Alzheimer's Disease

Topic Overview

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Alzheimer’s disease is the most common cause of mental decline, or dementia. But dementia also has many other causes. For more information, see the topic Dementia.

What is Alzheimer's disease?

Picture of the brain Alzheimer's disease damages the brain. It causes a steady loss of memory and of how well you can speak, think, and carry on daily activities.

Alzheimer's disease always gets worse over time, but how quickly this happens varies. Some people lose the ability to do daily activities early on. Others may still do fairly well until much later in the disease.

Mild memory loss is common in people older than 60. It may not mean that you have Alzheimer’s disease. But if your memory is getting worse, see your doctor. If it is Alzheimer’s, treatment may help.

What causes Alzheimer's disease?

Alzheimer’s disease happens because of changes in the brain. These include lower levels of chemical messengers (neurotransmitters) that help brain cells work properly. What causes these changes is not clear.

The risk of getting Alzheimer’s disease increases as you get older. But this does not mean that everyone will get it. By age 85, about 35 out of 100 people have some form of dementia.1 That means that 65 out of 100 don't have it. Dementia is rare before age 60.

Having a relative with Alzheimer’s raises your risk of getting it, but most people with Alzheimer's disease do not have a family history of it.

What are the symptoms?

For most people, the first symptom of Alzheimer's disease is memory loss. Often the person who has a memory problem does not notice it, but family and friends do. But the person with the disease may also know that something is wrong.

As the disease gets worse, the person may:

  • Have trouble making decisions.
  • Be confused about what time and day it is.
  • Get lost in places he or she knows well.
  • Have trouble learning and remembering new information.
  • Have trouble finding the right words to say what he or she wants to say.
  • Have more trouble doing daily tasks like cooking a meal or paying bills.

The symptoms of Alzheimer’s get worse slowly over time. A person who gets these symptoms over a few hours or days or whose symptoms suddenly get worse needs to see a doctor right away, because there may be another problem.

As people with Alzheimer’s get worse, they may get restless and wander, especially in late afternoon and at night. This is called sundowning. Over time, they may also start to act very different. They may withdraw from family and friends. They may see or hear things that are not really there. They may falsely believe that others are lying, cheating, using them, or trying to harm them. They may strike out at others.

Later, they may not be able to take care of themselves. They may not know their loved ones when they see them. They may forget how to eat, dress, bathe, use the toilet, or get up from a bed or a chair and walk.

How is Alzheimer's disease diagnosed?

To check for the disease, your doctor will ask about your past health and do a physical exam. He or she may ask you to do some simple things that test your memory and other mental skills. Your doctor may also check how well you can do daily tasks.

The exam usually includes blood tests to look for another cause of your problems. You may have tests such as CT and MRI scans, which look at your brain. By themselves, these tests can't show for sure whether you have Alzheimer’s.

How is it treated?

There is no cure for Alzheimer's disease, but there are medicines that may slow it down for a while and make it easier to live with. Drugs that may be prescribed include:

  • Medicines to help with memory and thinking problems, such as donepezil (Aricept).
  • Medicines to help with help with moderate to severe confusion and memory loss, such as memantine (Namenda).

These medicines may not work for everyone or have a big effect, but most experts think they are worth a try.

As the disease gets worse, the person may get depressed or angry and upset. The doctor may also prescribe medicines to help with these problems.

How can you help your loved one with Alzheimer's disease?

If you are or will be taking care of a loved one with Alzheimer’s, start learning what you can expect. This can help you make the most of the person's abilities as they change, and it can help you deal with new problems as they arise.

Work with your loved one to make decisions about the future before the disease gets worse. It is important to write a living will and a durable power of attorney. A living will states the types of medical care your loved one wants. A durable power of attorney lets your loved one pick someone to be his or her health care agent. This person makes care decisions when your loved one cannot.

Your loved one will need more and more care as the disease gets worse. In time, he or she may need help to eat, get dressed, or use the bathroom. You may be able to give this care at home, or you may want to think about using a nursing home. A nursing home can give this kind of care 24 hours a day. The time may come when a nursing home is the best choice.

Because people are living longer than they used to, Alzheimer's disease is becoming a more common problem. Ask your doctor about local resources such as support groups or other groups that can help as you care for your loved one. You can also search the Internet for online support groups. Help is available.

Frequently Asked Questions

Learning about Alzheimer's disease:

Being diagnosed:

Getting treatment:

Living with Alzheimer's disease:

End-of-life decisions:

Health Tools Health Tools help you make wise health decisions or take action to improve your health.

Health Tools help you make wise health decisions or take action to improve your health.


Decision Points focus on key medical care decisions that are important to many health problems. Decision Points focus on key medical care decisions that are important to many health problems.
  Alzheimer's disease: Should I take medicines?
  Alzheimer's or other dementia: Should I move my relative into long-term care?

Cause

The cause of Alzheimer's disease is not clear, and it is likely there are several causes of this condition. Alzheimer's disease causes changes or deterioration in certain areas of the brain that control thinking, communication, and behavior. Some of the deterioration may be related to a loss of chemical messengers in the brain (neurotransmitters)—acetylcholine, in particular—that allow nerve cells in the brain to communicate properly.

It is not clear why these changes in the brain occur, but they are a major focus of Alzheimer's research. Although most people who have Alzheimer's disease do not have a family history of the condition, you are at increased risk for the condition if a member of your family has it.

Some theories have suggested that metals, such as zinc or aluminum, play a role in Alzheimer's disease. But research has not found much evidence to support these theories. Experts agree that there is no reason to leave zinc out of your diet or to avoid items that contain aluminum, such as cooking utensils or soda pop cans.

Symptoms

Memory loss is usually the first sign of Alzheimer's disease. Many older people may worry about Alzheimer's disease if they start to have memory problems. Having some short-term memory loss in your 60s and 70s is common, and some people with mild memory problems will go on to develop Alzheimer's disease. If you start having memory problems, share your concerns with your family and your doctor.

Examples of normal forgetfulness include forgetting:

  • Parts of an experience.
  • Where the car is parked.
  • Events from the distant past.
  • A person's name, remembering it later.
  • Where you left an object, such as your car keys.

Examples of memory loss caused by Alzheimer's disease include forgetting:

  • An entire experience.
  • How to drive a car or read a clock.
  • Recent events, such as forgetting you left the stove on.
  • Ever having known a particular person.

Alzheimer's disease also causes changes in thinking, behavior, and personality. Early in the disease, the person may still behave appropriately in social situations, leading others to believe that the person is not ill. Close family members and friends may first notice the symptoms of Alzheimer's disease, although the person may also realize that something is wrong. Learn the warning signs of dementia—such as having difficulty thinking or remembering, or having trouble balancing a checkbook—and talk to a doctor if a friend or family member has developed any of the signs. Symptoms vary as the disease progresses.

The Alzheimer's Association has identified 10 warning signs for Alzheimer's disease. These signs are:2

  • Memory loss, such as forgetting recently learned information like names and phone numbers.
  • Difficulty performing familiar tasks, such as cooking a meal.
  • Problems with language, such as forgetting simple words or substituting unusual words.
  • Disorientation as to time and place, such as forgetting where you live on your street.
  • Poor or decreased judgment, such as dressing improperly for the weather or giving away large sums of money to strangers.
  • Problems with abstract thinking, such as not being able to balance a checkbook or understand what numbers represent.
  • Misplacing things, like putting an iron in the freezer or a wristwatch in the sugar bowl.
  • Changes in mood or behavior, such as rapid mood swings—from calm to tears to anger—for no apparent reason.
  • Changes in personality, such as becoming extremely confused, suspicious, fearful, or dependent on a family member.
  • Loss of initiative, such as sleeping all the time, watching television all day, or not wanting to do any usual activities.

Symptoms that may be but are not always present include:

  • Firmly held false beliefs (delusions), such as that someone is stealing from the person.
  • Seeing or hearing things that aren't really there (hallucinations).
  • Lack of interest in surroundings or activities, or withdrawal from family and friends.
  • Purposeless activity, such as opening and closing a purse, packing and unpacking clothing, pacing, or repeating demands or questions.
  • Verbal and physical aggression.
  • Inability to control impulses, which may lead to unusual or inappropriate actions. Men are somewhat more likely than women to exhibit behavior problems such as wandering, abusiveness, and social impropriety.

Early in the disease, Alzheimer's usually does not affect a person's fine motor skills (such as the ability to button or unbutton clothes or use utensils) or sense of touch. A person who develops motor symptoms (such as weakness or shaking hands) or sensory symptoms (such as numbness) probably has a condition other than Alzheimer's disease. Conditions such as Parkinson's disease, for instance, may cause motor symptoms along with dementia.

Other conditions with symptoms similar to those of Alzheimer's disease may include:

What Happens

Researchers have discovered changes that take place in the brains of people who have Alzheimer's disease. These include:

  • Lower levels of acetylcholine in certain areas of the brain. Acetylcholine is a chemical messenger in the brain (neurotransmitter) needed for some nerve cells to work properly. Other neurotransmitters also are affected.
  • Senile plaques, which are clumps of abnormal nerve cells surrounding abnormal protein (amyloid) deposits, and neurofibrillary tangles, which are clumps of material that disrupt the normal structure of nerve cells. Senile plaques and neurofibrillary tangles can be seen during an examination of the brain after the person has died.

These brain changes may cause the memory loss and decline in other mental abilities that occur with Alzheimer's disease. It is not fully understood why these brain changes occur in some people but not in others.

Alzheimer's disease always gets worse over time, but the course of the disease varies from person to person. Some people may still be able to function relatively well until late in the course of the disease. Others may lose the ability to do everyday activities very early on.

  • The disease tends to get worse gradually. It usually starts with mild memory loss and progresses to severe mental and functional problems and eventual death.
  • Symptoms sometimes are described as occurring in early, middle, and late phases. It is difficult to predict how long each phase will last.
  • The average amount of time a person lives after developing symptoms of Alzheimer's disease is 8 to 10 years.

Mild dementia

Usually, a person with mild dementia:

  • Becomes confused about where he or she is and gets lost easily.
  • Loses the ability to start tasks on his or her own without prompting.
  • Avoids new and unfamiliar situations.
  • Has delayed reactions and slowed learning ability.
  • Begins speaking more slowly than in the past.
  • Develops difficulty handling money and paying bills.
  • Starts using poor judgment and making inappropriate decisions.
  • May have mood swings and become depressed, irritable, or restless.

These symptoms often are more obvious when the person is in a new and unfamiliar place or situation.

Moderate dementia

With moderate dementia, a person typically:

  • Has problems recognizing close friends and family.
  • Becomes restless and wanders, especially in late afternoon and at night. This is called sundowning.
  • Has problems reading, writing, and dealing with numbers.
  • Has problems organizing thoughts and thinking logically.
  • Can't find the right words to say or makes up stories to fill in the blanks.
  • Has trouble dressing.
  • Gets upset easily and can be hostile or unwilling to cooperate.
  • Has firmly held false beliefs (delusions), suspicion of others (paranoia), and agitation.
  • Needs full-time supervision.
  • Loses recognition of time.

Severe dementia

With severe dementia, a person usually:

  • Can no longer remember how to bathe, eat, dress, or go to the bathroom independently. The person may become bedridden or confined to a wheelchair because he or she has forgotten how to move.
  • Loses the ability to chew and swallow.
  • Has trouble with balance or walking and may fall frequently.
  • Becomes more confused in the evening (sundowning) and has trouble sleeping.
  • Cannot communicate using words.
  • Loses bowel or bladder control (incontinence).

A person with severe dementia becomes more vulnerable to other illnesses. Death often results from complications of being confined to bed, such as pneumonia.

What Increases Your Risk

The main factor that raises your risk for Alzheimer's disease is getting older. About 6 out of 100 people over 65 years and 35 out of 100 people over 85 years have some form of dementia.1 People rarely have dementia before age 60. Other factors that increase your risk of developing Alzheimer's disease include:

When To Call a Doctor

Alzheimer's disease tends to develop slowly over time. If confusion and other changes in mental abilities come on suddenly, within hours or days, the problem may be delirium, a condition that needs immediate treatment.

Seek care immediately if:

  • Symptoms such as a shortened attention span, memory problems, or seeing or hearing things that aren't really there (hallucinations) develop suddenly over hours to days.
  • A person who has Alzheimer's disease has a sudden, significant change in normal behavior or if symptoms suddenly become worse.

Call your doctor to schedule an appointment if:

  • Symptoms such as a shortened attention span, memory problems, or false beliefs (delusions) develop gradually over a few weeks or months.
  • Memory loss and other symptoms begin to interfere with the person's work or social life or could result in injury or harm to the person.
  • You need help caring for a person with Alzheimer's disease.

Watchful Waiting

If memory loss is not rapidly becoming worse or interfering with your work, social life, or ability to function, it may be normal age-related memory loss. Talk to your doctor if you are concerned about new memory loss or memory loss that is getting worse or other signs of dementia, such as having trouble finding your way around familiar places.

Who To See

The following health professionals can evaluate symptoms of memory loss or confusion:

A family member or friend will need to go with the person who needs to be evaluated.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Alzheimer's disease is diagnosed after other conditions are ruled out. If you are suffering from a decline in mental abilities (dementia), your doctor will attempt to find out if another treatable condition may be causing those symptoms.

  • It is very important to rule out delirium as a possible cause of symptoms, especially if the symptoms came on suddenly rather than gradually. Delirium may require emergency medical attention.
  • Symptoms of confusion and memory loss can sometimes be caused by depression. Depression is very common among older adults, but it is sometimes difficult to recognize. It may be successfully managed with medicine and counseling.

Alzheimer's disease is diagnosed with a medical history and a physical exam. A physical exam is used to help find out if a physical problem may be causing a person's dementia symptoms. It may be possible to correct some of these problems. For example, sometimes a simple hearing or vision problem can cause confusion, social withdrawal, or a change in behavior, such as hostility or unresponsiveness. The person may have an undiagnosed illness or infection that is causing the symptoms.

In addition, the doctor will do a mental and functional status exam and a mental health assessment. During these exams, the person will be asked to perform simple tasks that check orientation. It usually is helpful to have a family member or someone in close contact with the person present at the appointment. A family member may be able to provide the best information about how a person's day-to-day functioning, memory, and personality have changed.

Brain imaging tests such as CT scans and magnetic resonance imaging (MRI) may also be done to make sure another problem is not causing the symptoms. Positron emission tomography (PET) or single photon emission tomography (SPECT), two other imaging tests, are not routinely done but may be useful in individual cases.

Lab tests

A small number of people with dementia have a condition that proper treatment can reverse (unlike Alzheimer's disease). Lab tests may be done to rule out other possible causes of a person's symptoms, such as levels of certain minerals or chemicals in the blood that are too high or too low, liver disease, abnormal thyroid levels, or nutritional problems, such as folate or vitamin B12 deficiencies. Treatment for these conditions may slow or reverse mental decline.

Blood tests often done to check for these conditions include:

  • Complete blood count (CBC), which shows the kinds and number of cells in your blood to help your doctor evaluate your symptoms.
  • Liver function tests (AST, ALT, alkaline phosphatase, bilirubin), which detect liver damage or disease.
  • Folate (folic acid) test, which detects the level of the B vitamin folic acid either in plasma (the liquid part of blood) or in the red blood cells. Folic acid is needed for the production of both red and white blood cells.
  • Vitamin B12 concentration, which detects the level of vitamin B12 in your blood. Vitamin B12 is needed to produce red blood cells and to maintain a healthy nervous system.
  • Electrolyte and blood glucose levels (sodium, potassium, creatinine, glucose, calcium), which are needed to keep the body's balance of fluids at the proper level and to maintain normal functions, such as heart rhythm, muscle contraction, and brain function.
  • Thyroid function tests. Abnormal thyroid hormone levels are a common cause of forgetfulness, confusion, lethargy, and other symptoms of dementia in older people. Medicine can easily improve symptoms if a thyroid problem is present.
  • Human immunodeficiency virus (HIV) infection test, if the person has risk factors for HIV or the medical history suggests it. Untreated HIV can cause symptoms such as personality changes or problems concentrating.

Other tests

  • Brain imaging tests such as a CT head scan or an MRI of the head may be done to rule out other causes of symptoms when the diagnosis is unclear.
  • A test that measures electrical activity in the brain called an electroencephalogram, or EEG, may be done if the medical history suggests a seizure disorder.

In some cases, examining the brain after death (autopsy) is done to look for changes in the brain that may show Alzheimer's disease. An autopsy is the only definite way to diagnose Alzheimer's disease, but the illness may not be clearly identified if the autopsy is performed when someone dies during the early stages of the illness. An autopsy is rarely necessary, but may be done if the family wants to confirm that the person had Alzheimer's disease.

Early Detection

At this time, there is no routine screening for Alzheimer's disease. It is difficult to diagnose Alzheimer's disease in its early stages. This does not mean that you should ignore symptoms of mental decline (dementia) or assume that they are a normal part of aging. Talk to your doctor if you are concerned about memory loss or other symptoms of dementia, such as having difficulty finding your way around familiar places.

Treatment Overview

While there is not yet a cure for Alzheimer's disease, there is much that can be done to maintain quality of life and help the person stay active.

Initial treatment

Medicines called cholinesterase inhibitors may be started as soon as Alzheimer's disease is diagnosed. These medicines—which include donepezil hydrochloride (Aricept), galantamine (Razadyne), and rivastigmine (Exelon)—may temporarily help with memory and thinking problems caused by the disease. The effect of these medicines usually is not dramatic, and they may not work for everyone who has the disease. Even though cholinesterase inhibitors may slow the progression of symptoms, they do not prevent the disease from getting worse. But most experts agree that cholinesterase inhibitors are worth trying for most people who have Alzheimer's disease.

Another medicine, called memantine (Namenda), may be used alone or with cholinesterase inhibitors to treat moderate to severe symptoms of confusion and memory loss caused by Alzheimer's disease.

For more information on when or whether to take medicines, see:

Click here to view a Decision Point. Alzheimer's disease: Should I take medicines?

Another important aspect of initial treatment is detecting and treating any other medical problems the person may have. For instance, depression occurs in nearly half of people with Alzheimer's disease, especially those in the early stage of the disease who are aware of what the future holds for them. Detecting and treating problems such as depression can minimize disability and maximize the person's remaining abilities.

Newly diagnosed individuals and their families face important questions during initial treatment:

  • What kind of care does the person need right now?
  • Who will take care of the person in the future?
  • What can the family expect as the disease progresses?
  • What kind of planning needs to be done?

Education of the family and other caregivers is critical to successful care for a person with Alzheimer's. If you are or will be the caregiver, start learning what you can expect and what you can do to manage problems as they arise.

Ongoing treatment

If treatment with a cholinesterase inhibitor medicine seems to be helping the person with Alzheimer's disease, it can be continued until it is no longer helpful. The medicine may remain effective longer in some people than in others. Treatment may be stopped at any time if the person is unable to tolerate side effects from the medicine.

Regular assessment by a doctor helps evaluate the person's response to medicine, detect new problems, monitor changing symptoms, and provide continuing education to the family. Decisions about treatment for behavior problems or other issues often need to be revisited as the disease progresses. A general guideline is that a person with Alzheimer's should see the doctor every 6 months, or sooner if a problem arises.

It is important to continue watching for and treating other conditions. Hearing and vision loss, arthritis, thyroid problems, kidney problems, and other conditions are common in older adults and may aggravate symptoms of Alzheimer's. Arthritis may make it harder to move around without help. A hearing or vision problem may make the person more agitated, anxious, or unresponsive. Treating these problems can improve quality of life and ease the burden on the caregiver.

Most people with Alzheimer's disease can be cared for at home by family or friends, at least until the disease becomes severe. Ongoing treatment focuses on making the most of the person's abilities as they change and dealing with new problems as they arise. Caregiving tasks range from keeping the environment safe and helping the person get dressed every day to finding ways to manage or minimize disruptive behaviors such as wandering and sleep problems. No single strategy works for everyone. Successful care also depends on making sure the caregiver is involved in making decisions about treatment. These decisions will affect both the person with the disease and the caregivers.

If you are a caregiver for someone with Alzheimer's, finding help and support is crucial to the person with Alzheimer's and your own well-being. Take advantage of respite services, home care nurses or aides, or adult day care. Seek help from family and friends. And take care of yourself. All of this is key to providing ongoing care. Seek support as soon as you need it. Contact the Alzheimer's Association at 1-800-272-3900 or visit its Web site (www.alz.org) for help and advice on being a caregiver for someone with Alzheimer's disease.

Treatment when the condition gets worse

As Alzheimer's disease progresses, providing care at home usually becomes more and more challenging. Being a caregiver for someone with Alzheimer's is not easy, no matter how much you know about the disease and how committed you are to taking care of the person. The decision to place a family member in a nursing home or other facility can be a very difficult one, but sometimes nursing home placement is the best choice. For more information, see:

Click here to view a Decision Point. Alzheimer's disease: Should I move my relative into long-term care?

What To Think About

Palliative care

As Alzheimer's disease gets worse, you may want to think about palliative care. Palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. It is different from care to cure a disease, which is called curative treatment. Palliative care focuses on improving quality of life—not only in the body but also in the mind and spirit. Some people combine palliative care with curative care.

Palliative care may help with symptoms or side effects from treatment. It may also help your family make future plans for medical care. It could even help the person living with the disease or his or her caregivers understand Alzheimer's disease or better cope with feelings about living with the disease.

If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.

For more information, see the topic Palliative Care.

End-of-life care

Because Alzheimer's disease gets worse over time, people may want to think about discussing health care and other legal issues that may arise near the end of life. Many people find it helpful and comforting to state their health care choices in writing (with an advance directive or living will) while they are still able to make and communicate these decisions. Some people want every possible medical treatment to sustain life, while others prefer measures to maintain their comfort without prolonging life. It may be helpful to think about what kind of medical treatment you want. For more information, see the topic Care at the End of Life.

Prevention

At this time, there is no known way to prevent Alzheimer's disease.

Research has been done to link physical activity and the risk of Alzheimer's disease and other dementias. Adults who are physically active may be less likely to get Alzheimer's disease or dementia than adults who are not physically active.5 Moderate activity is safe for most people, but it's always a good idea to talk to your doctor before starting an exercise program.

There is also good evidence that older adults who stay mentally active may be at lower risk for developing Alzheimer's disease.6, 7 Regularly reading newspapers, books, and magazines, playing cards and other games, working crossword puzzles, going to museums, and doing other social activities, and even actively watching television or listening to the radio may help you avoid symptoms of Alzheimer's disease. Although this "use it or lose it" approach has not been proved, no harm can come from regularly putting your brain to work.

Research has also shown that people who eat more fruits and vegetables, high-fiber foods, fish, and omega-3 rich oils (sometimes known as the Mediterranean diet) and who eat less red meat and dairy may have some protection against dementia. But the reason for this is still being studied.8, 9

As we learn more about the causes of Alzheimer's disease, we also may learn more about how to prevent the disease. Drugs now in development to prevent the formation of neurofibrillary "tangles" or amyloid plaques that damage the nerve cells in the brain may someday be used in people who are at risk for Alzheimer's.

Research into a vaccine for Alzheimer's disease is ongoing.

Home Treatment

If you have just been diagnosed with early Alzheimer's disease, you may feel angry, frightened, depressed, anxious, and worried about the future. Although the disease does get worse over time, some people are able to continue their usual activities for many years, even if at a reduced level or in different ways.

Common issues faced by people in the early stages of Alzheimer's disease and by their families include:

  • Whether to continue driving. People in the very early stages of Alzheimer's disease can have their driving performance checked regularly to make sure they can drive safely. Family members can help find out about changes in the person's ability to drive by riding along when the person is driving. Talk to your loved one's doctor if you are concerned about his or her ability to drive safely.
  • What kind of legal and financial planning to do. Soon after the diagnosis of Alzheimer's disease, consider writing a living will and assigning a durable power of attorney for health care. These documents will ensure that your wishes for medical care are documented.

The following tips may be helpful in the early stages of dementia:

  • Tailor tasks to abilities. A task may take longer than it used to, but if you want to continue doing it, you should try. Make changes as needed. For example, if you no longer feel comfortable cooking, consider other tasks you are comfortable with, such as helping with shopping and meal planning or setting the table. Try making recipes that are easier.
  • Make your home safe. Tack down rugs, put nonslip tape in the tub or use handrails, and put safety switches on stoves and appliances if you have trouble remembering to turn them off. Think about the risk of injury as well as the benefits of independence from continuing to cook.
  • Make sure you eat a balanced diet. It's important to get plenty of whole grains, fruits, and vegetables every day. If you aren't hungry at mealtimes, plan snacks for midmorning and afternoon. Consider supplement drinks such as Boost, Ensure, or Sustacal if you are having trouble gaining weight.
  • Some people with dementia have trouble sleeping. If you do, avoid napping during the day, get regular exercise (but not within several hours of bedtime), and try drinking a glass of warm milk or caffeine-free herbal tea before going to bed.
  • Deal with depression. Many people with dementia have a problem with depression too. Talk with your family or friends about how you feel. And ask your doctor what you can do to help with depression. You may feel better if you spend more time with other people (for example, going to events at a senior center or volunteering). Or you may need to talk to a counselor or try medicines.
  • Schedule activities and tasks for times of day when you are best able to handle them. It may be helpful to develop a routine that doesn't vary much from day to day. You may feel less frustrated or confused with a clear, simple daily schedule.
  • Be creative in dealing with memory problems. Use labels, lists, sticky notes, and other helpful devices as reminders. Write daily activities on a calendar or daily planner, and keep it where you can refer to it often. Keep calendars and clocks in clear view.
  • Before you go out alone, write down the destination, how to get there, and how to get back home, even if you have gone there many times before. Take someone along with you when possible.
  • Remain active. Staying active and involved may slow the deterioration of mental abilities.
  • Plan for the future. You should review legal and financial documents while your judgment is clear and you can make decisions.

Information for caregivers

Most people who have Alzheimer's disease are cared for at home by family members and friends. Taking care of someone with Alzheimer's disease can be physically and emotionally draining, but there are ways to make it easier. One of the keys to successful home care is educating yourself. You can do a lot to make the most of the person's remaining abilities, manage the problems that develop, and improve the quality of his or her life as well as your own. Also remember that caregiving can be a positive experience for you and the person you are caring for.

If you are taking care of someone with Alzheimer's, one of the goals is to keep the person as healthy and safe as possible. A safe environment, good nutrition, regular sleep habits, good hygiene, and prompt care of other medical problems are important to the person's overall well-being.

  • Make your home safe by keeping rooms free from clutter, using locks on doors and cupboards, and installing handrails on the bathtub.
  • Maintain good nutrition by making meal time a positive experience. You may need to serve finger foods that are easily held by the person with Alzheimer's. Set aside enough time for the person to eat, and limit choices. Too many choices may be confusing to the person.
  • Manage sleep problems by discouraging napping during the day and offering warm milk before bedtime.
  • Manage bladder and bowel control problems (incontinence) by encouraging the person to regularly use the bathroom and restricting liquids before bedtime.

Dealing with behavior problems and failing mental abilities often is the biggest challenge for caregivers. Strategies for dealing with these problems may not eliminate all the problems, but may make the problems easier to deal with.

  • Make the most of remaining abilities. Let the person make decisions as long as he or she is able to.
  • Help the person be at ease in his or her surroundings. Put labels on items and surround the person with familiar objects such as photographs.
  • Understand behavior changes. Wandering or disruptive behaviors may occur. Try to remember the person's background and consider that the behaviors may be the person's way of trying to continue past activities or habits.
  • Manage agitation. Keep distractions to a minimum and keep your voice quiet.
  • Manage "sundowning." Sundowning is when symptoms of agitation and wandering become worse during the early evening hours. Try turning on lights as evening nears and give the person a single task to focus on.
  • Manage wandering. Get the person an ID bracelet in case he or she does wander away. Lock outside doors to make it more difficult for the person to get out of the house without your knowing it.
  • Consider the way you communicate. For example, don't argue with the person. Offer reassurance and try to focus the person's attention on something else. Use short, simple, familiar words and sentences.

It also is critical that you take good care of yourself. Finding and relying on sources of caregiver support can be extremely helpful. Try to find a support group in your area and an adult day care for some respite care. Remember to take care of your own health and not to shoulder all the responsibility of caring for your loved one who has Alzheimer's disease. Groups such as the Alzheimer's Association and the Dementia Advocacy and Support Network can provide not only educational materials but also information on support groups and services.

Nursing home placement

Taking care of a person with Alzheimer's disease at home is not always possible. Even when it is possible, it often becomes more difficult with time as the person develops new behaviors or medical problems that are hard to manage. The caregiver may develop medical problems of his or her own. Or the stress of caring for the person at home may become too overwhelming. There are many assisted living arrangements that you may consider, though many people with Alzheimer's will need full-time care at some point. Making the decision about nursing home placement is often very difficult because there are no guidelines that fit every situation. Every family has different needs, preferences, and situations to think about. For more information, see:

Click here to view a Decision Point. Alzheimer's disease: Should I move my relative into long-term care?

Medications

At this time, there are no medicines that can prevent or cure Alzheimer's disease or that will restore normal mental abilities. Medicine may help some people function better by temporarily reducing memory loss and thinking problems. Other medicines may be needed to treat associated conditions, such as depression.

Improving memory and daily functioning

Medicines include donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon). These medicines, called cholinesterase inhibitors, have been approved specifically for treatment of Alzheimer's disease. Research suggested that people with moderate to severe Alzheimer's disease who took cholinesterase inhibitors experienced improvement in thinking and daily functioning when they added memantine (Namenda) to their treatment.10

All these medicines may temporarily help improve memory and daily functioning in some people who have Alzheimer's disease. The improvement varies from person to person. These medicines do not prevent the disease from getting worse, although they may slow down mental decline.

The main decision about using medicines to treat failing mental function usually is not whether to try a medicine but when to begin and, later, when to stop treatment. Medicine treatment can be started as soon as Alzheimer's disease is diagnosed. But the person may or may not significantly improve when taking medicines because they do not work for everyone. If the medicines are effective, they are continued until the side effects outweigh the benefits or until the person no longer responds to the medicines. For more information, see:

Click here to view a Decision Point. Alzheimer's disease: Should I take medicines?

Treating behavior problems

Sometimes, medicine may be used to manage behaviors or symptoms that are causing strain for the person with Alzheimer's disease and his or her caregivers. Medicines generally are used only when other treatments have failed. For example, if the person still has trouble sleeping after trying regular exercise and avoiding naps, a medicine may be needed.

When it comes to disruptive behaviors, caregivers are encouraged to try to understand the reasons for the behaviors and to develop other ways to manage them whenever possible. Distracting the person, avoiding situations that seem to cause the behavior, and using good communication often can help limit these behaviors.

Although other approaches to managing behaviors should always be tried first, medicines such as tranquilizers may be needed if:

  • A behavior is severely disruptive or harmful to the person or to others.
  • Efforts to manage or reduce disruptive behavior by making changes in the person's environment or routines have failed.
  • The behavior is making the situation intolerable for the caregiver.
  • The person has trouble telling the difference between what is and is not real (psychosis) in addition to dementia. Psychosis causes the person to have false beliefs (delusions) and to hear or see things that are not there (hallucinations).

Treating depression

Depression occurs in close to half of people who have Alzheimer's disease. It is especially common during the early stages of the disease when a person may be aware of losing his or her ability to think and function independently. Antidepressants can relieve symptoms of depression and may improve quality of life, although they will not slow down the progression of Alzheimer's disease.

For more information , see the topic Depression.

Treating other causes of dementia

Conditions such as high blood pressure (which can lead to multi-infarct dementia), thyroid problems, or Parkinson's disease, also can contribute to dementia in an older person with Alzheimer's disease. Some of these conditions may respond well to treatment with medicines.

Medication Choices

Medicines used to treat symptoms of mental decline in people who have moderate Alzheimer's disease include cholinesterase inhibitors such as donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon).

Memantine (Namenda) is a medicine for treating severe symptoms of confusion and memory loss from Alzheimer's disease. It works differently than cholinesterase inhibitors. But, like cholinesterase inhibitors, it does not prevent Alzheimer's disease from progressing. This medicine may cause dizziness, confusion, headache, and/or constipation in some people.

Other medicines may be tried to treat anxiety, agitated or hostile behavior, sleep problems, frightening or disruptive false beliefs (delusions), suspicion of others (paranoia), or hallucinations (seeing or hearing things that aren't there).

What To Think About

Close monitoring and regular reevaluation of the person with Alzheimer's disease are very important during treatment with medicine. As the disease progresses and symptoms change, the person's medicine needs often change. If you are a caregiver for someone with Alzheimer's disease, be alert for adverse drug reactions or side effects that further impair the person's ability to function.

Before deciding to manage behavior problems with a medicine, try to figure out what is causing the behavior. Understanding why a person is behaving in a certain way can point to better ways of dealing with that behavior. If you are able to find other ways of dealing with behavior problems, you may be able to avoid treatment with medicine and the side effects and costs that come with it.

Doctors don't know for sure that cholinesterase inhibitors help with behavior problems in people who have Alzheimer's disease.11 Some studies show that these medicines do help, which can mean less burden on caregivers.12 If that burden is reduced, people who have Alzheimer's may be able to live at home longer.

Other studies show that cholinesterase inhibitors do not help with behavior.13, 14 But these medicines may still help some people with memory and daily functioning.

Rivastigmine (Exelon) can now be given through a skin patch. Skin patches release medicine into the blood at a steady level and may reduce side effects. And when the person uses a skin patch, it’s easier for caregivers to make sure a person is taking the medicine properly.

Some behaviors, such as agitation, wandering, and becoming restless and agitated in the early evening (called sundowning), do not always respond well to treatment with medicine. Figuring out what is causing the behavior and taking steps to manage or change it can sometimes be helpful. It may be worth trying this approach before resorting to medicine.

Development of new drugs

As research on the causes and progression of Alzheimer's disease continues, the search for effective medicines continues.

Researchers are studying many medicines, including those used for other conditions, as possible treatments for Alzheimer's disease. Some of the medicines may be available only to people who are enrolled in clinical trials. It may be some time before researchers know whether these medicines are effective in treating Alzheimer's disease. For more information on clinical trials, contact the Alzheimer's Disease Education and Referral Center (ADEAR) by calling 1-800-438-4380 or by going online at www.alzheimers.org.

Research into a vaccine for Alzheimer's disease is ongoing.

Surgery

There is no surgical treatment for Alzheimer's disease at this time.

Other Treatment

Treatment with the herbal supplement ginkgo biloba to improve mental functioning is considered experimental.

Other therapies, such as light therapy, aromatherapy, and exercise, may help reduce behaviors such as agitation but should only be done with supervision.

Other Treatment Choices

  • Ginkgo biloba. Many people take ginkgo biloba to improve or preserve memory. But studies have not shown that ginkgo biloba helps improve memory or prevent dementia.15 Ginkgo biloba is widely used in Europe to treat age-related dementia, including Alzheimer's disease.
  • Aromatherapy. One small study indicates that this therapy, when used as a lotion containing essential balm oil, may be safe and effective for reducing significant agitation in people with severe dementia.16 But more research is needed to prove its effectiveness.
  • Light therapy. This treatment is often used to relieve depression. It may help reduce depression, agitation, and sleeplessness associated with Alzheimer's disease. The person is exposed to either natural light or artificial light for several hours every morning or at night to reduce depression.
  • Exercise. Gentle exercise, such as walking or swimming, can also relieve symptoms of depression associated with Alzheimer's disease. Exercise is most effective when it is combined with teaching caregivers how to work through behavioral problems with the person who has Alzheimer's disease.

Another way a caregiver can try to reduce agitation is to play soothing music for the person who has Alzheimer's disease, during meals and when the caregiver is helping with bathing.

What To Think About

As with other new drugs in development, other treatments for Alzheimer's disease such as ginkgo biloba need further study. Their effectiveness and possible side effects are not yet fully known. Talk to your doctor before you decide to try any herbal therapies, supplements, or nonprescription treatments.

Other Places To Get Help

Organizations

Alzheimer's Association
225 North Michigan Avenue, Floor 17
Chicago, IL  60601-7633
Phone: 1-800-272-3900
Fax: 1-866-699-1246 toll-free
TDD: 1-866-403-3073 toll-free
E-mail: info@alz.org
Web Address: www.alz.org
 

The Alzheimer's Association is a national organization that provides educational materials, support groups, and community services for people dealing with Alzheimer's disease. It has more than 200 local chapters throughout the United States. The organization publishes a newsletter as well as a wide range of brochures and videos. The Web site includes a lot of useful information for people with Alzheimer's and other dementias, as well as for their caregivers.


Alzheimer's Disease Education and Referral (ADEAR) Center
P.O. Box 8250
Silver Spring, MD  20907
Phone: 1-800-438-4380
Fax: (301) 495-3334
Web Address: www.nia.nih.gov/alzheimers
 

Part of the National Institute on Aging, ADEAR is a government-funded agency that prepares computer searches on educational and library resources as well as information on clinical drug trials.


Alzinfo.org
Fisher Center for Alzheimer's Research Foundation
One Intrepid Square, West 46th Street & 12th Avenue
New York, NY  10036
Phone: 1-800-ALZ-INFO (1-800-259-4636)
E-mail: info@alzinfo.org
Web Address: www.alzinfo.org
 

Alzinfo.org was created by the Fisher Center for Alzheimer's Research Foundation to educate people about Alzheimer's disease. The mission of the Web site is to build an online community with 24-hours-a-day/7-days-a-week access to information and support via online chats, message boards, and resource databases.


Family Caregiver Alliance
180 Montgomery Street
Suite 1100
San Francisco, CA  94104
Phone: 1-800-445-8106
(415) 434-3388
E-mail: info@caregiver.org
Web Address: www.caregiver.org
 

This organization supports and assists people who are providing long-term care at home. It also provides education, research, services, and advocacy.


National Institutes of Health Senior Health
9000 Rockville Pike
Bethesda, MD  20892
Phone: (301) 496-4000
E-mail: custserv@nlm.nih.gov
Web Address: www.NIHSeniorHealth.gov
 

This Web site for older adults offers aging-related health information. The Web site's senior-friendly features include large print, simple navigation, and short, easy-to-read segments of information. A visitor to this Web site can click special buttons to hear the text aloud, make the text larger, or turn on higher contrast for easier viewing.

The site was developed by the National Institute on Aging (NIA) and the National Library of Medicine (NLM), both part of the National Institutes of Health (NIH). NIHSeniorHealth features up-to-date health information from NIH. Also, the American Geriatrics Society provides independent review of some of the material found on this Web site.


References

Citations

  1. Beers MH, et al., eds. (2004). Merck Manual of Health and Aging. Whitehouse Station, NJ: Merck Research Laboratories.
  2. Alzheimer's Association (2007). Symptoms of Alzheimer’s. Available online: http://www.alz.org/alzheimers_disease_symptoms_of_alzheimers.asp.
  3. Espeland MA, et al. (2004). Conjugated equine estrogens and global cognitive function in postmenopausal women: Women's Health Initiative memory study. JAMA, 291(24): 2959–2968.
  4. Shumaker SA, et al. (2004). Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women: Women's Health Initiative memory study. JAMA, 291(24): 2947–2958.
  5. Wang L, et al. (2006). Performance-based physical function and future dementia in older people. Archives of Internal Medicine, 166(10): 1115–1120.
  6. Wilson RS, et al. (2002). Participation in cognitively stimulating activities and risk of incident Alzheimer disease. JAMA, 287(6): 742–748.
  7. Wilson RS, et al. (2007). Relation of cognitive activity to risk of developing Alzheimer disease. Neurology, 69(20): 1911–1920.
  8. Barberger-Gateau P, et al. (2007). Dietary patterns and risk of dementia: The three-city cohort study. Neurology, 69(20): 1921–1930.
  9. Sofi F, et al. (2008). Adherence to Mediterranean diet and health status: Meta-analysis. BMJ. Published online September 11, 2008 (doi:10.1136/bmj.a1344).
  10. Tariot PN, et al. (2004). Memantine treatment in patients with moderate to severe Alzheimer's disease already receiving donepezil. JAMA, 291(3): 317–324.
  11. Sink KM, et al. (2005). Pharmacological treatment of neuropsychiatric symptoms of dementia: A review of the evidence. JAMA, 293(5): 596–608.
  12. Trinh NH, et al. (2003). Efficacy of cholinesterase inhibitors in the treatment of neuropsychiatric symptoms and functional impairment in Alzheimer disease: A meta-analysis. JAMA, 289(2): 210–216.
  13. Raina P, et al. (2008). Effectiveness of cholinesterase inhibitors and memantine for treating dementia: Evidence review for a clinical practice guideline. Annals of Internal Medicine, 148(5): 379–397.
  14. Howard RJ, et al. (2007). Donepezil for the treatment of agitation in Alzheimer's disease. New England Journal of Medicine, 357(14): 1382–1392.
  15. Birks J, Grimley Evans J (2009). Ginkgo biloba for cognitive impairment and dementia. Cochrane Database of Systematic Reviews (2).
  16. Ballard CG, et al. (2002). Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: The results of a double-blind placebo-controlled trial with Melissa. Journal of Clinical Psychiatry, 63(7): 553–558.

Other Works Consulted

  • California Workgroup on Guidelines for Alzheimer’s Disease Management (2008). Guideline for Alzheimer’s disease management. Chicago: Alzheimer’s Association. Available online: http://www.alz.org/californiasouthland/documents/professional_GuidelineFullReport.pdf.
  • Desai AK, Grossberg GT (2005). Diagnosis and treatment of Alzheimer's disease. Neurology, 64(Suppl 3): S34–S39.
  • National Center for Health Statistics (2008). Alzheimer's Disease. Available online: http://www.cdc.gov/nchs/fastats/alzheimr.htm.
  • Petersen RC, et al. (2001, reaffirmed 2003). Practice parameter: Early detection of dementia: Mild cognitive impairment (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 56(9): 1133–1142.
  • Small SA, Mayeux R (2005). Alzheimer disease and related dementias. In LP Rowland, ed., Merritt's Neurology, 11th ed., pp. 771–780. Philadelphia: Lippincott Williams and Wilkins.

Credits

Author Monica Rhodes
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Peter J. Whitehouse, MD - Neurology
Last Updated November 10, 2008

Last Updated: November 10, 2008

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