Alzheimer’s & Dementia
Worldwide, 50 million people are living with Alzheimer’s and other dementias.
Alzheimer’s disease is a degenerative brain disease and the most common form of dementia. Dementia is not a specific disease. It’s an overall term that describes a group of symptoms.
What is Dementia?
Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Memory loss is an example. Alzheimer’s is the most common type of dementia.
What is Alzheimer’s?
Alzheimer’s is a type of dementia that causes problems with memory, thinking and behaviour. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks.
Alzheimer’s and dementia facts
- Alzheimer’s is the most common cause of dementia, a general term for memory loss and other cognitive abilities serious enough to interfere with daily life. Alzheimer’s disease accounts for 60 percent to 80 percent of dementia cases.
- Alzheimer’s is not a normal part of ageing. The greatest known risk factor is increasing age, and the majority of people with Alzheimer’s are 65 and older. But Alzheimer’s is not just a disease of old age.
- Alzheimer’s worsens over time. Alzheimer’s is a progressive disease, where dementia symptoms gradually worsen over a number of years. In its early stages, memory loss is mild, but with late-stage Alzheimer’s, individuals lose the ability to carry on a conversation and respond to their environment. On average, a person with Alzheimer’s lives four to eight years after diagnosis but can live as long as 20 years, depending on other factors.
- Alzheimer’s has no current cure, but treatments for symptoms are available and research continues. Although current Alzheimer’s treatments cannot stop Alzheimer’s from progressing, they can temporarily slow the worsening of dementia symptoms and improve quality of life for those with Alzheimer’s and their caregivers.
- Today, there is a worldwide effort under way to find better ways to treat the disease, delay its onset, and prevent it from developing.
Symptoms of Alzheimer’s
The most common early symptom of Alzheimer’s is difficulty remembering newly learned information.
Just like the rest of our bodies, our brains change as we age. Most of us eventually notice some slowed thinking and occasional problems with remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work may be a sign that brain cells are failing.
The most common early symptom of Alzheimer’s is difficulty remembering newly learned information because Alzheimer’s changes typically begin in the part of the brain that affects learning. As Alzheimer’s advances through the brain it leads to increasingly severe symptoms, including disorientation, mood and behaviour changes; deepening confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more serious memory loss and behaviour changes; and difficulty speaking, swallowing and walking.
People with memory loss or other possible signs of Alzheimer’s may find it hard to recognize they have a problem. Signs of dementia may be more obvious to family members or friends. Anyone experiencing dementia-like symptoms should see a doctor as soon as possible.
Earlier diagnosis and intervention methods are improving dramatically, and treatment options and sources of support can improve quality of life.
Alzheimer’s Tests & Diagnosis
There is no single test that proves a person has Alzheimer’s. While physicians can almost always determine if a person has dementia, it may be difficult to determine the exact cause. Diagnosing Alzheimer’s involves a complete assessment that considers all possible causes.
During the medical workup, your doctor will review your medical history. He or she will want to know about any current and past illnesses, as well as any medications you are taking. The doctor will also ask about key medical conditions affecting other family members, including whether they may have had Alzheimer’s disease or other dementias.
Physical exam and diagnostic tests
During a medical workup, you can expect the physician to:
- Ask about diet, nutrition and use of alcohol.
- Review all medications. (Bring a list or the containers of all medicines currently being taken, including over-the-counter drugs and supplements.)
- Check blood pressure, temperature and pulse.
- Listen to the heart and lungs.
- Perform other procedures to assess overall health.
- Collect blood or urine samples for laboratory testing
Information from a physical exam and laboratory tests can help identify health issues that can cause symptoms of dementia. Conditions other than Alzheimer’s that may cause confused thinking, trouble focusing or memory problems include anaemia, infection, diabetes, kidney disease, liver disease, certain vitamin deficiencies, thyroid abnormalities, and problems with the heart, blood vessels and lungs.
During a neurological exam, the physician will closely evaluate the person for problems that may signal brain disorders other than Alzheimer’s. The doctor will look for signs of small or large strokes, Parkinson’s disease, brain tumours, fluid accumulation on the brain, and other illnesses that may impair memory or thinking.
The physician will test:
- Coordination, muscle tone and strength.
- Eye movement.
The neurological exam may also include a brain imaging study.
Mental status tests
Mental status testing evaluates memory, ability to solve simple problems and other thinking skills. Such tests give an overall sense of whether a person:
- Is aware of symptoms.
- Knows the date, time, and where he or she is.
- Can remember a short list of words, follow instructions and do simple calculations.
Mini-Mental State Exam (MMSE) and the Mini-Cog test
The MMSE and Mini-Cog test are two commonly used assessments.
During the MMSE, a health professional asks a patient a series of questions designed to test a range of everyday mental skills. The maximum MMSE score is 30 points. A score of 20 to 24 suggests mild dementia, 13 to 20 suggest moderate dementia, and less than 12 indicates severe dementia. On average, the MMSE score of a person with Alzheimer’s declines about two to four points each year.
During the Mini-Cog, a person is asked to complete two tasks:
- Remember and a few minutes later repeat the names of three common objects.
- Draw the face of a clock showing all 12 numbers in the right places and time specified by the examiner.
The results of this brief test can help a physician determine if further evaluation is needed.
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A growing area of research is the development of devices to administer computer-based tests of thinking, learning and memory, called cognitive tests.
The U.S. Food and Drug Administration (FDA) has cleared several computerized cognitive testing devices for marketing. Some physicians use computer-based tests such as these in addition to the MMSE and Mini-Cog. Computerized tests have several advantages, including giving tests exactly the same way each time. Using both clinical tests and computer-based tests can give physicians a clearer understanding of the cognitive difficulties experienced by patients.
In addition to assessing mental status, the doctor will evaluate a person’s sense of well-being to detect depression or other mood disorders that can cause memory problems, loss of interest in life, and other symptoms that can overlap with dementia.
A standard medical workup for Alzheimer’s disease often includes structural imaging with magnetic resonance imaging (MRI) or computed tomography (CT). These tests are primarily used to rule out other conditions that may cause symptoms similar to Alzheimer’s but require different treatment. Structural imaging can reveal tumors, evidence of small or large strokes, damage from severe head trauma, or a build up of fluid in the brain.
Imaging technologies have revolutionized our understanding of the structure and function of the living brain. Researchers are studying other brain imaging techniques so they can better diagnose and track the progress of Alzheimer’s.
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