This article is about
Alzheimer's disease and other types of dementia. It presents information for patients,
family members, and other caregivers. It talks about the effects Alzheimer's disease can
have on you, your family members, and your friends. This article describes the early signs
and symptoms of Alzheimer's disease. This article is not about treating Alzheimer's
disease, nor should it be construed as medical advice. Consult your physician or other
medical professional immediately if you suspect that you or a loved one has Alzheimer's
Terms You Need to Know
Dementia is a medical condition that interferes with the way the brain works.
Symptoms include anxiety, paranoia, personality changes, lack of initiative, and
difficulty acquiring new skills. Besides Alzheimer's disease, some other types or causes
of dementia include: alcoholic dementia, depression, delirium, HIV/AIDS-related dementia,
Huntington's disease (a disorder of the nervous system), inflammatory disease (for
example, syphilis), vascular dementia (blood vessel disease in the brain), tumors and
Alzheimer's disease is the most common form of dementia. It proceeds in stages
over months or years and gradually destroys memory, reason, judgment, language and
eventually the ability to carry out even simple tasks.
Delirium is a state of temporary but acute mental confusion that comes on
suddenly. Symptoms may include anxiety, disorientation, tremors, hallucinations,
delusions, and incoherence. Delirium can occur in older persons who have short-term
illnesses, heart or lung disease, long-term infections, poor nutrition, or hormone
disorders. Alcohol or drugs (including medications) also may cause confusion. Delirium
may be life-threatening and requires immediate medical attention.
Depression can occur in older persons, especially those with physical problems.
Symptoms include sadness, inactivity, difficulty thinking and concentrating, and feelings
of despair. Depressed persons often have trouble sleeping, changes in appetite, fatigue,
and agitation. Depression usually can be treated successfully.
What Is Alzheimer's Disease?
In Alzheimer's disease and other dementias, problems with memory, judgment, and thought
processes make it hard for a person to work and take part in day-to-day family and social
life. Changes in mood and personality also may occur. These changes can result in loss of
self-control and other problems. Some 2 to 4 million persons have dementia associated with
aging. Of these individuals, as many as two-thirds have Alzheimer's disease.
Although there is no cure for Alzheimer's disease at this time, it may be possible to
relieve some of the symptoms, such as wandering and incontinence. The earlier the
diagnosis, the more likely your symptoms will respond to treatment. Talk to your doctor as
soon as possible if you think you or a family member may have signs of Alzheimer's
disease. Research is under way to find better ways to treat Alzheimer's disease. Ask your
doctor if there are any new developments that might help you.
Who Is Affected?
The chances of getting Alzheimer's Disease increase with age. It usually occurs after
age 65. Most people are not affected even at advanced ages. There are only two definite
factors that increase the risk for Alzheimer's Disease: a family history of dementia and
Family History of Dementia: Some forms of Alzheimer's Disease are
inherited. If Alzheimer's Disease has occurred in your family members, other members are
more likely to develop it. Discuss and family history of dementia with your family doctor.
Down Syndrome: Persons with Down syndrome have a higher chance of
getting Alzheimer's Disease. Close relatives of persons with Down syndrome also may be at
What Are the Signs of Alzheimer's Disease?
The classic sign of early Alzheimer's Disease is gradual loss of short-term memory.
Other signs include:
- Problems finding or speaking the right word.
- Inability to recognize objects.
- Forgetting how to use simple, ordinary things, such as a pencil.
- Forgetting to turn off the stove, close windows, or lock doors.
Mood and personality changes also may occur. Agitation, problems with memory, and poor
judgment may cause unusual behavior. These symptoms vary from one person to the next.
Symptoms appear gradually in persons with Alzheimer's disease but may progress more
slowly in some persons than in others. In other forms of dementia, symptoms may appear
suddenly or may come and go.
If you have some of these signs, this does not mean you have Alzheimer's disease.
Anyone can have a lapse of memory or show poor judgment now and then. When such lapses
become frequent or dangerous, however, you should tell your doctor about them immediately.
Possible Signs of Alzheimer's Disease
Do you or your elder have problems with any of these activities:
- Learning and remembering new information. Do you repeat things that you say or do?
Forget conversations or appointments? Forget where you put things?
- Handling complex tasks. Do you have trouble performing tasks that require many steps
such as balancing a checkbook or cooking a meal?
- Reasoning ability. Do you have trouble solving everyday problems at work or home, such
as knowing what to do if the bathroom is flooded?
- Spatial ability and orientation. Do you have trouble driving or finding your way around
- Language. Do you have trouble finding the words to express what you want to say?
- Behavior. Do you have trouble paying attention? Are you more irritable or less trusting
Remember, everyone has occasional memory lapses. Just because you can't recall
where you put the car keys doesn't mean you have Alzheimer's disease.
Consulting the Doctor
Identifying mild cases of Alzheimer's disease can be very difficult. Your doctor will
review your health and mental status, both past and present. Changes from your previous,
usual mental and physical functioning are especially important. Persons with Alzheimer's
disease may not realize the severity of their condition. Your doctor will probably want to
talk with family members or a close friend about their impressions of your condition. The
doctors first assessment for Alzheimer's disease should include a focused history, a
physical examination, a functional status assessment, and a mental status assessment.
Medical and Family History: Questions your doctor may ask in taking
your history include: How and when did problems begin? Have the symptoms progressed in
steps or worsened steadily? Do they vary from day to day? How long have they lasted? Your
doctor will ask about past and current medical problems and whether other family members
have had Alzheimer's disease or another form of dementia.
Education and other cultural factors can make a difference in how you will do on mental
ability tests. Language problems (for example, difficulty speaking English) can cause
misunderstanding. Be sure to tell the doctor about any language problems that could affect
your test results.
It is important to tell the doctor about all the drugs you take and how long you have
been taking them. Drug reactions can cause dementia. Bring all medication bottles and
pills to the appointment with your doctor.
Do you take any medications? Even over-the-counter drugs, eye drops, and alcohol can
cause a decline in mental ability. Tell your doctor about all the drugs you take. Ask if
the drugs are safe when taken together.
Physical Examination: A physical examination can determine whether
medical problems may be causing symptoms of dementia. This is important because prompt
treatment may relieve some symptoms.
Functional Status Assessment: The doctor may ask you questions about
your ability to live alone. Sometimes, a family memberor close friend may be asked how
well you can do activities like these:
- Write checks, pay bills, or balance a checkbook.
- Shop alone for clothing, food, and household needs.
- Play a game of skill or work on a hobby.
- Heat water, make coffee, and turn off stove.
- Pay attention to, understand, and discuss a TV show, book, or magazine.
- Remember appointments, family occasions, holidays, and medications.
- Travel out of the neighborhood, drive, or use public transportation.
Sometimes a family member or friend is not available to answer such questions. Then,
the doctor may ask you to perform a series of tasks ("performance testing").
Mental Status Assessment: Several other tests may be used to assess
your mental status. These tests usually have only a few simple questions. They test mental
functioning, including orientation, attention, memory and language skills. Age,
educational level and cultural influences may affect how you perform on mental status
tests. Your doctor will consider these factors in interpreting test results.
Alzheimer's disease affects two major types of abilities:
- The ability to carry out everyday activities such as bathing, dressing, using the
toilet, eating and walking.
- The ability to perform more complex tasks such as using the telephone, managing
finances, driving a car, planning meals and working in a job.
When a person has Alzheimer's disease, problems with complex tasks appear first and
over time progress to more simple activities.
Treatable Causes of Dementia
Sometimes the physical examination reveals a condition that can be treated. Symptoms
may respond to early treatment when they are caused by:
- Medication (including over-the-counter drugs).
- Problems with the heart, lungs, or blood vessels.
- Metabolic disorders (such as thyroid problems).
- Head injury.
- Vision or hearing problems.
Drug reactions are the most common cause of treatable symptoms. Older
persons may have reactions when they take certain medications. Some medications should not
be taken together. Sometimes, adjusting the dose can improve symptoms.
Delirium and depression may be mistaken for or occur with Alzheimer's
disease. These conditions require prompt treatment. See the inside front cover of this
booklet for more information on delirium and depression.
Gathering as much information as possible will help your doctor diagnose early
Alzheimer's disease while the condition is mild. You may be referred to other specialists
for further testing. Some special tests can show a persons mental strengths and weaknesses
and detect differences between mild, moderate, and severe impairment. Tests also can tell
the difference between changes due to normal aging and those caused by Alzheimer's
If you go to a special doctor for these tests, he or she should return all test results
to your regular family doctor. The results will help your doctor track the progress of
your condition, prescribe treatment, and monitor treatment effects.
Getting the Right Care
When the diagnosis is Alzheimer's disease, you and your family members have serious
issues to consider. Talk with your doctor about what to expect in the near future and
later on, as your condition progresses. Getting help early will help ensure that you get
the care that is best for you.
When tests do not indicate Alzheimer's disease, but your symptoms continue or worsen,
check back with your doctor. More tests may be needed. If you still have concerns, even
though your doctor says you do not have Alzheimer's disease, you may want to get a second
Whatever the diagnosis, followup is important
Report any changes in your symptoms. Ask the doctor what followup is right for you.
Your doctor should keep the results of the first round of tests for later use. After
treatment of other health problems, new tests may show a change in your condition.
Recognizing Alzheimer's disease in its early stages, when treatment may relieve mild
symptoms, gives you time to adjust. During this time, you and your family can make
financial, legal, and medical plans for the future.
Your health care team may include your family doctor and medical specialists such as
psychiatrists or neurologists, psychologists, therapists, nurses, social workers, and
counselors. They can work together to help you understand your condition, suggest memory
aids, and tell you and your family about ways you can stay independent as long as
Talk with your doctors about activities that could be dangerous for you or others, such
as driving or cooking. Explore different ways to do things.
Telling Family and Friends
Ask your doctor for help in telling people who need to know that you have Alzheimer's
Disease members of your family, friends, and coworkers, for example.
Alzheimer's Disease is stressful for you and your family. You and your caregiver
will need support from others. Working together eases the stress on everyone.
Where To Get Help?
Learning that you have Alzheimer's Disease can be very hard to deal with. It is
important to share your feelings with family and friends. Many kinds of help are available
for persons with Alzheimer's Disease, their families, and caregivers.
These resources include:
- Support groups. Sometimes it helps to talk things over with other people and
families who are coping with Alzheimer's Disease. Families and friends of people with
Alzheimer's Disease have formed support groups. The Alzheimer's Association has active
groups across the country. Many hospitals also sponsor education programs and support
groups to help patients and families.
- Financial and medical planning. Time to plan can be a major benefit of identifying
Alzheimer's Disease early. You and your family will need to decide where you will live and
who will provide help and care when you need them.
- Legal matters. It is also important to think about certain legal matters. An
attorney can give you legal advice and help you and your family make plans for the future.
A special document called an advance directive lets others know what you would like them
to do if you become unable to think clearly or speak for yourself.