What is Alzheimer’s disease?
Alzheimer’s disease is a brain disease that slowly affects memory, thinking, and, over time, the ability to handle daily life. It is the most common cause of dementia.
In Alzheimer’s disease, two proteins build up in the brain. One is called amyloid, and the other is called tau. Over time, they harm brain cells and the connections between them. These changes begin years before symptoms appear.
Alzheimer’s disease usually starts slowly and changes over years. It is different for every person. It is not a normal part of aging, and it is not caused by anything you did.
Common symptoms
Early symptoms
- Forgetting recent conversations or events, and asking the same question again
- Misplacing things more often
- Trouble planning, paying bills, or following a recipe
- Trouble finding words
- Getting lost in a familiar place
- Losing track of dates or appointments
Later symptoms
As the disease moves forward, people may need more help with dressing, bathing, and other daily tasks. Changes in mood, sleep, and behavior are common. Some people become anxious, restless, or suspicious. These changes are part of the disease, and there are ways to help.
Stages of Alzheimer’s disease
Overview of disease progression
The symptoms of Alzheimer’s disease worsen over time, although the rate at which the disease progresses varies. On average, a person with Alzheimer’s lives four to eight years after diagnosis, but can live as long as 20 years, depending on other factors. Changes in the brain related to Alzheimer’s begin years before any signs of the disease. This time period, which can last for years, is referred to as preclinical Alzheimer’s disease.
The stages below provide an overall idea of how abilities change once symptoms appear and should only be used as a general guide. (Dementia is a general term to describe the symptoms of mental decline that accompany Alzheimer’s and other brain diseases.)
The stages are separated into three categories: mild Alzheimer’s disease, moderate Alzheimer’s disease, and severe Alzheimer’s disease. Be aware that it may be difficult to place a person with Alzheimer’s in a specific stage, as stages may overlap.
Early-stage Alzheimer’s (mild)
In the early stage of Alzheimer’s, a person may function independently. He or she may still drive, work, and be part of social activities. Despite this, the person may feel as if he or she is having memory lapses, such as forgetting familiar words or the location of everyday objects.
Symptoms may not be widely apparent at this stage, but family and close friends may take notice, and a doctor would be able to identify symptoms using certain diagnostic tools.
Common difficulties include:
- Coming up with the right word or name.
- Remembering names when introduced to new people.
- Having difficulty performing tasks in social or work settings.
- Forgetting material that was just read.
- Losing or misplacing a valuable object.
- Experiencing increased trouble with planning or organizing.
Middle-stage Alzheimer’s (moderate)
Middle-stage Alzheimer’s is typically the longest stage and can last for many years. As the disease progresses, the person with Alzheimer’s will require a greater level of care.
During the middle stage of Alzheimer’s, the dementia symptoms are more pronounced. The person may confuse words, get frustrated or angry, and act in unexpected ways, such as refusing to bathe. Damage to nerve cells in the brain can also make it difficult for the person to express thoughts and perform routine tasks without assistance.
Symptoms, which vary from person to person, may include:
- Being forgetful of events or personal history.
- Feeling moody or withdrawn, especially in socially or mentally challenging situations.
- Being unable to recall information about themselves, like their address or telephone number, and the high school or college they attended.
- Experiencing confusion about where they are or what day it is.
- Requiring help choosing proper clothing for the season or the occasion.
- Having trouble controlling their bladder and bowels.
- Experiencing changes in sleep patterns, such as sleeping during the day and becoming restless at night.
- Showing an increased tendency to wander and become lost.
- Demonstrating personality and behavioral changes, including suspiciousness and delusions or compulsive, repetitive behavior like hand-wringing or tissue shredding.
In the middle stage, the person living with Alzheimer’s can still participate in daily activities with assistance. It’s important to find out what the person can still do or find ways to simplify tasks. As the need for more intensive care increases, caregivers may want to consider respite care or an adult day center so they can have a temporary break from caregiving while the person living with Alzheimer’s continues to receive care in a safe environment.
Late-stage Alzheimer’s (severe)
In the final stage of the disease, dementia symptoms are severe. Individuals lose the ability to respond to their environment, to carry on a conversation, and, eventually, to control movement. They may still say words or phrases, but communicating pain becomes difficult. As memory and cognitive skills continue to worsen, significant personality changes may take place, and individuals need extensive care.
At this stage, individuals may:
- Require around-the-clock assistance with daily personal care.
- Lose awareness of recent experiences as well as of their surroundings.
- Experience changes in physical abilities, including walking, sitting, and, eventually, swallowing.
- Have difficulty communicating.
- Become vulnerable to infections, especially pneumonia.
The person living with Alzheimer’s may not be able to initiate engagement as much during the late stage, but he or she can still benefit from interaction in ways that are appropriate, like listening to relaxing music or receiving reassurance through gentle touch. During this stage, caregivers may want to use support services, such as hospice care, which focus on providing comfort and dignity at the end of life. Hospice can be of great benefit to people in the final stages of Alzheimer’s and other dementias and their families.
How we make the diagnosis
An accurate diagnosis starts with a careful evaluation. Memory problems have many causes, and some of them can be treated.
At your visit, we will:
- Talk with you and a family member or friend about what has changed and when it started
- Review your medicines and other health conditions
- Do a neurological exam
- Do in-office cognitive testing to check memory, attention, language, and problem solving
We use blood tests to rule out reversible causes, such as thyroid problems or low vitamin B12. A brain MRI can look for strokes, other changes, and problems that can be treated.
Confirming Alzheimer’s disease. Today, testing for amyloid can help confirm Alzheimer’s disease during life. We order an amyloid blood biomarker test, an amyloid PET scan, or a spinal fluid (CSF) test. These tests are done outside our office. A confirmed diagnosis helps you and your family plan, and it is required before anti-amyloid infusions can be considered.
Tracking changes over time. Routine neuropsychological testing is available to track the long-term stability of thinking and memory in patients with mild cognitive impairment or Alzheimer’s disease.
Treatment options
Treatment is built around your stage of the disease, your health, and your goals. It often changes over time.
Medications
Two kinds of medicine are used for the symptoms of Alzheimer’s disease:
- Cholinesterase inhibitors. These help a brain chemical that is important for memory last longer. They may help with memory and thinking for a time. Possible side effects include nausea, loose stools, vivid dreams, and a slow heart rate.
- Memantine. This works on a different brain chemical. It is often used in moderate to severe Alzheimer’s disease, sometimes along with a cholinesterase inhibitor.
We also treat problems with sleep, mood, anxiety, and behavior. Some medicines can make confusion worse, so we review every medicine you take.
Make sure you bring a typed list of medications used to treat Alzheimer’s disease that failed or caused side effects. Use BPMedTracker to track your medications and print a list.
Anti-amyloid infusions
We offer Kisunla (donanemab) and Leqembi (lecanemab) infusions at the infusion center in our building for early Alzheimer’s disease (mild cognitive impairment or mild dementia) with confirmed amyloid. These medicines help clear amyloid from the brain. The goal is to slow the decline in memory and thinking. They do not reverse symptoms that are already present.
Not everyone qualifies. We review your testing, brain MRI, health history, and medicines to decide whether these infusions are safe for you. Scheduled MRI scans watch for ARIA, a side effect that can cause brain swelling or small bleeds. ARIA often causes no symptoms, which is why the scans matter. Tell us right away about a new headache, confusion, or vision changes. Genetic (APOE) testing is recommended before starting, because it affects the risk of ARIA. Learn more about infusions at the infusion center in our building.
Holistic, evidence-based care
We offer an evidence-based holistic treatment plan for Alzheimer’s disease, used alongside standard medical care and chosen with your doctor. It includes:
- Lifestyle changes. Staying socially and mentally active, not smoking, limiting alcohol, and good control of blood pressure, blood sugar, and cholesterol, which matter for the brain as well as the heart.
- A nutrition program. A brain-healthy eating plan based on the Mediterranean-style MIND diet, with plenty of vegetables, berries, beans, whole grains, nuts, fish, and olive oil, and fewer processed foods and sweets.
- Exercise. Regular aerobic exercise, such as brisk walking, along with strength and balance training, as your doctor advises.
- Better sleep. We treat sleep problems with sleep hygiene: a regular bedtime and wake-up time, daylight and activity during the day, less caffeine and fewer naps late in the day, and a dark, quiet bedroom. We also check for sleep apnea. When needed, supplements such as melatonin may be added.
- Natural treatments for anxiety. Relaxation and mindfulness practices, music, and time outdoors, and, when appropriate, natural supplements chosen with your doctor.
Supplements can interact with other medicines, so always review them with us before starting.
Planning ahead
Planning ahead for legal, money, and health decisions while you can take part is also important.
Support for caregivers
Caring for someone with Alzheimer’s disease is hard work. Caregivers are welcome at every visit. We can talk about safety at home, driving, and changes in behavior, and help you find support. Taking care of your own health matters too.
When to see a specialist
Consider a memory evaluation if you or a loved one has:
- Memory problems that are getting worse or affecting daily life
- Trouble with money, medicines, cooking, or driving
- Getting lost or confused in familiar places
- Changes in personality, mood, or behavior
- Questions about whether anti-amyloid infusions might be right for you
The earlier the evaluation, the more choices you have. Anti-amyloid infusions are only for the early stage of the disease. Call 940-828-MOVE (6683) to schedule a visit.
Staying mentally active
Staying active in body, mind, and social life is part of living well with Alzheimer’s disease. These habits work alongside your medical care, not in place of it.
- Stay social. Visit with family and friends, go to religious services, or join a group.
- Move your body. Walk, garden, or join an exercise class, as your doctor advises.
- Enjoy activities. Music, reading, puzzles, crafts, and hobbies can all be part of your week.
- Keep a routine. A regular schedule, a calendar, and a pill box can make each day easier.
Some people also enjoy brain exercise apps. One option is Mind Sage.
Support and resources
Alzheimer’s disease affects the whole family. The Alzheimer’s Association offers free education, local support groups, and a 24/7 Helpline for people living with Alzheimer’s disease and their caregivers.
