World Alzheimer's Month

What is Alzheimer’s disease?

Alzheimer’s disease is the most common type of dementia – a group of diseases that cause memory loss and disrupt a person’s ability to think normally and go about their daily life.¹ Alzheimer’s is a form of dementia that progresses very slowly over time and is characterized by buildup of certain substances in the brain called beta-amyloid plaques and tau tangles. 

Who has Alzheimer’s disease and how many people are affected?

Alzheimer’s disease usually occurs in people who are 65 years and older, but in some cases people in their 40’s or 50’s can get it.² The older a person is, the more likely he or she is to have Alzheimer’s. Besides age, other factors that can contribute to eventually developing Alzheimer’s include smoking, depression, diabetes, having a first-degree relative with Alzheimer’s, and certain genetic mutations.^2,3 Recent evidence indicates that high blood pressure, obesity and high cholesterol – issues that are usually linked to heart disease – are also associated with a higher risk of developing Alzheimer’s disease.

It is estimated that more than 5 million people in the United States are living with Alzheimer’s and almost 2 out of 3 of those are women.² In addition to the impact on the individuals actually afflicted with Alzheimer’s, there is a tremendous burden imposed on the family and friends who provide care for them.⁴ It is estimated that in 2013, over 15 million caregivers spent nearly 18 billion hours caring for family and friends with dementia.

What are the symptoms of Alzheimer’s disease and how do they change over time?

Alzheimer’s affects different people in different ways.¹ Table 1 highlights the typical symptoms of Alzheimer’s disease.

Table 1. Stages and symptoms of Alzheimer’s disease.¹

Stage	Symptoms
Early	Short-term memory loss Difficulty remembering words Difficulty following directions
Middle	Gets confused and lost easily Difficulty speaking and understanding others Difficulty getting dressed and eating
Late	Ability to think logically and use good judgment is greatly decreased Sleeping patterns change Movements may become slow and awkward
Final	Unable to move or speak Unable to eat without assistance May have seizures

The majority of Alzheimer’s patients also suffer from behavioral and psychiatric problems such as irritability, anxiety, depression, agitation, and aggression.² These can occur at any stage in the disease, but like other symptoms, usually become worse as time goes on. The length of each stage and of the disease as a whole is different for each person, but in most cases, patients survive for about 8 to 10 years.¹

How is Alzheimer’s disease diagnosed?

There is no single test that can determine if a person has Alzheimer’s disease.⁴ While the disease is always characterized by certain changes in the brain, these changes cannot be detected until after death. Therefore, doctors use a combination of interview questions with the patient and his or her family and friends, memory and thinking tests, laboratory measurements, and brain imaging to determine if a person has Alzheimer’s.^4,5 The lab and imaging tests cannot directly indicate if a person has Alzheimer’s, but if the other tools show that he or she has dementia, they can be used to rule out other forms, leaving Alzheimer’s as the most likely diagnosis. Research is currently being conducted to identify “biomarkers” – substances in the body that can be tested to identify Alzheimer’s early.⁵

Can Alzheimer’s disease be prevented?

While it is impossible to prevent all cases of Alzheimer’s disease, you can make certain changes in your lifestyle to reduce your risk.⁶  Table 2 provides lifestyle modifications for the prevention of Alzheimer’s disease.

Table 1. Lifestyle modifications for the prevention of Alzheimer’s disease.⁶

What you can do:	Why you should do it:
Reduce the amount of saturated and trans fats in your diet.	Diets high in saturated and trans fats are known to raise cholesterol, which contributes to the development of Alzheimer’s and other diseases. These fats are found in meats, dairy, and fried foods.
Replace meat and dairy foods with more vegetables, legumes, fruits, and whole grains.	These foods can provide the protein, healthy fats and carbohydrates your body needs without the unhealthy fats found in meat and dairy. Additionally, they can provide vitamins that may support healthy brain function.
Include natural sources of vitamin E in your diet, such as seeds, nuts, green leafy vegetables, and whole grains.	While some studies indicate that high vitamin E diets are linked with lower rates of dementia, vitamin E supplements do not appear to share this link. It is thought that the reason for this may be that vitamin supplements do not contain all of the different forms of vitamin E found in natural sources.
Exercise regularly.	Studies have shown that aerobic exercise may improve brain function and is associated with lower rates of Alzheimer’s. Walking for 40 minutes three times a week or a similar regimen is recommended.

Can Alzheimer’s disease be treated?

Treatments for memory loss caused by Alzheimer’s disease are available, but they cannot reverse the damage already done, or even stop the progression of the disease.⁴ Drug therapy can only temporarily improve the symptoms. Other medications are sometimes used to treat the behavioral symptoms of Alzheimer’s such as depression and agitation. All medications are associated with adverse effects and have interactions with other drugs. Talk to your doctor or pharmacist to find out what medications are right for you.

Where can I find more information?

Some informative websites include:

The Alzheimer’s Association: www.alz.org

The National Institute on Aging: www.nia.nih.gov

References:

1. Seeley WW, Miller BL. Dementia. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J, eds. Harrison's Principles of Internal Medicine. 18^th ed. New York, NY: McGraw-Hill; 2012. http://accesspharmacy.mhmedical.com/content.aspx?bookid=331&Sectionid=40727187. Accessed August 13, 2014.

2. 2014 Alzheimer ’s disease Facts and Figures. Alzheimer’s Association website. http://www.alz.org/downloads/Facts_Figures_2014.pdf. Accessed August 14, 2014.

3. DynaMed [database online]. Ipswich, MA: EBSCO Publishing; 2014. http://www.ebscohost.com/dynamed/. Accessed August 14, 2014

4. Alzheimer’s association website. www.alz.org. Accessed August 14, 2014.

5. About Alzheimer’s disease: diagnosis. National Institute on Aging website.  http://www.nia.nih.gov/alzheimers/topics/diagnosis. Accessed August 14, 2014.

6. Barnard ND, Bush AI, Ceccarelli A, et al. Dietary and lifestyle guidelines for the prevention of Alzheimer’s disease. Neurobiol Aging. 2014;35(suppl 2):s74-s78.

Written by:

Yaakov Samberg, PharmD Candidate 2015