Introduction:

Alzheimer's disease is a brain disease that causes loss of memory and mental function. It gets worse in stages, and people with Alzheimer's have gradual memory loss as well as loss of judgment, difficulty concentrating, loss of language skills, personality changes, and a decline in the ability to learn new tasks. In advanced stages, people with Alzheimer's can lose all memory and mental abilities.

Alzheimer's is the most common kind of dementia. About 5 million Americans have Alzheimer's, and this number is expected to grow as the population gets older. How it progresses is different for each person. If Alzheimer's develops rapidly, it usually gets worse rapidly. If it has been slow to get worse, it will likely continue on a slow course.

Alzheimer's symptoms happen because the disease kills brain cells. In a healthy brain, billions of neurons create chemical and electrical signals that are relayed from cell to cell and help a person think, remember, and feel. Neurotransmitters -- brain chemicals -- help these signals move from cell to cell. In people with Alzheimer's, neurons in certain places start to die, causing lower levels of neurotransmitters to be produced. That causes the brain to have problems with its signals.

There is no cure for Alzheimer's, but there are some medications that can help slow the progression of the disease in some people. Some herbs and supplements, and lifestyle adjustments, may help reduce the risk or improve quality of life.

Signs and Symptoms:

The early symptoms of Alzheimer's disease can be missed because they look like the ones that many people attribute to "natural aging." The following are the most common signs and symptoms of Alzheimer's:

Psychological Symptoms

• Memory loss that gets worse, starting with forgetting recent events and new information, progressing to not recognizing friends and family members
• Having a hard time concentrating
• Having a hard time understanding words, completing sentences, or finding the right words
• Getting lost in familiar places
• Restlessness
• Depression
• Aggression, agitation, anxiety, restlessness
• Distrusting others
• Withdrawal, disinterest, hostility, loss of inhibitions

Physical Symptoms

• Problems with movement or coordination
• Muscle stiffness, shuffling or dragging feet while walking
• Insomnia or change in sleep patterns
• Weight loss
• Incontinence
• Muscle twitching or seizures

Causes:

Researchers aren't sure what causes Alzheimer's disease. Both genetics and the environment may combine in some cases. Recent research indicates that free radicals (molecules that can cause oxidation and damage cells and DNA) may play a role in the development of Alzheimer's.

Alzheimer's is characterized by the buildup in the brain of two types of proteins. Clumps of abnormal cells are called plaques, made of beta-amyloid protein. These plaques build up between neurons and may stop them from communicating with each other. Inside nerve cells are tangles, made of twisted tau protein. The brain needs tau protein to function, but in people with Alzheimer's the protein becomes twisted, which may cause damage to brain cells.

People with the APOE-e4 gene are more likely to develop Alzheimer's -- it's known as a "risk gene" for the condition. But scientists think there may be many more genes involved. And even people without inherited genes for the disease can get Alzheimer's.

Risk Factors:

The causes and risk factors associated with Alzheimer's disease are not entirely clear but include:

• Family history of Alzheimer's
• Older age -- the risk of getting Alzheimer's doubles every 5 years after age 65.
• Long-term high blood pressure
• Heart disease
• History of head trauma -- one or more serious blows to the head may put a person at increased risk.
• Down syndrome
• Education level -- people with higher levels of education are less likely to develop Alzheimer's.

Diagnosis:

There is no single test for Alzheimer's disease. A true diagnosis can be made only after a person dies and an autopsy is done on the brain.

However, Alzheimer's usually has a pattern of symptoms. A doctor will start by ruling out other possible causes. The doctor will ask questions about medical history and symptoms and do a physical exam, including a neurological exam.

The following tests may also be used:

• Mental status evaluation, to test memory and attention span. It can also show any problems in problem-solving, social, and language skills.
• Genetic test, using a blood test for the APOE-e4 gene. Having the gene may suggest Alzheimer's, 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 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 Alzheimer's, they rule out other causes of dementia such as stroke and tumor.

Preventive Care:

No one knows exactly how to prevent Alzheimer's disease, but eating a healthy diet and exercising regularly help.

• Eating more fatty, cold-water fish, such as tuna and salmon, may be associated with a lower risk of dementia. This may be because these fish have high levels of omega-3 fatty acids, which benefit the heart and the brain. Eating fish at least two to three times per week provides a healthy amount of omega-3 fatty acids.
• 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 Alzheimer's.
• Keeping mentally and socially active may help delay the start or slow the progression of Alzheimer's.

Treatment:

The goals in treating Alzheimer's disease are to:

• Slow progression of the disease
• Manage behavior problems, confusion, and agitation
• Change the home environment to be safe
• Support family members and other caregivers
• There is no cure for Alzheimer's. The most promising treatments include lifestyle changes and medications.

Lifestyle

Studies show the following lifestyle changes may help improve behavior in people with Alzheimer's disease:

• A regular walk with a caregiver or trusted companion may improve communication skills and reduce the chance of wandering.
• Bright light therapy may reduce insomnia and wandering.
• Calming music may reduce wandering and restlessness, boost brain chemicals, and improve behavior.
• Pets can sometimes help people improve behavior.
• Relaxation training and other exercises that require focused attention may help boost social interaction and make it easier to do tasks.
• The Safe Return Program, implemented by the Alzheimer's Association, encourages identification bracelets, wallet cards, and clothing labels for people with Alzheimer's. Information is stored in a national database and given to authorities when a person is reported missing.

Medications

Several drugs are available to try to slow the progression of Alzheimer's and possibly improve mental function.

• Cholinesterase inhibitors -- increase the amount of acetylcholine in the brain. Side effects can include nausea, fatigue, and diarrhea. This class of drugs includes:
  • Donepezil (Aricept)
  • Rivastigmine (Exelon)
  • Galantamine (Razadyne, formerly called Reminyl)

• Memantine (Namenda) -- This drug works by regulating a chemical messenger called glutamate, which is involved in information storage and retrieval in the brain. Side effects can include headache, constipation, confusion, and dizziness. It is the only drug approved for treatment of moderate-to-severe Alzheimer' s disease.

The following medications may also ease the symptoms related to Alzheimer' s:

• Selective serotonin reuptake inhibitors (SSRIs) increase activity of a brain chemical called serotonin. They are used to treat depression that often occurs in the early stages of Alzheimer's.
• Methylphenidate (Concerta) is a stimulant that is often prescribed for attention deficit hyperactivity disorder. It is sometimes used to treat withdrawal and apathy in people with Alzheimer's.
• Carbamazepine is an anti-seizure drug that stabilizes sodium levels in the brain. It is sometimes used to treat agitation in people with Alzheimer's.

Nutrition and Dietary Supplements

People with Alzheimer's may need help with their diet. They often forget to eat and drink and can get dehydrated.

Follow these tips for a healthy diet:

• 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, 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
• 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.
• Don' t smoke.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

Some supplements may interact with certain medications and may have negative side effects. Always tell you doctor about any herb or dietary supplement you are taking. These supplements may help with some symptoms of Alzheimer's, although further study is needed:

• Phosphatidylserine, 100 mg three times per day, shows promise in several studies. Phosphatidylserine is a substance that occurs naturally in the brain. It may raise levels of brain chemicals that deal with memory, according to several studies. It may work best in people with mild symptoms, and may lose its effect after about 16 weeks. Do not take phosphatidylserine if you are taking blood thinners such as warfarin (Coumadin). Use caution if taking it with ginkgo. In both cases, your risk of bleeding may increase. Phosphatidylserine may cause sleeplessness in some people. It may interact with other medications for Alzheimer' s and glaucoma. Ask your doctor before taking it.
• Antioxidants may protect against the development of dementia. They may even slow the progression of dementia. In some, but not all, studies, vitamin E (400 - 800 IU per day) combined with Aricept seemed to slow mental decline in people with Alzheimer' s disease. Another antioxidant, coenzyme Q10 (10 - 50 mg three times per day), may help the brain get more oxygen. Coenzyme Q-10 might help the blood clot. By helping the blood clot, coenzyme Q-10 might decrease the effectiveness of warfarin (Coumadin). The skins of dark berries also provide valuable antioxidants. Try eating half a cup of frozen blueberries daily -- freezing makes the antioxidants in the berries' skin more easily absorbed.
• Vitamins: biotin (300 mcg); B1 (50 - 100 mg), B2 (50 mg), B6 (50 - 100 mg), B12 (100 - 1,000 mcg), folic acid (400 - 1,000 mcg). No scientific evidence shows a direct benefit, but B12 and folic acid lower the levels of an amino acid in the blood that is often high in Alzheimer's patients. Shots of B12 may work better than pills.
• Zinc (30 - 50 mg per day) is often low in elderly people, and may help improve memory.

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 - 50 mg three times per day, shows some evidence for treating early Alzheimer's disease and vascular dementia. However, one large randomized, double-blind, placebo-controlled study found that ginkgo did not prevent Alzheimer' s or dementia. If you are taking blood-thinning medication such as warfarin (Couamdin) or aspirin, don' t use ginkgo without your doctor' s supervision.
• Huperzine A, a chemical made from the plant Huperzia serrata, may improve memory in both vascular and Alzheimer's dementia, according to several studies in China. However, more studies are needed to know for sure. The usual dose is 200 mcg twice a day. Do not take huperzine A if you have liver disease or if you are about to have anesthesia. Talk to your doctor before taking huperzine A if you already take medication to treat Alzheimer' s.
• American ginseng (Panax quinquefolium) improves blood flow to the brain. Use with caution if you have high blood pressure, and talk to your doctor before combining ginseng with gingko.
• One study showed that lemon balm (Melissa officinalis), 60 drops per day, helped improve mental function in people with mild-to-moderate Alzheimer's. Lemon balm may have some sedating effects.
• Bacopa (Bacopa monnieri) leaf extract, called Brahmi, is used in Ayurvedic or Indian medicine to improve brain function and learning. However, no scientific studies have looked at bacopa to see whether it might work for dementia. One study found that 300 mg per day for 12 weeks seemed to improve cognition in healthy people.
• Vinpocetine (isolated from Vinca minor), 10 - 40 mg twice daily, may increase blood flow to the brain and help the brain better use oxygen. However, most of the studies done so far have been of poor quality. More research is needed. Vinpocetine may interact with blood thinning medications such as warfarin (Coumadin) and aspirin.

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 Alzheimer's. More studies are needed.

Massage and Physical Therapy

People with Alzheimer's disease become frustrated and anxious because they cannot communicate well with language. Using touch, or massage, as a form of nonverbal communication may help. In one study, people with Alzheimer's who received hand massages and were spoken to in a calming manner had lower pulse rates and didn' t engage in as much inappropriate behavior. Health care professionals think that massage may help not only because it is relaxing, but because it provides a form of social interaction.

Mind-Body Medicine

Music Therapy

Music therapy -- using music to calm and heal -- cannot slow or reverse dementia. But it may improve quality of life for both a person with Alzheimer's disease and their caregiver. Clinical reports suggest that music therapy may reduce wandering and restlessness and increase chemicals in the brain that promote sleep and ease anxiety. Mood also got better after listening to the music.

Support for the Caregiver

Studies suggest that caregivers who receive emotional support have better quality of life, which also benefits the people they care for.

Other Considerations:

Alzheimer's disease can lead to many complications, including:

• Falls
• "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 may live for many years. Those with a long-standing history of high blood pressure are more likely to get worse faster.

Alternative Names:

Memory loss