Alzheimer’s disease~

Alzheimer’s disease is a brain disorder named for German physician Alois Alzheimer, who first described it in 1906. Scientists have learned a great deal about Alzheimer’s disease in the century since Dr. Alzheimer first drew attention to it. Today we know that Alzheimer’s:

• Is a progressive and fatal brain disease. As many as 5.3 million Americans are living with Alzheimer’s disease. Alzheimer's destroys brain cells, causingmemory loss and problems with thinking and behavior severe enough to affect work, lifelong hobbies or social life. Alzheimer’s gets worse over time, and it is fatal. 

• Is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer’s disease accounts for 50 to 80 percent of dementia cases. Other types of dementia include vascular dementia, mixed dementia, dementia with Lewy bodies and frontotemporal dementia.
• Has no current cure. But treatments for symptoms, combined with the right services and support, can make life better for the millions of Americans living with Alzheimer’s. There is an accelerating worldwide effort under way to find better ways to treat the disease, delay its onset, or prevent it from developing.

About Dr. Alzheimer

At a scientific meeting in November 1906, German physician Alois Alzheimer presented the case of “Frau Auguste D.,” a 51-year-old woman brought to see him in 1901 by her family. Auguste had developed problems with memory, unfounded suspicions that her husband was unfaithful, and difficulty speaking and understanding what was said to her. Her symptoms rapidly grew worse, and within a few years she was bedridden. She died in Spring 1906.

Dr. Alzheimer had never before seen anyone like Auguste D., and he gained the family’s permission to perform an autopsy. In Auguste’s brain, he saw dramatic shrinkage, especially of the cortex, the outer layer involved in memory, thinking, judgment and speech. Under the microscope, he also saw widespread fatty deposits in small blood vessels, dead and dying brain cells, and abnormal deposits in and around cells.

The condition entered the medical literature in 1907, when Alzheimer published his observations about Auguste D. In 1910, Emil Kraepelin, a psychiatrist noted for his work in naming and classifying brain disorders, proposed that the disease be named after Alzheimer.

Alzheimer's and the brain

Just like the rest of our bodies, our brains change as we age. Most of us notice some slowed thinking and occasional problems with remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work are not a normal part of aging. They may be a sign that brain cells are failing. 

The brain has 100 billion nerve cells (neurons). Each nerve cell communicates with many others to form networks. Nerve cell networks have special jobs. Some are involved in thinking, learning and remembering. Others help us see, hear and smell. Still others tell our muscles when to move. In Alzheimer’s disease, as in other types of dementia, increasing numbers of brain cells deteriorate and die.  

Early-stage and younger-onset Alzheimer's disease

Early-stage is the early part of Alzheimer’s disease when problems with memory, thinking and concentration may begin to appear in a doctor’s interview or medical tests. Individuals in the early-stage typically need minimal assistance with simple daily routines. At the time of a diagnosis, an individual is not necessarily in the early stage of the disease; he or she may have progressed beyond the early stage.  

The term younger-onset refers to Alzheimer's that occurs in a person under age 65. Younger-onset individuals may be employed or have children still living at home. Issues facing families include ensuring financial security, obtaining benefits and helping children cope with the disease. People who have younger-onset dementia may be in any stage of dementia – early, middle or late. Experts estimate that some 500,000 people in their 30s, 40s and 50s have Alzheimer's disease or a related dementia.

The difference between Alzheimer's and typical age-related changes

Signs of Alzheimer's	Typical age-related changes
Poor judgment and decision making	Making a bad decision once in a while
Inability to manage a budget	Missing a monthly payment
Losing track of the date or the season	Forgetting which day it is and remembering later
Difficulty having a conversation	Sometimes forgetting which word to use
Misplacing things and being unable to retrace steps to find them	Losing things from time to time

Risk factors

Age
The greatest known risk factor for Alzheimer’s is increasing age. Most individuals with the disease are 65 or older. The likelihood of developing Alzheimer’s doubles about every five years after age 65. After age 85, the risk reaches nearly 50 percent.  
Family history
Another risk factor is family history. Research has shown that those who have a parent, brother or sister, or child with Alzheimer’s are more likely to develop Alzheimer’s. The risk increases if more than one family member has the illness. When diseases tend to run in families, either heredity (genetics) or environmental factors or both may play a role.   
Genetics (heredity)
Scientists know genes are involved in Alzheimer’s. There are two categories of genes that can play a role in determining whether a person develops a disease. Alzheimer genes have been found in both categories:

1)  Risk genes increase the likelihood of developing a disease, but do not guarantee it will happen. 

2)  Deterministic genes directly cause a disease, guaranteeing that anyone who inherits them will develop the disorder.

Treatments for behavioral and psychiatric symptoms

For many individuals, Alzheimer's disease affects the way they feel and act in addition to its impact on memory and other thought processes. As with cognitive symptoms, the chief underlying cause is progressive destruction of brain cells. In different stages of Alzheimer's, people may experience:

• Physical or verbal outbursts
• General emotional distress
• Restlessness, pacing, shredding paper or tissues and yelling
• Hallucinations (seeing, hearing or feeling things that are not really there)
• Delusions (firmly held belief in things that are not real)

Many diagnosed individuals and their families find these symptoms the most challenging and distressing effects of the disease. For more information about behaviors in Alzheimer's disease, please see the Behaviors section.

There are two approaches to managing behavioral symptoms: using medications specifically to control the symptoms or non-drug strategies. Non-drug approaches should always be tried first.

Non-drug approaches

Steps to developing successful non-drug treatments include:

• Recognizing that the person is not just "acting mean or ornery," but is having further symptoms of the disease
• Understanding the cause and how the symptom may relate to the experience of the person with Alzheimer's
• Changing the person's environment to resolve challenges and obstacles to comfort, security and ease of mind

Everyone who develops behavioral symptoms should receive a thorough medical exam, especially if symptoms appear suddenly. Even though the chief cause of behavioral symptoms is the effect of Alzheimer's disease on the brain, an exam may reveal treatable conditions that are contributing to the behavior.

Treatable conditions may include:

• Drug side effects. Many people with Alzheimer's take prescription medications for other health problems. Drug side effects or interactions between drugs can sometimes affect behavior.
• Physical discomfort. As the disease gets worse, those with Alzheimer's have more and more difficulty communicating about their experience. As a result, symptoms of common illnesses may sometimes go undetected. Pain from infections of the urinary tract, ear or sinuses may lead to restlessness or agitation. Discomfort from a full bladder, constipation, or feeling too hot or too cold may also be expressed through behavior.
• Uncorrected problems with hearing or vision. These can contribute to confusion and frustration and foster a sense of isolation.

Factors in the environment may also trigger behaviors. Events or changes in a person's surroundings may contribute to a sense of uneasiness, or increase fear or confusion.

Situations affecting behavior may include:

• Moving to a new residence or nursing home
• Changes in the environment or caregiver arrangements
• Misperceived threats
• Admission to a hospital
• Being asked to bathe or change clothes
• Fear and fatigue resulting from trying to make sense out of an increasingly confusing world

Potential solutions

• Monitor personal comfort. Check for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation. Maintain a comfortable room temperature.
• Avoid being confrontational or arguing about facts; instead, respond to the feeling behind what is being expressed. For example, if a person expresses a wish to go visit a parent who died years ago, don't point out that the parent is dead. Instead, say, "Your mother is a wonderful person. I would like to see her too."
• Redirect the person's attention. Try to remain flexible, patient and supportive.
• Create a calm environment. Avoid noise, glare, insecure space, and too much background distraction, including television.
• Simplify the environment, tasks and solutions.
• Allow adequate rest between stimulating events.
• Provide a security object or privacy.
• Equip doors and gates with safety locks.
• Remove guns.

Caring for someone who has Alzheimer’s disease can be overwhelming, exhausting and stressful. A family caregiver may feel loss over changes in relationships with a loved one with Alzheimer’s, other family members and friends. During this time, it is critical that caregivers look after their own physical and mental health.