Alzheimer’s is a disease that causes dementia. It is probably the best-known cause of dementia, accounting for about two-thirds of cases in the elderly.
This information aims to give an introduction to Alzheimer’s, by providing an overview of the causes, symptoms and treatments. We hope you will find it helpful.
Alzheimer’s often develops slowly over several years. It is not always obvious to begin with and symptoms can overlap with other illnesses.
Sometimes it can be difficult to distinguish Alzheimer’s from mild forgetfulness which can be seen in normal ageing.
Everyone with Alzheimer’s will experience symptoms in their own way. Early signs usually include difficulties forming new memories, but people may also experience language or spatial awareness difficulties.
Typical early symptoms of Alzheimer’s include:
- Regularly forgetting recent events, names and faces.
- Regularly misplacing items or putting them in odd places.
- Confusion about the time of day.
- Disorientation, especially away from your normal surroundings.
- Getting lost.
- Problems finding the right words.
- Mood or behaviour problems such as apathy, irritability, or losing confidence.
Alzheimer’s gets worse over time, but the speed of change varies from person to person as Alzheimer’s progresses:
- People will find that their ability to remember, think and make decisions worsens.
- Communication and language become more difficult.
- A person’s behaviour may change and some people can become sad or depressed.
- Anxieties or phobias are quite common.
- People may experience hallucinations, where they may see things or people that aren’t there.
- Problems with sleeping and restlessness at night often occur.
- Anger or agitation become more common.
- People may become increasingly unsteady on their feet and fall more often.
- People gradually require more help with daily activities like dressing, toileting and eating.
Diagnosing Alzheimer’s is important. It means you can get the right support and treatments. It also means you can plan for the future.
If you are worried about your health or someone else’s, you should talk to your GP. If your GP suspects dementia, they may refer you to a memory clinic or another specialist clinic. Here, a doctor or nurse may run through some questions and tests with you. These are likely to include:
• Asking you some questions about your symptoms and medical history.
• Asking about your mood.
• Speaking with your partner or someone close to you about your symptoms.
• Having a physical check-up.
• Completing some standard pen-and-paper tests to check your memory, language and problem-solving skills.
These tests may be repeated, perhaps every six to 12 months, to see if there are any changes. Sometimes, if symptoms are mild, looking for change with time is the best way to be sure if anything is wrong.
You may also be asked to undergo other tests, including brain scans and blood tests. Together all of these things will help a doctor find out about any problems in memory or thinking and the likely cause.
If you are assessed for the possibility of having Alzheimer’s or another form of dementia, you can choose not to know the diagnosis. You can also choose who else can know about your diagnosis.
If you are given a diagnosis of Alzheimer’s, you may be offered various types of support. You may also be prescribed drugs or other treatments to help with symptoms or improve your quality of life.
There are several treatments available to help with the symptoms of Alzheimer’s.
Non-drug treatments
Cognitive stimulation activities are designed to stimulate thinking skills and engage people who have Alzheimer’s. They are often group-based and include games, with an emphasis on enjoyment. The benefits of cognitive stimulation for people with Alzheimer’s could include improvement in memory, thinking skills and quality of life.
People with mild to moderate dementia, including Alzheimer’s, should be given the opportunity to participate in cognitive stimulation programmes, if available.
Treatments for depression, agitation, anxiety and aggression
People with depression or anxiety in Alzheimer’s may be offered social support or psychological treatments, such as cognitive behavioural therapy (CBT), to help with symptoms. CBT provides an opportunity for people to talk about their concerns with a specialist, and aims to help people develop different ways of thinking and behaving. People with more severe symptoms may also be offered an antidepressant drug, although these are not always suitable for someone with Alzheimer’s. Your doctor will carefully consider what may be appropriate.
To help relieve symptoms of agitation and aggression a doctor should review someone’s physical and mental health and environment. This helps to identify any causes or triggers which could be removed. Approaches such as aromatherapy or music therapy may also be considered. This is likely to depend on your preference as well as the availability of treatments.
In some circumstances antipsychotic drugs such as risperidone (Risperdal) may be used to relieve very severe symptoms. These drugs are not suitable for everyone and your doctor will carefully consider what is appropriate. These drugs can have serious side effects and their use should be carefully monitored.
There are a number of organisations that can provide help and support to people with Alzheimer’s, their families and carers.
A couple of good places to find support:
Although often thought of as a disease of the elderly, around 4% of people with Alzheimer’s are under 65. This is called early-onset or young-onset Alzheimer’s. It usually affects people in their 40s, 50s and 60s.
If you are worried about yourself or someone else who is showing symptoms of dementia, talk to your GP. They will be able to rule out other health issues such as depression or anxiety which may cause similar symptoms in younger people. They will also be able to refer you to a specialist for other tests if necessary.
While some symptoms can be similar to those of late-onset Alzheimer’s, the disease can also reveal itself in more unusual ways in younger people. This can make it more difficult for people, families and doctors to recognise.
Symptoms of early-onset Alzheimer’s can include:
• Memory problems which interfere with everyday life. This may include forgetting messages or recent events which would normally be remembered, or repeating questions.
• Confusion or disorientation. People may become confused in unfamiliar situations and lose a sense of place and time.
• Changes in personality and behaviour. These may be subtle at first and could include apathy, depression or loss of confidence.
• Language problems – difficulty finding the right words and communicating. This may sometimes be called ‘progressive aphasia’.
• Visual problems – people can have difficulty recognising words and objects and judging speed or distance. When visual problems are a major symptom, the disease may be called ‘posterior cortical atrophy’.
Alzheimer’s is a progressive disease, which means that symptoms get worse over time.
The impact of early-onset Alzheimer’s can be significant – people are often working and may have young families. For details of organisations that can offer support and advice, visit the caring for someone with dementia section of our website. You can also ask your doctor.
Can I inherit early-onset Alzheimer’s?
In most cases the answer is no. Inherited or ‘familial’ forms of Alzheimer’s are rare.
Several genes have been identified that play a role in the development of rare familial Alzheimer’s. Mistakes in these genes (called mutations) can cause a build-up of a toxic protein called amyloid in the brain. If someone has a strong family history of Alzheimer’s at a young age, genetic testing may be suggested and genetic counselling may be offered to close relatives.
In the vast majority of cases, the cause is still unclear. It is likely to be a combination of our age, lifestyle, environment and genetic make-up.
Will early-onset Alzheimer’s progress faster?
It is difficult to know. There is some evidence that early-onset Alzheimer’s may progress faster and more aggressively, but experts are unsure whether this is conclusive. Every person’s experience is different and there can be a huge amount of variability in people’s response to the disease. Difficulties with diagnosis may mean that people are diagnosed later, making their progression seem faster. Research into better methods of detection will help to improve early diagnosis.
Alzheimer’s symptoms vary. The stages below provide a general idea of how abilities change during the course of the disease.
Not everyone will experience the same symptoms or progress at the same rate. This seven-stage framework is based on a system developed by Barry Reisberg, M.D., clinical director of the New York University School of Medicine’s Silberstein Aging and Dementia Research Center.
Stage 1 : No impairment (normal function)
The person does not experience any memory problems. An interview with a medical professional does not show any evidence of symptoms of dementia.
Stage 2: Very mild cognitive decline (may be normal age-related changes or earliest signs of Alzheimer’s disease)
The person may feel as if he or she is having memory lapses — forgetting familiar words or the location of everyday objects. But no symptoms of dementia can be detected during a medical examination or by friends, family or co-workers.
Stage 3: Mild cognitive decline (early-stage Alzheimer’s can be diagnosed in some, but not all, individuals with these symptoms)
Friends, family or co-workers begin to notice difficulties. During a detailed medical interview, doctors may be able to detect problems in memory or concentration. Common stage 3 difficulties include:
- Noticeable problems coming up with the right word or name
- Trouble remembering names when introduced to new people
- Having noticeably greater difficulty performing tasks in social or work settings Forgetting material that one has just read
- Losing or misplacing a valuable object
- Increasing trouble with planning or organizing
Stage 4: Moderate cognitive decline (Mild or early-stage Alzheimer’s disease)
At this point, a careful medical interview should be able to detect clear-cut symptoms in several areas:
- Forgetfulness of recent events
- Impaired ability to perform challenging mental arithmetic — for 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
Stage 5: Moderately severe cognitive decline (Moderate or mid-stage Alzheimer’s disease)
Gaps in memory and thinking are noticeable, and individuals begin to need help with day-to-day activities. At this stage, those with Alzheimer’s may:
- Be unable to recall their own address or telephone number or the high school or college from which they graduated
- Become confused about where they are or what day it is
- Have trouble with less challenging mental arithmetic; such as counting backward from 40 by subtracting 4s or from 20 by 2s
- Need help choosing proper clothing for the season or the occasion
- Still remember significant details about themselves and their family
- Still require no assistance with eating or using the toilet
Stage 6: Severe cognitive decline (Moderately severe or mid-stage Alzheimer’s disease)
Memory continues to worsen, personality changes may take place and individuals need extensive help with daily activities. At this stage, individuals may:
- Lose awareness of recent experiences as well as of their surroundings
- Remember their own name but have difficulty with their personal history
- Distinguish familiar and unfamiliar faces but have trouble remembering the name of a spouse or caregiver
- Need help dressing properly and may, without supervision, make mistakes such as putting pajamas over daytime clothes or shoes on the wrong feet
- Experience major changes in sleep patterns — sleeping during the day and becoming restless at night
- Need help handling details of toileting (for example, flushing the toilet, wiping or disposing of tissue properly)
- Have increasingly frequent trouble controlling their bladder or bowels
- Experience major personality and behavioral changes, including suspiciousness and delusions (such as believing that their caregiver is an impostor) or compulsive, repetitive behavior like hand-wringing or tissue shredding
- Tend to wander or become lost
Stage 7: Very severe cognitive decline (Severe or late-stage Alzheimer’s disease)
In the final stage of this disease, individuals lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement. They may still say words or phrases.
At this stage, individuals need help with much of their daily personal care, including eating or using the toilet. They may also lose the ability to smile, to sit without support and to hold their heads up. Reflexes become abnormal. Muscles grow rigid. Swallowing impaired.
The risk of developing Alzheimer’s increases with age. That means as we get older, we are more likely to develop it. We can’t change our age and there is currently no way we can completely prevent dementia but research suggests there may be some simple things we can all do that might help lower our risk. To read more about these, visit our section on risk factors and prevention.
In Alzheimer’s, there are changes in the brain beyond those associated with normal ageing.
Among the most prominent are the build-up of two proteins, called amyloid and tau. Research suggests that both of these are involved in the disease process, but the exact sequence of events is still not understood. As the disease progresses, more and more nerve cells in the brain become damaged. This damage leads to the symptoms of Alzheimer’s.
We still need to learn more about why these proteins build up in the brain and how they damage nerve cells. Research is underway to understand more about what happens in the brain during Alzheimer’s.