Alzheimer’s disease

Alzheimer’s disease is the most common cause of dementia. The word dementia describes a set of
symptoms that can include memory loss and difficulties with thinking, problem-solving or
language. These symptoms occur when the brain is damaged by certain diseases, including
Alzheimer’s disease.

Symptoms

Alzheimer’s often develops slowly over several years. It is not always obvious to begin with and
symptoms can overlap with other illnesses. Sometimes it can be difficult to distinguish Alzheimer’s
from mild forgetfulness which can be seen in normal ageing. Everyone with Alzheimer’s will
experience symptoms in their own way. Early signs usually include difficulties forming new
memories, but people may also experience language or spatial awareness difficulties. Typical early
symptoms of Alzheimer’s may include:
Memory
Regularly forgetting recent events, names and faces.
Repetition
Becoming increasingly repetitive, e.g. repeating questions after a very short interval.
Disorientation
Disorientation, especially away from normal surroundings. Getting lost.
Language
Problems finding the right words.
Mood and behavior
Some people become disinterested in what’s happening around them, become irritable, or lose
confidence.
Misplacing things
Regularly misplacing items or putting them in odd places.
Confusion
Uncertainty about the time of day.

As the disease develops

Alzheimer’s gets worse over time, but the speed of change varies between people. As Alzheimer’s
progresses:
Memory and thinking skills
People will find that their ability to remember, think and make decisions worsens.
Communication
Communication and language become more difficult.
Behavior
A person’s behavior may change and some people can become sad or depressed. Anger and
agitation become more common and people may develop anxieties or phobias.
Hallucinations
People may experience hallucinations, where they may see things or people that aren’t there.
Restlessness
Problems with sleeping and restlessness at night often occur.
Unsteadiness
People may become increasingly unsteady on their feet and fall more often.
Daily activities
People gradually require more help with daily activities like dressing, toileting and eating.

Who gets Alzheimer’s disease?

Most people who develop Alzheimer’s disease do so after the age of 65, but people under this age
can also develop it. This is called early-onset Alzheimer’s disease, a type of young-onset dementia.
In the UK there are over 40,000 people under the age of 65 with dementia. Developing Alzheimer’s
disease is linked to a combination of factors, explained in more detail below. Some of these risk
factors (such as lifestyle) can be controlled, but others (such as age and genes) cannot.

Risk factors for dementia.

Age
Age is the greatest risk factor for Alzheimer’s. The disease mainly affects people over 65. Above this
age, a person’s risk of developing Alzheimer’s disease doubles approximately every five years. One
in six people over 80 have dementia.
Gender
For reasons that are not clear, there are about twice as many women as men over 65 with
Alzheimer’s disease. This difference is not fully explained by the fact that women on average live
longer than men. It may be that Alzheimer’s in women is linked to a lack of the hormone estrogen
after the menopause.
Genetic inheritance
Many people fear that the disease may be passed down to them from a parent or grandparent.
Scientists are investigating the genetic background to Alzheimer’s. There are a few families with a
very clear inheritance of Alzheimer’s from one generation to the next. In such families the dementia
tends to develop well before age 65. However, Alzheimer’s disease that is so strongly inherited is
extremely rare.
In the vast majority of people, the influence of genetics on risk of Alzheimer’s disease is much more
subtle. A number of genes are known to increase or reduce a person’s chances of developing
Alzheimer’s. For someone with a close relative (parent or sibling) who was diagnosed with
Alzheimer’s when over 65, their own risk of developing the disease is increased. However, this does
not mean that Alzheimer’s is inevitable, and everyone can reduce their risk by living a healthy
lifestyle. People with Down’s syndrome are at particular risk of developing Alzheimer’s disease,
because of a difference in their genetic makeup.
Health and lifestyle
Medical conditions such as diabetes, stroke and heart problems, as well as high blood pressure, high
cholesterol and obesity in mid-life, are all known to increase the risk of both Alzheimer’s disease
and vascular dementia. Anyone can reduce their risk by keeping these under control. Depression is
a probable risk factor for dementia; getting it treated early is important. People who adopt a
healthy lifestyle, especially from mid-life onwards, are less likely to develop Alzheimer’s disease.
This means taking regular physical exercise and keeping to a healthy weight, not smoking, eating a
healthy balanced diet and drinking only in moderation. Leading an active lifestyle that combines
regular physical, social and mental activity will help to lower risk.

Diagnosis

Anyone who is concerned that they may have Alzheimer’s disease (or any other form of dementia)
should seek help from their GP. If someone does have dementia, an early diagnosis has many
benefits: it provides an explanation for the person’s symptoms; it gives access to treatment, advice
and support; and it allows them to prepare for the future and plan ahead. There is no single test for
Alzheimer’s disease. The GP will first need to rule out conditions that can have similar symptoms,
such as infections, vitamin and thyroid deficiencies (from a blood test), depression and side effects
of medication. The doctor will also talk to the person, and where possible someone who knows
them well, about their medical history and how their symptoms are affecting their life. The GP or a
practice nurse may ask the person to do some tests of mental abilities. The GP may feel able to
make a diagnosis of Alzheimer’s at this stage. If not, they will generally refer the person to a
specialist. This could be an old-age psychiatrist (who specializes in the mental health of older
people) often based in a memory service. Or it might be a geriatrician (who specializes in the
physical health of older people), a neurologist (who specializes in conditions of the brain and
nervous system) or a general adult psychiatrist (who specializes in mental health in adults) in a
hospital. The specialist will assess the person’s symptoms, and how they developed, in more detail.
In Alzheimer’s disease there will usually have been a gradual worsening of memory over several
months. A family member may be more aware of these changes than the person with suspected
Alzheimer’s is themselves.
The person’s memory, thinking and other mental abilities will also be assessed further with a pen-
and-paper test. When someone with Alzheimer’s is tested, they will often forget things quite
quickly. They will often not be able to recall them a few minutes later even when prompted.
The person may undergo a brain scan, which can show whether certain changes have taken place in
the brain. There are a number of different types of brain scan. The most widely used are CT
(computerised tomography) and MRI (magnetic resonance imaging). A brain scan may rule out
certain conditions such as stroke, tumour or a build-up of fluid inside the brain. These can have
symptoms similar to those of Alzheimer’s. It may also clarify the type of dementia. In a person with
early Alzheimer’s disease a brain scan may show that the hippocampus and surrounding brain
tissue have shrunk.
The diagnosis should be communicated clearly to the person and usually also to those closest to
them, along with a discussion about the next steps.

Treatment and support

There are several treatments available to help with the symptoms of Alzheimer’s.
Non-drug treatments
Cognitive stimulation activities are designed to stimulate thinking skills and engage people who
have Alzheimer’s. They are often group-based and include games, with an emphasis
on enjoyment. The benefits of cognitive stimulation for people with Alzheimer’s could include
improvement in memory, thinking skills and quality of life.People with mild to moderate
dementia, including Alzheimer’s, should be given the opportunity to participate in cognitive
stimulation programmes, if available. You can discuss your options with your doctor.
Drug treatments - Cholinesterase inhibitors
People with mild to moderate Alzheimer’s disease could benefit from taking a cholinesterase
inhibitor. These drugs work by increasing the amount of a chemical called acetylcholine which
helps messages to travel around the brain. Cholinesterase inhibitors do not prevent the disease
from progressing, but may help people to function at a slightly higher level than they would do
without the drug. There are three cholinesterase inhibitors to treat Alzheimer’s: donepezil
(Aricept) , rivastigmine (Exelon),galantamine (Reminyl).These are available on NHS
prescription for people with mild and moderate stage Alzheimer’s. Some people with
Alzheimer’s find that their condition improves by taking a cholinesterase inhibitor. This may
include improvement in thinking, memory, communication or day-to-day activities. Others may
not notice an effect. Some people have side effects from these drugs. The most Common are
feeling sick, vomiting, diarrhea, being unable to sleep, muscle cramp and tiredness. These effects
are often mild and usually don’t last long. Not everyone will have side effects.
Drug treatment – Memantine
Memantine (Ebixa or Axura) is recommended for people with severe Alzheimer’s disease, and
for people with moderate Alzheimer’s if cholinesterase inhibitors don’t help or are not suitable.
Memantine does not stop the disease from progressing but can help with some symptoms.
Some people taking memantine may not notice any effect at all. Others may find that their
condition stays the same,when they would have expected it to decline. Some people experience
side effects when taking memantine. The most common side effects are headaches, dizziness,
drowsiness and constipation. These are usually short-term effects.
Treatments for depression, agitation,anxiety and aggression
People with depression or anxiety in Alzheimer’s may be offered social support or psychological
treatments, such as cognitive behavioural therapy (CBT), to help with symptoms.CBT provides
an opportunity for people to talk about their concerns with a specialist, and aims to help people
develop different ways of thinking and behaving. People with more severe symptoms may also
be offered an antidepressant drug, although these are not always suitable for someone with
Alzheimer’s. Your doctor will carefully consider what may be appropriate.
Treatments
To help relieve symptoms of agitation and aggression a doctor should review someone’s physical
and mental health and environment. This helps to identify any causes or triggers which could be
removed. Approaches such as aromatherapy or music therapy may also be considered. This is
likely to depend on your preference as well as the availability of treatments.In some
circumstances antipsychotic drugs such as risperidone (Risperdal) may be used to relieve very
severe symptoms. These drugs are not suitable for everyone and your doctor will carefully
consider what is appropriate. These drugs can have serious side effects and their use should be
carefully monitored.

Support

Alzheimer’s has a huge impact on someone’s life, as well as on their family and careers. There is
practical and emotional support available to help. Accessing services and support can make a
positive difference to someone with dementia and their family. Some services are provided by local
authorities, others can be arranged through GPs.Many organizations provide information, support
and care services to people affected by dementia, as well as families and careers.