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Alzheimer's disease

Also listed as: Dementia; Memory loss

• Signs and Symptoms
• Causes
• Risk Factors
• Diagnosis
• Preventive Care
• Treatment
• Other Considerations
• Supporting Research

Alzheimer's disease (AD) is a progressive, degenerative brain disease that results in impaired memory, thinking, and behavior. People with AD experience gradual memory loss as well as impaired judgement, difficulty concentrating, loss of language skills, personality changes, and a decline in the ability to learn new tasks.

The rate of progression is different for each person. If AD develops rapidly, it is likely to continue to progress rapidly. If it has been slow to progress, it will likely continue on a slow course.

There is no cure for AD, but studies suggest that medications, herbs and supplements, and lifestyle adjustments may help slow the progression and improve the symptoms of the disease.

Signs and Symptoms

The early symptoms of AD are occasionally overlooked because they resemble signs that many people attribute to "natural aging." The following are the most common signs and symptoms of AD:

Psychological Symptoms

• Memory loss, including not recognizing friends and family members
• Difficulty concentrating
• Difficulty comprehending words, completing sentences, or finding the right words
• Loss of familiarity with surroundings, wandering aimlessly
• Depression
• Hallucinations, delusions, and psychosis
• Aggression, agitation, anxiety, restlessness
• Accusatory behaviors (such as accusations of spousal infidelity)
• Withdrawal, disinterest, hostility, loss of inhibitions

Physical Symptoms

• Impaired movement or coordination
• Muscle rigidity, shuffling or dragging feet while walking
• Insomnia or disturbances in sleep patterns
• Weight loss
• Incontinence
• Muscle twitching or seizures

Causes

The causes of AD are not entirely known but are thought to include genetics and environmental factors. New research indicates that free radicals (highly reactive molecules that can cause oxidation, or damage to cells) may play a role in the development of AD.

A gene for the protein epsilon apolipoprotein (Apo E) -- especially Apo E3 and Apo E4 varieties -- is thought to accelerate the formation of abnormal deposits (called plaques) in the brain and increase the risk for AD. Reports indicate that 50 - 90% of those with the Apo E4 gene develop AD. However, even people without inherited genes for the disease can get AD.

Scientists also believe the environment may play a part in AD because people in different regions of the world have widely varying risks of developing the disease. For example, people living in Japan and West Africa have much less risk for AD than Japanese Americans and African-Americans.

People with AD have abnormal deposits, or plaques, in their brain tissue. These plaques contain beta amyloid, a protein that releases free radicals, or highly reactive molecules, that can cause damage to cells through a process called oxidation. These free radicals are believed to lower levels of acetylcholine (a brain chemical that helps transmit impulses in the nervous system) and damage brain tissue, bringing on the symptoms of AD.

Although not confirmed by scientific studies, other factors that have been speculated to contribute to the development of AD include infections (such as herpesvirus type 1), exposure to metal ions (such as aluminum, mercury, zinc, copper, and iron), or prolonged exposure to electromagnetic fields.

Risk Factors

The causes and risk factors contributing to the development of AD are not entirely clear. The following all appear to have an association with AD to varying degrees.

• Family history of AD
• Older age -- 20 - 40% of people with AD are older than 85
• Female gender -- while women tend to develop AD more than men, this may be related to the tendency for women to live longer.
• Americans are more likely to get AD than Asians or Native Americans
• Long-term high blood pressure
• History of head trauma -- one or more serious blows to the head may put a person at an increased risk.
• Down syndrome
• Elevated levels of homocysteine (a body chemical that contributes to chronic illnesses such as heart disease, depression, and AD)
• Aluminum or mercury poisoning
• Prolonged exposure to electromagnetic fields

Diagnosis

There is no definitive test for AD. A true diagnosis can only be made after a person dies and an autopsy is performed on the brain.

However, AD usually has a characteristic pattern of symptoms. A health care provider will try to narrow down a diagnosis by ruling out other possible causes. The health care provider will ask questions about medical history and symptoms and do a physical exam (including a neurological exam).

The following tests may also be used to aid in the diagnosis:

• Psychological tests assess the individual's memory and attention span. They may also reveal difficulties in problem-solving, social, and language skills.
• Electroencephalograph (EEG) traces brain-wave activity. This test sometimes reveals "slow waves" in people with AD.
• Blood test for the Apo E4 gene may indicate a genetic tendency for AD. The presence of the gene in the blood may suggest AD, but it does not always make an accurate diagnosis.
• Imaging tests such as CT, MRI, or PET scans.

In the early stages of dementia, brain image scans may be normal. In later stages, an MRI may show a decrease in the size of certain brain areas. While the scans do not confirm the diagnosis of AD, they do exclude other causes of dementia such as stroke and tumor.

Preventive Care

• Consuming a low-fat, low-calorie diet may reduce the risk for AD.
• Higher intake of fatty, cold-water fish (such as tuna, salmon, and mackerel) may be associated with a lower risk of dementia. This may be due to the high level of omega-3 fatty acids found in such fish. Eating fish at least two to three times per week provides a healthy amount of omega-3 fatty acids, but dietary supplementation with capsules or liquid products is still recommended.
• Reducing intake of linoleic acid (found in margarine, butter, and dairy products) may prevent cognitive decline.
• Antioxidants, such as vitamins A, E, and C (found in darkly colored fruits and vegetables), may help prevent damage caused by free radicals.
• Maintaining normal blood pressure levels may reduce the risk for AD.
• Hormone-replacement therapy (HRT) in postmenopausal women may decrease production of chemicals that cause AD, stimulate growth of brain cells, and improve blood flow in the brain. However, the role of hormones in the prevention of AD is still controversial. HRT has also been shown to increase the risk for breast cancer, heart attacks, strokes, and blood clots.
• Some studies suggest that certain medications may prevent AD, including statin drugs (such as pravastatin or lovastatin, used to lower cholesterol) and nonsteroidal anti-inflammatories (NSAIDs), with the exception of aspirin. More research is necessary, however, to determine how effective these medications are in reducing the risk of the disease.
• Keeping mentally and socially active may help delay the onset or slow the progression of AD.

Treatment

The goals in managing AD are to:

• Slow the progression of the disease.
• Manage behavior problems, confusion, and agitation.
• Modify the home environment.
• Support family members and other caregivers.

There is no cure for AD. The most promising treatments include lifestyle changes, medications, and antioxidant supplements.

Lifestyle

Research indicates that the following lifestyle modifications may help improve behavior in people with AD:

• Walking regularly with a caregiver or other reliable companion may improve communication skills and diminish the risk of wandering.
• Bright light therapy may reduce insomnia and wandering.
• Calming music may reduce wandering and restlessness, boost brain chemicals, and improve behavior.
• Pet dogs can increase appropriate social behaviors.
• Relaxation training and other exercises that require focused attention (often used with refreshments as rewards) can improve social interaction and the ability to perform tasks.

The Safe Return Program, implemented by the Alzheimer's Association, encourages identification bracelets, wallet cards, and clothing labels for patients with AD. Identifying information is stored in a national database and distributed to authorities when a patient is reported missing. If a registered person is found, the information is used to contact their caregiver.

Medications

Several drugs are available to try to slow the progression of AD and possibly improve the person's mental capabilities. These include:

• Donepezil (Aricept)
• Rivastigmine (Exelon)
• Galantamine (Razadyne, formerly called Reminyl)
• Tacrine (Cognex)

Memantine (Namenda) is currently the only drug approved for treatment of moderate-to-severe Alzheimer’s disease.

The following medications may ease the symptoms related to AD:

• Selective serotonin reuptake inhibitors (SSRIs) increase activity of a brain chemical called serotonin. They are used to treat depression.
• Methylphenidate stimulates the brain to increase alertness. It is used to treat withdrawal and apathy.
• Risperidone, olanzapine, and haloperidol are mood stabilizers. They help improve social interactions, and reduce delusions, paranoia, and aggression.
• Carbamazepine is an anti-seizure drug that stabilizes sodium levels in the brain. It is used to treat agitation.

Nutrition and Dietary Supplements

Individuals with AD may have particular dietary concerns. People with AD often forget to eat and drink, and, as a result, often become dehydrated.

Following these nutritional tips may help improve general health and well-being:

• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
• Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables such as kelp and dulce.
• Eat more high-fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed.
• Avoid refined foods such as white breads, pastas, and especially sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
• Use healthy oils in foods, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, five days a week.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 3 tablespoonfuls oil, one to three times daily, to help decrease inflammation and help with immunity. Cold-water fish, such as salmon or halibut, are good sources but not substitutes for supplementation.
• Vitamin C, 500 - 1,000 mg one to three times daily, as an antioxidant and for immune support.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support.
• Acetyl-L-carnitine, 500 mg daily, for antioxidant and muscle protective activity.
• Probiotic supplement (containing Lactobacillus acidophilus and other species), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
• L-glutamine, 500 - 1,000 mg three times daily, for support of gastrointestinal health and immunity.
• L-arginine, 1 -2 gm three times daily, for blood vessel support.
• SAMe (s-adenosyl-L-methionine), 100 - 200 mg before breakfast daily, for mood improvement.
• Resveratrol (from red wine), 50 - 200 mg daily, for antioxidant and immune system effects.
• L-theanine, 200 mg one to three times daily, for nervous system and brain support.
• Melatonin, 2 - 5 mg one hour before bedtime, for sleep and immune protection. Ask your health care provider about potential drug interactions with the use of melatonin.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day.

• Ginkgo ( Ginkgo biloba ) standardized extract, 40 - 80 mg three times daily, for blood flow and brain health. Ginkgo is the most widely studied herb, especially for symptoms related to dementia and Alzheimer's disease.
• Green tea ( Camellia sinensis ) standardized extract, 250 - 500 mg daily, for antioxidant, anti-inflammatory, and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Milk thistle ( Silybum marianum ) seed standardized extract, 80 - 160 mg two to three times daily, for detoxification support and antiviral effects.
• Bacopa ( Bacopa monnieri ) standardized extract, 50 - 150 mg three times daily, traditionally used in India to improve mental performance.
• Vinpocetine (isolated from Vina minor ), 10 - 40 mg twice daily, for symptoms of Alzheimer's disease or dementia.

Acupuncture

Small studies have shown that transcutaneous electrical nerve stimulation (TENS), a technique used in physical therapy and certain types of acupuncture, may improve memory and daily living skills in people with AD. Further studies are needed to confirm whether acupuncture may be effective in the treatment of AD.

Massage and Physical Therapy

The inability to communicate normally with language increases anxiety and frustration in people with AD. Using touch, or massage, as a form of nonverbal communication has been shown to benefit those with AD. In one study, people with AD who received hand massages and were spoken to in a calming manner had a reduction in pulse rate and in inappropriate behavior. Health care professionals speculate that massage may be beneficial for people with AD not only because it is relaxing, but because it provides a form of social interaction and a moderate form of exercise.

Mind-Body Medicine

Music Therapy

Music therapy, the use of music to calm and heal an individual, cannot slow or reverse dementia, but it may improve quality of life for both a person with AD and their caregiver. Clinical reports suggest that music therapy may reduce wandering and restlessness and increase chemicals in the brain that enhance sleep and ease anxiety. For example, people with AD have been shown to experience significant increases in levels of brain chemicals such as melatonin, norepinephrine, and epinephrine after listening to live music regularly for a month. Mood also improved after listening to the music.

Support for the Caregiver

Studies suggest that caregivers who receive emotional support tend to experience an improvement in their quality of life, and those they are caring for benefit as well.

Other Considerations

A person with AD can experience the following complications:

• Falls (from impaired coordination)
• "Sundowning" (withdrawal or agitation in the evening)
• Malnutrition and dehydration
• Infection (from urinary tract infections or pneumonia)
• Asphyxiation (stopped breathing)
• Harmful or violent behavior toward self or others
• Suicide
• Poor health and support due to caregiver burnout
• Physical and emotional abuse, including neglect
• Heart disease

Alzheimer's disease gets worse over time. However, people with the disease can survive for many years. Those with a long-standing history of high blood pressure are more likely to get worse faster.

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• Review Date: 11/8/2006
• Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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