Menu Close

Dementia

What is
Alzheimer's disease

get started today

It effects more people than you may think

Alzheimer's disease

What we understand so far ...

Alzheimer’s disease (AD), also referred to simply as Alzheimer’s, is a chronic neurodegenerative disease that usually starts slowly and gradually worsens over time. It is the cause of 60–70% of cases of dementia.The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems with language, disorientation (including easily getting lost), mood swings, loss of motivation, not managing self-care, and behavioural issues. As a person’s condition declines, they often withdraw from family and society. Gradually, bodily functions are lost, ultimately leading to death. Although the speed of progression can vary, the typical life expectancy following diagnosis is three to nine years.

The cause of Alzheimer’s disease is poorly understood. About 70% of the risk is believed to be inherited from a person’s parents, with many genes usually involved. Other risk factors include a history of head injuries, depression, and hypertension. The disease process is associated with plaques and neurofibrillary tangles in the brain. A probable diagnosis is based on the history of the illness and cognitive testing with medical imaging and blood tests to rule out other possible causes. Initial symptoms are often mistaken for normal ageing. Examination of brain tissue is needed for a definite diagnosis. Mental and physical exercise, and avoiding obesity may decrease the risk of AD; however, evidence to support these recommendations is weak. There are no medications or supplements that have been shown to decrease risk.

No treatments stop or reverse its progression, though some may temporarily improve symptoms. Affected people increasingly rely on others for assistance, often placing a burden on the caregiver. The pressures can include social, psychological, physical, and economic elements. Exercise programs may be beneficial with respect to activities of daily living and can potentially improve outcomes. Behavioural problems or psychosis due to dementia are often treated with antipsychotics, but this is not usually recommended, as there is little benefit and an increased risk of early death.

In 2015, there were approximately 29.8 million people worldwide with AD. It most often begins in people over 65 years of age, although 4–5% of cases are early-onset Alzheimer’s. It affects about 6% of people 65 years and older. In 2015, dementia resulted in about 1.9 million deaths. The disease is named after German psychiatrist and pathologist Alois Alzheimer, who first described it in 1906. In developed countries, AD is one of the most financially costly diseases.

Signs and symptoms

The disease course is divided into four stages, with a progressive pattern of cognitive and functional impairment.

Pre-dementia

The first symptoms are often mistakenly attributed to ageing or stress. Detailed neuro-psychological testing can reveal mild cognitive difficulties up to eight years before a person fulfils the clinical criteria for diagnosis of AD. These early symptoms can affect the most complex activities of daily living. The most noticeable deficit is short term memory loss, which shows up as difficulty in remembering recently learned facts and inability to acquire new information.

Subtle problems with the executive functions of attentiveness, planning, flexibility, and abstract thinking, or impairments in semantic memory (memory of meanings, and concept relationships) can also be symptomatic of the early stages of AD. Apathy and depression can be seen at this stage, with apathy remaining as the most persistent symptom throughout the course of the disease. The preclinical stage of the disease has also been termed mild cognitive impairment (MCI). This is often found to be a transitional stage between normal ageing and dementia. MCI can present with a variety of symptoms, and when memory loss is the predominant symptom, it is termed “amnestic MCI” and is frequently seen as a prodromal stage of Alzheimer’s disease.[28]

Early

In people with AD, the increasing impairment of learning and memory eventually leads to a definitive diagnosis. In a small percentage, difficulties with language, executive functions, perception (agnosia), or execution of movements (apraxia) are more prominent than memory problems. AD does not affect all memory capacities equally. Older memories of the person’s life (episodic memory), facts learned (semantic memory), and implicit memory (the memory of the body on how to do things, such as using a fork to eat or how to drink from a glass) are affected to a lesser degree than new facts or memories.

Language problems are mainly characterised by a shrinking vocabulary and decreased word fluency, leading to a general impoverishment of oral and written language. In this stage, the person with Alzheimer’s is usually capable of communicating basic ideas adequately. While performing fine motor tasks such as writing, drawing, or dressing, certain movement coordination and planning difficulties (apraxia) may be present, but they are commonly unnoticed. As the disease progresses, people with AD can often continue to perform many tasks independently, but may need assistance or supervision with the most cognitively demanding activities.

Moderate

Progressive deterioration eventually hinders independence, with subjects being unable to perform most common activities of daily living. Speech difficulties become evident due to an inability to recall vocabulary, which leads to frequent incorrect word substitutions (paraphasias). Reading and writing skills are also progressively lost. Complex motor sequences become less coordinated as time passes and AD progresses, so the risk of falling increases. During this phase, memory problems worsen, and the person may fail to recognise close relatives. Long-term memory, which was previously intact, becomes impaired.

Behavioural and neuropsychiatric changes become more prevalent. Common manifestations are wandering, irritability and labile affect, leading to crying, outbursts of unpremeditated aggression, or resistance to caregiving. Sundowning can also appear. Approximately 30% of people with AD develop illusionary misidentifications and other delusional symptoms. Subjects also lose insight of their disease process and limitations (anosognosia). Urinary incontinence can develop. These symptoms create stress for relatives and carers, which can be reduced by moving the person from home care to other long-term care facilities.

Advanced

During the final stages, the patient is completely dependent upon caregivers. Language is reduced to simple phrases or even single words, eventually leading to complete loss of speech. Despite the loss of verbal language abilities, people can often understand and return emotional signals. Although aggressiveness can still be present, extreme apathy and exhaustion are much more common symptoms. People with Alzheimer’s disease will ultimately not be able to perform even the simplest tasks independently; muscle mass and mobility deteriorates to the point where they are bedridden and unable to feed themselves. The cause of death is usually an external factor, such as infection of pressure ulcers or pneumonia, not the disease itself.

Related News

  • Unlikely that high cholesterol or statins increase the risk of dementia

    Many patients stop taking medication for high cholesterol because they are afraid it may have negative side effects. But the observed association between risk of dementia and high cholesterol, may be caused by your lifestyle.

  • Inverse relationship found between cancer diagnosis and Alzheimer's disease

    With increased age comes the increased risk to develop cancer or dementia. Both conditions share similar risk factors such as hypertension and diabetes. Many cancer patients experience cognitive impairment from cancer and its treatments with symptoms similar to dementia.

  • Exploring the 'dark side' of Alzheimer's disease reveals new biomarkers

    Neurophysiological techniques (e.g., electroencephalography, EEG, transcranial magnetic stimulation, TMS) allow an informed investigation of the brain overexcitability underpinning the typical difficulty of maintaining a stable level of vigilance or experiencing a regular sleep-wake cycle in patients living with Alzheimer's disease (AD). Importantly, this difficulty has a significant impact on the level of consciousness of patients, affecting patients' ability to follow TV programs and social conversation during the daytime and preventing a deep sleep at night. As an important advantage, neurophysiological techniques can be applied in preclinical and clinical research models of the disease, its progression, and the effects of pharmacological and non-pharmacological interventions.

  • Reprogramming the brain's cleaning crew to mop up Alzheimer's disease

    The discovery of how to shift damaged brain cells from a diseased state into a healthy one presents a potential new path to treating Alzheimer's and other forms of dementia, according to a new study from researchers at UC San Francisco.

  • Which leisure activities are linked to lower risk of dementia?

    Leisure activities, such as reading a book, doing yoga and spending time with family and friends may help lower the risk of dementia, according to a new meta-analysis published in the August 10, 2022, online issue of Neurology. The meta-analysis reviewed available studies on the effects of cognitive activities, physical activities, and social activities and the risk of dementia.