Alzheimer’s disease
- Dr Pravir Sharma, Consultant in Mental Health Care and Old Age Psychiatry
Alzheimer’s disease affects the brain and is the most common cause of dementia. Dementia is a brain condition that causes progressive difficulties with how your brain functions. It affects things such as your memory, language, judgement, control of emotions, and thinking deeply.
Just what is the difference between Alzheimer's disease and dementia?
Alzheimer's disease or dementia? | Watch in 2:15 minutes
This video explains the difference between Alzheimer's disease and dementia, and helps to answer your questions.
About Alzheimer's disease
Alzheimer’s disease affects your ability to think and remember things. This gets worse over time and can change your personality and behaviour. People with Alzheimer’s disease can find it increasingly difficult to manage their behaviour and to communicate.
Alzheimer’s disease is more common in older people, particularly in the over 60s. Almost 1 in 100 people have dementia by the age of 60. By 90, around one in three people have it. Alzheimer’s is the most common type of dementia. Early-onset dementia, or young-onset dementia, is when you get dementia before the age of 65. Alzheimer’s disease is also the most common type of early-onset dementia.
More women than men are diagnosed with Alzheimer’s disease. This may partly be because women generally live longer.
Causes of Alzheimer’s disease
Doctors don’t fully understand what causes Alzheimer’s disease. It’s related to changes in the brain, especially as people get older. It may be caused by an abnormal build-up of proteins that affect how brain cells work, communicate, and repair themselves.
One of these proteins is called amyloid; it forms plaques around brain cells. Another protein called tau can become twisted and tangled inside brain cells. The more of these tangles there are, the worse symptoms generally get.
Doctors don’t know exactly why these proteins build up. Some parts of the brain shrink as nerve cells die in those areas. When you look at brain tissue affected by Alzheimer’s under a microscope, you can see plaques of protein and dead cells collecting between the nerve cells. These may block signals between nerve fibres in the brain, so nerve cells can’t work anymore. There may also be inflammation in parts of the brain affecting how well some chemical messengers work. These chemical messengers are involved in sending messages between brain cells.
You may be more likely to develop Alzheimer’s disease if you’ve had a head injury or depression in the past. Alzheimer’s has also been linked to lifestyle – things like smoking and being overweight in middle age may affect your risk of getting it.
For more information, see our section on prevention of Alzheimer’s disease.
Symptoms of Alzheimer’s disease
People with early Alzheimer's symptoms often have trouble remembering times and dates. New information becomes harder to grasp – for example learning to do something new. Other early symptoms include:
- forgetting names of people and places
- difficulty finding words for things
- not remembering recent events
- forgetting appointments
They may have behavioural changes, too. Some people become withdrawn and lose interest in their usual activities and hobbies. They may forget familiar places and start to get lost. In the early stages of Alzheimer’s disease, people realise they’re having memory problems and this can cause a lot of anxiety. To try and reassure themselves, they may fill memory gaps by making things up. Or they may let other people answer questions for them instead.
As it worsens, Alzheimer’s can cause problems with:
- planning and making decisions
- language
- memory and confusion
- thinking logically and carrying out specific tasks
People with Alzheimer’s may also have other difficulties. As well as anxiety, they may develop depression or mood swings. In the later stages of Alzheimer’s disease, they may start wandering and walking off by themselves.
Other symptoms can include:
- differences in sleep patterns – they may sleep more during the day or have difficulty sleeping at all
- agitation and aggression towards others
- problems going to the toilet (incontinence)
- problems with eating and drinking – for example, losing interest
- hallucinations and delusions
If someone with Alzheimer’s suddenly gets even more confused than usual, it’s important to see a doctor. Sudden confusion may be caused by an untreated infection, constipation or pain.
Diagnosis of Alzheimer’s disease
Diagnosing dementia can be difficult as early symptoms can be hard to spot and begin slowly. Doctors need as much information as possible from family and friends who see the person regularly. They may be able to help explain exactly what’s changed and how long that’s taken.
The doctor will want to know whether anyone else in the family has had any form of dementia. People are more likely to get Alzheimer’s if it runs in their family. The doctor may recommend tests to see if there’s another reason for memory problems and other symptoms.
These may include blood tests and urine (pee) tests for:
- infections
- liver problems
- thyroid problems (the thyroid makes hormones)
- vitamin and mineral disorders
- anaemia
Doctors may also recommend:
- CT and MRI scans
- an assessment of activities of daily living – this may be done by an occupational therapist. This assessment can help to identify anything a person with Alzheimer’s finds difficult, and suggest measures to overcome the difficulties
- memory tests – answering questions or doing simple tasks
Specialist dementia care homes
As a leading provider of dementia care, our care homes provide the very best support for our residents living with dementia. With 24 hour care, we get to know each resident and we tailor our care to meet their individual needs.
If you’re thinking about care, our customer care team can guide you every step of the way. Call 0370 218 5192^ and we’ll be happy to answer any questions you may have.
How Alzheimer’s disease progresses
Alzheimer’s is a long-term condition that gradually gets worse over time. There are generally early, middle, and late stages of Alzheimer’s disease, and these stages may overlap.
How quickly Alzheimer’s disease gets worse varies a great deal from person to person. It may depend on how old they were when Alzheimer’s started. Symptoms get worse in around three years for some people. In others it takes closer to 10 years.
There may be long periods where there’s no noticeable change. In the early stages, people with Alzheimer’s disease may be able to manage with a little support from family and friends. They may need a bit of help with taking medicines, shopping, managing money, and transport.
Memory and orientation difficulties mean that anything that needs planning can be a problem. People increasingly need help managing day-to-day life, including basic daily care such as washing and dressing. Eventually, in the late stages of Alzheimer’s disease, many people need to be looked after full time. This is often only possible in residential care.
As with many long-term illnesses, Alzheimer’s can have complications. People may:
- be prone to falls, which can lead to broken bones, because they feel disorientated and are not able to move well
- have difficulty swallowing, which can lead to inhaling food or drink, and cause pneumonia.
- lose a lot of weight if they’re not eating properly
Treatment of Alzheimer's disease
There isn’t a cure for Alzheimer’s disease. Alzheimer’s disease treatment aims to slow down memory loss and help people to manage Alzheimer’s for as long as possible.
Medicines can help to slow down the development of symptoms. Some behavioural and psychological therapies, social support, and activities may help too.
It can be hard to remember what medicines people with dementia need to take and when. You may find it helpful to download our medicines planner for dementia carers (PDF, 0.08MB).
Medicines for early-stage Alzheimer’s
A doctor may prescribe:
- donepezil (Aricept)
- galantamine (Reminyl)
- rivastigmine (Exelon)
The names in brackets are the brand names. There are other brands too.
All these medicines seem to work as well as each other. There’s evidence that they can slow down the progress of Alzheimer’s disease symptoms for a year or so. Memory may get noticeably better in some people, but this isn’t always the case.
These medicines inhibit acetylcholinesterase (pronounced asset-isle-coleen-ester-aze). Acetylcholinesterase is an enzyme that breaks down acetylcholine (asset-isle-coleen, a chemical messenger) in the brain. The effect of these medicines is to help nerve cells to keep in contact with each other.
These medicines have to be initially prescribed by a specialist. They are tablets or capsules you swallow once or twice a day. Rivastigmine also comes as a stick-on patch that needs to be changed every 24 hours.
The doctor will gradually increase the dose over the first month. This is to get the most effect with the fewest possible side-effects. The most common side-effects are feeling or being sick, and diarrhoea. Skin patches may cause fewer side-effects.
People with Alzheimer’s disease shouldn’t stop taking their dementia medicines without speaking to a specialist first. Even if their dementia is getting worse, the medicines may still be slowing it down.
Medicines for later stage Alzheimer’s
Memantine (Ebixa) is for moderate-to-severe Alzheimer’s. A doctor may prescribe it when medicines for earlier stage dementia don’t seem to help anymore. The doctor may suggest memantine as well as or instead of the early stage medicines.
Memantine is an NMDA inhibitor. It blocks signals from a chemical messenger called glutamate, which can be overactive in Alzheimer’s. Memantine is a tablet you take once a day. Side-effects include headache, constipation, and dizziness.
Other medicines for Alzheimer’s
Around 9 out of 10 people with dementia have some sort of emotional distress or a change in behaviour at some point. For example, they may show agitation, depression, or aggression. Half of those with dementia will also have depression. Doctors usually recommend counselling and therapies such as cognitive behavioural therapy (CBT) for mild-to-moderate depression. If depression gets very bad, the doctor may suggest antidepressants for three to six months, to see if they help.
It’s important that older people don’t take too many medicines. So doctors will consider the benefit of medicines against risks and will only prescribe them if they’re absolutely necessary. They may prescribe medicines called anti-psychotics to treat agitation and aggressive behaviour, for example. But this is considered a last resort after other therapies have been tried first.
Other Alzheimer’s disease treatments
Several therapies may help people with mild-to-moderate Alzheimer’s symptoms.
- Talking therapies, such as cognitive behavioural therapy. Sharing how they’re feeling may help people with anxiety and depression.
- Cognitive rehabilitation or occupational therapy helps people to maintain their usual everyday tasks. In cognitive rehabilitation, the person with dementia is set goals to achieve. This may be learning or re-learning how to use a mobile phone or how to dress themselves.
- Cognitive stimulation therapy involves activities and discussions to help memory and social interactions.
- Group reminiscence therapy stimulates memory with objects from daily life.
Complementary therapies may help with relaxation. Aromatherapy and massage, for example, may help with difficult symptoms such as agitation. But there’s not enough research to prove they work. Complementary therapies may help with relaxation. Aromatherapy and massage, for example, may help with difficult symptoms such as agitation. But there’s not enough research to prove they work.
Here are some other ways carers, family and friends can help people with early Alzheimer’s.
- Find ways to make it easier for people to do things for themselves.
- Manage any other health problems that affect their daily life.
- Encourage them to stay as active as possible.
- Help them to sleep at night – try limiting daytime naps and encourage them to get outside in the daylight .
- Write reminder notes and lists.
- Help them communicate with carers and healthcare professionals.
- Check their hearing and eyesight regularly.
Dementia symptoms cause a lot of stress and upset for carers and families. It’s important to look after your own physical and mental health. There’s lots of support for family carers through charities and local support groups. If you’re struggling, speak to a GP or a counsellor. There are also training courses to help you manage, including planning enjoyable activities to do together.
Prevention of Alzheimer’s disease
Some things that can increase your risk of dementia are unavoidable – for example, your family history. But if you make some changes to your lifestyle, it may reduce the risk of dementia later in life.
- Stop smoking or cut down on smoking.
- Stop drinking alcohol or cut down.
- Maintain a healthy weight and eat a healthy diet that’s low in saturated fat.
- Treat high blood pressure.
- Keep to a healthy blood sugar, especially if you have diabetes.
- Exercise regularly and keep active.
Alzheimer’s disease is a condition that affects your brain. It’s the most common cause of dementia. Alzheimer’s disease affects memory and thinking and can affect people’s behaviour.
For more information, see our section about Alzheimer’s disease.
Many people with dementia eventually need 24-hour care. When this becomes necessary will vary between people because it depends on how well they can look after themselves.
For more information, see our section on how Alzheimer’s disease develops.
Dementia is the overall term for conditions that affect the brain and cause difficulties with memory, thinking, and behaviour. Alzheimer’s disease is a type of dementia (the most common type). Other types of dementia include: dementia with Lewy bodies; frontotemporal dementia, and vascular dementia. So, although they both refer to a problem with the brain, the terms are different.
For more information, see our section on the difference between Alzheimer’s and dementia.
There are early, middle, and late stages of Alzheimer’s disease, although these stages may overlap. In the early stage of Alzheimer’s disease, people may function almost normally but realise they’re having memory problems. This can cause a lot of anxiety. In the middle stage, usually the longest stage, the symptoms of Alzheimer’s disease are more noticeable. The person may confuse words, and their behaviour can change. In the later stage of Alzheimer’s disease, they may start wandering and walking off by themselves.
For more information, see our section on how Alzheimer’s disease develops.
How to look after someone with dementia
Dementia can affect everyone differently, so the support people need varies too. Here, we explore some practical ways you can do to help support someone with dementia, while caring for your own wellbeing.
Six ways to look after yourself as a carer
Supporting your own health and wellbeing is one of the most important things you can do while caring for someone. In this article, we share six self-care tips for carers.
What’s the difference between Alzheimer’s and dementia?
Dementia is a condition that affects the way your brain works, including changes to your memory, thinking, and language. The most common cause of dementia in the UK is Alzheimer’s disease.
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- Rachael Mayfield-Blake, Freelance Health Editor
