basics of

alzheimer’s disease
What it is and
what you can do


Basics of
Alzheimer’s disease

Alzheimer’s (AHLZ-high-merz) is a disease of the

brain that causes problems with memory, thinking
and behavior. It is not a normal part of aging.

Alzheimer’s gets worse over time. Although

symptoms can vary widely, the first problem
many people notice is forgetfulness severe
enough to affect their ability to function at home
or at work, or to enjoy lifelong hobbies.

Other symptoms include confusion, getting lost

in familiar places, misplacing things and trouble
with language.
What it is and
what you can do

Perhaps you have noticed possible signs of Alzheimer’s disease.

Or you may know someone who has just been diagnosed.
Basics of Alzheimer’s disease is intended for anyone who would
like to learn more about this disease and related dementias.

When memory loss is a warning sign . . . . . . . . . . . . . . . . . . . . . . . . 5

10 warning signs of Alzheimer’s disease© . . . . . . . . . . . . . . . . . . . . . 6

Alzheimer’s disease and other types of dementia . . . . . . . . . . . . . 8

How Alzheimer’s affects the brain . . . . . . . . . . . . . . . . . . . . . . . . . .10

Causes and risk factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

How to find out if it’s Alzheimer’s disease . . . . . . . . . . . . . . . . . . . 14

When the diagnosis is Alzheimer’s . . . . . . . . . . . . . . . . . . . . . . . . . 18

Stages of the disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Treating the symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Hope for the future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

We can help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
It can be easy
to explain away unusual behavior,
especially for someone who seems
physically healthy. Instead, seek a
diagnosis as early as possible.
When memory loss
is a warning sign

Many people worry about becoming An early diagnosis helps individuals

more forgetful as they grow older. receive treatment for symptoms and
Our brains change as we age just like may allow them to take part
the rest of our bodies. in decisions about care, living
arrangements, money and legal matters.
Most of us eventually notice some slowed
thinking and problems remembering If you need assistance finding a doctor
certain things. However, serious with experience evaluating memory
memory problems, your local Alzheimer’s
loss, confusion and other major changes Association chapter can help.
in the way our minds work are not a
normal part of aging.

Many conditions can disrupt memory What’s

What’sthe difference?
the difference?
and mental function. Symptoms
may improve when the underlying Someone with Someone with
Alzheimer symptoms normal age-related
cause is treated.
memory changes
Possible causes of memory Forgets whole Forgets part of
problems include: experiences an experience

• Depression Rarely remembers Often remembers

later later
• Medication side effects
Is gradually unable Is usually able
• Excess use of alcohol to follow written/
to follow written/
• Thyroid problems spoken directions spoken directions

• Poor diet Is gradually unable Is usually able

to use notes to use notes
• Vitamin deficiencies
• Certain infections Is gradually unable Is usually able
to care for self to care for self
• Alzheimer’s disease and related
dementias

Anyone experiencing significant

memory problems should see a doctor
as soon as possible. Early diagnosis and
intervention methods are improving
dramatically, and treatment options and
sources of support can improve quality
of life.

10 warning signs
of Alzheimer’s disease ©

Memory loss that disrupts 1. Memory loss

everyday life is not a normal Forgetting recently learned
information is one of the most
part of aging. The Alzheimer’s common early signs of dementia.
Association has developed a A person begins to forget more
often and is unable to recall the
checklist to help you recognize
information later.
the difference between normal,
What’s normal?Forgetting names
age-related memory changes
or appointments occasionally
and Alzheimer’s disease.
2. Difficulty performing
There’s no clear line that familiar tasks
People with dementia often find it
separates normal changes hard to plan or complete everyday
from warning signs. It’s tasks. Individuals may lose track of
the steps involved in preparing a
always a good idea to check
meal, placing a telephone call or
with a doctor if a person’s playing a game.
abilities seem to be declining.
What’s normal? Occasionally
forgetting why you came into a
room or what you planned to
say

3. Problems with language

People with Alzheimer’s disease
often forget simple words or
substitute unusual words, making
their speech or writing hard to
understand. They may be unable to
find the toothbrush, for example,
and instead ask for “that thing for
my mouth.”

What’s normal? Sometimes

having trouble finding the
right word


 4. Disorientation to 7. Misplacing things
time and place A person with Alzheimer’s
People with Alzheimer’s disease disease may put things in unusual
can become lost in their own places: an iron in the freezer or a
neighborhoods, forget where they wristwatch in the sugar bowl.
are and how they got there, and
not know how to get back home. What’s normal? Misplacing keys
or a wallet temporarily
What’s normal?Forgetting the
day of the week or where you 8. Changes in
were going mood or behavior
Someone with Alzheimer’s
5. Poor or decreased disease may show rapid mood
judgment swings – from calm to tears to
Those with Alzheimer’s may anger – for no apparent reason.
dress inappropriately, wearing
several layers on a warm day What’s normal? Occasionally
or little clothing in the cold. feeling sad or moody
They may show poor judgment
9. Changes in personality
about money, like giving away
The personalities of people with
large sums to telemarketers.
dementia can change dramatically.
What’s normal? Making a They may become extremely
questionable or debatable confused, suspicious, fearful or
decision from time to time dependent on a family member.

6. Problems with What’s normal? People’s

abstract thinking personalities do change
Someone with Alzheimer’s disease somewhat with age
may have unusual difficulty
10. Loss of initiative
performing complex mental tasks,
A person with Alzheimer’s disease
like forgetting what numbers are
may become very passive, sitting
and how they should be used.
in front of the TV for hours,
What’s normal? Finding sleeping more than usual or not
it challenging to balance wanting to do usual activities.
a checkbook
What’s normal? Sometimes
feeling weary of work or
social obligations


Alzheimer’s disease
and other types of dementia

Other types of dementia

Alzheimer’s disease accounts for 60 to

70 percent of cases of dementia. Other
disorders that can cause memory loss,
confusion and other symptoms associated
with dementia include:

Vascular or multi-infarct dementia,

often considered the second-most
common form, refers to impairment
caused by reduced blood flow to parts
of the brain. The most common type
is what used to be called “multi-infarct
dementia,” in which a series of very small
strokes block small arteries. Individually,
Dementia (dih-MEN-shuh) is a
these strokes are too small to cause major
general term for the loss of symptoms, but over time their combined
memory and other intellectual effect becomes noticeable.

abilities serious enough to Symptoms of vascular dementia can be

interfere with daily life. similar to Alzheimer’s disease.They include
problems with memory, confusion and
Alzheimer’s is the most difficulty following instructions. In some
common form of dementia. cases, the impairment associated with
vascular dementia can occur in “steps”
Today we estimate that 4.5 million rather than in the slow, steady decline
Americans have Alzheimer’s.That includes usually seen in Alzheimer’s.
10 percent of those over 65 years old and
nearly 50 percent of those 85 and older. Mixed dementia is a condition in which
By 2050, that number may reach 16 Alzheimer’s disease and vascular dementia
million. occur together. Some experts believe that
this combination is also very common.
Because 70 percent of those with
Alzheimer’s live at home, the impact of Parkinson’s disease affects control of
the illness extends to millions of family movement, resulting in tremors, stiffness
members, friends and caregivers. and impaired speech. Many individuals
with Parkinson’s also develop dementia
in later stages of the disease. Drugs for
Parkinson’s can help steadiness and
muscle control, but have no effect on
 dementia symptoms.
Dementia with Lewy bodies often Jakob disease (vCJD)” was identified
starts with wide variations in attention as the human disorder believed to be
and alertness. Individuals affected by caused by eating meat from cattle
this illness often experience visual affected by “mad cow disease.”
hallucinations as well as muscle rigidity
and tremors similar to those associated Frontotemporal dementia or
with Parkinson’s disease. Pick’s disease is another rare
disorder that may sometimes be hard
Physical injury to the brain caused to distinguish from Alzheimer’s.
by an automobile accident or other Personality changes and disorientation
significant trauma can damage or destroy often occur before memory loss.
brain cells, and cause symptoms of
dementia such as behavioral changes, Normal pressure hydrocephalus
memory loss and other cognitive (NPH) is caused by a buildup of fluid
difficulties. in the brain. The cause of most cases is
unknown. Symptoms include difficulty
Huntington’s disease is an inherited, walking, memory loss and inability to
progressive disorder that causes irregular control urine. NPH can sometimes be
movements of the arms, legs and facial corrected with surgery to drain the
muscles, personality changes and a excess brain fluid.
decline in the ability to think clearly.

Creutzfeldt-Jakob disease (CJD)

(CROYZ-felt YAH-kob) is a rare, rapidly
fatal disorder that impairs memory
and coordination, and causes behavior
changes. Recently, “variant Creutzfeldt-

Mild cognitive impairment (MCI)

Although a person may have noticeable difficulty with memory or other
thinking skills, a doctor may determine the person does not meet criteria for
being diagnosed with Alzheimer’s or another form of dementia. Some doctors
use the term mild cognitive impairment (MCI) to describe this situation.

Research has shown that individuals with MCI have an increased risk of
progressing to Alzheimer’s disease over the next few years, especially when
their main area of difficulty involves memory. But a diagnosis of MCI does not
always mean the person will develop Alzheimer’s.


How Alzheimer’s
affects the brain

The changes that take place in What goes wrong in the brain
the brain begin at the The brain has 100 billion nerve cells
(neurons). Each nerve cell connects to
microscopic level long before many others to form communication
the first signs of memory loss. networks. In addition to nerve cells, the
brain includes cells specialized to support
and nourish other cells.

Groups of nerve cells have special jobs.

Some are involved in thinking, learning
and memory. Others help us see, hear
and smell. Still others tell our muscles
when to move.

To do their work, brain cells operate

like tiny factories. They receive supplies,
generate energy, construct equipment
and get rid of waste. Cells also process and
store information and communicate with
other cells. Keeping everything running
requires coordination as well as large
amounts of fuel and oxygen.

Scientists believe
Alzheimer’s disease
prevents parts of the
cell’s factory from
running well. They
are not sure where the
trouble starts. But just
like a real factory, backups
and breakdowns in one
system cause problems
in other areas. As damage
spreads, cells lose their
ability to do their jobs
and, eventually, die.

10
The role of plaques How Alzheimer’s
and tangles spreads in the brain
The brains of individuals with Alzheimer’s
have an abundance of plaques and tangles.
Plaques are deposits of a protein fragment
called beta-amyloid that build up in the
spaces between nerve cells. Tangles are
twisted fibers of another protein called
tau that build up inside cells.

Though autopsy studies show that most

people develop some plaques and tangles Plaques and tangles begin in
brain areas involved in memory.
as they age, those with Alzheimer’s tend
to develop far more. They also tend
to develop them in a predictable pattern,
beginning in the areas important for
memory before spreading to other
regions.

Scientists do not know exactly what role

plaques and tangles play in Alzheimer’s
disease. Most experts believe that they
somehow play a critical role in blocking
communication among nerve cells They gradually spread to
and disrupting processes the cells need other areas.
to survive.

It’s the destruction and death of nerve

cells that causes the memory failure,
personality changes, problems in
carrying out daily activities and other
symptoms of Alzheimer’s disease.

Illustrations:
Alzheimer’s Disease Education Eventually much of the brain
and Referral Center, a service of is affected.
the National Institute on Aging

11
Causes and
risk factors

Age
The greatest known risk factor for
Alzheimer’s is increasing age. Most
individuals with the illness are 65
and older. The likelihood of developing
Alzheimer’s approximately doubles
every five years after age 65. After age
85, the risk reaches nearly 50 percent.

Family history and genetics

Another risk factor is family history.
Research has shown that those who
have a parent, brother or sister with
Alzheimer’s are two to three times
more likely to develop the disease.
The risk increases if more than one
family member has the illness.
While scientists know that
Scientists have so far identified one gene
Alzheimer’s disease involves that increases the risk of Alzheimer’s but
the failure of nerve cells, does not guarantee an individual will
develop the disorder. Research has also
why this happens is still not
revealed certain rare genes that virtually
known. However, they have guarantee an individual will develop
identified certain risk factors Alzheimer’s. The genes that directly
cause the disease have been found in
that increase the likelihood of only a few hundred extended families
developing Alzheimer’s. worldwide and account for less than

Aluminum
During the 1960s and 1970s, aluminum emerged as a possible suspect
in causing Alzheimer’s disease. This suspicion led to concerns about
everyday exposure to aluminum through sources such as cooking pots,
foil, beverage cans, antacids and antiperspirants. Since then, studies have
failed to confirm any role for aluminum in causing Alzheimer’s. Almost all
scientists today focus on other areas of research, and few experts believe
that everyday sources of aluminum pose any threat.

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5 percent of cases. Experts believe the Studies of donated brain tissue provide
vast majority of cases are caused by a additional evidence for the heart-head
complex combination of genetic and connection. These studies suggest that
nongenetic influences. plaques and tangles are more likely to
cause Alzheimer symptoms if strokes or
Other risk factors damage to the brain’s blood vessels are
Age, family history and genetics are also present.
all risk factors we can’t change. Now,
research is beginning to reveal clues
about other risk factors that we may Latinos and
be able to influence. There appears to African-Americans at risk
be a strong link between serious head Because African-Americans and
injury and future risk of Alzheimer’s. Latinos in the United States have
It’s important to protect your head by higher rates of vascular disease,
buckling your seat belt, wearing your they may also be at greater risk for
helmet when participating in sports and developing Alzheimer’s. According
“fall-proofing” your home. to a growing body of evidence,
risk factors for vascular disease
One promising line of research suggests – including diabetes, high blood
that strategies for overall healthy aging pressure and high cholesterol – may
may help keep the brain healthy and also be risk factors for Alzheimer’s
may even offer some protection against and stroke-related dementia.
Alzheimer’s. These measures include
eating a healthy diet; staying socially
active; avoiding tobacco and excess
alcohol; and exercising both body
and mind.

Some of the strongest evidence links

brain health to heart health.The risk
of developing Alzheimer’s or vascular
dementia appears to be increased by
many conditions that damage the heart
and blood vessels.These include heart
disease; diabetes; stroke and high blood
pressure; or high cholesterol. Work with
your doctor to monitor your heart
health and treat any problems that arise.

13
How to find out if it’s
Alzheimer’s disease

People with memory loss or The first step in following up on

symptoms is finding a doctor with
other possible warning signs of
whom a person feels comfortable.
Alzheimer’s may find it hard to Your local Alzheimer’s Association
recognize they have a problem chapter can help find the right doctor.
and may resist following up There is no single type of doctor
on their symptoms. Signs of that specializes in diagnosing and
treating memory symptoms or
dementia may be more obvious Alzheimer’s disease. Many people
to family members or friends. contact their regular primary care
physician about their concerns.
Primary care doctors often oversee
the diagnostic process themselves.

In many cases, the doctor may refer the

patient to a specialist such as a:

• Neurologist, who specializes

in diseases of the brain and
nervous system
• Psychiatrist, who specializes in
disorders that affect mood or
the way the mind works
• Psychologist with special training
in testing memory and other
mental functions

ciation
er’s Asso
imokaitis/Alzheim
harles S
Photo: C

14
There is no single test that proves a Evaluating mood and
person has Alzheimer’s. The workup is mental status
designed to evaluate overall health and Mental status is tested to give the
identify any conditions that could affect doctor a general idea of how well the
how well the mind is working. mind is working. This testing gives
an overall sense of whether a person:
Experts estimate that a skilled physician
can diagnose Alzheimer’s with more • Is aware of symptoms
than 90 percent accuracy. Physicians can
• Knows the date, time and where
almost always determine that a person
he or she is
has dementia, but it may sometimes be
difficult to determine the exact cause. • Can remember a short list of
words, follow instructions and do
Steps to diagnosis include: simple calculations
Understanding the problem The doctor may ask the person his or
Be prepared for the doctor to ask: her address, what year it is or who is
serving as president. The individual may
• What kind of symptoms the person also be asked to spell a word backward,
has been having draw a clock or copy a design.
• When they began
The doctor will assess mood and sense
• How often they happen of well-being to detect depression or
• If they have gotten worse other illnesses that can cause memory
loss and confusion.
Reviewing medical history
The doctor will interview the person
being tested or family members to Partnering With Your Doctor
gather information about current and The Alzheimer’s Association
past mental and physical illnesses. Partnering With Your Doctor
workshop offers tips on how to:
It is helpful to bring a list of all the
• Get a proper diagnosis
medications the person is taking. The
doctor will also obtain a history of • Work with your doctor to get
key medical conditions affecting other the best care
family members, especially whether • Plan for follow-up visits
they may have had Alzheimer’s disease Booklets are available in English
or related disorders. and Spanish. Call 1.800.272.3900 or
visit www.alz.org.

15
 Physical exam and Neurological exam
diagnostic tests A doctor, sometimes a neurologist who
specializes in disorders of the brain and
A physician will: nervous system, will closely evaluate
the person for problems that may signal
• Evaluate diet and nutrition
brain disorders other than Alzheimer’s.
• Check blood pressure, temperature
and pulse The physician will also test:
• Listen to the heart and lungs • Reflexes
• Perform other procedures to • Coordination
assess overall health
• Muscle tone and strength
Samples of blood and urine will be • Eye movement
collected, and other laboratory tests may
also be ordered. Information from these • Speech
tests can help identify disorders such as • Sensation
anemia; infection; diabetes; kidney or
liver disease; certain vitamin deficiencies; The doctor is looking for signs of small
thyroid abnormalities; and problems or large strokes, Parkinson’s disease,
with the heart, blood vessels or lungs. brain tumors, fluid accumulation on the
All of these conditions may cause brain and other illnesses that may impair
confused thinking, trouble focusing memory or thinking.
attention, memory problems or other
symptoms similar to dementia. The neurological examination may also
include studying the brain’s structure
with magnetic resonance imaging
(MRI) or computed tomography (CT).
MRIs and CTs can reveal tumors,
evidence of small or large strokes,
damage from severe head trauma or a
buildup of fluid.

Researchers are studying other imaging

techniques so they may better diagnose
and track the progress of Alzheimer’s.
Medicare will cover a positron emission
tomography (PET) scan as an aid in
diagnosis in certain cases.

16
Diagnosis and treatment
methods are improving dramatically.

17
 When the diagnosis
is Alzheimer’s

Once testing is complete, the doctor Research has shown that taking full
will make an appointment to review advantage of available treatment, care
results and share his or her conclusions. and support options can make life better.

A diagnosis of Alzheimer’s reflects a Consider:

doctor’s best judgment about the cause
of a person’s symptoms, based on all the • How to provide increasing levels of
tests that have been performed. care as the disease progresses
• How the individual and family
You may want to ask the doctor: members will cope with changes in
• Why the diagnosis is Alzheimer’s the person’s ability to drive, cook and
perform other daily activities
• Where the person may be in the course
of the disease • How to ensure the person’s safety

• What to expect in the future Families also need to begin making legal
and financial plans. One advantage of
Find out if the doctor will manage timely diagnosis is that the person with
the person’s care going forward and, if dementia can often participate in this
not, who will be the primary doctor. planning. The person can also decide
The doctor can then schedule the next who will make medical and financial
appointment or provide a referral. decisions on his or her behalf in later
stages of the disease.
Alzheimer’s disease is life-changing for
both the diagnosed individuals and those To learn more about planning for the
close to them. While there is currently future, contact the Alzheimer’s Association.
no cure, treatments are available that may
help relieve some symptoms.

Reliable support
Your local Alzheimer’s Association chapter can connect you with the resources
you need to cope with the challenges of Alzheimer’s.

Many chapters also provide special programs tailored to their communities,

including services for African-Americans, Asian-Americans, Latinos, rural
residents and those who live alone.

Our 24/7 helpline operates around the clock to provide information, referral
and care consultation by master’s level professionals in 140 languages.

18
To find the Alzheimer’s Association
office nearest you, call 1.800.272.3900
or visit www.alz.org.

19
 Stages of
the disease

Alzheimer’s disease gets Stage 1

No impairment
worse over time. Experts have
Normal function
developed “stages” to describe The person does not experience any
how a person’s abilities change memory problems. An interview with a
medical professional does not show any
from normal function through
evidence of symptoms.
advanced Alzheimer’s.
Stage 2
It is important to keep in mind Very mild decline
that stages are general guides, and May be normal age-related changes
symptoms vary greatly. Every person or earliest signs of Alzheimer’s
is unique, but we can speak about The individual may feel that he or she
some common patterns of the is having memory lapses – forgetting
illness. Those with Alzheimer’s live familiar words or the location of
an average of eight years after their everyday objects. But no symptoms
symptoms become noticeable to can be detected during a medical exam
other people, but survival can range or by friends, family or co-workers.
from three to 20 years, depending on
age and other health conditions. Stage 3
Mild cognitive decline
This seven-stage framework is based Early-stage Alzheimer’s may be
on a system developed by Barry diagnosed in some, but not all,
Reisberg, M.D., clinical director of individuals at this point
the New York University School of Friends, family or co -workers begin
Medicine’s Silberstein Aging and to notice difficulties. During a detailed
Dementia Research Center. medical interview, doctors may be
able to detect problems in memory
or concentration.

20
Common Stage 3 difficulties include: Stage 5
Moderately severe cognitive decline
• Noticeable problems coming up with Moderate or mid-stage Alzheimer’s
the right word or name Gaps in memory and thinking are
• Trouble remembering names when noticeable, and individuals begin to
introduced to new people need help with day-to-day activities.
• Having noticeably greater difficulty At this stage, those with
performing tasks in social or Alzheimer’s may:
work settings
• Be unable to recall their own address
• Forgetting material that one has just
or phone number or the high school
read
or college from which they graduated
• Losing or misplacing a valuable object
• Become confused about where they
• Increasing trouble with planning are or what day it is
or organizing
• Have trouble with less challenging
Stage 4 mental arithmetic, such as counting
Moderate cognitive decline backward from 40 by subtracting
Mild or early-stage Alzheimer’s fours, or from 20 by twos
At this point, a careful medical • Need help choosing proper clothing
interview should be able to detect for the season or occasion
clear-cut problems in several areas:
• Still remember significant details
• Forgetfulness of recent events about themselves and their family
• Impaired ability to perform • Still require no assistance eating
challenging mental arithmetic – for or using the toilet
example, counting backward from 100
by 7s
• Greater difficulty performing complex
tasks, such as planning dinner for guests,
paying bills or managing finances
• Forgetfulness about one’s own
personal history
• Becoming moody or withdrawn,
especially in socially or mentally
challenging situations

21
Stage 6 • Have increasingly frequent trouble
Severe cognitive decline controlling their bladder or bowels
Moderately severe or
• Experience major personality
mid-stage Alzheimer’s
and behavioral changes, including
Memory continues to worsen, personality suspiciousness and delusions (such as
changes may take place and individuals believing the caregiver is an impostor)
need significant help with daily activities. or compulsive, repetitive behavior like
The person may: hand-wringing or tissue shredding
• Tend to wander or become lost
• Lose awareness of recent experiences
as well as their surroundings Stage 7
Very severe cognitive decline
• Remember their own name but have
Severe or late-stage Alzheimer’s
difficulty with their personal history
In the final stage of this disease,
• Distinguish familiar and unfamiliar individuals lose the ability to respond
faces but have trouble remembering to the environment, to carry on a
the name of a spouse or caregiver conversation and, eventually, to control
• Need help dressing properly and may, movement. They may still say words
without supervision, make mistakes or phrases.
such as putting pajamas over daytime
At this stage, individuals need help
clothes or shoes on the wrong feet
with much of their daily personal care,
• Experience major changes in their including eating or using the toilet. They
sleep patterns – sleeping during the may also lose the ability to smile, to sit
day and becoming restless at night without support and to hold their heads
• Need help handling details of the toilet up. Reflexes become abnormal. Muscles
(for example: flushing the toilet, wiping grow rigid. Swallowing is impaired.
or disposing of tissue properly)

Wandering and Safe Return

Six out of 10 people with Alzheimer’s disease will wander and become lost. If
not found within 24 hours, up to half of those who wander risk serious injury
or death. Alzheimer’s Association Safe Return® is a nationwide program that
provides assistance when a person with dementia becomes lost.
Enroll in Safe Return today at 1.888.572.8566
or www.alz.org/safereturn

22
Six out of 10 people with
Alzheimer’s will wander and become lost.

23
 Treating
the symptoms

Currently, there is no cure for Cognitive symptoms

FDA-approved treatments
Alzheimer’s and no way to
Two types of drugs are currently
stop the underlying death of approved by the U.S. Food and
brain cells. But drugs and Drug Administration (FDA) to
treat cognitive symptoms of
non-drug treatments may
Alzheimer’s disease.
help with both cognitive
The first type, cholinesterase
and behavioral symptoms.
(KOH-luh-NES-ter-ays) inhibitors, are
designed to prevent the breakdown
A comprehensive care plan of acetylcholine (a-SEA-til-KOH-
for Alzheimer’s disease: lean), a chemical messenger important
for memory and learning. By keeping
• Considers appropriate treatment
levels of acetylcholine high, these
options
drugs support communication among
• Monitors their effectiveness as the nerve cells. They delay worsening
disease progresses of symptoms for six to 12 months
• Changes course and explores for about half of the people who
alternatives as necessary take them.

• Respects individual and family goals Three cholinesterase inhibitors are

for treatment, and tolerance for risk commonly used to treat mild to
moderate Alzheimer’s:

• Donepezil (Aricept®), approved in 1996

• Rivastigmine (Exelon®), approved
in 2000
• Galantamine (Razadyne®), approved
in 2001

24
The second type of drug works by Key terms
regulating the activity of glutamate,
a different messenger chemical Symptoms
involved in information processing: Cognitive
Symptoms that affect memory,
• Memantine (Namenda®), approved awareness, language, judgment and
in 2003 other thought processes.

Memantine is the only currently Behavioral

available drug in this class. Approved A group of additional symptoms that
for treatment of moderate to severe occur to at least some degree in many
Alzheimer’s disease, memantine may individuals with Alzheimer’s.
also temporarily delay the worsening
of symptoms for some people. In early stages, people may experience
personality changes such as irritability,
Vitamin E anxiety or depression.
Doctors sometimes prescribe vitamin E
for cognitive symptoms of Alzheimer’s In later stages, individuals may
disease. One large federally funded study develop sleep disturbances; wandering
impulses; agitation (physical or verbal
showed that vitamin E slightly delayed
aggression, general emotional distress,
loss of ability to carry out daily activities
restlessness, pacing, shredding paper
and placement in residential care.
or tissues, yelling); delusions (firmly
Scientists think that vitamin E may held belief in things that are not real);
work because it is an antioxidant or hallucinations (seeing, hearing or
feeling things that are not there).
(an-tee-OX-uh-dent), a substance that
may protect cells from certain kinds Treatments
of chemical wear and tear.
FDA-approved
No one should use vitamin E to treat Medication approved by the U.S.
Alzheimer’s disease except under the Food and Drug Administration (FDA)
supervision of a physician. The doses that specifically treats a symptom of
used in the federal study were relatively Alzheimer’s disease.
high, and vitamin E can negatively
interact with other medications, Non-drug
including those prescribed to prevent A strategy other than medication
that helps relieve a symptom of
blood from clotting.
Alzheimer’s disease.

25
Caregiver tips Behavioral symptoms
Create a calm, safe setting that is
Many people find changes in the
suited for the person’s abilities:
person’s behavior the most challenging
and distressing effect of the disease. These
• Eliminate clutter, noise, glare and too include anxiety, agitation, aggression
much background noise and sleep disturbances. They can have an
• Develop soothing rituals with regular enormous impact on care and quality of
daily routines, comforting objects, life for individuals living in both family
gentle music and a reassuring touch situations and long-term residential care.
• Provide opportunities for exercise As with cognitive symptoms of
and satisfying activities geared to Alzheimer’s disease, the chief underlying
the person’s abilities cause of behavioral and psychiatric
• Monitor personal comfort: ensure a symptoms is the progressive damage to
comfortable temperature and check brain cells.
regularly for pain, hunger, thirst,
constipation, full bladder, fatigue, Other possible causes of behavioral
infection and skin irritation symptoms include:
• Be sensitive to frustration about
• Drug side effects
expressing wants and needs
Side effects from prescription
• Rather than arguing or disagreeing, medications may be at work.
redirect the person’s attention Drug interactions may occur
• Simplify tasks and routines when taking multiple medications
• Avoid open-ended questions – for several conditions.
instead, ask yes or no questions • Medical conditions
• Allow enough rest between Symptoms of infection or illness,
stimulating events, such as visits which may be treatable, can affect
from friends or neighbors behavior. Pneumonia or urinary tract
• Use labels to cue or remind the person infections can bring discomfort.
Untreated ear or sinus infections can
•  Equip doors and gates with safety
cause dizziness and pain.
locks
• Remove guns • Environmental influences
Situations affecting behavior include
Contact the Alzheimer’s Association moving to a new private residence or
for more information about behavior. residential care facility; misperceived
threats; or fear and fatigue from trying
to make sense of a confusing world.

26
There are two types of treatments Prescription medications
for behavioral symptoms: non-drug Medications can be effective in
treatments and prescription medications. managing some behavioral symptoms,
Non-drug treatments should be tried but they must be used carefully and are
first. most effective when combined with
non-drug strategies. Medications should
Non-drug treatments target specific symptoms so that response
Steps to developing non-drug to treatment can be monitored.
treatments include:
Prescribing any drug for a person with
1. Identifying the symptom Alzheimer’s is medically challenging. Use
2. Understanding its cause of drugs for behavioral and psychiatric
symptoms should be closely supervised.
3. Changing the caregiving environment
to remove challenges or obstacles

Identifying what has triggered

behavior can often help in selecting
the best approach.

Often the trigger is a change in the

person’s environment, such as:

• New caregivers
• Different living arrangements
• Travel
• Admission to a hospital
• Presence of houseguests
• Being asked to bathe or
change clothes

Because people with Alzheimer’s

gradually lose the ability to communicate,
it is important to regularly monitor their
comfort and anticipate their needs.

27
Hope for
the future

The Alzheimer’s Association Clinical studies drive progress

is the largest private nonprofit Although many ideas about Alzheimer
treatment and prevention begin in
funding resource for Alzheimer the laboratory, the final stage of testing
research. Since 1982, we usually involves clinical studies. At any
given time, dozens of these studies are
have awarded $185 million
actively seeking participants.
to more than 1,400
Participating in research is a big step.
research investigations.
Treatment studies typically last at least
When Alois Alzheimer first described several months, and prevention research
the disease in 1906, a person in the can run for years. Most treatment
United States lived an average of studies require the involvement of a
about 50 years. Few people reached caregiver as well as the person with
the age of greatest risk. As a result, the disease. And joining a study is not
the disease was considered rare and a surefire way to get an experimental
attracted little scientific interest. drug, since most studies randomly assign
participants to receive either the drug
That attitude changed as life span or an inactive treatment, called a placebo.
increased and scientists began to
realize how often Alzheimer’s strikes Still, many people find hope and
people in their 70s and 80s. The U.S. comfort in participating. Others are
Department of Health and Human motivated by the valuable information
Services recently estimated average provided by research, whether or not
life expectancy to be 79 . 6 years. the drug or prevention strategy works
as hoped.
Today, Alzheimer’s is at the forefront
of biomedical research, with 95 percent If you are interested in taking part
of what we know discovered in the last in clinical research, contact the
15 years. Some of the most remarkable Alzheimer’s Association about
progress has shed light on how opportunities in your area.
Alzheimer’s disease affects the brain.
Better understanding of its impact may
lead to better ways to treat it.

28
New directions in treatment
and prevention
One promising target is beta-amyloid.
This protein fragment builds up into
the plaques considered one hallmark of
the disease. Researchers have developed
several ways to clear beta-amyloid from
the brain or prevent it from forming.
The first experimental drugs that zero in
on beta-amyloid are now being tested.

Many other new approaches to

treatment are also under investigation
worldwide. We don’t yet know which of
these strategies may work, but scientists
say that, with the necessary
funding, the outlook is excellent
for major breakthroughs over the
next 10 years.

Significant progress in prevention

is also on the horizon. Some of the
most exciting research in this area
suggests there are steps people can
take to maintain brain health and
possibly even reduce the risk of
Alzheimer’s disease. Eating a low-fat
diet rich in fruits and vegetables, ’s Associa
tion
/Alzheimer
exercising regularly, and staying imokaitis
Photo: Charles S
mentally and socially active may
all help protect the brain.
everything they can to keep weight,
Some of the strongest evidence links blood pressure, cholesterol and blood
brain health to heart health. This sugar within recommended ranges to
connection makes sense, because the reduce the risk of heart disease, stroke
brain is nourished by one of the body’s and diabetes.
richest networks of blood vessels. It’s
especially important for people to do

29
We can help

When Alzheimer’s disease touches your • Professionally facilitated support

life, the Alzheimer’s Association is here groups, conducted at hundreds of
to help. We are the trusted resource for locations, provide people with
reliable information, education, referral Alzheimer’s and their families a
and support to the millions of people confidential, open forum to share
affected by the disease, their families and concerns and receive support.
caregivers, and health care professionals. • Educational workshops, led by our
Our nationwide network of chapters, professional colleagues, provide people
representing 300 local offices from coast with the information and skills
to coast, is the core of our support necessary to care for those living
lifeline. Dedicated professional staff with dementia.
members help people navigate through • The Alzheimer’s Association
the difficult decisions and uncertainties Green-Field Library is the nation’s
of the disease. largest resource center devoted to
Alzheimer’s disease and dementia.
• Our 24/7 Nationwide Contact Expert staff librarians fulfill more than
Center Helpline provides information, 6,000 inquiries each year from the
referral and care consultation in more public and from professionals in health
than 140 languages. care, public policy and research.
• Our award-winning Web site at • The Alzheimer’s Association Maintain
www.alz.org is a rich resource with Your Brain® campaign works to raise
evidence-based content that helps awareness about breakthroughs in
inform our diverse audiences. prevention and risk reduction, and the
• More than half of those with importance of brain health.
Alzheimer’s disease will wander and
become lost. Alzheimer’s Association
Safe Return® is a 24-hour nationwide For reliable information and
identification and support program. support, contact the
Safe Return works with local law Alzheimer’s Association:
enforcement to quickly return the 1.800.272.3900
person with dementia to safety. www.alz.org

30
Our vision is a world
without Alzheimer’s.

31
 The Alzheimer’s Association,
the world leader in Alzheimer research,
care and support, is dedicated to finding
prevention methods, treatments and an
eventual cure for Alzheimer’s.

For reliable information and support,

contact the Alzheimer’s Association:
1.800.272.3900
www.alz.org

© 2005 Alzheimer’s Association. All rights reserved.

This is an official publication of the Alzheimer’s Association but may

be distributed by unaffiliated organizations and individuals. Such
distribution does not constitute an endorsement of these parties or
their activities by the Alzheimer’s Association.

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