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.

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.

Language Fluency May Ward Off Dementia

By Michael Smith, North American Correspodent, MedPage Today

The ability to learn and speak two languages in addition to one's native tongue appears to keep the brain in shape, protecting it from dementia.

 

Wed. Feb. 23, 2011 — Speak English? Parlez français? Habla espanol?

Those who can say yes, oui, or si to all three questions are significantly more likely to avoid cognitive problems late in life than those who speak only two languages, according to Dr. Magali Perquin, of the Public Research Center for Health in Luxembourg, and colleagues. 

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Get a Memory Boost From These Foods

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Moreover, the effect appears to add up — more languages equal a lower risk of cognitive impairment, Perquin and colleagues reported in a study to be presented at the American Academy of Neurology meeting in Honolulu in April.

“It appears speaking more than two languages has a protective effect on memory in seniors who practice foreign languages over their lifetime or at the time of the study,” Perquin said in a statement.

The findings, from a study of 230 people with an average age of 73, fit into the context of a growing body of literature that suggests a so-called “cognitive reserve” — developed by intellectual activities — protects against dementia.

Indeed, a similar study from a Canadian group, presented at the annual meeting of the American Association for the Advancement of Science this month, showed that having two languages rather than one appeared to delay the onset of dementia.

The “use it or lose it model of cognitive function” has been gaining popularity for several years, according to Richard Lipton, MD, of Albert Einstein College of Medicine in New York City. With colleagues, Lipton showed in 2003 that such activities as chess, bridge and doing crossword puzzles appeared to protect against Alzheimer’s disease.

In that context, Perquin’s findings “are not surprising to me,” Lipton told MedPage Today.

But he cautioned that there are at least two other possible explanations for such data, including his own findings.

On one hand, he said, it’s possible that the intellectual activities themselves are not protective, but that being the sort of person who does crossword puzzles or learns several languages is the key factor.

On the other hand, he said, it may be that the causality is reversed — that incipient cognitive impairment impairs the ability to perform such activities.

But the study is “fascinating,” he added, and “as an optimist, I would like to believe it is completely true.” 

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Which Conditions Are Related to Dementia?

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The so-called MémoVie study in Luxembourg is a longitudinal analysis of cognition and its risk factors in the elderly and one of the aspects of the study is the effect of multilingualism.

Luxembourg, a small country in the heart of western Europe, has three official languages and a large number of people who speak several tongues.

For the analysis, participants in the MémoVie study were classified as having normal cognition, some cognitive impairment, or frank dementia, with the latter being excluded.

All told, 44 participants had cognitive impairment and the remaining 186 were cognitively normal, the researchers reported.

Participants had spoken — or currently spoke — two through seven languages; those with only two languages were considered the reference group for a multivariate analysis that adjusted for age and years of education, Perquin and colleagues reported.

Analysis showed that, compared with bilinguals:

• Participants who had spoken three languages were four times more likely to be protected against cognitive impairment.
• Those with four or more languages were even better off — they were six times less likely to develop dementia than those who mastered only their native tongue.

Perquin noted that more research is needed to confirm the findings and to see if protection is limited to thinking skills related to language “or if it also extends beyond that and benefits other areas of cognition.”

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.

Alzheimer's: A Woman's Disease?

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

Women are more likely to develop Alzheimer's disease and other forms of dementia than men — but why?

There are many theories as to what may cause Alzheimer's disease but here’s one thing researchers know for sure: Women are diagnosed with various forms of dementia, including Alzheimer's, at greater rates than men. In fact, the Alzheimer’s Association’s 2011 Alzheimer’s Disease Facts and Figures report shows that 3.4 million of the 5.4 million Americans living with Alzheimer’s are female.

Why the Gender Discrepancy?

The current state of research seems to favor the simplest explanation for this phenomenon: Women just live longer. According to 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, "Alzheimer's disease depends so much on time. Men tend to die earlier, and therefore they have less prevalence of Alzheimer's. There is a mortality difference."

On average, a girl born in 2005 is expected to live to age 80, according to the U.S. Centers for Disease Control and Prevention. A boy born that same year is expected to live to age 75. According to current consensus, that's why more women tend to develop Alzheimer's disease. They are simply more vulnerable to the greatest risk factor associated with Alzheimer's: advancing age.

Alzheimer's Symptoms in Men Vs. Women

Alzheimer's also appears to affect men and women differently. Here are some ways in which the condition can present itself in men versus women:

• Men with Alzheimer's disease tend to develop more aggression — physical, verbal, and sexual — than women do as the disease progresses. They also tend to wander and perform socially inappropriate actions more frequently than women diagnosed with Alzheimer's.
• Women with Alzheimer's disease tend to become more reclusive and emotionally unstable. They hoard items more often than men do, refuse help more often, and exhibit laughter or crying at inappropriate moments. They also seem more vulnerable to depression and to suffering from delusions.

Alzheimer's Risk: Other Roles Gender Might Play

New studies have found that hormonal differences might also play a role in increasing the risk of Alzheimer's in women. Beyond that, there appear to be gender differences in which risk factors for Alzheimer's affect men and women. Gender also appears to affect how Alzheimer's develops, since men and women exhibit different symptoms of dementia.

Gender is a factor in Alzheimer's disease for "a combination of reasons," says Allen Levey, MD, chair of neurology at Emory University School of Medicine and director of the Emory Center for Neurodegenerative Disease and Alzheimer’s Disease Center. "There are more women who are living longer. There may also be an increased risk for women beyond that. There has been a lot of research pointing toward the effects of female hormones, like estrogen, on dementia."

One study, for instance, has found that hormone replacement therapy can increase a person's risk of developing dementia. Another study found that high or low levels of a thyroid hormone called thyrotropin may be associated with an increased risk of Alzheimer's disease in women.

Gender also seems to play a role in which risk factors matter in the development of dementia. A French study found that men who had suffered a stroke were three times more likely to develop dementia, while stroke seemed to have no effect at all as a risk factor in women. But women with depression were twice as likely to suffer from dementia, and women unable to live without assistance due to an inability to perform routine tasks were 3.5 times more likely to develop dementia.

Researchers will continue to probe these gender differences in hopes of finding different ways to help men and women with Alzheimer's disease and, perhaps, find new treatments or, eventually, a cure.

 

How Do Alzheimer's and Dementia Progress?

By HealthTalk Staff | Medically reviewed by Ed Zimney, MD

Learn about the seven stages of Alzheimer's and specific symptoms that typically arise during each period. 

The way the disease proceeds and the array of symptoms that arise over time can vary from person to person. For consistency, physicians use the following staging system to identify the progression of the disease:

 

Stage 1: No impairment

The person has no memory problems, no perceptible symptoms, and is functioning normally.

 

Stage 2: Very mild cognitive decline

Decline in memory or thought processing may be normal for the person’s age or may be the first signs of Alzheimer’s. The person may complain of memory lapses, such as forgetting familiar words or losing personal items, like glasses and keys. But these are subjective indicators, and problems probably will not be apparent yet to friends or family members.

 

Stage 3: Mild cognitive decline

The person may:

• Not remember the names of new people they are introduced to
• Have a noticeably impaired ability to work or interact socially
• Lose or misplace valuable items
• Have a marked inability to plan or organize

Stage 4: Moderate cognitive decline

The person may:

• Not recall recent events
• Be unable to perform relatively challenging mental tasks, such as counting backwards from 100 by 7s
• Have a diminished ability to do complicated everyday tasks, such as shopping and paying bills
• Not remember significant events in his or her own life
• Begin to be withdrawn, particularly in challenging situations

Stage 5: Moderately severe cognitive decline

The person may:

• Not remember important information, such as their address or telephone number
• Know where they are, the day of the week, the month, or the season
• Have trouble with less challenging mental tasks, such as counting backwards from 40 by 4s
• Need help choosing clothing appropriate for the season or the setting
• Retain knowledge about themselves, such as their own name and the names of their immediate family members
• Eat, use the toilet, and perform similar personal functions on their own.

Stage 6: Severe cognitive decline

The person may:

• Be unaware of their surroundings and recent events
• Know their own name, but not remember their own personal history very well
• Sometimes forget their spouse’s name, but distinguish familiar from unfamiliar people
• Need assistance to dress
• Have an abnormal sleep/waking cycle
• Need help using the toilet (wiping, disposing of toilet paper, or flushing toilet)
• Develop urinary or fecal incontinence
• Undergo personality changes, such as extreme suspiciousness
• Experience delusions or hallucinations, or exhibit compulsive, repetitive behaviors such as hand-wringing
• Wander and become easily lost

Stage 7: Very severe cognitive decline

The patient may:

• Lose their ability to speak coherently (although they may utter occasional words or phrases)
• Need help with eating, using the toilet, and personal hygiene
• Have general urinary incontinence
• Be unable to walk or sit without help
• Eventually, be unable to hold up their head or swallow

 

5 Ways to Help Prevent Alzheimer's Disease

By Jan Sheehan

Healthy habits that are good for you now have been shown to help prevent Alzheimer's later

Even though no drug therapy or treatment regimen has yet been found that will definitively prevent Alzheimer's disease, lifestyle choices can make a big difference in your risk of developing the condition down the line. Researchers are now discovering, in fact, that certain healthy habits and lifestyle practices appear to reduce your chances of developing Alzheimer's — and they say it's never too early to begin making healthy changes.

"We know that alterations in the brain associated with Alzheimer's can start decades before symptoms appear, so it may be wise to start thinking about prevention as early as your 30s and 40s," says Zoe Arvanitakis, MD, an Alzheimer's researcher at Rush University's Alzheimer's Disease Center in Chicago and associate professor of neurology at Rush University Medical School.

But what behaviors really make a difference? While there are no guarantees, experts believe that concentrating on the following five areas may give you a leg up on this difficult and debilitating illness.

1. Eat Smart
   Sticking to a healthy, low-fat diet has been linked to Alzheimer's prevention. One Harvard study of 13,000 women, age 70 and older, found that those who ate the most vegetables — especially green leafy ones (like spinach and romaine lettuce) and cruciferous ones (like broccoli and cauliflower) — experienced a slower rate of cognitive decline than those who ate the fewest vegetables. Turmeric, a traditional Indian yellow spice used in curry, also shows promise in Alzheimer's prevention. In animal studies, UCLA researchers discovered that Alzheimer's-like brain plaques disappeared after treatment with compounds found in this spice. A diet loaded with heart-healthy foods may also help stave off the disease. "High cholesterol increases the risk of developing Alzheimer's since clogged arteries around the heart can lead to damaged blood vessels in the brain," says Dr. Arvanitakis. Because it is thought that this type of damage may disrupt brain circuits that are important for memory, eating a diet low in saturated fat and trans fats may help keep cholesterol in check and protect against Alzheimer's.
2. Get Moving
   Simply getting off the couch and going for a brisk walk may help prevent dementia and Alzheimer's disease. An Australian study recently published in the Journal of the American Medical Association found that as little as six months of regular exercise produced improvement in memory and cognitive function in a group of older adults. A separate six-year study of 1,700 seniors 65 and older found that working out three or more times per week slashed the risk of developing Alzheimer's and dementia by 35 percent.
3. Maintain a Healthy Weight
   Obesity during midlife appears to raise the risk of developing Alzheimer's in the later years. A 2008 Kaiser Permanente study of 6,500 men and women found that those who were 30 or more pounds overweight and accumulated lots of belly fat in their 40s were 3.6 times more likely to develop Alzheimer's decades later. Studies also show that diabetes, which is linked to obesity, also increases the risk of Alzheimer's. "This may be a direct result of high blood sugar or because diabetes is associated with high cholesterol," says Arvanitakis. But dropping weight during midlife, especially in the belly, can reduce your risk of developing Alzheimer's.
4. Consider Supplements
   Scientists are studying whether certain nutrients acquired in dietary-supplement form can help protect against Alzheimer's. Folic acid, which is known to reduce levels of the amino acid homocysteine, shows some promise because elevated homocysteine levels can increase the risk of both heart disease and Alzheimer's. In one European study, a daily dose of 800 mcg of folic acid lowered homocysteine levels and significantly improved memory and cognitive function in a group of middle-aged and senior adults. At one time, high doses of vitamin E were also thought to have a possible protective role against Alzheimer's disease, but recent studies have found no link between vitamin E supplements and Alzheimer's development. Some research, however, has suggested that ginkgo biloba, a popular memory-enhancing herb, may be helpful in delaying the development of Alzheimer's.
5. Stay Mentally Active
   Exercising your mind is one of the easiest ways to help prevent Alzheimer's. Researchers at Rush University's Alzheimer's Disease Center found that seniors who stayed mentally active by reading, doing crossword puzzles, and taking classes were more than twice as likely to stay free from Alzheimer's disease in comparison to less mentally active people. Other studies have produced similar results. "Using your brain to learn new information, solve problems, and form memories not only helps to maintain existing brain circuits but may also create new ones," says Arvanitakis. "This could prevent Alzheimer's disease from ever developing." So pick up a book or click on an informative Web site today. You may be helping to keep Alzheimer's at bay!