Alzheimer’s disease is a progressive disease that destroys memory and other important mental functions. At first, someone with Alzheimer’s disease may notice mild confusion and difficulty remembering. Eventually, people with the disease may even forget important people in their lives and undergo dramatic personality changes.
If you have Alzheimer’s, you may be the first to notice that you’re having unusual difficulty remembering things and organizing your thoughts. Or you may not recognize that anything is wrong, even when changes are noticeable to your family members, close friends or co-workers.
Everyone has occasional memory lapses. It’s normal to lose track of where you put your keys or forget the name of an acquaintance. But the memory loss associated with Alzheimer’s disease persists and worsens, affecting your ability to function at work and at home.
People with Alzheimer’s may:
- Repeat statements and questions over and over, not realizing that they’ve asked the question before
- Forget conversations, appointments or events, and not remember them later
- Routinely misplace possessions, often putting them in illogical locations
- Get lost in familiar places
- Eventually forget the names of family members and everyday objects
- Have trouble finding the right words to identify objects, express thoughts or take part in conversations
Thinking and reasoning
Alzheimer’s disease causes difficulty concentrating and thinking, especially about abstract concepts like numbers. Multitasking is especially difficult, and it may be challenging to manage finances, balance checkbooks and pay bills on time. These difficulties may progress to inability to recognize and deal with numbers.
Making judgments and decisions
Responding effectively to everyday problems, such as food burning on the stove or unexpected driving situations, becomes increasingly challenging.
Planning and performing familiar tasks
Once-routine activities that require sequential steps, such as planning and cooking a meal or playing a favorite game, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer’s may forget how to perform basic tasks such as dressing and bathing.
Changes in personality and behavior
Brain changes that occur in Alzheimer’s disease can affect the way you act and how you feel. People with Alzheimer’s may experience:
- Social withdrawal
- Mood swings
- Distrust in others
- Irritability and aggressiveness
- Changes in sleeping habits
- Loss of inhibitions
- Delusions, such as believing something has been stolen
Many important skills are not lost until very late in the disease. These include the ability to read, dance and sing, enjoy old music, engage in crafts and hobbies, tell stories and reminisce. This is because information, skills and habits learned early in life are among the last abilities to be lost as the disease progresses; the part of the brain that stores this information tends to be affected later in the course of the disease. Capitalizing on these abilities can foster successes and maintain quality of life even into the moderate phase of the disease.
Drugs. Current Alzheimer’s medications can help for a time with memory symptoms and other cognitive changes. Two types of drugs are currently used to treat cognitive symptoms:
- Cholinesterase inhibitors. These drugs work by boosting levels of a cell-to-cell communication by providing a neurotransmitter (acetylcholine) that is depleted in the brain by Alzheimer’s disease. The improvement is modest. Cholinesterase inhibitors can improve neuropsychiatric symptoms, such as agitation or depression, as well.
Commonly prescribed cholinesterase inhibitors include donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon). The main side effects of these drugs include diarrhea, nausea, loss of appetite and sleep disturbances. In people with cardiac conduction disorders, serious side effects may include a slow heart rate and heart block.
- Memantine (Namenda). This drug works in another brain cell communication network and slows the progression of symptoms with moderate to severe Alzheimer’s disease. It’s sometimes used in combination with a cholinesterase inhibitor. Side effects may include constipation, dizziness and headache.
Sometimes other medications such as antidepressants are used to help control the behavioral symptoms associated with Alzheimer’s disease. But some medications should only be used with great caution. For example, some common sleep medications—zolpidem (Ambien), eszopiclone (Lunesta) and others—may increase confusion and the risk of falls.
Anti-anxiety medications—clonazepam (Klonopin) and lorazepam (Ativan)—increase the risk of falls, confusion and dizziness. Always check with your doctor before taking any new medications.
Creating a safe and supportive environment. Adapting the living situation to the needs of a person with Alzheimer’s is an important part of any treatment plan. For someone with Alzheimer’s, establishing and strengthening routine habits and minimizing memory-demanding tasks can make life much easier.
You can take these steps to support a person’s sense of well-being and continued ability to function:
- Always keep keys, wallets, mobile phones and other valuables in the same place at home, so they don’t become lost.
- See if your doctor can simplify your medication regimen to once-daily dosing, and arrange for your finances to be on automatic payment and automatic deposit.
- Develop the habit of carrying a mobile phone with location capability so that you can call in case you are lost or confused and people can track your location via the phone. Also, program important phone numbers into your phone, so you don’t have to try to recall them.
- Make sure regular appointments are on the same day at the same time as much as possible.
- Use a calendar or whiteboard in the home to track daily schedules. Build the habit of checking off completed items so that you can be sure they were completed.
- Remove excess furniture, clutter and throw rugs.
- Install sturdy handrails on stairways and in bathrooms.
- Ensure that shoes and slippers are comfortable and provide good traction.
- Reduce the number of mirrors. People with Alzheimer’s may find images in mirrors confusing or frightening.
- Keep photographs and other meaningful objects around the house.
Exercise. Regular exercise is an important part of everybody’s wellness plan—and those with Alzheimer’s are no exception. Activities such as a daily walk can help improve mood and maintain the health of joints, muscles and the heart.
Exercise can also promote restful sleep and prevent constipation. Make sure that the person with Alzheimer’s carries identification or wears a medical alert bracelet if she or he walks unaccompanied.
People with Alzheimer’s who develop trouble walking may still be able to use a stationary bike or participate in chair exercises. You may be able to find exercise programs geared to older adults on TV or on DVDs.
Nutrition. People with Alzheimer’s may forget to eat, lose interest in preparing meals or not eat a healthy combination of foods. They may also forget to drink enough, leading to dehydration and constipation.
- High-calorie, healthy shakes and smoothies. You can supplement milkshakes with protein powders (available at grocery stores, drugstores and discount retailers) or use your blender to make smoothies featuring your favorite ingredients.
- Water, juice and other healthy beverages. Try to ensure that a person with Alzheimer’s drinks at least several full glasses of liquids every day. Avoid beverages with caffeine, which can increase restlessness, interfere with sleep and trigger a frequent need to urinate.
Certain nutritional supplements are marketed as “medical foods” specifically to treat Alzheimer’s disease. The Food and Drug Administration (FDA) does not approve products marketed as medical foods. Despite marketing claims, there’s no definitive data showing that any of these supplements is beneficial or safe.
Alternative medicine. Various herbal mixtures, vitamins and other supplements are widely promoted as preparations that may support cognitive health or prevent or delay Alzheimer’s. Currently, there’s no strong evidence that any of these therapies slow the progression of cognitive decline.
Some of the treatments that have been studied recently include:
- Omega-3 fatty acids. Omega-3 fatty acids in fish may help prevent cognitive decline. Studies done on fish oil supplements haven’t shown any benefit, however.
- Curcumin. This herb comes from turmeric and has anti-inflammatory and antioxidant properties that might affect chemical processes in the brain. So far, clinical trials have found no benefit for treating Alzheimer’s disease.
- Ginkgo. Ginkgo is a plant extract containing several substances. A large study funded by the NIH found no effect in preventing or delaying Alzheimer’s disease.
- Vitamin E. Although vitamin E isn’t effective for preventing Alzheimer’s, taking 2,000 international units daily may help delay the progression in people who already have the disease. However, study results have been mixed, with only some showing this benefit. Further research into the safety of 2,000 international units daily of Vitamin E in a dementia population will be needed before it can be routinely recommended.
Supplements promoted for cognitive health can interact with medications you’re taking for Alzheimer’s disease or other health conditions. Work closely with your health care team to create a treatment plan that’s right for you. Make sure you understand the risks and benefits of everything it includes.