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Alzheimer’s Disease
Student Health Information Page compiled by: Christina Small

Introduction

According to the Alzheimer’s Association, Alzheimer’s is “a type of dementia that causes problems with memory, thinking, and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks” (“Alzheimer’s Association”, 2014). A healthy brain has 100 billion neurons in it that connect through channels called synapses. In an Alzheimer’s disease patient, these synapses begin to fail and neurons die. This causes neurological changes in the brain that will affect behaviors and cognitive function (“Alzheimer’s Association”, 2014). Alzheimer’s can significantly affect a person’s life and that of their family. There is no cure for Alzheimer’s and the disease is progressive, or gets worse over time, and is ultimately fatal.

According to the Centers for Disease Control and Prevention (CDC), 5 million people in America have Alzheimer’s disease. Although the CDC notes that it is not just part of aging, around half of elderly adults over 85 have it. Around 5 percent of adults between 65 and 85 have Alzheimer’s (“Alzheimer's Disease”, 2011).

The cause of Alzheimer’s disease is still very much unknown to clinicians around the world. Healthcare practitioners hypothesize that there is a genetic component to the disease (“Alzheimer's Disease”, 2011). Additionally, age is a significant risk factor in getting Alzheimer’s, as this risk increases two fold every five years starting at age 65 (“Alzheimer's Disease”, 2011).

According to the CDC, Alzheimer’s is one of the top ten leading causes of death in the United States and the 6th leading cause for America adults, 5th for adults over 65 years old. Over 5.4 million people in the United States have Alzheimer’s (“Alzheimer's Disease”, 2011). This is twice as many from the 1980’s and is expected to be 16 million by 2050 (Herbert et al., 2003). The increase in elderly adults is the main cause for this significant increase of the prevalence of Alzheimer’s in the future. It has also been estimated that in persons over 60 years old, 11.2 percent of years lived with disability occur because of dementia (Qiu et al., 2009).

Symptoms

Alzheimer’s main symptom is dementia. This is a rapidly progressing disease, which means it gets worse over time. The first noticeable sign of Alzheimer’s is loss of memory. This can be hard to recognize as it can also happen with normal aging. According to the Alzheimer’s Association, there are 10 signs to look for to determine Alzheimer’s disease.
  1. Loss of memory. This would look like significant changes in memory that would affect everyday activities. The Alzheimer’s Association denotes that this is not a normal side effect of aging, as this memory loss would be significant and would require the use of memory aids or family members (“Alzheimer’s Association”, 2014).
  2. The second sign is difficulty with problem solving. This would disrupt normal day-to-day activities such as balancing a checkbook (“Alzheimer’s Association”, 2014).
  3. The third symptom is trouble with everyday activities, whether that is at work or at home. This could involve having trouble playing a familiar or favorite game (“Alzheimer’s Association”, 2014).
  4. Confusion with time and place. Alzheimer’s patients may forget where they are, what they were doing, and what date and time it is. As the disease progresses this may become more severe.
  5. Trouble understanding visual images and spatial relationships. Alzheimer’s patients may have a hard time reading books and deciphering pictures. This may cause driving impairments.
  6. New problems with words in speaking or writing. Alzheimer’s patients may have trouble keeping up with a conversation. He or she may stop in the middle, not be able to find the right word to say, or say the wrong word.
  7. Misplacing things and not being able to replace steps. People with dementia may have a problem finding items around the house.
  8. Decreased and poor judgment. People with Alzheimer’s may exhibit bad judgment. Adults with dementia are three times more likely to end up hospitalized for a preventable injury (“Alzheimer’s Association”, 2014).
  9. Withdrawal from work or social activities. Patients with dementia may not understand what is happening so they may withdrawal from people they once were comfortable around.
  10. Changes in mood and personality. Alzheimer’s patients can develop many emotions that they were not shown before. The Alzheimer’s Association specifically notes feelings of confusion, suspicion, depression, and anxiety.

Stages of Alzheimer’s

There are seven stages according to the Alzheimer’s Association. Barry Reisberg, M.D. from New York University School of Medicine’s Silberstein Aging and Dementia Research Center, developed these (“Alzheimer’s Association”, 2014).
  1. Stage one is where there is no impairment.
  2. Stage two looks like normal age-related changes, such as some minor memory loss like forgetting the names of objects or people.
  3. Stage 3 is mild cognitive decline, where people around the patient will notice some signs of Alzheimer’s and sometimes this stage is diagnosed. These symptoms include problems coming up with a familiar name, forgetting easy things, misplacing items, having trouble planning and organizing.
  4. Stage four signifies moderate cognitive decline, which can be diagnosed with a psychological exam. These symptoms are easily recognizable through examination, such as issues with problem solving, recent memory loss, moodiness or depression, forgetting personal history, and difficulty in everyday activity.
  5. Stage five depicts severe cognitive decline or mid-stage Alzheimer’s disease. At this stage the patient would have significant difficulty with everyday tasks and greater memory loss. There may be significant personal history details lost and the patient may often become confused as to where they are and why they are there.
  6. Stage 6 is severe cognitive decline where memory is getting worse, personality changes may occur, and patients require significant assistance with everyday tasks.
  7. Stage seven is very severe cognitive decline, or late-stage Alzheimer’s disease. These patients can no longer respond to the world around them. Alzheimer’s patients in late-stage need help eating, using the restroom, and even sitting up (“Alzheimer’s Association”, 2014).

Early vs. Late Onset Alzheimer’s

Early onset, otherwise known as younger onset Alzheimer’s disease refers to anyone with a diagnosis younger than 65 years. This does not refer to the stage of the disease. Younger onset disease has no known cause and diagnosis usually occurs between ages 40-59. The Alzheimer’s Association estimates that there are 200,000 people with early onset Alzheimer’s (“Alzheimer’s Association”, 2014).   

Late onset Alzheimer’s disease accounts for the majority of cases and refers to anyone with a diagnosis older than 65 years.

Risk Factors

There are several risk factors associated with Alzheimer’s disease although the cause has not yet officially been identified. As said above, age is the most important factor of Alzheimer’s. Additionally noted is heredity. A patient who has an immediate family member with Alzheimer’s is more likely to be diagnosed with it themselves. There are a few genes that the Alzheimer’s association has pinpointed as potentially linked to Alzheimer’s, but not everyone has one easily identifiable gene. Scientists have found three genes that are linked to early-onset Alzheimer’s and four genes linked to late-onset Alzheimer’s (“Dementias, Including Alzheimer's Disease”, 2014).

There are two overarching types of genes that affect Alzheimer’s. The first is risk genes, which increase the risk of the disease without guaranteeing diagnosis. One of these genes is APOE-e4, which is suspected to be involved in 20-25 percent of Alzheimer’s patients (“Alzheimer’s Association”, 2014). Everyone receives two APOE genes from a parent, but it is the e4 gene that is specifically related to Alzheimer’s diagnosis. The second type of gene associated with Alzheimer’s is deterministic. Anyone with a deterministic gene will have Alzheimer’s eventually. Variations of the genes coding three proteins are viewed as these deterministic genes (“Alzheimer’s Association”, 2014). This type of diagnosis is referred to as “autosomal dominant Alzheimer’s disease (ADA)” or “familial Alzheimer’s disease” and is early-onset Alzheimer’s disease. These deterministic genes are prevalent in less than 5 percent of cases.

There are a few risk factors that are more environmental in nature. One link that scientists have found is between head trauma and Alzheimer’s disease. Heavy drinking causes a condition called “alcoholic dementia”. An alcoholic would have an increased chance of developing Alzheimer’s (Qiu et al., 2009). There is additional connection between heart disease and Alzheimer’s. High blood pressure, heart disease, stroke, diabetes, and high cholesterol can all be risk factors for developing Alzheimer’s disease (“Alzheimer’s Association”, 2014). There has also been research on diet in regards to Alzheimer’s. According to Qiu et al., a “Mediterranean diet” was correlated with a reduced risk of Alzheimer’s disease (2014). There is also evidence to suggest that psychosocial factors may help reduce the risk of Alzheimer’s disease. According to Qiu et al., these factors include “early life high educational attainment, adult-life high work complexity, late-life rich social network and high levels of social engagement, and more frequently participating in physically and mentally stimulating activity” (2014).

Unfortunately there is no cure for Alzheimer’s (“Alzheimer’s Association”, 2014). There are treatments for the symptoms such as sleep, behavior, and memory loss. Unfortunately, these treatments will only work so much and ultimately the disease will potentially progress rapidly. Alzheimer’s disease can progress and worsen in anywhere between four and ten plus years (“Alzheimer’s Association”, 2014). There are other factors that have been hypothesized, but confirmation on any one single risk factor has yet to be determined. There is still much unknown about the cause of Alzheimer’s disease and other forms of dementia.

Statistics

The Alzheimer’s Association published a 2014 Alzheimer’s disease facts and figures report on this disease. These statistics came from a Chicago Health and Aging Project, which was a population-based study of chronic disease in the elderly (“Alzheimer’s Association”, 2014). According to the Alzheimer’s Association, 1 in 9 older Americans has Alzheimer’s. As the population in the United States ages, the number of people diagnosed with Alzheimer’s will rise as well (2014). Prevalence of a disease signifies how many cases of Alzheimer’s there are today. Over 5.2 million Americans of all ages have Alzheimer’s disease in 2014. Five million of these people are 65 and older (“Alzheimer’s Association”, 2014). There is a difference in prevalence of dementia between men and women. Of the 5 million 65+ Americans, 3.2 million are women and 1.8 million are men. This may be explained because women live longer than men and age is a significant risk factor in Alzheimer’s disease.

There are also differences in prevalence for White, African-America, and Hispanic races. African- Americans are two times as likely to have Alzheimer’s than Whites, and Hispanics are 1.5 times more likely to have Alzheimer’s than whites (“Alzheimer’s Association”, 2014). It is believed that this is because of a higher prevalence of risk factors associated with Alzheimer’s in Hispanic and African-American people. Higher blood pressure, diabetes, and other health conditions are more prevalent in non-white races. In addition, lower levels of education are correlated with an increased risk for Alzheimer’s and other forms of dementia (“Alzheimer’s Association”, 2014).

Incidence is different than prevalence as incidence describes the amount of new cases of Alzheimer’s each year. According to the Alzheimer’s Association, 469,000 people age 65 or older will be diagnosed in 2014 (2014). Every 67 seconds Alzheimer’s is diagnosed and by 2050, this will increase to every 33 seconds (“Alzheimer’s Association”, 2014). By 2050, the Alzheimer’s Association has predicted that there will be 13.8 million cases of Alzheimer’s. This prediction may change of course if a cure has been found by then (“Alzheimer’s Association”, 2014). There is a pretty significant prediction of increase in prevalence of Alzheimer’s as the population in the United States grows (“Alzheimer’s Association”, 2014).

Alzheimer’s often goes undetected because it is not part of a routine checkup. This undiagnosed Alzheimer’s happens more often among populations that consist of rural or minority people.

Healthy People 2020

Healthy People 2020 have created several steps to improve the care of persons with dementia including those with Alzheimer’s. These are taken directly from the 2020 website and listed below:
  • Increasing the availability of existing effective diagnostic tools.
  • Decreasing the number of people with undiagnosed dementia.
  • Reducing the severity of symptoms through better medical management.
  • Supporting family caregivers with social, behavioral, and legal resources.
  • Encouraging healthy behaviors to reduce the risk of co-occurring conditions.
    (“Dementias, Including Alzheimer's Disease”, 2014)

The two main objectives for intervention are DIA-1 (Developmental), “Increase the proportion of persons with diagnosed Alzheimer’s disease and other dementias, or their caregiver, who are aware of the diagnosis” and DIA-2 (Developmental), “Reduce the proportion of preventable hospitalizations in persons with diagnosed Alzheimer’s disease and other dementias” (“Dementias, Including Alzheimer's Disease”, 2014). These are two new objectives, thus the interventions have not been laid out in detail yet. I think that these objectives are feasible interventions for Alzheimer’s disease. The first objective would be completed through better Alzheimer’s screening. This could be implemented through hospital protocols. There could also be an educational campaign used to describe the symptoms to look for in people with an Alzheimer’s diagnosis. The second objective could be implemented through family therapy and better social support. Education for family members is important so that they know what signs to look for and also how to help prevent accidents. In addition, labeling, cognitive therapy and memory aids around the house could help prevent these unforeseeable accidents.

One of the most difficult aspects about Alzheimer’s is the fact that there is no viable cure, which makes interventions for the future difficult. Primary interventions are not as easy to target for dementia and Alzheimer’s because the causes are unknown. The primary intervention is put into effect in order to prevent the onset as one enters later adulthood. This is especially important in regards to both head traumas and heart disease. If young adults can avoid any traumatic head injuries and stay heart healthy, they will have decreased risk to be diagnosed with Alzheimer’s

There are many researchers all over the country who are continuing to study Alzheimer’s disease. There are important advancements to be made in all aspects of Alzheimer’s since there is so much unknown about the disease. Healthy People 2020 recognizes that medical advancements through research are needed to improve diagnostic procedures, better ways to prevent Alzheimer’s altogether, pinpoint the cause of Alzheimer’s and associated risk factors, and determine better treatment options for someone already diagnosed with Alzheimer’s (“Dementias, Including Alzheimer's Disease”, 2014).

Prevention

There are improvements to be made in all types of primary prevention methods. Primary prevention methods would help stop people from being diagnosed with Alzheimer’s. Finding out risk factors and specific causes of the disease or coming up with an effective vaccine would be important in this regard. Staying heart healthy, avoiding brain trauma, and eating “brain food” have all been suggested to reduce the risk of Alzheimer’s. In addition, maintaining an active social lifestyle, complete with stimulating cognitive activities, would presumably reduce the risk of Alzheimer’s disease. Qui et al. mentions a life-course approach for prevention, which takes into account biological, environmental, and psychosocial factors. This model speaks of “time windows” at exposure, which may help to explain latent Alzheimer’s periods (Qiu et al., 2009). If primary preventions were to work, healthcare practitioners would be able to see a decrease incidence of Alzheimer’s.

Secondary prevention methods would help diagnose and treat symptoms of Alzheimer’s early on after the diagnosis. Genetic testing can be done, however there are conflicting viewpoints on whether this is productive. Since no treatments exist to stop the onset or progression of Alzheimer’s, genetic testing does not impact treatment whatsoever (Qiu et al., 2009). There is the benefit of knowing and understanding what will happen, however there will still be no way to stop the onset of the disease. There is additional research being done on an Alzheimer’s biomarker test to diagnose the disease, however this has yet to be officially implemented.

Tertiary prevention methods would treat all of the other symptoms that are related to Alzheimer’s including memory loss, speaking skills, problem solving skills, etc. Cognitive training is a tertiary prevention method that may help maintain cognitive function. There are medications to treat dementia, which include cholinesterase inhibitors (Qiu et al., 2009). According to the Alzheimer’s Association there are five FDA-approved Alzheimer’s drugs that work to treat the symptoms of the disease, but none currently that impact its progression. There is research currently being done to target the process of the disease itself (“Alzheimer’s Association, 2014). These are also used to help maintain cognitive health. Tertiary prevention methods would also help with the 2020 objective to reduce the amount of hospitalizations because of accidents. If these interventions worked, healthcare practitioners would see a decrease in Alzheimer patient accident hospitalizations. There is still much research being done to discover better preventative methods, but unfortunately Alzheimer’s has proven to be a difficult disease to diagnose, explain, and treat.

Resources and Support

Alzheimer’s Association
24/7 Helpline: 800-272-3900
Alzheimer's Navigator
(to connect with local support)

Chicago Alzheimer’s Association
8430 W. Bryn Mawr, Suite 800
Chicago, IL 60631
Phone 24/7 hotline: 847.933.2413
alz.org

Arden Courts Memory Care Community
2 South 706 Park Blvd.
Glen Ellyn, IL 60137
Phone: 630-469-5500
Arden Courts