Alzheimer's disease

Alzheimer's disease is a degenerative neurological disease that affects memory, emotions, behaviour, and the ability to think and communicate. Learn more about Alzheimer’s and how you or someone you love can cope with it.

What is Alzheimer’s?

Alzheimer's disease is a degenerative neurological disease that causes changes to certain cells of the brain. This leads to the progressive and irreversible deterioration of brain functions like memory, emotions, behaviour, thinking and communicating. Alzheimer's is the main cause of dementia in Canada. It is estimated that over 500,000 Canadians have Alzheimer's disease or a similar neurological disorder.

What causes Alzheimer's?

The exact causes of Alzheimer's disease are still unknown. However, we know that it generally appears in people who have a combination of both modifiable and non-modifiable risk factors.

Modifiable risk factors

The main modifiable risk factors of Alzheimer's include hypertension, diabetes, dyslipidemia, smoking, obesity, depression, cognitive inactivity and physical inactivity.

Non-modifiable risk factors

Family history, aging and certain diseases (e.g., multiple sclerosis, Parkinson's disease, chronic kidney disease, HIV, Down syndrome) are non-modifiable risk factors of Alzheimer's disease. A history of major or repeated head injuries is another risk factor for the disease.

To understand the impact of family history, we need to distinguish between two forms of the disease:

• About 5% of people with Alzheimer’s have the familial form. These people have a specific genetic mutation that is passed down from generation to generation. If one parent has the familial form of the disease, each child has a 50% chance of getting it too.
• The sporadic form of Alzheimer's is by far the most common. This form isn’t hereditary, meaning that it isn't related to specific genetic mutations. However, someone with multiple family members with this form will be more at risk of getting Alzheimer's than someone without any family history of the disease.

How to prevent or stop Alzheimer's

Many factors that increase the risk of Alzheimer's disease can be avoided with a healthy lifestyle.

• Don’t smoke. Smoking increases the risk of Alzheimer's by nearly 50%. Ask your pharmacist or doctor for help to quit smoking.
• Get regular exercise.
• Eat a balanced diet.
• Achieve or maintain a healthy weight.
• Limit your alcohol intake.
• Control your cholesterol and blood pressure. If you have diabetes, control your blood glucose levels as well.
• Avoid head injuries.
• Do mentally stimulating activities.

Does aluminum cause Alzheimer’s?

A lot of research has been done on whether aluminum in our environment (such as the aluminum in pots and pans) increases the risk of Alzheimer's. The results haven't shown a conclusive link between the two.

How is Alzheimer's diagnosed?

Before making a diagnosis of Alzheimer’s disease, a doctor must rule out all other causes of dementia, such as major depression, vascular or neurological diseases, certain medications, or alcohol intake. The doctor will then conduct a full physical and neurological exam and may run additional tests, such as an electroencephalogram (EEG).

How does Alzheimer's disease progress?

Alzheimer’s disease generally progresses slowly but steadily. The disease lasts for 8 to 12 years on average, although this period can range from 3 to 20 years. To better understand how the disease evolves, we can divide it into 3 stages.

Early stage

During the early stage, the person with Alzheimer’s has mild symptoms and is still independent. In this stage, short-term memory is mainly affected. They can remember what they did last year, but not what they ate the day before. They may also have trouble communicating, i.e., problems finding the right word or following a conversation.

People in this stage are generally aware of their condition, which can lead to mood changes, anxiety or depressive symptoms . It’s important not to ignore these emotions and to provide support for the person with Alzheimer's. The family also shouldn’t hide the diagnosis so that the person can participate in decisions about their future care.

Middle stage

During the middle stage, mental and physical abilities continue to deteriorate. Memory loss becomes more severe. People in this stage of Alzheimer's no longer recognize their friends or family. They become more and more confused as they can't orient themselves in time or space. They have behaviour and mood changes, such as mood swings, aggressiveness, agitation, apprehension, disrupted sleep or inappropriate behaviour. They are also at risk of wandering. During this stage, they need help carrying out their daily activities (getting dressed, bathing or going to the bathroom). 

Late stage

In the late stage of Alzheimer’s, people start to lose long-term memory. They have greater difficulty communicating. They will express themselves non-verbally, for example, with looks, crying or moaning. They may lose control of bodily functions (trouble swallowing, incontinence, immobility). They become dependent on a caregiver. Death most often occurs from complications of the disease, which can include pneumonia or infection from bed sores.

Alzheimer's treatment

Currently, no treatment can cure Alzheimer's disease. Treatments that do exist aim to slow the progression of the disease. This helps people with Alzheimer’s maintain functional and mental abilities for a longer period, which keeps them independent longer and delays the need for constant care. Without treatment, their health condition will deteriorate more quickly. They should therefore start treatment as soon as possible.

Treatment combines a healthy lifestyle with medication.

• Cholinesterase inhibitors are used to treat mild to moderate symptoms. In Canada, there are three drugs in this class: Exelon^TM, Reminyl^TM ER  and Aricept^TM. Aricept can also be used for advanced symptoms
• NMDA receptor antagonists (Ebixa^TM) are used to treat people with moderate to advanced symptoms.
• Other medications can be prescribed to control problems such as mood disorders, agitation and aggressive behaviour.

How to cope with Alzheimer's disease

Lifestyle changes can make a big difference to help people with Alzheimer's stay independent for as long as possible. Here are some coping tips if you are a family caregiver or if you have the disease.

• Establish a routine. Make sure the person gets up, gets ready, gets dressed, and eats at fixed hours to help them stay oriented in time. Help the person keep track of time with calendars, clocks and newspapers.
• Encourage them to choose their own clothes. If it gets too difficult for them to button shirts or tie shoe laces, clothing and footwear with self-gripping fasteners (Velcro^TM) can make this easier.
• Use night lights to make it easier to get around at night.
• Make your environment safe.
• Lock the doors so that the person can't leave the house and get lost. Register with Safely Home^TM, a program established by MedicAlert^TM in collaboration with the Alzheimer Society of Canada to improve the safety of people with Alzheimer's disease or a similar illness. For more information, visit medicalert.ca.
• If you’re a family caregiver, don’t forget to take care of yourself too. Supporting someone with Alzheimer's can be physically and emotionally draining. Memory problems, impaired judgment and wandering require increased supervision. Repetitive behaviour, disturbed nights, and possible aggressive behaviour can quickly exhaust the person's family. You need to know your limits and ask for help when you need it. With other family members or friends, try to come up with a weekly schedule so that everyone can give a few hours of their time.

Although no treatment can cure Alzheimer’s disease, scientific research continues to make progress. Don’t hesitate to consult your pharmacist to find out about new treatment advances and learn how to better live with Alzheimer’s on a daily basis.

Resource:
Alzheimer Society of Canada