What is alzheimer's disease?

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What is Alzheimer's disease?
Alzheimer's disease is the most common cause of dementia, affecting around417,000 people in the UK. The term 'dementia' is used to describe thesymptoms that occur when the brain is affected by specific diseases andconditions. This factsheet outlines the symptoms and risk factors forAlzheimer's disease, and describes what treatments are currently available.
Alzheimer's disease, first described by the German neurologist AloisAlzheimer, is a physical disease affecting the brain. During the course of thedisease, 'plaques' and 'tangles' develop in the structure of the brain, leading tothe death of brain cells. People with Alzheimer's also have a shortage of someimportant chemicals in their brains. These chemicals are involved with thetransmission of messages within the brain.
Alzheimer's is a progressive disease, which means that gradually, over time,more parts of the brain are damaged. As this happens, the symptoms becomemore severe. Symptoms
People in the early stages of Alzheimer's disease may experience lapses ofmemory and have problems finding the right words. As the diseaseprogresses, they may: • become confused, and frequently forget the names of people, places, • experience mood swings. They may feel sad or angry. They may feel scared and frustrated by their increasing memory loss • become more withdrawn, due either to a loss of confidence or to As the disease progresses, people with Alzheimer's will need more supportfrom those who care for them. Eventually, they will need help with all their dailyactivities.
While there are some common symptoms of Alzheimer's disease, it isimportant to remember that everyone is unique. No two people are likely toexperience Alzheimer's disease in the same way. Mild cognitive impairment
Recently, some doctors have begun to use the term 'mild cognitive impairment'(MCI) when an individual has difficulty remembering things or thinking clearlybut the symptoms are not severe enough to warrant the diagnosis ofAlzheimer's disease. Recent research has shown that a small number ofindividuals with MCI have an increased risk of progressing to Alzheimer'sdisease. However, the conversion rate from MCI to Alzheimer's is small (about10-15 per cent), and consequently a diagnosis of MCI does not always meanthat the person will go on to develop Alzheimer's.
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What causes Alzheimer's disease?
So far, no one single factor has been identified as a cause for Alzheimer'sdisease. It is likely that a combination of factors, including age, geneticinheritance, environmental factors, diet and overall general health, areresponsible. In some people, the disease may develop silently for many yearsbefore symptoms appear and the onset of clinical disease may require atrigger.
Age is the greatest risk factor for dementia. Dementia affects one in 14 peopleover the age of 65 and one in six over the age of 80. However, Alzheimer's isnot restricted to elderly people: in the UK, there are 15,000 people under theage of 65 with dementia, although this figure is likely to be an underestimate. Genetic inheritance
Many people fear that they may inherit Alzheimer's disease, and scientists arecurrently investigating the genetic background to Alzheimer's.
We do know that there are a few families where there is a very clearinheritance of the disease from one generation to the next. This is often infamilies where the disease appears relatively early in life.
In the vast majority of cases, however, the effect of inheritance seems to besmall. If a parent or other relative has Alzheimer's disease, your own chancesof developing the disease are only a little higher than if there were no cases ofAlzheimer's in the immediate family.
However, carriers of the ApoE4 gene variant have a much higher chance ofdeveloping Alzheimer's disease. For more information see Factsheet 405,Genetics and dementia.
Environmental factors
The environmental factors that may contribute to the onset of Alzheimer'sdisease have yet to be identified. A few years ago, there were concerns thatexposure to aluminium might cause Alzheimer's disease. However, these fearshave largely been discounted.
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Other factors
Because of the difference in their chromosomal make-up, people with Down'ssyndrome who live into their 50s and 60s may develop Alzheimer's disease. People who have had severe head or whiplash injuries also appear to be atincreased risk of developing dementia. Boxers who receive continual blows tothe head are at risk too.
Research has also shown that people who smoke, and those who have highblood pressure or high cholesterol levels, increase their risk of developingAlzheimer's.
Getting a diagnosis
If you are concerned about your own health, or the health of someone close toyou, it is important to seek help from a GP. An early diagnosis will: • enable the person with dementia to benefit from the treatments that are now • help you identify sources of advice and support.
There is no straightforward test for Alzheimer's disease or for any other causeof dementia. A diagnosis is usually made by excluding other causes whichpresent similar symptoms. The GP will need to rule out conditions such asinfections, vitamin deficiency, thyroid problems, brain tumours, depression andthe side-effects of drugs.
Specialists
Your GP may ask a specialist for help in carrying out a diagnosis. Thespecialist may be an old-age psychiatrist, a neurologist, a physician in geriatricmedicine or a general psychiatrist. Who you see depends on the age of theperson being examined, how physically able they are, and how well servicesare developed in the local area.
The person being tested will usually be given a blood test and a full physicalexamination to rule out or identify any other medical problems. The person'smemory will be assessed, initially with questions about recent events and pastmemories. Their memory and thinking skills may also be assessed in detail bya psychologist.
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A brain scan may be carried out to give some clues about the changes takingplace in the person's brain. There are a number of different types of scan,including computerised tomography (CT) and magnetic resonance imaging(MRI).
Treatment
There is currently no cure for Alzheimer's disease. However, some drugtreatments are available that can ameliorate the symptoms or slow down thedisease progression in some people.
People with Alzheimer's have been shown to have a shortage of the chemicalacetylcholine in their brains. The drugs Aricept, Exelon and Reminyl (tradenames for the drugs donepezil hydrochloride, rivastigmine and galantamine,respectively) work by maintaining existing supplies of acetylcholine. Thesedrugs are available to people in the moderate stages of dementia, and at yourGP's discretion, for people in the early stages. Please refer to the NationalInstitute for Clinical Excellence (NICE) for guidance (see 'Useful organisations'at the end of this factsheet). Side-effects may include diarrhoea, nausea,insomnia, fatigue and loss of appetite.
A drug called Ebixa (trade name for the drug memantine) was launched in theUK in 2002. This drug works in a different way to the other three - it preventsthe excess entry of calcium ions into brain cells. Excess calcium in the braincells damages them and prevents them from receiving messages from otherbrain cells. Ebixa is the only drug that is suitable for use in people in the middleto later stages of dementia. Side-effects may include hallucinations, confusion,dizziness, headaches and tiredness.
These drugs are not a cure, but they may stabilise some of the symptoms ofAlzheimer's disease for a limited period of time.
Some evidence suggests that dietary supplements of antioxidants, such asvitamins D and C, can reduce the prevalence of Alzheimer's. However, morerecent studies have been unable to repeat this finding and further work isnecessary to clarify the role that dietary supplements have in Alzheimer'sdisease.
Caring for someone with dementia
Much can be done at a practical level to ensure that people with Alzheimer'slive as independently as possible for as long as possible. Alzheimer's Societyproduces information on a wide range of topics, including Factsheets 523,Carers: looking after yourself; 500, Communicating; 524, Understanding andrespecting the person with dementia; and 525, Unusual behaviour. See alsothe details for Carers UK in 'Useful organisations', below. Your local Alzheimer's Society branch will always be willing to talk to you andoffer advice and information to support your needs.
For more information, Dementia Catalogue, our specialist dementia informationresource, is available on the website at www.alzheimers.org.uk
Useful organisations
Alzheimer's Society
Devon House58 St Katharine's WayLondon E1W 1JXT 020 7423 3500E info@alzheimers.org.ukW alzheimers.org.uk Carers UK
20 Great Dover StreetLondon SE1 4LX T 0808 808 7777 (free carers' line, Wednesday and Thursday 10am-12pm and2pm-4pm)E info@ukcarers.orgW http://www.carersuk.org/ Provides information and advice to carers about their rights, and how to accesssupport.
National Institute of Clinical Excellence (NICE)
MidCity Place71 High HolbornLondonWC1V 6NA T 0845 003 7780E nice@nice.org.ukW http://www.nice.org.uk/ Provides national guidance on promoting good health and preventing andtreating ill health. It produces guidance on public health, health technologies,and on appropriate treatment and care of people with specific diseases andconditions within the NHS. For the most up-to-date information on Alzheimer'streatments, go to the website.
www.alzheimers.org.uk
Factsheet 401
Last updated: August 2008Last reviewed: August 2008 Reviewed by: Dr Nicholas MacInnes, Research Fellow, Alzheimer's Society

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