzheimer's disease exists. All medication treatment for Alzheimer's disease is supportive, not curative. New medications appear with some regularity and time can change what medications are and are not used. No medication is always effective with Alzheimer's patients and no medication always creates the side effects listed below. When considering or continuing a medication, a close relationship with your physician is critical. Only he or she can suggest what is best and monitor the patient adequately.

Drugs to treat behavior problems

Drugs to improve memory and thinking

Many experimental drugs with the potential to improve memory and other basic thinking deficits in Alzheimer's disease are currently being investigated. Some of the medications that have been approved by the FDA are: Cognex (tacrine), Aricept (donepezil), Exelon (rivastigmine) and Reminyl (galantamine). Cognex was the first to be approved, but is no longer widely used because of troublesome side effects. All of these medications have similar actions, so only one is prescribed at a time, and response is usually modest. They do not stop the progression of Alzheimer's disease, but may improve some of its symptoms.