Frequently Asked Questions

Mild forgetfulness and memory delays often occur as part of the normal aging process. Older individuals simply need more time to learn a new fact or to remember an old one. We all have occasional difficulty remembering a word or someone's name; however, those with Alzheimer's disease (AD) will find these symptoms progressing in frequency and severity. Everyone, from time to time will forget where they placed their car keys; an individual with Alzheimer’s may not remember the purpose of the keys.

There has been recent interest in a condition called mild cognitive impairment (MCI). Individuals with MCI have memory impairment (pronounced forgetfulness), but are able to perform routine activities without assistance. However, MCI has been identified as a major risk factor for developing AD. While all patients who develop some form of dementia go through a period of MCI, not all patients exhibiting MCI will go on to develop AD.

Many conditions can contribute to the development of memory problems and dementia; AD is just one of them. A decline in intellectual functioning that significantly interferes with normal social relationships and daily activities is characteristic of dementia, of which AD is the most common form. AD and multi-infarct dementia (a series of small strokes in the brain) cause the vast majority of dementias in the elderly. Other possible causes of dementia-like symptoms include infections, drug interactions, a metabolic or nutritional disorder, brain tumors, depression or another progressive disease like Parkinson's disease.

If memory loss increases in frequency or severity, makes an impression on friends and family, begins to interfere with daily activities (employment tasks, social interactions, and family chores, for example), seek out qualified professional advice and evaluation by a physician with extensive knowledge, experience and interest in dementia and memory problems.

Medicare is a federal health insurance program for people age 65 or older who receive Social Security retirement benefits. To receive assistance from Medicare, a person must meet specific eligibility requirements. Medicare covers some, but not all, of the services a person with Alzheimer's disease may require. For example, the program does not cover long term healthcare. Medicaid is a federal program for certain individuals and families with low incomes and resources, typically administered by state agencies; eligibility and benefits vary from state to state. Medicaid can cover all or a portion of nursing home costs. A person with Alzheimer's can qualify for long term care only if there are minimal income and cash assets. Medicaid may be applied for by calling each state's Department of Human Services or Medicaid Assistance Program.

Dementia is a progressive deterioration of intellectual function due to the death of brain cells. Dementia can be caused by medical conditions such as hypothyroidism or stroke, drug toxicity or brain injury. Some conditions are treatable, and others cause irreversible brain damage. Alzheimer’s disease (AD) is irreversible, and in western countries, it accounts for more than half of dementia cases. Currently, the only way to diagnose AD definitively is through a brain autopsy. However, on living patients, physicians can correctly diagnose AD about 90 percent of the time based on mental and behavioral symptoms, a physical examination, and neuropsychological and laboratory tests.

A physician will normally take a history of mental and behavioral symptoms, using information provided by the patient and the family. In nearly 75 percent of cases, AD starts with the inability to remember recent events and to learn and retain new information. Early stage AD patients experience memory problems that interfere with daily living and steadily worsen. Other early AD symptoms can include difficulty managing money, driving, orientation, shopping, following instructions, abstract (conceptual) thinking and finding the right words. There may also be other problems, such as poor judgment, emotional instability and apathy. AD can be distinguished from other types of dementia in part by the symptoms exhibited, the extent to which these symptoms occur and the speed with which the disease progresses.

A physical examination will be performed to help identify and rule out other potential causes of dementia. This exam will normally include a general physical, blood tests and urinalysis. Through a blood test, for example, the physician can measure thyroid function; hypothyroidism or failure to produce sufficient thyroid hormones is common in the elderly and can cause dementia. Dementia may also be the result of a vitamin B12 deficiency which is common in the elderly, and can be measured through blood tests. Physicians may use brain scans (such as magnetic resonance imaging or MRI) to rule out other possible causes of dementia, including brain tumors, stroke, blood accumulation on the brain surface or other conditions. In addition, brain scans can show characteristic structural changes present in AD. Physicians may administer an electroencephalogram (EEG) to measure the electrical activity in the brain. Occasionally, spinal fluid may be tested through a lumbar puncture.

Neuropsychological tests identify behavioral and mental symptoms associated with brain injury or abnormal brain function. The neuropsychological tests used will depend on the symptoms and the dementia’s state of advancement. Usually, physicians start with a brief screening tool, such as the Mini-Mental Status Examination (MMSE), to help confirm that the patient is experiencing problems with intellectual functions. The MMSE includes tests of memory, attention, mathematical calculation and language. If a patient has severe dementia, further neuropsychological testing beyond the MMSE is usually not necessary. However, for patients with mild intellectual deficits, more tests may be needed to determine whether the patient is simply showing signs of advanced age or is developing AD. The patient may be referred to a neuropsychologist, who will administer a battery of tests to identify more specific deficits.

In terms of health care expenses and lost wages of both patients and their caregivers, the cost of Alzheimer's disease nationwide is estimated to be $100 billion per year. The yearly cost of caring for one Alzheimer's patient ranges from $18,400 to $36,100 depending on the stage of the disease. The average direct cost of caring for an Alzheimer's patient from diagnosis to death is $174,000. According to MetLife market surveys, on average, home health aides cost $19 per hour, the annual cost for an assisted living facility is $34,860, and the daily cost of a private room in a nursing home is $203, which calculates to $74,095 per year.

Familial Alzheimer’s disease (FAD) or early-onset Alzheimer’s is an inherited, rare form of the disease, affecting less than 10 percent of Alzheimer’s disease patients. FAD develops before age 65, in people as young as 35. It is caused by one of three gene mutations on chromosomes 1, 14 and 21. If even one of these mutated genes is inherited from a parent, the person will almost always develop FAD. All offspring in the same generation have a 50/50 chance of developing FAD if one parent has it.

The majority of Alzheimer’s disease cases are late-onset, usually developing after age 65. Late-onset Alzheimer’s disease has no known cause and shows no obvious inheritance pattern. However, in some families, clusters of cases are seen. Although a specific gene has not been identified as the cause of late-onset Alzheimer’s disease, genetic factors do appear to play a role in the development of this form of the disease. A gene called Apolipoprotein E (ApoE) appears to be a risk factor for the late-onset form of AD. There are three forms of this gene: ApoE2, ApoE3 and ApoE4. Roughly one in four Americans has ApoE4 and one in twenty has ApoE2. While inheritance of ApoE4 increases the risk of developing AD, ApoE2 substantially protects against the disease.

Scientists believe that several other genes may influence the development of Alzheimer’s disease. Two of these genes, UBQLN1 and SORL1, are located on chromosomes 9 and 11. Researchers have also identified three genes on chromosome 10, one of which produces an insulin degrading enzyme that may contribute to the disease. A gene, called TOMM40, appears to significantly increase one’s susceptibility to developing Alzheimer’s when other risk factors are present, such as having the ApoE-4 gene. Several recently discovered genes that influence Alzheimer’s disease risk are CLU (also called APOJ) on chromosome 8, which produces a protein called clusterin, PICALM on chromosome 11 and CR1 on chromosome 1.

Genetic risk factors alone are not enough to cause the late-onset form of Alzheimer’s disease, so researchers are actively exploring education, diet and environment to learn what role they might play in the development of this disease.

There is a test currently available that can identify which forms of apolipoprotein (ApoE) are present in the blood. One form, ApoE4, is associated with an already well-studied condition, heart disease, and appears to increase the risk of developing Alzheimer’s as well. However, this blood can only detect whether ApoE4 is present, not if and when the person will develop Alzheimer's.

In 2007, researchers at Stanford University published some promising study results in which 18 blood proteins (and resultant chemical signals) were tested to determine the risk of advancement from mild cognitive impairment (MCI) to Alzheimer’s disease. In the study, the scientists were able to predict whether the subjects would progress to Alzheimer’s with 90% accuracy. However, this study tested a relatively small number of people, and larger studies will need to be undertaken.