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Alzheimer’s disease

Expert reviewers, Dr Daniel Edward Anderson, Consultant Psychiatrist, Dr Naveen Puri, Bupa Clinics GP and Lead Physician, and Adrian Raby, General Practitioner
Next review due January 2025

Alzheimer’s disease is a condition that affects the brain and progresses over time. It’s the most common cause of dementia. Dementia can cause problems with memory and thinking, and can stop people doing everyday tasks on their own.

About Alzheimer's disease

Alzheimer’s disease affects people’s ability to think and remember things. This can keep getting worse, leading to changes in people’s personality and behaviour. Over time, they find it harder to do their usual activities and communicate with other people.

Alzheimer’s disease is more common as people get older, particularly after the age of 60. More women than men have Alzheimer’s disease. But this may be because women generally live longer, so there are more women in the older age groups.

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Symptoms of Alzheimer’s disease

People with early Alzheimer's symptoms may find it hard to remember times and dates. They may also find it difficult to take in new information – for example, learning to do something new. Other early Alzheimer's symptoms include:

  • forgetting names of people and places
  • difficulty finding words for things
  • not remembering recent events
  • forgetting appointments

 

Some people with early Alzheimer’s have behavioural changes, too. They may get more withdrawn and lose interest in their usual activities and hobbies. They may get confused about where familiar places are and start to get lost. In the early stages, people may be aware that they’re having memory problems. This can cause a lot of anxiety. To try and reassure themselves, they may make things up to fill in any gaps in their memory. Or they may let family or friends answer any questions for them instead.

As their condition gets worse, someone with Alzheimer’s may have more problems with:

  • planning and making decisions
  • language
  • memory and confusion
  • thinking logically and carrying out specific tasks

 

A person with Alzheimer’s may also have difficulties other than thinking and memory problems. As well as the anxiety mentioned above, they may experience depression. In the later stages of the condition, they may start ‘wandering’ out of the house and walking off by themselves.

Other symptoms can include:

  • sleep problems
  • getting agitated and aggressive towards other people
  • problems going to the loo (incontinence)
  • losing interest in eating and drinking
  • hallucinations and delusions
  • problems moving around, which can lead to falls and broken bones

 

Sometimes, changes in behaviour and mood – for example, depression or agitation – may be a reaction to living in unsupportive surroundings.

Diagnosing Alzheimer’s disease

Diagnosing dementia can involve tests, assessments and information from family members.

People with early Alzheimer's symptoms may find it hard to remember times and dates. They may also find it difficult to take in new information – for example, learning to do something new. Other early Alzheimer's symptoms include:

  • infections
  • liver problems
  • thyroid (gland that makes hormones) problems
  • vitamin and mineral disorders

 

Doctors may also recommend:

  • CT and MRI scans
  • an assessment of activities of daily living – this may be done by an occupational therapist
  • memory testing, such as answering some questions and doing some simple tasks

 

Alzheimer’s disease can be hard to diagnose. The early symptoms can be hard to spot and come on slowly. It’s very important for doctors to get as much information as possible from family and friends who see the person regularly. They may be able to help to explain exactly what’s changed and how long it’s taken for things to change.

The doctor will also want to know whether anyone else in the family has had any form of dementia. People are more likely to get Alzheimer’s disease if it runs in their family, especially if a relative had it before they reached the age of 60.

How Alzheimer’s disease progresses

Alzheimer’s is a long-term condition that gradually gets worse over time. This can be a very slow process in some people. How quickly it gets worse varies a great deal from person to person. It may depend on how old they were when the Alzheimer’s started.

  • In some people, the symptoms may get worse in around three years.
  • In other people, this may take closer to 10 years.

 

There may be long periods where there’s no noticeable change. These periods are called plateaus.

Early on, people with Alzheimer’s may be able to manage with a little support from family and friends. They may need a bit of help with:

  • taking medicines
  • shopping
  • getting from place to place
  • managing their finances

 

Often, the first activities to become a problem are tasks that need a bit of forward planning. These problems are caused by difficulties with memory and orientation.

As the condition progresses, the person will have more difficulty managing day-to-day life. They’re likely to need help with more basic daily care, such as washing and dressing. The condition gets worse over time, so eventually many people need to be looked after all the time. This is often only possible in residential care.

As with many long-term illnesses, Alzheimer’s can have complications.

  • People with Alzheimer’s may be more likely to get infections such as urine infections. This may make their confusion worse.
  • Difficulty swallowing can cause people to breathe in small amounts of food or drink. This can lead to pneumonia.
  • People with Alzheimer’s may lose a lot of weight if they’re not eating properly.

 

Alzheimer’s disease symptoms usually get worse slowly over several months or years. If someone with Alzheimer’s suddenly gets even more confused than usual, it’s important that they see a doctor. Sudden confusion may be caused by something else such as:

Treatment of Alzheimer's disease

Unfortunately, Alzheimer’s disease can’t be cured. Treatments for Alzheimer’s disease aim to:

  • slow down memory loss
  • help people with Alzheimer’s to manage their daily lives for as long as possible

 

Medicines can help to treat the symptoms and slow down how quickly they get worse, but they don’t treat the underlying illness. Some behavioural and psychological therapies, social support and activities may help with the early stages of Alzheimer’s disease too.

If you’re caring for someone with dementia, it can be hard to remember what medicines they need to take and when. You may find it helpful to download our medicines planner for dementia carers (PDF, 0.8MB).

Medicines for early-stage Alzheimer’s

The doctor is likely to prescribe one of the three medicines available:

  • donepezil (Aricept)
  • galantamine (Reminyl)
  • rivastigmine (Exelon)

 

The names in brackets are the brand names. There are other brands too.

These medicines are all acetylcholinesterase inhibitors (pronounced asset-isle-coleen-ester-aze). They stop the enzyme acetylcholinesterase from breaking down the ‘chemical messenger’ acetylcholine in the brain. This helps the nerve cells in the brain to keep in contact with each other.

All these medicines work as well as each other. There’s evidence that they can slow down the progress of Alzheimer’s symptoms for a year or so. Memory may get noticeably better in some people, but this won’t be the case in everyone.

The medicines have to be prescribed by a specialist and are tablets or capsules to be swallowed. Donepezil is taken once a day and the other two medicines, twice a day. Rivastigmine also comes as a stick-on patch that needs to be changed every 24 hours. This can be easier for some families to manage than tablets.

The dose of all these medicines is gradually increased over the first month. This is to try and get them to work as well as possible with as few side-effects as possible. The most common side-effects are generally feeling sick, being sick and diarrhoea. Skin patches may cause fewer side-effects than tablets or capsules.

People with Alzheimer’s disease shouldn’t stop taking their dementia medicines just because their dementia is getting a lot worse. The medicine may still be slowing down the dementia. It’s best for a dementia specialist to make the decision to change treatment.

Medicines for later stage Alzheimer’s

Memantine (Ebixa) is available for moderate-to-severe Alzheimer’s. It doesn’t help with early Alzheimer’s, so isn’t usually prescribed until the disease is getting worse. It may be prescribed for someone taking acetylcholinesterase inhibitors for earlier stage dementia when these don’t seem to be helping anymore. The doctor may suggest taking memantine as well as or instead of earlier medicines.

Memantine is a type of drug called an NMDA inhibitor. It works by helping to block signals from a ‘chemical messenger’ called glutamate, which can be overactive in Alzheimer’s. Memantine is a tablet that is taken once a day. It can cause side-effects including headache, constipation and dizziness.

Other medicines that may be used in Alzheimer’s

Around nine out of 10 people diagnosed with dementia will have some sort of emotional distress or behavioural disturbance at some point.

As many as half of people diagnosed with dementia will also have depression. Doctors don’t usually prescribe antidepressants for people with Alzheimer’s who have mild-to-moderate depression. They’ll recommend trying counselling and therapies such as cognitive behavioural therapy (CBT) instead. If the depression gets very bad, a doctor may suggest trying a course of antidepressants for three to six months. It’s important that doctors don’t prescribe too many medicines for older people, so they would stop the antidepressants if they’re not helping.

Doctors used to treat agitation and aggressive behaviour with medicines called anti-psychotics. But we now know that these medicines are much more likely to cause side-effects in older people, especially if they have Alzheimer’s disease. So anti-psychotic medicines are now less likely to be prescribed. If someone has behavioural problems, their doctor is are more likely to prescribe medicines such as acetylcholinesterase inhibitors and suggest calming, relaxing therapies.

Other therapies for Alzheimer’s disease

Several therapies may help people with mild-to-moderate Alzheimer’s symptoms.

  • Talking therapies such as cognitive behavioural therapy may help them to share how they’re feeling. This may help with anxiety and depression.
  • Cognitive rehabilitation or occupational therapy may help them carry on doing their usual everyday tasks. In cognitive rehabilitation, a therapist sets goals for the person with dementia 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 that may help their memory and social interactions with other people.
  • Group reminiscence therapy uses objects from daily life and may help to stimulate their memory.

 

People with mild-to-moderate Alzheimer’s disease may find that complementary therapies such as aromatherapy can help them relax. Aromatherapy and massage may also help difficult symptoms such as agitation as the dementia gets worse. But there’s not enough research yet for doctors to recommend aromatherapy and massage for people with Alzheimer’s disease. National Institute for Health and Care Excellence (NICE) guidelines don’t recommend acupuncture or herbal remedies for people with Alzheimer’s disease.

There are lots of other ways that carers, family and friends may be able to help people with early Alzheimer’s disease. These include:

  • making changes to how they live so it’s easier for them to do things for themselves
  • helping them treat or manage other health problems that are affecting their daily life
  • encouraging them to stay as active as possible
  • making sure they’re getting enough sleep at night try limiting daytime naps and giving them a milky drink before bedtime
  • helping them remember things, with reminder notes and lists
  • making sure they can communicate properly with their carers and healthcare professionals
  • helping them get their hearing and vision checked regularly

 

Dementia symptoms can cause a lot of stress and upset for carers and families. If you’re looking after someone with dementia, there is lots of support available for you through charities and local support groups. It’s important to look after your own physical and mental health. So, if you’re struggling, speak to a GP or a counsellor. Carers can have training to help them care for someone with Alzheimer’s disease, including planning enjoyable activities to do together.

Causes of Alzheimer’s disease

Doctors don’t fully understand what causes Alzheimer’s disease. But they do know that the disease can be caused by some changes in the brain, especially as people get older.

Alzheimer’s disease may be caused by an abnormal build-up of proteins in and around brain cells. One of these proteins is called amyloid – it forms plaques around brain cells. Another protein, called tau, forms tangles inside brain cells. Doctors don’t know exactly why these proteins build up.

Alzheimer’s disease seems to affect how nerve cells in the brain:

  • communicate with each other
  • repair themselves
  • work properly

 

Alzheimer’s disease causes some parts of the brain to get smaller (shrink). This is caused by nerve cells dying in these parts of the brain.

Inside normal brain cells are protein fibres that run in straight lines. These fibres are the ‘transport system’ of the cell. But inside cells damaged by Alzheimer’s, these protein fibres are twisted and tangled. Once the fibres get tangled, the cells die. The more of these tangles there are, the worse the Alzheimer’s symptoms generally get.

In Alzheimer's disease, there’s also an abnormal build-up of a particular type of protein in the brain. Normal nerve cells work by sending chemical signals to each other via ‘chemical messengers’. 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 cells in the brain, so they can’t work anymore.

Preventing Alzheimer's disease

It’s not possible to avoid some of the risk factors for dementia – for example, family history. But there may be some changes that can help reduce the risk of dementia later in life. It may help to:

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Related information

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  • Reviewed by Victoria Goldman, Freelance Health Editor, January 2022
    Expert reviewers, Dr Daniel Edward Anderson, Consultant Psychiatrist, Dr Naveen Puri, Bupa Clinics GP and Lead Physician, and Adrian Raby, General Practitioner
    Next review due January 2025

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