Alzheimer's: Stages, Symptoms, and Treatment
By: Sai Srihaas Potu
Alzheimer's disease (AD) is the most common form of age-related dementia with more than 5 million Americans currently affected. Although the majority of cases occur in individuals age 65 or older, the 2007 AD Facts and Figures published by the Alzheimer’s Association estimates 500,000 people have early-onset AD (EOAD) or another dementia with symptoms appearing before the age of 65 years. One out of 8 people age 65 and older and nearly 1 out of every 2 over age 85 have AD. AD is the seventh leading cause of death in the United States.
Like all types of dementia, Alzheimer’s is caused by brain cell death. It is a neurodegenerative disease, which means there is progressive brain cell death that happens over time. In a person with Alzheimer’s, the tissue has fewer and fewer nerve cells and connections. Autopsies have shown that the nerve tissue in the brain of a person with Alzheimer’s has tiny deposits, known as plaques and tangles, that build on the tissue. The plaques are found between the dying brain cells and they are made from a protein known as beta-amyloid. The tangles occur within the nerve cells and they are made from another protein, called tau. Researchers do not fully understand why these changes occur. Several different factors are believed to be involved.
Although each person with Alzheimer's is different, most progress through a series of stages, each of which is characterized by more serious Alzheimer's symptoms. The following seven stages were developed by researchers and physicians to describe how you or your loved one will change over time.
Stage 1: There are no problems with memory, orientation, judgment, communication, or daily activities. You or your loved one is a normally functioning adult.
Stage 2: You or your loved one might be experiencing some lapses in memory or other cognitive problems, but neither family nor friends can detect any changes. A medical exam would not reveal any problems either.
Stage 3: Family members and friends recognize mild changes in memory, communication patterns, or behavior. A visit to the doctor might result in a diagnosis of early-stage or mild Alzheimer's disease.
Stage 4: Cognitive decline is more evident. You or your loved one may become more forgetful of recent events or personal details. Other problems include impaired mathematical ability, a diminished ability to carry out complex tasks like throwing a party or managing finances, moodiness, and social withdrawal.
Stage 5: Some assistance with daily tasks is required. Problems with memory and thinking are quite noticeable. Even though symptoms are worsening, people in this stage usually still know their names and the names of key family members and can eat and use the bathroom without assistance.
Stage 6: This is often the most difficult stage for caregivers because it is characterized by personality and behavior changes. In addition, memory continues to decline and assistance is required for most daily activities.
Stage 7: In the final stage, it is usually no longer possible to respond very much to the surrounding environment. You or your loved one may be able to speak words or short phrases, but communication is extremely limited. Basic physical functions begin to shut down, such as motor coordination and the ability to swallow. Total care is required around the clock.
The only definitive way to diagnose someone with Alzheimer’s disease is to examine their brain tissue after death. But your doctor can use other examinations and tests to assess your mental abilities and rule out other conditions.
There is no known cure for Alzheimer’s disease. However, your doctor can recommend medications and other treatments to help ease your symptoms and delay the progression of the disease for as long as possible. For early to moderate Alzheimer’s, your doctor may prescribe medications such as donepezil (Aricept) or rivastigmine (Exelon). These drugs can help maintain high levels of acetylcholine in your brain. This is a type of neurotransmitter that can help aid your memory. To treat moderate to severe Alzheimer’s, your doctor may prescribe donepezil (Aricept) or memantine (Namenda). Memantine can help block the effects of excess glutamate. Glutamate is a brain chemical that damages brain cells and is released in higher amounts in Alzheimer’s disease. Your doctor may also recommend antidepressants, antianxiety medications, or antipsychotics to help treat symptoms related to Alzheimer’s.
In addition to medication, lifestyle changes may help you manage your condition. For example, limiting confusion, staying focused on one task, getting enough rest every day, and most importantly staying calm. Though these changes will not cure Alzheimer’s they will provide some relief during the process. Also, some people believe that vitamin E can help prevent a decline in mental abilities, but studies indicate that more research is needed. Be sure to ask your doctor before taking vitamin E or any other supplements. It can interfere with some of the medications used to treat Alzheimer’s disease.
AD is one of the most challenging disorders of the century and is considered a looming public health issue. Understanding the genetics of late-onset AD may lead to early detection, prevention, and treatment. The genetics of the rare, early-onset familial form of AD has resulted in a better understanding of the pathophysiology of the disease. In the future, researchers are working to better understand the mechanisms behind Alzheimer’s in order to have better prevention and treatment options.
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2. Liesi E. Hebert, Jennifer Weuve, Paul A. Scherr, Denis A. Evans. Alzheimer's disease in the United States (2010-2015) estimated using the 2010 census. Neurology. 2013.
3. National Center for Chronic Disease Prevention and Health Promotion. Promoting Health for Older Adults. CDC. 2019.