Topic Overview
Is this topic for you?
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?
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.
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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 symptoms down for a while
and make the disease easier to live with. Drugs that may be prescribed include donepezil (Aricept) and 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
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Learning about Alzheimer's disease:
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Being diagnosed:
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Getting treatment:
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Living with Alzheimer's disease:
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End-of-life decisions:
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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 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 that disrupts daily life, such as forgetting recently
learned information like names and phone numbers.
- Challenges in planning or solving problems.
- Difficulty
completing familiar tasks, such as cooking a meal.
- Confusion with time and place, such as forgetting
where you live on your street.
- Trouble understanding visual images and spatial relationships, such as problems reading or judging distance.
- New problems with words in speaking or writing, such as calling things by the wrong name or having trouble finding the right word.
- Misplacing things and being unable to go back over your steps to find them again, like putting an iron in the freezer
or a wristwatch in the sugar bowl.
- Poor or decreased judgment, such as
dressing improperly for the weather or giving away large sums of money to
strangers.
- Withdrawing from work or social activities, such as not wanting to keep up with a favorite sports team or favorite hobby.
- Changes in mood and personality,
such as rapid mood swings—from calm to tears to anger—for no apparent
reason.
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 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.
Some people have memory loss called mild cognitive impairment. People with this condition are at risk for developing dementia. But not all people with mild cognitive impairment progress to dementia.
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 try 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.
Also, the doctor will do a 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. Your doctor may also test for certain proteins in your spinal fluid to rule out other causes. Positron emission
tomography (PET) or single photon emission tomography (SPECT), two other
imaging tests, are not routinely done but may be useful in some
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:
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Complete blood count (CBC), which shows the kinds and number of cells in your blood to help
your doctor evaluate your symptoms.
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Liver function tests (AST, ALT, alkaline phosphatase, bilirubin), which detect liver
damage or disease.
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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.
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Vitamin B12 concentration, which detects the level of
vitamin B12 in your blood. Vitamin B12 is needed to produce red blood cells and
to keep a healthy nervous system.
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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.
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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.
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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 lumbar puncture to test for certain proteins in the spinal fluid may also be done to rule out other causes of symptoms.
- 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 needed, but one 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:
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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 not able 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 website (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:
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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.
Adults who are physically active may be less likely to get
Alzheimer's disease or dementia than adults who are not physically
active.3 Moderate activity is safe for most people,
but it's always a good idea to talk to your doctor before starting an exercise
program.
Older adults who stay
mentally active may be at lower risk for developing Alzheimer's
disease.4 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.
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.5, 6
As we
learn more about the causes of Alzheimer's disease, we also may learn more
about how to prevent the disease. Drugs now being developed to prevent damage the nerve
cells in the brain may someday be used in people who are at risk for
Alzheimer's.
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 you go 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 build 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.
-
Practice good nutrition by making meal
time a positive experience. You may need to serve finger foods that are easily
held by the person who has 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 harder 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
have or 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:
-
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.7
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 symptoms of 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:
-
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
who has Alzheimer's disease and/or for 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 find 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. Counseling, such as cognitive-behavioral therapy, is also used to treat depression.
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 who has 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 who has 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.8 Some studies
show that these medicines do help, which can mean less burden on
caregivers.9 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.10, 11 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 using
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.nia.nih.gov/alzheimers.
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.12 Ginkgo biloba is widely used in Europe to treat age-related dementia, including Alzheimer's disease.
-
Aromatherapy. Researchers are studying the use of aromatherapy oils, such as lavender, rosemary, and lemon, to reduce significant agitation in people who have dementia.13 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 |
| Email: |
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) |
| Email: |
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 |
| Email: |
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: |
1-800-222-2225 Aging Information Line
(301) 496-4000 |
| TDD: |
1-800-222-4225 |
| Email: |
custserv@nlm.nih.gov |
| Web Address: |
www.NIHSeniorHealth.gov |
| |
|
This website for older adults offers aging-related
health information. The website's senior-friendly features include large
print, simple navigation, and short, easy-to-read segments of information. A
visitor to this website 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 and the National
Library of Medicine, 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 website.
|
|
References
Citations
-
Beers MH, et al., eds. (2004). Merck Manual of Health and Aging. Whitehouse Station, NJ: Merck Research
Laboratories.
-
Alzheimer's Association (2010). 10 signs of Alzheimer’s. Available online: http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp.
-
Wang L, et al. (2006). Performance-based physical function and future dementia in older people. Archives of Internal Medicine, 166(10): 1115–1120.
-
Wilson RS, et al. (2007). Relation of cognitive
activity to risk of developing Alzheimer disease. Neurology, 69(20): 1911–1920.
-
Barberger-Gateau P, et al. (2007). Dietary patterns
and risk of dementia: The three-city cohort study. Neurology, 69(20): 1921–1930.
-
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).
-
Tariot PN, et al. (2004). Memantine treatment in
patients with moderate to severe Alzheimer's disease already receiving
donepezil. JAMA, 291(3): 317–324.
-
Sink KM, et al. (2005). Pharmacological treatment of
neuropsychiatric symptoms of dementia: A review of the evidence.
JAMA, 293(5): 596–608.
-
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.
-
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.
-
Howard RJ, et al. (2007). Donepezil for the treatment
of agitation in Alzheimer's disease. New England Journal of Medicine, 357(14): 1382–1392.
-
Birks J, Grimley Evans J (2009). Ginkgo biloba for
cognitive impairment and dementia. Cochrane Database of Systematic Reviews (1).
-
Nguyen QA, Paton C (2008). The use of aromatherapy to treat behavioural problems in dementia. International Journal of Geriatric Psychiatry, 23: 337–346.
Other Works Consulted
- American Psychiatric Association (2007). Practice Guideline for the Treatment of Patients With Alzheimer's Disease and Other Dementias. Arlington, VA: American Psychiatric Association. Available online: http://www.psychiatryonline.com/pracGuide/PracticePDFs/AlzPG101007.pdf.
- 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/national/documents/2008_Guidelines_Final_Report.pdf.
- Desai AK, Grossberg GT (2005). Diagnosis and treatment of Alzheimer's disease. Neurology, 64(Suppl 3): S34–S39.
- National Center for Health Statistics (2010).
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.
- Qaseem A, et al. (2008). Current pharmacologic treatment of dementia: A clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Annals of Internal Medicine, 148: 370–378.
- Small SA, Mayeux R (2010). Alzheimer disease. In LP Rowland, TA Pedley, eds., Merritt's Neurology, 12th ed., pp. 713–718. Philadelphia: Lippincott Williams and Wilkins.
Credits
|
By
|
Healthwise Staff |
|
Primary Medical Reviewer
|
Anne C. Poinier, MD - Internal Medicine |
|
Specialist Medical Reviewer
|
Peter J. Whitehouse, MD - Neurology |
|
Last Revised
|
November 9, 2010 |
Beers MH, et al., eds. (2004). Merck Manual of Health and Aging. Whitehouse Station, NJ: Merck Research
Laboratories.
Alzheimer's Association (2010). 10 signs of Alzheimer’s. Available online: http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp.
Wang L, et al. (2006). Performance-based physical function and future dementia in older people. Archives of Internal Medicine, 166(10): 1115–1120.
Wilson RS, et al. (2007). Relation of cognitive
activity to risk of developing Alzheimer disease. Neurology, 69(20): 1911–1920.
Barberger-Gateau P, et al. (2007). Dietary patterns
and risk of dementia: The three-city cohort study. Neurology, 69(20): 1921–1930.
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).
Tariot PN, et al. (2004). Memantine treatment in
patients with moderate to severe Alzheimer's disease already receiving
donepezil. JAMA, 291(3): 317–324.
Sink KM, et al. (2005). Pharmacological treatment of
neuropsychiatric symptoms of dementia: A review of the evidence.
JAMA, 293(5): 596–608.
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.
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.
Howard RJ, et al. (2007). Donepezil for the treatment
of agitation in Alzheimer's disease. New England Journal of Medicine, 357(14): 1382–1392.
Birks J, Grimley Evans J (2009). Ginkgo biloba for
cognitive impairment and dementia. Cochrane Database of Systematic Reviews (1).
Nguyen QA, Paton C (2008). The use of aromatherapy to treat behavioural problems in dementia. International Journal of Geriatric Psychiatry, 23: 337–346.