What is Alzheimer's

What is Alzheimer’s: The Basics

For seniors and their families, even the mention of dementia can be terrifying. It’s important to understand what Alzheimer’s is before jumping to conclusions. Understanding the condition and what can be done about it empowers families to make better choices.
While dementia and Alzheimer’s disease are terms often used interchangeably, there are distinct differences. Read on to learn about how Alzheimer’s is different from related dementias as well as its causes, symptoms, stages, and tips for prevention.

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What Is the Difference Between Dementia and Alzheimer’s Disease?

Dementia is a blanket term for a group of brain disorders characterized by chronic and progressive loss of mental functions. Mental functions affected include memory, speech, emotional coping skills, and thinking/ problem-solving skills. There are many forms of dementia, but Alzheimer’s is the most common form. [i]

Alzheimer’s disease makes up 60-80% of all dementia cases. [ii] While Alzheimer’s is not just a disease for elderly individuals, most people with the disease are sixty-five or older. It is estimated that around five million people in America have Alzheimer’s.

Given its prevalence, this is the disease that comes to mind for most people when they hear the word “dementia.” Alzheimer’s is progressive with symptoms gradually worsening over time.

There is currently no cure; however, early diagnosis is important to determine the best care and treatment options.

What Causes Alzheimer’s?

Alzheimer’s is not a normal part of the aging process, and scientists aren’t sure why it affects some people and not others. Alzheimer’s isn’t exclusively a disease of seniors. There are cases where symptoms appear in the patients 40’s and 50’s, but the overwhelming majority of people living with Alzheimer’s disease are over the age of 65 [iii].

The causes and contributing factors are not firmly understood. Some lifestyle factors may contribute to the onset, but it seems relatively clear that risk increases with age and particularly if there is a history of dementia in the family. [iv] People of all backgrounds and genders are affected by the condition, although women are more likely to have the disease. The average lifespan of an individual with Alzheimer’s is about nine years.

The exact causes of Dementia and Alzheimer’s disease are still being determined. Neurons – the biological cells of the brain – are slowly being damaged and destroyed over time, and the body is unable to reverse this on its own. The human brain is robust; the damage can build up for some time before symptoms begin to manifest themselves.

As the damage increases, so too do the symptoms become worse. Scientists use scans of the brain to view damage. They can see a building up of proteins in the areas of the brain being damaged. Between the cells appear what is called ‘Plaque,’ a sticky buildup of these proteins. The inside of cells have ‘Tangles,’ which are very small cotton-candy like buildups of different proteins.
Aging brains all have some of these two buildups, but it is clear that they become dramatically worse in Alzheimer’s disease patients. The challenge scientists face is understanding the cause of this buildup, how to prevent it, and how to reverse buildup that has already taken place.

Alzheimer’s Symptoms

The Symptoms may develop differently from person to person, but they are characterized as being persistent, and get worse over time. WebMD describes the most common early symptoms as [v]:

  • Minor/Major memory loss
  • Difficulties planning, solving problems, and performing daily tasks
  • Becoming disoriented easily
  • Problems with vision including determining distances, words on a page, or colors
  • Challenges with vocabulary, such as difficulty expressing oneself in speech or print and jumbling or confusing words
  • Losing / Misplacing things in unusual places and/or accusing others of taking them
  • Mood changes resulting in becoming upset easily, depression/anxiety, loss of motivation or social withdrawal
  • Difficulty focusing
  • Feelings of frustration or confusion, especially at night
  • Getting lost easily
  • Physical changes like poor coordination or an odd gait
  • Inability to recognize loved ones

The list isn’t exhaustive, but it is enough to bring anyone to a specialist to be screened.

7 Stages of Alzheimer’s Disease

If you have a loved one with Alzheimer’s disease, it’s helpful to become familiar with the stages of the disease in order to plan for the best level of care possible with each stage. This will also help you prepare emotionally for the challenges that lie ahead.[vi]

Stage 1: Normal Behavior

During the first stage, you will likely not notice any changes in outward behavior. In fact, the only way to detect the disease is with a PET scan, which can show how the brain is working.

Stage 2: Mild Noticeable Changes

In stage two, you may or may not notice a change in behavior, but your loved one might be noticing some small changes like losing things more often or having trouble recalling words. While this will not interfere with his or her daily functioning or independence, it is a good idea to get to a doctor to see exactly what is going on.

Stage 3: Subtle Decline

Once stage three begins, changes in your loved one’s reasoning and thinking will become more noticeable. He or she may:

  • Have trouble remembering names when meeting new people
  • Begin asking the same question repeatedly
  • Forget something she just read or heard
  • Have difficulty organizing or planning

At this point, you can help make life easier by reminding the individual to make appointments, pay bills, take medications, and other important tasks. This is a good time to encourage your loved one to get their finances and legal affairs in order and consider retiring to decrease stress levels.

Stage 4: Decline Is Moderate

The symptoms observed in stage three will now become more noticeable in stage four. Additionally, you will notice the following symptoms:

  • Forgetting details about him or herself
  • Difficulty remembering the date, month, and season
  • Trouble ordering menu items or cooking meals

You can assist by helping with chores and monitoring for safety. At this point, driving is no longer an option. Also, keep an eye out for anyone who could take financial advantage of your loved one.

Stage 5: Decline Becomes Moderately Severe

During stage five, an individual with Alzheimer’s may begin to forget what time it is, where she is, or what clothing is appropriate for the season. It can become difficult for your loved one to recall basic personal information. They may begin to repeat questions.

Caregivers can assist by doing things like laying out clothes for the day and answering questions patiently to reassure the individual.

Stage 6: Decline Becomes Severe

At this stage, the individual may not be able to put names with faces. He or she may confuse one person with another. Delusions may also set in, causing the person to think they need to do something when they don’t, like go to work or pick up the kids. They may require assistance with bathroom needs.
While having a conversation could be difficult, you can connect with your loved one through music, photos, or by reading together.

Stage 7: Decline Becomes Very Severe

In this final stage, the individual will lose the ability to walk, eat, or even sit up straight. Caregiving during this phase will include feedings using soft foods and encouraging liquids throughout the day.

Alzheimer’s Treatments

While we don’t have a cure yet, the medical community worldwide is working aggressively to understand the disease. There are a number of treatments available to address behavioral and cognitive symptoms. These include: [vii]

1. Medications

There are drugs on the market that can help diminish symptoms such as confusion and temporary memory loss. The two types of drugs frequently used are cholinesterase inhibitors and memantine. These drugs work by stabilizing or lessening cognitive symptoms by affecting the chemicals that carry messages among the nerve cells of the brain.

Cholinesterase Inhibitors are typically used for early to moderate stages of Alzheimer’s. These medications treat the following memory-related symptoms:

  • Language
  • Thinking
  • Judgemen
  • Other thought-related processes

These drugs are typically well-tolerated, and side effects may include vomiting, appetite loss, increased bowel movements, and nausea.
Memantine medications are used for moderate to severe stages of Alzheimer’s. They work by regulating the activity of glutamate, which is related to the processing, storage, and retrieval of information. Some patients taking memantine experience improved mental function and ability to complete basic tasks. This medication treats the following symptoms:

  • Memory
  • Attention
  • Language
  • Ability to perform basic tasks

Side effects of memantine can include headaches, dizziness, confusion, and constipation.
In some cases, individuals can be prescribed a medication that contains cholinesterase inhibitors and memantine.

2. Treatments for Behavior

Oftentimes, the most difficult aspect of having a loved one with Alzheimer’s is the behavioral symptoms that present during the stages of Alzheimer’s as brain cells progressively deteriorate.
People suffering from Alzheimer’s disease often encounter changes in behavior, including depression, anxiety, irritability, anger, aggression, agitation, emotional distress, verbal or physical outbursts, and other symptoms. [viii]

Here are some common ways to treat and/or prevent some behavioral symptoms:

2.Non-Drug Treatments

There are a number of drug-free strategies focused on providing emotional and physical comfort to curb behavioral symptoms. These include the following tips to cope with Alzheimer’s-related behaviors:

  • Assess regularly for comfort.
  • As symptoms progress, an elderly person with Alzheimer’s will lose the ability to communicate his or her basic needs. Be sure that the environment is set at a comfortable temperature and monitor the individual for discomfort, including pain, thirst or hunger, fatigue, constipation, skin irritations, or the possibility of infection.

  • Redirect the individual’s attention.
  • When behavioral outbursts happen, be patient and flexible in your response by redirecting attention to something else to de-escalate the situation.

  • Do not become confrontational.
  • Avoid getting into arguments with the individual. For example, if a client or loved one repeatedly asks to visit a parent who has passed, instead of pointing out that the parent is dead, try something like, “I enjoy visiting your father, too. He is wonderful to be around.”

  • Encourage a low-stress environment.
  • Try to keep noise and distractions to a minimum. It is also helpful to provide a security object—a “go-to” item that the individual finds security in. This could be any number of things, like a pillow, photo, or other objects— even a song

  • Encourage rest.
  • Rest and relaxation are important, especially between stimulating activities

  • Don’t take behaviors to heart.
  • It’s important to recognize that a person suffering from Alzheimer’s is not trying to be mean or stubborn. This is a normal symptom of the disease, so don’t take outbursts personally.

  • Assess behaviors to determine possible causes.
  • Is the individual more uneasy or combative in certain settings or during specific activities? Analyzing behaviors can help prevent them through a change in environment or approach. Enlist the help of a primary care physician or care team for ideas.

    Medications to Treat Behaviors

    While it is recommended that caregivers try non-drug approaches prior to opting for medication, there are drugs available. While effective in some situations, the dosage should be as low as possible to monitor for side effects and used in conjunction with other types of treatments.

    Medication is often recommended for individuals with Alzheimer’s who are in danger of harming themselves or others or are experiencing severe symptoms.

    Types of medications prescribed can include antidepressants, anxiolytics, and antipsychotic medications depending on the symptoms being treated.

    3. Treatments to Address Sleep Changes

    It is common for people with Alzheimer’s to have sleeping problems or experience changes to their sleeping schedules because of the impact of the disease on the brain. [ix]

    Common sleep changes can include:

    • Problems sleeping at night.
    • Alzheimer’s can cause difficulty getting to sleep and staying asleep at night.

    • Increased napping during the day.
    • Individuals can have trouble getting to sleep at night but be very drowsy during the day, leading to increased napping.

    • Sundowning.
    • This term describes the experience where the individual can become agitated or restless as evening approaches.

    In later stages, experts say that individuals spend roughly 40% of the time awake at night and much of their days sleeping. In more extreme cases, there can be a complete reversal in sleep patterns.

    Why does this happen? Certain medical factors like depression, sleep apnea, and Restless Leg Syndrome are common contributors.
    The National Institutes of Health (NIH) experts strongly discourage the use of medications to aid with sleep. Not only have studies found that sleep meds are less effective with older individuals, they increase other risks, such as the risk of falls.

    Non-Drug Treatments for Sleep Issues

    To promote better sleep patterns among those with Alzheimer’s without the use of drugs, try these strategies:

    • Discourage TV watching during awake hours
    • Encourage the individual to use the bed for sleeping only
    • Use security objects and nightlights for added comfort
    • Ensure a comfortable room temperature
    • Avoid giving Cholinesterase inhibitor medications near bedtime
    • Address pain issues
    • Avoid drinking and smoking near bedtime
    • Encourage exercise daily, but not near bedtime
    • Follow a consistent schedule
    • Allow exposure to a good deal of sunlight in the morning

    Medications to Treat Sleeping Problems

    Sometimes non-drug treatments just don’t work or disruptive behaviors begin occurring at night.

    The dosage and type of medication will depend on the specific behaviors being exhibited by the individual.
    These sleep medications can be very risky for older people with cognitive impairments, so they should be discontinued if possible as soon as a sleep schedule has been re-established.

    4. Other Treatments for Alzheimer’s

    There are several non-traditional treatments out there. Many of them, including dietary supplements and herbal remedies, are not yet backed by large scientific research studies. It’s always a good idea to talk to your medical team before beginning new treatments.

    Music therapy has been shown to have a dramatic impact for those suffering from Alzheimer’s and related dementias because it helps bring back cherished memories, enables better communication, and gives individuals back a sense of self-identity which may have been lost given the effects of the disease.

    Can I Prevent Alzheimer’s?

    While there is no way to completely prevent Alzheimer’s, research shows that strategies used to reduce the risk of stroke and heart disease can help prevent Alzheimer’s disease and related dementias.

    And it is never too soon to get started. In fact, medical professionals recommend taking certain steps to prevent this disease by middle age. These preventative strategies include:

    • Regular exercise
    • Healthy, low-fat diet full of antioxidant nutrients
    • Maintain healthy cholesterol and blood pressure levels
    • Tackle depression issues as depression is a predictor of Alzheimer’s later in life
    • Don’t smoke
    • Limit exposure to environmental pollutants

    Final Thoughts

    As of now, there is no cure for Alzheimer’s. The progression of symptoms can be slowed, but they cannot be stopped. It’s crucial to stay positive. Research into new treatments and medications is ongoing and is taking place around the world.

    The improvement of treatment options has been dramatic, and this is expected to continue.
    The best chances of slowing progress come from identifying the condition early. Healthcare practitioners familiar with dementia can establish a baseline. This information can be used to track rate of decline and response to treatments. With proper care, healthy mental function can be extended for years.

    Health agencies now have Alzheimer’s disease specialists on staff that can work directly with those afflicted and customize the best treatment plan.

    Would someone you know benefit from an in-home explanation of what Alzheimer’s is and what treatments are available? Call or contact Caring People Inc. to schedule a free in-house consultation. Qualified homecare specialists will meet with you, assess your unique situation, and match your needs to the right services.

    sources

    [i] http://www.alzheimer.ca/en/About-dementia/What-is-dementia
    [ii] https://www.alz.org/alzheimers_disease_what_is_alzheimers.asp
    [iii] http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp
    [iv] https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=102
    [v] http://www.webmd.com/alzheimers/guide/early-warning-signs-when-to-call-the-doctor-about-alzheimers
    [vi] https://www.webmd.com/alzheimers/guide/alzheimers-disease-stages#1
    [vii] https://www.alz.org/alzheimers_disease_standard_prescriptions.asp
    [viii] https://www.alz.org/alzheimers_disease_treatments_for_behavior.asp
    [ix] https://www.alz.org/alzheimers_disease_10429.asp