Alzheimer's Disease

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 go to the bathroom 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).

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.

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.

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 exam. 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 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.

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.

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.

• Develop a routine. The person will feel less frustrated or confused with a clear, simple daily plan. Remind him or her about important facts and events.
• Be patient. It may take longer for the person to complete a task than it used to.
• Help the person eat a balanced diet. Serve plenty of whole grains, fruits, and vegetables every day. If the person is not eating well at mealtimes, give snacks at midmorning and in the afternoon. Offer drinks such as Boost, Ensure, or Sustacal if he or she is losing weight.
• Encourage exercise. Walking and other activity may slow the decline of mental ability. Help the person keep an active mind. Encourage hobbies such as reading and crossword puzzles.
• Take steps to help if the person is sundowning. This is the restless behavior and trouble with sleeping that may occur in late afternoon and at night. Try not to let the person nap during the day. Offer a glass of warm milk or caffeine-free tea before bedtime.
• Ask family members and friends for help. You may need breaks where others can help care for the person.
• Talk to the person's doctor about what resources are available for help in your area.
• Review all of the person's medicines with his or her doctor.
• For as long as the person is able, allow him or her to make decisions about activities, food, clothing, and other choices. Let the person be independent, even if tasks take more time or are not done perfectly. Tailor tasks to the person's abilities. For example, if cooking is no longer safe, ask for other help. He or she can help set the table or make simple dishes such as a salad. When the person needs help, offer it gently.

Keeping safe

• Make your home (or the person's home) safe. Tack down rugs, and put no-slip tape in the tub. Install handrails, and put safety switches on stoves and appliances. Keep rooms free of clutter. Make sure walkways around furniture are clear. Do not move furniture around, because the person may become confused.
• Use locks on doors and cupboards. Lock up knives, scissors, medicines, cleaning supplies, and other dangerous things.
• Do not let the person drive or cook if he or she cannot do it safely. A person with Alzheimer's should not drive unless he or she is able to pass an on-road driving test. Your state driver's license bureau can do a driving test if there is any question.
• Get medical alert jewelry for the person so you can be contacted if he or she wanders away. If possible, provide a safe place for wandering, such as an enclosed yard or garden.

Taking care of yourself

• If your doctor gives you medicines, take them exactly as prescribed. Call your doctor 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, Ensure, or Sustacal 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 a list of advance directives. Advance directives are 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 state driver's license bureau 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 bathrooms.
• Lower the hot water temperature setting to 120°F or lower to avoid burns.