Maybe you can’t find your keys. Or there’s a word on the tip of your tongue, but you can’t quite get it out. Or you forgot the name of the woman you met at a business meeting last week.
You may be concerned that these are signs of Alzheimer’s disease.
In reality though, those examples are probably small moments of forgetfulness that do become more common as we grow older. But if you don’t remember the purpose of your keys, or you refer to a “watch” as “a clock with hands” or you can’t recall the name of your best friend, those are reasons to be evaluated by a physician.
September is Alzheimer’s disease awareness month, a great opportunity for us to call attention to this illness, its prevalence, its symptoms and what we can do to help.
What is Alzheimer’s disease?
Alzheimer’s disease is the most common cause of dementia. Dementia is a loss of mental skills significant enough to interfere with daily life. Dementia can be also caused by other conditions that damage the brain, including strokes, certain infections, traumatic brain injuries, and sustained alcohol abuse, for example, or a combination of factors.
Alzheimer’s disease is characterized by changes in the brain, including the loss of nerve cells that allow the brain to work properly. Patients with Alzheimer’s have amyloid plaques – clumps of a protein called beta amyloid – and neurofibrillary tangles that are thought to damage or kill nerve cells while inhibiting the ability of brain cells to communicate with each other.
According to the U.S. Centers for Disease Control and Prevention, approximately 5.8 million Americans were living with Alzheimer’s disease in 2020. As the size and proportion of the U.S. population over 65 continue to increase due to the aging Baby Boom generation, the number of Americans affected by Alzheimer’s is projected to increase exponentially.
What is the difference between forgetfulness and Alzheimer’s disease?
Nearly everyone experiences cognitive aging as they get older. Just as our muscles and joints age from wear and tear, so does our brain. The brain may lose cells and shrink as we age.
It’s considered typical for people to have more trouble multitasking as they get older. It’s also not unusual for people to have a harder time drowning out distractions, becoming discombobulated from a change in routine, having trouble remembering the name of an acquaintance or getting lost going to a store they haven’t been to in a while.
These can certainly be inconveniences but generally don’t interfere with quality of life or typical daily function.
But if forgetfulness becomes a pattern rather than an inconvenience, and instances of forgetfulness rapidly increase, I advise you get evaluated by a physician.
Family members usually notice symptoms first. Symptoms of Alzheimer’s disease include:
- Having trouble doing familiar tasks, such as using a microwave or remote control.
- Getting lost driving to familiar places.
- Losing track of seasons and the passage of time. Occasionally losing track of the days of the week generally isn’t cause for concern, but being unsure whether something happened two days ago or 10 years ago is concerning.
- Difficulty with language such as having trouble finding the right words to say.
- Difficulty managing finances and paying bills.
- Changes in judgment and decision making, such as falling prey to telemarketing scams and other scams.
- Changes in hygiene and grooming.
- Changes in personality and mood. For example: Not wanting to initiate conversation, becoming increasingly agitated or wanting to stay home.
- Having trouble learning and remembering new information.
There are different stages of Alzheimer’s disease. Those with mild disease can probably still live at home as long as someone is available to help. People with mild Alzheimer’s disease may have any or many of the symptoms listed above.
Those with moderate Alzheimer’s disease may need help with personal care, often referred to as activities of daily living. This includes showering, dressing, eating and toileting. Language use and ability to reason deteriorate. People with moderate disease probably shouldn’t be left home alone.
Those with severe Alzheimer’s disease usually can’t recognize their family. They may not be verbal, may be unable to chew or swallow and may prefer to stay in bed or seated all day. At this stage they often lose control of their bladder and bowel. People with severe disease are usually completely dependent on others for care.
The main risk factor for Alzheimer’s disease is age. Most people who develop Alzheimer’s disease start showing symptoms in their mid-60s or 70s. Researchers are also studying whether people with a certain genes can increase the risk of developing Alzheimer’s disease. So far, mutations in the apolipoprotein E-4 (ApoE-4) gene have been found in some families with dementia, but is very rare in the community.
Minorities and women are at increased risk of developing Alzheimer’s disease and other dementias.
Risk factors for other forms of dementia include health problems such as diabetes, high blood pressure, heart disease, a sedentary lifestyle, and a history of depression and mood disorders.
Though there is no medication or treatment that can prevent Alzheimer’s disease, everyone is encouraged to control health risk factors to protect against other issues that can affect brain function. That means:
- Exercise. Exercising for at least 150 minutes a week can slow cognitive decline. Physical exercise can improve brain health dramatically.
- Sleep. Get at least seven hours a night. Brain cells shrink during sleep, allowing fluid to wash out neurotoxins and other chemicals that built up during the day. Insomnia and other sleep disorders may be a risk factor for Alzheimer’s disease.
- Eat well. Control your blood sugar levels and your blood pressure by sticking to a healthy Mediterranean diet of fruits, vegetables, fatty fish, whole grains and lean meats.
It’s also important to keep your brain active and stimulated. Engage your brain in activities that you enjoy, such as art, music or writing. Socializing has been shown to stimulate the brain.
Unfortunately, there’s no cure for Alzheimer’s disease at this time, though researchers are actively working on this issue. Some medications, called cholinesterase inhibitors, boost levels of neurotransmitters. These won’t fix damage already done to the brain but can be effective in helping the brain cells communicate with each other so the person can maintain the ability to function for longer.
At the Mid-Atlantic Permanente Medical Group, we launched a Memory Clinic in partnership with the Alzheimer’s Association. The goal of this initiative is to provide patients and their caregivers with comprehensive dementia care. We provide an accurate diagnosis, information about what to expect as the condition progresses and we actively manage the condition while preserving the patient’s dignity and independence.
Everyone will have some cognitive changes as they get older, but if you are worried or scared about your own memory loss or the forgetfulness of a loved one, get evaluated by a physician.
Angela Hsu, MD, is board-certified in internal medicine and geriatric medicine. The Mid-Atlantic Permanente Medical Group physician sees patients at the Kaiser Permanente Tysons Corner Medical Center.
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