Introduction

Everyone forgets things from time to time. Occasionally misplacing keys, forgetting a name, or remembering a birthday two weeks late is not cause for alarm. But when memory lapses become routine and start to interfere with a person's normal daily activities and relationships, it may be Alzheimer's disease. Early diagnosis and treatment cannot reverse or cure Alzheimer's disease, but can relieve symptoms and provide a better quality of life for those afflicted and for their caregivers.

What is Alzheimer's disease?

Alzheimer's disease is the most common cause of dementia (a condition of deteriorating memory and mental functioning) among adults age 65 and older. For unknown reasons, some people suffer gradual deterioration of brain cells that causes irreversible nerve damage in areas that are vital to memory, decision-making and other mental abilities. An estimated 4 million Americans suffer from Alzheimer's disease.

Nearly 10 percent of all people over age 65 and up to half of those over age 85 are thought to have Alzheimer's disease or another dementia. As the population of older Americans increases, so will the number of people with Alzheimer's disease.

What are symptoms of the disease?

People developing Alzheimer's disease might have trouble remembering familiar names and faces, recent activities, today's date or what they ate for breakfast. Family and friends often don't notice early symptoms of Alzheimer's disease because they begin as imperceptible behavior and personality changes and slowly worsen. Other times, these symptoms are dismissed as part of the normal aging process. But Alzheimer's disease symptoms are not normal aging.

A person in the early stages of Alzheimer's disease can continue to carry on with regular day-to-day activities. This makes recognizing Alzheimer's disease even more difficult. Later, the symptoms become more noticeable and begin to interfere with the person's everyday life.

As the disease advances, it may cause drastic changes in mood and judgment and loss of physical coordination. Ideally, the disease will be diagnosed before these changes begin occurring. If family or friends suspect that a person has Alzheimer's disease, they should take him or her to a physician as soon as possible. A complete psychiatric evaluation and medical exam can determine whether these symptoms are actually Alzheimer's disease or another disorder. In either case, early treatment can ease the suffering. And if it is Alzheimer's disease, early diagnosis will make it easier to cope with the disease later on.

When someone has Alzheimer's disease, changes in otherwise normal behavior may be symptoms of the disease. Recognizing symptoms of Alzheimer's disease is not always easy. However, below are some common symptoms to look for, ranging from mild to severe.

Mild Symptoms

• frequent memory lapses
• inability to perform everyday tasks
• confusion and disorientation in familiar surroundings
• noticeable personality changes (agitation, anxiety or depression)

Moderate Symptoms

• lapses in speech
• needs help with bathing, grooming and hygiene
• inability to recognize family and friends
• disturbing behavior (aggression)

Severe Symptoms

• slowed or incomprehensible speech
• loss of bladder/bowel control
• increased/total dependence on caregiver

Who is at risk?

Increasing age and family history of Alzheimer's disease are the most important risk factors associated with the development of the disease. With few exceptions, researchers believe Alzheimer's disease is not caused by any single factor or gene, but by a combination of factors acting together. Other risk factors that increase a person's likelihood of developing Alzheimer's disease include head injury that causes loss of consciousness, cardiovascular disease and low educational levels. Older women are at somewhat higher risk for Alzheimer's disease than men.

By studying different ethnic, racial and social groups, scientists continue to identify risk factors and their role in Alzheimer's disease. These findings can help reveal origins of the disease and how it progresses, which may eventually lead to prevention strategies and early treatment of the illness -- and someday lead to a cure.

How does the doctor know if it's Alzheimer's disease?

The only absolute means of diagnosing Alzheimer's disease is recognizing symptoms -- then confirming it after death through an autopsy. Doctors have developed other reliable means to determine if a patient has Alzheimer's disease -- with 85 to 90 percent accuracy. They carefully review a patient's symptoms, record a thorough medical history and conduct a complete medical examination. This exam might include a medical, psychiatric and neurological evaluation, along with other tests appropriate for diagnosing Alzheimer's disease, and ruling out other forms of dementia that can mimic it. The earlier and more accurate the diagnosis, the greater chance of managing the course of the disease.

What treatments are available?

Currently, there is no treatment that can stop or cure Alzheimer's disease. Some medications may help slow the disease and control behavioral symptoms, such as insomnia, irritability, anxiety and depression. Treating these symptoms can help the patient feel more comfortable and can make caregiving easier. People with Alzheimer's disease may not experience physical pain that is common in other medical illnesses, but they do require medical care and continued treatment just the same.

Research for a cure for Alzheimer's disease continues to challenge scientists, who persist in testing potential new treatments. In the meantime, understanding the disease and how to care for someone with it can reduce stress for the patient and family members. Geriatric psychiatrists, specialists in Alzheimer's disease, are medical doctors specially trained to help Alzheimer's patients and family members.

What are geriatric psychiatrists and how can they help?

A geriatric psychiatrist's training includes additional clinical and educational requirements beyond those of general psychiatrists. These specialists -- often in combination with primary care doctors and other health professionals -- provide care for and manage the unique needs of seniors facing illnesses such as Alzheimer's disease, depression and anxiety. Geriatric psychiatrists also can help family members cope with the psychological toll of caregiving.

Caring for the patient

Ensuring that someone with Alzheimer's disease feels mentally and physically secure is an important and meaningful part of caregiving.

People with Alzheimer's disease need help minimizing confusion and maintaining a sense of stability and comfort in their lives. Establishing a daily routine in familiar surroundings is one way to help. It is also important to provide nourishing meals on a regular schedule for proper nutrition and optimal health. Keeping patients in touch with family and friends and reminding them of past memories, current events and important dates are good mental exercises.

Safeguarding the home is important for preventing accidents. Caregivers can remove rugs and cords that cause falls, post a list of emergency numbers near the phone and keep alcohol and hazardous substances out of reach. Other safety precautions include placing sharp or breakable objects out of reach, keeping the temperature at a constant, comfortable level and guarding against electrical hazards.

There are many ways to reassure and comfort someone with Alzheimer's disease. One of the most important things a caregiver can do is to obtain as much information about the disease as possible and identify community resources. Good places to start are local support groups, information clearinghouses and Alzheimer's care resources, which can explain what to expect throughout the illness (see below for a list of resources).

Caring for the caregiver

Caring for someone with Alzheimer's disease can be a meaningful experience. It can also be exhausting, overwhelming and physically and emotionally draining. Most of the caregiver's time and attention is devoted to the Alzheimer's patient, which leaves little or no time for caregivers to spend on themselves. As a result, they may neglect their own needs for emotional support and respite, or they may recognize these needs but be unsure how or where to get help. For these reasons, the caregiver is often called the second, or silent, victim of Alzheimer's disease.

It is common for caregivers to experience fatigue, anxiety, irritability, anger, depression, social withdrawal or health problems. They must learn to recognize these symptoms and seek medical attention or emotional support to maintain optimal health and well-being. Too much stress can be detrimental to the caregiver and the patient, which is why it is critical to seek help early (see below for a list of resources).

Other considerations

Family members can alleviate stress by planning ahead for the financial, legal and emotional considerations that arise as the disease progresses in an Alzheimer's patient. Consulting an attorney or financial adviser about such issues as future medical care, power of attorney, a living will, assets, debts and other considerations can help ensure that the patient's personal affairs are organized and in place ahead of time. Whatever the patient's financial situation, a financial adviser can help develop a plan to assist the patient and family in preparing for the financial complications that can accompany a long-term illness.