The most common form of dementia—a decrease in intellectual abilities such as memory, language, and judgment—is Alzheimer’s disease, which accounts for about 60 to 70% of dementia cases. About 4.5 million Americans have this disorder.
Usually, the first symptoms of Alzheimer’s disease involve a loss in the ability to process episodic, semantic, and working memory. This amnesia occurs as a result of the declining amounts of acetylcholine in the brain involved with learning and memory. Other symptoms involve forms of aphasia.
In the early stages, patients have trouble making lists and finding words. During the late stages of Alzheimer’s, patients become mute. Patients may have trouble cooking, remembering things around the house and how to drive. A person with Alzheimer’s lives an average of 8 years after diagnosis and can live as many as 20 years after.
Alzheimer’s disease is classified as a cortical dementia (which affect the cerebral cortex, responsible for cognitive abilities such as language and memory). Types of cortical dementias include Alzheimer’s, atherosclerotic dementia and Creutzfeldt-Jakob disease.
There are three known types of Alzheimer’s disease:
– Early-onset Alzheimer’s. This is a rare form of Alzheimer’s disease in which people are diagnosed with the disease before age 65. Fewer than 10% of all Alzheimer’s disease patients have this type.
– Late-onset Alzheimer’s. The most common form of Alzheimer’s disease, accounting for about 90% of cases and usually occurring after age 65.
– Familial Alzheimer’s disease (FAD). A form of Alzheimer’s disease that is known to be entirely inherited. In affected families, members of at least two generations have had Alzheimer’s disease. FAD is extremely rare, accounting for less than 1% of all cases of Alzheimer’s disease.
You should be aware of the seven warning signs that may help you identify Alzheimer’s disease. If someone has several or even most of these symptoms, it does not mean they definitely have the disease. It does mean they should be thoroughly examined by a medical specialist trained in evaluating memory disorders, such as a neurologist or a psychiatrist, or by a comprehensive memory disorder clinic, with an entire team of expert knowledge about memory problems.
The seven warning signs of Alzheimer’s disease are:
– Asking the same question over and over again.
– Repeating the same story, word for word, again and again.
– Forgetting how to cook, or how to make repairs, or how to play cards—activities that were previously done with ease and regularity.
– Losing one’s ability to pay bills or balance one’s checkbook.
– Getting lost in familiar surroundings, or misplacing household objects.
– Neglecting to bathe, or wearing the same clothes over and over again, while insisting that they have taken a bath or that their clothes are still clean.
– Relying on someone else, such as a spouse, to make decisions or answer questions they previously would have handled themselves.
Coping with the disease is often a scary and difficult prospect. Here are some suggestions on how best to cope in those initial days after diagnosis, whether for yourself or a loved one.¦lt;br /> Go easy on yourself. A scary diagnosis is a personal crisis and should be treated as one. You needn’t act as though nothing in your life has changed.
Know that you won’t always feel this way. Many people describe feeling shock and numbness upon learning they have a serious health problem. That’s normal and, believe it or not, the intensity of these initial feelings doesn’t last forever.
Expect to absorb only some of what you’re told. As soon as you hear a doctor tell you that you have a serious illness, chances are you’ll absorb very little else of that conversation. That’s completely normal.
Be patient when learning information about your disease. When a serious illness is first diagnosed, it’s not always possible to pinpoint its scope. Often, additional tests or even surgery is required to fully understand the extent of an illness and related health problems.
Choose the support that works for you. How you come to terms with a scary diagnosis is a very personal decision. Choosing whom to tell and lean on for support is a significant part of the process, and there’s no right or wrong way to do it.
– Numerous medications are intended to reduce the symptoms of Alzheimer’s, by helping to slow memory loss, control behavior problems, or improve sleep. It is important to work with physicians who have considerable knowledge and experience in using these medications.
– In a process called oxidant stress, cells produce free radicals, highly reactive molecules that can overwhelm and damage normal cells. Vitamin E and other antioxidants have been studied in patients who have Alzheimer’s disease. The use of Vitamin E is controversial. A physician will determine if Vitamin E is appropriate.
– Cholinesterase Inhibitors In the brains of people with Alzheimer’s, there is a dramatic drop in the level of the chemical acetylcholine, which transmits messages in the brain. This chemical is important for attention and memory. The enzyme acetylcholinesterase rapidly breaks down acetylcholine. The enzyme can be blocked with cholinesterase inhibitors, which may help improve cognitive and neuropsychiatric symptoms and might affect the long-term course of the disease.
– Memantine: Glutamate is a chemical in the brain that acts on receptors known as NMDA receptors. There is evidence that overstimulation of these receptors may be bad for brain cells. The medication memantine, which blocks NMDA receptors, has recently been approved by the U.S. Food and Drug Administration for treatment of patients with moderate to severe Alzheimer’s disease. A physician will determine if memantine is appropriate.
– Antipsychotics or Neuroleptics These drugs can help control behaviors caused by Alzheimer’s, such as agitation, anger, hallucinations and delusions (seeing and hearing nonexistent things), and insomnia (inability to sleep). Many of these drugs have significant side effects.
– Antidepressants and Anxiolytics Some medications help treat depression and anxiety in patients with Alzheimer’s. Because some drugs may increase anxiety or agitation, patients should be closely monitored. The drugs may also cause insomnia, tremors, nausea and other side effects.
– Sleeping Medications As Alzheimer’s progresses, a common behavior is to become increasingly agitated, confused and restless toward the end of the day, which is often called “sundowning.” Patients with Alzheimer’s disease may also wake or even wander at night. If the problem can’t be managed through adjusting living environments, patients may benefit from sleep medications. Antianxiety medications may also help reduce these symptoms.
– Genetic Testing If one person has early-onset Alzheimer’s and a blood-related relative shows signs or symptoms of dementia, it may be useful for the relative to have genetic testing to make an accurate diagnosis. Genetic testing should be discussed with the physician.
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Eric R. Braverman, M.D.
Dr. Braverman is a Summa Cum Laude and Phi Beta Kappa graduate of Brandeis University and NYU Medical School, did brain research at Harvard Medical School, and trained at an affiliate of Yale Medical School. He is acknowledged worldwide as an expert in brain-based diagnosis and treatment, and he lectures to and trains doctors in anti-aging medicine.