Alzheimer's Disease

Signs and Symptoms

Alzheimer's disease usually appears after the age of 60. The first symptom tends to be memory lapses, especially for recent events or newly learned information. Memory lapses may be very subtle at first, but leads to more significant gaps and confusion. Eventually, the disease leads to severe brain damage that impairs a person's ability to complete everyday tasks as well as to reason, learn and imagine.

People with Alzheimer's experience difficulties communicating, learning, thinking and reasoning -- problems severe enough to impact their work, social activities and family life.

One of the most common early signs of dementia is memory loss, forgetting information that has been recently learned. While it can be normal to forget appointments, names or telephone numbers, individuals with dementia have more severe deficits in memory. They often find it hard to complete everyday tasks that are so familiar that most people ordinarily wouldn't think twice about how to do them. Alzheimer's disease may cause a person to forget how to prepare a meal, use a household appliance or to participate in a lifelong hobby.

Symptoms

Some symptoms of Alzheimer's disease include:

• Abstract Thinking -- Balancing a checkbook may be hard when the task is more complicated than usual. Someone with Alzheimer's disease, however, might forget what the numbers are and what needs to be done with them.

• Disorientation -- It's normal to forget the day of the week or where you're going. People with Alzheimer's disease can become lost on the street where they live, forget where they are and how they got there, and not know how to get back home.

• Initiative -- People often tire of housework, business activities or social obligations at times. However, a person with Alzheimer's disease may become excessively passive, sitting in front of the television for hours, sleeping more than usual or not doing usual activities.

• Judgment -- No one has perfect judgment all of the time but those with Alzheimer's disease may dress without regard to the weather, wearing several shirts or blouses on a warm day or very little clothing in cold weather. Individuals with dementia often show poor judgment about money, giving away large amounts of money to telemarketers or paying for home repairs or products they don't need.

• Language -- All of us have trouble finding the right word from time to time, but people with Alzheimer's disease often forget simple words or substitutes unusual words, making their speech or writing hard to understand. If a person with Alzheimer's is unable to find his or her toothbrush, for example, the individual may ask for "that thing for my mouth."

• Misplacing Items -- Anyone can temporarily misplace a wallet or key. A person with Alzheimer's disease may put things in unusual places -- an iron in the freezer or a wristwatch in the sugar bowl.

• Mood Changes -- Everyone can become sad or moody from time to time. However, someone with Alzheimer's disease can show rapid mood swings -- from calm to tears to anger -- for no apparent reason.

• Personality -- Personalities ordinarily change somewhat with age but a person with Alzheimer's disease may have a severe personality change, becoming extremely confused, suspicious, fearful or dependent on a family member.

Diagnosis

There is no single diagnostic test that can detect if a person has Alzheimer's disease. The process involves several tests and may take more than a day. Tests and criteria make it possible for doctors to make a diagnosis of Alzheimer's with an accuracy of about 90 percent.

There are two abnormal structures in the brain associated with Alzheimer's disease -- amyloid plaques and neurofibrillary tangles:

• Amyloid Plagues -- Amyloid plaques are sticky clumps or patches of protein found surrounded by the debris of dying nerve cells in the brain of Alzheimer's patients.

• Neurofibrillary Tangles -- These are the damaged remains of protein called tau, which are required for the normal functioning of the brain. In people with Alzheimer's, threads of tau protein become twisted, which researchers believe may damage neurons and cause them to die.

Research about these structures have provided clues about why cells die, but scientists have not determined exactly what role plaques and tangles play in the disease process and whether these are the key factors.

At the UCSF Memory and Aging Center, the evaluation and treatment recommendations for Alzheimer's are performed by a specially trained team including neurologists, radiologists, pharmacists, nurses and other health professionals. Evaluations may include the following steps:

• Brain Scans -- These test will be performed to detect other possible causes of dementia such as stroke.

• Evaluations -- A series of evaluations will test memory, reasoning, vision-motor coordination and language skills.

• Interviews -- An interview with the patient and another person close to the patient, such as a relative, spouse or close friend who can provide examples of memory loss and functional decline.

• Laboratory Tests -- Lab tests, such as blood and urine tests, may provide information about problems other than Alzheimer's that may cause dementia

• Medical History -- Information about current mental or physical conditions, prescription and nonprescription drug use, and family health history will be collected.

• Mental Status -- An evaluation will be conducted to assess sense of time and place; ability to remember, understand and communicate and ability to do simple math problems.

• Physical Exam -- The patient's nutritional status, blood pressure and pulse will be assessed as part of this examination. Tests of sensation, balance and other functions of the nervous system also will be conducted.

• Psychiatric Evaluation -- An assessment of mood and other emotional factors that could cause dementia-like symptoms or may accompany Alzheimer's disease will be completed.

Treatment

Currently, there are several medications approved to manage Alzheimer's disease. Many patients improve with medication. However, the period of improvement and stability varies with each patient. It appears that in all patients, AD progresses in the long term, despite treatment.

In addition to drugs, an aerobic and weight-bearing exercise regimen may increase energy levels, reduce apathy and improve the overall sense of well-being. Since lack of motivation can be a problem, a personal trainer may be helpful to ensure participation in an exercise program.

One treatment that holds promise for the future is a vaccine that targets the beta-amyloid protein. Research on the vaccine in mice has been encouraging. Studies involving humans are in the early stages.