Alzheimer's

Alzheimer's disease (AD) is perhaps one of the best-known illnesses associated with old age. A complex disease of the brain, Alzheimer's now affects roughly 4.5 million people in the United States, according to the Alzheimer's Association. As the U.S. population grows older, the number of people with AD is expected to increase. But AD is not a normal or inevitable part of aging. It is a progressive disease that starts in one part of the brain and gradually invades other regions. As it progresses, AD destroys nerve cells within the brain and the connections between them, leaving behind clumps of proteins called plaques and twisted fibers in brain cells called tangles. Over time, this destruction erodes the most vital abilities of human nature: language, learning, memory and reason. Personality and behavior also are dramatically affected by AD. Alzheimer's disease is the most common causes of dementia in older people. Dementia is a medical term used to describe deterioration in thinking ability severe enough to disrupt a person's normal activities and relationships. The disease usually begins in people 65 or older, but in rare instances it can affect individuals as young as 40. An estimated one in 10 people over 65 have AD, and close to half of all adults in the United States aged 85 and older are believed to have at least a mild form of the disease. There is no evidence that women are at greater risk than men for developing the disease. However, nearly 42,000 women die of AD each year, more than twice the number of men. This is because women live longer than men so more women have the disease at any time than men. Early symptoms of the disease include forgetfulness, difficulty using or remembering words and difficulty concentrating. For some individuals, these early symptoms of AD may be mistaken for what many people consider "natural" symptoms of aging. But symptoms caused by AD worsen over time, while the short-term memory problems that trouble many people as they age do not progress to other more serious symptoms. The rate that AD symptoms progress varies greatly from person to person. Some people have AD only for the last three years of life, while others may live with the disease for 20 years. Symptoms of Alzheimer's often are divided into three phases: mild, moderate and severe, though symptoms in these phases often overlap. Because Alzheimer's damages the brain, unpredictable and uncharacteristic behavior is common. Anxiety, aggressiveness or compulsive behaviors—repetitious activities that the person doesn't seem to be able to control or stop—are also common. Mood swings and irritability are common and can escalate if not treated early. These behavioral patterns typically change as the disease progresses. Mild AD symptoms include: confusion and memory loss personality changes judgment problems difficulties with routine tasks getting lost or disoriented in familiar places Moderate AD symptoms often add: difficulty with personal care (bathing, dressing, feeding) anxiety, agitation, paranoia wandering and pacing trouble recognizing or inability to recognize familiar faces sleep disturbances Severe AD includes symptoms listed above plus: loss of intelligible speech loss ability to eat independently loss of bladder and bowel control complete dependence on caregiver The major risk factor for AD is age. According to the Alzheimer's Association, a person's risk of developing any form of dementia, including Alzheimer's, doubles approximately every five years after age 65. Although researchers still don't know for sure what causes Alzheimer's disease, most believe it is related to the abnormal processing of normal brain proteins, particularly amyloid precursor protein and tau. For some reason, later in life these proteins, which serve a normal function, begin to be abnormally processed. When this happens, the abnormally processed proteins assemble themselves into clumps, which interfere with thinking. These clumped proteins are called neurofibrillary tangles and senile (amyloid) plaques (often simply referred to as tangles and plaques), and eventually destroy critical parts of the brain. Family history is also a risk factor for AD. For example, early—onset AD, a rare form of the disease that strikes people between the ages of 30 and 60, is often inherited. So far, only one genetic factor has been identified that makes late-stage AD more likely—a gene that makes a particular form of a protein called apolipoprotein E (ApoE). Fifteen percent of the population has this form of ApoE. Other theories link the disease's development to the death of cells critical for maintaining levels of certain brain chemicals required for normal thought processes; chronic inflammation; accumulation of heavy metals in the brain; and vascular factors that affect the health of blood vessels in the brain. Another potential risk factor is severe head injury. In addition, scientists are investigating the role of education, diet and environment in AD. They are also looking into the link between the risk factors of heart disease—such as high blood pressure, high cholesterol and low levels of folate—and AD. On the positive side, there is some evidence that higher levels of education early in life and more social, mental and physical activities in older age may help prevent the disease. At one time, hormone therapy was thought to reduce a woman's risk of developing dementia and Alzheimer's. However, several studies have shown it may have the opposite effect. One major study published in the Journal of the American Medical Association found that estrogen plus progestin hormone therapy increased the risk of dementia, including Alzheimer's disease. Another study found that estrogen did not improve the symptoms of those who already had Alzheimer's disease. To date, there is no cure for AD, but there are some drug and nondrug treatments that may help with both behavioral and cognitive symptoms. If you think you have AD or suspect someone you know might be experiencing symptoms, it's important to consult with medical professionals as soon as possible. Early diagnosis can help rule out other medical reasons for symptoms. Because AD eventually affects an individual's ability to care for him or herself, short- and long-term planning is important. The earlier you can develop a support system, as well as review financial and medical management strategies, the better. Plus, the sooner someone with AD begins taking medications to minimize or stabilize symptoms, the better. Issues to consider include: caregiving support and establishing a power of attorney and a living will, as well as making other end-of-life decisions. The Alzheimer's Association and the support groups it sponsors can provide additional information about AD and the needs you and your family are likely to face. It's natural to feel overwhelmed by such a diagnosis. These organizations, together with your medical team, can help you cope.