Condition Basics

What is Alzheimer's disease?

Alzheimer's disease is a type of dementia that damages the brain. It causes a steady loss of memory and of how well you can speak, think, and do your daily activities.

The disease gets worse over time, but how quickly this happens varies. Some people lose the ability to do daily activities in the first few years. Others may 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 it?

Alzheimer's disease is caused by changes in the brain. Some of the symptoms may be linked to a loss of chemical messengers in the brain, called neurotransmitters. Neurotransmitters allow nerve cells in the brain to communicate properly.

What are the symptoms?

For most people, the first symptom of Alzheimer's disease is memory loss. Other symptoms include having trouble making decisions, getting lost in places you know, and having trouble learning. The symptoms get worse slowly over time. Alzheimer's disease also causes changes in thinking, behaviour, and personality.

How is it diagnosed?

Your doctor will do a number of tests to make sure your symptoms are caused by Alzheimer's disease and not another condition. You may have to do some simple memory tests and tests that show how well you can do daily tasks. You may get blood tests and tests that look at your brain.

How is Alzheimer's disease treated?

There is no cure for Alzheimer's disease. But there are medicines that may slow down the symptoms for a while and make the disease easier to live with. If you're a caregiver, there are steps you can take to help the person be independent for as long as possible.

How can you care for someone who has Alzheimer's disease?

Care needs will change over time. You'll work with health professionals to create a safe and comfortable environment and make tasks of daily living easier. You can help by making sure the person eats well. You can also help manage sleep problems. Your loved one may also need help with bladder and bowel control.

Cause

Alzheimer's disease is caused by changes in the brain. Some of the symptoms may be linked to a loss of chemical messengers in the brain. These messengers are called neurotransmitters. They allow nerve cells in the brain to communicate properly.

People with Alzheimer's disease have two things in the brain that aren't normal: amyloid plaques and neurofibrillary tangles. Experts don't know if these things are side effects of Alzheimer's disease or part of the cause.

Prevention

At this time, there is no known way to prevent Alzheimer's disease. But there are things that may make it less likely.

Adults who are physically active may be less likely than adults who aren't active to get this disease or another type of dementia. Moderate activity is safe for most people. But it's always a good idea to talk to your doctor before you start an exercise program.

Older adults who stay mentally active may be at lower risk for this disease. Activities that may help include reading, playing cards and other games, and working crossword puzzles. Going out and staying as socially active as possible may also help lower the risk. Although this "use it or lose it" approach hasn't been proven, no harm can come from often putting the brain to work.

Eating a balanced diet may also help. This includes whole grains, dairy, fruits, and vegetables.

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Symptoms

Memory loss is usually the first sign of Alzheimer's disease. Often the person who has a memory problem doesn't notice it, but family and friends do.

Having some short-term memory loss in your 60s and 70s is common, but this doesn't mean it's Alzheimer's disease.

Normal memory problems aren't the same as the kind of memory problems that may be caused by Alzheimer's disease. For example, normally you might forget:

• Parts of an experience.
• Where your car is parked.
• A person's name. (But you may remember the name later.)

With Alzheimer's disease, you might forget:

• An entire experience.
• What your car looks like.
• Having ever known a certain person.

Following are some of the symptoms of mild, moderate, and severe Alzheimer's disease. Symptoms vary as the disease progresses. Talk to your doctor if a friend or family member has any of the signs.

Mild Alzheimer's disease

Usually, a person with mild Alzheimer's disease:

• Avoids new and unfamiliar situations.
• Has delayed reactions.
• Has trouble learning and remembering new information.
• Starts speaking more slowly than in the past.
• Starts using poor judgment and making wrong decisions.
• May have mood swings and become depressed, grouchy, 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 Alzheimer's disease or another type of dementia. But not all people with mild cognitive impairment progress to dementia.

Moderate Alzheimer's disease

With moderate Alzheimer's disease, a person typically:

• Has problems recognizing close friends and family.
• Becomes more restless, especially in late afternoon and at night. This is called sundowning.
• Has problems reading, writing, and dealing with numbers.
• Has trouble dressing.
• Has more trouble doing daily tasks like cooking a meal or paying bills. For example, maybe the person can't use simple appliances such as a microwave.
• Has trouble making decisions.
• Is confused about what time and day it is.
• Gets lost in places that the person knows well.
• Has trouble finding the right words to say what he or she wants to say.

Severe Alzheimer's disease

With severe Alzheimer's disease, a person usually:

• Can't remember how to bathe, eat, dress, or use the toilet without help.
• No longer knows when to chew and swallow.
• Has trouble with balance or walking and may fall often.
• Becomes more confused in the evening (sundowning) and has trouble sleeping.
• Can't use words to communicate.
• Loses bowel or bladder control (incontinence).

Other conditions with similar symptoms

Early in the disease, Alzheimer's usually doesn't affect a person's fine motor skills (such as the ability to button or unbutton clothes or use utensils) or sense of touch. So a person who has 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:

• Dementia caused by small strokes (multi-infarct dementia).
• Thyroid problems, such as hyperthyroidism or hypothyroidism.
• Depression.
• Other problems such as kidney and liver disease and some infections such as HIV (human immunodeficiency virus).

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What Happens

Alzheimer's disease gets worse over time. But the course of the disease varies from person to person. Some people may still be able to function fairly well until later in the course of the disease. Others may lose the ability to do everyday activities very early on.

• The disease tends to get worse little by little. It usually starts with mild memory loss. It progresses to severe mental and functional problems and then to death.
• Symptoms sometimes are described as occurring in early, middle, and late phases. It's hard to predict how long each phase will last.
• The average amount of time a person lives after getting symptoms of Alzheimer's disease is 8 to 10 years.

When To Call

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. Delirium needs treatment right away.

Seek care now 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 behaviour or if symptoms suddenly get 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 start to interfere with the person's work or social life or could cause injury or harm to the person.
• You need help caring for a person with Alzheimer's disease.

Watchful waiting

If memory loss isn't quickly getting worse or interfering with work, social life, or the ability to function, it may be normal age-related memory loss. Talk to your doctor if you are concerned about memory loss.

Examinations and Tests

Your doctor will do a number of tests to make sure your symptoms are caused by Alzheimer's disease and not another condition.

Your doctor will ask about your past health and do a physical examination. The doctor 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 examination usually includes blood tests to look for another cause of your problems. You may have tests such as CT scans and MRI scans, which look at your brain. By themselves, these tests can't show for sure whether you have Alzheimer's.

It usually is helpful to bring a family member or someone else you trust to the appointment. A family member may be able to provide the best information about how your day-to-day functioning, memory, and personality have changed.

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Treatment Overview

There isn't a cure yet for Alzheimer's disease. But there are things that can be done to maintain quality of life.

The doctor, family, and the loved one can work together to make a care plan. Care plans may include any of the following:

• Medicines. These may slow down symptoms for a while and make the disease easier to live with. These medicines may not work for everyone or have a big effect. But most experts think they're worth a try.
• Regular doctor visits to check the person's response to medicine, look for new problems, see how symptoms are changing, and provide continuing education to the family.
• Treating other health conditions, such as depression or hearing and vision loss.
• Planning how the person can be as independent as possible and manage his or her own life for as long as possible.

Self-Care

Taking care of yourself

• If your doctor gives you medicines, take them exactly as prescribed. Call your doctor or nurse advice line if you think you are having a problem with your medicine. You will get more details on the medicines your doctor prescribes.
• Eat a balanced diet. Get plenty of whole grains, fruits, and vegetables every day. If you are not hungry at mealtimes, eat snacks at midmorning and in the afternoon. Try drinks such as Boost or Ensure if you are having trouble keeping your weight up.
• Stay active. Exercise such as walking may slow the decline of your mental abilities. Try to stay active mentally too. Read and work crossword puzzles if you enjoy these activities.
• If you have trouble sleeping, do not nap during the day. Get regular exercise (but not within several hours of bedtime). Drink a glass of warm milk or caffeine-free herbal tea before going to bed.
• Ask your doctor about support groups and other resources in your area. They can help people who have Alzheimer's disease and their families.
• Be patient. You may find that a task takes you longer than it used to.
• If you have not already done so, make an advance care plan. An advance care plan provides instructions to your doctor and family members about what kind of care you want if you become unable to speak or express yourself. Talk to a lawyer about making a will, if you do not already have one.

Keeping schedules

• Develop a routine. You will feel less frustrated or confused if you have a clear, simple plan of what to do every day.
  • Make lists of your medicines and when to take them.
  • Write down appointments and other tasks in a calendar.
  • Put sticky notes around the house to help you remember events and other things you have to do.
  • Schedule activities and tasks for times of the day when you are best able to handle them.

Staying safe

• Tell someone when you are going out and where you are going. Let the person know when you will be back. Before you go out alone, write down where you are going, how to get there, and how to get back home. Do this even if you have gone there many times before. Take someone along with you when possible.
• Make your home safe. Tack down rugs, put no-slip tape in the tub, use handrails, and put safety switches on stoves and appliances.
• Have a family member or other caregiver tell you whether you are driving badly. Deciding to stop driving is very hard for many people. Driving helps you feel independent. Your provincial ministry of transportation can do a driving test if there is any question. Plan for other means of getting around when you are no longer able to drive.
• Use strong lighting, especially at night. Put night-lights in bedrooms, hallways, and washrooms.
• Lower the hot water temperature setting to 50°C or lower to avoid burns.

Medicines

There are no medicines that can prevent or cure Alzheimer's disease. Medicine may help some people do daily tasks better. They can reduce memory loss and thinking problems for a period of time. They are also used for behaviour problems.

Medicines for memory problems

• Cholinesterase inhibitors treat symptoms of mental decline in people who have mild to moderate Alzheimer's disease. They include donepezil, galantamine, and rivastigmine. Donepezil can be used to help those who have severe Alzheimer's disease.
• Memantine treats more severe symptoms of confusion and memory loss.

These medicines may help improve memory and daily functioning for a period of time in some people who have Alzheimer's disease. How well they work varies. They don't prevent the disease from getting worse.

Medicines for behaviour problems

Medicines may be used if someone with Alzheimer's is agitated or disruptive. The medicines used include antipsychotic, anti-anxiety, and anticonvulsant medicines.

Medicines generally are used only for behaviour problems when other treatments have failed.

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Caring for Someone Who Has Alzheimer's Disease

You'll work with a team of health professionals to create a safe and comfortable environment and to make tasks of daily living as easy as possible. Some people with early or mild Alzheimer's disease can care for themselves.

How to help

Work with the team of health professionals to:

• Make sure the home is safe.
• Keep the person eating well.
• Manage sleep problems.
• Manage bladder and bowel control problems.

The team can also help you learn how to manage behaviour problems. For example, you can learn ways to help the person avoid confusion, manage agitation, and communicate clearly.

Decisions to make

You have decisions to make about both medical care and legal issues. They include:

• Whether your loved one should continue to drive.
• When it's time for a nursing home or assisted living.
• When it's time for hospice palliative care.
• What kind of end-of-life care and surroundings your loved one wants.

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