Alzheimer’s and Dementia

Brain Disorders and Diseases

What is Alzheimer’s Disease? 

Alzheimer’s is a disease that attacks the brain and is the most common form of dementia. Alzheimer’s is characterized by a decline in cognitive functioning due to damage and destruction of the neurons in the parts of the brain that control cognitive functioning.

 

Alzheimer's DiseaseWhat are the Risk Factors for Developing Alzheimer’s Disease?

 

  • Age- the greatest risk factor for developing Alzheimer’s disease is advancing age with risk of developing Alzheimer’s doubling every 5 years after age 65.

 

  • Genetics- genetic links have been found to both early-onset and late-onset Alzheimer’s disease.

 

  • Family history- the risk of developing Alzheimer’s is increased for those who have a parent or sibling with Alzheimer’s disease.

 

  • Heart health- the risk of developing Alzheimer’s is increased for those with conditions that damage the heart or blood vessels such as high blood pressure, heart disease, stroke, diabetes, and high cholesterol.

 

  • Ethnicity- because Latinos and African-Americans in the U.S. have higher rates of vascular disease, they also may be at greater risk for developing Alzheimer’s.

 

  • Lifestyle- maintaining a healthy lifestyle, such as regular exercise and good nutrition, is key to Alzheimer’s prevention.

 

  • Head trauma- current research indicates a strong link between serious head injury and future risk of Alzheimer’s, specifically when trauma occurs repeatedly or involves loss of consciousness.

 

 

 

What are the Warning Signs of Alzheimer’s Disease? Dementia

Alzheimer’s disease research indicates that early detection is key to slowing the progression of the disease and improving disease prognosis. Early warning signs of Alzheimer’s disease include:

  • Challenges in planning or problem solving
  • Difficulty completing routine tasks
  • Confusion with time or place
  • Problems with words in speaking or writing
  • Misplacing things and losing the ability to retrace steps
  • Poor judgment
  • Withdrawal from work or other social activities
  • Changes in mood and personality

 

What are the symptoms of Alzheimer’s disease?

Symptoms of Alzheimer’s usually develop slowly and gradually worsen over time, progressing from mild forgetfulness to widespread brain impairment. Symptoms of Alzheimer’s disease are categorized as cognitive or psychiatric.

Cognitive symptoms:

  • Amnesia– Loss of memory both short-term and long-term.
  • Aphasia– Inability to communicate expressively (inability to speak and write) or receptively (inability to understand spoken or written words).
  • Apraxia– Inability to complete activities of daily living (brushing teeth, showering, dressing self) or instinctive functions (walking, chewing, swallowing).
  • Agnosia– Inability to correctly interpret signals from the five basic senses. Perhaps the most devastating symptom of agnosia is an individual’s inability to recognize friends and loved ones.

Psychiatric symptoms: 

  • Irritability
  • Anxiety
  • Fear
  • Agitation
  • Paranoia
  • Apathy
  • Withdrawal
  • Isolation
  • Verbal and Physical Aggression
  • Depression
  • Delusions
  • Hallucinations

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What are the Stages of Alzheimer’s Disease? 

The following stages are used a framework to provide general guidelines for understanding the progression of Alzheimer’s disease and symptoms. It is important to remember that each case of Alzheimer’s progresses differently. Cognitive, physical, and functional phases often overlap and time spent in each stage varies widely from patient to patient. It is also important to note that not everyone experiences all Alzheimer’s symptoms.

Stage 1: Early or Mild Stage Alzheimer’s disease (2-4 years) – A person continues to function independently and have the ability to drive, work, and participate in social activities. Despite having the ability to function in the above domains, they may experience:

  • Memory lapses
  • Forgetfulness
  • Difficulty with word articulation
  • Trouble remembering names when introduced to new people
  • Increased difficulty performing tasks
  • Forgetting material just read
  • Losing or misplacing valuable objects
  • Increased trouble with planning or organizing

Stage 2: Middle or Moderate Stage Alzheimer’s disease (2-10 years)– A person has greater difficulty performing tasks but may still remember significant details about their lives. Other symptoms include:

  • Confusing words
  • Getting easily frustrated or angry
  • Acting in unexpected ways
  • Forgetfulness of events or personal history
  • Moodiness
  • Withdraw in socially or mentally challenging situations
  • Inability to recall own address or telephone number
  • Confusion regarding person, place, or time
  • Inability to choose proper clothing for weather or occasion
  • Trouble controlling bladder or bowels
  • Changes in sleeping patterns
  • Personality and behavioral changes
  •  Wandering and becoming lost

Stage 3: Late or Severe Stage Alzheimer’s disease (1-3 years)A person loses the ability to respond to their surroundings.

During this stage a person will:

  • Require full-time, around-the-clock care
  • Be bedridden
  • Unable to complete activities of daily living without assistance

 

How is Alzheimer’s Diagnosed?

Experts estimate a skilled neurologist can diagnose Alzheimer’s with more than 90 percent accuracy. The first step in following up on your symptoms is finding a doctor you feel comfortable with. At Kentucky Neurology and Rehab we guarantee that Dr. Landfield will make you feel comfortable and confident in the care you receive.

Dr. Landfield may preform several exams and tests to determine if Alzheimer’s is causing your symptoms. These test include:

  • Medical history
  • Mental status testing
  • Physical Exam
  • Neurological and neuro-psychological exams
  • Blood Tests
  • Brain scans
  • Brain imaging

Differential Diagnosis 

Receiving a proper and timely diagnosis is crucial as conditions other than Alzheimer’s may be causing your symptoms. The following conditions can cause an individual to experience symptoms similar to those of someone with Alzheimer’s and dementia:

  • Depression
  • Drug interactions
  • Thyroid problems
  • Vitamin deficiencies
  • Diabetes
  • Kidney Disease
  • Liver Disease
  • Alcoholism
  • Mild Cognitive Impairment (MCI)
  • Vascular Dementia
  • Mixed Dementia
  • Dementia with Lewy Bodies
  • Parkinson’s Disease
  • Frontotemporal Dementia
  • Creutzfeldt-Jakob Disease
  • Normal Pressure Hydrocephalus
  • Huntington’s Disease
  • Wernicke-Korsakoff Syndrome

 

Treatments for Alzheimer’s and Dementia 

Although Alzheimer’s disease cannot be stopped or reversed, diagnosis and treatment will allow a person the opportunity to live well with the disease for as long as possible. Common treatments for Alzheimer’s and dementia include:

 

Drug therapy for cognitive symptoms  

Cholinesterase inhibitors– this class of drug works by boosting levels of cell-to-cell communication by supplementing neurotransmitters that are depleted in the brain by Alzheimer’s disease. This class of drug has been shown to improve cognitive and psychiatric symptoms of Alzheimer’s disease. The most common side effect of these drugs include diarrhea, nausea, loss of appetite, and sleep disturbances. Commonly prescribed cholinesterase inhibitors include: Razadyne, Aricept, and Exelon.

Memantine/Namenda– this drug works by regulating the activity of glutamate, the neurotransmitters in the brain involved in learning and memory. This has been shown to slow the progression of symptoms with moderate to severe Alzheimer’s disease. This drug can be used in combination with a cholinesterase inhibitor. Common side effects include constipation, dizziness, and headache.

 

Drug therapy for psychiatric symptoms 

Antidepressants– this class of drug works by balancing neurotransmitters that affect mood. Commonly prescribed antidepressants include: Paxil, Prozac, Zoloft, Celexa, Luvox, Wellbutrin, Cymbalta, Effexor, Lexapro, Elavil, Remeron, Strattera, and Sarafem.

Sleep Aids– also referred to as hypnotics, this class of drugs works to induce and maintain sleep by increasing the activity of gamma-aminobutyric acid, the neurotransmitter responsible for causing drowsiness, in the brain. Commonly prescribed hypnotics include: Lunesta, Ambien, and Sonata.

Anti-Anxiety Agents– also referred to as benzodiazepines, this class of drug works by slowing down the nervous system. Commonly prescribed anti-anxiety agents include: Valuim, Klonipin, Xanax, and Ativan.

 

Modify environment– Adapting the environment to the needs of a person with Alzheimer’s is an important part of any treatment plan. Establishing and strengthening routine habits and minimizing memory-demanding tasks can make life much easier for someone living with Alzheimer’s. Steps that can be taken to modify living environment include:

  • Keep keys, wallets, valuables, and medication in the same place
  • Fill weekly pill counters with prescribed medications
  • Set up bank accounts for automatic deposit and withdrawal
  • Keep mobile phone on your person with GPS location enabled
  • Keep important numbers programmed into phone
  • Use a white board or calendar to keep track of daily schedule and appointments
  • Use a daily checklist
  • Remove excess furniture, clutter, and tripping hazards such as throw rugs
  • Install handrails on stairways and in bathrooms
  • Wear shoes that are comfortable and provide good traction
  • Wear medical identification tag at all times
  • Reduce or remove mirrors as people with Alzheimer’s may find images in mirrors confusing and frightening

 

Exercise- Regular exercise can help improve mood, promote sleep, prevent constipation, and maintain joint, muscle, and heart health. Recommended exercises include:

  • Walking
  • Stationary bike
  • Chair exercises
  • TV/DVD/Digital download exercise programs

Nutrition- People with Alzheimer’s often have difficulty eating and drinking due to memory loss, cognitive impairment, and decline in physical ability. To avoid dehydration and malnutrition, try offering:

  • High-calorie shakes and smoothies
  • Milkshakes with protein powders
  • Nutritional supplements labeled for use with Alzheimer’s
  • Water or juice, avoid beverages with caffeine as it may increase restlessness, trigger a frequent need to urinate, and interfere with sleep

Homeopathic Medicine- Although homeopathic treatments are not empirically supported or approved by the FDA, many Alzheimer’s patients report symptom relief from the following herbal remedies and vitamins:

  • Omega-3 fatty acids– may help prevent cognitive decline.
  • Curcumin– an herb that comes from turmeric and has anti-inflammatory and antioxidant properties that might affect chemical processes in the brain.
  • Ginkgo– Ginkgo is a plant extract containing several substances.
  • Vitamin E–  2,000 international units daily may help slow the progression of Alzheimer’s

Physical, occupational, and speech therapy- all assist a person with Alzheimer’s to function independently for as long as possible.

  • Physical therapy– physical therapists assist Alzheimer’s patients with increasing strength, maintaining strength, and maintaining mobility.
  • Occupational therapy– occupational therapists assist Alzheimer’s patients with maintaining independence for as long as possible by developing routines and adapting their environments to their cognitive abilities.
  • Speech therapy– speech therapists assist Alzheimer’s patients with cognitive, communication, and swallowing deficits by using techniques such as teaching written cues for completing tasks or to assist memory recall, creating books to help recall information, and teaching family members and caregivers how to communicate more effectively with the Alzheimer’s patient.

What is the Prognosis of Alzheimer’s? 

It is difficult for doctors to predict how long a person with Alzheimer’s has to live after receiving their diagnosis since there are so many variables that contribute to life expectancy. Over time, a person with Alzheimer’s disease will continue to develop more symptoms and their condition will worsen. Sadly, Alzheimer’s is an ultimately fatal disease because over time it will causes all the body systems to fail. Although Alzheimer’s disease cannot be cured, early diagnosis and treatment can allow a person the opportunity to live well with the disease for as long as possible. If you or a loved is living with Alzheimer’s disease, visit Dr. Lanfield at Kentucky Neurology and Rehab.

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