Alzheimer's disease (AD) is a slowly progressive disease of the brain that is characterized by impairment of memory and eventually by disturbances in reasoning, planning, language, and perception. Alzheimer's disease is the most common cause of dementia, which afflicts 24 million people worldwide. Alzheimer's disease is not a normal part of aging and is not something that inevitably happens in later life. It is rarely seen before the age of 65. The likelihood of having Alzheimer's disease increases substantially after the age of 70 and may affect around 50% of persons over the age of 85. 

Many scientists believe that Alzheimer's disease results from an increase in the production or accumulation of a specific protein (beta–amyloid protein) in the brain that leads to nerve cell death.  It is the Plaques which contain misfolded peptides of the beta-amyloid protein formed in the brain and neurofibrillary tangles that form many years before the clinical signs of Alzheimer's are observed form the pathological hallmarks of the disease. Unfortunately with today’s science these features can only be discovered at autopsy and help to confirm the clinical diagnosis.

The ultimate cause of Alzheimer's is unknown. Genetic factors are clearly indicated as dominant mutations in three different genes that account for the small number of cases of familial, early-onset AD have been identified. In addition to age and family history, risk factors for AD may include:

• Longstanding high blood pressure
• History of head trauma
• High levels of homocysteine (a body chemical that contributes to chronic illnesses such as heart disease, depression, and possibly AD)
• Female gender -- because women usually live longer than men, they are more likely to develop AD

Symptoms

In the early stages, the symptoms of AD may be subtle and resemble signs that people mistakenly attribute to "natural aging." Symptoms often include:

• Misplacing items
• Repeating statements
• Getting lost on familiar routes
• Personality changes
• Easily angered or defensive when approached about their health
• Having trouble finding names for familiar objects
• Losing interest in things previously enjoyed
• Difficulty performing tasks that take some thought, but used to come easily, like balancing a checkbook, learning new information or routines, etc.

In a more advanced stage, symptoms are more obvious:

• Forgetting details about current events
• Forgetting events in your own life history, losing awareness of who you are
• Problems choosing proper clothing
• Hallucinations, arguments, striking out, and violent behavior
• Depression
• Delusions
• Difficulty performing basic tasks like preparing meals and driving
• At end stages of AD, a person can no longer survive without assistance. Most people in this stage no longer:

Recognize family members

•  Perform basic activities of daily living such as eating, dressing, and bathing
• Understand language

Exams and Tests

• The first step in diagnosing Alzheimer's disease is to establish if dementia is present.
• Then, the type of dementia should be clarified.
• A health care provider will take a history, do a physical exam (including a neurological exam), and perform a mental status examination.
• Tests may be ordered to help determine if there is a treatable condition that could be causing dementia or contributing to the confusion of AD. These conditions include drug and medication intoxication, thyroid disease, vitamin deficiency, chronic infection, anemia, and severe depression.
• Often a computed tomography (CT), scan is ordered to determine if any brain tumor is present.
• Other tests that are often done to evaluate or exclude other causes of dementia include magnetic resonance imaging (MRI), and blood tests.
• While the scans do not confirm the diagnosis of AD, they do exclude other causes of dementia (such as stroke and tumor).

Treatment

Unfortunately, currently there is no cure for AD.  Treatment today currently focuses on treating the symptoms of AD, and slowing the progression of the disease.

Currently the most promising treatments include lifestyle changes focused in reducing stress and increasing sociability, brain exercises, medications (such as anti-depressants), and antioxidant supplements like vitamin E and ginkgo biloba.

Lifestyle Changes

The following lifestyle changes may help people with AD:

• Increase brain activity through reading, crossword puzzles, board games.
• Exercise regularly.
• <!--[endif]-->Socialize. This can improve communication skills, and slow decline.
• Get a pet.
• Perform activities that reduce stress (massage, listen to calming music, etc.). This may boost brain chemicals, ease anxiety, enhance sleep, and improve behavior.
• Practice relaxation techniques. This may boost brain chemicals, ease anxiety, enhance sleep, and improve behavior.

Drug Treatment

There are controversies surrounding the effects of medications regarding the disease.  Medications used today are focused on reducing the symptoms of the disease; they cannot change the course of the underlying pathology and reverse the disease.

While memantine (Namenda) is the only drug currently approved for the treatment of moderate-to-severe Alzheimer’s disease. there are several drugs available being used to try to slow the progression of AD as well as to possibly improve the person's mental capabilities.

Routine medical Assessments

Because not all medicines may be successful, and some may make things worse routine visits to the doctor is important for assessments.  It is also important to understand that certain OTC medicines and herbs may interact with drug therapy or may make AD worse.  Such medicines may include pain killers, cimetidine, central nervous system depressants, antihistamines, sleeping pills, and others.

Supplements

There are many supplements that may be valuable in preventing AD, slowing down the onset of AD, and/or improving the symptoms of AD. For instance:

• Antioxidant supplements, like ginkgo biloba and vitamin E, scavenge free radicals. These products of metabolism are highly reactive and can damage cells throughout the body.Vitamin E dissolves in fat, readily enters the brain, and may slow down cell damage. In at least one well-designed study of people with AD who were followed for 2 years, those who took vitamin E supplements had improved symptoms compared to those who took a placebo pill. Patients who take blood-thinning medications like warfarin (Coumadin) may should talk to their doctor before taking vitamin E.

• Ginkgo biloba is an herb widely used in Europe for treating dementia. It improves blood flow in the brain and contains flavonoids (plant substances) that act as antioxidants. Although many of the studies to date have been somewhat flawed, the idea that ginkgo may improve thinking, learning, and memory in those with AD has been promising. DO NOT use ginkgo if you take blood-thinning medications like warfarin (Coumadin) or a class of antidepressants called monoamine oxidase inhibitors (MAOIs).

• High levels of homocysteine and low levels of both folate and vitamin B12 have been found in people with AD. Therefore supplementing with Folate (vitamin B9) and B12 may be helpful to those with low levels of these vitamins and higher levels of homocysteine (a body chemical that contributes to chronic illnesses) in their blood.

Important Note: If you are considering any drugs or supplements, you MUST talk to your doctor first, since they are NOT regulated by the FDA and may effect the health of the person with AD.

Other Things to Consider

The person with AD should be carefully monitored, as the symptoms will progressively worsen.

The person with AD may have special dietary needs. Extra calories due to increased physical activity from restlessness and wandering. They should also be monitored for weight loss, since people with AD often forget to eat and drink, and can become dehydrated as a result. Supervised eating may help alleviate these risks.

Alzheimer's Association has implemented a Safe Return Program for those with AD. This program requires that a person with AD wear in identification bracelet so if the person becomes lost, or wanders, caregiver can contact the police and the national Safe Return office, where information about the person is stored and shared nationwide. To help locate the person with AD

AD worsens with age and eventually, 24-hour monitoring and assistance may be necessary to provide a safe environment (they may forget to turn off the stove, leave running water on, not realize water is scalding and burn themselves, or wander from their home).