Overview - What It's All About

 

There is so much that encompasses the topic of Alzheimer's. It may be helpful to get a general overview of things before getting into specifics. This page will help you do that. Provided by the Duke Family Support Program, this page offers part of what is offered in their Tool Kit for Alzheimer's and Dementia Caregivers.

We'll briefly discuss:

  • Symptoms
  • It May be Alzheimer's if the Person has Trouble With...
  • How is Alzheimer's Disease Different From Normal Aging?
  • When to Seek Help
  • Diagnosis
  • How Can You Help the Doctor?
  • What Should You Ask the Doctor?
  • Treatment
  • What Can Be Done to Help Behavior Changes?

Rather than linking to each part, as an overview, it would be more effective to scroll down the entire page to access the information. After reading through this information, we suggest that you return to the Alzheimer's Section Homepage to find out more information on any one topic of interest.

 

Symptoms

Symptoms of Alzheimer’s can include gradual memory loss, decline in the ability to perform routine tasks, disorientation, difficulty in learning, loss of language skills, impairment of judgment and planning and personality changes. The rate of progression varies from person to person.

The time from the onset of symptoms until death ranges from 3 to 20 years; the average is 8 years. Eventually, persons with Alzheimer’s disease become totally incapable of caring for themselves.

 

It May be Alzheimer's if the Person has Trouble With...

Learning and retaining new information
Is repetitive; has trouble remembering recent conversations, events, appointments; frequently misplaces objects.

Handling complex tasks
Has trouble following a complex train of thought or performing tasks that require many steps such as balancing a checkbook or cooking a meal.

Reasoning ability
Is unable to respond with a reasonable plan to problems at work or home, such as knowing what to do if the bathroom is flooded. Shows uncharacteristic disregard for rules of social conduct.

Spatial ability and orientation
Has trouble driving, organizing objects around the house, finding his or her way around familiar places.

Language
Has increasing difficulty with finding the words to express what he or she wants to say and with following conversations.

Behavior
Appears more passive and less responsive; is more irritable than usual; is more suspicious than usual; misinterprets visual or auditory stimuli.

And...
Failure to arrive at the right time for appointments, look for difficulty discussing current events in an area of interest and changes in behavior or dress. Positive findings in any of these areas generally indicate the need for further assessment for the presence of dementia.*

*AHRQ Guideline Panel 1996

 

 

How is Alzheimer's Disease Different From Normal Aging?

The symptoms of Alzheimer’s disease involve more than simple lapses in memory. People with Alzheimer’s have difficulties in communicating, learning, thinking and reasoning that can affect their work, social and family life. Alzheimer’s is a disease that destroys brain cells – which is not a normal part of aging.

 

When to Seek Help

Alzheimer’s or other memory disorders symptoms may develop slowly and go unnoticed for some time. First there is a gradual loss of “what just happened” or recent memory, thinking or reasoning ability. Families begin looking for help when there are changes in daily function or in the person’s ability to manage safely on his/her own.

Consider these 10 items from the Functional Activities Questionnaire (AHRQ, 1996) as indicators that it’s time for a medical evaluation and help from community services.

  • Trouble writing checks, paying bills, doing simple math or the checkbook.
  • Problems with business records, taxes or personal papers.
  • Difficulty shopping alone for clothes, household items or groceries.
  • Trouble with a familiar game or remembering words from a familiar hobby.
  • Difficulty heating water, making a hot drink or turning off the stove.
  • Problems preparing or eating balanced meals at reasonable times.
  • Problems keeping track of current events.
  • Trouble paying attention to or understanding a TV show or book.
  • Problems remembering family events, holidays, medications.
  • Difficulty traveling out of the neighborhood.

 

Note: Dementia is a decline from previous abilities. If the person never did one of these activities, it is not a change indicating a problem.

 

Diagnosis

Early and careful evaluation is important because many conditions, including some that are treatable or reversible, can cause dementia. Potentially reversible conditions include depression, adverse drug reactions, metabolic changes and nutritional deficiencies.

There is no single clinical test to identify Alzheimer’s disease. A comprehensive evaluation to establish diagnosis will include a complete health history, physical examination, neurological exam, and tests including analysis of blood and urine and tests of memory and problem solving. Documenting symptoms and behavior over time, in a diary fashion, will help physicians understand the person’s illness. The physician may order additional tests including brainscans (CT or MRI), psychiatric evaluation, and/or neuropsychological testing. While this evaluation may provide a diagnosis of possible or probable Alzheimer’s disease, confirmation of Alzheimer’s disease requires examination of brain tissue, which is usually done by an autopsy.

 

How Can You Help the Doctor?

Be prepared for an evaluation with a list of current prescribed medicines and doses, and a list of anything the person is taking or doing for his/her health.

Bring a list of signs, symptoms or situations that indicate a change and a decline in the person’s abilities, mood, personality or behavior. For behavior changes, be ready to describe when each behavior started, the frequency of the behavior, the time of day it occurs or what seems to bring it on, and what strategies you have tried already to handle the behavior changes.

 

What Should You Ask the Doctor?

  • What is the diagnosis?
  • Which tests are needed and why?
  • What are the treatment options?
  • Should any foods, activities or other medications be avoided while taking medicine for memory symptoms?
  • What is the future course of the disease?
  • Do you have written information about the disease or treatment?
  • Are there services available to help or support our family?
  • Do we need to see another doctor or specialist?
  • Can we schedule a follow-up appointment?
  • What changes should I call you about? When is the best time to call?

You Must

  • Be organized, clear and concise. Use visits to clear up doubts, worries and misunderstandings.
  • Prioritize your top three concerns for this visit.
  • Be prepared to both ask and answer questions.
  • Explain what you think is going on and ask for both written and verbal explanations.
  • Encourage the person with dementia to ask and answer questions as well.

 

 

Treatment

Although no treatment can stop Alzheimer’s disease, good planning and medical and social management can ease the burdens on the patient and family. There are currently four FDA approved drug treatments specifically for the memory symptoms: tacrine (Cognex), donepezil hydrochloride (Aricept), and rivastigmine (Exelon), and galantamine hydrobromide (Reminyl). These and other medicines may help with mood, behaviors and function. *
*Alzheimer’s Association, 7/2001

There are ways to treat some of the symptoms.

  • Use of cholinesterase inhibitors to treat memory symptoms. These medicines may improve quality of life, memory, thought, attention and reasoning. These medications work most effectively for people who are mildly to moderately affected by the disease. This is why early recognition and diagnosis is so important.
  • Vitamin E is an option to help with some symptoms of Alzheimer’s disease. Vitamin E is an antioxidant, and it may aid in the breakdown of free radicals that may be damaging brain cells in people with Alzheimer’s disease.
  • Referral to appropriate activities like exercise or adult day centers.
  • Prompt treatment of medical or psychological conditions that may add to memory problems or symptoms of confusion.

 

 

What Can Be Done to Help Behavior Changes?

At times, people with dementia may have changes in behavior such as wandering, paranoia, suspiciousness, hitting or resistance to help with personal hygiene. The doctor may suggest:

  • Enrollment in the Alzheimer’s Association MedicAlert + Safe Return Program, an identification program for memory impaired adults.
  • Modifying the person’s environment to reduce confusion caused by overstimulation from noise, glare or other sources.
  • Explaining a task with step-by-step directions.
  • Providing a predictable routine at home, playing music during meals or bathing, insuring regular light exercise and sleep.
  • Providing reassurance to the confused person without challenging his/her accusations or misperceptions, just redirecting or distracting him/her.
  • If these strategies aren’t enough, the doctor may prescribe medicines for symptoms of depression, restlessness, hallucinations, hostility and agitation.

 

 

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