Alzheimer’s disease is a degenerative brain disease and the most common cause of dementia.

Dementia is a syndrome — a group of symptoms — that has a number of causes. The characteristic symptoms of dementia are difficulties with memory, language, problem-solving and other cognitive skills that affect a person’s ability to perform everyday activities. These difficulties occur because nerve cells (neurons) in parts of the brain involved in cognitive function have been damaged or destroyed. In Alzheimer’s disease, neurons in other parts of the brain are eventually damaged or destroyed as well, including those that enable a person to carry out basic bodily functions such as walking and swallowing. People in the final stages of the disease are bed-bound and require around-the-clock care. Alzheimer’s disease is ultimately fatal.

Dementia – When an individual has symptoms of dementia, a physician will conduct tests to identify the cause. Different causes of dementia are associated with distinct symptom patterns and brain abnormalities, Studies show that many people with dementia symptoms have brain abnormalities associated with more than one cause of dementia. For example, studies report that about half of people who had the brain changes of Alzheimer’s dementia on autopsy also had the brain changes of a second cause of dementia, most commonly vascular dementia. This is called mixed dementia. In some cases, individuals have dementia-like symptoms without the progressive brain changes of Alzheimer’s or other degenerative brain diseases. Common causes of dementia-like symptoms are depression, delirium, side effects from medications, thyroid problems, certain vitamin deficiencies and excessive use of alcohol. Unlike Alzheimer’s and other brain diseases, these conditions often may be reversed with treatment.

Alzheimer’s Disease – Alzheimer’s disease was first described in 1906, but about 70 years passed before it was recognized as a common cause of dementia and a major cause of death. Only then, did Alzheimer’s disease become a significant focus of research. The research that followed has revealed a great deal, including the fact that Alzheimer’s disease begins years before the symptoms of Alzheimer’s dementia are present. Much is yet to be discovered about the precise biological changes of Alzheimer’s disease that lead to the symptoms of Alzheimer’s dementia, why the disease and its symptoms progress more quickly in some than in others, and how the disease can be prevented, slowed or stopped.

Diagnosis of Alzheimer’s Dementia

There is no single test for Alzheimer’s dementia. Instead, physicians (often with the help of specialists such as neurologists and geriatricians) use a variety of approaches and tools to help make a diagnosis. They include the following:

• Obtaining a medical and family history from the individual, including psychiatric history and history of cognitive and behavioral changes.
• Asking a family member to provide input about changes in thinking skills and behavior.
• Conducting cognitive tests and physical and neurologic examinations.
• Having the individual undergo blood tests and brain imaging to rule out other potential causes of dementia symptoms, such as a tumor or certain vitamin deficiencies.
• In some circumstances, using brain imaging to find out if the individual has high levels of beta-amyloid, a hallmark of Alzheimer’s; normal levels would suggest Alzheimer’s is not the cause of dementia.

Diagnosing Alzheimer’s dementia requires a careful and comprehensive medical evaluation. Although physicians can almost always determine if a person has dementia, it may be difficult to identify the exact cause. Several days or weeks may be needed for an individual to complete the required tests and examinations and for the physician to interpret the results and make a diagnosis.

Signs of Alzheimer’s or Other Dementias Compared with Typical Age-Related Changes*

Sign of Alzheimer’s: One of the most common signs of Alzheimer’s is memory loss, especially forgetting recently learned information. Others include forgetting important dates or events, asking for the same information over and over, and increasingly needing to rely on memory aids (for example, reminder notes or electronic devices) or family members for things that used to be handled on one’s own. Typical Age-related changes: Sometimes forgetting names or appointments, but remembering them later.

Sign of Alzheimer’s: Challenges in planning or solving problems: Some people experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe, keeping track of monthly bills or counting change. They may have difficulty concentrating and take much longer to do things than they did before. Typical Age- Related Change: Making occasional errors when balancing a checkbook.

Sign of Alzheimer’s: Difficulty completing familiar tasks at home, at work or at leisure: People with Alzheimer’s often find it hard to complete daily tasks. Sometimes, people have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game. Typical Age-related Change: Occasionally needing help to use the settings on a microwave or record a television show.

Sign of Alzheimer’s: Confusion with time or place: People with Alzheimer’s can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they forget where they are or how they got there. Typical Age-Related Change: Getting confused about the day of the week but figuring it out later.

Sign of Alzheimer’s: Trouble understanding visual images and spatial relationships: For some people, having vision problems is a sign of Alzheimer’s. They may have difficulty reading, judging distance and determining color or contrast, which may cause problems with driving. Typical Age-Related Change: Vision changes related to cataracts, glaucoma or age-related macular degeneration.

Sign of Alzheimer’s: New problems with words in speaking or writing: People with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a watch a “hand clock”). Typical Age-Related Change: Sometimes having trouble finding the right word.

Sign of Alzheimer’s: Misplacing things and losing the ability to retrace steps: People with Alzheimer’s may put things in unusual places, and lose things and be unable to go back over their steps to find them again. Sometimes, they accuse others of stealing. This may occur more frequently over time. Typical Age-Related Change: Misplacing things from time to time and retracing steps to find them.

Sign of Alzheimer’s: Decreased or poor judgment: People with Alzheimer’s may experience changes in judgment or decision making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean. Typical Age-Related Change: Making a bad decision once in a while.

Sign of Alzheimer’s: Withdrawal from work or social activities: People with Alzheimer’s may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced. Typical Age-Related Change: Sometimes feeling weary of work, family and social obligations.

Sign of Alzheimer’s: Changes in mood and personality: The mood and personalities of people with Alzheimer’s can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zones. Typical Age-Related Change: Developing very specific ways of doing things and becoming irritable when a routine is disrupted.

Early diagnosis of Alzheimer’s provides a number of important benefits to diagnosed individuals, their caregivers and loved ones, as well as society as a whole. In addition to providing significant medical, emotional and social benefits and facilitating participation in important clinical trials, early diagnosis enables individuals to prepare legal, financial and end-of-life plans while they are still cognitively able to make decisions and share their wishes and will also yield significant cost savings in medical and long term care for both the U.S. government and diagnosed individuals. Given the numerous benefits, continued research remains a top priority of Alzheimer’s disease research.

If you have any questions about this information, see our Parish Nurse, Judi M, go to alz.org, or speak to your physician.