Alzheimer's Disease

The first thing many of us think of when we start to forget things as we get older is that we have Alzheimer's disease. More people seem to be affected nowadays by this well-known form of dementia because our population is aging. Fortunately, Alzheimer's is less common than some people think; it is not a normal function of aging. Only 1 in 13 Canadians over 65 have the disease, although the proportion does change with the years until it reaches nearly 1 in 2 people over the age of 85.

Memory loss or Alzheimer's?

A certain amount of memory loss is normal as we age, especially from what's called our "recent memory" banks, which include, for example, what we watched on television the night before. Aging, however, does not normally affect short-term memory (as in the name of the person we met moments ago) or remote memory (as in childhood memories). So while it may be frustrating when you can't recall a word you know, this kind of memory lapse is not usually serious.

If you feel that your lapses of memory are causing you difficulties in your day-to-day living - and particularly if you feel the lapses are getting more frequent over time - consult your family doctor. Forgetting where you put your car keys is irritating, but discovering that you put the keys in the sugar bowl is disturbing - and may indicate a more serious problem.

There are many reasons why someone might experience memory problems besides Alzheimer's. Alcoholism, depression, medication side effects, and strokes are just a few things that can lead to forgetfulness. Your doctor will be able to help you find the cause of your memory problems.

Symptoms of Alzheimer's

Alzheimer's is a fatal, degenerative disorder characterized by changes in the structure and chemistry of the brain. The appearance of protein plaques between the nerve cells in the brain tissue is modified. Symptoms of the disease advance in stages, moving from mild memory loss to a deterioration in intellectual and thinking abilities (cognitive function) to abnormal changes in personality and behaviour.

The progression of Alzheimer's varies from person to person and the time course ranges from 5 to 20 years. In general, a person in the early days of Alzheimer's experiences problems carrying out simple mathematical routines, such as those involving money, or following recipes, even familiar ones. The person may exhibit speech problems, choosing the wrong words, for instance, or not understanding simple sentences. Later, the person may get easily disoriented or confused; anxiety may make the person restless and sleepless at night. Delusions of sight, sound, or smell may appear from time to time. Although at first the person may only have trouble with recent memory, as the disease progresses the ability to remember anything is destroyed. He or she will be unable to speak or move, so that even the notion of self-care will be lost. People with Alzheimer's generally die of some kind of infection.

Causes

Although our understanding of Alzheimer's has increased in leaps and bounds recently, we still don't know what causes this disease or how to stop its progression. While researchers see a connection between family history and the disease, the link to heredity is not completely clear. They are also exploring the possibility that the cause may be located in our environment - perhaps something in the water, soil, or air. Other possibilities include that the disease is caused by something in the body, perhaps a slow virus, an imbalance of chemicals, or a problem with the immune system. Most likely, there is no one cause of Alzheimer's, but rather a combination of factors conspiring together.

Risk factors

The primary risk factor for Alzheimer's appears to be age; most people who develop the disease do so after the age of 65. There is, however, a form of Alzheimer's that appears around the age of 40. Other risk factors include family history, education, previous head injury, diabetes, and Down's syndrome.

Diagnosis

There is no one test to diagnose Alzheimer's, so doctors cannot make a definite diagnosis until they examine the affected brain tissue after death. In the meantime, however, doctors are able to come up with a "probable" diagnosis by ruling out other possibilities for the decline in brain function. They do this by performing memory and cognitive tests, carrying out blood work, and performing brain scans.

Treatment

Alzheimer's has no cure yet. For now, the goal is to help the affected person maintain his or her mental and physical function as much and as long as possible. This can often be done by controlling other conditions such as heart disease or depression, following a healthy diet, exercising regularly, and keeping mentally active.

Various medications are being explored in the treatment of the disease. Some medications (i.e., Aricept™, Exelon™, Reminyl™) are believed to slow memory loss in the early stages of the disease. Others are used to reduce anxiety, agitation, and depression. While these drugs may help with some of the symptoms, they are not a cure because they do not stop the underlying progression of the disease. If you or a family member have been prescribed a medication to treat Alzheimer's, do not hesitate to discuss the potential effects - and side effects - with your pharmacist.

Living with Alzheimer's

If you or someone you love is diagnosed with Alzheimer's, keep in mind that you are not alone. There are people in your community who can help not only in the management of the disease but also in providing support for the caregivers. Alzheimer's is a family disease; everyone connected with it suffers to a greater or lesser degree.

The person with Alzheimer's should be encouraged to participate in making the decisions about eventual care when independence is lost. He or she should not delay making a living will or assigning power of attorney for medical and financial matters. Most importantly, family and friends need to assuage any fears of abandonment or embarrassment that the affected person harbours.

For more information:

• Alzheimer Society Canada