Alzheimers

The Basics

Alzheimer’s Disease (AD) is the most common form of dementia among older people. It is rare among people under 60 although it can have an early inset, and more common in those over 85. It’s a brain disorder which seriously and increasingly affects a person’s ability to function and carry out daily activities.

There are a number of conditions producing some of the symptoms of Alzheimer’s. If you have such symptoms obviously see your doctor first and right away. You may well have something else entirely which could be curable – but note: We’ve had real problems with early diagnosis in the UK. Your GP may not diagnose or refer you for diagnosis for a number of reasons. You have a right to a full and thorough diagnosis process. The Dementia Action Alliance says that: “If people with dementia are diagnosed early, and they and their families receive help, they can continue to live a good quality of life”. Of course that depends on the condition and how late diagnosis is – but you should not be refused early diagnosis. There are also new drugs coming through to help control Alzheimer’s, so early this is increasingly important. Other dementias can be treatable. Be sure to go to www.dementiaaction.org.uk and click on the National Dementia Declaration to learn what you should require in dealing with Alzheimer’s and other dementias.

Alzheimer’s is not currently curable. There are exciting prospects coming through, but most current strategies are about slowing the progress of the condition and coping with all the related problems. You will find that there are a remarkable number of ways for both sufferers and carers to get help and support which can make a huge difference.

In Alzheimer’s disease, the ability to remember, think, understand, communicate, and control behaviour progressively declines because brain tissue degenerates. The symptoms of Alzheimer’s disease are similar to those of other dementias and some totally unrelated conditions. They include memory loss, changes in personality, problems using language, disorientation, difficulty doing daily activities, and disruptive behaviour. A person with Alzheimer’s disease may not have all the symptoms.

Symptoms usually begin subtly. People may not notice any changes at first, depending on what activities they are involved in. At some point, people with Alzheimer’s disease may notice they are not doing their job or activities quite as well as in the past.

In most people with Alzheimer’s disease, the first sign is forgetting recent events. In some people it may begin with changes in personality. Changes can include becoming emotionally unresponsive, depressed, or unusually fearful or anxious. Emotions may rapidly and unpredictably change from one extreme to another. Early in the disease, people have difficulty using language. They may use a general word or many words rather than a specific word, use words incorrectly, or be unable to find the right word. They become less able to use good judgment and think abstractly.

Again: there are a number of other problems and conditions which can produce some or all of these early symptoms.

Disruptive or inappropriate behaviour is common with Alzheimer’s. People with the disease may become agitated, irritable, hostile, and physically aggressive. Many of them wander.

Many people with Alzheimer’s disease have insomnia. They have trouble falling or staying asleep. Some people become confused about day and night. Thinking it is day, they may get up and get dressed in the middle of the night.

As Alzheimer’s disease progresses, some people have symptoms such as hallucinations, delusions, or paranoia. A long-time carer recently said something really important about caring for a person with Alzheimer’s. She said that the sufferer has no choice but to live entirely in the moment. If the carer understands this, and lives in the moment too as much as possible when interacting with the sufferer, everything goes much better (see our Complimentary Techniques and Therapies Guide).

The progress of Alzheimer’s is unpredictable. After symptoms begin, people live, on average, 8 to 10 years. During a good part of this time, many people can continue to enjoy much of what they enjoyed before developing Alzheimer’s disease. Eventually memory is completely lost, and people with Alzheimer’s disease become totally dependent on others. Once people can no longer walk, they live, on average, about 6 months (although some bed-bound people can live much longer). Even at these late and dependent stages, however, techniques in our Complimentary Techniques and Therapies Guide can be of real benefit.

What causes degeneration of brain tissue in Alzheimer’s disease is not entirely clear, although the mechanism involves proteins combining. For most people, the cause seems to be a combination of genes and environment. There may also be environmental factors involved. For some people, genes appear to be a deciding factor. The disease seems to run in some families, particularly when it develops at an early age, but: Note that having close family members with Alzheimer’s does not mean you will get the disease.

In Alzheimer’s disease brain tissue degenerates in a particular way. Nerve cells are lost. Tangles (neurofibrillary tangles) form in nerve cells, and clumps (senile or amyloid plaques) form between nerve cells. People with Alzheimer’s disease also have a low level of acetylcholine in the brain. Acetylcholine is a chemical that helps nerve cells communicate with one another.

Diagnosis: If dementia seems to be striking an older person, and the person’s memory has gradually deteriorated, doctors should suspect Alzheimer’s disease. The diagnosis is based partly on symptoms, which are identified by asking the person and family members or other caregivers questions. The diagnosis is also based on a physical examination and the results of tests, such as mental status tests, blood and urine tests, and computed tomography (CT) or magnetic resonance imaging (MRI). This information helps doctors exclude other types and causes of dementia.

Some people with Alzheimer’s disease also have atherosclerosis. Atherosclerosis can lead to strokes, which sometimes result in vascular dementia. Thus, such people may have two types of dementia at once.

Your GP should be consulted first if you are concerned that you or someone you are caring for may have Alzheimer’s or another dementia.

Don’t delay talking to your GP. Alzheimer’s-like symptoms can be the result of something else. Health problems producing such worrying symptoms can include certain heart conditions, chest and urinary infections, sight – hearing and emotional problems, the side-effects of some drugs, severe constipation (strange but true), vitamin and thyroid deficiencies and brain tumours and other conditions – all of which may be treatable.

If the diagnosis is probable Alzheimer’s, getting it early will help in terms of possible early stage medications (see out “Therapies” section). A full medical assessment will mean that both patient and carers get much needed help from extended medical teams and social services. Proper diagnosis, not a brush-off about ‘old age and what can you expect’, is your right. So is referral to a Geriatrician and a Memory Clinic. If you have problems with these things contact the Alzheimer’s Society.

Community care assessment is a vital next step after diagnosis and medical assessment for treatment. If a person is confused or has dementia and needs support, their local authority social services department should be asked to carry out a community care assessment. If this assessment shows that the person needs certain services, the local authority has a duty to ensure that these services are provided.