Alzheimer's Disease and Cognitive Disorders
Alzheimer’s disease is the most common cause of dementia. It is a degenerative condition, which means that it progressively gets worse over time. Its intensity can range from mild to severe.
With Alzheimer’s, two changes occur around the same time:
- Inside brain cells, proteins called neurofibrillary tangles begin to form.
- Outside of brain cells, in the gray matter of the brain, another abnormal protein called beta-amyloid starts to be deposited. These are known as senile or amyloid plaques.
At first, the number of tangles and plaques are small and they are found in areas of the brain that are important for memory. Over time, the number of plaques and tangles increases and spreads throughout the brain. This process eventually results in the death of brain cells and a decrease in the mass of the brain as a whole. This reduction in mass can sometimes be seen on x-rays.
Dementia is a general term used to describe loss of social skills and the ability to think and reason clearly. Dementia is not a disease itself but a cluster of symptoms that often occurs together. It can be caused by a number of different conditions or diseases. People with dementia usually have the following symptoms:
- Severe memory problems
- Trouble with speech
- Difficulty with abstract thinking
- Poor judgment
How common is Alzheimer’s disease?
Alzheimer’s disease is very common. Approximately 5.2 million people in the United States are living with Alzheimer’s, and 469,000 new cases are diagnosed every year. As the baby boomer generation gets older, those numbers will likely increase. In fact, it is expected that around 13.8 million Americans will have Alzheimer’s disease by the year 2050.
Who gets Alzheimer’s disease?
Alzheimer’s affects older adults and is most common over the age of 65. Over one-third of the population over the age of 85 is affected. Alzheimer’s disease is slightly more common in women than in men.
The following factors are associated with an increased risk for developing Alzheimer’s disease:
- Untreated high blood pressure
- High cholesterol
- Physical and intellectual inactivity
- Presence of Down’s syndrome
Heredity and genetics may also play a role. People who have a parent or sibling with Alzheimer’s disease have a somewhat greater risk than someone without a family history. However, having a relative with Alzheimer’s does not mean that you are going to get Alzheimer’s. On the other hand, having no family history does not mean that you are immune. Genetic factors are usually more important in rare cases of early-onset (before age 65) Alzheimer’s disease.
How is Alzheimer’s disease diagnosed?
If a doctor suspects someone may have Alzheimer’s disease, they may recommend the following course of action:
- Take a detailed medical history. Specialized questionnaires are also used in some instances.
- Perform a thorough neurological examination, including an assessment of the person’s mental state.
- If needed, a neuropsychologist will determine the extent and nature of memory loss and other impairments.
- Certain blood tests may need to be performed.
- The brain may be scanned using computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and/or an amyloid scan, in selected cases.
- Examine the spinal fluid and/or genetic testing in select cases.
Some of the symptoms of Alzheimer’s disease include:
- Memory loss that affects skills at work and/or at home
- Difficulty performing familiar tasks like driving or handling finances
- Disorientation to time and place
- Difficulty with learning and abstract thinking
- Poor judgment
- Noticeable loss of initiative
- Changes in personality
- Changes in mood and behavior
These symptoms usually develop very slowly over a long period, although sometimes they may appear to start abruptly or to worsen after an injury, illness, or an operation.
The milder forms of the symptoms described above can be normal or signs of other conditions. Careful evaluation by an experienced physician is needed to confirm or rule out a diagnosis of Alzheimer’s.
Please seek the help of a licensed medical professional if you are concerned about your health, and dial 9-1-1 if you are experiencing an emergency.
Two classes of medication are approved for Alzheimer’s disease.
The first class, cholinesterase inhibitors, includes three drugs:
- Donepezil (Aricept®)
- Galantamine (Razadyne®)
- Rivastigmine (Exelon®)
This type of drug is believed to work by replenishing a chemical in the brain that is important for memory. Cholinesterase inhibitors are used for mild, moderate, and severe Alzheimer’s disease.
Memantine (Namenda®) is another type of drug used to treat Alzheimer’s disease and works in a different way than cholinesterase inhibitors. It blocks certain receptors in the brain which may protect nerve cells from too much stimulation. It is used in moderate to severe Alzheimer’s, often in combination with one of the cholinesterase inhibitor drugs.
These drugs cannot cure or reverse Alzheimer’s disease. However, there may be a moderate improvement or stabilization of symptoms for a period of time. There is clear evidence that people who take these medications do better in the long run than those who do not.
Some people with Alzheimer’s develop depression, which may be treated by an antidepressant medication, counseling, or both. A small percentage may become agitated or see and hear things that are not really there (auditory and visual hallucinations). Most of the time hallucinatory symptoms can be addressed without medications. Occasionally, small doses of antipsychotic medications such as risperidone or quetiapine may be necessary for limited periods.
Cognitive and Physical Rehabilitation
At some institutions, researchers are looking at ways to help those with Alzheimer’s improve their memory. Because this type of treatment is new, it is unknown how much it can help long-term.
In the advanced stages of Alzheimer’s disease, some patients may develop problems with walking, balance, and muscle tone. These symptoms can be helped by physical therapy. At Barrow Neurological Institute at Dignity Health St. Joseph’s Hospital and Medical Center, our highly trained rehabilitation team is skilled in the care of Alzheimer’s. We offer both inpatient and outpatient neuro-rehabilitation.
It is important for people with Alzheimer’s to maintain optimal general health. Anything that worsens your medical condition also can make worsen dementia .
Maintaining physical and intellectual activity is also important. However, it is important to not stress someone beyond their capacities. Our Alzheimer’s specialists can discuss with you which activities are appropriate and may be helpful.
- Date of last review: November 25, 2019
- Author: Anna Burke, MD