Women Bear Greatest Burden of Alzheimer's

By Mary Elizabeth Dallas, HealthDay News 

Survey finds they're more likely than men to have Alzheimer's or take care of someone with the disease. 

 

MONDAY, July 18, 2011 (HealthDay News) — Women fear Alzheimer's disease more than any other illness except cancer, and they are more often on the front lines of providing care for loved ones battling the disease, new research shows.

"With statistics consistently pointing to the fact that more women are living with Alzheimer's and caring for people with Alzheimer's, it is clear women are disproportionately affected by this disease," said Angela Geiger, chief strategy officer of the Alzheimer's Association.

A survey of women in France, Germany, Spain, Poland and the United States revealed that women are at the center of the global Alzheimer's epidemic. The multinational research team found women in all five countries were more concerned than men about a loved one developing the disease.

Women in all countries, the survey also found, were more likely than men to be involved in the daily care of someone with the disease. In fact, women in France and Poland were significantly more involved in the decision-making and financial support of an Alzheimer's patient.

If roles were reversed and those polled were to develop the disease, most identified their spouse as the person who would be responsible for their primary care. Men, however, identified their wives 6 percent to 18 percent more often than wives identified their husbands. In contrast, women were more likely to say they would rely on their children or paid caregivers outside the family to care for them.

Despite their fear of the disease, which currently affects 36.5 million people worldwide, and their greater burden as caregivers, 71 percent of women in France and 76 percent of women in the United States seem to be more optimistic that a treatment for Alzheimer's will be developed within five years. That may be one reason why the survey also showed that women believe government spending on Alzheimer's research should be increased.

"These insights reinforce the conclusions published in The Shriver Report: A Women's Nation Takes on Alzheimer's, which found the impact of Alzheimer's on women is significant. The perspectives we see in this survey must prompt thoughtful conversations about Alzheimer's with our friends, family members and government officials to change the trajectory of Alzheimer's disease," concluded Geiger.

The research was slated for presentation Monday at the Alzheimer's Association International Conference in Paris. Research presented at medical meetings should be viewed a preliminary until it is published in a peer-reviewed medical journal.

Falls Could Signal Early Alzheimer's Disease

By HealthDay News Staff 

Seniors whose brain scans indicated preclinical disease twice as likely to fall, study finds. 

 

SUNDAY, July 17, 2011 (HealthDay News) — Compared with older people with no signs of Alzheimer's, those whose brains show early signs of the disease are twice as likely to experience a fall, researchers have found. 

In the new study, investigators looked at brain scans of 125 older adults who were participating in a study of memory and aging. The seniors were also asked to keep track of how many times they fell over the course of eight months. 

An increased risk of falls was noted among individuals whose scans showed early signs of Alzheimer's. The study authors suggested that falls could indicate the need for an evaluation for the memory-robbing disease. 

"To our knowledge, this is the first study to identify a risk of increased falls related to a diagnosis of preclinical Alzheimer's disease," study author Susan Stark, an assistant professor of occupational therapy and neurology at Washington University in St. Louis, said in a news release from the Alzheimer's Association International Conference. 

"This finding is consistent with previous studies of mobility problems among persons with very early symptomatic Alzheimer's or mild cognitive impairment. It suggests that higher rates of falls can occur very early in the disease process," Stark added. 

The study, which was slated for presentation Sunday at the Alzheimer's Association International Conference in Paris, found that of the 125 adults studied, 48 people experienced at least one fall. 

The brain scans of the participants showed that higher levels of an imaging agent that binds to the abnormal protein growth that is a signature of Alzheimer's disease, was associated with a 2.7 times higher risk of a fall for each unit of increase on the scan. 

The researchers noted that Alzheimer's has been linked to balance and gait disorders, as well as problems with visual and spatial perception, which could put people with the disease at higher risk for falls. Based on their findings, they added, these symptoms may appear before other more obvious signs of the disease, such as memory loss and impaired thinking. 

"Growing scientific evidence suggests that 'silent' biological changes may be occurring in the brain a decade or more before we can see the outward symptoms of Alzheimer's," Maria Carrillo, Alzheimer's Association senior director of medical and scientific relations, said in the news release. "According to this study, a fall by an older adult who otherwise has a low risk of falling may signal a need for diagnostic evaluation for Alzheimer's." 

The study authors concluded that additional research is needed to improve early detection and intervention in Alzheimer's disease. Lowering the risk of falls, they added, could also have an economic impact since these incidents contribute to higher rates of disability among older adults, premature placements in nursing homes and more than $19 billion in direct medical costs in 2000 alone. 

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

Could a Diet Help Prevent Alzheimer's?

By Amanda Gardner, HealthDay News

Low-fat, low-glycemic eating plan improved 'biomarkers' of the disease, researchers say. 

 

MONDAY, June 13, 2011 (HealthDay News) — The low-fat, low-glycemic diet often promoted for general health and well-being may lower the risk of developing Alzheimer's disease if adopted early in life, researchers say. 

But starting such an eating plan after symptoms surface doesn't seem to help prevent deterioration of brain function, according to new research published online June 13 in Archives of Neurology. 

"This is not the first time this concept has emerged, that things you do in midlife or earlier on may have effects later on," said Dr. Marc L. Gordon, chief of neurology at Zucker Hillside Hospital and an Alzheimer's researcher at the Feinstein Institute for Medical Research in Manhasset, N.Y. 

"For example, we know that midlife obesity is associated epidemiologically with a higher risk of late-life dementia," he continued. "Whether that's causal or an effect of the disease is open to speculation, but it suggests that there may be periods of vulnerability that are different in different times in the life span." 

Although numerous studies have probed connections between lifestyle factors and cognitive ability, no solid proof yet exists that diet (or much else) can prevent Alzheimer's, the most common form of dementia among the elderly. 

A low-glycemic diet, which focuses on eating fruits and vegetables, whole grains and lean meats, avoids spikes in blood sugar and is said to promote feelings of fullness. 

A U.S. National Institutes of Health conference convened last spring concluded that, for now, older age is the leading known risk factor for Alzheimer's disease. A gene variation is also tied to increased risk for the brain disorder, the NIH review said. Experts at the conference stressed that the general public should still focus on avoiding behaviors already linked to other chronic diseases. 

This new study looked at the effect of different diets on biomarkers associated with Alzheimer's, such as blood sugar levels, cholesterol and blood lipid levels. The researchers also tested memory after participants followed the assigned diets. 

Twenty healthy adults and 29 with mild memory problems that could be predictive of Alzheimer's followed either a high-fat, high simple-carbohydrate diet ("HIGH" diet) or a diet lower in fat and simple carbohydrates ("LOW" diet). 

After four weeks, healthy participants on the LOW diet had changes in biomarkers, including insulin and lipid levels in the blood, which were moving away from those normally associated with dementia. 

In participants with mild cognitive impairment, this diet had the opposite effect. 

Commenting on the study, Dr. Suzanne de la Monte, professor of neurosurgery and pathology at Brown University and Rhode Island Hospital in Providence, said it remains to be seen if the changes noted in this study actually translate, over the longer term, into differences in risk for developing Alzheimer's disease. 

The bottom line, though, is the same as it's been for eons: A healthy diet lowers your risk of type 2 diabetes, heart disease, cancer and maybe even Alzheimer's. 

That means staying away as much as possible from processed foods, de la Monte advised. 

A second study, in the same issue of the journal, also looked at biomarkers and found that different levels were associated with different measures of cognitive function associated with Alzheimer's disease. 

This finding could help improve diagnosis of Alzheimer's, which now relies mostly on clinical observation.

Forgetfulness About Paperwork, Medicines Might Herald Cognitive Decline

By HealthDay Staff

But one expert added that everyday forgetfulness isn't necessarily a sign that Alzheimer's is near.

 

MONDAY, June 6, 2011 (HealthDay News) — A new study finds that older people with mild cognitive impairment — sometimes a precursor to Alzheimer's disease — have a harder time remembering important dates and medications than those without cognitive problems. 

Mild cognitive impairment can be annoying but it isn't as severe as conditions that significantly disrupt daily life. It can, however, occur before serious conditions such as Alzheimer's disease and other causes of dementia. 

Patrick J. Brown of the New York State Psychiatric Institute and his colleagues looked at neurological test results, brain-imaging studies and other data from 229 people with no cognitive problems, 394 with mild cognitive impairment and memory problems, and 193 diagnosed with mild Alzheimer's disease. 

Those in the latter two groups had much more trouble with at least one kind of cognitive function, especially "assembling tax records, business affairs or other papers" and "remembering appointments, family occasions, holidays and medications," according to the study. 

"These findings show that even mild disruptions in daily functioning may be an important clinical indicator of disease and represent the latter phases of disease progression," the study authors wrote. 

Still, one expert not involved with the study cautioned that people shouldn't read too much into the findings. 

"Just because someone misplaces their keys or glasses, forgets an appointment or a dose of medication does not mean they have early Alzheimer's disease," stressed Dr. James E. Galvin, professor of neurology and psychiatry and director of the Pearl S. Barlow Center for Memory Evaluation and Treatment at NYU Langone Medical Center in New York City. 

He pointed out that the study was seeking to understand which individuals with mild memory problems (called mild cognitive impairment, or MCI) were likely to progress to Alzheimer's disease. 

"Everyone occasionally forgets," Galvin said. "It's when the forgetfulness becomes a consistent feature and in some way interferes with everyday activities that it is time to discuss with your doctor." 

The study was published in the June issue of the Archives of General Psychiatry.

Alzheimer's Risk Gene May Damage Brain Decades Before Symptoms Show

By HealthDay News

Scans indicate even young adults who have the gene have some white-matter deterioration.

 

WEDNESDAY, May 18, 2011 (HealthDay News) — A gene allele that increases the risk of Alzheimer's disease starts to damage the brain 50 years before symptoms of the disease appear, a new study suggests.

An allele is one of two or more forms of a gene.

In 2009, scientists concluded that the clusterin (CLU) gene boosts the chances of Alzheimer's disease by 16 percent, but it wasn't clear how it increased risk.

This new study concluded that the C-allele of the CLU gene impairs development of myelin, the protective covering around the axons of neurons in the brain. This impairs brain wiring and can make a person more vulnerable to the onset of Alzheimer's later in life.

About 88 percent of whites have the CLU C-allele, according to the University of California, Los Angeles (UCLA) researchers.

For this study, they used a newer type of MRI to map the connections in the brains of nearly 400 healthy adults aged 20 to 30. The scans revealed that participants with the CLU C-allele had lower white matter integrity than those with a different variant called the CLU T-allele.

The findings are interesting on several levels, according to senior study author Paul Thompson, a professor of neurology.

"For example, Alzheimer's has traditionally been considered a disease marked by neuronal cell loss and widespread gray matter atrophy," he said in a UCLA news release. "But degeneration of the myelin in white matter fiber pathways is more and more being considered a key disease component and another possible pathway to the disease, and this discovery supports that."

Understanding the effects of the CLU C-allele could lead to ways to intervene and protect the brain in the decades before Alzheimer's develops, Thompson suggested.

The study appears in the current online edition of the Journal of Neuroscience.

Little Evidence That Diet, Lifestyle Cuts Alzheimer's Risk

By Alan Mozes, HealthDay 

Until better data exist, experts still advise practicing good health habits.

Monday, May 9, 2011 (HealthDay News) — Numerous studies have attempted to link specific behaviors and health conditions to the onset of Alzheimer's disease, but scientists still can't say for sure that anything you do or don't do will prevent the brain disorder, according to a new U.S. review of recent research.

The U.S. National Institutes of Health convened a conference last spring to analyze 18 studies of potential risk factors, such as poor eating habits, chronic illness, smoking or little exercise, and development of Alzheimer's disease.

"Although we are not dismissing the potential or important role that these major risk factors might play in the development of Alzheimer's disease, at this time, with what we have currently, we cannot confirm any risk associations," said study lead author Dr. Martha L. Daviglus, a professor of preventive medicine and medicine at the Northwestern University Feinberg School of Medicine in Chicago.

"So we need to conduct more research, if we want to have the evidence in hand," she added.

The study, which summarizes the NIH conference results, is published in the May 9 online edition and September print issue of the Archives of Neurology.

For now, older age is the leading known risk factor for Alzheimer's disease, the study noted. A gene variation is also tied to increased risk, it said. 

An estimated 5.3 million Americans struggle with Alzheimer's, a figure projected to grow as the country's Baby Boomer population ages, the authors said. The disease is responsible for between 60 and 80 percent of dementia cases.

"What we're talking about here is something that is going to affect so many Americans in the years to come," said one expert, Catherine Roe, an instructor in neurology at Washington University School of Medicine in St. Louis. "In fact, there's going to be an explosion in the next 50 years, because everyone is living longer in general," she said.

The studies included in the NIH research review were conducted between 1984 and 2009 in English. Participants were at least 50 years old and living in developed countries.

Some of the studies looked into dietary influences, such as folic acid intake, Mediterranean diet and nutritional supplements. Others looked for a link between health problems, such as diabetes or high cholesterol, and Alzheimer's. Still others explored levels of physical activity or alcohol consumption and risk of Alzheimer's disease.

The NIH team found that, as a whole, the studies were "compromised by methodological limitations" that undercut the ability to draw a firm association between any particular behavioral habit and/or health condition and Alzheimer's.

The authors noted that such limitations resulted from the use of poor diagnostic criteria, poor knowledge of the inner workings of Alzheimer's disease itself, and/or the unreliability of patient-reported physical and mental health status.

Yet despite determining that the current quality of evidence is "inadequate" to draw causal linkages, Daviglus and her colleagues stressed that the general public should still focus on lifestyles that avoid behaviors already linked to other chronic diseases.

"People should follow a healthy lifestyle, which includes exercising, blood pressure control, not smoking, not becoming overweight, and trying to sleep properly," Daviglus said.

"And, of course, our recommendation is that it is very important that we make sure that, in the future, more well-constructed, well thought-out studies be conducted so that we can get better quality results that can confirm associations, when they exist, between risk factors that a large proportion of the population have and the onset of Alzheimer's," she added.

Roe agreed that "more quality research is needed," but added that, "I don't think it's a worse situation than in any other field of research. This is difficult and challenging work. And it costs a lot of money at a time when there's a funding crisis in science."

Still, a sense of urgency should prevail, Roe said. "Today the Baby Boomers are starting to hit the age where Alzheimer's comes into play," she noted. "And it's going to take a huge human toll and economic toll, if we don't find a way to treat it or slow it down. So it's very important that we do more and do it better."

The 'Grey's Anatomy' Alzheimer's Test: Could You Pass It?

By Sharon Tanenbaum | Medically reviewed by Ed Zimney

Characters from the hit show are testing patient memory as part of an Alzheimer's disease clinical trial — but should you worry if the questions trip you up? 

 

Wednesday, March 30, 2011 — What did you do for Thanksgiving last year? Where did you go on your honeymoon? Starting at 100, count backward by seven. Remember the following three-word sequence: truck, cabin, spoon.

These are among the series of questions Derek Shepherd and Meredith Grey are asking of Alzheimer’s disease patients to determine whether they’re qualified for entry into a clinical trial on this season’s Grey’s Anatomy.

But if you’re sitting on the couch five minutes later struggling to remember the word “cabin,” should you worry about your own brain health? And just how accurate is such a test at gauging Alzheimer’s disease risk? Everyday Health asked leading memory experts for answers. 

What the Grey’s Memory Tests Means

 

Although the test used on the TV show is not identified by name, some of the questions, like the three-word memory sequence and counting back directive, are included in the Folstein Mini Mental State Examination (MMSE), a 30-point questionnaire introduced in 1975.

“It’s the most commonly used cognitive evaluation for memory loss,” says Cynthia Green, PhD, assistant clinical professor of psychiatry at Mt. Sinai School of Medicine in New York City. “It’s a screening test, so it doesn’t delve deeply into someone’s mental functioning across different areas of intellectual performance.” (Other types of MMSE questions include drawing certain pictures and performing a three-step command, such as “take a piece of paper, fold it in half, and place it on the floor.”)

Keep in mind that the questions used by Derek and Meredith in their fictional version of the test are just a sampling of the total number of questions that would be used in a real test. Otherwise the limited number of answers wouldn’t tell clinicians much. The questions portrayed on TV are such a small snippet that the results are not that significant for the average person, says Dr. Green. And the question of whether a patient can remember where she spent her honeymoon isn’t likely to be on a real test: “That’s more of a remote memory, which is usually retained until later stages of the disease,” Green notes.

 

Senior Moments vs. Real Red Flags

 

So why can’t you remember the above word sequence or where you parked the car at the supermarket? You probably just weren’t paying attention, or you were multitasking or just plain distracted. Such everyday “senior moments” aren’t enough to raise a red flag for dementia, says Green.

“Everybody forgets things once in a while. It’s important to forget, otherwise think how awfully full your brain would be. You wouldn’t be able to sleep at night,” says Laurel Coleman, MD, a geriatric physician in Augusta, Maine, and national board member of the Alzheimer’s Association.

What is concerning, according to Green: “When a change in memory lasts for four to six months, impairs your ability to function independently at work or at home, and if your family and friends notice a change in your abilities or behavior.” If you or a loved one experience any of these symptoms of possible dementia, you should talk to your doctor and get evaluated.

Even then, keep in mind that memory loss doesn’t automatically mean you have Alzheimer’s, which counts language problems, disorientation, and face-recognition issues among its other symptoms. “Memory loss can be a symptom of at least 75 different medical conditions,” says Green, including a vitamin B12 deficiency, thyroid disorders, emotional distress, depression, and side effects from medication.

Alzheimer’s is the most common form of dementia, accounting for about 70 percent of cases in people age 71 and older. But it strikes only five percent of people between 65 and 74. The younger you are, the more likely a memory-related issue is something other than Alzheimer’s.

“We worry so much about memory loss because it’s something we’re afraid of,” says Green. “But since there are so many different things that can cause it and many of those conditions are reversible, it’s important to seek evaluation, and to do it sooner rather than later.” 

The Role of Memory Tests in Real-Life Alzheimer’s Studies

 

Diagnosing Alzheimer’s disease is challenging, since the only way to definitively determine the presence of disease is by looking at brain cells after someone has died. Instead, doctors evaluate the likelihood of Alzheimer’s with a variety of tests that also seek to rule out other possible causes of dementia.

These can include a thorough medical history, complete physical examination, lab tests of blood, urine, and sometimes spinal fluid, and brain scans, in addition to cognitive testing. Doctors at specialized Alzheimer’s treatment centers can diagnose the disease with 90 percent accuracy, according to the National Institute on Aging. Read more about how Alzheimer’s is diagnosed here.

During the cognitive tests, clinicians check on a wide range of brain functions — assessing not just memory— but a patient’s calculation ability, attention, insight, judgment, and how they prioritize things, says Dr. Coleman. “We examine a variety of things because people think in so many different ways.” 

Clinical Trials for Alzheimer’s Disease

 

The fictional Grey’s Anatomy clinical trial highlights the importance of real-life research: According to the Alzheimer’s Association, there currently are more than 100 Alzheimer’s clinical trials that need 50,000 volunteers — with and without the disease — to participate. Such trials are studying new ways to detect, treat, and prevent Alzheimer’s and related types of dementia.

Although researchers can’t offer regular mental state exams by Dr. McDreamy, if you or a loved one is coping with an Alzheimer’s diagnosis, consider finding a study that may be right for you through the Alzheimer’s Association Trial Match program or on ClinicalTrials.gov. Research shows that people involved in studies tend to do somewhat better than people at a similar stage of Alzheimer’s who are not enrolled in trials, the association says.

Common Causes of Dementia

By Madeline Vann, MPH | Medically reviewed by Pat F. Bass III, MD, MPH 

Alzheimer's disease is the best-known cause of dementia — but there are a slew of other causes, too. Do you know what they are?

 

Dementia is really a big umbrella term that covers a number of different conditions that cause dementia symptoms. Of these, Alzheimer’s disease is the most common and perhaps best known — but it’s not the only one.

“There are many different types of dementia,” says Ross Andel, PhD, associate professor at the School of Aging Studies at the University of South Florida in Tampa. “The most common types of dementia are Alzheimer’s disease, vascular dementia, Lewy body dementia, and Parkinson’s disease. All types of dementia are characterized by abnormal neurodegeneration, that is, brain cells dying off in high numbers daily. In most cases, this leads to cognitive and behavioral deficits or, in Parkinson’s disease, to deficits in motor skills.”

One of the ways in which types of dementia are categorized is by where the damage to these cells is occurring in the brain.

Broadly speaking, types of dementia are grouped as cortical or subcortical. Cortical refers to dementias that originate in damage to the cortex — the outer, gray, wrinkled layer layer of brain tissue with which people may be most familiar. Subcortical dementia has its roots in structures below the cortex, inside the brain. The dementia symptoms vary based on whether the dementia is cortical or subcortical. Despite this distinction, dementias of all kinds often involve multiple parts of the brain, and there is ongoing debate as to whether this is a meaningful way to categorize dementia symptoms.

 

Cortical Dementia 

 

Cortical dementia is likely to result in dementia symptoms such as loss of memory, loss of the ability to recognize people, and difficulty recalling the right words for things or concepts. Cortical dementias include:

• Alzheimer’s disease. Alzheimer’s disease causes a loss of memory and ability to think clearly. It is a progressive disease, eventually leading to a loss of ability to complete tasks of daily living.
• Creutzfeldt-Jakob disease. Also sometimes called mad cow disease, Creutzfeldt-Jacob occurs when naturally occuring brain proteins called prions start to change shape. This leads to cognitive impairments such as loss of memory, changes in thought processes, and changes in behavior.
• Frontotemporal dementia. This type of dementia results from degeneration of cells in the frontal lobe; it's characterized by behavioral and language deficits at a relatively young age — as young as 40.
• Wernicke-Korsakoff syndrome. This type of dementia is due to a deficiency in thiamine (vitamin B1) but is also often related to a history of heavy alcohol consumption or to having AIDS, or acquired immunodeficiency syndrome. Memory is affected, and people with this dementia often tell untrue stories that they fully believe to be true. Physically, this dementia can interfere with a person’s ability to move smoothly.

 

Subcortical Dementia

 

Dementia symptoms associated with subcortical dementias include loss of motor skills and the ability to learn processes, resulting in a general sense of slowing down. These types of dementia include:

• Huntington’s disease. A rare, inherited cause of dementia, Huntington’s disease leads to problems with motion such as twitches and lack of balance or coordination and may also lead to changes in mood, personality, and behavior.
• Parkinson’s disease. Parkinson’s disease is characterized by the gradual loss of motor skills, or shakiness and tremors while in motion. People with Parkinson’s disease may eventually experience other dementia symptoms, such as loss of memory.
• Vascular dementia. Vascular dementia occurs as the result of loss of oxygenated blood to parts of the brain. This can be the result of a single stroke or many small strokes, in which case it is called multi-infarct dementia. Evidence shows that subcortical vascular dementia also has effects in the cortex, leading to cortical dementia symptoms.

Some types of dementia appear to affect both cortical and subcortical areas of the brain. Dementia with Lewy bodies falls in this group. This type of dementia occurs because clusters of a certain type of protein called alpha-synuclein form in the neurons in various areas of the brain, leading to impaired memory, motor skills, and mood. Dementia with Lewy bodies can resemble both Alzheimer’s disease and Parkinson’s disease — and Lewy bodies are often found in patients with other types of dementia.

These are only a few of the many possible causes of dementia — and it’s important to understand the cause of your dementia because it will affect treatment decisions.

What Is Sundowner's Syndrome?

By Dennis Thompson, Jr. | Medically reviewed by Kevin O. Hwang, MD, MPH

People with Alzheimer's may develop agitation and other behavioral problems, which seem to worsen as the day progresses. To help them cope with "sundowning" symptoms, think "calm" and "structured." 

 

Sometimes people with Alzheimer's disease become more and more agitated as afternoon dissolves into evening. They pace and wander about, becoming more and more aggravated as the darkness deepens. Confusion, paranoia, and demanding behavior all become increasingly noticeable. Eventually, the person might yell or even lash out physically because of their growing frustration.

This phenomenon has long been called "sundowning" because of its prevalence during evening hours. Doctors now believe, however, that this behavior has little, if anything, to do with the sun going down. "That term has been around since the 1960s and 1970s and is now a little outdated," says Christopher Callahan, MD, a professor at the Indiana University School of Medicine and director of the Indiana University Center for Aging Research in Indianapolis. "The notion used to be that when the sun went down and it got dark outside, there were less external stimuli, and patients would get confused." But doctors now say that symptoms associated with sundowner's syndrome can occur at any point during the day or night in Alzheimer's patients.

Still, an estimated 12 to 25 percent of people with Alzheimer's experience this phenomenon, so if you're caring for a loved one with the disease, it's important to know how to handle sundowning symptoms in the event that they present themselves.

 

Alzheimer's Disease: Causes of Agitation

Doctors now believe that agitation can occur in Alzheimer's patients for a number of reasons, many of them overlapping. Underlying factors involved in the development of so-called sundowning symptoms can include:

• Feeling tired and overwhelmed. "Your brain is often vulnerable after eight hours of being awake. You're tired and you can't handle stimulation as well, you aren't processing it," says Malaz Boustani, MD, a researcher with the Regenstrief Institute and the Indiana University Center for Aging Research, both in Indianapolis. ·
• Having a biological clock that is out of whack. Suffering a hormone imbalance or reacting to other issues that disturb one's "biological clock" can lead to sundowning symptoms. A common cause of biological clock disturbance, for instance, is a lack of exposure to sunlight. ·
• Changing routines. For those accustomed to daylong activities, a lull in their afternoon or evening schedule can cause them to grow bored and restless. ·
• Suffering depression symptoms. People with Alzheimer's may feel depressed and as a result may have trouble in their daily functioning, increasing their potential for agitation.

Some doctors believe that the caregiver or facility looking after the Alzheimer's patient can also be a reason for the person's behavior. "You see it most of the time in an institutional situation," Dr. Boustani says. If your loved one is cared for in a nursing facility or by other hired help, Dr. Boustani recommends looking at sundowning symptoms as "a red flag that the staffing isn't adequate or skilled enough to meet the needs of Alzheimer's patients."

For example, the caregiver could be inadvertently communicating stress or fatigue to the Alzheimer's patient, making the person nervous or anxious. Or a nursing home may regularly have a sudden increase in stimulation late in the day, through noise or social interactions, which can then make the person with Alzheimer's agitated. Even bright lights kept on all night can lead to irritation in an Alzheimer's patient.

 

Easing Sundowning Symptoms: Begin with a Structured, Calm Day

The best way to keep people with Alzheimer’s from becoming agitated is to introduce some structure and peace into their daily routine. The following tips can help:

• Maintain a regular schedule. Wake the person at the same time every day and provide meals on a regular schedule each day. Make bedtime the same time every day, too. ·
• Limit caffeine. Be aware of the caffeine content in any food or drinks that your loved one consumes and limit intake as much as possible, especially in the afternoon and evening. ·
• Provide regular activity. It's important to keep people with Alzheimer's involved or interested in activities during the day; this will not only distract them from the agitation and confusion of Alzheimer's but it also discourages napping so that the person is able to fall asleep at bedtime. Activities that incorporate exercise are encouraged as they burn up additional energy and make it easier for the patient to sleep at night. A daily walk, which benefits both the patient and the caregiver, is often recommended, for instance. ·
• Wind down the day. As it gets closer to the person's bedtime, gradually decreasing the amount of stimulation the person experiences will help them to calm down. Turn down the sound on radios, televisions, and stereos and try to keep the home as dark as possible. Limit evening visitors and move noisy family activities to another part of the house, away from the person with Alzheimer's. ·
• Seek out medical help. If your loved one is unable to become calm enough to get to sleep at night, visit your doctor — he or she can look into other medical conditions that might be making it difficult for your loved one to sleep, and can recommend specific treatments.

Can Caffeine Ward Off Alzheimer's?

By Marie Suszynski | Medically reviewed by Pat F. Bass III, MD, MPH

A hot cup of joe may do more than keep you awake through your next meeting. Research is finding that it may help prevent memory problems. 

 

Anyone with a family history of Alzheimer’s disease or dementia wants to do everything possible to avoid the diseases. Now, researchers have found that some protection may be as close as your coffee mug.

The Journal of Alzheimer’s Disease recently published a special supplement of key findings that suggest caffeine may help keep the brain functioning properly and help ward off Alzheimer’s and dementia.

Here’s what researchers are discovering about caffeine’s role in the brain and how it may protect against memory problems.

 

Key Research Findings About Alzheimer’s and Caffeine

Research shows that caffeine seems to have a big effect on adenosine receptors, which are found in brain cells. An imbalance of adenosine has been associated with neurological disorders like Alzheimer’s disease, and higher levels of caffeine intake seem to protect against Alzheimer’s disease. Researchers believe regular consumption of caffeine “normalizes” memory function, or protects against the loss of memory, especially among people who are under stress. And stress is a well-known cause of memory problems.

One study found that coffee drinking during the previous two decades was associated with a lower risk of developing Alzheimer’s disease. Another study of 1,409 people 65 and older found that drinking three to five cups of coffee a day meant a 65 percent decreased risk of developing Alzheimer’s disease, compared with consumption of little or no coffee.

Animal studies also found that caffeine had beneficial effects on the brain, but the research is conflicting. Some studies have concluded that moderate doses of caffeine helped memory, while high doses seemed to hurt it.

Though caffeine seems to help protect against memory problems, researchers aren’t convinced that it actually enhances memory. A review of studies of caffeine’s effect on memory in people who don’t have dementia found conflicting results — several studies that suggested it improved memory, while others found that it didn’t. At best, researchers say, caffeine may be mildly beneficial in this regard.

 

Applying the Research to Alzheimer’s Prevention

Although there’s no evidence that anyone can prevent Alzheimer’s disease, some doctors like Dharma Singh Khalsa, MD, the Tucson, Ariz.-based founding president and medical director of the Alzheimer’s Research and Prevention Foundation and author of Brain Longevity, believe that numerous lifestyle factors can have an important impact on the brain and be protective.

Nutrition, stress-management, exercise, mental stimulation, and possibly hormone therapy may all influence how healthy your brain is, Dr. Khalsa says. “Caffeine is the next level out. Caffeine is a mild stimulant — we think stimulation is synonymous with a better-functioning brain,” he explains, but adds that there’s no one magic bullet. Living a complete, healthy lifestyle is important for keeping your brain healthy.

 

Other Strategies to Thwart Dementia

While filling up your coffee mug every day may offer some protection, here are other important approaches to Alzheimer’s prevention.

• Eat a balanced diet with plenty of vitamins. Diets that focus on fruits and vegetables with little red meat, such as the Mediterranean diet, are associated with healthier brain function, Khalsa says. Getting enough B vitamins, fish oil, and vitamins C and E may also contribute to a healthy brain.
• Stop stressing. Lowering your stress level, particularly when you do it with exercise, is also part of the cognitive health picture, Khalsa says.
• Stay mentally active. Continue to constantly challenge yourself with new, stimulating experiences from travel to artistic expression to just enjoying nature. Learn to play a new musical instrument or dabble in a hobby you’ve always wanted to try.

Although caffeine looks promising and is easy to get, leading a lifestyle that includes a variety of brain-healthy practices is your best bet.

What's Involved in Reaching an Alzheimer's Diagnosis?

By Dennis Thompson Jr. | Medically reviewed by Niya Jones, MD, MPH

Learn which medical exams and screening tests may be needed before a clear diagnosis of Alzheimer's disease can be made. 

Diagnosing Alzheimer's disease as early as possible can help patients and their families to better prepare for the progression of the disease. But diagnosing Alzheimer's can be a complicated process, given that it is only one of a group of brain diseases known as dementia, meaning neurological disorders that rob the mind of its intellectual ability.

Alzheimer's expert Malaz Boustani, MD, MPH, recommends that family members get a potential Alzheimer's patient checked out, even if they just have a "gut feeling" something might be wrong. "That feeling in and of itself is a big red flag, and families need to get their loved one evaluated as soon as possible. If you have any doubt — even if it just crosses your mind — it's worth investigating," says Dr. Boustani, assistant professor at the Indiana University School of Medicine and a center scientist with the Indiana University Center for Aging Research.

Alzheimer's Diagnosis: Finding a Doctor
If you or a family member needs to be evaluated for Alzheimer's disease, medical experts say the first stop should be your primary care physician. Your family doctor will often coordinate the diagnostic process. If your doctor wants more input from a specialist, you could be referred to one of the following professionals:

• A geriatrician, a medical doctor who specializes in the care of elderly patients
• A neurologist, a medical doctor who specializes in diseases of the brain or nervous system and can assess different types of dementia
• A psychiatrist, a medical doctor who specializes in mental disorders and can diagnose a mood disorder, such as severe depression that may mimic Alzheimer's symptoms.
• A psychologist, a licensed medical professional (a PhD or PsyD) who can test such mental functions as logic, memory, and concentration.

Boustani says that ideally, any specialist you see should have training in memory disorders and dementia. It can often be difficult, however, to find someone with those qualifications. "Our current health care system, unfortunately, doesn't have enough memory-care practitioners capable of performing a full diagnostic assessment," he says.

Screening Tests for Alzheimer's
Currently, the only definitive way to diagnose Alzheimer's disease is by looking at brain cells under a microscope after a person has died. But since that's too late to do the person any good, physicians have come up with a battery of tests that can help determine the likelihood of an Alzheimer's diagnosis. Experts believe that a skilled doctor using these tests can diagnose Alzheimer’s accurately in nine out of 10 cases.

Doctors can evaluate the possibility of Alzheimer's disease by:

• Taking a medical history. During this process, the doctor will learn whether anyone in the patient's family has suffered from Alzheimer's or other forms of dementia. The doctor will also ask about any medications or illnesses that could cause side effects that resemble Alzheimer's symptoms. Both the patient and their family must be involved in this step, since short-term memory loss is an early symptom in 75 percent of people with Alzheimer's and family members may have to help provide key information.
• Administering a mental exam. A series of tasks will test the patient's memory and problem-solving skills. Attention span is also assessed, as well as the ability to count and speak logically.
• Performing a thorough physical examination. This hands-on exam includes a general check-up as well as a neurological exam that tests things like muscle tone, reflexes, and coordination. The doctor will also order blood work and urine test(s), and may order other, more specialized testing such as an MRI or CT scan of the brain.

Alzheimer's Diagnosis: Ruling Out Other Causes
Most of the aforementioned tests aren't just used to look for Alzheimer's disease. They're also aimed at ruling out other conditions that could be interfering with a person's memory. For example, problems with memory or concentration can stem from an emotional disorder. "You might have depression, which can include memory complaints," Boustani says.

A person with symptoms common to Alzheimer's also might be suffering from a brain tumor, or bleeding inside the brain caused by a bad fall or a stroke. In other cases, memory loss could be caused by different forms of dementia, by a reaction to a medication the person is taking for an unrelated illness, or even by a vitamin deficiency. The important thing is to undergo the screening process so you know what's wrong and can address it appropriately, Boustani says.

As with most medical conditions, an earlier diagnosis can bring quicker treatment and help ease the stress of dealing with a new illness. If you have any concerns about your risk of Alzheimer's, do not hesitate to contact your doctor. Together you can decide on what, if any, testing is best for you or a loved one.

 

Understanding the Stages and Symptoms of Alzheimer's Disease

By Dennis Thompson Jr. | Medically reviewed by Pat F. Bass III, MD, MS, MPH
 

Learn about the symptoms of Alzheimer's, and how they change as the disease progresses through three distinctive stages.

 

 

No one experiences Alzheimer's disease in exactly the same way. As memory loss occurs, it affects cognition (the process of knowing and thinking), coordination, personality, and standard of living very differently from person to person. However, researchers have identified some patterns in the way the disease progresses, allowing doctors to group Alzheimer's symptoms into three specific stages. This classification can help people to better understand how symptoms might unfold after an Alzheimer's diagnosis and can assist families in making plans for the future.
It's important to keep in mind, though, that while Alzheimer's symptoms have been clustered into stages, there's no way to tell how long any one stage or symptom will last or how quickly others will progress. People with Alzheimer’s die on average about four to six years after their diagnosis, but the disease can also take its relentless toll for as long as 20 years before death occurs.
Alzheimer's Symptoms: Early Warning Signs
You've forgotten where you've placed your keys. Or you can't remember the name of an actress in a particular movie. Or maybe you are relying more and more on notes to remind yourself you need to do important tasks. Are you suffering from Alzheimer's?
In most cases, the answer is probably not. Most of us experience some “normal” loss of memory, those annoying “senior moments,” as we age. Experts say that misplacing your keys isn’t the issue; forgetting what the keys are used for, however, can be. With this in mind, if you or a loved one is having memory problems that seem to be getting worse more rapidly or happening much more frequently than before, it might be time to pay your doctor a visit.

The following are some early warning signs of Alzheimer's, along with caveats you should keep in mind:

• Forgetfulness. People with early Alzheimer's often find themselves regularly forgetting important information they've just recently learned. On the other hand, there’s probably no need to worry about occasional lapses, such as misplacing your wallet or forgetting names — these types of memory lapses are normal and happen to most people as they get older.

Difficulty completing tasks. People with early Alzheimer's might not be able to remember the steps needed to cook a meal, balance a checkbook, or use a computer program. However, forgetting what you were just going to say or why you went into a particular room isn't unusual when it happens every now and then.

Disorientation. If you've found yourself getting lost in your neighborhood, or ever feel as if you suddenly don't know how to get home because you've forgotten where you are and how you got there, these are signs that could indicate the presence of Alzheimer's. But remember, both of these issues are much different than simply forgetting where you were headed, which can happen to anyone from time to time.

Misplacing objects. Putting objects in strange places — like your car keys in the microwave, or your hair dryer in the washing machine — can be a sign of early Alzheimer's disease. Don't worry if you or your loved one temporarily misplaces keys or a purse, though.

Lapses in judgment. If you notice that you or your loved one has started exhibiting some strange behaviors — like putting on several heavy layers of clothing on a warm day, wearing the same clothes day after day, or giving lots of money away to telemarketers or scam artists, there's reason to suspect Alzheimer's might be present.

Stages of Alzheimer's Symptoms

Once you've been diagnosed with Alzheimer's, researchers say you can expect three phases of symptoms, generally classified as mild, moderate, and severe.

Stage I (Mild) can last two to four years. There will be minor memory loss, as well as mood swings and personality changes. However, relative independence can be maintained. Stage I symptoms can include:

• Getting lost easily
• Difficulty handling money and/or paying bills
• Repeating questions or bits of conversation out of context
• Taking longer to finish routine tasks
• Exercising poor judgment
• Losing or misplacing items

Stage II (Moderate) Alzheimer's causes the brain to begin experiencing significant neural damage. Simple tasks can still be accomplished, but people in stage II will struggle with language, reason, sensory perception, and cognition. Stage II Alzheimer's tends to be the longest, lasting anywhere from two to 10 years. Symptoms may include:

• Trouble completing tasks with multiple steps, such as getting dressed or cooking a meal.
• Increased memory loss, where both recent events as well as personal history are no longer remembered
• Confusion as past memories blend with the present
• Difficulty recognizing familiar people or family
• Loss of ability to read and write
• Impulsive behavior and tendencies to wander

Stage III (Severe) lasts one to three years. People with stage III Alzheimer's generally lose all independence and most of their mental ability. At this stage, you will require constant care. Many people remain homebound or in bed nearly all day. Symptoms can include:

• Inability to recognize anyone, including yourself
• Loss of communication, relying instead on grunts or moans
• Increased vulnerability to other diseases, such as skin or respiratory infections
• Loss of control over bodily functions, such as trouble swallowing or lack of bowel and bladder control
• Further decrease in memory, which becomes nearly nonexistent.

Alzheimer's Disease: Beyond Staging

Some researchers believe that the stages of Alzheimer's now recognized by medical professionals should be modified to reflect the complex nature of the disease, says Malaz Boustani, MD, assistant professor of medicine at the Indiana University School of Medicine and a center scientist with the Indiana University Center for Aging Research. "That kind of staging is decades-old," Dr. Boustani says. "These days, it should be clear that Alzheimer's is more complicated."

Along with ranking cognition as mild, moderate, or severe, Boustani and other doctors think the disease could also be staged by other factors, including:

• Ability to function, ranging from "high level," in which the person can still managing finances and driving, down to "low level," in which they need help with very simple tasks, such as eating and dressing.
• Behavioral and psychological symptoms, such as wandering and pacing, which are more prevalent in later stages of the disease.
• Caregiver burden, taking into account how much a caregiver needs to contribute to the person’s wellbeing and how much they are still able to manage on their own. Because caregivers play such an integral role in the lives of people with Alzheimer's, Boustani says some medical professionals have "started changing the definition of the patient and expanded it to include their caregiver."

If you suspect that you or your loved one might be exhibiting one or more of the symptoms mentioned in these stages, don't hesitate to contact your doctor. While there is no cure for Alzheimer's disease, getting an early diagnosis can help you plan for the future accordingly and a number of treatments are available to help ease problematic Alzheimer's symptoms.