CARE GUIDE Alzheimer's Disease

Alzheimer's Disease

Alzheimer’s disease is the most common form of dementia— a brain disorder that affects a person's ability to carry out daily activities.

In the beginning stages, Alzheimer’s disease affects the parts of the brain that control thought, memory and language. Those with the disease may have trouble remembering recent events or peoples’ names. As symptoms gets worse, patients may not recognize family members, have communication difficulties, and forget how to do day-to-day tasks like brushing their teeth or getting dressed. Later stages of AD may include anxiety or aggression. Eventually, AD patients need complete care.

Alzheimer’s disease usually begins after age 60. Your risk is also higher if a family member has had the disease.

There is no cure for Alzheimer’s disease, but some drugs may delay the progression of symptoms.

Doctors and Specialists

Patients with Alzheimer’s disease (AD) may see a variety of doctors and specialists, each focused on a different aspect of care. The following providers may make up the care team for a patient with AD:

Neurologist: This doctor deals with disorders of the nervous system. A neurologist will help to rule out other nervous system disorders that have similar symptoms to Alzheimer’s disease.

Psychiatrist: A doctor who treats disorders that affect mood or the way mind works. A psychiatrist often helps the AD patient control mood swings associated with the disease. They usually provide medical interventions and drug therapies rather than analysis and counseling.

Psychologist: A clinician with special training in testing memory loss and other mental functions. They may help prevent and relieve psychologically-based distress or dysfunction associated with AD.

Geriatric Doctor: An internist who has special knowledge of the aging process and special skills in treating illness in the elderly. This specialist cares for geriatric patients in the home, office and long-term care settings such as nursing homes.

Prepare for Your Appointment

After you or a loved one makes an appointment for Alzheimer’s disease (AD) treatment, there are some steps you can take to make your visit a smooth one:

  • Be aware of any pre-appointment restrictions. When you make your appointment, ask if you need to fast for blood work or if you need to do anything else to prepare for tests.
  • Write down all of your symptoms. Your doctor will want to know details about possible memory loss or problems with mental function. Make notes about some of the most important examples of forgetfulness or other lapses you’ve experienced. Try to remember when you first started to suspect that something might be wrong. If you think your difficulties are getting worse, be ready to explain why.
  • Take along a family member or friend, if possible. They can help to explain problems you may not remember. Having someone along can also help you to remember all of the information the doctor gives you during your appointment.
  • Make a list of your other medical problems. Your doctor will want to know if you’re currently being treated for diabetes, heart disease, past strokes or any other conditions.
  • Make a list of all your medications. Include over-the-counter drugs and vitamins or supplements that you take regularly. Note the dosage of each drug you take.

Questions to Ask

After you are diagnosed with Alzheimer’s disease, you’ll probably have some questions. This list can help you figure out what you should ask. Look it over before your next appointment, or print it out to bring with you.

  • Do I have a memory loss problem or other cognitive changes?
  • Do you think my memory loss symptoms could be caused by another condition besides Alzheimer’s disease?
  • What tests do I need?
  • Do I need to see a specialist? What will that cost? Will my insurance cover it?
  • Will my symptoms affect how I manage my other health conditions?
  • Are treatments available for Alzheimer’s disease?
  • Is there a generic alternative to the medicine you’re prescribing?
  • Are there any clinical trials of experimental treatments I should consider?
  • Will you or another doctor manage my ongoing care? Can you help me get a plan in place for ongoing care?
  • What should I expect to happen over the long term?
  • Do I need to follow any restrictions?
  • What changes should I make to my routine?
  • Is Alzheimer’s disease genetic?

Tests and Diagnosis

There is no one test that can diagnose early stages of Alzheimer’s disease (AD). A diagnosis is based solely on the symptoms the patient is experiencing. Doctors may perform tests to rule out other conditions and diseases that may be contributing to memory loss.

Severe and late stages of AD can be diagnosed by a change in brain size due to the deterioration of cells.

Brain Image Tests

  • Computerized Tomography (CT) scan: Brain x-rays to detect tumors, stokes and head injuries.
  • Magnetic Resonance Imaging (MRI) test: Rules out other conditions that may account for symptoms. Helps detect shrinkage of brain cells in late stages of AD. Radio waves and strong magnets produce images of the brain with more detail than the CT test.
  • Positron Emission Tomography (PET) scan: Helps detect brain areas that are not working and records the level of plaque in the brain, which is used to detect and monitor AD. Low-level radioactive tracer is injected into a vein, and the scanner tracks the flow to the brain

Lab Tests

  • Thyroid function test and vitamin deficiency test: To rule out thyroid disorders and vitamin deficiencies, which can cause memory loss.
  • Neurological Examination: To rule neurological disorders that have similar symptoms to AD. Physical exam is done to test reflexes, muscle tone and strength, coordination and balance.
  • Mental Status Testing: To assess level of memory loss and other skills. Several tasks are given by physician, like naming the date and current location, following written instructions, and writing complete sentence.
  • Neuropsychological Testing: More extensive test of thinking and memory skills. May take several hours to complete. These tests help identify patterns associated with different types of dementia.

Medications and Treatment

There is no cure for Alzheimer’s, but some memory loss medications help delay progression symptoms. Some common types include:

  • Cholinesterase Inhibitors: Increases the levels of acetylcholine (a brain chemical important for memory and thinking) in the brain; reduces the progression of symptoms by 6-12 months
  • Memantine: Treats memory loss, confusion and problems with thinking and reasoning
  • Vitamin E: This antioxidant is thought to protect nerve cells from damage. It is usually combined with other medications.

Depending on the severity of behavioral and mood changes in Alzheimer’s patients, the following drugs may also be prescribed:

  • Antidepressants: Treats irritability and mood swings
  • Anxiolytics: Treats restlessness and anxiety
  • Antipsychotics: Treats hallucinations, delusions, agitation and aggression