What Are the Symptoms of Alzheimer’s Disease?

Most patients’ symptoms progress slowly over a number of years. Symptoms may not be noticed early on. Sometimes, it is only when family members look back that they realize when the changes started to occur.

Common symptoms of Alzheimer’s disease include:

• Impaired memory and thinking. The person has difficulty remembering things or learning new information. In the later stages of the disease, long-term memory loss occurs, which means that the person can’t remember personal information, such as his or her place of birth or occupation, or names of close family members.
• Disorientation and confusion. People with Alzheimer’s disease may get lost when out on their own and may not be able to remember where they are or how they got there. They may not recognize previously familiar places and situations. They also may not recognize familiar faces or know what time of the day it is, or even what year it is.
• Misplacing things. The person forgets where he or she put things used every day, such as glasses, a hearing aid, keys, etc. The person may also put things in strange places, such as leaving their glasses in the refrigerator.
• Abstract thinking. People with Alzheimer’s disease may find certain tasks — such as balancing a checkbook — more difficult than usual. For example, they might forget what the numbers mean and what needs to be done with them.
• Trouble performing familiar tasks. The person begins to have difficulty performing daily tasks, such as eating, dressing, and grooming. Planning for normal day-to-day tasks is also impaired.
• Changes in personality and behavior. The person becomes unusually angry, irritable, restless, or quiet. At times, people with Alzheimer’s disease can become confused, paranoid, or fearful.
• Poor or decreased judgment. People with Alzheimer’s disease may leave the house on a cold day without a coat or shoes, or could go to the store wearing their pajamas.
• Inability to follow directions. The person has difficulty understanding simple commands or directions. The person may get lost easily and begin to wander.
• Problems with language and communication. The person can’t recall words, name objects (even ones that are very familiar to them — like a pen), or understand the meaning of common words.
• Impaired visual and spatial skills. The person loses spatial abilities (the ability to judge shapes and sizes, and the relationship of objects in space) and can’t arrange items in a certain order or recognize shapes.
• Loss of motivation or initiative. The person may become very passive and require prompting to become involved and interact with others.
• Loss of normal sleep patterns. The person may sleep during the day and be wide-awake at night.

How Is It Diagnosed?

It is important to visit a doctor if you or a loved one experiences any of these symptoms so you can receive the proper evaluation and diagnosis. There are other conditions — such as depression, a head injury, certain chemical or vitamin imbalances, or the effects of some medications — that can produce symptoms that are similar to Alzheimer’s disease. Many of these conditions are treatable.

Your doctor can only determine if the symptoms are probably due to Alzheimer’s disease after a thorough medical, psychiatric, and neurological evaluation. He will evaluate other possible causes of dementia to rule out all other factors before settling on Alzheimer’s disease as a diagnosis.

Currently, no definitive diagnostic test for Alzheimer’s exists. A definite diagnosis of Alzheimer’s disease is possible only after death, when a pathologist can more closely examine a patient’s brain for the telltale changes associated with Alzheimer’s disease.

What’s the Prognosis?

The course of Alzheimer’s disease varies widely from person to person. The duration of the illness could be short (2-3 years) or long (up to 20 years). Usually the parts of the brain that control memory and thinking are affected first, but over time, cells die in other areas of the brain.

Eventually, a person with Alzheimer’s will need complete care. If the person has no other serious illnesses, the loss of brain function itself will eventually cause death.
Can Alzheimer’s Disease be Prevented?

Because the exact cause of Alzheimer’s disease is not known, there is currently nothing that can be done to guarantee its prevention. Some interventions may be worth incorporating into your life as more research reveals some potentially controllable risk factors. Staying mentally and physically active, maintaining a normal blood pressure and avoiding head injury by wearing seat belts and helmets may decrease your chances of developing Alzheimer’s dementia.

It is important to remember, however, that there are causes of dementia other than Alzheimer’s disease that may be preventable such as eating properly, exercising, quitting smoking, and limiting how much alcohol you drink. Your doctor can advise you about other healthy lifestyle habits you can adopt that may help prevent dementia.

Reviewed by the doctors at the The Cleveland Clinic Neuroscience Center.

Using powerful new drug-screening technologies, researchers are identifying dozens, perhaps hundreds of possible targets for drugs aimed at preventing, treating, or slowing the progression of Alzheimer’s disease (AD). Many of these compounds appear to work in animals with Alzheimer’s-type dementia — good news for little furry creatures.

But for the estimated 25 million people worldwide with Alzheimer’s disease and other forms of dementia and the millions more who care for them, the news about drugs for Alzheimer’s disease — after the first blush of enthusiasm has faded — has ranged from mildly promising to disheartening.

Perhaps it’s a measure of how difficult the problem is that one of the biggest headlines from the 9th International Conference on Alzheimer’s Disease and Related Disorders in Philadelphia came from a clinical trial of the drug Aricept. The drug appears to delay the onset of Alzheimer’s disease in people with mild cognitive impairment by six to perhaps 18 months, according to researcher Ronald Petersen, MD, PhD, from the Mayo Clinic in Rochester, Minn. Mild cognitive impairment appears to set the stage for the development of Alzheimer’s dementia.

There is no cure for Alzheimer’s disease. The drugs used to treat the disease work to slow the progression of symptoms. Aricept works by preventing the breakdown of acetylcholine, a chemical used by the brain for memory and thinking. But studies have shown that the benefits of this treatment are short lived; by 18 months, patients who received Aricept had the same rate of progression to Alzheimer’s disease as those who received a placebo.

Aricept is one many drugs used to treat Alzheimer’s disease. It and medications such as Reminyl and Exelon are called cholinesterase inhibitors. In various studies, these drugs have shown small to modest improvements in memory and thinking skills in people with AD.

In April 2005, Reminyl’s label was changed to include information about the deaths of 13 elderly patients who were taking the drug during a study. The deaths were due to various causes, including heart attack and stroke.

Another group of drugs, called NMDA receptor antagonists, have also shown minor improvements in mental function among patients with moderate to severe AD. These drugs work by controlling the levels of another chemical that is involved in processing and retrieving information.

Namenda is the only drug in this class approved for the treatment of moderate to severe AD. A recently published study showed that Namenda combined with Aricept allowed people with moderate to severe Alzheimer’s disease to perform better in daily activities such as grooming, being left alone, and using the toilet. People receiving the drug combination also had a reduction in behavioral disturbances such as agitation and psychiatric symptoms that are among the most common causes of nursing-home placements among patients with AD. Studies presented at the current meeting also suggest that the drug is safe and effective at improving mental abilities and daily functioning.

New Approaches Needed

There are only five drugs approved by the FDA specifically for treatment of AD, and only four are widely used (the fifth, Cognex, has serious side effects and has largely fallen out of use). But because they work on the symptoms of Alzheimer’s — memory loss, confusion, agitation — rather than on the actual pathology that causes the symptoms, these drugs may be a case of too little, too late.

“Everybody feels like we have to do something about this disease fast. The numbers of people who are going to be affected by it is so great, we know what a difference it could make if we could delay onset even by five years. And we also know that the disease takes a long time to evolve in the brain, so the sooner we intervene, the better,” says Marilyn Albert, PhD, director of the division of cognitive neuroscience in the department of neurology at Johns Hopkins University School of Medicine in Baltimore.

The first brain changes of Alzheimer’s disease may occur as early as 10 to 20 years before the first symptoms of the disease appear, Bengt Winbald, MD, PhD, professor of geriatric medicine and chief physician at the Karolinska University Hospital and Karolinska Institute in Stockholm, Sweden, tells WebMD.

Until recently, those changes have been too small or too subtle to easily detect, making it extremely difficult to identify people who could benefit from early intervention.

But that appears to be changing. A key theme at this year’s Alzheimer’s conference is advances in brain imaging that may make it possible to detect and diagnose early AD, leading to the development of drugs and other treatment strategies that could halt or at least slow the progression of disease.

Plaque Attacks and Tangled Webs

One of the most intriguing strategies discussed at this year’s conference involves drugs or vaccines aimed at clearing deposits of an abnormal form of a protein that accumulates in the brains of people who suffer from Alzheimer’s. The protein, known as beta amyloid, forms clumps or “plaques” and is a hallmark of Alzheimer’s disease.

One experimental drug, called Alzhemed, has been shown in animal and human studies to clear significant amounts of beta amyloid deposits from the brain. A similar drug, known only as LY450139, has shown similar effects in humans.

Several companies are also working on vaccines that can stimulate the body to make antibodies that attack and dissolve beta-amyloid deposits. Other experimental drugs and vaccines are aimed at treating another suspected cause of AD, a different protein known as tau, which normally serves as a building block of nerves. In the brains of people with advanced AD, strands of twisted tau proteins, called fibrillary tangles, can be found inside brain cells.

But whether beta amyloid and tau are the causes of Alzheimer’s disease or a result of it is still unclear.

“Clearly, beta-amyloid and tau pathology are part of the disease. The question is at what point in the cascade of events these things come into the picture,” Alzheimer’s disease research pioneer Zaven Khatchaturian, PhD, tells WebMD.

Khatchaturian, who is a consultant to other Alzheimer’s disease researchers, formerly headed the Office of Alzheimer’s Disease Research at the National Institute on Aging. He says that while it’s encouraging that anti-amyloid therapies have gotten over the first hump — safety in humans — it’s still unclear whether these therapies will have a positive effect on the disease itself.

Khatchaturian says instead of attacking late-stage features of the disease, it might be possible to intervene at an earlier step, before the normal brain protein known as amyloid precursor protein (APP) is transformed into the abnormal form beta amyloid.

“[APP] is a very significant protein in cell-to-cell communication. It’s been around since the fruit fly, and there are different versions of it, but we don’t have any idea about its function. One target may be that we’re looking at the wrong end of the story, that the real story might be before it gets broken,” Khatchaturian says.

Could Stem Cells Stem the Tide of AD?

Although human embryonic stem cells show promise for many neurological diseases such as Parkinson’s disease, Huntington’s chorea, spinal cord injuries, and other conditions, the complexity of Alzheimer’s disease and the difficulty of delivering stem cells to the regions of the brain that are affected make them impractical for widespread use.

“Stem cells, although they’re promising for other diseases, it’s not very likely practically that they’ll be used for Alzheimer’s disease, because the way stem cell replacement is practiced in clinical research is by surgically implanting stem cells into regions of the brain where there has been degeneration, and that’s fairly local in terms of Parkinson’s disease and Huntington’s, but for the entire cerebral cortex you’re talking about making dozens of little holes in the skull,” says Sam Gandy, MD, PhD, director of the Farber Institute for Neurosciences at Thomas Jefferson University in Philadelphia.

“There is a fairly new area focusing on identification of stem cells that are still present in the adult brain that weren’t thought to be there,” Gandy tells WebMD. “It’s conceivable that if there were enough of those in quantity or you could deliver them, and if they have enough dividing potential you could stimulate them to replace the dying nerve cells in their immediate environment, but that still is very complicated.”

The job would involve turning on dormant stem cells, getting them to change into the right kind of cell, and then getting them to move to the part of the brain where they’re needed to repair damage, a series of tasks that are beyond our current capabilities, Gandy says.

Sheldon L. Goldberg, president and CEO of the Alzheimer’s Association, tells WebMD that few or none of the 800 or so grant applications for research funding received by the association this year have been for stem cell research.

The State of Statins?

Observations that there appears to be an association between the use of cholesterol-lowering drugs known as statins and a lower incidence of Alzheimer’s disease have prompted researchers to see whether these drugs could also help prevent it. As reported by WebMD, several studies presented at the conference here point to a link between heart disease risk factors and AD.

Statins also have anti-inflammatory effects that could be beneficial for Alzheimer’s disease patients, and there is intriguing evidence indicating that the drugs may help to reduce the production of beta amyloid.

Yet to date, evidence about statins and Alzheimer’s disease prevention has been mixed, and at least one study presented at the meeting suggests that the drugs may be less effective in people who have inherited a form of a gene that is associated with increased risk for AD and early-onset Alzheimer’s.

“Whether eliminating the amyloid is going to eliminate the clinical picture, we don’t know,” Khatchaturian tells WebMD about current Alzheimer’s disease research. “We have to start somewhere, but we may wind up with a big disappointment. That’s science. There’s no certainty. But compared to the amount of things we didn’t know, compared to the total field of 10, 15, 20 years ago, I’m like a kid in a toy store.”

Originally published July 23, 2004.

Medically updated April 6, 2005.

Most housing, however, is designed for young, active and mobile people. To live at home, a person must, at the very least, be able to drive, go shopping, cook. and do household chores. Many of us will lose one or more of these abilities as we grow older.

One option is to purchase in-home services to cope with declining abilities. For a fee, an army of workers will appear to cut your grass, wash your windows, cook your meals, do the shopping, and even provide personal care and/or skilled nursing care. This may be the option for you, depending on the amount of help you need. However, this can be expensive and will require a lot of management and coordination.

For people willing to relocate, there are plenty of options, although there may be some confusion about what all the terms mean. You may hear about “board and care homes,” “personal care homes,” “life care” and “continuing care retirement facilities.” All refer to some type of “assisted living” or service-oriented housing.

Housing options generally fall into three categories, based on level of services and/or care provided:

1. Independent Retirement Housing, providing meals, activities, house-keeping and maintenance to more active seniors
2. “Assisted Living,” providing housing along with supportive services for seniors needing assistance with personal care or medication taking
3. Housing providing nursing care services for seniors who become temporarily ill or who require long term health care. Some examples of these retirement options are:

Independent Living Retirement Communities

These complexes are for seniors who are able to live on their own, but want the convenience of a comprehensive service package. Meals, housekeeping, activities, transportation and security are provided to active older adults.

“Assisted Living” Facilities

In addition to the services mentioned above, these facilities provide personal care assistance to residents. This means that, in addition to housekeeping services, residents receive assistance in managing their medications and a helping hand with bathing, grooming and dressing.

“Assisted Living” facilities come in all shapes and sizes. Settings can range from three or more older people in a home-like setting, to dozens of residents in an institutional environment.

Nursing Homes

For individuals already disabled to the point of requiring daily nursing care as well as other support services, nursing homes provide comprehensive care services in a single setting. While most older persons and their families see nursing home care only as a last resort, they may in fact be the best setting for disabled persons with multiple problems and requiring multiple types of services.

Continuing Care Retirement Communities, sometimes also called Life Care Communities, combine all three levels of care (independent living, assisted living and nursing home care) in a single setting. Traditionally, such communities required a sizeable entry fee, plus monthly maintenance fees, in exchange for a living unit, meals, and eventual health care coverage, up to the nursing home level. More recently, such communities have also begun to make their services available on a pure rental basis, rather than on the shared risk basis of the traditional life care endowment. In short, CCRCs provide residents with the independence of retirement home living and the security of long term care.

Some Other Housing Options

Group Homes provide independent, private living in a house shared by several senior citizens who split the cost of rent, housekeeping services, utilities, and meals.

Shared Housing is offered by home owners who are willing to share their house with others. Service provision must be negotiated on a case by case basis.

Adult Foster Care involves a family caring for a dependent person in their home. Meals, housekeeping and help with dressing, eating, bathing, and other personal care are provided. Ask the local social services department if adult foster care is available in your area.

To Move or Not to Move

The main advantage of living in some type of congregate housing is security. The presence of others provides continued monitoring of health care. Another big draw of such facilities, especially for those with limited mobility, are the built-in social contacts and activities. Experts agree that social contacts increase satisfaction with life and have a positive impact on physical health. Other seniors report relief at relinquishing housekeeping tasks.

Weighing the advantages of service oriented housing against the independence offered by a single family home is a complicated task. Timing is all-important. The most useful way to approach such decisions is to begin early by getting all the information possible on one’s various options.

“I would like to take this opportunity to commend You, Cascade Living Group and especially Trudy Hendricks and her entire staff at Desert Hills Memory Care Center in Hemet, California.

My Father who was diagnosed with Alzheimer’s Disease, check into Desert Hills Memory Care Center on July 30, 2008.  The reception showed genuine concern and compassion and was far beyond my wildest expectations.  Ms. Hendricks and her entire staff were Angels in disguise.  I was very pleased with the cleanliness and beauty of the facility and the outside grounds.

My Father stayed at Desert Hills from that day until April 14, 2009, when I took him to his Doctor appointment.

During that appointment it became necessary to Hospitalize my Father.

My Father passed away at the hospital on April 19, 2009.

During my Father’s (Harry L Williams) (RED), stay at Desert Hills, he received the best of care and medical attention that anyone could expect.

If I have the opportunity, I will strongly recommend Desert Hills to anyone who should ask.

Thank You For Being There in our time of need,”

– James P. W.

Our family felt secure in seeing the care given to others and glimpsing those little acts of kindness that mean so much.

When you bring your mother to a place of care, there are so many thoughts and concerns that enter your mind. The staff showed a consistent attitude of empathy that we appreciated.

In the early morning when Mom passed away we all were given the best of care. Tears were shared. Moments that we will never forget.

Everytime we drive down College Way we’ll think of Ashley Gardens as Mom’s home. That feeling will never leave us.”

Thank You All
Gary and Kathy B.