Alzheimer’s Disease

Dementia describes a wide range of symptoms associated with a decline in memory and cognitive skills. This decline may be severe enough to reduce a person's ability to perform activities of daily living, though the range of symptoms can vary greatly. At least two of the following areas of impairment must be present in order for a diagnosis of dementia to be considered: learning and memory, communication, language, focusing and paying attention, reasoning ability, judgment, social cognition, and visual perception. For example, a loved one might notice their family member struggling to articulate or find the right words; difficulty completing ordinary tasks such as balancing a checkbook or playing a game with many rules; difficulty following story lines; or struggling to adapt to change. While there is no one specific test to diagnose different types of dementias, it is important to consult with a doctor to determine symptomology. Generally, doctors utilize medical history, physical examinations, laboratory tests, family/caretaker reports, and observable changes in thinking and behavior. While individuals may be predisposed to dementia, there are certain risk factors and preventative measures one can take to manage symptoms and slow disease progression. Those include but not limited to maintaining a healthy diet and regular physical exercise, practicing good cardiovascular care (e.g., refraining from smoking, maintaining a healthy cholesterol level), and trying new and challenging activities such as learning an instrument, picking up knitting, or brain teasers.

What is Alzheimer's Disease?

Alzheimer's Disease is a progressive, degenerative disorder (i.e., a type of dementia) that occurs when brain cells die; it causes problems severe enough to affect work, life-long hobbies and eventually the ability to carry out even the simplest tasks. The brain cells (neurons) that are affected are the ones that produce the chemical neurotransmitter acetylcholine. When they can no longer produce it, they break connections with other nerve cells and ultimately cease to function, leading to one or more of the following symptoms:

  • Serious memory loss
  • Confusion
  • Problems with concentration
  • Restlessness
  • Personality changes, such as paranoia, social withdrawal, apathy, or a loss of interest in activities and people that were once meaningful (i.e., anhedonia)
  • Poor judgment
  • Language deterioration (i.e., aphasia), including difficulty understanding the meaning of words, finding the right words, inventing words, speaking at inappropriate times or about off-topic content
  • Inability to follow directions
  • Impaired thought processes involving visual and spatial awareness

Alzheimer's Disease is named for a German physician, Dr. Alois Alzheimer. In 1906, he presented a case history at a medical meeting involving a 51-year-old woman who suffered from a rare brain disorder. An autopsy of her brain helped identify the main characteristics of Alzheimer's: plaques, tangles and a loss of connections among nerve cells (neurons).

Alzheimer’s Disease is the most common form of dementia found among older people, accounting for 50% to 70% of all cases. Typically, Alzheimer’s Disease begins after 65 years of age. Dementia is the general term used to describe a loss of memory and cognitive functioning severe enough to interfere with daily life. According to the Alzheimer’s Association, as many as 5.3 million Americans are living with this disease.

Early-Onset

Early-Onset, or Familial, Alzheimer’s Disease refers to a rare form of the disease that occurs between 30 and 65 years old. Five to 10 percent of the people with Alzheimer’s Disease develop symptoms before 65 years. While it is very uncommon to develop the disease between ages 30 and 40, it occurs with greater frequency after the age of 50. This rare disorder tends to run in families and follows a genetic inheritance pattern. Misdiagnosis may be more likely in Early-Onset Alzheimer’s. Middle-age individuals with Alzheimer’s and their families face unique issues as they are often still employed and may have children living at home. Furthermore, the progression of this variation of Alzheimer’s Disease may follow a different pattern than the majority of AD cases. However, the diagnosis is made in a similar manner, and requires thorough evaluation by medical and mental health professionals. 

Changes in the Brain

Although what triggers the Alzheimer's disease process remains unknown, two abnormal structures found in the brain of its sufferers are the prime suspects in damaging nerve cells. The first are plaques, containing protein fragments and cellular material called beta-amyloid that build up between nerve cells. The second are tangles -- twisted fibers composed largely of a protein called tau -- that form inside dying nerve cells. Most scientists believe that somehow these plaques and tangles block communication among nerve cells; as more of these form in particular brain areas, healthy neurons begin to work less efficiently. They eventually lose the ability to function and communicate with each other, and then die.

Causes of Alzheimer’s Disease

While the causes of Alzheimer’s Disease are not fully understood, scientists know its development involves a complex series of events over a long period of time. Likely causes include age, genetic make-up, environmental factors and lifestyle.

Slowed thinking and occasional problems remembering are typical signs of aging, but serious memory loss, confusion and other changes in the way the mind functions are not normal. According to the Alzheimer’s Association, the following are warning signs or symptoms of this disease:

  • Memory changes that disrupt daily life
  • Challenges in planning or solving problems
  • Difficulty completing familiar tasks at home, at work or at leisure
  • Confusion with time or place
  • Trouble understanding visual images and spatial relationships
  • New problems with words in speaking or writing
  • Misplacing things and losing the ability to retrace steps
  • Decreased or poor judgment
  • Withdrawal from work or social activities
  • Changes in mood and personality (i.e., symptoms of depression, agitation)

Individuals may experience one or more of these in different degrees.

Other Types of Dementia

Although Alzheimer’s Disease is the most commonly diagnosed type of dementia, there are a variety of other disorders that also impact cognition in older adults. Below is some information about some of the different types:

  • Vascular Dementia
    • 2nd most common type of dementia
    • Typically associated with a history of vascular illness
    • Commonly seen along with Alzheimer’s Disease
    • Symptoms may include: hallucinations, gait problems, urinary incontinence, seizures
  • Dementia with Lewy Bodies
    • Accounts for about 15-20% of dementias
    • Symptoms may include: motor problems (i.e., Parkinsonism), visual hallucinations, depression, wandering
    • Better naming and verbal memory than Alzheimer’s Disease, but poorer executive functions and visuospatial skills
  • Frontotemporal Dementia
    • Tends not to have as many memory impairments as other dementias
    • Symptoms include: behavioral disinhibition, executive dysfunction, apathy, personality changes
  • Parkinson’s Disease
    • Parkinson’s Disease is a common, progressive illness that primarily affects bodily movements, affecting about 2% of the older adult population
    • Many people diagnosed with Parkinson’s Disease eventually show signs of a related dementia
    • Typically presents with memory and attention difficulties, depression, irritability, and sleep problems
    • May be attributable to the same underlying mechanisms as Dementia with Lewy Bodies
  • Huntington’s Disease
    • Huntington’s is a progressive genetic brain disease, primarily affecting mood, movement, and cognition
    • Symptoms may include anxiety, depression, insomnia, irritability, and obsessive-compulsive behaviors, short-term memory and planning deficits

Diagnosis and Treatment

Since there is as yet no single diagnostic test for Alzheimer’s, the only way to definitively diagnose this disease is through autopsy. However, doctors have several methods and tools available which enable them to make a diagnosis with about 90% accuracy. It is important for older adults suspected of having dementia to see their primary care doctor as soon as possible for an evaluation. Doctors can:

  • Complete a medical history along with neurological, motor and sensory exams;
  • Conduct tests of memory, problem solving, attention, counting, and language;
  • Ask questions about a person’s ability to carry out daily activities;
  • Carry out medical tests of blood, urine and spinal fluid;
  • Perform brains scans, CAT scans or MRI tests.

There is no known cure for Alzheimer's disease or other types of dementia. Current treatment focuses on helping people maintain mental function and manage behavioral symptoms. The Food and Drug Administration (FDA) has approved medications, known as cholinesterase inhibitors, for Alzheimer's disease patients. These drugs inhibit the enzyme that breaks down acetylcholine, and may help slow the worsening of symptoms. However, they do not impact the underlying disease process and may provide help for only a few months to a few years.

Help for Caregivers

Caring for a person with Alzheimer’s can be physically and emotionally demanding. Support, education and guidance for the caregiver(s) are essential. It is important for caregivers to take care of themselves while they are caring for their loved ones with dementia. Some of the ways to do this might be seeking support from their friends or loved ones, making sure they are eating and practicing good sleep hygiene, continuing to engage in activities they enjoy, and practicing stress management such as deep breathing, exercising, or yoga.

Resource Organizations » Alzheimer's Disease and Dementia

In Massachusetts

Organizations with hotlines

Alzheimer's Association, Massachusetts/ New Hampshire

24-hour Helpline: 800-272-3900

Massachusetts Chapter Office Number: 617-868-6718

New Hampshire Chapter Office Number: 603-606-6590

The Alzheimer's Association's mission is to eliminate Alzheimer's disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. It is the largest private investor in innovative research related to Alzheimer's and related disorders. The Alzheimer's Association has a highly regarded scientific program. The Massachusetts/ New Hampshire chapter has published an online guide to participating in research trials. This is also available in hard copy by calling the Helpline. In addition, the Alzheimer's Association in Massachusetts/ New Hampshire has five offices: Watertown, Raynham, Springfield and Worcester, MA and Bedford, NH.

 

Organizations without hotlines

Elder Community Care

508-573-7250

"Elder Community Care is a network of agencies working together to serve elders in their own homes. The organization provides comprehensive assessment and counseling services to elders and their families in Metrowest. It also provides comprehensive assessment, counseling and referral services." 

Springwell, Inc.

617-926-4100

Email: inforef@springwell.com

Springwell is a private, non-profit agency that has been creating, managing, and coordinating services for seniors, individuals with disabilities and those who help care for them for more than 30 years. Along the way, the organization has amassed a wealth of knowledge and insight about the many public and private resources available. It serves all elders, individuals with disabilities and their families regardless of financial situation or level of need. It's reputation for excellence is why more than 10,000 families turn to it each year for support.

Outside Massachusetts

Alzheimer's Association

312-335-8700

Email: info@alz.org

The Alzheimer's Association's mission is to eliminate Alzheimer's disease through the advancement of research and to enhance quality care and support for individuals, their families and care partners.

Find your local community: http://www.alz.org/apps/findus.asp

Alzheimer's Disease Education and Referral Center (ADEAR)

800-438-4380

Email: adear@nia.nih.gov

As a public, U.S. Government-funded resource, the ADEAR Center strives to be a current, comprehensive, unbiased source of information about Alzheimer's disease and related dementias.

Alzheimer's Foundation of America

866-232-8484 (Toll-Free Helpline)

1-646-638-1542

This site includes information about Alzheimer's disease and related illnesses, care giving strategies and behavioral issues, as well as daily news about Alzheimer's disease, and links to AFA member organizations and AFA divisions. It also maintains a nationwide toll-free hotline (866.AFA.8484). AFA's hotline provides information, counseling by licensed social workers and referrals to resources across the nation, including community organizations that offer hands-on support services.

Dementia Friendly America

Email: info@dfamerica.org

Through the work of over 35 national, leading organizations, the Dementia Friendly America initiative is catalyzing a movement to more effectively support and serve those across America who are living with dementia and their family and friend care partners.

Department of Health & Human Services

This is a free informational website provided by the U.S. Department of Health & Human Services. The site includes information on Alzheimer’s disease, possible treatment options, caring for someone with Alzheimer’s, and insurance and payment information on the cost of treatment and care.

Family Caregiver Alliance

(800) 445-8106

Family Caregiver Alliance is first and foremost a public voice for caregivers. Founded in the late 1970s, they were the first community-based nonprofit organization in the country to address the needs of families and friends providing long-term care for loved ones at home. Their services, education programs, and publications are developed with caregivers’ expressed needs in mind, to offer real support, essential information, and tools to manage the complex and demanding tasks of caregiving.

Geriatric Mental Health Foundation

(703) 556-9222

Email: web@GMHFonline.org

The Geriatric Mental Health Foundation was established by the American Association for Geriatric Psychiatry to raise awareness of psychiatric and mental health disorders affecting the elderly, eliminate the stigma of mental illness and treatment, promote healthy aging strategies, and increase access to quality mental health care for the elderly. Explore the site for mental health information for older adults and their families, to find a geriatric psychiatrist, for news of Foundation programs and events, and much more.

Latino Alzheimer's & Memory Disorders Alliance

(708) 395-5472

Email: info@latinoalzheimersalliance.org

The Latino Alzheimer's & Memory Disorders Alliance empowers Hispanic and Latino caregivers and families of those afflicted with Alzheimer's disease and memory disorders by providing education, skill building training and support programs.  It also provides training programs to healthcare providers who work with the Hispanic and Latino communities.