Alzheimer's Disease

Symptoms

The symptoms of Alzheimer's disease progress slowly over several years. Sometimes these symptoms are confused with other conditions and may initially be put down to old age. 

The rate at which the symptoms progress is different for each individual. 

In some cases, other conditions can be responsible for symptoms getting worse. These conditions include: 

• infections 
• stroke 
• delirium 

As well as these conditions, other things, such as certain medicines, can also worsen the symptoms of dementia. 

Anyone with Alzheimer's disease whose symptoms are rapidly getting worse should be seen by a doctor so these can be managed. There may be reasons behind the worsening of symptoms that can be treated.

Causes

Alzheimer's disease is thought to be caused by the abnormal build-up of proteins in and around brain cells.

Although it's not known exactly what causes this process to begin, scientists now know that it begins many years before symptoms appear. 

As brain cells become affected, there's also a decrease in chemical messengers (called neurotransmitters) involved in sending messages, or signals, between brain cells. 

Levels of one neurotransmitter, acetylcholine, are particularly low in the brains of people with Alzheimer's disease. 

Over time, different areas of the brain shrink. The first areas usually affected are responsible for memories. 

In more unusual forms of Alzheimer's disease, different areas of the brain are affected. The first symptoms may be problems with vision or language rather than memory.

Risk Factors

Although it's still unknown what triggers Alzheimer's disease, several factors are known to increase your risk of developing the condition. 

Age 

Age is the single most significant factor. The likelihood of developing Alzheimer's disease doubles every 5 years after you reach 65. 

But it's not just older people who are at risk of developing Alzheimer's disease. Around 1 in 20 people with the condition are under 65. 

This is called early- or young-onset Alzheimer's disease and it can affect people from around the age of 40. 

Family history 

The genes you inherit from your parents can contribute to your risk of developing Alzheimer's disease, although the actual increase in risk is small. 

But in a few families, Alzheimer's disease is caused by the inheritance of a single gene and the risks of the condition being passed on are much higher.

Down's syndrome 

People with Down's syndrome are at a higher risk of developing Alzheimer's disease. 

This is because the genetic changes that cause Down's syndrome can also cause amyloid plaques to build up in the brain over time, which can lead to Alzheimer's disease in some people.

Head injuries 

People who have had a severe head injury may be at higher risk of developing Alzheimer's disease, but much research is still needed in this area. 

Cardiovascular disease 

Research shows that several lifestyle factors and conditions associated with cardiovascular disease can increase the risk of Alzheimer's disease. 

These include: 

• smoking 
• obesity 
• diabetes 
• high blood pressure 

• high cholesterol
  

Diagnosis

It's best to see a GP if you're worried about your memory or are having problems with planning and organising.

An accurate, timely diagnosis gives you the best chance to adjust, prepare and plan for the future, as well as access to treatments and support that may help.

Memory problems are not just caused by dementia – they can also be caused by: 

• depression or anxiety 
• stress 
• medicines 
• alcohol or drugs 
• other health problems – such as hormonal disturbances or nutritional deficiencies 

A GP can carry out some simple checks to try to find out what the cause may be. They can then refer you to a specialist for assessment, if necessary. They'll also check other aspects of your health and carry out a physical examination. 

They may also organise some blood tests and ask about any medicines you're taking to rule out other possible causes of your symptoms. 

You'll usually be asked some questions and to carry out some memory, thinking, and pen and paper tasks to check how different areas of your brain are functioning.

If a GP is unsure about whether you have Alzheimer's disease, they may refer you to a specialist, such as: 

• a psychiatrist (usually called an old age psychiatrist) 
• an elderly care physician (sometimes called a geriatrician) 
• a neurologist (an expert in treating conditions that affect the brain and nervous system)

A specialist will usually assess your mental abilities, such as memory or thinking, using tests known as cognitive assessments. 

Most cognitive assessments involve a series of pen and paper tests and questions, each of which carries a score. 

These tests assess a number of different mental abilities, including: 

• short-term and long-term memory 
• concentration and attention span 
• language and communication skills 
• awareness of time and place (orientation) 
• abilities related to vision (visuospatial abilities) 

It's important to remember that test scores may be influenced by a person's level of education. For example, someone who cannot read or write very well may have a lower score, but they may not have Alzheimer's disease. Similarly, someone with a higher level of education may achieve a higher score, but still have dementia.  

These tests can therefore help doctors work out what's happening, but they should never be used by themselves to diagnose dementia.

To rule out other possible causes of your symptoms and look for possible signs of damage caused by Alzheimer's disease, your specialist may recommend having a brain scan. This could be a CT (computed tomography) scan or MRI (Magnetic resonance imaging) scan.

Treatment Options

A number of medicines may be prescribed for Alzheimer's disease to help temporarily improve some symptoms.

The main medicines are:

• Acetylcholinesterase (AChE) inhibitors
• Memantine

Treatments that involve therapies and activities:

Medicines for Alzheimer's disease symptoms are only one part of the care for the person with dementia. 

Other treatments, activities and support – for the carer, too – are just as important in helping people live well with dementia. 

Cognitive stimulation therapy 

Cognitive stimulation therapy (CST) involves taking part in group activities and exercises designed to improve memory and problem-solving skills. 

Cognitive rehabilitation 

This technique involves working with a trained professional, such as an occupational therapist, and a relative or friend to achieve a personal goal, such as learning to use a mobile phone or other everyday tasks. 

Cognitive rehabilitation works by getting you to use the parts of your brain that are working to help the parts that are not. 

Reminiscence and life story work 

Reminiscence work involves talking about things and events from your past. It usually involves using props such as photos, favourite possessions or music. 

Life story work involves a compilation of photos, notes and keepsakes from your childhood to the present day. It can be either a physical book or a digital version.

Prevention Tips

As the exact cause of Alzheimer's disease is still unknown, there's no certain way to prevent the condition. But a healthy lifestyle can help reduce your risk.

You may be able to reduce your risk of developing these conditions – as well as other serious problems, such as strokes and heart attacks – by taking steps to improve your cardiovascular health. 

These include: 

• stopping smoking 
• keeping alcohol to a minimum 
• eating a healthy, balanced diet, including at least 5 portions of fruit and vegetables every day 
• exercising for at least 150 minutes every week by doing moderate-intensity aerobic activity (such as cycling or fast walking), or as much as you're able to 
• making sure your blood pressure is checked and controlled through regular health tests 
• if you have diabetes, make sure you keep to the diet and take your medicine

Staying mentally and socially active 

There's some evidence to suggest that rates of dementia are lower in people who remain mentally and socially active throughout their lives. 

It may be possible to reduce your risk of Alzheimer's disease and other types of dementia by: 

• reading 
• learning foreign languages 
• playing musical instruments 
• volunteering in your local community 
• taking part in group sports, such as bowling 
• trying new activities or hobbies 

• maintaining an active social life
  

When To See A Doctor

If you're worried about your memory or think you may have dementia, it's a good idea to see a GP.

If you're worried about someone else's memory problems, encourage them to make an appointment and perhaps suggest that you go along with them.

Memory problems are not just caused by dementia – they can also be caused by depression, stress, medicines or other health problems.

A GP can carry out some simple checks to try to find out what the cause may be, and they can refer you to a specialist for more tests if necessary.