Frequently Asked Questions about Alzheimer's Disease
The fundamental causes of Alzheimer’s disease are still unknown but researchers are pursuing many avenues of discovery to better understand the disease. The most common theories for what may cause Alzheimer’s include the amyloid and tau hypotheses. Abnormal deposits of these proteins clump together in the brain, forming plaques and tangles that interfere with normal brain function.
Early signs and symptoms of Alzheimer’s disease are short term memory loss, problems with reasoning, judgment and critical thinking skills. Because is it impossible to pin down a date of onset, it is often referred to as an “insidious onset.” Individuals with the disease and their caregivers will typically have several examples of events taking place that eventually became too difficult to ignore, leading to the eventual diagnosis of Alzheimer’s disease.
Dementia is a syndrome and has many causes including vascular disease, Parkinson’s disease, alcoholism, traumatic brain injury, vitamin deficiencies and more. Alzheimer’s disease is the most common cause of dementia. While everyone with Alzheimer’s has dementia, not everyone with dementia has Alzheimer’s.
Approximately 44 million people worldwide are living with Alzheimer’s disease with an estimated 5.5 million people with Alzheimer’s are in the United States. With the aging of the population worldwide and in the US, these numbers are expected to double or triple over the next 50 years.
More women are affected with Alzheimer’s disease; however women, in general, live longer than men so the population of women is much larger. Research has shown that when the data is controlled for age effects, women still appear to be more affected than males and it is not clear why.
The rates of dementia and Alzheimer’s disease are higher in African Americans in the United States than in Caucasians. The reasons for these disparities are still unclear; however, African Americans also have higher rates of cardiovascular diseases such hypertension and diabetes. Cardiovascular disease, particularly occurring in midlife, has been implicated in some studies as risk factors for dementia.
The earliest structural changes that can be seen on routine neuroimaging, such as an MRI, is shrinkage – also called atrophy – usually in the middle parts of the temporal lobes in the hippocampus. In a less common version of Alzheimer’s disease, there can be atrophy in posterior cortical areas of the brain including the parietal lobes. Abnormal protein accumulation occurs in other parts of the brain even before the atrophy is detectable.
A person with Alzheimer’s disease typically has trouble with cognition – thinking, reasoning, judgment and decision-making skills – that may interfere with important functions like paying bills and driving. Over time, these individuals begin to have trouble with activities of daily living such as personal hygiene, using the restroom and bathing independently, and begin having behavioral disturbances as their cognitive skills further decline:
- Pre-symptomatic: Subjective cognitive complaints or mild cognitive impairment can precede any measurable changes. Depression may also occur.
- Mild: The individual experiences memory loss, diminished judgement, poor decision-making skills, language issues, mood swings and/or personality changes.
- Moderate: Behavioral challenges such as agitation, aggression and/or delusions occur. The individual may also be unable to learn or recall new information, wander or get lost in familiar places, and/or require more assistance with activities of daily living. Long-term memory may also be affected at this stage.
- Severe: An individual at the severe stage of Alzheimer’s disease may experience difficulty walking and/or other motor disturbances, are unable to perform activities of daily living, and/or are bedridden. Placement in a long-term care facility is necessary for almost all Alzheimer’s patients in this stage.
Alzheimer’s disease is considered early-onset when an individual is diagnosed before age 65. Approximately 250,000 people in the U.S. are estimated to have early-onset Alzheimer’s. This includes rare forms of dementia known as frontotemporal degeneration. While some cases are likely due to genetic factors, others are sporadic like later onset Alzheimer’s.
The vast majority of Alzheimer’s disease cases are sporadic, meaning that there is no history in the family of someone having ever had Alzheimer’s or another dementia. However, some cases of Alzheimer’s disease are indeed “genetic” and classified as Familial Alzheimer’s Disease (FAD). A child whose biological mother or father carries a genetic mutation for early-onset Alzheimer’s has a 50 percent chance of inheriting that mutation. If the mutation is inherited, the child has a very strong probability of developing early-onset FAD.
Many early-onset Alzheimer’s cases are caused by any one of a number of different single-gene mutations on chromosomes 21, 14 and 1. Each of these mutations causes abnormal proteins to be formed. Mutations on chromosome 21 cause the formation of abnormal amyloid precursor protein (APP). A mutation on chromosome 14 causes abnormal presenilin 1 to be made, and a mutation on chromosome 1 leads to abnormal presenilin 2.
Alzheimer’s disease is often said to be a “family” disease. At some point, individuals who are diagnosed cannot live alone, resulting in a minimum of two people being affected with each case of the disease. As the disease progresses, the person affected will increasingly require more care as Alzheimer’s robs the person not only of function, but also of language and communication skills, thinking, reasoning and decision-making skills, and will eventually require total care. Caring for a person with Alzheimer’s is a job that no one “applies” for, so family members are not trained, and are unexperienced or unprepared for this role making them susceptible to physical and emotional exhaustion, depression and feeling a sense of hopeless and helplessness in the face of the growing demands of care.
Nearly everyone has been affected by Alzheimer’s disease in one way or another. This is due to the fact that the fastest growing segment of the population are individuals over the age of 85 and Alzheimer’s is highly correlated with advancing age. The more people living into old age, the higher the percentage of Alzheimer’s disease and related dementia.
Despite all the research efforts and several symptomatic treatments for symptoms, there is no known prevention, cure, or approved disease-modifying intervention for Alzheimer’s disease. Physicians and clinicians have many symptomatic treatments that they use to treat the common behavioral symptoms of the Alzheimer’s and other dementias. Providers also work with families and community providers to teach them how to use non-pharmacological interventions first, then try medications to manage challenging behaviors if necessary. Effective non-pharmacological interventions include strategies such as:
- Daily exercise to improve mood and function. Exercise has been shown to helpful for both the person with Alzheimer’s disease and the family caregiver.
- Managing the environment to reduce too much stimuli such as decluttering spaces, having adequate lighting to reduce confusion visually
- Avoiding falls by installing grab bars in the bathroom, removing scatter rugs, reducing/eliminating stairs for the person with Alzheimer’s, installing night lights in the hallway and bathroom to assist the individual to be able to see at night
- Hand massages with an essential oil like lavender oil reduces agitation as much as giving the person a powerful antipsychotic drug.
- Pet therapy, music therapy and art therapy have been shown to be effective at reducing depression.
When these types of interventions fail, then we will providers use atypical antipsychotic medications to manage difficult behaviors.
The Indiana Alzheimer Disease Center at IU School of Medicine is a multidisciplinary research program intensely committed to the U.S. National Alzheimer’s Project Act to prevent and effectively treat Alzheimer’s disease by 2025.
Outreach to local and statewide communities is critical to inform the aging members of the general population in Indiana and their families about the importance of early diagnosis, available treatment and management options for Alzheimer’s disease. Outreach must also emphasize the critically important role of participating in research at the Indiana Alzheimer Disease Center at IU School of Medicine.