For more questions and answers about research, science, and caregiving issues concerning Alzheimer's disease, please visit the Real Life Questions sections of our website:
What treatments are available?
Currently, there is no cure for Alzheimer's disease (AD). Many research programs, however, are pursuing promising studies focused on halting or preventing the disease process completely. For those who are currently suffering from AD, there are medications that can help control symptoms of the disease. In addition, medication treatments are also available to help manage agitation, depression, or psychotic symptoms (hallucinations or delusions), which may occur as the disease progresses.
Medications that can control depression, anxiety, and psychotic symptoms can help patients in the middle stages of AD. The medications prescribed for these symptoms are not specifically designated for AD, but they may be considered as part of the treatment plan by the supervising physician(s). Aggression, hyperactivity, and combativeness are all examples of agitated behavior. Psychotic behavior may include paranoid thoughts, delusions, or hallucinations. Generally, medications for these symptoms are considered when other alternatives have failed and/or these symptoms put the AD patient, or others, in danger.
There have been studies supporting the use of vitamin E supplements in the management of AD; however, other research has produced conflicting results. Further rigorous scientific research will help clarify this issue. There are ongoing clinical trials investigating whether the progression of AD can be slowed by taking vitamins E and C. Another clinical trial is examining whether AD or cognitive decline can be prevented by taking vitamin E and/or selenium.
In April of 2005, the results of multicenter study comparing vitamin E; Aricept (donepezil), an AD treatment drug; and placebo for delay or prevention of progression to Alzheimer’s disease in patients with mild cognitive impairment were published in the New England Journal of Medicine. Mild cognitive impairment is a transitional stage between the forgetfulness of normal aging and the more serious memory decline and other problems associated with AD. The results of the study indicated that Vitamin E had no effect on slowing the progression to AD over the course of the study. Additional research will help clarify the role of vitamin E and other antioxidants for delaying or preventing the progression to AD.
For women taking estrogen to manage the symptoms of menopause, research has suggested that the hormone may also protect the brain. Therefore, scientists have been interested in whether estrogen could reduce the risk or slow the progression of Alzheimer’s disease. Clinical trials with patients already diagnosed with Alzheimer’s disease, however, showed that estrogen had no impact on the progression of the disorder. Other studies have indicated that women who begin using estrogen after age 60 to 65 are at increased risk of developing dementia. Based on these findings, the U.S. Food and Drug Administration has recommended that women who choose to use hormone therapy (either estrogen alone or progestin plus estrogen) to help relieve the symptoms of menopause should take the medication for the shortest period of time at the lowest dose possible.
Recent research has helped clarify the neuroprotective role of estrogen taken by younger women before menopause. According to a study published in August 2007, scientists from the Mayo Clinic found that women who had one or both ovaries removed prior to menopause had an increased long-term risk of dementia or cognitive impairment. However, those who underwent ovary removal, but also had estrogen treatment until at least age 50 did not experience this higher risk. These findings suggest that if taken before menopause, the neuroprotective benefits of estrogen may outweigh the risks of side effects, such as heart problems, stroke and cognitive impairment.
Women of any age should consult with a physician about the individual risks and benefits of undergoing or considering hormone replacement therapy.
Studies suggest that brain inflammation may play a role in Alzheimer’s disease damage, and that nonsteroidal anti-inflammatory drugs (NSAIDs) could potentially slow the progression of the disease. However, human clinical trials have not shown that these medications are beneficial. For example, in patients who already have Alzheimer’s, naproxen (Aleve®) and rofecoxib (Vioxx®) did not delay disease progression. Another clinical trail was examining whether celecoxib (Celebrex®) and naproxen could prevent Alzheimer’s disease in older healthy people at risk for this disease. The trial was stopped because the data indicated an apparent increase in cardiovascular and cerebrovascular events among the participants taking naproxen when compared with those on placebo. This was a precautionary measure to ensure the safety of the study’s participants. Researchers are continuing to explore the role of other anti-inflammatory drugs in the treatment or prevention of Alzheimer’s disease.
Ginkgo biloba is an extract made from the leaves of the ginkgo tree, and some studies have suggested that the extract may help in treating symptoms of Alzheimer’s disease. While there is no evidence that ginkgo biloba will prevent or cure Alzheimer’s disease, there is an ongoing clinical trial that will help determine if it can prevent dementia or delay cognitive decline in older people.
A thoughtful evaluation must be performed by a physician before taking any medications, over-the-counter drugs, supplements, or herbs. The American Health Assistance Foundation does not endorse any of these medications, vitamins, or herbs. A qualified physician should make an informed decision based on each person's medical history and current prescriptions.
Are there drugs that can delay the onset of Alzheimer's disease?
Aricept (donepezil), an Alzheimer's disease treatment drug appears to have a slowing effect—though limited—on the progression from mild cognitive impairment to Alzheimer's disease, according to a study published in the April, 2005 edition of the New England Journal of Medicine. These patients had the memory-related variety of mild cognitive impairment, a transitional stage between the forgetfulness of normal aging and the more serious memory decline and other problems associated with Alzheimer's disease. Over the first year of the three-year trial, mild cognitive impairment patients treated with Aricept had a reduced risk of progressing to Alzheimer's disease compared to patients who took placebo, an inactive pill. The study found the effect of the Aricept treatment lasted longer (up to two to three years) in those patients carrying the ApoE4 gene. Previous studies have shown those with the ApoE4 gene have a higher propensity to develop Alzheimer's than the general population. The findings of this study open the door for discussion of donepezil treatment on an individual basis for patients with mild cognitive impairment. Source: Mayo Clinic, Rochester and the National Institute on Aging
Is Alzheimer's disease hereditary?
Familial Alzheimer’s disease (FAD) is a rare form of the disease, affecting less than 10 percent of Alzheimer’s disease patients. All FAD is early-onset, meaning the disease develops before age 65. It is caused by gene mutations on chromosomes 1, 14, and 21. Even if one of these mutated genes is inherited from a parent, the person will almost always develop early-onset Alzheimer’s disease. All offspring in the same generation have a 50/50 chance of developing FAD if one of their parents had 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. The ApoE gene on chromosome 19 has three forms—ApoE2, ApoE3 and ApoE4. Studies have shown that people who inherit the E4 version of the gene are more likely to develop the late-onset form of Alzheimer’s disease. Scientists estimate that an additional four to seven genes influence the risk of developing late-onset Alzheimer’s disease. Two of these genes are UBQLN1 and SORL1, which are located on chromosomes 9 and 11, respectively.
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.
What are the stages of Alzheimer's disease?
There are three general stages of Alzheimer's disease:
Stage 1: Early in the illness, Alzheimer's patients tend to have less energy and spontaneity, though often no one notices anything unusual. They exhibit minor memory loss and mood swings, and are slow to learn and react. After a while they start to shy away from anything new and prefer the familiar. Memory loss begins to affect job performance. The patient is confused, gets lost easily, and exercises poor judgment.
Stage 2: In this stage, the Alzheimer's victim can still perform tasks independently, but may need assistance with more complicated activities. Speech and understanding become slower, and patients often lose their train of thought in mid-sentence. They may also get lost while traveling or forget to pay bills. As Alzheimer's victims become aware of this loss of control, they may become depressed, irritable an restless. The individual is clearly becoming disabled. The distant past may be recalled, while recent events are more difficult to remember. Advancing Alzheimer's has affected the victim's ability to comprehend where they are, the day and the time. Caregivers must give clear instructions and repeat them often. As the Alzheimer's victim's mind continues to slip away, the patient may invent words and not recognize familiar faces.
Stage 3: During the final stage, patients lose the ability to chew and swallow. The very essence of the person is vanishing. Memory is now very poor and no one is recognizable. Patients lose bowel and bladder control, and eventually need constant care. They become vulnerable to pneumonia, infection and other illnesses. Respiratory problems worsen, particularly when the patient becomes bedridden. This terminal stage eventually leads to death.
Who should I go to if I suspect Alzheimer's disease?
First, go to your regular family physician. The physician will probably do a variety of tests to determine if you have probable Alzheimer's. Neurologists, gerontologists, and geriatric psychiatrists may also become part of the patient's treatment team.
What kind of information should I bring to my first visit to the doctor?
Bring any medical records you have and a list of the medicines you are currently taking to your first visit. If you don't know the names of the drugs, bring the pill bottles with you. A medication or a combination of medications can sometimes cause symptoms that resemble Alzheimer's disease. It's a good idea to make a list of symptoms or behaviors in yourself or your loved one that you're concerned about and give it to your doctor.
What are the diagnostic tests used in Alzheimer's disease?
The term “dementia” refers to a progressive deterioration of intellectual functions due to a brain disease, organ failure, toxins, or other causes. In western countries, Alzheimer’s disease (AD) accounts for more than half of dementia cases.
At present, the only way to diagnose AD definitely is to perform a brain autopsy. If the patient exhibited Alzheimer-like symptoms while alive and the brain tissue contains the microscopic abnormalities typical of AD, then a definitive diagnosis of AD can be made. While the patient is alive, physicians can correctly diagnose AD about 90 percent of the time based on mental and behavioral symptoms, a physical examination, neuropsychological tests, and laboratory tests.
The physician first takes 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 that become steadily worse.
Other early AD symptoms can include difficulty with 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 causes of dementia in part by the symptoms exhibited, the extent to which these symptoms occur, and the speed with which the disease progresses.
Neuropsychological tests identify behavioral and mental symptoms that are associated with brain injury or abnormal brain function. Determining which of the many neuropsychological tests to use with a particular patient depends on the symptoms the patient is exhibiting and how far advanced the dementia is. 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. In another section, the patient copies a design, such as intersecting pentagons.
If a patient has severe dementia, further neuropsychological testing beyond the MMSE and perhaps another screening tool 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 deficits more specifically.
A number of different laboratory tests can be performed in order to help identify the cause of dementia, although the American Academy of Neurology (AAN) recommends routine use of only three tests. One is the thyroid function test, which measures blood levels of hormones secreted by the thyroid, a gland located in the neck. A condition known as hypothyroidism, in which the thyroid fails to produce sufficient thyroid hormones, is common in the elderly and, in some cases, can cause dementia. Another test involves measuring the level of vitamin B12 in the blood. Vitamin B12 deficiency is also common in the elderly and can cause dementia.
Finally, the AAN recommends a brain scan, using computed tomography or structural magnetic resonance imaging. This can rule out other possible causes of dementia, including brain tumors, stroke, blood accumulation on the brain surface, or other conditions. In addition, the appearance in the brain scan of characteristic structural changes that occur in the brains of AD patients can lend support to an AD diagnosis.
Using the patient’s history of symptoms and the results from the physical examination, neuropsychological tests, and laboratory tests, the physician can accurately diagnose AD in 9 out of 10 cases.
How long does Alzheimer's disease last on average?
On average, patients with Alzheimer's disease live for 8 to 10 years after they are diagnosed. It can last as long as 20 years, and always ends in death.
Is there a genetic test to see if you have a predisposition to Alzheimer's?
A blood test is available to identify which ApoE alleles a person has, because apolipoprotein is associated with an already well-studied condition, heart disease. However, this blood test cannot tell people whether they will develop Alzheimer's or when. Although some people want to know whether they will get Alzheimer's disease later in life, this type of prediction is not yet possible. In fact, some researchers believe that apoE tests or other screening measures may never be able to predict Alzheimer's with 100% accuracy.
Is there a connection between Alzheimer's disease and aluminum? Should I get rid of my aluminum pots and pans?
Metals have been implicated in neurodegenerative diseases, although it is unlikely that they are the sole cause for any of them. Interest in a possible connection between aluminum and Alzheimer's disease arose when autopsies of the brains of Alzheimer's patients revealed higher than normal concentrations of aluminum. The toxicity of aluminum has been the subject of much controversy in the past few decades. Although it is generally believed that the metal is harmless to human health, a role for aluminum in Alzheimer's disease has been suggested. The exact mechanism of aluminum toxicity is not known and a direct causal role has not been determined. Many scientists believe that the buildup of aluminum in the brain of Alzheimer's patients is the result of damage to nerve cells, rather than the cause of this damage. Some studies have even suggested that the processing of the brain tissue at autopsy may artificially raise aluminum levels. However, there is some evidence showing that aluminum compounds may increase the formation of agents called reactive oxygen species. These substances, which are constantly formed in the human body, have been shown to damage proteins and play a role in various diseases. In relation to Alzheimer's disease, these compounds may play an important role in nerve cell damage. Aluminum is also known to alter the activity of several key enzymes in the central nervous system. Further, there are also some studies showing elevated risk of Alzheimer's disease in areas where there is high concentration of aluminum in drinking water. This is in contrast to many studies examining antacid exposure and Alzheimer's disease that have been largely negative (antacids contain thousands of times more aluminum than the amounts taken in through drinking water). Exposure to aluminum from cooking utensils, baking powder, deodorants, or antacids is not sufficient to cause the disease. In total, these studies provide some evidence that potential links between aluminum and Alzheimer's disease exist, but this area requires continued research efforts.
What is the cost of Alzheimer's disease?
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 how advanced the disease is.. 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.*
Is Alzheimer's covered by Medicare/Medicaid?
Medicare is a federal health insurance program for people age 65 or older who are receiving Social Security retirement benefits. There are specific eligibility requirements in order for a person to receive assistance from this program. Medicare covers some, but not all, of the services a person with Alzheimer's disease may require. Medicaid is a federal program for certain individuals and families with low incomes and resources, administered by each state, so eligibility and benefits vary from state to state. The program is typically administered by a state agency. Medicaid can cover all or a portion of nursing home costs. A person with Alzheimer's can qualify for long-term care only if he has minimal income and cash assets. Medicaid may be applied for by calling your state's Department of Human Services or Medicaid Assistance Program.
Are memory problems an indication of Alzheimer's disease?
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 experiences when it is difficult to remember a word or someone's name; however, those afflicted 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 AD, however, may not remember what the keys are for.
There has been recent interest in a condition called Mild Cognitive Impairment (MCI), which consists of pronounced forgetfulness, but not dementia and has recently 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.
There are many conditions that may 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), it is advisable to seek out qualified professional advice. A physician with extensive knowledge, experience, and interest in dementia and memory problems should be involved in the evaluation process.
Where in my community can I go for more help or information?
For listing of local resources, please visit our Resource section.
*Source: The 2005 MetLife Market Survey of Nursing Home & Home Care Costs and the 2005 MetLife Market Survey of Assisted Living Costs
Some of the information in this section of our website was obtained from the Center for Medicare and Medicaid Services, the Alzheimer’s Disease Education and Referral Center, the World Health Organization, the National Center for Health Statistics, the National Institute on Aging, the FDA, the National Library of Medicine and the U.S. Department of Labor (Bureau of Labor Statistics).
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