Alzheimers disease

Alzheimer's disease Illnesses and conditions Brain, nerves and spinal cord Alzheimers disease Alzheimers disease About Alzheimers disease Symptoms of Alzheimers disease Causes of Alzheimers disease Diagnosing Alzheimers disease Treating Alzheimers disease Preventing Alzheimers disease About Alzheimers disease Alzheimers disease is the most common type of dementia, affecting an estimated 850,000 people in the UK. Dementia is a progressive neurological disease which affects multiple brain functions, including memory. The exact causeof Alzheimers disease is unknown, although a number of things are thought to increase your risk of developing the condition. These include: increasing age a family history of the condition previous severe head injuries lifestyle factors and conditions associated with cardiovascular disease Its becoming increasingly understood that its very common to have both changes of Alzheimers and vascular dementia together (mixed dementia). Read more about the causes of Alzheimers disease Signs and symptoms of Alzheimers disease Alzheimers disease is a progressive condition, which means the symptoms develop gradually and become more severe over the course ofseveral years. It affects multiple brain functions. The first sign of Alzheimers disease is usually minor memory problems. For example, this could beforgetting about recent conversations or events, and forgetting the names of places and objects. As the condition develops, memory problems become more severe andfurther symptoms can develop, such as: confusion, disorientation and getting lost in familiar places difficulty planning or making decisions problems with speech and language problems moving around without assistance or performing self-care tasks personality changes, such as becoming aggressive, demanding and suspicious of others hallucinations(seeing or hearing things that arent there) and delusions (believing things that are untrue) low moodor anxiety Read more about the symptoms of Alzheimers disease Who is affected? Alzheimers disease is most common in people over the ageof65, and affects slightly more women than men. The risk of Alzheimers disease and other types of dementiaincreases with age,affecting an estimated 1 in 14 people over the age of 65 and 1 in every 6 people over the age of 80. However, around1 in every 20 cases of Alzheimers disease affects people aged 40 to 65. Receivinga diagnosis As the symptoms of Alzheimers disease progress slowly, it can be difficult to recognise that theres a problem. Many people feel that memory problems are simply a part of getting older. However,a timely diagnosis of Alzheimers disease can give youthe best chance to prepare and plan for the future, as well as receive any treatment or supportthat may help. If youre worried about your memory or think you may have dementia, its a good idea to see your GP. If youre worried about someone else, you should encourage them to make an appointment and perhaps suggest that you go along with them. Theres no single test that can be used to diagnose Alzheimers disease. Your GP will ask questions about any problems you are experiencing and may do some tests to rule out other conditions. If Alzheimers disease is suspected, you may be referred to a specialist memory service to: discuss the process of making the diagnosis organise testing create a treatment plan Read more about diagnosing Alzheimers disease How Alzheimers disease is treated Theres no cure for Alzheimers disease,but medication is available that can helprelieve some of the symptoms and slow down the progression of the condition in some people. Various other types of support are also available to help people with Alzheimers live as independently as possible, such as making changes to your home environment so its easier to move around and remember daily tasks. Psychological treatments such as cognitive stimulation therapy may also be offered tohelpsupport your memory, problem solving skills and language ability. Read more about treating Alzheimers disease Outlook On average, people with Alzheimers disease live for around8 to 10 years after they start to develop symptoms. However, this can vary considerably from person to person. Some people with the condition will live longer than this, but others will not. Alzheimers disease is a life-limiting illness, although many people diagnosed with the condition will die from another cause. AsAlzheimers disease is a progressive neurological condition, it can cause problems with swallowing. This can lead to aspiration (food being inhaled into the lungs) which can cause frequent chest infections. Its also common for people with Alzheimers disease to eventually have difficulty eating and to have a reduced appetite. Theres increasing awareness that people with Alzheimers disease need palliative care . This includes support for families, as well as the person with Alzheimers. Can Alzheimers disease be prevented? As the exact cause of Alzheimers disease isnt clear, theres no known way to prevent the condition. However, there are things you can do that may reduce your risk or delay the onset of dementia, such as: stoppingsmoking and cutting down on alcohol eating a healthy, balanced diet and maintaining a healthy weight staying physically fit and mentally active These measures have other health benefits, such as lowering your risk of cardiovascular disease and improving your overall mental health. Read more about preventing Alzheimers disease Symptoms of Alzheimers disease The symptoms of Alzheimers 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 and its not possible to predict exactly how quickly it will get worse. In some cases,infections, medications, strokes or deliriumcan be responsible for symptoms getting worse. Anyone with Alzheimers disease whose symptoms are rapidly getting worse should be seen by a doctor, so these can be managed. Stages of Alzheimers disease Generally, the symptoms of Alzheimers disease are divided intothree main stages. Early symptoms In the early stages, the main symptom ofAlzheimers disease is memory lapses. For example, someone with early Alzheimers disease may: forget about recent conversations or events, or misplace items forget the names of places and objects, or have trouble thinking of the right word repeat themselves regularly, such as asking the same question several times show poor judgement or find it harder to make decisions become less flexible and more hesitant to try new things There are often signs ofmood changes, such as increasing anxiety or agitation, or periods of confusion. Middle-stage symptoms As Alzheimers disease develops, memory problems will get worse. Someone with the condition may find it increasingly difficult to rememberthe names of people they know and may struggle to recognise their family and friends. Other symptoms may also develop, such as: increasing confusion and disorientation for example, getting lost, or wandering and not knowing what time of day it is obsessive, repetitive or impulsive behaviour delusions (believing things that are untrue) or feeling paranoid and suspicious about carers or family members problems with speechorlanguage (aphasia) disturbed sleep changes inmood, such as frequent mood swings, depression and feelingincreasingly anxious, frustrated or agitated difficulty performingspatial tasks, such asjudging distances hallucinations By this stage, someone with Alzheimers disease usually needs support to help them with their everyday living. For example, they mayneed help eating, washing, getting dressed and using the toilet. Later symptoms In the later stages of Alzheimers disease, the symptoms become increasingly severe and distressing for the person with the condition, as well as their carers, friends and family. Hallucinations and delusions may come and go over the course of the illness, but can getworse as the condition progresses. Sometimes people with Alzheimers disease can beviolent, demanding and suspicious of those around them. A number of other symptoms may also develop as Alzheimers disease progresses, such as: difficulty eating and swallowing (dysphagia) difficulty changing position or moving around without assistance considerable weight loss  although some people eat too much and put on weight unintentional passing ofurine (urinary incontinence) or stools ( bowel incontinence ) gradual loss of speech significant problems with short- and long-term memory In the severe stages of Alzheimers disease, people may need full-time care and assistance with eating, moving and using the toilet. Read more about how Alzheimers disease is treated Seeking medical advice If youre worried about your memory or think you may have dementia, its a good idea to see your GP. If youre worried about someone else, you should encourage them to make an appointment and perhaps suggest that you go along with them. Memory problems are not just caused by dementia  theycan also be caused by depression, stress, medications or other health problems. Your 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. Read more about diagnosing Alzheimers disease Causes of Alzheimers disease Alzheimers disease is caused by parts of the brain shrinking (atrophy), which affects the structure and function of particular brain areas. Its not known exactly what causes this process to begin. However,in the brains of people with Alzheimers disease, scientistshave foundamyloid plaques (abnormal deposits of protein), neurofibrillary tangles (containing tau) and imbalances in a chemical called acetylcholine. Its also common to have a degree of vascular damage in the brain. Thesereduce the effectiveness ofhealthy neurons (nerve cells that carry messages to and from the brain), gradually destroying them. Over time, this damage spreads toseveral areas of the brain. The first areas affected are responsible for memories. Increased risk Although its still unknown what triggersAlzheimers disease,several factors are known to increase your risk of developing the condition. Age Age is the single most significant factor in the development of Alzheimers disease. The likelihood of developing the condition doubles every five years after you reach 65 years of age. However, its not just older people who are at risk of developing Alzheimers disease. Around1 in20people with the condition are under 65.This is called early onset Alzheimers disease andit can affect people from around the age of 40. Family history The genes you inherit fromyour parents can contribute to your risk of developing Alzheimers disease, although the actual increase in risk is small if you have aclose family member with the condition. However, in a few families, Alzheimers disease is caused by the inheritance of a single gene, and the risks of the conditionbeing passed on are much higher. If several of your family members have developed dementia over the generations, it may be appropriate to seek genetic counsellingfor information and advice about your chances of developing Alzheimers disease when you are older. The AlzheimersSociety website has more information about the genetics of dementia . Downs syndrome People with Downs syndrome are at a higher risk of developing Alzheimers disease. This is because the genetic fault that causes Downs syndrome can also cause amyloid plaques to build up in the brain over time, which can lead to Alzheimers disease in some people. Head injuries People who have had a severe head injury have been found to be at higher risk of developing Alzheimers disease. Cardiovascular disease Research shows that several lifestyle factors and conditions associated with cardiovascular disease can increase the risk of Alzheimers disease. These include: smoking obesity diabetes high blood pressure high cholesterol You can help reduce your risk by: stopping smoking eating a healthy, balanced diet leading an active life, both physically and mentally losing weight if you need to drinking less alcohol havingregular health checks as you get older Read more about reducing your risk of Alzheimers disease Diagnosing Alzheimers disease Its best to see your GP if youre worried about your memory or think you may have dementia. If youre worried about someone else, encourage them to make an appointment and perhaps suggest going with them. Its often very helpful having a friend or family member there. A timelydiagnosis gives you the best chance to adjust, prepare and plan for the future, as well as accessing treatments and support that may help. Seeing your GP Memory problems arent just caused by dementia they can also be caused by: depression or anxiety stress medications alcohol or drugs other health problems  such as hormonal disturbances or nutritional deficiencies Your GP can carry out some simple checks to try to find out what the cause may be. Theycan then refer you to a specialist for assessment, if necessary. Your GP will ask about your concerns and what you or your family have noticed. Theyll also checkother aspects of your health, and carry out a physical examination. They may also organise some blood tests and ask about any medication youre taking to rule out other possible causes of your symptoms. Youll usually be asked some questionsand carry outsomememory, thinking, and pen and paper tasks to check how different areas of your brain are functioning. This can help your GP decide if youneed tobe referred to a specialist for more assessments. Referral to a specialist Your GP may refer you to a specialist memory assessment service to help with your diagnosis. Memory clinics are staffed by professionals from multiple disciplines who are experts in diagnosing, caring for and advising people with dementia and their families. Memory clinic staff can include the following, depending on your local area: a nurse  usually a trained mental health nurse who specialises in diagnosing and caring for people with dementia a psychologist  a healthcare professional who specialises in the assessment and treatment of mental health conditions a psychiatrist  a qualified medical doctor who has training in treating mental health conditions a neurologist  a specialist in treating conditions that affect the nervous system (the brain and spinal cord) a geriatrician  a physician with specialist training in the care of older people a social worker  a trained member of staff able to advise and assist with accessing social services within the local area an occupational therapist  a member of staff with specialist skills in assessing and supporting people with dementia and their families with adjusting to disabilities Theres no simple and reliable test for diagnosing Alzheimers disease,butthe staff will listen to the concerns of both you and your family about your memory or thinking. They will assess your skills and arrange more tests to rule out other conditions. Assessing your mental abilities A specialist will usually assess your mental abilities using a special series of questions. One widely used test is the mini mental state examination (MMSE). This involves being asked to carry out activities such as memorising a short list of objectscorrectly and identifying the current day of the week, month and year. Different memory clinics may also use other, longer tests. The MMSE isnt used to diagnoseAlzheimers disease,but its useful to initially assess areas of difficulty that a person withthe condition may have. This helps specialists to make decisions about treatment and whether more tests are necessary. Tests To rule out other possible causes of your symptoms and look for possible signs of damage caused by Alzheimers disease, your specialist may recommend having a brain scan. This could be a: computerised tomography (CT) scan  where several X-rays of your brain are taken at slightly different angles and a computer is used to put the images together magnetic resonance imaging (MRI) scan  where a strong magnetic field and radio waves are used to produce detailed images of the inside of your brain Some specialist centres offer scans which look at brain function and particular protein deposits. However, at the moment, these are mostly experimental and only used if the diagnosis is unclear. Afterdiagnosis It may take severalappointments and tests over months, or even years, before a diagnosis of Alzheimers disease can be confirmed. For some people, a diagnosis ofAlzheimers disease is a huge shock, especially as its not unusual for people with dementia to have less awareness of their difficulties. For others, the diagnosis can be very important in helping them and their families to make sense of symptoms theyve been concerned about for a long time. If youve just been given a diagnosis of dementia, you may be feeling numb, scared and unable to take everything in. It may be helpful to have the diagnosis explained again to help make sense of the idea over time. It might help to talkthings through with family and friends. It takes time to adapt to a diagnosis of dementia, for both you and your family. Some people find it helpful to seek information and plan for the future, but others may need a longer period to process the news. However, as dementia is a progressive illness, the weeks to months after a diagnosis is often a good time to think about legal, financial and healthcare matters for the future. Read more about what to do if youve just been diagnosed with dementia Treating Alzheimers disease Theres currently no cure for Alzheimers disease, although medication is available that can temporarily reduce some symptoms or slow down the progression of the condition in some people. Support is also available to help someone with the condition cope with everyday life. Care plan If youre diagnosed withAlzheimers disease, its helpful if your health and social care needs are assessed and plans made forthe future. A care plan is a way of ensuring you receive the right treatment for your needs. It involves identifying areas where you may need some assistance, such as: what support you or your carer need for you to remain as independent as possible whether there are any changes that need to be made to your home to make it easier to live in whether you need any financial assistance Healthcare professionals (such as your GP or psychiatrist) and social care services (which is normally your local council working with the NHS), will usually both be involved in helping draw up and carry out care plans. Medication Anumber of medicationsmay be prescribed for Alzheimers disease to help temporarily improve some symptoms and slow down the progression of the condition. Donepezil,galantamineand rivastigmine (known as AChE inhibitors)can be prescribed for people with early to mid-stage Alzheimers disease. Memantine may be prescribed for people with mid-stage disease who cannot take AChE inhibitors, orfor those withlate-stage disease. Theres no difference in how well each of the three different AChE inhibitors work, althoughsome peoplerespond bettertocertain types or have fewer side effects. All of these medications can only be prescribed by specialists such as psychiatrists, neurologists and geriatricians. They may be prescribed by your GP on the advice of a specialist. If youre caring for someone with Alzheimers disease, your views should be taken into account when prescribing medication, as well as at regular assessments. These assessments take place to ensure the medication is having a worthwhile effect and to identify and monitor side effects. Read guidance from the National Institute for Health and Care Excellence (NICE) on donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimers disease . Side effects Donepezil, galantamine and rivastigminecan cause side effectssuch as: feeling and being sick dizziness diarrhoea headache agitation insomnia muscle cramps more rarely, slowing of the heartbeatwhich can cause issues if you already have problems with your heart rhythm. These side effects are more likely to occur at the beginning of therapy or when the dose is increased. Your doctor should review your medical history and your other medications to check the suitability and risk of interactions. Common side effects of memantine include: dizziness headaches high blood pressure tiredness constipation shortness of breath more rarely, problems with walking or increased confusion very rarely, seizures For more information about the possible side effects of your specific medication, refer to the patient information leaflet that comes with it or speak to your doctor. Supportive measures and treatments In addition to medication, treatment for Alzheimers disease involves a wide range of other measures and treatments to helppeople with dementialive as independently as possible. For example, an occupational therapist can identify problems or unsafe areasin your everyday life and help you to develop strategies or use alternative tools to manage these. They may suggest: ways of prompting and reminding yourself of important taskssuch as using diaries or calendars assistive technologydevices or systems to help maintain the independence andsafety of people living with dementia adding grab bars and handrails to your home to help you move around safely other professionals visiting you at home and assisting with daily tasks to maintain your independence in the community Psychological treatments, such as cognitive stimulation,may be offered tohelp improve your memory, problem solving skills and language ability. Medication, other psychological therapies, such as cognitive behavioural therapy (CBT), music and art therapy, reminiscence and relaxation therapies may also be offered. These may help with managing depression , anxiety, agitation, hallucinations, delusions and challenging behaviour that can occur with Alzheimers disease. Read more about how dementia is treated Practical tips for people with Alzheimers If you have Alzheimers disease, you may find it useful to: keep a diary and write down things you want to remember pin a weekly timetable to the wall put your keys in an obvious place, such as in a large bowl in your living room have a daily newspaper delivered to remind you of the day and date put labels on cupboards and drawers keep useful telephone numbers by the phone write yourself remindersfor example, put a note on the front door to remind you to take your keys with you if you go out programme peoples names and numbers into your telephone set the alarm on your watch to act as a reminder install safety devices such as gas detectors and smoke alarms throughout your home It may also be helpful toget in touch with a local or national Alzheimers or dementia support group, such as the Alzheimers Society , for more information and advice about living with Alzheimers disease. Read more about living well with dementia Future care planning People with dementia often live for many years after their diagnosis. However, as its a progressive condition, it can be helpful and reassuring for both you and your family if you make plans for the future. Future care planning means considering, discussing and possibly recording your wishes and decisions for future care. Its about planning for a time when you may not be able to make some decisions for yourself. In the earlier stages of the disease, you should have the opportunity to discuss with health professionals and your family about the future. This may involve the use of: advance statements advance decisions to refuse treatment lasting power of attorney preferred prioritiesfor care Palliative care Although the outlook is variable, dementia is a life-limiting illness and can begin to affect multiple body systems in the later stages. End of life care, or palliative care, provides support for people with an incurable illness, so theyre able to live as well and as comfortably as possible until their death. It also involves support for family members. Caremay be provided at home, a hospice, a care home or hospital. For people nearing the end of life, their care team should assess their needs, make them feel comfortable and allow them to die with dignity in a place of their choosing. Read more about palliative care Telecare Self-Check online tool Visit the Telecare Self-Check online tool to find the right support for you in your area.This easy to use online tool allows you to find helpful information on telecare services that could help you live independently at home for longer. Preventing Alzheimers disease As the exact cause of Alzheimers disease is still unknown, theres no way to prevent the condition. However, there are steps you can take that may help to delay the onset of dementia. Reducing your risk of cardiovascular disease Cardiovascular disease has been linked with an increased risk of Alzheimers disease and vascular dementia. You may be able to reduceyour 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, including: stopping smoking not drinking large amounts of alcohol eating a healthy, balanced diet , including at least five portions of fruit and vegetables every day exercising for at least 150 minutes (2 hours and 30 minutes) every week bydoing moderate-intensity aerobic activity (such as cycling or fast walking) this will improve both your physical and mental health make sure your blood pressure is checked and controlled through regular health tests if you have diabetes , make sure you keep to the diet and takeyour medication Read more about preventing dementia Staying mentally active Theres some evidence to suggest that rates of dementia are lower in people who remain as mentally, physically and socially active as possible throughout their lives, as well as among those who enjoy a wide range of different activities and hobbies. It may be possible to reduce your risk of Alzheimers disease and other types of dementia by: reading writing for pleasure learning foreign languages playing musical instruments taking part in adult education courses playing tennis playing golf swimming group sports, such as bowling walking Interventions such as brain training computer games have been shown to improve cognition over a short period, but research hasnt yet demonstrated whether this can prevent dementia. Future research Research into Alzheimers disease is continuing.As more is revealed about the condition, other ways to treat or prevent it may be found. Participation in research is important and helps to improve dementia care and support for people with dementia, plus their carers and families. You can read about ongoing dementia researchon the Alzheimers Research UK website. You can also ask your local memory clinic about projects taking place. The National Institute for Health and Care Excellence (NICE) has advised that there isnt evidence to support the use of the following to prevent dementia: statins hormone replacement therapy  when chemicals are taken to replace those that your body no longer produces vitamin E  found in a variety of foods, such as olive oil, nuts and seeds non-steroidal anti-inflammatory drugs (NSAIDs)