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Memory

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Alzheimer Disease

Symptoms

Increasing forgetfulness and short-term memory loss.

Difficulty making decisions.

Impaired judgment; new difficulty making mathematical calculations or handling money.

Decreased knowledge of current events.

Anxiety, withdrawal, and depression as awareness of deficits becomes frightening and embarrassing.

Language 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.

Loss of ability to communicate verbally or to write and understand written language.

Delusions, hallucinations, paranoia, or irrational accusations.

Agitation and combativeness.

Unusual quiet and social withdrawal.

Wandering or getting lost in familiar places.

Urinary and fecal incontinence.

Inappropriate social behavior; indifference to others.

Failure to recognize friends and family.

Inability to dress, eat, bathe, or use a bathroom without assistance.

Walking difficulty or multiple falls.

When To Call Your Doctor

Occasional 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?

Good evidence 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.

Prevention

There is no proven way to prevent Alzheimer disease.

Diagnosis

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:

Magnetic 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

Blood tests to rule out vitamin deficiencies, endocrine disorders (such as hypothyroidism), syphilis, HIV, and heavy-metal poisoning.

How To Treat It

Donepezil, galantamine, and rivastigmine—inhibitors of the enzyme acetylcholinesterase—provide modest improvement of symptoms in some patients with mild to moderate Alzheimer disease. Side effects include nausea and loss of appetite.

Insomnia, depression, 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 caregiver’s burden. Contact your local chapter of the Alzheimer Association for further information.

 

From Johns Hopkins Symptoms and Remedies, the complete home medical reference. You can order this book now on our secure server.


 

MEMORY BULLETIN
The Memory Bulletin is a quarterly publication that presents the latest information available to help you make informed decisions to prevent memory loss and take charge of cognitive health.
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2005
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Memory

The Memory White Paper from The Johns Hopkins White Papers series is an annual, in-depth report written by Hopkins physicians.


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Johns Hopkins Symptoms and Remedies
An easy-to-use reference work that can help you pinpoint the cause of hundreds of symptoms, from abdominal pain to skin rash to swollen glands.

 

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