Early Alzheimer's Disease
Terms You Need to Know
Dementia is a medical condition that interferes with the way
the brain works. Symptoms include anxiety, paranoia, personality
changes, lack of initiative, and difficulty acquiring new skills.
Besides Alzheimer's disease, some other types or causes of dementia
include alcoholic dementia, depression, delirium, HIV/AIDS-related
dementia, Huntington's disease (a disorder of the nervous system),
inflammatory disease (for example, syphilis), vascular dementia (blood
vessel disease in the brain), tumors, and Parkinson's disease.
Alzheimer's disease is the most common form of dementia. It
proceeds in stages over months or years and gradually destroys memory,
reason, judgment, language, and eventually the ability to carry out even
simple tasks.
Delirium is a state of temporary but acute mental confusion
that comes on suddenly. Symptoms may include anxiety, disorientation,
tremors, hallucinations, delusions, and incoherence. Delirium can occur
in older persons who have short-term illnesses, heart or lung disease,
long-term infections, poor nutrition, or hormone disorders. Alcohol or
drugs (including medications) also may cause confusion.
Delirium may be life-threatening and requires immediate
medical attention.
Depression can occur in older persons, especially those with
physical problems. Symptoms include sadness, inactivity, difficulty
thinking and concentrating, and feelings of despair. Depressed persons
often have trouble sleeping, changes in appetite, fatigue, and
agitation. Depression usually can be treated successfully.
Purpose of this Booklet
This booklet is about Alzheimer's disease and other types of
dementia. It presents information for patients, family members, and
other caregivers. It talks about the effects Alzheimer's disease can
have on you, your family members, and your friends.
The booklet describes the early signs and symptoms of Alzheimer's
disease. Sources of medical, social, and financial support are listed
in the back of the booklet. This booklet is not about treating
Alzheimer's disease.
What Is Alzheimer's Disease?
In Alzheimer's disease and other dementias, problems with memory,
judgment, and thought processes make it hard for a person to work and
take part in day-to-day family and social life. Changes in mood and
personality also may occur. These changes can result in loss of
self-control and other problems.
Some 2 to 4 million persons have dementia associated with aging.
Of these individuals, as many as two-thirds have Alzheimer's disease.
Although there is no cure for Alzheimer's disease at this time, it
may be possible to relieve some of the symptoms, such as wandering and
incontinence.
The earlier the diagnosis, the more likely your symptoms will respond
to treatment. Talk to your doctor as soon as possible if you think you
or a family member may have signs of Alzheimer's disease.
Research is under way to find better ways to treat Alzheimer's
disease. Ask your doctor if there are any new developments that might
help you.
Who Is Affected?
The chances of getting Alzheimer's disease increase with age. It
usually occurs after age 65. Most people are not affected even at
advanced ages. There are only two definite factors that increase the
risk for Alzheimer's disease: a family history of dementia and Down
syndrome.
Family History of Dementia
Some forms of Alzheimer's disease are inherited. If Alzheimer's
disease has occurred in your family members, other members are more
likely to develop it. Discuss any family history of dementia with your
family doctor.
Down Syndrome
Persons with Down syndrome have a higher chance of getting
Alzheimer's disease. Close relatives of persons with Down syndrome also
may be at risk.
What Are the Signs of Alzheimer's Disease?
The classic sign of early Alzheimer's disease is gradual loss of
short-term memory. Other signs include:
- Problems finding or speaking the right word.
- Inability to recognize objects.
- Forgetting how to use simple, ordinary things, such as a
pencil.
- Forgetting to turn off the stove, close windows, or lock
doors.
Mood and personality changes also may occur. Agitation, problems
with memory, and poor judgment may cause unusual behavior. These
symptoms vary from one person to the next.
Symptoms appear gradually in persons with Alzheimer's disease but may
progress more slowly in some persons than in others. In other forms of
dementia, symptoms may appear suddenly or may come and go.
If you have some of these signs, this does not mean you have
Alzheimer's disease. Anyone can have a lapse of memory or show poor
judgment now and then. When such lapses become frequent or dangerous,
however, you should tell your doctor about them immediately.
Possible Signs of Alzheimer's Disease
Do you have problems with any of these activities?
- Learning and remembering new information. Do you repeat
things that you say or do? Forget conversations or appointments?
Forget where you put things?
- Handling complex tasks. Do you have trouble performing
tasks that require many steps such as balancing a checkbook or cooking a
meal?
- Reasoning ability. Do you have trouble solving everyday
problems at work or home, such as knowing what to do if the bathroom is
flooded?
- Spatial ability and orientation. Do you have trouble driving
or finding your way around familiar places?
- Language. Do you have trouble finding the words to express
what you want to say?
- Behavior. Do you have trouble paying attention? Are you more
irritable or less trusting than usual?
Remember, everyone has occasional memory lapses. Just because you
can't recall where you put the car keys doesn't mean you have
Alzheimer's disease.
Consulting the Doctor
Identifying mild cases of Alzheimer's disease can be very difficult.
Your doctor will review your health and mental status, both past and
present. Changes from your previous, usual mental and physical
functioning are especially important.
Persons with Alzheimer's disease may not realize the severity of
their condition. Your doctor will probably want to talk with family
members or a close friend about their impressions of your condition.
The doctor's first assessment for Alzheimer's disease should include
a focused history, a physical examination, a functional status
assessment, and a mental status assessment.
Medical and Family History
Questions the doctor may ask in taking your history include: How and
when did problems begin? Have the symptoms progressed in steps or
worsened steadily? Do they vary from day to day? How long have they
lasted?
Your doctor will ask about past and current medical problems and
whether other family members have had Alzheimer's disease or another
form of dementia.
Education and other cultural factors can make a difference in how you
will do on mental ability tests. Language problems (for example,
difficulty speaking English) can cause misunderstanding. Be sure to
tell the doctor about any language problems that could affect your test
results.
It is important to tell the doctor about all the drugs you take and
how long you have been taking them. Drug reactions can cause dementia.
Bring all medication bottles and pills to the appointment with your
doctor.
Do you take any medications? Even over-the-counter drugs, eye
drops, and alcohol can cause a decline in mental ability. Tell your
doctor about all the drugs you take. Ask if the drugs are safe when
taken together.
Physical Examination
A physical examination can determine whether medical problems may be
causing symptoms of dementia. This is important because prompt
treatment may relieve some symptoms.
Functional Status Assessment
The doctor may ask you questions about your ability to live alone.
Sometimes, a family member or close friend may be asked how well you can
do activities like these:
- Write checks, pay bills, or balance a checkbook.
- Shop alone for clothing, food, and household needs.
- Play a game of skill or work on a hobby.
- Heat water, make coffee, and turn off the stove.
- Pay attention to, understand, and discuss a TV show,
book, or magazine.
- Remember appointments, family occasions, holidays, and
medications.
- Travel out of the neighborhood, drive, or use public
transportation.
Sometimes a family member or friend is not available to answer such
questions. Then, the doctor may ask you to perform a series of tasks
("performance testing").
Mental Status Assessment
Several other tests may be used to assess your mental status. These
tests usually have only a few simple questions. They test mental
functioning, including orientation, attention, memory, and language skills. Age, educational level, and cultural influences may affect how
you perform on mental status tests. Your doctor will consider these
factors in interpreting test results.
Alzheimer's disease affects two major types of abilities:
- The ability to carry out everyday activities such as bathing,
dressing, using the toilet, eating, and walking.
- The ability to perform more complex tasks such as using the telephone,
managing finances, driving a car, planning meals, and working in a job.
When a person has Alzheimer's disease, problems with complex tasks
appear first and over time progress to more simple
activities.
Treatable Causes of Dementia
Sometimes the physical examination reveals a condition that can be
treated. Symptoms may respond to early treatment when they are caused
by:
- Medication (including over-the- counter drugs).
- Alcohol.
- Delirium.
- Depression.
- Tumors.
- Problems with the heart, lungs, or blood vessels.
- Metabolic disorders (such as thyroid problems).
- Head injury.
- Infection.
- Vision or hearing problems.
Drug reactions are the most common cause of treatable
symptoms. Older persons may have reactions when they take certain
medications. Some medications should not be taken together. Sometimes,
adjusting the dose can improve symptoms.
Delirium and depression may be mistaken for or occur with
Alzheimer's disease. These conditions require prompt treatment. See
the inside front cover of this booklet for more information on delirium
and depression.
Special Tests
Gathering as much information as possible will help your doctor
diagnose early Alzheimer's disease while the condition is mild. You may
be referred to other specialists for further testing.
Some special tests can show a person's mental strengths and weaknesses
and detect differences between mild, moderate, and severe impairment.
Tests also can tell the difference between changes due to normal aging
and those caused by Alzheimer's disease.
If you go to a special doctor for these tests, he or she should
return all test results to your regular family doctor. The results will
help your doctor track the progress of your condition, prescribe
treatment, and monitor treatment effects.
Getting the Right Care
When the diagnosis is Alzheimer's disease, you and your family
members have serious issues to consider. Talk with your doctor about
what to expect in the near future and later on, as your condition
progresses. Getting help early will help ensure that you get the care
that is best for you.
When tests do not indicate Alzheimer's disease, but your symptoms
continue or worsen, check back with your doctor. More tests may be
needed. If you still have concerns, even though your doctor says you do
not have Alzheimer's disease, you may want to get a second opinion.
Whatever the diagnosis, followup is important.
Report any changes in your symptoms. Ask the doctor what followup is
right for you. Your doctor should keep the results of the first round
of tests for later use. After treatment of other health problems, new
tests may show a change in your condition.
Recognizing Alzheimer's disease in its early stages, when treatment
may relieve mild symptoms, gives you time to adjust. During this time,
you and your family can make financial, legal, and medical plans for the
future.
Coordinating Care
Your health care team may include your family doctor and medical
specialists such as psychiatrists or neurologists, psychologists,
therapists, nurses, social workers, and counselors. They can work
together to help you understand your condition, suggest memory aids, and
tell you and your family about ways you can stay independent as long as
possible.
Talk with your doctors about activities that could be dangerous for
you or others, such as driving or cooking. Explore different ways to do
things.
Telling Family and Friends
Ask your doctor for help in telling people who need to know that you
have Alzheimer's disease &emdash; members of your family, friends, and
coworkers, for example.
Alzheimer's disease is stressful for you and your family. You and
your caregiver will need support from others. Working together eases
the stress on everyone.
Where To Get Help?
Learning that you have Alzheimer's disease can be very hard to deal
with. It is important to share your feelings with family and
friends.
Many kinds of help are available for persons with Alzheimer's
disease, their families, and caregivers. Turn to the back of this
booklet for a list of resources for patients and families. These
resources include:
- Support groups. Sometimes it helps to talk things over
with other people and families who are coping with Alzheimer's disease.
Families and friends of people with Alzheimer's disease have formed
support groups. The Alzheimer's Association has active groups across
the country. Many hospitals also sponsor education programs and support
groups to help patients and families.
- Financial and medical planning. Time to plan can be a major
benefit of identifying Alzheimer's disease early. You and your family
will need to decide where you will live and who will provide help and
care when you need them.
- Legal matters. It is also important to think about certain
legal matters. An attorney can give you legal advice and help you and
your family make plans for the future. A special document called an
advance directive lets others know what you would like them to do if you
become unable to think clearly or speak for
yourself.
Other Booklets Are Available
The information in this booklet is based on Recognition and
Initial Assessment of Alzheimer's Disease and Related Dementias:
Clinical Practice Guideline No. 19. A multidisciplinary panel of
physicians, psychiatrists, psychologists, neurologists, nurses, a
geriatrician, a social worker, and two consumer representatives
developed the guideline. The Agency for Health Care Policy and Research
(AHCPR), an agency of the U.S. Department of Health and Human Services,
supported its development. Other AHCPR guidelines may be helpful to
families affected by Alzheimer's disease. They include the following:
- Depression Is a Treatable Illness: Patient Guide
discusses major depressive disorder, which usually can be treated
successfully with the help of a health professional. (AHCPR Publication
No. 93-0053)
- Recovering After a Stroke: Patient and Family Guide tells
how to help a person who has had a stroke achieve the best possible
recovery. (AHCPR Publication No. 95-0664)
- Understanding Urinary Incontinence in Adults: Patient Guide
describes why people lose urine when they don't want to and what can be
done about it. (AHCPR Publication No. 96-0684)
- Preventing Pressure Ulcers: Patient Guide discusses
symptoms and causes of bed sores and ways to prevent them. (AHCPR
Publication No. 92-0048)
- Treating Pressure Sores: Consumer Guide describes basic
steps of care for bed sores. (AHCPR Publication No.
95-0654)
For more information on these or other guidelines, or to receive more
copies of this booklet, call toll-free: 800-358-9295. Or write
to:Agency for Health Care Policy and Research, Publications
Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907
Source: Agency for Healthcare Research and Quality
AHCPR Publication No. 96-0704
Page last modified or reviewed on September 15, 2009
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