Alzheimer disease

• Degenerative, irreversible, progressive disorder of the cerebral cortex (especially the frontal lobe) that accounts for 60% to 80% of all cases of dementia
• Considered the most common cause of dementia in older adults.
• Early-onset Alzheimer disease occurs between age 30 and 60; late-onset, in the mid-60s.
• Stages include preclinical, mild, moderate, and severe.
• No cure or definitive treatment.
• Ranked as the 6th leading cause of death in the United States.
• Alzheimer disease affects more than 5 million people in the United States, usually occurring in patients older than 60.
• Slightly more females than males are affected.
• The disease affects African Americans about twice as commonly as Caucasians.
• The cause of Alzheimer’s is unknown.

The disease initially involves the parts of the brain that control thought, memory, and language. Neurons involved with communication, metabolism, and repair are disrupted. Brain damage is caused by a substance called amyloid.

• Aging (age over 60)
• Down syndrome
• Family history
• Smoking (twofold to fourfold increase)
• Obesity
• Insulin resistance
• High-fat, high-cholesterol diet
• Hypertension
• Gene mutation
• Exposure to aluminum and manganese
• Traumatic brain injury
• Slow-growing central nervous system viruses
• Depression
• Hormone replacement therapy (females)

• Insidious onset: Initial changes almost imperceptible
• Forgetfulness and subtle memory loss
• Misplacement of objects
• Inability to concentrate
• Personality changes; increased anxiety
• Poor judgment
• Taking longer to complete daily tasks
• Trouble handling money
• Impaired sense of smell (usually an early symptom)
• Loss of recent memory

• Difficulty remembering past
• Disorientation
• Episodes of wandering and getting lost
• Feeling of moodiness in social situations
• Bladder and bowel changes
• Shorter attention span
• Misperceptions about own environment
• Misidentification of objects and people (inability to recognize family and friends)
• Decline in word finding; visual/spatial problems and impaired reasoning or judgment
• Difficulty learning and remembering new information
• Personality changes (irritability, depression, paranoia, hostility, apathy, anxiety, fear)
• Restlessness and agitation increasing in late afternoon or at night
• Tendency to perform repetitive actions or statements
• Suspicion and fear of imaginary people and situations
• Complaints of stolen or misplaced objects
• Inappropriate actions or impulses, such as undressing
• Motor problems, such as increased difficulty getting out of car or chair
• Nocturnal awakening or sleep disturbances
• Tremors
• Delusions

• General deterioration in personal hygiene
• Difficulty swallowing
• Increased amount of time sleeping or remaining in bed
• Weight loss
• Loss of bowel and bladder control
• Groans or grunts
• Difficulty communicating
• Seizures
• Agnosia
• Apraxia
• Anhedonia

• Behavioral interventions (patient-centered or caregiver training) focused on managing cognitive and behavioral changes
• Occupational therapy
• Music therapy
• Advance directive planning

• Well-balanced (may need to be monitored)
• Avoidance of caffeine-containing foods, such as coffee, tea, cola, and chocolate
• Nutritional supplements in later stages

• Alzheimer’s NJ
• Alzheimers.net
• Alzheimer's Association
• Alzheimer's Disease Education and Referral Center
• Alzheimer's Foundation of America
• Family Caregiver Alliance