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Alzheimer's Disease

Topic Overview

Picture of the brain

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 do your 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 isn't clear.

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 doesn't notice it, but family and friends do. But the person with the disease may also know that something is wrong.

The symptoms of Alzheimer’s get worse slowly over time. You may:

  • Have trouble making decisions.
  • Be confused about what time and day it is.
  • Get lost in places you know well.
  • Have trouble learning and remembering new information.
  • Have trouble finding the right words to say what you want to say.
  • Have more trouble doing daily tasks like cooking a meal or paying bills.

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.

How is Alzheimer's disease diagnosed?

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 scans 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. 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, you 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's important to write a living will and a durable power of attorney.

Your loved one will need more and more care as the disease gets worse. You may be able to give this care at home, or you may want to think about using a nursing home.

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

Learning about Alzheimer's disease:

Being diagnosed:

Getting treatment:

Living with Alzheimer's disease:

End-of-life decisions:

Health Tools Health Tools help you make wise health decisions or take action to improve your health.

Health Tools help you make wise health decisions or take action to improve your health.
Decision Points focus on key medical care decisions that are important to many health problems. Decision Points focus on key medical care decisions that are important to many health problems.
  Alzheimer's Disease: Should I Take Medicines?
  Alzheimer's or Other Dementia: Should I Move My Relative Into Long-Term Care?

Cause

The cause of Alzheimer's disease isn't clear. It's likely that there are several causes. 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.

Some theories have suggested that metals, such as zinc or aluminum, play a role in Alzheimer's disease. But research hasn't 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. Having some short-term memory loss in your 60s and 70s is common, but this doesn't mean it's Alzheimer's disease.

Compare these examples of normal memory problems and the types of memory problems that may be caused by Alzheimer's disease.

Symptoms of normal forgetfulness versus Alzheimer's disease

In normal forgetfulness, the person may forget:

In Alzheimer's disease, the person may forget:
Parts of an experience. An entire experience.
Where the car is parked. How to drive a car.
Events from the distant past. Recent events, such as leaving the stove on.
A person's name, but remember it later. Ever having known a particular person.

Alzheimer's disease also causes changes in thinking, behavior, and personality. Close family members and friends may first notice these symptoms, although the person may also realize that something is wrong.

Following are some of the symptoms of the different stages of Alzheimer's disease. They 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 and slowed learning ability.
  • Begins speaking more slowly than in the past.
  • Starts having trouble 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 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 restless and wanders, especially in late afternoon and at night. This is called sundowning.
  • Has problems reading, writing, and dealing with numbers.
  • Has trouble dressing.
  • Cannot work simple appliances such as a TV remote or a microwave.

Severe Alzheimer's disease

With severe Alzheimer's disease, 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.
  • No longer knows when 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).

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. 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's 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. It progresses to severe mental and functional problems and eventual 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 developing symptoms of Alzheimer's disease is 8 to 10 years.

A person with severe dementia becomes more vulnerable to other illnesses, such as pneumonia.

What Increases Your Risk

Certain things make getting a disease more likely. These are called risk factors. Risk factors for Alzheimer's disease include:

  • Getting older. This is the main risk factor. 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.
  • A family history of Alzheimer's disease, especially if one or more of your parents or siblings has the disease.
  • The presence of the apolipoprotein E-4 gene.
  • Having Down syndrome.

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. Delirium needs treatment right away.

Seek care right away 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 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 rapidly becoming 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.

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. Your doctor will use a variety of tests to do this.

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.

Initial tests

The doctor will use a medical history and physical exam to help find out if a physical problem may be causing the person's dementia symptoms. Sometimes another problem can cause the same symptoms as Alzheimer's.

The person will also have a functional status exam and a mental health assessment. During these exams, he or she will be asked to perform simple tasks.

Lab tests

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, 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 that may be done include:

Imaging and other tests

Other tests done to rule out other causes include:

In some cases, examining the brain after death is done if the family wants to confirm that the person had Alzheimer's disease.

Treatment Overview

While there is not yet a cure for Alzheimer's disease, you can create a care plan to maintain quality of life and help the person stay active.

As you get started, ask yourself, other family members, and your doctor these questions:

  • 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?

Care plan

Care plans may include any of the following:

  • Medicines, such as cholinesterase inhibitors and memantine. These medicines may temporarily help with memory and thinking problems caused by the disease.
    Click here to view a Decision Point.Alzheimer's Disease: Should I Take Medicines?
  • Regular checkups. The doctor will check the person's response to medicine, look for new problems, see how symptoms are changing, and provide continuing education to the family. Treatment decisions often need to be revisited as the disease progresses. A person with Alzheimer's should see the doctor every 6 months, or sooner if a problem arises.
  • Helping the person remain independent and manage daily life as long as possible.
  • A plan for 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.

See Home Treatment to learn more about helping the person remain independent, making the most of the person's abilities, and dealing with new problems as they arise.

What to think about

An important part of treatment is finding and treating other medical problems the person may have.

  • Depression occurs in nearly half of people with Alzheimer's disease, especially those in the early stage of the disease. Helping them get treatment for depression can help them to do better with the abilities they still have.
  • Hearing and vision loss, arthritis, thyroid problems, kidney problems, and other conditions are common in older adults and may make Alzheimer's worse. Treating these problems can improve quality of life and ease the burden on the caregiver.

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 physically active to get Alzheimer's disease or another type of dementia.2 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 Alzheimer's disease.3 Reading, playing cards and other games, working crossword puzzles, and even watching television or listening to the radio may help them avoid symptoms of the disease. So can going out and remaining as socially active as possible. Although this "use it or lose it" approach hasn't been proved, no harm can come from regularly putting the 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.4, 5

Home Treatment

Most people who have Alzheimer's disease are cared for at home by family members and friends. Taking care of someone with the disease can be physically and emotionally draining, but there are ways to make it easier.

Home treatment involves teamwork among health professionals and caregivers 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 be involved in planning for the future and organizing the home and daily tasks.

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.

Tips for caregivers

Work with the team of health professionals to:

The team can also help you learn how to manage behavior problems. For example, you can learn ways to:

Caregivers should remember to seek support from other family and friends. 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. For more information, see the topic Caregiver Tips.

Plan for the future

As Alzheimer's disease progresses, you have decisions to make about medical care and legal issues.

  • A nursing home. Providing care at home usually becomes more and more challenging. 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.
    Click here to view a Decision Point.Alzheimer's Disease: Should I Move My Relative Into Long-Term Care?
  • Palliative care. This is a kind of care for people who have illnesses that don't go away and that often get worse over time. Palliative care focuses on improving quality of life—not only in the body but also in the mind and spirit. Talk to your doctor if you are interested in this type of care. See the topic Palliative Care.
  • End-of-Life Care. You may want to discuss health care and other legal issues that may arise near the end of life. An advance directive or living will lets people with the disease give others their health care instructions. To learn more, see the topic Care at the End of Life.

Medications

There are no medicines that can prevent or cure Alzheimer's disease. Medicine may help some people function better by temporarily reducing memory loss and thinking problems. Other medicines may be needed 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 for memory problems

  • Cholinesterase inhibitors treat symptoms of mental decline in people who have moderate Alzheimer's disease. They include donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon).
  • Memantine (Namenda) treats symptoms of confusion and memory loss from Alzheimer's disease.

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 don't prevent the disease from getting worse. But they may slow down symptoms of mental decline.

The main decision about using these usually isn't whether to try a medicine but when to begin and stop treatment. Treatment can be started as soon as Alzheimer's disease is diagnosed. 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.

Click here to view a Decision Point.Alzheimer's Disease: Should I Take Medicines?

Medicines for behavior problems

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).

Before deciding to use medicine for behavior problems, try to see what is causing the behavior. If you know the cause, you may be able to find better ways of dealing with that behavior. You may be able to avoid treatment with medicine and the side effects and costs that come with it.

Medicines generally are used only for behavior problems when other treatments have failed. They 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). Psychosis causes the person to have false beliefs (delusions) and to hear or see things that aren't there (hallucinations).

What to think about

Some research suggests that people with moderate to severe Alzheimer's disease who took cholinesterase inhibitors had improved thinking and daily functioning when they added memantine (Namenda) to their treatment.6

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.

Other Treatment

Other therapies, such as light therapy, aromatherapy, and exercise, may help reduce behaviors such as agitation. But they should only be done with supervision.

Other treatment choices

  • Ginkgo biloba is widely used in Europe to treat age-related dementia, including Alzheimer's disease. But studies haven't shown that ginkgo biloba helps improve memory or prevent dementia.7
  • Aromatherapy. Researchers are studying the use of aromatherapy oils, such as lavender, rosemary, and lemon, to reduce significant agitation in people who have dementia.8 But more research is needed to prove its effectiveness.
  • Light therapy is often used to relieve depression. It may help reduce depression, agitation, and sleeplessness associated with Alzheimer's disease.
  • 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 in a person who has Alzheimer's disease is to play soothing music during meals and when the caregiver is helping with bathing.

What to think about

Other treatments for Alzheimer's disease need further study. Their effectiveness and possible side effects aren't 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 Center
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

  1. Beers MH, et al., eds. (2004). Merck Manual of Health and Aging. Whitehouse Station, NJ: Merck Research Laboratories.
  2. Wang L, et al. (2006). Performance-based physical function and future dementia in older people. Archives of Internal Medicine, 166(10): 1115–1120.
  3. Wilson RS, et al. (2007). Relation of cognitive activity to risk of developing Alzheimer disease. Neurology, 69(20): 1911–1920.
  4. Barberger-Gateau P, et al. (2007). Dietary patterns and risk of dementia: The three-city cohort study. Neurology, 69(20): 1921–1930.
  5. 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).
  6. Tariot PN, et al. (2004). Memantine treatment in patients with moderate to severe Alzheimer's disease already receiving donepezil. JAMA, 291(3): 317–324.
  7. Birks J, Grimley Evans J (2009). Ginkgo biloba for cognitive impairment and dementia. Cochrane Database of Systematic Reviews (1).
  8. 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

  • Albert MS, et al. (2011). The diagnosis of mild cognitive impairment due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's and Dementia, 7 (3): 270–279.
  • 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.
  • McKhann GM, et al. (2011). The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's and Dementia, 7 (3): 263–269.
  • 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.
  • Sperling RA, et al. (2011). Toward defining the preclinical stages of Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's and Dementia, 7 (3): 280–292.

Credits

By Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Peter J. Whitehouse, MD - Neurology
Last Revised February 7, 2012

Last Revised: February 7, 2012

Author: Healthwise Staff

Medical Review: Anne C. Poinier, MD - Internal Medicine & Peter J. Whitehouse, MD - Neurology

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