Definition

By Mayo Clinic staff

Subscribe to our Alzheimer's caregiving newsletter to stay up to date on Alzheimer's topics.

Alzheimer's disease causes brain changes that gradually get worse. It's the most common cause of
dementia — a group of brain disorders that cause progressive loss of intellectual and social skills,
severe enough to interfere with day-to-day life. In Alzheimer's disease, brain cells degenerate and die,
causing a steady decline in memory and mental function.

Current Alzheimer's disease medications and management strategies can temporarily improve
symptoms, maximize function and maintain independence. It's also important to seek social services
and tap into your support network to make life better. Research efforts aim to discover treatments
that prevent Alzheimer's or slow its progression.

Symptoms
The first symptoms of Alzheimer's disease you may notice are increasing forgetfulness and mild
confusion. Over time, the disease has a growing impact on your memory, your ability to speak and
write coherently, and your judgment and problem solving. If you have Alzheimer's, you may be the
first to notice that you're having unusual difficulty remembering things and organizing your thoughts.
Or you may not recognize that anything is wrong, even when changes are noticeable to your family
members, close friends or co-workers.

Brain changes associated with Alzheimer's disease lead to growing trouble with:

Memory
Everyone has occasional memory lapses. It's normal to lose track of where you put your keys or forget
the name of an acquaintance. But the memory loss associated with Alzheimer's disease persists and
gets worse. People with Alzheimer's may:

 Repeat statements and questions over and over

 Forget conversations, appointments or events, and not remember them later

 Routinely misplace possessions, often putting them in illogical locations

 Eventually forget the names of family members and everyday objects

Disorientation and misinterpreting spatial relationships

People with Alzheimer's disease may lose their sense of what day it is, the time of year, where they
are or even their current life circumstances. Alzheimer's may also disrupt your brain's ability to
interpret what you see, making it difficult to understand your surroundings. Eventually, these
problems may lead to getting lost in familiar places.

Speaking and writing

Those with Alzheimer's may have trouble finding the right words to identify objects, express thoughts
or take part in conversations. Over time, the ability to read and write also declines.

Thinking and reasoning

Alzheimer's disease causes difficulty concentrating and thinking, especially about abstract concepts
 like numbers. Many people find it challenging to manage their finances, balance their checkbooks, and
keep track of bills and pay them on time. These difficulties may progress to inability to recognize and
deal with numbers.

Making judgments and decisions

Responding effectively to everyday problems, such as food burning on the stove or unexpected driving
situations, becomes increasingly challenging.

Planning and performing familiar tasks

Once-routine activities that require sequential steps, such as planning and cooking a meal or playing a
favorite game, become a struggle as the disease progresses. Eventually, people with advanced
Alzheimer's may forget how to perform basic tasks such as dressing and bathing.

Changes in personality and behavior

Brain changes that occur in Alzheimer's disease can affect the way you act and how you feel. People
with Alzheimer's may experience:

 Depression

 Anxiety

 Social withdrawal

 Mood swings

 Distrust in others

 Increased stubbornness

 Irritability and aggressiveness

 Changes in sleeping habits

 Wandering

Causes
Scientists believe that for most people, Alzheimer's disease results from a combination of genetic,
lifestyle and environmental factors that affect the brain over time.

Less than 5 percent of the time, Alzheimer's is caused by specific genetic changes that guarantee a
person will develop the disease.

While the causes of Alzheimer's are not yet fully understood, its effect on the brain is clear.
Alzheimer's disease damages and kills brain cells. A brain affected by Alzheimer's disease has many
fewer cells and many fewer connections among surviving cells than does a healthy brain.

As more and more brain cells die, Alzheimer's leads to significant brain shrinkage. When doctors
examine Alzheimer's brain tissue under the microscope, they see two types of abnormalities that are
considered hallmarks of the disease:
 Plaques. These clumps of a protein called beta-amyloid may damage and destroy brain cells
in several ways, including interfering with cell-to-cell communication. Although the ultimate cause of
brain-cell death in Alzheimer's isn't known, abnormal processing of beta-amyloid is a prime suspect.

 Tangles. Brain cells depend on an internal support and transport system to carry nutrients
and other essential materials throughout their long extensions. This system requires the normal
structure and functioning of a protein called tau. In Alzheimer's, threads of tau protein twist into
abnormal tangles, leading to failure of the transport system. This failure is also strongly implicated in
the decline and death of brain cells.

Risk factors
Age
Increasing age is the greatest known risk factor for Alzheimer's. Alzheimer's is not a part of normal
aging, but your risk increases greatly as you grow older. After you reach age 65, your risk of
developing the disease doubles about every five years. Nearly half of those over age 85 have
Alzheimer's.

People with rare genetic changes that guarantee they'll develop Alzheimer's often begin experiencing
symptoms in their 40s or 50s.

Family history and genetics

Your risk of developing Alzheimer's appears to be somewhat higher if a first-degree relative — your
parent, sibling or child — has the disease. Scientists have identified rare changes (mutations) in three
genes that guarantee a person who inherits them will develop Alzheimer's. But these mutations
account for less than 5 percent of Alzheimer's disease. Most genetic mechanisms of Alzheimer's
among families remain largely unexplained. The strongest risk gene researchers have found so far is
apolipoprotein e4 (APOE-e4). Other risk genes have been identified but not conclusively confirmed.

Sex
Women may be more likely than are men to develop Alzheimer's disease, in part because they live
longer.

Mild cognitive impairment

People with mild cognitive impairment (MCI) have memory problems or other symptoms of cognitive
decline that are worse than might be expected for their age, but not severe enough to be diagnosed
as dementia. Those with MCI have an increased risk — but not a certainty — of later developing
dementia.

Lifestyle and heart health

There's no lifestyle factor that's been conclusively shown to reduce your risk of Alzheimer's disease.

However, some evidence suggests that the same factors that put you at risk of heart disease may also
increase the chance that you'll develop Alzheimer's. Examples include:

 Lack of exercise
 Smoking

 High blood pressure

 High cholesterol

 Poorly controlled diabetes

These risk factors are also linked to vascular dementia, a type of cognitive decline caused by damaged
blood vessels in the brain. Many people with cognitive decline have brain changes characteristic of
both Alzheimer's disease and vascular dementia. Some researchers think that each condition helps
fuel the damage caused by the other.

Working with your health care team on a plan to control these factors will help protect your heart —
and may also help reduce your risk of dementia.

Lifelong learning and social engagement

Studies have found an association between lifelong involvement in mentally and socially stimulating
activities and reduced risk of Alzheimer's disease.

Factors that may reduce your risk of Alzheimer's include:

 Higher levels of formal education

 A stimulating job

 Mentally challenging leisure activities, such as reading, playing games or playing a musical
instrument

 Frequent social interactions

Scientists can't yet explain this link. One theory is that using your brain develops more cell-to-cell
connections, which protects your brain against the impact of Alzheimer-related changes. Another
theory is that it may be harder to measure cognitive decline in people who exercise their minds
frequently or who have more education. Still another explanation is that people with Alzheimer's
disease may be less inclined to seek out stimulating activities years before their disease can be
diagnosed.

Complications
Memory loss, impaired judgment and other cognitive changes caused by Alzheimer's can complicate
treatment for other health conditions. A person with Alzheimer's disease may not be able to:

 Communicate that he or she is experiencing pain — for example, from a dental problem

 Report symptoms of another illness

 Follow a prescribed treatment plan

 Notice or describe medication side effects

 As Alzheimer's disease progresses, brain changes begin to affect physical functions such as
swallowing, balance, and bowel and bladder control. These effects can increase vulnerability to
additional health problems such as:

 Pneumonia and other infections. Difficulty swallowing may cause people with Alzheimer's
to inhale (aspirate) food or liquid into their airways and lungs, which can lead to pneumonia. Inability
to control emptying of the bladder (urinary incontinence) may require placement of a tube to drain
and collect urine (urinary catheter). Having a catheter increases your risk of urinary tract infections,
which can lead to more-serious, life-threatening infections.

 Injuries from falls. People with Alzheimer's become increasingly vulnerable to falling. Falls
can lead to fractures. In addition, falls are a common cause of serious head injuries, such as
concussion or bleeding in the brain.

Tests and diagnosis

There's no specific test today that confirms you have Alzheimer's disease. Your doctor will make a
judgment about whether Alzheimer's is the most likely cause of your symptoms based on the
information you provide and results of various tests that can help clarify the diagnosis.

Doctors can nearly always determine whether you have dementia, and they can accurately identify
whether your dementia is due to Alzheimer's disease about 90 percent of the time. Alzheimer's
disease can be diagnosed with complete accuracy only after death, when microscopic examination of
the brain reveals the characteristic plaques and tangles.

To help distinguish Alzheimer's disease from other causes of memory loss, doctors now typically rely
on the following types of tests.

Physical and neurological exam

Your doctor will perform a physical exam, and is likely to check your overall neurological health by
testing your:

 Reflexes

 Muscle tone and strength

 Ability to get up from a chair and walk across the room

 Sense of touch and sight

 Coordination

 Balance

Lab tests
Blood tests may help your doctor rule out other potential causes of memory loss and confusion, such
as thyroid disorders or vitamin deficiencies.

Mental status testing

Your doctor may conduct a brief mental status test to assess your memory and other thinking skills.
Short forms of mental status testing can be done in about 10 minutes. Commonly used tests include
the following tasks and questions:
 Draw a clock face with the hands showing a time specified by the examiner.

 Name today's date and your location.

 Copy a design, such as two intersecting pentagons.

 Follow a three-step command.

 Remember a list of three words spoken to you by the examiner.

 Follow a written instruction.

 Write down a complete sentence.

 Count backward from 100 by sevens.

Neuropsychological testing
Your doctor may recommend a more extensive assessment of your thinking and memory. Longer
forms of neuropsychological testing, which can take several hours to complete, may provide additional
details about your mental function compared with others' of a similar age and education level. This
type of testing may be especially helpful if your doctor thinks you may have a very early stage of
Alzheimer's disease or another dementia. These tests may also help identify patterns of change
associated with different types of dementia.

Brain imaging
Images of the brain are now used chiefly to pinpoint visible abnormalities related to conditions other
than Alzheimer's disease — such as strokes, trauma or tumors — that may cause cognitive change.
New imaging applications — currently used primarily in major medical centers or in clinical trials —
may enable doctors to detect specific brain changes caused by Alzheimer's.

Brain-imaging technologies include:

 Computerized tomography (CT). For a CT scan, you'll lie on a narrow table that slides into
a small chamber. X-rays pass through your body from various angles, and a computer uses this
information to create cross-sectional images, or slices, of your brain. This test is painless and takes
about 20 minutes. It's currently used chiefly to rule out tumors, strokes and head injuries.

 Magnetic resonance imaging (MRI). An MRI uses radio waves and a strong magnetic field
to produce detailed images of your brain. You lie on a narrow table that slides into a tube-shaped MRI
machine, which makes loud banging noises while it produces images. The entire procedure can take
an hour or more. MRIs are painless, but some people feel claustrophobic inside the machine and are
disturbed by the noise. MRIs are currently used primarily to rule out other conditions that may
account for cognitive symptoms. In the future, they may be used to measure the volume of your brain
tissue and whether shrinkage in brain regions implicated in Alzheimer's disease has occurred.

 Positron emission tomography (PET). During a PET scan, you'll be injected in a vein with a
low-level radioactive tracer. You'll lie on a table while an overhead scanner tracks the tracer's flow
through your brain. The tracer may be a special form of glucose (sugar) that shows overall activity in
various brain regions. This can show which parts of your brain aren't functioning well. New PET
techniques may be able to detect your brain level of plaques — one hallmark abnormality linked to
Alzheimer's.

Future diagnostic tools

Researchers are working with doctors to develop new diagnostic tools to help clinch the diagnosis of
Alzheimer's. Another important goal is to detect the disease before it causes the symptoms targeted
 by current diagnostic techniques — at the stage when Alzheimer's may be most treatable as new
drugs are discovered. New tools under investigation include:

 Additional approaches to brain imaging

 Measuring levels of key proteins or protein patterns in blood or spinal fluid

 More-sensitive mental status tests

Treatments and drugs

Drugs
Current Alzheimer's medications can help for a time with memory symptoms and other cognitive
changes. Two types of drugs are currently used to treat cognitive symptoms:

 Cholinesterase inhibitors.These drugs work by boosting levels of a cell-to-cell

communication chemical depleted in the brain by Alzheimer's disease. Commonly prescribed
cholinesterase inhibitors include donepezil (Aricept), galantamine (Razadyne) and rivastigmine
(Exelon). The main side effects of these drugs include diarrhea, nausea and vomiting.

 Memantine (Namenda). This drug works in another brain cell communication network. It's
sometimes used in combination with a cholinesterase inhibitor. Memantine's most common side effect
is dizziness.

Creating a safe and supportive environment

Adapting the living situation to the needs of a person with Alzheimer's is an important part of any
treatment plan. You can take these steps to support a person's sense of well-being and continued
ability to function:

 Remove excess furniture, clutter and throw rugs.

 Install sturdy handrails on stairways and in bathrooms.

 Ensure that shoes and slippers are comfortable and provide good traction.

 Reduce the number of mirrors. People with Alzheimer's may find images in mirrors confusing
or frightening.

Exercise
Regular exercise is an important part of everybody's wellness plan — and those with Alzheimer's are
no exception. Activities like a daily 30-minute walk can help improve mood and maintain the health of
joints, muscles and your heart. Exercise can also promote restful sleep and prevent constipation. Make
sure that the person with Alzheimer's carries identification if she or he walks unaccompanied.

People with Alzheimer's who develop trouble walking may still be able to use a stationary bike or enjoy
chair exercises. You may be able to find exercise programs geared to older adults on TV or on DVDs.

Nutrition
People with Alzheimer's may forget to eat, lose interest in preparing meals or not eat a healthy
combination of foods. They may also forget to drink enough, leading to dehydration and constipation.

Offer:
 High-calorie, healthy shakes and smoothies. You can supplement milkshakes with protein
powders (available at grocery stores, drugstores and discount retailers) or use your blender to make
smoothies featuring your favorite ingredients.

 Water, juice and other healthy beverages. Try to ensure that a person with Alzheimer's
drinks at least several full glasses of liquids every day. Avoid beverages with caffeine, which can
increase restlessness, interfere with sleep and trigger frequent need to urinate.

Certain nutritional supplements are marketed as "medical foods" specifically to treat Alzheimer's
disease. The Food and Drug Administration (FDA) does not approve products marketed as medical
foods. Despite marketing claims, there's no definitive data showing that any of these supplements is
beneficial or safe.