WHAT IS ALZHEIMER’S DISEASE?
Alzheimer’s disease is the most common of a large group of disorders known as “dementias”. It is an irreversible disease of the brain in which the progressive degeneration of brain cells causes thinking ability and memory to deteriorate. Alzheimer’s disease also affects behaviour, mood and emotions, and the ability to perform daily living activites.
Alzheimer’s is the most common cause of dementia. Dementia is a gradual loss of mental functions such as the ability to think, remember, reason, and plan. Dementia is the most common reason for admission to a long term care facility.
Alzheimer’s disease (AD) affects brain cells. It gradually worsens memory and thinking skills. Over time the ability to speak, remember, control emotions, and make decisions may be affected.
HOW DOES IT OCCUR?
There are changes in the chemistry and structures of the brain when you have Alzheimer’s disease. These changes keep you from being able to process, store, and retrieve information. No one knows why these changes happen.
AD may start between the ages of 30 and 65, but it most often affects people 65 and older. Age is the most important known risk factor for AD. The number of people diagnosed with the disease doubles every 5 years after age 65.
Scientists have found a rare form of Alzheimer’s which is directly passed from parent to child. Members of these families who have AD usually show signs of the disease well before age 60. (Most people with AD do not have symptoms until after age 65.) This type of AD affects less than 5% of the people who have Alzheimer’s.
WHAT ARE THE SYMPTOMS?
The symptoms of Alzheimer’s disease are different from person to person, and they change as the illness gets worse.
The first symptom is usually forgetfulness. Almost everyone starts to have some memory problems as they get older. When you are in the early stages of AD, however, these problems are more obvious than in others of the same age. You have trouble remembering recent events, activities, or the names of familiar people or things. Your attention span gets shorter. It’s harder to focus. But, at this stage, being forgetful does not have a big effect on your lifestyle or work.
Over time your memory loss gets worse. Co-workers and friends notice the memory loss. You have problems reading, writing, and understanding. You have trouble knowing how to pay for things with money. You may misplace or lose things. You may get lost while driving or even when you are at home. As the disease gets worse, you completely forget things that happened recently. You may forget parts of your past as well. In general, recent memory is affected more than long-term memory.
In later stages of AD you will often be disoriented and confused. You will no longer be able to recall major facts about yourself or others. Things and people that were once familiar will become unfamiliar. You may have mood and personality changes. You may have false beliefs (delusions) or see or hear things that are not there (hallucinations). You may be anxious. You may be restless and tend to wander late in the day (a problem called sundowning).
HOW IS IT DIAGNOSED?
The first step in diagnosis is a careful medical history and physical exam. Several tests may be done to check for other illnesses that might cause your symptoms. Blood and urine tests can check for problems such as thyroid disease, diabetes, or kidney disease.
There is no specific test for Alzheimer’s disease except for a test of brain tissue after death. However, healthcare providers can determine if Alzheimer’s disease is a likely cause of your symptoms.
MRI scans may be done to take pictures of the brain. MRI shows a lot of detail about the brain, but it does not show Alzheimer’s disease directly. Experts disagree about the usefulness of these scans. Some experts say that they are needed to rule out other brain problems that would require different treatment. Other experts say that the scans are not needed unless something specific shows up in the person’s history or from a physical exam. These experts say that if someone has symptoms of Alzheimer’s, they should be treated, so scanning is not necessary.
More important than MRI scans are tests of mental abilities (memory, problem solving, counting, and language). It is also important to rule out major depression, which can cause many of the same symptoms as Alzheimer’s disease.
HOW IS IT TREATED?
There is no cure for Alzheimer’s disease. The goal of treatment is to control symptoms and improve quality of life as much as possible. This includes treating other illnesses, eating a healthy diet, and getting regular exercise.
Medicine may help. Donepezil (Aricept), galantamine (Reminyl), and rivastigmine (Exelon) are drugs that may slow memory loss early in the disease. Memantine (Ebixa) may help slow memory loss in later stages of the disease. These drugs are costly and may have side effects. Some ar covered by the provincial Pharmacare program plan or other insurance plans. None of these medicines can cure or reverse Alzheimer’s disease. Not all people with dementia should take these medicines. Those whose disease is very severe will not benefit. Talk to your primary healthcare provider about these issues. Other medicines are being studied to see if they might be helpful.
People with Alzheimer’s disease may experience depression and anxiety. Medicines for depression or anxiety may help.
HOW LONG WILL THE EFFECTS LAST?
Alzheimer’s disease causes brain function to keep getting worse until end of life. The time from when memory problems begin until death from Alzheimer’s disease varies a lot–from 5 to 20 or more years. Many people have other major medical problems like heart disease or cancer, and those illnesses often cause death earlier than would happen just from Alzheimer’s disease.
HOW CAN I HELP TAKE CARE OF SOMEONE WITH THIS DISEASE?
Sometimes people who have Alzheimer’s do not think they need help and may resist it. But as the disease gets worse, bowel and bladder control may be lost, as is the ability to independently do many daily tasks and functions.
While it is still possible, people who have AD should be involved in decisions about the care they will get. Someone with AD fears embarrassment from the loss of independence and needs to be reassured sincerely and often.
Friends and family, as well as the person with AD, may be able to join support groups as soon as possible after the disease is diagnosed. Everyone’s needs must be considered and balanced. Caregivers will become emotionally and physically worn out if they have no help or no time away from caregiving.
Community resources are very important. To find out about services in your area, contact the Alzheimer Society of Nova Scotia (ASNS), talk with your primary healthcare provider, Continuing Care or public health department:
- ASNS provides one on one support, information, referrals, education programs and a number of services for persons with dementia and care givers.
- Social workers find and organize help, including possible financial aid.
- Home healthcare agencies provide the services of nurses, medical social workers, and therapists. They also provide home health aides for personal care.
- Out-of-home services may include adult day programs; mental health services, including support groups for people with dementia and family caregivers; transportation; and nursing facilities.
IS A POWER OF ATTORNEY NEEDED?
Yes, it is important to have an enduring power of attorney for medical and financial matters. The person with Alzheimer’s should sign a power of attorney before he or she becomes unable to make legal decisions. If desired, a personal directive, also known as a living will, should be made out as well. Ask your primary healthcare provider for more information about these documents.
WHAT CAN BE DONE TO HELP PREVENT ALZHEIMER’S DISEASE?
Alzheimer’s disease cannot be prevented until its causes are better understood. However, if you have a family history of Alzheimer’s, tell your primary healthcare provider. Early diagnosis may allow you to take advantage of new treatments as they become available.
Challenge Your Brain: Keep your brain active every day
- Try something new or change the way you usually do a task, such as brushing your hair with your less dominant hand
- Play games to challenge your mind – chess, cards, word or number puzzles, jigsaws, crosswords, and memory games
- Pursue a new interest, learn a language, play a musical instrument, take a course, visit galleries and museums, enjoy old and new hobbies
Be Socially Active: Staying connected socially helps you stay connected mentally
- Enjoy events with family and friends
- Stay active in the workforce or become a volunteer
- Join an exercise group, a book club or hobby group
Choose a Healthy Lifestyle: A healthy lifestyle is as important to brain health as it is to the rest of your body
- Make healthy food choices: eat a varied diet rich in dark-coloured fruits and vegetables, including foods rich in anti-oxidants, such as blueberries and spinach; and omega 3 oils found in fish and canola oils
- Be active: regular moderate physical activity helps maintain cardiovascular health and can significantly reduce the risk of heart attacks, stroke and diabetes.
- Track your numbers: keep your blood pressure, cholesterol, blood sugar and weight within recommended ranges. If you have diabetes it is important to manage it well.
- Reduce stress; practice relocation, medication or other stress reduction techniques.
- Choose wisely; quit or avoid smoking and avoid excessive alcohol consumption.
- See your doctor regularly; both for check-ups and any specific health concerns. Your doctor is an important partner in maintaining your health.
Protect Your Head: Brain injuries, especially repeated concussions, are risk factors for the later development of Alzheimer’s disease.
- Wear an approved helmet when engaging in sporting activities such as skating, skiing, skateboarding, rollerblading and cycling.
- Protect against concussions by avoiding falls. Check your house for safety hazards; install handrails, arrange for snow clearance and throw out the scatter rugs.
- Drive safely and wear a seatbelt.
HOW CAN I GET MORE INFORMATION?
Alzheimer Society of Nova Scotia (ASNS)
112-2719 Gladstone Street
Halifax, Nova Scotia
Phone Toll Free (within Nova Scotia): 1-800-611-6345
Web site: http://alzheimer.ca/ns