Effects of Alzheimer’s on the Elderly

Alzheimer’s Disease is characterized by loss of memory and the ability to perform daily tasks that were once within a person’s ability. It is a form of dementia that generally begins after the age of 65; however, it has been diagnosed in adults as early as age 40. Alzheimer’s disease was discovered in 1906 by Dr. Alois Alzheimer who examined the brain of a female who had displayed loss of memory, inexplicable behavior changes, and problems with language. Upon death Dr. Alzheimer was able to examine the brain tissue and noted clumps and bundles of fiber in the brain. These are now referred to as “amyloid plaques” and “neurofibrillary tangles,” and they are primary features in the brain of a patient with Alzheimer’s disease. These changes may begin years, even decades, before an individual begins to exhibit symptoms of the disease. Symptoms usually begin gradually and may be undetected or unrecognized in the earlier stages. Personality traits may change as well, causing the individual to be short-tempered or moody.

There is no cure for Alzheimer’s disease. Newer and more advanced brain scans are being developed to identify the tangles and plaques associated with the disease so that physicians are more able to slow down the severity of the disease. Alzheimer’s disease is usually identified as early, moderate, and severe; there are medicines available not only to slow down the disease but also some that alleviate the symptoms of the disease. Alzheimer’s is not dementia. It can be a cause of dementia, but patients with dementia do not necessarily have Alzheimer’s. Some things that are maintained in patients with Alzheimer’s are long-term memory, muscle feeling and ability, and vision. Individuals who begin to exhibit episodes of memory loss or begin to lose the ability to function as previously should see a physician to get the best possible care at the earliest time.

Some of the signs that individuals can identify as early symptoms of Alzheimer’s disease include:

• Difficulty expressing in speech what you mean
• Sudden inability to identify familiar objects
• Forgetting to do simple tasks such as writing with a pen
• Failing to remember to do tasks such as locking doors or turning of the stove
• Change in temperament or personality.
• The inability to comprehend new information or remember phone numbers or appointments.
• Change in reasoning or trouble-shooting situations.
• Difficulty paying attention.
• Misplacing items and failing to be able to “retrace steps”
• Displaying poor judgment

Unfortunately, at this time the only definitive diagnosis for Alzheimer’s disease can be done at the time of death with an autopsy and direct examination of the brain tissue. As noted previously, researchers are seeking to advance the ability of x-ray and computer tomography (CT scans) to detect these changes while the patient is alive. Until those advancements are recognized, physicians rely on a patient’s symptoms, abilities, and history to diagnose the disease.

• X-Rays For Early Alzheimer’s Disease Detection
• Diagnosis

Apolipoprotein E (APOE) is the most common gene associated with late-onset Alzheimer’s disease. These patient develop the disease after the age of 65. There are three forms of APOE. One (APOE e2) decreased the risk of a patient developing Alzheimer’s. A second (APOE e3) appears to have no influence on an individual’s risk. However, the third (APOE e4) appears in patients who develop Alzheimer’s disease. An individual has two APOE genes, one from the father and one from the mother. The presence of two APOE e4 genes increases the risk of developing the disease. Even so, the presence of this gene does not guarantee that a patient will develop the disease. Also, there are patients with Alzheimer’s that have no APOE e4 gene. The statistics are that about 40-65% of patients who have the APOE e4 allele go on to develop Alzheimer’s disease

New research suggests that the presence of APOE e4 in an individual not only increases the risk of developing Alzheimer’s, but also may change the way the disease manifests itself in a patient. Patients with the gene tend to display more significant memory losses than those without. Anatomically, those that carry the APOE e4 allele have greater medial temporal lobe atrophy.

Early-onset Alzheiemer’s diseaese is identified by the fact that it occurs in adults younger than 65. There are genes associated with this condition other than the APOE gene. These genes include Amyloid precursor protein (APP), Presenilin (PS1), and Presenilin 2 (PS2). However, again, patients with these abnormalities may not develop Alzheimer’s as well, so other genetic abnormalities or mutations are being explored. Therefore, patients may do well with getting genetic testing for form of Alzheimer’s if a member of the family has Alzheimer’s, especially of early onset. However, a patient cannot definitively determine whether or not Alzheimer’s is imminent.

• Alzheimer’s: Is It In Your Genes?
• APOE - apolipoprotein E - Genetics Home Reference
• APOE Genotype Modulates Alzheimer’s Disease Phenotype
• Apolipoprotein E4

Preventive measures to lessen the possibility of developing Alzheimer:

• Watching one’s diet and including healthy foods such as whole grains; fruits such as cranberries and blueberries; the spice curcumin which is used in Indian cuisine; and foods rich in Vitamin D may prevent the development of Alzheimer’s disease and improve cognitive function
• Patients who exercised three times a week, 15 minutes a day, had a risk 35 to 40 percent lower of developing Alzheimer’s disease.
• An individual should begin challenging themselves mentally from childhood with activities such as reading, doing puzzles, learning a musical instrument, and playing chess. These activities will keep the mind alert and less likely to lose cognitive skills.
• Recent research has indicated that the use of NSAID’s such as ibuprofen and naproxen may prevent the Alzheimer’s disease.

• Alzheimer’s Risk Factors & Prevention
• Alzheimer’s Research | Alzheimer’s Research Aimed at Prevention
• What Can I Do To Prevent Alzheimer’s Disease
• Diet Tips To Help Prevent Alzheimers

For Caretakers

There are behaviors exhibited by patients suffering from Alzheimer’s disease that are destructive to themselves and others. Caretakers and family can take steps to curb some of the behaviors or manage them such as redirecting a wanderer with another activity or keeping a patient safe with child-safety devices. Reassure your family member if she becomes disoriented and doesn’t know where she is. Encouragement can go a long way in reassuring an individual that he is ok. For those caretakers who are at risk of their family member rummaging through their things or damaging items, a locked area may be the best defense. Many times the patient will not curb or understand that he is damaging something. Prevention is the best reassurance that valuables will not be disturbed. It is imperative that products such as cleaning products, alcohol, and medications be locked and put out of reach of the individual. If anger is exhibited, the caretaker should try to minimize the stress level by providing a calm environment and quiet voice; distract the patient with an activity that she enjoys; or provide a time-out away from everyone and anything that may be making the patient angry. Medications can sometimes minimize the presence of hallucinations, but if a patient describes things that are not there, the caretaker should not argue about fantasy vs. real. Instead, the caretaker should respond to the patient’s emotions about the hallucinations. If a patient refuses food, there are steps that can be taken to encourage eating such as exercise to increase hunger, make the patient their favorite foods and make mealtime pleasing, or feed the patient small bits at a time accompanied by song or rhyme.

• Alzheimer’s Behavior Management
• Alzheimer’s: Managing sleep problems - MayoClinic.com
• Managing Agitation Behavior in Alzheimer’s Patients
• Managing Alzheimer’s Delusions and Hallucinations
• Caregiving

Facts and Statistics

• There are approximately 5.4 million people in the United States that have Alzheimer’s disease.
• Approximately ten percent of people over age 65 have Alzheimer’s disease. However, by the time a patient reaches age 85, there is 50% possibility that he will have Alzheimer’s.
• Alzheimer’s disease costs approximately 172 billion dollars annually.
• In the United States alone, there are approximately 11 million people caring for an individual with Alzheimer’s disease, generally a family member.
• Every 70 seconds a new individual develops the disease. It is predicted that by the year 2050, this frequency will increase to every 33 seconds.
• Deaths that are associated and attributed to Alzheimer’s disease rose from 2000 to 2006 by 47%.
• About 500,000 Americans have been diagnosed with dementia, some attributable to early-onset Alzheimer’s disease.
• Alzheimer’s disease is the cause of 65% of all dementia patients.
• Up to 74% of all Alzheimer patients are women.

Other Dementias

• Understanding Dementia: Signs, Symptoms, Types, Causes, and Treatment: This site explores dementia and its symptoms. It compares the normal memory loss experienced by many older individuals to actual diagnosed dementia, and explores ways that dementia can be curbed or prevented.
• Most Early-Onset Dementia Not Alzheimer’s: This article explores the fact that most early-onset dementia is not caused by Alzheimer’s disease, but, in fact, the number one cause is an autoimmune or inflammatory disorder.
• Dementia: It’s not always Alzheimer’s: This CNN report examines the types of dementia not associated with Alzheimer’s. These include vascular dementia, lewy body dementia, frontotemporal dementia, Huntington’s disease, Parkinson’s disease, and AIDS. Dementia can also be attributed to reactions to medications, nutritional abnormalities, and infections, among others.
• Delirium and Dementia: This site introduces the signs and symptoms of dementia and other things that may be happening in a patient that could be interpreted as dementia. This includes depression and normal age-associated memory loss. It also explains to the reader the disorders that can cause dementia and ones that can be reversed more readily than others.
• Alzheimer’s vs Dementia: This in-depth article explores the differences between Alzheimer’s dementia and other kinds of dementia.

Further Reading

• Alzheimer’s Disease Fact Sheet
• FASTSTATS - Alzheimers Disease
• Early Alzheimer’s Disease
• NC DAAS: Alzheimer’s Disease and Other Dementias
• Guideline for Alzheimer’s disease management
• Alzheimer’s Disease | Understanding Alzheimer’s Disease
• Alzheimer’s Foundation of America - Caring for the Nation
• Alzheimer’s disease - Diagnosis
• Alzheimer’s Disease
• AlzOnline: Alzheimer’s Caregiver Support Online
• Harvard Medicine Research: Alzheimers Disease
• Alzheimer’s Advances Show Need For Better Drugs: NPR
• The Forgetting | PBS
• FCA: Alzheimer’s Disease

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