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 What To Expect As We Age
Maturity & Aging Definitions
Maturity and Aging Statistics
Alzheimer’s Disease Fact Sheet
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Alzheimer’s Disease Fact Sheet
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What is Alzheimer’s Disease?
Alzheimer’s disease (AD)
- is an irreversible, progressive brain disease
- slowly destroys memory and thinking skills
- eventually destroys the ability to carry out the simplest tasks
In most people with AD, symptoms first appear after age 60.
AD is the most common cause of dementia among older people. Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—to such an extent that it interferes with a person’s daily life and activities. According to recent estimates, as many as 2.4 to 4.5 million Americans are living with AD.
AD is named after Dr. Alois Alzheimer. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. Her symptoms included memory loss, language problems, and unpredictable behavior. After she died, he examined her brain and found many abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary tangles). Plaques and tangles in the brain are two of the main features of AD. The third is the loss of connections between nerve cells (neurons) in the brain.
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Changes in the Brain in AD
Although we still don’t know what starts the AD process, we do know that damage to the brain begins as many as 10 to 20 years before any problems are evident.
- Tangles begin to develop deep in the brain, in an area called the entorhinal cortex.
- Plaques form in other areas of the brain.
- As more and more plaques and tangles form in particular brain areas, healthy neurons begin to work less efficiently. Then, they lose their ability to function and communicate with each other, and eventually they die.
- This damaging process spreads to a nearby structure, called the hippo-campus, which is essential in forming memories.
- As the death of neurons increases, affected brain regions begin to shrink.
- By the final stage of AD, damage is widespread and brain tissue has shrunk significantly.
Very Early Signs and Symptoms
Memory problems are one of the first signs of AD.
- Some people with memory problems have a condition called amnestic mild cognitive impairment (MCI). People with this condition have more memory problems than normal for people their age, but their symptoms are not as severe as those with AD. More people with MCI, compared with those without MCI, go on to develop AD.
- Recent research has found links between some movement difficulties and MCI. Additionally, researchers have seen links between some problems with the sense of smell and cognitive problems.
Mild AD
As AD progresses, memory loss continues and changes in other cognitive abilities appear. Problems can include:
- getting lost
- trouble handling money and paying bills
- repeating questions
- taking longer to complete normal daily tasks
- poor judgment
- mood and personality changes
People often are first diagnosed in this stage.
Moderate AD
In this stage, damage occurs in areas of the brain that control language, reasoning, sensory processing, and conscious thought.
- Memory loss and confusion increase.
- People begin to have problems recognizing family and friends.
- They may be unable to learn new things, carry out tasks that involve multiple steps (such as getting dressed), or cope with new situations.
- They may have hallucinations, delusions, and paranoia, and may behave impulsively.
Severe AD
By the final stage, plaques and tangles have spread throughout the brain and brain tissue has shrunk significantly. People with severe AD cannot communicate and are completely dependent on others for their care. Near the end, the person may be in bed most or all of the time as the body shuts down.
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What Causes AD
Scientists don’t yet fully understand what causes AD, but it is clear that it develops because of a complex series of events that take place in the brain over a long period of time. It is likely that the causes include genetic, environmental, and lifestyle factors. Because people differ in their genetic make-up and lifestyle, the importance of these factors for preventing or delaying AD differs from person to person.
The Basics of AD
Scientists are conducting studies to learn more about plaques, tangles, and other features of AD. They can now visualize plaques by imaging the brains of living individuals. They are also exploring the very earliest steps in the disease process. Findings from these studies will help them understand the causes of AD.
One of the great mysteries of AD is why it largely strikes older adults. Research on how the brain changes normally with age is shedding light on this question. For example, scientists are learning how age-related changes in the brain may harm neurons and contribute to AD damage. These age-related changes include inflammation and the production of unstable molecules called free radicals.
Genetics
For more about this area of research, see the Alzheimer’s Disease Genetics Fact Sheet, available at www.nia.nih.gov/Alzheimers/.
Lifestyle Factors
A nutritious diet, exercise, social engagement, and mentally stimulating pursuits can all help people stay healthy. New research suggests the possibility that these factors also might help to reduce the risk of cognitive decline and AD. Scientists are investigating associations between cognitive decline and heart disease, high blood pressure, diabetes, and obesity. Understanding these relationships and testing them in clinical trials will help us understand whether reducing risk factors for these diseases may help with AD as well.
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How AD Is Diagnosed
AD can be definitively diagnosed only after death by linking clinical course with an examination of brain tissue and pathology in an autopsy. But doctors now have several methods and tools to help them determine fairly accurately whether a person who is having memory problems has “possible AD” (the symptoms may be due to another cause) or “probable AD” (no other cause for the symptoms can be found). To diagnose AD, doctors:
- ask questions about the person’s overall health, past medical problems, ability to carry out daily activities, and changes in behavior and personality
- conduct tests of memory, problem solving, attention, counting, and language
- carry out medical tests, such as tests of blood, urine, or spinal fluid
- perform brain scans, such as a computerized tomography (CT) scan or a magnetic resonance imaging (MRI) test
These tests may be repeated to give doctors information about how the person’s memory is changing over time.
Early diagnosis is beneficial for several reasons. Having an early diagnosis and starting treatment in the early stages of the disease can help preserve function for months to years, even though the underlying AD process cannot be changed. Having an early diagnosis also helps families plan for the future, make living arrangements, take care of financial and legal matters, and develop support networks.
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How AD Is Treated
AD is a complex disease, and no single “magic bullet” is likely to prevent or cure it. That’s why current treatments focus on several different aspects:
- maintaining mental function
- managing behavioral symptoms
- slowing, delaying, or preventing AD
Helping People with AD Maintain Mental Function
Four medications are approved by the U.S. Food and Drug Administration to treat AD.
- Donepezil (Aricept®) for mild to severe AD
- Rivastigmine (Exelon®) for mild AD
- Galantamine (Razadyne®) for mild AD
- Memantine (Namenda®) for moderate to severe AD
These drugs work by regulating neurotransmitters (the chemicals that transmit messages between neurons). They may help maintain thinking, memory, and speaking skills, and help with certain behavioral problems. However, these drugs don’t change the underlying disease process and may help only for a few months to a few years.
Managing Behavioral Symptoms
Common behavioral symptoms of AD include:
- sleeplessness
- agitation
- wandering
- anxiety
- anger
- depression
Scientists are learning why these symptoms occur and are studying new treatments—drug and non-drug—to manage them. Treating behavioral symptoms often makes people with AD more comfortable and makes their care easier for caregivers.
Slowing, Delaying, or Preventing AD
AD research has developed to a point where scientists can look beyond treating symptoms to think about addressing the underlying disease process. In ongoing AD clinical trials, scientists are looking at many possible interventions, such as cardiovascular treatments, antioxidants, immunization therapy, cognitive training, and physical activity.
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Advancing Our Understanding
Thirty years ago, we knew very little about AD. Since then, scientists have made many important advances. Research supported by NIA and other organizations has expanded knowledge of brain function in healthy older people, identified ways we might lessen normal age-related declines in mental function, and deepened our understanding of AD. Many scientific and clinical fields are now working together to untangle the genetic, biological, and environmental factors that, over many years, ultimately result in AD. This effort is bringing us closer to the day when we will be able to manage successfully or even prevent this devastating disease.
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Supporting Families and Caregivers
Caring for a person with AD can have high physical, emotional, and financial costs. The demands of day-to-day care, changing family roles, and difficult decisions about placement in a care facility can be hard to handle. Researchers are learning a lot about AD caregiving, and studies are helping experts develop new ways to support caregivers.
Becoming well-informed about AD is one important long-term strategy. Programs that teach families about the various stages of AD and about flexible and practical strategies for dealing with difficult care-giving situations provide vital help to those who care for people with AD.
Developing good coping skills and a strong support network of family and friends also are important ways that caregivers can help themselves handle the stresses of caring for a loved one with AD. For example, staying physically active provides physical and emotional benefits.
Some AD caregivers have found that participating in an AD support group is a critical lifeline. These support groups allow caregivers to find respite, express concerns, share experiences, get tips, and receive emotional comfort. The Alzheimer’s Association, Alzheimer’s Disease Centers, and many other organizations sponsor in-person and online AD support groups across the country. There are a growing number of groups for people in the early stage of AD and their families. Support networks can be especially valuable when caregivers face the difficult decision of whether and when to place a loved one in a nursing home.
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RESOURCES OUTSIDE THIS ARTICLE
View the article Tips for Caregivers of Individuals with Alzheimer’s Disease
View other Alzheimer’s resources from the National Institute on Aging
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