ALZHEIMERS DISEASE

Types of Alzheimer’s Disease

Nearly everyone with Alzheimer’s disease has the same symptoms — memory loss, confusion, trouble with once-familiar tasks, and making decisions. Though the effects of the disease are similar, there are three different types.

• Early-onset Alzheimer’s. This type happens to people who are younger than age 65. Often, they’re in their 40s or 50s when they’re diagnosed with the disease
• Late-onset Alzheimer’s. This is the most common form of the disease, which happens to people age 65 and older.
• Familial Alzheimer’s disease (FAD). In families that are affected, members of at least two generations have had the disease.

Ten warning signs and symptoms of Alzheimer’s disease:

1. Memory loss (forgetting important dates or events)
2. Difficulty performing familiar tasks (problems remembering the rules to a favorite game or driving to a familiar place)
3. Problems talking with others or writing (For example, a person may struggle to find the right words for items or names of people or places.)
4. Disorientation to time and place (for example, forgetting where they are, loosing track of the seasons, dates, and passage of time)
5. Poor or decreased judgment (for example, poor hygiene or poor judgment when dealing with money or financial matters)
6. Vision problems (problems reading or judging distances)
7. Problems with solving problems or planning (for example, problems tracking regular bills or following familiar recipes)
8. Misplacing things (for example, a person put items in unusual places and then are not able to retrace their steps find them again)
9. Changes in mood, personality, or behavior
10. Loss of initiative or withdrawal from social or work activities

DIAGNOSIS

To help distinguish Alzheimer’s disease from other causes of memory loss, doctors now typically rely on the following types of tests.

Physical and neurological exam

Your doctor will perform a physical exam, and is likely to check your overall neurological health by testing your:

• Reflexes
• Muscle tone and strength
• Ability to get up from a chair and walk across the room
• Sense of sight and hearing
• Coordination
• Balance

Lab tests

Blood tests may help your doctor rule out other potential causes of memory loss and confusion, such as thyroid disorders or vitamin deficiencies.

Mental status testing

Your doctor may conduct a brief mental status test to assess your memory and other thinking skills. Short forms of mental status testing can be done in about 10 minutes.

Neuropsychological testing

Your doctor may recommend a more extensive assessment of your thinking and memory. Longer forms of neuropsychological testing, which can take several hours to complete, may provide additional details about your mental function compared with others’ of a similar age and education level.

This type of testing may be especially helpful if your doctor thinks you may have a very early stage of Alzheimer’s disease or another dementia. These tests may also help identify patterns of change associated with different types of dementia and can help doctors estimate your ability to safely manage important activities, such as financial and medical decision-making.

Brain imaging

Images of the brain are now used chiefly to pinpoint visible abnormalities related to conditions other than Alzheimer’s disease — such as strokes, trauma or tumors — that may cause cognitive change. New imaging applications — currently used primarily in major medical centers or in clinical trials — may enable doctors to detect specific brain changes caused by Alzheimer’s.

Brain-imaging technologies include:

• Magnetic resonance imaging (MRI). An MRI uses radio waves and a strong magnetic field to produce detailed images of your brain. You lie on a narrow table that slides into a tube-shaped MRI machine, which makes loud banging noises while it produces images. MRIs are painless, but some people feel claustrophobic inside the machine and are disturbed by the noise.
MRIs are used to rule out other conditions that may account for or be adding to cognitive symptoms. In addition, they may be used to assess whether shrinkage in brain regions implicated in Alzheimer’s disease has occurred.
• Computerized tomography (CT). For a CT scan, you’ll lie on a narrow table that slides into a small chamber. X-rays pass through your body from various angles, and a computer uses this information to create cross-sectional images (slices) of your brain. It’s currently used chiefly to rule out tumors, strokes and head injuries.
• Positron emission tomography (PET). During a PET scan, you’ll be injected in a vein with a low-level radioactive tracer. You’ll lie on a table while an overhead scanner tracks the tracer’s flow through your brain.
The tracer may be a special form of glucose (sugar) that shows overall activity in various brain regions. This can show which parts of your brain aren’t functioning well. New PET techniques may be able to detect your brain level of plaques and tangles, the two hallmark abnormalities linked to Alzheimer’s.

RECOMMENDED MEDICATIONS

There are no medicines that can prevent or cure Alzheimer’s disease. Medicine may help some people function better by temporarily reducing memory loss and thinking problems. Other medicines may be needed to manage behaviors or symptoms that are causing strain for the person who has Alzheimer’s disease and/or for his or her caregivers.

Medicines for memory problems:

• Cholinesterase inhibitors treat symptoms of mental decline in people who have mild to moderate Alzheimer’s disease. They include donepezil, galantamine, and rivastigmine. Donepezil can be used to help those who have severe Alzheimer’s disease.
• Memantine (Namenda) treats more severe symptoms of confusion and memory loss from Alzheimer’s disease.

Because these medicines work differently, they are sometimes used together (for example, memantine and donepezil).

These medicines may temporarily help improve memory and daily functioning in some people who have Alzheimer’s disease. The improvement varies from person to person. These medicines don’t prevent the disease from getting worse. But they may slow down symptoms of mental decline.

The main decision about using these usually isn’t whether to try a medicine but when to begin and stop treatment. Treatment can be started as soon as Alzheimer’s disease is diagnosed. If the medicines are effective, they are continued until the side effects outweigh the benefits or until the person no longer responds to the medicines.

Medicines for behavior problems

Other medicines may be tried to treat anxiety, agitated or hostile behavior, sleep problems, frightening or disruptive false beliefs (delusions), suspicion of others (paranoia), or hallucinations (seeing or hearing things that aren’t there).

Before deciding to use medicine for behavior problems, try to see what is causing the behavior. If you know the cause, you may be able to find better ways of dealing with that behavior. You may be able to avoid treatment with medicine and the side effects and costs that come with it.

Medicines generally are used only for behavior problems when other treatments have failed. They may be needed if:

• A behavior is severely disruptive or harmful to the person or to others.
• Efforts to manage or reduce disruptive behavior by making changes in the person’s environment or routines have failed.
• The behavior is making the situation intolerable for the caregiver.
• The person has trouble telling the difference between what is and is not real (psychosis). Psychosis means the person has false beliefs (delusions) or hears or sees things that aren’t there (hallucinations).