forgetfulness and short-term memory loss.
judgment; new difficulty making mathematical calculations or
knowledge of current events.
withdrawal, and depression as awareness of deficits becomes frightening
difficulties, including rambling speech, frequent inability to
name familiar objects, long pauses to find the right word, and
repetition of the same words, phrases, or questions.
of ability to communicate verbally or to write and understand
hallucinations, paranoia, or irrational accusations.
quiet and social withdrawal.
or getting lost in familiar places.
and fecal incontinence.
social behavior; indifference to others.
to recognize friends and family.
to dress, eat, bathe, or use a bathroom without assistance.
difficulty or multiple falls.
When To Call Your Doctor
forgetfulness, such as misplacing the car keys, is normal and
rarely anything to worry about. However, consult a doctor if
you or a family member begins to show increasing signs of memory
lapses; becomes lost in a familiar place; loses the ability to
do everyday activities; or undergoes a change in personality.
What Is It?
Alzheimer disease results from the gradual degeneration
of crucial nerve cells (neurons) in the parts of the brain that
process learning and memory. Symptoms usually appear very slowly,
get progressively worse, and are irreversible. Minor forgetfulness
becomes more pronounced, speech deteriorates, and the ability
to do everyday things, such as dressing, bathing, and eating,
grows increasingly difficult. In the final stages, severe mental
impairment leads to complete dependence upon caregivers. Half
of patients die within 3.3 years of disease onset, often from
complications such as malnutrition or pneumonia. Alzheimer disease
affects about 10% of people over the age of 65 and upward of
50% of those over 85.
What Causes It?
indicates that a genetic component predisposes some individuals
to Alzheimer disease, but the true cause or causes are unknown.
The mechanism of the disease is nonetheless distinctive and is
characterized by the death of neurons in certain areas of the
cerebral cortex of the brain. This process leads to atrophy in
the brain regions where integration of new information and retrieval
of memory take place.
In people with
Down syndrome, Alzheimer disease occurs at an early age.
There is no
proven way to prevent Alzheimer disease.
Except for examination of the brain during an autopsy,
no test or examination can definitively diagnose Alzheimer disease.
Instead, a diagnosis of possible or probable Alzheimer disease
is based on patient history (including input from family members)
and clinical examination, including a test of mental status.
The primary criterion is gradual loss of memory and additional
cognitive functions. Other disorders that can cause dementia
must be ruled out; this may be facilitated by imaging of the
brain and various laboratory tests, including:
resonance imaging (MRI) or computed tomography (CT) scans of
the brain to rule out cancer, subdural hematoma (a collection
of blood), adult hydrocephalus (an accumulation of spinal fluid),
or multiple small strokes due to vascular disease; and
to rule out vitamin deficiencies, endocrine disorders (such
as hypothyroidism), syphilis, HIV, and heavy-metal poisoning.
How To Treat It
galantamine, and rivastigmineinhibitors of the enzyme acetylcholinesteraseprovide
modest improvement of symptoms in some patients with mild to
moderate Alzheimer disease. Side effects include nausea and loss
aggression, and other psychological manifestations may be treated
with various medications.
Much of the
responsibility to care for a patient with Alzheimer disease falls
into the hands of the primary caregiver. Supportive counseling,
day care, visiting nurses, and eventual inpatient nursing facilities
may help to ease the caregivers burden. Contact your local
chapter of the Alzheimer Association for further information.
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