Alzheimer's Disease Contributions by FoundHealth

Alzheimer's disease is the most common cause of severe mental deterioration (dementia) in the elderly. It has been estimated that 30% to 50% of people over 85 years old suffer from this condition. The cause of Alzheimer's is largely not known but many theories have been and continue to be investigated.

Alzheimer’s disease is a chronic, slowly progressive, gradual in onset, irreversible condition that destroys brain nerve cells and other structures in the central nervous system. People with Alzheimer’s disease slowly develop dementia —a loss of memory and intellectual and social skills that result in confusion, disorientation, and the inability to think, reason, and understand. The decline in cognition and memory results in activities of daily living to performed with increasing difficulty.

People with Alzheimer’s disease (and other dementias) can have symptoms that change significantly from day to day, usually getting worse but occasionally seeming to get better. However, people with Alzheimer’s disease do get worse over time, especially regarding memory loss (which is the most common initial symptom).

Common symptoms of Alzheimer's disease include:

• Difficulty with short term memory (often with maintenance of long term memories)
• Forgetting recent events and conversations
• Impaired orientation
• Misplacing items
• Poor judgment and insight
• Loss of interest in hobbies
• Difficulty with cooking, dressing, shopping, finances
• Changes in behavior and mood
• Depression
• Anxiety
• Irritability

Scientists know that Alzheimer’s disease is caused by damage to brain nerve cells, as well as a loss of certain chemicals that facilitate communication between nerve cells. What is still not clearly understood is why this damage occurs.

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Areas of the Brain Affected by Alzheimer's Disease

Brain autopsies of Alzheimer's patients show two characteristic brain abnormalities:

• Neurofibrillary tangles (twisted nerve cell fibers)—These are found inside nerve cells in the hippocampus and temporal and frontal lobes of the brain. A type of protein called tau is found within these tangles.

• Neuritic plaques—Located outside the nerve cells, the plaques are surrounded by dying neurons (nerve cells) and contain a sticky protein called beta amyloid. It is believed that beta amyloid may cause narrowing of blood vessels in the brain, which in turn plays a role in killing nerve cells. The presence of the plaque seems to be linked to reduction of an important chemical called acetylcholine. Acetylcholine helps neurons relay messages in the brain and is essential for memory and learning.

It has been estimated that over 4 million Americans have Alzheimer’s disease and the total healthcare costs are estimated to be over $100 billion in the US alone. The number of patients with Alzheimer’s disease is expected to triple during the next 20 years as the baby boomer generation ages with an associated rise in the economic burden. In most cases, Alzheimer’s disease develops in people over the age of 65. Although, there is a rare, early-onset form of the disease that may strike people as young as 30. Nearly all people who have Down syndrome develop Alzheimer's disease if they live into their forties.

[What are the risk factors for Alzheimer’s disease?

What are the symptoms of Alzheimer’s disease?

How is Alzheimer’s disease diagnosed?

What are the treatments for Alzheimer’s disease?

Are there screening tests for Alzheimer’s disease?

How can I reduce my risk of Alzheimer’s disease?

[What questions should I ask my doctor?

Where can I get more information about Alzheimer’s disease?][15]

Alzheimer's Disease and Lyme Disease

Also, there seems to exist a correlation between Lyme disease and Alzheimer's disease, possibly suggesting that the infectious agent responsible for an initial Lyme disease infection could later be implicated as a cause of Alzheimer's disease. (This is speculated after autopsy of some Alzheimer's patients showed a presence of Lyme spirochetes in the brain.)¹

References:

Alzheimer’s Association website. Available at: http://www.alz.org/ .

References:

Alzheimer’s Association website. Available at: http://www.alz.org/ .

Carrillo MC, Blackwell A, Hampel H, et al. Early risk assessment for Alzheimer's disease. Alzheimers Disease. 2009;5(2):182-196.

National Institute on Aging. National Institutes of Health website. Available at: http://www.nia.nih.gov/ .

Rolland Y, Abellan van Kan G, Vellas B. Healthy brain aging: role of exercise and physical activity. Clin Geriatr Med. 2010;26(1):75-87.

9/18/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Anstey KJ, Mack HA, Cherbuin N. Alcohol consumption as a risk factor for dementia and cognitive decline: meta-analysis of prospective studies. Am J Geriatr Psychiatry. 2009;17:542-555.

8/23/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Ritchie K, Carrière I, Ritchie CW, Berr C, Artero S, Ancelin ML. Designing prevention programmes to reduce incidence of dementia: prospective cohort study of modifiable risk factors. BMJ.2010;341:c3885.

Because the causes are unknown, there are currently no guidelines for reducing your risk of Alzheimer’s disease . Scientists are studying medicines and lifestyle factors (eg, diet, mental activity, exercise, stress reduction) that may help ward off the condition. Control of high blood pressure, high cholesterol, and diabetes may also help to reduce your risk. Other studies have found that drinking alcohol in moderation (one drink per day for women, two drinks per day for men) may be beneficial, as well. In addition, some researchers have argued that long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) can lower the risk.

Earlier studies indicated that hormone replacement therapy (HRT) in women decreased the risk of developing Alzheimer’s disease. However, recent studies showed that HRT may actually increase the risk of Alzheimer’s disease in postmenopausal women. As our understanding of Alzheimer’s disease grows, your doctor may have more information regarding steps for reducing your risk as you age.

There is some evidence that exercise may decrease the risk of dementia.

Alzheimer’s Disease Education and Referral Service (ADEAR)

Address:

PO Box 8250
Silver Spring, MD 20907-8250

Phone:

1-800-438-4380

Internet address:

http://www.nia.nih.gov/alzheimers/

Description of services provided:

This site is part of the National Institute on Aging. It provides information and referral service, news and research information, publications, multimedia, and links to other resources.

Alzheimer’s Association

Address:

Alzheimer’s Association
225 N Michigan Ave, Fl 17
Chicago, IL 60601-7633

Phone:

1-800-272-3900
1-312-335-8700

Internet address:

http://www.alz.org/

Description of services provided:

This association is a network of national chapters. The organization funds Alzheimer’s research and provides research, educational, and support information to patients, family, caregivers, and professionals.

Alzheimer's Foundation of America

Address:

Alzheimer’s Foundation of America
322 8th Avenue, 7th Floor
New York, NY 10001

Phone:

1-866-232-8484

Internet address:

http://www.alzfdn.org/

Description of services provided:

This website provides information about services for those with dementia, as well as information for their caregivers and families.

National Institute of Neurological Disorders and Stroke (NINDS)

Address:

NIH Neurological Institute
PO Box 5801
Bethesda, MD 20824

Phone:

1-800-352-9424

Internet address:

http://www.ninds.nih.gov/index.htm/

Description of services provided:

NINDS provides educational, news, and research information for consumers and health professionals on various neurological conditions, including Alzheimer’s disease.

The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without any current symptoms, but who may be at high risk for certain diseases or conditions.

Screening Tests or Guidelines

There are several tests that doctors may use to screen for Alzheimer's disease . Examples include:

• Neurological exam—This exam tests the nervous system (brain, spinal cord, nerves, and muscles) for evidence of other neurological disorders.
• Wechsler's Logical Memory and Visual Reproduction and Kendrick Object Learning Test—These test may be used if you have depressive symptoms.
• Seven-Minute Screen
• Mini-Mental State Exam
• Memory Impairment Screening
• Self-assessment cognitive test—This is a test that you take on your own to assess your memory.

Genetic testing is available, but it is not routinely used in most patients. Researchers are also studying whether imaging tests would be helpful in screening for Alzheimer's disease.

You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with Alzheimer’s disease. By talking openly and regularly with your doctor, you can take an active role in your care.

General Tips for Gathering Information

Here are some tips that will make it easier for you to talk to your doctor:

• Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.
• Write out your questions ahead of time, so you don't forget them.
• Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.
• Don't be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.

Specific Questions to Ask Your Doctor

About Your Risk of Developing Alzheimer’s Disease

• Based on my medical history, lifestyle, and family background, am I at risk for Alzheimer’s disease?

• What are the first signs and symptoms of Alzheimer’s disease?

About a Diagnosis of Alzheimer’s Disease

• What does the diagnosis mean?

• Are additional tests needed?

• How certain is this diagnosis?

About Treatment Options

• What can be done to alleviate symptoms?

• Which medications are best for my condition?

• What does this medication do? Does it alleviate symptoms, slow progression of the disease, etc?
• What benefits/side effects will I experience with this medication?
• Will this medication interact with other medications, over-the-counter products, or dietary or herbal supplements I am already taking for other conditions?
• Are there any clinical trials that I might be able to participate in?

• Are there any complementary or alternative therapies that may help me?

About Lifestyle Changes

• What plans should my family and I be making right now regarding:

• Provisions for future healthcare
• Finances
• Legal issues
• Living situation

• How long will I safely be able to drive, work, or live alone?

About Your Outlook

• What changes in mental capacity can be expected over time?

• What changes in behavior and functioning should my family and I expect over time?

• How long will it be before family and friends can no longer provide the necessary care?

• Are there any resources available for my family and friends here at this institution?

References:

1. Buhner, S.H. Healing Lyme: Natural Healing and Prevention of Lyme /borreliosis and Its Coinfections. Silver City, NM Raven Press. 2005 p.46

Alzheimer’s Association website. Available at: http://www.alz.org/ .

Alzheimer's disease is the most common cause of severe mental deterioration (dementia) in the elderly. It has been estimated that 30% to 50% of people over 85 years old suffer from this condition. The cause of Alzheimer's is largely not known but many theories have been and continue to be investigated.

Alzheimer’s disease is a chronic, slowly progressive, gradual in onset, irreversible condition that destroys brain nerve cells and other structures in the central nervous system. People with Alzheimer’s disease slowly develop dementia —a loss of memory and intellectual and social skills that result in confusion, disorientation, and the inability to think, reason, and understand. The decline in cognition and memory results in activities of daily living to performed with increasing difficulty.

People with Alzheimer’s disease (and other dementias) can have symptoms that change significantly from day to day, usually getting worse but occasionally seeming to get better. However, people with Alzheimer’s disease do get worse over time, especially regarding memory loss (which is the most common initial symptom).

Common symptoms of Alzheimer's disease include:

• Difficulty with short term memory (often with maintenance of long term memories)
• Forgetting recent events and conversations
• Impaired orientation
• Misplacing items
• Poor judgment and insight
• Loss of interest in hobbies
• Difficulty with cooking, dressing, shopping, finances
• Changes in behavior and mood
• Depression
• Anxiety
• Irritability

Scientists know that Alzheimer’s disease is caused by damage to brain nerve cells, as well as a loss of certain chemicals that facilitate communication between nerve cells. What is still not clearly understood is why this damage occurs.

Areas of the Brain Affected by Alzheimer's Disease

Brain autopsies of Alzheimer's patients show two characteristic brain abnormalities:

• Neurofibrillary tangles (twisted nerve cell fibers)—These are found inside nerve cells in the hippocampus and temporal and frontal lobes of the brain. A type of protein called tau is found within these tangles.

• Neuritic plaques—Located outside the nerve cells, the plaques are surrounded by dying neurons (nerve cells) and contain a sticky protein called beta amyloid. It is believed that beta amyloid may cause narrowing of blood vessels in the brain, which in turn plays a role in killing nerve cells. The presence of the plaque seems to be linked to reduction of an important chemical called acetylcholine. Acetylcholine helps neurons relay messages in the brain and is essential for memory and learning.

It has been estimated that over 4 million Americans have Alzheimer’s disease and the total healthcare costs are estimated to be over $100 billion in the US alone. The number of patients with Alzheimer’s disease is expected to triple during the next 20 years as the baby boomer generation ages with an associated rise in the economic burden. In most cases, Alzheimer’s disease develops in people over the age of 65. Although, there is a rare, early-onset form of the disease that may strike people as young as 30. Nearly all people who have Down syndrome develop Alzheimer's disease if they live into their forties.

What are the risk factors for Alzheimer’s disease?

What are the symptoms of Alzheimer’s disease?

How is Alzheimer’s disease diagnosed?

What are the treatments for Alzheimer’s disease?

Are there screening tests for Alzheimer’s disease?

How can I reduce my risk of Alzheimer’s disease?

What questions should I ask my doctor?

Where can I get more information about Alzheimer’s disease?

Alzheimer's Disease and Lyme Disease

Also, there seems to exist a correlation between Lyme disease and Alzheimer's disease, possibly suggesting that the infectious agent responsible for an initial Lyme disease infection could later be implicated as a cause of Alzheimer's disease. (This is speculated after autopsy of some Alzheimer's patients showed a presence of Lyme spirochetes in the brain.)¹

References:

Alzheimer’s Association website. Available at: http://www.alz.org/ .

National Institute on Aging, National Institutes of Health website. Available at: http://www.nia.nih.gov/ .

References:

Alzheimer’s Association website. Available at: http://www.alz.org/ .

Hampel H, Frank R, Broich K, et al. Biomarkers for Alzheimer’s disease: academic, industry and regulatory perspectives. Nat Rev Drug Discov.2010;9(7):560-574.

References:

Alzheimer's disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated March 2009. Accessed April 1, 2009.

Dementia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated November 2009. Accessed November 6, 2009.

Risk factor. Alzheimer’s Association website. Available at: http://www.alz.org/ . Accessed April 1, 2009.

8/23/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Ritchie K, Carrière I, Ritchie CW, Berr C, Artero S, Ancelin ML. Designing prevention programmes to reduce incidence of dementia: prospective cohort study of modifiable risk factors. BMJ.2010;341:c3885.

Alzheimer’s disease progresses slowly, and changes take place gradually over time. People can live with Alzheimer’s disease for 3-25 years, although the average duration of the disease is about 8-10 years. In general, changes can be characterized in three phases.

Early Phase

Subtle changes occur, but the problem is sometimes hard to pinpoint. More often, family members recognize these changes rather than the patients themselves. Common changes may include:

• Forgetfulness and attempts to hide frequent forgetting
• Misplacing things
• Getting lost while driving
• Loss of interest in hobbies
• Difficulty concentrating
• Inability to recall words
• Decrease in sentence complexity
• Problems with mathematical calculations
• Getting lost in familiar surroundings
• Difficulty with tasks that require fine motor ability, such as putting a key in the keyhole or buttoning a shirt
• Difficulty in dealing with daily life tasks, such as managing finances, tending to household tasks, maintaining personal hygiene
• Repeating questions and stories
• Nonsensical wordy speech
• Naming difficulties
• Depressed mood

Middle Phase

Impairments in memory and mental functioning become more obvious. Long-term memory may still be intact, but short-term memory fails. Other changes include:

• Difficulty sleeping
• Becoming less sociable and less aware of the feelings of others
• Needing help in making decisions
• Needing assistance with bathing, grooming, dressing
• Forgetting one’s own past history of personal events
• Personality changes, such as sudden mood shifts, anger, worry, or fearfulness

Advanced Phase

Abilities decline dramatically. Changes include:

• Inability to use language
• Becoming easily disoriented
• Incontinence
• Walking with a shuffle
• Frequent falls
• Showing minimal emotional response
• Immobility and pain
• Weight loss and inability to swallow
• Agitation, paranoia, hallucinations, delusions, and mood changes
• Difficulty sleeping

A risk factor is something that increases your likelihood of getting a disease or condition.

It is possible to develop Alzheimer’s disease with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing Alzheimer’s disease.

There are still many questions regarding the exact cause of Alzheimer’s disease, so risk factors are still being identified. Currently, risk factors for Alzheimer’s disease include:

Age

Age is the most important known risk factor for developing Alzheimer’s disease. The number of people with Alzheimer’s disease doubles every five years beyond age 65 until age 85, when almost 50% of all people have the disease.

Gender

Alzheimer’s disease affects both men and women, but women may have a slightly higher risk of developing the disease than men. Some experts believe that this is due to the fact that women live longer than men, but others dispute this claim.

Genetic Factors

Individuals with a first-degree relative of someone with Alzheimer’s disease (a parent or sibling) have a two- to three-times risk of developing the disease when compared to the rest of the population. In addition, there has been a clear genetic link established for an early-onset form of Alzheimer’s disease (occurs in people during their 30s, 40s, and early 50s), and a genetic link is suspected for late-onset Alzheimer’s disease. However, a specific gene has not yet been identified. One gene that has been implicated as being a major risk factor for late-onset Alzheimer’s disease is the ApoE4 gene. Scientists continue to study the role of genetic factors in the development of this disease.

Medical Conditions

• Head injury —There are some studies that suggest that people who suffered a serious, traumatic head injury at some time in their lives may be at higher risk of developing Alzheimer’s disease.

• Down syndrome —Nearly all people with Down syndrome who live to be age 40 or older develop Alzheimer’s disease.

• High cholesterol and high blood pressure

• Vitamin B12 deficiency —Low levels of the vitamin B12 and folate have been linked to a development of Alzheimer’s disease.

• Depression and anxiety

• Overweight or obese

• Diabetes

Mental Activity and Education

Some research has suggested that people who have higher education levels and continue to be mentally active and engaged in their later years are less likely to develop Alzheimer’s disease. However, some experts suggest that this finding may actually be due to the fact that those with higher education levels tend to do better on the psychological tests used to diagnose Alzheimer’s.

Environment

Some theories suggest that Alzheimer’s disease may be linked to exposure to certain environmental factors, such as toxins, certain viruses and bacteria, certain metals, or electromagnetic fields. Currently, there is no conclusive evidence to support these theories.

Diagnostic Tests

There are no laboratory tests to confirm a diagnosis of Alzheimer's disease. However, your doctor will be able do a thorough clinical evaluation and conduct tests that will provide a diagnosis with a relatively high accuracy rate, and other potential conditions will be ruled out.

Initially, the doctor will ask about your symptoms and medical history, and perform a physical exam. Tests to rule out other conditions may include:

Blood and Urine Tests

This may be done to rule out other causes of dementia. These tests may include:

• Electrolytes (eg, sodium, potassium, and calcium)
• Thyroid function tests
• Complete blood count (CBC)
• Levels vitamins (including B vitamins)
• Erythrocyte sedimentation rare (ESR)
• Lyme disease test
• HIV test
• Vasculitis work up

Genetic Tests

Genetic tests are being offered for people with family members with early-onset Alzheimer’s.

Other Tests

• Neurological exam—This exam tests the nervous system (brain, spinal cord, nerves, and muscles) for evidence of other neurological disorders.

• Psychological evaluation—Pyschological testing is used to rule out depression or other emotional illnesses that may often be the first sign of Alzheimer’s disease.

• Neuropsychological evaluation—This evaluation tests language, memory, reasoning, judgment, and orientation, and may assist in the diagnosis of Alzheimer’s disease in the early stage or indicate other causes of dementia.

• Mental status testing—This testing is used to evaluate memory, sense of time and place, and problem-solving abilities, attention span, language skills, visual spatial perception, learning capacity, judgement, insight, and decision making skills. This is often a part of the Neurological examination and Neuropsychologic testing.

• CT and MRI scan—Your doctor may suggest tests, such as CT scan or MRI , which will take a picture of your brain. These scans may help to identify any abnormalities in the brain, which may indicate Alzheimer’s disease or point to other causes of dementia. Special MRI sequences (eg, funtional MRI) are also being investigated for evaluating Alzheimer’s.

• PET scan— PET scan is a special type of brain imaging scan that involves use of special radioactive compounds.

Though not routine, a lumbar puncture (spinal tap) to test the cerebrospinal fluid (CSF) and an ophthalmologic screening can be done to investigate for other atypical causes of dementia. Additionally, electroencephalogram (EEG) is a test that evaluates and follows the electrical activity of the brain. This is not a routine test for evaluating dementia.

Diagnostic Categories

A diagnosis of Alzheimer’s disease usually falls into one of three categories:

• Probable Alzheimer’s—This indicates that other dementia-related disorders have likely been ruled out, and that the symptoms are likely due to Alzheimer’s disease. At least two areas of cognition are affected; one is worsening of memory.

• Possible Alzheimer’s—The dementia is possibly caused by Alzheimer’s disease. But, there may be other disorders present that may be the underlying cause of the dementia.

• Definite Alzheimer’s—This diagnosis can only be made at the time of death through an autopsy, when a pathologist can study the brain tissue. This is the only way to diagnose the disease with complete certainty.

References:

Alzheimer’s Association website. Available at: http://www.alz.org/ .

Alzheimer's disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated June 2009. Accessed July 6, 2009.

Hampel H, et al. Biomarker’s for Alzheimer’s disease: academic, industry and regulatory perspectives. Nat Rev Drug Discov. 2010;9(7):560-74.

Wolk DA, Klunk W. Update on amyloid imaging: from healthy aging to Alzheimer's disease. Curr Neurol Neurosci Rep. 2009;9(5):345-352.

7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Brown J, Pengas G, Dawson K, Brown LA, Clatworthy P. Self administered cognitive screening test (TYM) for detection of Alzheimer's disease: cross sectional study. BMJ. 2009;338:b2030.