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Alzheimer's disease

Published by Bupa's health information team, April 2009.

This factsheet is for people who have Alzheimer's disease, or who would like information about it.

Alzheimer's disease is a slowly progressing form of dementia. Over time, Alzheimer's disease gradually damages the function and structure of the brain, which affects a person's ability to remember, talk and carry out routine daily activities.

About Alzheimer's disease
Symptoms of Alzheimer's disease
Causes of Alzheimer's disease
Diagnosis of Alzheimer's disease
Treatment of Alzheimer's disease
Help and support
Further information
Questions and answers
Related topics
Sources

About Alzheimer's disease

Alzheimer's disease is the most common cause of dementia. Dementia is the term used to describe a range of conditions that cause a deterioration of brain function, resulting in memory loss, reduced language skills and behavioural and emotional problems. Of the 700,000 people with dementia in the UK, around 400,000 have Alzheimer's disease. Most people who develop dementia are over 65.

There is no cure for Alzheimer's disease, although research is underway to identify the causes of the disease and develop new treatments. Life expectancy often depends on how quickly symptoms progress. The period of time between diagnosis and the person dying can be anything from 18 months to 15 years, but is usually seven to 10 years. Most people with Alzheimer's disease need full-time care within five to 10 years. Often the cause of death in a person with Alzheimer's disease is another illness, such as an infection or stroke.

What happens in the brain of a person with Alzheimer's disease?

When your brain is working normally, signals in the form of electrical impulses travel along nerves to and from your body and other parts of your brain. Nerve signals travel across the gaps (synapses) between nerve cells (neurons) with the help of chemicals called neurotransmitters, including one called acetylcholine. These signals are essential for brain activity such as memory, language and problem solving. They are also involved in controlling movements.

In Alzheimer's disease, the number of nerve cells in the brain gradually reduces and the brain shrinks. Nerve cells can't be replaced, so if you have Alzheimer's disease, memory and thinking get progressively worse as more cells are destroyed. Alzheimer's disease also causes a reduction in neurotransmitters, particularly acetylcholine, leading to weakened transmission of nerve signals.

Symptoms of Alzheimer's disease

Alzheimer's disease is chronic and progressive, meaning that as more parts of the brain are damaged, symptoms become more severe. However, Alzheimer's disease affects individuals differently. It's unlikely you will have every symptom and there is no set time period for the appearance of symptoms.

Early stages

Common symptoms of early-stage Alzheimer's disease include mild forgetfulness or problems finding the right words. Family or friends may notice small changes in your usual behaviour. For example, you may become confused easily, forget people's names or recent events, lose interest in hobbies or have mood swings. You may find it difficult to concentrate or make decisions. These changes are often mild and difficult to pinpoint.

Middle stages

As Alzheimer's disease progresses, your memory loss will get worse and you may have increased trouble with speech. You may find that new surroundings and new people are confusing. You may have trouble recognising previously well-known family and friends. Changes in your usual behaviour will be obvious. For example, you may have episodes of unprovoked aggression or become depressed, although sometimes depression can occur at the beginning of the illness. Everyday tasks such as getting dressed, washing, cooking, shopping and handling money will no longer be as easy. You may find that you lose your sense of time and place.

Late stages

During the late stages of Alzheimer's disease, you're likely to be totally dependent on others for your care. You may have difficulty eating. Walking can become difficult and you may become incontinent. You may not recognise relatives or friends or understand what is happening around you.

The symptoms of Alzheimer's disease can cause a great deal of stress and upset for carers and family who feel they have lost the person they once knew.

Causes of Alzheimer's disease

Doctors don't know exactly why people develop Alzheimer's disease, but it's likely to be caused by a combination of factors.

The main risk factor for developing Alzheimer's disease is age. In the UK, only about one person in 1,000 under 65 develops Alzheimer's disease. This figure rises to around three people in 100 over 65 and from 10 to 15 people per 100 over 80.

About half of people with Alzheimer's disease have parents, brothers or sisters who have it. However, only about one in 20 people with Alzheimer's disease has directly inherited it. There are some inherited risk factors that make you more likely to get Alzheimer's disease, but these don't mean that you will definitely do so. For example, inheritance of certain genes appears to increase the likelihood of developing Alzheimer's disease.

Other factors that make you more likely to develop Alzheimer's disease include previous head injury, a low level of education, high blood pressure and high cholesterol levels. Women are more likely to develop the disease than men.

Various lifestyle and environmental factors have been linked with Alzheimer's disease. Some researchers have suggested that people who keep their brains active, for example by doing crosswords, are less likely to develop the disease. Eating a healthy diet with enough omega-3 fatty acids, which are found in oily fish such as mackerel and salmon, may help to prevent dementia. Staying physically active may also reduce the risk of developing the disease. However, more research is needed in this area.

Diagnosis of Alzheimer's disease

Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history.

There is currently no single practical test for Alzheimer's disease. If your GP suspects you have Alzheimer's disease, he or she will try to confirm some of the symptoms, such as memory loss and difficulty with speech. He or she may do blood tests to help exclude other conditions that might look like Alzheimer's disease.

Your GP will probably refer you to a specialist service involved in the treatment of dementia and its effects. You may be seen by:

a psychiatrist (a doctor who specialises in mental health conditions)
a neurologist (a doctor who specialises in conditions of the nervous system)
a doctor who specialises in care of the elderly
a psychologist (a health professional who specialises in emotional and behavioural problems and who can provide counselling)

Tests may include a series of questions and tests that investigate memory, language and mathematical skills. Other investigations may include a brain scan, typically magnetic resonance imaging (MRI). An MRI scan uses magnets and radiowaves to produce images of the inside of your brain. You may be referred to a 'memory clinic' that specialises in diagnosing conditions like Alzheimer's disease.

Treatment of Alzheimer's disease

Medicines

Medicines called acetylcholinesterase inhibitors are used to help people with moderate Alzheimer's disease. However, they aren't very effective and most people get little benefit from them. They may slow down the progression of symptoms and delay the need for residential care. Your doctor may prescribe one of the three acetylcholinesterase inhibitors available:

donepezil (Aricept)
rivastigmine (Exelon)
galantamine (Reminyl)

Another medicine, memantine (Ebixa), is for people in the late stages of Alzheimer's disease. However, there isn't enough evidence to show that memantine is effective and the National Institute for Health and Clinical Excellence (NICE) recommends that doctors don't prescribe it. Memantine may be available for some people who are taking part in a clinical trial.

Sometimes, antidepressant medicines are prescribed to help treat the depression that can be associated with Alzheimer's disease. Your doctor may prescribe tranquillisers, which can help with the behavioural problems of Alzheimer's disease such as irritability and aggression.

Talking therapies

Your doctor may suggest other treatments, such as:

group activities and discussions – these aim to stimulate your mind (sometimes this is referred to as cognitive stimulation therapy)
reminiscence therapy – this involves discussing past events in groups, usually using photos or familiar objects to jog your memory, although there are conflicting opinions on whether this is effective

Help and support

It's important that carers looking after someone with Alzheimer's disease at home receive plenty of help and support. Respite care, to give carers a break, is an important part of looking after someone with Alzheimer's disease. Contact the Alzheimer's Society or Carers UK (see Further information) for more information about respite care.

Helping to keep someone with Alzheimer's disease safe, such as preventing them from wandering or from having accidents at home, is also important. For help and advice on keeping your loved one safe, contact the Alzheimer's Society (see Further information).

Further information

Alzheimer's Society
0845 300 0336
www.alzheimers.org.uk
Alzheimer Scotland
0808 808 3000
www.alzscot.org.uk
Carers UK
0808 808 7777
www.carersuk.org