Alzheimer's disease damages the brain's intellectual functions (memory, orientation, calculation), but at first, it largely spares those parts of the brain that control sensation and movement. Short term memory often is affected early. Gradually other intellectual functions deteriorate and judgment becomes impaired. In later stages of the disease, most people with advanced Alzheimer's lose their ability to do normal daily activities. Alzheimer's usually begins later in life, generally after age 60. Occasionally, it will affect younger people.

Although scientists are uncertain about what specifically causes the symptoms of Alzheimer's disease, those that are affected consistently develop excessive deposits of proteins called amyloid and TAU. It is believed that these proteins distort communication between brain cells. Also, levels of a chemical called acetylcholine that helps transmit messages between brain cells begins to drop, adding to the communication problems. Eventually, brain cells themselves are affected. They begin to shrivel and die, causing certain areas of the brain to shrink.

Alzheimer's disease is the most common cause of dementia, accounting for nearly 70% of all cases in people aged 65 and older. More than 5 million people in the United States currently have the disease.

Everyone is born with the potential to develop Alzheimer's disease. Your lifetime risk of developing the disease is about 10% to 15%. However, several factors may increase your risk:

• Age � The older you get, the greater your chance of developing Alzheimer's disease.



• Family history � If members of your family, especially parents or siblings, have Alzheimer's or have died of it, your risk of developing the disease increases. Your personal risk also depends on several factors, including how many family members are affected with Alzheimer's.



• Genetic factors � Inheriting certain genes increases your lifetime risk of getting Alzheimer's disease.

In the earliest stages of Alzheimer's disease, new or recent memories are difficult to recall. The person will find it hard to learn and retain new information. Eventually, older or more distant memories are gradually lost. Other symptoms may appear, including difficulty expressing thoughts as spoken words, difficulty carrying out simple instructions and difficulty interpreting familiar faces or other well-known objects.

A person with early Alzheimer's disease may not be able to plan meals, manage money, remember to keep doors locked or take medicines. He or she also may lose your sense of direction and get lost while driving or walking, even in a familiar neighborhood.

A person with early Alzheimer's disease usually is able to feed, bathe, dress and groom without help. Two thirds of people develop psychological problems, such as personality changes, irritability, anxiety or depression. When these types of symptoms appear before the disease is diagnosed, relationships with family members and friends can become strained.

As Alzheimer's disease progresses to its middle and late stages, the affected individual may have delusions (irrational beliefs, especially about being persecuted or having your belongings stolen) and hallucinations (seeing, hearing, smelling, tasting or being touched by something that isn't really there). The person may become aggressive or may begin to wander away from home if left alone.

A person with Alzheimer's often doesn't recognize that there is a problem. Usually family members and close friends notice the forgetfulness and changes in behavior. Rather than trying to convince a person with symptoms that he or she has a problem, arrange for an appointment with the person's doctor. At least one family member or close friend should accompany the patient.

The doctor will want to know about memory lapses, difficulty using language, problems learning and retaining new information, difficulty following directions or handling complex tasks, episodes of poor judgment or unusual or risky behaviors. More of this information is likely to be provided by family members and friends. The doctor will do a neurological examination (to check the brain and nerves), as well as a brief mental status examination, which includes visual, writing and memory testing. The doctor will check for other illnesses that can cause symptoms that resemble Alzheimer's disease. Testing may include blood tests to make sure that blood chemistry and the levels of vitamin B-12 and thyroid hormone are normal.

In some cases, the doctor may order a brain imaging study to be more certain that there is not some other reason for the symptoms. The results of a computed tomography (CT) scan, a magnetic resonance imaging (MRI) scan and a positron emission tomography (PET) scan cannot diagnose Alzheimer's with certainty. However, the radiologist (doctor who reads the scans) can suggest that the images are consistent with the disease. If your symptoms are not typical (10% to 20% of cases) or if the neurological examination shows signs of a sensory or movement problem, the doctor may refer you to a specialist, such as a neurologist, geriatrician or a geriatric psychiatrist, to confirm the diagnosis.

Alzheimer's disease is irreversible. Once the diagnosis is made, mental function usually declines over 3 to 20 years (average, 10 years) until death.

There is no way to prevent Alzheimer's disease. Staying physically and mentally active and having a high educational level is associated with a lower risk of developing the disease. Also, regular physical exercise and Mediterranean-sytle diet (fish, olive oil, plenty of vegetables) may delay the onset of symptoms and slow the progression of the disease.

Four medications, tacrine (Cognex), donepezil (Aricept), rivastigmine tartrate (Exelon) and galantamine (Razadyne, formerly known as Reminyl), may slow the intellectual decline in some people with mild to moderate Alzheimer's disease. These drugs (called cholinesterase inhibitors) increase the brain's levels of acetylcholine, which helps to restore communication between brain cells. Another medication, memantine (Namenda), has been shown to stabilize memory in people with moderate to severe Alzheimer's disease. It is the first in a new class of medications called NMDA receptor antagonists.

Other strategies used to help people with Alzheimer's include psychotherapy techniques (reality orientation and memory retraining) and medications to relieve depression and calm agitated behavior.

As much as possible, you should follow a regular exercise routine, maintain normal social contacts with family and friends and continue intellectual activities. In addition to regularly scheduled doctor visits, patients and their families should take advantage of community resources and support groups. Discuss any safety concerns, especially driving, with the doctor.

Although several nonprescription products claim to improve mental function, the scientific evidence to support this claim is weak. Check with your doctor before taking any nonprescription medication, especially if you are taking a prescription medication for heart problems, diabetes, high blood pressure or mental illness or if you have problems with your heart or liver.

Call your doctor whenever you or a family member has any of the following problems: serious lapses in memory or judgment (forgets medication, forgets the stove is on, allows strangers into the home); disorientation (gets lost) while driving or walking, especially in a familiar neighborhood; a substantial change in personality. The affected person often is unaware of these problems and may even deny that they exist.

Although no medication is available to cure Alzheimer's disease, cholinesterase inhibitors and memantine may improve the ability to perform daily activities, relieve behavior problems or possibly delay the need for a nursing home.

Alzheimer's Association
National Office
225 N. Michigan Ave.
Floor 17
Chicago, IL 60601
Phone: 312-335-8700
Toll-Free: 1-800-272-3900
Fax: 312-335-1110
Email: info@alz.orghttp://www.alz.org/

Alzheimer's Disease Education & Referral Center (ADEAR)
National Institute on Aging
P.O. Box 8250
Silver Spring, MD 20907-8250
Toll-Free: 1-800-438-4380
Fax: 301-495-3334
Email: adear@alzheimers.org
http://www.alzheimers.org/

Fisher Center for Alzheimer's Research Foundation
One Intrepid Square
West 46th Street and 12th Avenue
New York, NY 10036
Toll-Free: 1-800-259-4636
http://www.alzinfo.org