Alzheimer's disease

What is Alzheimer's disease?

Alzheimer's disease is the most common cause of dementia. Dementia is progressive and affects many brain functions, including memory.

The exact cause of Alzheimer's disease is not yet known. However it is known that there is a gradual process of damage to part of the brain called the cerebral cortex. This is called cortical atrophy, which means destruction of the cells of the cerebral cortex so that the brain cells can't function properly.

The damage to the cerebral cortex of the brain probably begins at least ten years before any symptoms develop.

The following can increase the risk of developing Alzheimer's disease:

• Increasing age.

• White skin.

• There is a small increased risk if a first-degree family member (father, mother, brother or sister) is affected.

• Moderate alcohol consumption (less than 14 units per week) may protect against dementia, but drinking more than 14 units per week is associated with an increased risk of developing Alzheimer's disease.

• People who have experienced a serious head injury.

• Lifestyle factors that also increase the risk of cardiovascular disease and cerebrovascular disease - for example, smoking, lack of physical exercise, and an unhealthy diet.

• Parkinson's disease.

• People with Down's syndrome.

Alzheimer's disease is a progressive condition, which means the symptoms gradually become more severe over the course of several years. It affects different functions of the brain, and people with Alzheimer's disease can suffer from the following:

• Memory problems. Recent events are usually forgotten first. Past events are usually remembered well until the dementia becomes severe.

• Language problems, such as difficulty understanding what is said or what is written down.

• Problems with attention and concentration.

• Disorientation, particularly in unfamiliar surroundings. Losing track of time.

• Difficulty with learning new skills.

• Psychological problems such as anxiety and depression.

• Changes in mood, behaviour and personality.

• Agitation and difficult and challenging behaviour, causing sleep problems, restlessness and aggression.

• Problems carrying out usual day-to-day activities and problem solving.

Alzheimer's disease can cause problems with swallowing and difficulty with eating. This can cause food to go down to the lungs when eating (aspiration), which can cause frequent chest infections, including aspiration pneumonia.

As Alzheimer's disease progresses, the symptoms become increasingly severe. Alzheimer's disease usually progresses slowly over a period of 7-10 years but the rate of progression varies from person to person.

See the separate leaflet called Memory loss and dementia for more information.

Some people living with dementia and Alzheimer's disease may no longer be able to drive. If you are in the UK, you should inform the DVLA if you have been diagnosed with Alzheimer's disease and they may ask your doctor to provide a report. See under Further Reading and References, below.

As the symptoms progress slowly, it can be difficult to realise that there's a problem. In the early stages of the disease the symptoms are often dismissed as a sign of ageing. However, early diagnosis of Alzheimer's disease is very important in order that you can plan for the future and receive the best treatment and support that can be offered.

There's no single test that can be used to diagnose Alzheimer's disease.

• There are various tests that can be used to assess how well your brain is working.

• Usually blood tests are also arranged to check whether your symptoms may be caused by a different condition, such as hypothyroidism or vitamin B12 deficiency.

• If Alzheimer's disease is suspected, you may be referred to a specialist memory clinic for further assessment. Magnetic resonance imaging (MRI) scans are used to rule out any other conditions that could affect the brain.

In the UK, the National Institute for Health and Care Excellence (NICE) advises perfusion hexamethylpropyleneamine oxime (HMPAO) single-photon emission computerised tomography (SPECT) to see whether the diagnosis is Alzheimer's disease or any other cause of dementia.

There's no cure for Alzheimer's disease; however, medication is available that can help relieve some of the symptoms and slow down the progression of the condition in some people. The treatment and support that can be provided include:

• Support from social services, including carers and respite care.

• Help with legal issues such as Power of Attorney and a Living Will.

• Changes to your home environment to make it easier to deal with day-to-day activities..

• Overcoming difficulties with memory, such as reminder notes, lists and reorganising possessions.

• Cognitive behavioural therapy (CBT) to help with depression or anxiety.

• Other ways to help with anxiety, depression and difficulties with behaviour include aromatherapy, music and dance, using animals as therapy, massage and exercise.

• Medicines used for Alzheimer's disease include acetylcholinesterase (AChE) inhibitors (donepezil, galantamine or rivastigmine) or memantine.

See the separate leaflet called Medication and treatment for dementia.

Early-onset Alzheimer's disease

Most people who develop Alzheimer's disease are more than 65 years old. However, it can affect younger people - when this occurs, it is called early-onset Alzheimer's disease.

Can Alzheimer's disease be cured?

There is no cure for Alzheimer's disease and the difficulties gradually become increasingly severe. This can cause a great deal of distress for both the person with Alzheimer's disease and for their family.

On average, people with Alzheimer's disease live for around 8 to 10 years after they start to develop symptoms but this is very variable from person to person.

Can Alzheimer's disease be prevented?

As the exact cause of Alzheimer's disease isn't clear, there's no known way to prevent the condition. However, there are things you can do that may reduce your risk or delay the onset of dementia, such as:

• Stopping smoking.

• Keeping to a moderate intake of alcohol.

• Eating a healthy, balanced diet and maintaining a healthy weight.

• Staying physically active and mentally active.

How common is Alzheimer's disease?

Alzheimer's disease is the most common type of dementia. Dementia affects about 850,000 people in the UK. It becomes more common with increasing age. About 1 in 50 people aged 65 to 69 years, and 1 in 5 people aged 85-89 years has dementia.