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What is Alzheimer's disease?

Eric Pfeiffer, MD, Director, University of South Florida Suncoast Alzheimer's and Gerontology Center.

Alzheimer's disease was named after Dr. Alois Alzheimer, who in 1906, provided the first descriptions of an affected brain. Alzheimer's is a progressive neurological condition that attacks the brain. It results in cognitive problems, such as memory loss, impaired thinking and learning. It is the most common form of dementia.

A brain scarred by Alzheimer's has abnormal plaque deposits and tangles. The plaques and tangles prevent certain electrochemical signals the brain routinely uses to process new information and to retrieve memories. The plaques may also trigger an inflammatory response in the brain, and may even affect the brain's blood supply.

Alzheimer's disease pathology and, in some cases, even cognitive deficits can be detected years, and possibly decades, before clinical symptoms are apparent. The early stage is known as “mild cognitive impairment” or MCI. Early diagnosis and treatment can help people delay symptoms and enjoy a higher quality of life. Alzheimer's disease is NOT a normal part of aging.

What is dementia?

Dementia is the overall term that refers to a group of symptoms characterized by loss of memory, disorientation, problems with reasoning and the decline of thinking and language skills. There are many causes of dementia but Alzheimer's disease is the most common.

Who gets Alzheimer's disease?

According to the Alzheimer's Association, one in 10 individuals over 65 and nearly half of those over 85 are affected. An estimated 4.5 million Americans have Alzheimer's disease. The number of Americans with Alzheimer's has more than doubled since 1980. The number of Americans with Alzheimer's disease will continue to grow – by 2050 the number of individuals with Alzheimer's could range from 11.3 million to 16 million.

What are the warning signs of Alzheimer's disease?

The following is a list of early warning signs of Alzheimer's disease. However, if someone has several of these symptoms, it does not mean they definitely have the disease. It does mean they should be evaluated by a medical specialist trained in memory disorders.

The seven warning signs 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 ones 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 somebody else, such as a spouse, to make decisions or answer questions they previously would have handled themselves

What is mild cognitive impairment (MCI)?

Mild Cognitive Impairment is a condition characterized by forgetfulness that has been getting more serious. Occasionally misplacing one's car keys or forgetting an acquaintance's name is normal as we age. Missing appointments or a worsening of forgetfulness, however, is cause for concern. The person with Mild Cognitive Impairment has mild memory loss and memory complaints that are abnormal for his/her age and educational background, but he/she is not impaired in performance of activities of daily living or in general cognitive functioning. Early detection and treatment may delay or stop the worsening of this condition.

Is Alzheimer's inherited?

The genetic form of Alzheimer's disease is found in less than 5% of AD patients and usually affects people younger than 50. This is referred to as “early onset”. The vast majority of Alzheimer's disease cases occur at advanced ages, and while there may be some increased risk in first-degree relatives, it is not considered to be primarily genetically inherited.  There are many factors that may affect its development.

Is Alzheimer's disease a mental illness?

Although Alzheimer's affects the brain, it is not a mental illness nor it is a normal part of aging.. However, depression is a common mental illness and can cause Alzheimer's like symptoms. Depression is a treatable disease and it therefore critical that the person be properly evaluated to rule out depression.

What can I do to prevent Alzheimer's disease?

There is no way to guarantee that you or your loved one will not get Alzheimer's. However, many of the things that are good for your heart are also good for your brain. Quit smoking, get regular exercise, and eat foods such as fruits, vegetables, and fish. Avoid foods high in saturated fat or cholesterol. Other helpful lifestyle changes include keeping mentally active, staying socially involved with others, reducing stress, and wearing seatbelts and bicycle/motorcycle helmets.

Assessment and diagnosis

It is a commonly held misconception that the diagnosis of Alzheimer's disease can only be made through autopsy. A well-trained clinician can diagnose Alzheimer's disease with about a 95% rate of accuracy. You want to make sure the physician has knowledge and experience in differential diagnosis of Alzheimer's disease.

There is no single test that will diagnose Alzheimer's disease. It is mostly a process to rule out other causes of dementia. When an individual begins to experience significant memory problems, begin with a complete physical exam, including at the very least, laboratory tests for complete blood count, urinalysis, thyroid and liver function tests, electrolytes, B12, RPR, folate levels, and blood glucose. A medical history and a social history are required to establish progressive intellectual deterioration and identify personality changes, problems with memory, and difficulty with daily activities. Mental status tests which evaluate orientation, attention, memory, judgment, thought processes, and mood are done to rule out emotional, intellectual, and psychiatric impairment as well as establish a baseline. A computerized topography scanning (CT scan), or a magnetic resonance imaging (MRI) should be done to rule out brain tumors, strokes, and other brain diseases. Many times, atrophy of the hippocampal complexes in the mesial temporal lobes can be seen in Alzheimer's, though it is not officially diagnostic of the disease. PET scans can also be helpful, though they are expensive and generally reserved for times of diagnostic uncertainty.

Current treatments available

Though there is still no cure, there is much that can be done to slow or delay the memory loss and other symptoms associated with the disease. There are four drugs currently approved by the FDA for the treatment of Alzheimer's disease. Aricept™, Exelon™, and Razadyne™ are all similarly-acting cholinesterase inhibitors approved by the FDA for the treatment of Alzheimer's disease. A fourth approved medication, Namenda™, an NMDA receptor antagonist, can be used by itself or in combination with any of the other three. There are many different antipsychotic, mood stabilizers and antidepressant medications available to alleviate the many mood and behavioral symptoms that sometimes accompany the disease, though they are not specifically FDA approved for that purpose.

Much research is being done to find even better treatments for Alzheimer's. Some areas of research for new treatments include drugs that prevent the formation of amyloid plaques in the brain, drugs that make nerve cells re-grow, and immunization against part or all of the toxic amyloid protein.

More Information on Alzheimers such as Identifying Alzheimers Symptoms Early and more, click here.

More information for health professionals is available at the Alzheimer's Association's website