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Alzheimer’s disease is the most common form of dementia. Symptoms include memory loss, impaired thinking and changes in psychology. This disease is progressive; Alzheimer’s symptoms become more severe with time. Although no cure is known, various healthcare treatments and thoughtful caregiving can improve quality of life.
Alzheimer’s disease (AD) begins in late middle age or old age. General symptoms are impaired memory, impaired communication, disorientation and a decline in everyday living skills.
Health care providers describe Alzheimer’s as having three stages: mild, moderate and severe. Researchers have also identified a pre-clinical period. During pre-clinical Alzheimer’s disease, brain changes might be evident on an MRI but symptoms of these changes aren’t evident.
Independent living is possible with mild Alzheimer’s symptoms. For example, symptoms might be limited to:
The moderate stage of Alzheimer’s can last for several years or longer. During this time, changes in mood and personality are likely to arise. Alzheimer’s patients also tend to become restless in the middle stage. This could show up as insomnia, fidgeting and/or wandering. Becoming lost when wandering is a common danger to patients, so Alzheimer’s assisted living centers and nursing homes set up for memory care have especially secure perimeters. Eventually patients require 24-hour supervision. With severe Alzheimer’s a person needs health care and personal care support, and they need to be monitored for their own safety and the safety of others.
Alzheimer’s is manifested differently in each patient. Listed here are common symptoms in several categories.
Impaired memory and jumbled thinking are classic symptoms of Alzheimer’s disease. Examples include:
Mood and Psychology
A certain diagnosis of Alzheimer’s disease can only be made with an autopsy that includes examining brain tissue with a microscope. Therefore, to determine whether a patient might have Alzheimer’s, doctors attempt to rule out other causes for dementia. There are dozens of possible causes, so many tests might be recommended. These are described above in Diagnosing the Cause of Dementia. Other common sorts of diagnostic tests are described below.
Also called the Folstein test, the Mini Mental Status Exam[pdf] is a 30-point test that helps doctors understand whether a person has trouble with attention span, problem solving, counting and memory.
Some questions on the Mini Mental Status Exam are:
A person’s score on this exam should be interpreted with caution. For instance, a person might score poorly because the test is given in their non-native language, or because they have a lifelong learning disability. Still, based on the test score and the patient’s education level, the doctor can generally render an informed opinion about whether the person has cognitive impairment and how much senior care they likely need.
CT stands for “computer tomography.” A CT machine takes X-rays from many different angles. A computer combines these images to produce what look like slices of the body. The composite images could show brain changes that are common with moderate and severe Alzheimer’s.
MRI stands for “magnetic resonance imaging.” An MRI machine uses a magnet, radio waves and a computer to produce pictures of the brain. Doctors study the pictures for tumors and signs of a stroke. Also, like a CT scan, an MRI may also show brain changes that are linked to Alzheimer’s disease.
A PET or “positron emission tomography” machine uses radioactive tracers to make images of the brain. It can be used to show amyloid plaque accumulation. Amyloid plaque buildup is present in all Alzheimer’s patients. However, some people have this plaque without symptoms of dementia.
No Alzheimer’s disease cure is known, but medications and other therapies can help maximize quality of life. Along with skilled caregiving they can slow progression of the disease and ease symptoms. If you are looking for Alzheimer’s care, you can call our Alzheimer’s helpline to find local care near you today.
For treating the cognitive symptoms of Alzheimer’s disease — memory loss, confusion and trouble reasoning — the US FDA has approved two kinds of medications:
Doctors may prescribe one or more of the above drugs to support the brain’s chemical messaging; the drugs reduce the breakdown of the neurotransmitter acetylcholine. Alternatively doctors could prescribe Namzaric, which is a combination of a cholinesterase inhibitor and memantine.
These drugs may be especially helpful during early and mid-stage Alzheimer’s. Later, because more neurons are lost, improving the levels of chemical messengers is less helpful. Different drugs are approved for use at different stages though, and some are beneficial even with severe Alzheimer’s. You can learn more about these drugs at alz.org.
Changes in mood and behavior, such as feeling anxious or being hostile toward loved ones, are common with moderate and severe Alzheimer’s disease. Many Alzheimer’s patients take medications to manage these psychological changes. As explored below, it’s also critical to ensure that symptoms aren’t partially or fully explained by other medical problems or the caregiving environment.
Antipsychotic medications such as those for paranoia and hallucinations may be toxic to people with dementia. However, Alzheimer’s patients might take mainstream medications for depression and anxiety.
Antidepressants are prescribed to lift mood. Among the commonly prescribed drugs and their brand names are:
Anxiolytics can help relieve anxiety and restlessness. They may also help reduce verbally disruptive behavior and resistance to requests.
All of the above may bring different side effects, and the correct dosage might not be set for a few months. An advanced blood panel might help a physician or psychiatrist determine which drugs are most likely to be helpful.
Antipsychotic medications can be deadly for older adults with dementia. They bring an increased risk of stroke and death. In younger adults these drugs are prescribed to help control hallucinations, delusions and extreme aggression or uncooperativeness. The following are among those that the FDA warns against for Alzheimer’s patients: aripiprazole (Abilify), clozapine (Clozaril), haloperidol (Haldol), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal) and ziprasidone (Geodon).
Before drugs are prescribed for psychological problems, it’s important to rule out other medical causes for the symptoms. For example:
Everyday caregiving decisions can significantly shape a patient’s physical and psychological comfort. Simply keeping the thermostat at the person’s preferred setting could have a noticeable effect on their mood. Caregivers are also advised to:
People with Alzheimer’s, more than the general population, have sleep problems. Generally Alzheimer’s patients should avoid sleep drugs because these medications bring an increased risk of disorientation, falling down, and being less independent. In this section we consider different medications, other medical issues to consider, and tips for naturally healthy sleep.
Sleep medications have proven dangerous for people with Alzheimer’s. Here are just a few cautions to keep in mind:
The least risky medications for this patient population might be mild antidepressants. Melatonin, which is available without a prescription, might be more effective. Melatonin is a natural regulator of the sleep cycle, and melatonin production is impaired in Alzheimer’s patients.
Remember that diet may help promote sleep. Foods with tryptophan, for example, bring on drowsiness. (Turkey, eggs, tofu, nuts and pineapple are some tryptophan sources.) Camomile and other herbal teas can promote sleep as well.
Various treatable medical conditions cause insomnia and other sleep problems. Some conditions to rule out:
The timing of medications can influence sleep too. Cholinesterase inhibitors (common medication to support memory in Alzheimer’s patients) shouldn’t be given before bedtime. Drugs prescribed for anxiety and depression might also be best taken at a certain time of day.
The following tips can help anyone, including Alzheimer’s patients, achieve healthy sleep.
With sound sleep, dementia patients (and their caregivers) are best able to handle stressors and appreciate life’s everyday gifts.
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