Dementia of the Alzheimer’s Type Uncomplicated

Alzheimer’s disease is the most common form of dementia, a condition that slowly destroys memory and thinking skills. While there is no cure, treatments exist to help manage symptoms and slow the disease’s progression, offering hope for improving quality of life for millions of people affected worldwide.

Table of contents

• What is Alzheimer’s disease?
• Signs and symptoms
• How Alzheimer’s changes the brain
• Who gets Alzheimer’s disease?
• Difference between dementia and Alzheimer’s disease
• How is Alzheimer’s disease diagnosed?
• Treatment options
• Tips for daily care
• Support for caregivers

What is Alzheimer’s disease?

Alzheimer’s disease is the most common cause of dementia, which is a general term for loss of memory and other mental abilities severe enough to interfere with daily life. Dementia is not a specific disease but rather describes a collection of symptoms that include problems with memory, thinking, reasoning, and behavior^[1].

Alzheimer’s disease accounts for 60% to 80% of all dementia cases^[5][6]. It is a disease that affects the brain and causes a slow, progressive decline in cognitive functioning. The decline interferes with a person’s ability to perform everyday tasks and eventually leads to a complete dependence on others for care^[3].

This specific type of dementia is characterized by the buildup of abnormal clumps of proteins in the brain. These clumps, called amyloid plaques and tau tangles, disrupt the usual functioning of brain cells^[3]. The disease causes brain cells to die over time and the brain to shrink^[7].

It is important to understand that Alzheimer’s disease is not a normal part of aging. While memory changes can occur naturally as people get older, the severe memory loss and cognitive decline seen in Alzheimer’s disease goes far beyond normal aging^[2][8].

Signs and symptoms

For most people with Alzheimer’s disease, symptoms first appear in their mid-60s^[3]. Memory problems are typically one of the first signs of the disease. Many people also notice a decline in other thinking skills^[3].

Early in the disease, memory loss is mild. People may have trouble remembering recent events or conversations. They may ask the same questions repeatedly, get lost easily in familiar areas, lose items or put them in odd places, and find even simple matters confusing^[3][7].

People with Alzheimer’s may also have trouble doing everyday things such as driving a car, cooking a meal, or paying bills. They may have difficulty finding the right words, experience problems with visual and spatial abilities, or have trouble with reasoning or judgment^[3].

As the disease worsens, symptoms become more severe. People may become worried, restless, or agitated. In advanced stages, individuals lose the ability to perform simple daily tasks such as eating or walking. They may lose the ability to carry on a conversation and respond to their environment^[3][7].

The essential features of dementia include memory problems and at least one of the following: aphasia (difficulty with language), apraxia (difficulty performing physical tasks), agnosia (difficulty recognizing objects or people), or problems with executive functioning (the ability to think abstractly and to plan, start, organize, monitor, and stop complex behavior)^[9].

How Alzheimer’s changes the brain

Alzheimer’s first damages the parts of the brain involved in memory. It later affects areas responsible for language, reasoning, and social behavior. Eventually, the disease damages many other areas of the brain^[3].

A hallmark feature of Alzheimer’s is the buildup of abnormal clumps of proteins in the brain. These include amyloid plaques, which are deposits of a protein fragment called beta-amyloid, and neurofibrillary tangles, which are twisted fibers of a protein called tau. These deposits disrupt the usual communication between brain cells^[3][7].

The disease also causes a depletion of acetylcholine, a brain chemical believed to be important for memory and thinking^[16]. As Alzheimer’s progresses, the brain produces less of this chemical, and over time, even medications that help preserve it lose their effectiveness^[14].

Who gets Alzheimer’s disease?

Current estimates suggest more than 6 million Americans age 65 and older may have Alzheimer’s disease^[3]. About 6.9 million people in the United States age 65 and older live with Alzheimer’s disease, and among them, more than 70% are age 75 and older^[7].

Dementia is considered a late-life disease because it tends to develop mostly in people who are older. About 5% to 8% of all people over the age of 65 have some form of dementia, and this number doubles every five years above that age. It’s estimated that as many as half of people 85 years of age and older have dementia^[2].

Age is the biggest known risk factor for Alzheimer’s, and rates of the disease are expected to rise as the population ages. An estimated 6.7 million older adults have Alzheimer’s disease in the United States, and that number is expected to double by 2060^[6]. By 2060, nearly 14 million adults are projected to have Alzheimer’s disease in the United States^[6].

Having a close relative, like a parent or sibling, with Alzheimer’s disease increases a person’s chance of developing it. However, there are many things people can do to reduce their risk, such as being physically active and controlling blood pressure^[6].

Women are more commonly affected than men^[7]. The number of people age 65 and older who have Alzheimer’s disease and related dementias also varies by race: Blacks (14%), Hispanics (12%), Non-Hispanic whites (10%), American Indian and Alaska Natives (9%), and Asian and Pacific Islanders (8%)^[2].

Difference between dementia and Alzheimer’s disease

Dementia is a description of the state of a person’s mental function and not a specific disease. It is an “umbrella category” describing mental decline that’s severe enough to interfere with daily living^[2][5].

There are many underlying causes of dementia, including Alzheimer’s disease and Parkinson’s disease. Alzheimer’s disease is the most common underlying cause of dementia^[2].

Dementia describes a group of symptoms associated with a decline in memory, reasoning, or other thinking skills. Many different types of dementia exist, and many conditions cause it^[5]. Other common types of dementia include vascular dementia, dementia with Lewy bodies, frontotemporal dementia, and mixed dementia^[1][6].

Alzheimer’s disease is the biological process that begins with the appearance of a buildup of proteins in the form of amyloid plaques and neurofibrillary tangles in the brain^[7]. While dementia must be driven by an underlying progressive neurodegenerative disease, not all cognitive decline is considered dementia^[5].

How is Alzheimer’s disease diagnosed?

To diagnose the cause of dementia, a healthcare professional must recognize the pattern of loss of skills and function and determine what a person is still able to do^[11]. A healthcare professional reviews the medical history and symptoms and conducts a physical exam. Someone who is close to the person may be asked about symptoms as well. No single test can diagnose dementia^[11].

Several types of tests help pinpoint the problem. Cognitive and neuropsychological tests evaluate thinking ability, including memory, orientation, reasoning and judgment, language skills, and attention^[11].

A neurological evaluation checks movement, balance, senses, reflexes, and other areas^[11]. Brain scans such as CT or MRI can check for evidence of stroke, bleeding, tumor, or fluid buildup. PET scans can show patterns of brain activity and can determine whether amyloid or tau protein, hallmarks of Alzheimer’s disease, have been deposited in the brain^[11].

Simple blood tests look for changes that affect brain function, such as too little vitamin B-12 in the body or a thyroid gland that is less active than typical. Sometimes spinal fluid is examined for infection, inflammation, or markers of some diseases^[11].

Before prescribing newer treatments that target amyloid, doctors may order PET scans or an analysis of cerebrospinal fluid to evaluate whether amyloid deposits are present in the brain^[14].

Treatment options

There is no cure for Alzheimer’s disease. However, several prescription drugs are approved to help either manage the symptoms or to treat the disease itself^[10][14].

Current medications fall into two categories: drugs that change disease progression in people living with early Alzheimer’s disease, and drugs that may temporarily help with some symptoms^[12].

Medications that slow disease progression

The newest treatments approved to fight Alzheimer’s disease are immune-based anti-amyloid therapies. They work by clearing different forms of amyloid-beta in the brain. Also known as disease-modifying medications, they target the potential cause of the disease, not just the symptoms^[17].

Lecanemab and donanemab are FDA-approved immunotherapy drugs for the treatment of early Alzheimer’s. These drugs target the protein beta-amyloid to help reduce amyloid plaques. Clinical studies showed that the drugs slowed the rate of cognitive decline among some study participants over the course of 18 months and reduced the levels of amyloid in the brain^[14].

Medications for symptoms

Galantamine, rivastigmine, and donepezil are cholinesterase inhibitors prescribed for mild to moderate Alzheimer’s symptoms. These drugs may help reduce or control some cognitive and behavioral symptoms. They prevent the breakdown of acetylcholine, a brain chemical believed to be important for memory and thinking^[14][16].

As Alzheimer’s progresses, the brain produces less acetylcholine, and over time, these medicines lose their effectiveness. Because cholinesterase inhibitors work in a similar way, switching from one to another may not produce significantly different results, but a person living with Alzheimer’s may respond better to one drug versus another^[14].

Memantine is an N-methyl-d-aspartate (NMDA) receptor antagonist approved for moderate to severe Alzheimer’s disease. Short-term use can modestly improve measures of cognition, behavior, and activities of daily living. Memantine can also be used in combination with cholinesterase inhibitors. It is generally well tolerated, but whether its benefits produce clinically meaningful improvement is controversial^[16].

Although these medications can slow the progression of Alzheimer’s disease, no pharmacologic agents can reverse the progression^[16]. Current medications may help slow the mental decline^[2].

Tips for daily care

People with dementia experience a range of symptoms related to changes in thinking, remembering, reasoning, and behavior. Living with dementia presents unique challenges, but there are steps people can take to help now and in the future^[19].

Managing everyday tasks

Even simple everyday activities can become difficult to complete as the disease progresses. To help cope with changes in memory and thinking, consider strategies that can make daily tasks easier. It helps to adopt them early on so there is more time to adjust^[19][24].

Write down to-do lists, appointments, and events in a notebook or calendar. Set up automated bill payments and consider asking someone you trust to help manage finances. Have groceries delivered. Manage medications with a weekly pillbox, a pillbox with reminders like an alarm, or a medication dispenser^[19].

Try to keep a routine, such as bathing, dressing, and eating at the same time each day. Plan activities that the person enjoys and try to do them at the same time each day^[20].

Sleep habits

Dementia often changes a person’s sleeping habits. Poor sleep quality can make dementia symptoms worse. Follow a regular schedule by going to sleep and getting up at the same time each day, even on weekends or when traveling. Develop a relaxing bedtime routine with lowered lights, cool temperature, and no electronic screens. Avoid caffeine and naps late in the day^[19].

Staying active

Participating in activities you enjoy and getting exercise may help you feel better, stay social, maintain a healthy weight, and have regular sleep habits. Try to be physically active for at least 30 minutes on most or all days of the week. Aim for a mix of exercise types including endurance, strength, balance, and flexibility^[19].

Home environment

The way a home is designed and laid out can have a big impact on someone with dementia. Symptoms of memory loss, confusion, and difficulty learning new things mean that someone with dementia may forget where they are, where things are, and how things work^[27].

Better lighting in the home can help avoid confusion and reduce the risk of falls. Lighting should be bright, even, and natural as much as possible. Increase natural light during the day by making sure curtains are open and nothing is blocking the windows. Light switches should be easy to reach and use^[27].

Choose contrasting colors on walls and floors. Furniture and furnishings in bright or bold colors that contrast with the walls and floors help define spaces. A toilet seat in a contrasting color to the rest of the bathroom helps make it easier to find^[27].

Labels and signs on cupboards and doors can be helpful, such as a toilet sign on the bathroom door. Post-it notes placed at certain points around the house can serve as useful reminders^[27].

Support for caregivers

A caregiver refers to anyone who provides care for another person. Millions of people living in the United States take care of a friend or family member with Alzheimer’s disease or a related dementia^[20].

Caring for someone with Alzheimer’s is one of the toughest jobs in the world. It is stressful, physically and emotionally draining, and very expensive, as almost 15 million unpaid caregivers for people with Alzheimer’s and other dementias can attest^[23].

Daily care tips

Early on in Alzheimer’s and related dementias, people experience changes in thinking, remembering, and reasoning that affect daily life and activities. Eventually, people with these diseases will need more help with simple, everyday tasks including bathing, grooming, and dressing^[20].

Help the person write down to-do lists, appointments, and events in a notebook or calendar. When dressing or bathing, allow the person to do as much as possible without hands-on help. Buy loose-fitting, comfortable, easy-to-use clothing, such as clothes with elastic waistbands, fabric fasteners, or large zipper pulls instead of shoelaces, buttons, or buckles^[20].

Be gentle and respectful. Tell the person what you are going to do, step by step while you help them bathe or get dressed. Serve meals in a consistent, familiar place and give the person enough time to eat^[20].

To reduce sensory confusion at meals, see that the dining area is well lit. Use a plate color that contrasts with the food. Remove condiments from the table. Limit choices by putting only one food on the plate at a time and offering only one utensil. Cut food into small pieces and remind the person to eat slowly and chew each bite thoroughly^[23].

Communication and behavior changes

Speak simply and patiently. To get the person’s attention, begin by using his or her name. Use simple phrasing and short sentences, but be careful to avoid talking to the person as if he or she were a child. Give someone with Alzheimer’s time to complete a sentence or thought, and try not to interrupt^[23].

Some people with dementia show uninhibited behavior, including making inappropriate jokes, neglecting personal hygiene, exhibiting undue familiarity with strangers, or disregarding conventional rules of social conduct. Anxiety is fairly common, and some patients manifest overwhelming emotional reactions^[9].

Taking care of yourself

Although it can be challenging, set aside time each day to do something you love, whether reading a book, going for a nature walk, or sipping a cup of your favorite tea. Aim for 15-30 minutes. Making time for self-care can prevent burnout, reduce stress, and help you be your best^[25].

In addition to making time to relax, focus on general well-being. Eat a balanced diet, exercise regularly, get enough sleep, and ask for help when you need it^[25]. Consider that 60% of family caregivers report feelings of burnout^[25].