7 Common Questions about Alzheimer’s Disease

Alzheimer’s disease is a neurodegenerative condition that affects thinking, behavior and social skills. Dr. Verna Porter, Director of the Dementia, Alzheimer’s Disease and Neurocognitive Disorders Program at Pacific Brain Health Center, talked about some everyday questions that people have with regard to this disease.

1. How common is Alzheimer’s disease?

Globally, 50 million people are estimated to suffer from dementia; 70% of these cases are caused by Alzheimer’s disease, making it the most common neurodegenerative disorder that causes in dementia. The terms dementia and Alzheimer’s are distinct from each other, in that dementia is a general term that describes symptoms resulting from mental decline that are severe enough to interfere with normal everyday activities and functioning; in contrast, Alzheimer’s disease is a condition that causes dementia.

2. What are the symptoms of Alzheimer’s disease?

Symptoms of Alzheimer’s disease include the progressive loss of working- and long-term memory, confusion and disorientation, changes in fluency with regard to speech or writing, lowered ability to concentrate, compromised judgment and reasoning leading to questionable decision making, and changes in mood such as apathy, anxiety and depression which can result in social withdrawal. Depression, if left untreated, can exacerbate confusion and forgetfulness.

3. What is the difference between normal memory loss due to aging and memory loss associated with Alzheimer’s disease?

Normal, age-related memory changes are very different from memory loss experienced from forms of dementia, such as with Alzheimer’s disease. In normal aging, forgetfulness does not interfere with the ability to carry on with normal daily activities and is not necessarily a cause for concern.

Examples of common memory complaints that may occasionally occur during normal aging include misplacing objects around the house, forgetting the names of less familiar acquaintances, forgetting one’s intent upon entering a room, or having some difficulty remembering lesser details of what you have read or of prior conversations.

Occasional word finding difficulty and feeling that a word is on the “tip of the tongue,” is also not uncommon. In contrast, dementia is characterized by a marked, persistent, and disabling decline in two or more intellectual abilities such as memory, language, judgment or abstract reasoning, that significantly interfere with, and disrupt, normal daily activities.

4. What is the cause of Alzheimer’s disease?

While the exact cause of Alzheimer’s disease is not completely understood, it appears to result from an alteration of proteins in the brain that become toxic and disrupt normal neuronal signaling.

Alzheimer’s disease pathology interferes with the formation of memories at both the biochemical level and at the structural level, through interference with the physical integrity of neural networks. The patterns of impaired memory functions observed relate to changes in the structure and function of the brain.

An association between head injury and Alzheimer’s disease has been suggested. Head injury can result in over-expression of the β-amyloid precursor protein, leading to the accumulation of β-amyloid deposits in the brain, one of the hallmark proteins seen in brains of Alzheimer’s disease patients.

A recent study demonstrated that increased vascular risk factors, such as high blood pressure and heart disease, in subjects affected by mild cognitive impairment resulted in an increased risk of developing Alzheimer’s disease. These results suggest that treatment of vascular damage can reduce the incidence of Alzheimer’s disease.

Finally, a 2010 study suggested that individuals who have had significant depression in their lives may be at greater risk for developing dementia. One possible speculative link is that brain inflammation, which occurs when a person is depressed, may increase the risk of pro-inflammatory factors that stimulate the potential future emergence of dementia. In addition, certain proteins found in the brain increase with depression, and these also may increase the risk of dementia.  

5. How is Alzheimer’s disease diagnosed?

Alzheimer’s disease is diagnosed by trained specialists who perform a series of medical, physical and cognitive assessments. The assessments are designed to answer the following questions:

• Are there changes in behavior, mood or personality?
• Is the decline in memory or thinking skills comparable to, or worse than, others within the same age group?
• What is the extent of the cognitive impairment?
• How does the cognitive deterioration affect daily life and functioning?

Additional tests such as brain scans, or neuropsychological and neurocognitive testing which provide a more in-depth memory assessment, may also be conducted. These can help to exclude conditions such as vitamin deficiencies or thyroid dysfunction which can sometimes be associated with symptoms similar to those seen in Alzheimer’s disease.

6. What treatments are available for Alzheimer’s disease?

There is no cure for Alzheimer’s disease, and no definite way to stop or slow its progression.

However, there are drugs and non-drug options that may help to treat symptoms. The US Food and Drug Administration (FDA) has approved two types of medications — cholinesterase inhibitors (Aricept, Exelon, Razadyne) and memantine (Namenda) — to symptomatically help manage the cognitive symptoms (memory loss, confusion and problems with thinking and reasoning) of Alzheimer’s disease.

Doctors can help patients and their families understand available options; these can help patients live with the disease, and help their caregivers to cope with symptoms and improve quality of life. For instance, the Bredesen Protocol has demonstrated some success in reversing some of the symptoms of Alzheimer’s disease. The protocol creates highly individualized plans for patients with regard to lifestyle and nutritional options that may alter the course of the disease in certain individuals.

7. What can people do to prevent or manage Alzheimer’s disease?

Engage in regular exercise

According to the Alzheimer’s Research & Prevention Foundation, regular physical exercise can reduce the risk of developing Alzheimer’s disease by up to 50 percent. Exercise may slow cognitive decline by not only stabilizing older brain connections, but by also helping make new connections possible.

Social engagement

Staying socially engaged may help protect against Alzheimer’s disease and dementia in later life; maintaining a strong network of family and friends is especially important. Social connections may also be enhanced through volunteer organizations, joining various clubs or social groups, taking group classes or getting out into the community.

Maintaining a healthy diet

A reduction in cognitive decline and Alzheimer’s disease has been associated with the MIND diet. This is a Mediterranean diet that includes 10 ‘brain-healthy food groups’: green leafy vegetables, other vegetables, beans, whole grains, fish, poultry, nuts, berries (especially blueberries and strawberries), olive oil and resveratrol (a supplement derived from red wine).

Mental stimulation

Cognitive stimulation of the brain throughout life by engaging intellectually can enhance cognitive agility and improve functioning; for instance, learning a new skill such as studying a foreign language, practicing a musical instrument, learning to paint or sew, or reading a good book.

Quality sleep

Research studies have linked poor sleep to higher levels of beta-amyloid depositions in the brain, one of the hallmark proteins seen in brains of Alzheimer’s disease patients. Other studies emphasize the importance of uninterrupted sleep for flushing out brain toxins – including beta-amyloid. Poor sleep may also lead to slowed thinking and a reduced mood. In addition, obstructive sleep apnea (OSA), if untreated or insufficiently treated, may increase the risk for cerebrovascular and/or cardiovascular diseases as well as the risk of developing dementia.  

Stress management

Chronic or persistent stress can lead to nerve cell decline and even death, increasing the risk of Alzheimer’s disease and dementia. Studies have shown that regular meditation, prayer, reflection, religious practice and relaxation techniques such as breathing and yogamay diminish the damaging effects of stress on the brain.

About Dr. Verna Porter

Dr. Verna Porter is Director of Programs for Alzheimer’s Disease, Dementia and Neurocognitive Disorders at the Pacific Brain Health Center, Pacific Neuroscience Institute, Providence Saint John’s Health Center in Santa Monica. She provides comprehensive, compassionate, clinical consultations and continuity of care for patients with mild cognitive impairment, Alzheimer’s disease and other dementias.

Written by Leela Basu, PhD
Leela Basu is a scientific writer with a background in biological research and education.