Alzheimer’s Disease

What is Alzheimer’s disease?

Alzheimer’s disease is the most common form of dementia, a serious brain disorder that impacts daily living through memory loss and cognitive changes.  Alzheimer’s is a degenerative disease, progressing from mild forgetfulness to widespread neurological impairment and ultimately death. Chemical and structural changes in the brain gradually destroy the ability to create, remember, learn, reason, and relate to others.  As critical cells die, drastic personality loss occurs and body systems fail.

Who has Alzheimer’s disease?

• Although not all memory loss indicates Alzheimer’s disease, one in ten people over 65 years of age, and over half of those 85+ have Alzheimer’s disease. Currently, 26 million people worldwide have this dementia, and over 15 million Americans will be affected by the year 2050.
• Early-onset Alzheimer’s effects patients under the age of 65.  This relatively rare condition is seen more often when parents or grandparents developed Alzheimer’s disease at a young age, and is generally associated with three genetic markers.

Signs and symptoms that may mean Alzheimer’s disease

For many, recognition of memory problems in themselves or a loved one brings fear of Alzheimer’s disease. Age-related brain shrinkage does produce normal changes in processing speed, attention, and short term memory, creating so-called “senior moments.” Understanding significance begins with knowing what is normal.

SIGNS OF NORMAL CHANGE VS. EARLY ALZHEIMER’S SYMPTOMS
Normal	Early Alzheimer’s disease
Can’t find your keys	Routinely place important items in odd places
Search for casual names and words	Forget names of family and common objects
Briefly forget conversation details	Frequently forget entire conversations
Can’t find a recipe	Can’t follow recipe directions
Forget to write down a check	Can no longer manage checkbook
Cancel a date with friends	Withdraw from usual interests
Miss an occasional right turn	Get lost in familiar places

What else might be causing these symptoms?

Significant cognitive and memory losses are not symptoms of normal aging.  Most people over 65 experience a level of forgetfulness that is merely inconvenient and generally involves unimportant information. Terms like eccentric and senile can mask fears of Alzheimer’s disease, while other conditions may actually be causing mental decline.  

Symptoms that mimic early Alzheimer’s disease may result from:

• Central nervous system and other degenerative disorders-, head injuries, brain tumors, stroke, epilepsy, Pick’s Disease, Parkinson’s disease, Huntington’s disease
• Metabolic ailments- hypothyroidism, hypoglycemia, malnutrition, vitamin deficiencies, dehydration, kidney or liver failure
• Substance-induced conditions-drug interactions, medication side-effects, alcohol and drug abuse
• Psychological factors- dementia syndrome, depression, emotional trauma, chronic stress, psychosis, chronic sleep deprivation, delirium
• Infections- meningitis, encephalitis, and syphilis

What to do if you notice Alzheimer’s symptoms

Research shows Alzheimer’s disease causes more worry than any other condition for Americans over 55 years of age.  If your family history includes Alzheimer’s and you find yourself forgetting things, it doesn’t necessarily mean you have this disease. Even when you fear the worst, it is important to share your concerns and seek expert advice.  

Where should I go if I suspect Alzheimer’s?

Although no single test for Alzheimer’s exists, a skilled general practitioner, neurologist, or geriatrician can make a reasonable diagnosis by excluding other causes of your symptoms.  Begin by preparing a list of concerns to discuss with your doctor.  Ask a family member or friend to go with you to take notes and help you remember your questions. If your doctor suspects Alzheimer’s disease and recommends further assessment, ask for support and information from your local Alzheimer’s Association while you wait for a diagnosis.

Can I prevent or inhibit Alzheimer’s disease?

With each forgotten name or misplaced item, memory loss can be frightening.  Maintaining a brain-healthy lifestyle, understanding controllable risk factors, and participating in research studies, can increase your sense of empowerment and protect your memory.  

Signs and symptoms that can lead to an Alzheimer’s diagnosis

In order to arrive at a diagnosis of Alzheimers, your doctor will gather family history information, order medical tests, and estimate your memory loss using a variety of assessments.  The most important information relates to past and present functioning.

Classic patterns not only eliminate other causes, but also distinguish Alzheimer’s from other forms of dementia. The following criteria must be present to diagnose Alzheimer’s disease:

• Significant memory problems - in immediate recall, short term, or long term memory
• Significant thinking deficits-in at least one of four areas, including expressing or comprehending language; identifying familiar objects through the senses; poor coordination, gate, or muscle function; and the executive functions of planning, ordering, and making judgments
• Decline severe enough to interfere with relationships and or work performance
• Symptoms appear gradually and become steadily worse over time
• Other causes are ruled out -memory and cognitive symptoms are not the result of another medical condition or disease

Signs of Alzheimer’s versus Mild Cognitive Impairment

Recent research examining Mild Cognitive Impairment reveals biological changes identical to those seen in an Alzheimer’s brain. Considered by some to be an intermediate stage between normal aging and the onset of Alzheimer’s disease, MCI is characterized by persistent forgetfulness, but lacks many of the more debilitating effects of Alzheimer’s. 

MCI often precedes the early stages of Alzheimer’s.  In other cases, patients plateau at a relatively milder stage of decline, and are able to live independently with little help from others.  Understanding how these conditions progress to dramatically different outcomes continues to be a source of scrutiny and study.

Stages of Alzheimer’s disease

Several methods based on the degeneration of the brain and nervous system are used to describe the symptoms of Alzheimer’s.  Although these staging systems provide useful guidelines for understanding how the disease may develop, it is important to remember that each individual progresses differently. Cognitive, physical and functional phases often overlap, the time in each stage varies widely, and not all patients experience all symptoms.

If you receive a diagnosis of Alzheimer’s disease that includes a stage reference, it is important to understand which system is used:

3 Stages of Alzheimer’s disease
Description	Duration	Characteristics
Mild/Early	2-4yrs	Frequent recent memory loss, particularly of recent conversations and events. Repeated questions, some problems expressing and understanding language.  Writing and using objects become difficult.  Depression and apathy can occur.  Drastic personality changes may accompany functional decline. Need reminders for daily activities, and difficulties with sequencing impact driving early in this stage.
Moderate/Middle	2-10 yrs	Can no longer cover up problems.  Pervasive and persistent memory loss impacts life across settings. Rambling speech, unusual reasoning, confusion about current events, time, and place.  Potential to become lost in familiar settings, sleep disturbances, and mood or behavioral symptoms accelerate.  Nearly 80% of patients exhibit emotional and behavioral problems which are aggravated by stress and change. Slowness, rigidity, tremors, and gait problems impact mobility and coordination.  Need structure, reminders, and assistance with activities of daily living.
Severe/Late	1-3+ yrs	Confused about past and present. Loss of recognition of familiar people and places.  Generally incapacitated with severe to total loss of verbal skills.  Unable to care for self.  Falls possible and immobility likely. Problems with swallowing, incontinence, and illness. Extreme problems with mood, behavioral problems, hallucinations, and delirium. Patients need total support and care, and often die from infections or pneumonia.

Other Models for understanding Alzheimer’s disease symptoms

Your doctor may also use a diagnostic framework with five, six, or seven levels.  Progression through these stages may last from 8 to 10 years.  Although it is rare, some live nearly 20 years from the time neuron change first occurs.

The seven stage framework includes the following dimensions:

• Stage 1 – No impairment. Memory and cognitive abilities appear normal.

• Stage 2 – Minimal Impairment/Normal Forgetfulness. Memory lapses and changes in thinking are rarely detected by friends, family, or medical personnel.  Half of those over 65 begin noticing problems in concentration and word recall.

• Stage 3 – Early Confusional/Mild Cognitive Impairment.  Subtle difficulties impact functions.  Try to hide problems. Problems with word retrieval, planning, organization, misplacing objects, and forgetting recent learning affect home and work environments.  New learning, complex planning and organization may be impacted. Depression and other mood disturbances can occur.  Duration:  2-7 years.

• Stage 4 – Late Confusional/Mild Alzheimer’s.  Problems handling finances result from mathematical challenges.  Recent events and conversations are increasingly forgotten.  Still know selves and family, but have problems carrying out sequential tasks, including cooking, driving, and home management tasks.  Ordering food at restaurants, independent shopping, and other sequential tasks are affected. Often withdraw from social situations, become defensive, and deny problems.  Need increasing assistance with the “business” of independent living.  Accurate diagnosis of Alzheimer’s disease possible.  Lasts roughly 2 years.

• Stage 5 – Early Dementia/Moderate Alzheimer’s disease- Decline is more severe, and requires assistance. No longer able to manage independently in community. Unable to recall personal history details and contact information.  Frequently disoriented to place and or time.  A severe decline in numerical abilities and judgment skills leaves patients vulnerable to scams and at risk from safety issues.  Even if able to dress, feed, and perform other basic daily living tasks, require supervision.  Loss of current information is inconsistent and personal history is no longer reliably recalled.  Duration:  average of 1.5 years.

• Stage 6 – Middle Dementia/Moderately Severe Alzheimer’s disease- Total lack of awareness of present events and can’t accurately remember the past. Progressively lose ability to dress and bathe independently. Bowel and bladder incontinence often occur, repetitive verbal or nonverbal behaviors are present, wandering, suspicion, and other dramatic personality changes are common.  Can’t remember close family members but know they are familiar.  Agitation and hallucinations are particularly present in the late afternoon or evening.  Late in this stage, need care and supervision but can respond to nonverbal stimuli, and communicate pleasure and pain behaviorally.  Lasts approximately 2.5 years.

• Stage 7 – Late or Severe Dementia and Failure to Thrive.  Severely limited intellectual ability. Communicate through short words, cries, mumbles or moans.  When speech is lost, also lose ability to ambulate without help.  Health declines considerably as body systems begin to shut down, swallowing is impaired, and the brain is no longer able to interpret sensory input.  Generally bedridden, increased sleeping, seizures possible. No longer responds to environmental cues and requires total support around the clock for all functions of daily living and care.  Duration is impacted by quality of care and average length is 1-2.5 years.

Coping with an Alzheimer’s diagnosis

While there is no cure for Alzheimer’s disease, it is important to remember that “if you’ve seen one Alzheimer’s patient, you’ve seen one Alzheimer’s patient.”  Considerable variation in functioning, behavior, psychological symptoms, and the impact on caregivers exists.  For many, the secrets to navigating this journey are learning, supporting, and loving.

The references below will provide a starting point for coping with an Alzheimer’s diagnosis.  Understanding what to expect, planning for care and transitions, honoring a loved one’s strengths and capabilities throughout each stage, and seeking support from others are key.

Related Articles

Related links for Alzheimer’s signs, stages, and symptoms

Signs, stages, and symptoms

Alzheimer's:  Know the 10 Signs-Discusses the 10 warning signs of Alzheimer’s disease and provides checklists for talking to your doctor (Alzheimer’s Association)

Alzheimer's-See the Symptoms:  Considers normal aging versus the early signs of Alzheimer’s, dementia and senility, and gives a quick link to stage information (seethesigns.com)

Alzheimer's Symptoms Checklist-Provides a quick memory checklist to see if a trip to the doctor is in order (Alzheimer’s Society of Ireland)

Clinical Stages of Alzheimer’s disease-Includes comprehensive functional descriptions for a seven stage assessment of Alzheimer’s progression

Signs, Symptoms, and Treatment for Alzheimer’s disease-Research and information on understanding, diagnosing, and treating Alzheimer’s disease (UCSF Medical Center)

Understanding Stages and Symptoms of Alzheimer’s disease-Lists signs, symptoms, and common changes in the 3 Stages of Alzheimer’s disease (National Institute on Aging)

Alzheimer’s diagnosis and risk factors

Alzheimer's Risk Factors:  Explores factors that contribute to the likelihood of Alzheimer’s disease, including those you might be able to control (Alzheimer’s Association)

Just Diagnosed:  What to Do When Symptoms Mean Alzheimer's-Suggestions for what to do in the first 48 hours after an Alzheimer’s diagnosis (OurAlzheimer’s.com)

Caregiver support

Caregiving: Maintain Your Support Network – Suggestions on how to engage family and friends in helping out with patient care. (Mayo Clinic)

Caregiver's Stress Check: Tests your stress and provides recommendations for addressing common caregiver’s issues (Alzheimer’s Association)

Melissa Wayne, MA and Jeanne Segal, Ph.D. collaborated on this article. Last modified: April 2009