Alzheimer’s disease

Your health experts: Dr Daniel Edward Anderson, Consultant Psychiatrist, Dr Naveen Puri, Bupa Clinics GP and Lead Physician, and Adrian Raby, General Practitioner
Content editor review by Victoria Goldman, January 2022
Next review due January 2025

Alzheimer’s disease affects the brain and is the most common cause of dementia. Dementia can causes 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 gets worse over time, changing personality and behaviour. People find it increasingly difficult to manage and communicate.

As people get older, Alzheimer’s becomes more common, particularly above 60. Around one in every 100 (1%) people has Alzheimer’s by the age of 60. By the age of 85, around 40 in every 100 (40%) have it.

More women than men are diagnosed. But this may be because women generally live longer.

Causes of Alzheimer’s disease

Doctors don’t fully understand what causes Alzheimer’s. It’s related to changes in the brain, especially as people get older.

Alzheimer’s may be caused by an abnormal build-up of proteins which affects how brain cells work, communicate and repair themselves.

One of these proteins is called amyloid, which forms plaques around brain cells. Other long ‘tau’ protein fibres normally act as the transport system of cells. In Alzheimer’s these fibres become twisted and tangled inside brain cells. The more of these tangles there are, the more cells die and 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 in Alzheimer’s disease, affecting how well some chemical messengers work.

Early onset dementia (before age 60) is more likely to affect people with a family history of Alzheimer’s. Alzheimer’s may be more likely to affect people who’ve had a head injury or depression in the past. Alzheimer’s has also been linked to some lifestyle factors, such as smoking and being overweight in middle age – see our Preventing Alzheimer’s disease section for more information.

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 usual activities and hobbies. They may get forget familiar places and start to get lost. In early stages, people realise they’re having memory problems, causing 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 mentioned above, they may develop depression or mood swings. In the later stages, they may start ‘wandering’ and walking off by themselves.

Other symptoms can include:

  • sleep problems
  • agitation and aggression towards others
  • problems going to the loo (incontinence)
  • losing interest in eating and drinking
  • hallucinations and delusions
  • problems moving around, leading to falls and broken bones

If someone with Alzheimer’s suddenly gets even more confused than usual, it’s important that they get seen by a doctor. Sudden confusion may be caused by an untreated infection, constipation or pain.

Diagnosing Alzheimer’s disease

Diagnosing dementia can be difficult. Early symptoms can be hard to spot and come on slowly. Doctors need 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 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, especially if a relative had it before they reached the age of 60. 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 tests for:

  • infections
  • liver problems
  • thyroid problems (the thyroid makes hormones)
  • 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 tests - answering questions or doing simple tasks

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How Alzheimer’s disease progresses

Alzheimer’s is a long-term condition that gradually gets worse over time. How quickly it 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 in some people. In others it takes closer to 10 years.

There may be long periods where there’s no noticeable change. 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, managing money and transport.

Memory and orientation difficulties mean that anything needing planning can be a problem. People increasingly need help managing day-to-day life, including basic daily care, such as washing and dressing. Eventually 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 infections, which can make confusion worse.
  • have difficulty swallowing, which can lead to inhaling food or drink, causing pneumonia.
  • lose a lot of weight if they’re not eating properly.

Treatment of Alzheimer's disease

Unfortunately, Alzheimer’s disease can’t be cured. Treatments aim 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 remembering 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 symptoms for a year or so. Memory may get noticeably better in some people, but this isn’t always the case.

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

The medicines have to be prescribed by a specialist. They are tablets or capsules you swallow once or twice a day. Or You take donepezil 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. You may find it helpful to download our medicines planner for dementia carers (PDF, 0.08MB).

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 your specialist first. Even if dementia is worsening, they may still be slowing it down.

Medicines for later stage Alzheimer’s

Memantine (Ebixa) is for moderate to severe Alzheimer’s. It may be prescribed when medicines for earlier stage dementia don’t seem to be helping anymore. The doctor may suggest memantine as well as, or instead of, these other 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 that may be used in Alzheimer’s

Around nine out of 10 people with dementia have some sort of emotional distress or behavioural disturbance at some point. 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 suggestf antidepressants for three to six months, to see if they help..

It’s important that older people don’t take too many medicines. Doctors used to treat agitation and aggressive behaviour with medicines called anti-psychotics. But these cause side-effects in older people, especially with Alzheimer’s. So these days they are more likely to prescribe the Alzheimer’s medicines listed above 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. Sharing how they’re feeling helps people with anxiety and depression.
  • Cognitive rehabilitation or occupational therapy helps to maintain usual everyday tasks. In cognitive rehabilitation, goals are set 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 to help memory and social interactions.
  • Group reminiscence therapy stimulates memory with objects from daily life.

Complementary therapies, can help with relaxation. Aromatherapy and massage may also help with difficult symptoms, such as agitation. 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.

Other ways carers, family and friends can help with early Alzheimer’s include:

  • finding ways to make it easier for people to do things for themselves
  • managing other health problems that are affecting their daily life
  • encouraging them to stay as active as possible
  • encouraging sleep at night – try limiting daytime naps and a milky drink before bed
  • providing reminder notes and lists
  • helping them communicate with carers and healthcare professionals
  • checking hearing and vision 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. So if you’re struggling, speak to a GP or a counsellor. There are even training courses to help you manage, including planning enjoyable activities to do together.

Preventing Alzheimer's disease

Some dementia risk factors are unavoidable, such as family history. But some lifestyle changes may reduce the risk of dementia later in life:

Alzheimer’s is a disease of the 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.

Alzheimer’s disease is caused by changes in the brain, especially from ageing. It affects how well nerve cells work, communicate and repair themselves. For more information, see our section: Causes of Alzheimer’s disease.

Many dementia patients need 24-hour care eventually. When this is necessary will vary between people. It depends how well they can look after themselves. For more information, see our How Alzheimer’s disease develops section.

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