Alzheimer's Disease Frequently Asked Questions
Source: BU Alzheimer's Disease Center
What is Alzheimer’s Disease?
Alzheimer’s disease (AD) is a brain disorder that develops over a period of years and often starts with short-term memory impairment. Initially, people experience memory loss, and they may eventually develop difficulties with decision-making, language, recognizing family and friends. They may gradually develop behavior and personality changes. These losses are related to the death of neurons in the brain. AD is one of a group of disorders called dementias that are characterized by cognitive and behavioral problems. AD is by far the most common form of dementia, being the cause of approximately 75% of dementia cases either by itself or in combination with other disorders. The overall prevalence of Alzheimer’s disease in the community is estimated at about 10% in population-based studies. Alzheimer’s disease becomes more prevalent with age, with most cases being diagnosed after the age of 65.
What is dementia?
Dementia is a term used to describe a group of symptoms affecting thinking and social abilities severely enough to interfere with daily functioning. There are many causes of dementia, and Alzheimer’s disease is the most common cause of dementia. People with dementia often have memory loss, however, memory loss alone does not mean someone has dementia. Dementia indicates that a person has problems with at least two brain functions, such as memory loss and impaired judgment or language, and the inability to perform some daily activities such as paying bills.
Is there any treatment?
Currently there are no cures for AD. However, four FDA-approved medications are used to treat AD symptoms and these medications can slow the progression of the cognitive decline. These drugs help individuals carry out the activities of daily living by maintaining thinking, memory, or speaking skills. They can also help with some of the behavioral and personality changes associated with AD. However, they will not stop or reverse AD. Donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne) are medications called cholinesterase inhibitors that are often prescribed to AD symptoms, including attention, memory, and behavior. In addition to treatment with cholinesterase inhibitors, we also recommend treatment with memantine (Namenda) in patients with moderate and severe Alzheimer’s disease, and in some cases, mild AD, who we believe would benefit. Memantine (Namenda) tends to improve functional and neuropsychiatric symptoms in patients with Alzheimer’s disease more than it improves memory.
How is Alzheimer’s disease detected?
- Cognitive testing by an expert in memory disorders to check your memory, language, and thinking
- A CT or MRI scan of your brain – These are imaging tests that a doctor can use to look at structures of your brain involved in thinking in memory
- Blood work may be done to make sure that there are no vitamin deficiencies (such as Vitamin B12) or thyroid problems that could cause trouble with thinking.
Is Alzheimer’s disease genetic?
A family history of Alzheimer’s disease in an immediate family member can increase the risk of developing the disease by about two-fold. There are specific gene mutations that have been associated with early onset AD, but these cases are incredibly rare (<1% of AD patients), and most often these patients have had family members before them with early-onset AD. Patients with early-onset disease usually start to have symptoms in their 40s and 50s. Genetic testing is sometimes helpful for diagnosing AD, however, this is something you should discuss personally with your own doctor.
What is the prognosis?
The course of this disease varies from person to person, as does the rate of decline. A rule of thumb is that people decline at their own rate: those who decline quickly may continue to do so, while those who decline more slowly may continue to have a slower rate of decline. The range is typically 6-12 years from diagnosis until complete care is needed
What is mild cognitive impairment?
There are many patients who have problems with their thinking and memory, but they do not meet criteria for any type of dementia. These patients have mild cognitive impairment (MCI). MCI is a brain disorder that causes trouble with memory or thinking, but does not interfere with daily activities. The word “cognitive” has to do with memory and thinking. The word “impairment” means having trouble doing something. It is normal for adults to have slight memory problems as they get older. But the problems in MCI are more significant than those of normal aging.
Patients with MCI may go on to develop Alzheimer’s disease or another dementia at a rate of about 12% per year. The prevalence of MCI has been estimated at 15% in individuals older than 65 years, and rising with increasing age.
What are the symptoms of MCI?
Memory problems are the most common symptom of MCI. Some people have other types of thinking problems. They might have trouble concentrating, reasoning, or remembering the correct word to use.
How is MCI treated?
Although there are no FDA approved treatments for patients with mild cognitive impairment, several studies have shown that patients with MCI are improved by donepezil (Aricept), at least for 1 year if not longer. Therefore, physicians may offer their patients with MCI treatment with a cholinesterase inhibitor (such as donepezil, for example).
Other treatments may also be helpful. Many patients with MCI may become anxious and depressed because of their awareness of their problems with thinking and memory, and may benefit from an anti-depressant medication such as sertraline (Zoloft).
There are also many non-pharmacological ways to keep your brain as healthy as possible. These include:
- Getting regular exercise, such as walking, swimming
- Having an active social life
- Keeping your brain busy and active
Do people with MCI always get dementia?
No. Although many people with MCI develop dementia later on, some do not. There is no way to know which people with MCI will develop dementia. That’s why it’s important to have regular follow-ups with your doctor. He or she can follow your symptoms to see if they change or get worse.
References:
National Institute of Neurological Disorders and Stroke
Budson, A & Solomon, P (2011). Memory Loss: A Practical Guide for Clinicians
For More Information on Alzheimer’s Disease and Research
Alzheimer’s Association National Chapter
Alzheimer’s Association MA/NH Chapter
National Institute on Aging’s Alzheimer’s Disease Education and Referral Center
Boston Medical Center Memory Disorder’s Clinic
AlzForum
Clinical Trials.Gov