facts for health--alzheimer's--frequently asked questions

We can't control our family history or genetic makeup. We can take steps to minimize other risk factors. Head injury is a risk factor and this risk can be minimized, for example, by wearing a seat belt in cars and a helmet while bicycling. A high level of homocysteine is a risk factor and can be minimized by eating a balanced diet to ensure adequate levels of vitamin B₁₂, vitamin B₆ and folate (which lower levels of homocysteine). Some population-based (epidemiological) studies suggest that modest wine drinking and consumption of fish, as opposed to diets high in pork or beef, may prevent or delay onset of Alzheimer's disease. Similarly, diets high in antioxidants may reduce risk. Many fruits and vegetables, such as prunes, raisins, blueberries, broccoli and spinach, are natural sources of antioxidants. There is preliminary but inconclusive evidence suggesting that the statin drugs that lower cholesterol or the frequent use of anti-inflammatory drugs may also reduce risk of AD. Keeping our minds active with reading, discussion and other intellectual pursuits and our bodies active with aerobic exercise may also have preventive benefits.

Isn't loss of memory normal with aging?

Whether memory decline is a normal part of aging is now recognized as a question requiring careful research. While some note less sharpness of memory as they age (e.g. "senior moments"), others at the same age retain remarkable memory function. A condition called mild cognitive impairment (MCI) involves increased forgetfulness but not other features of Alzheimer's disease (such as difficulty finding words, disorientation, problems with planning, judgment and insight, depression, apathy and/or agitation). MCI may precede development of Alzheimer's disease (AD), though not everyone with MCI develops AD. Everyone forgets things occasionally, but those with Alzheimer's disease forget things all the time and eventually can't even remember what things are for. All experts now recognize that severe memory loss that interferes with day-to-day functioning is abnormal and a sign of serious illness.

Can Alzheimer's disease be fatal?

Alzheimer's disease (AD) is an illness that causes death by debilitating the individual and increasing susceptibility to other diseases, such as pneumonia, and to injuries often caused by falls. On average, death usually occurs 8 to 10 years after the initial diagnosis of AD.

Is Alzheimer's disease inherited?

Early-onset Alzheimer's disease (AD), which usually afflicts people in their 30's, 40's and 50's, can be inherited. Three different genes appear to be involved. However, this rare form of Alzheimer's disease has only been found in about 200 families worldwide.

Late-onset Alzheimer's disease, the most common form, usually begins after age 65. The risk of this late-onset Alzheimer's disease increases with increasing age. One allele or variant of the apolipoprotein E gene (APOE), epsilon 4 (ε4), is associated with increased risk of late-onset Alzheimer's disease. Each of us inherits one APOE gene from each parent. There are several APOE alleles or gene variations that can be inherited. In addition to ε4, there are ε2 and ε3 alleles. The possible inherited pairings (one gene from each parent) are ε2/ε2, ε2/ε3, ε2/ε4, ε3/ε3, ε3/ε4 and ε4/ε4. The presence of at least one APOE ε4 gene increases risk from approximately 9% to approximately 29%. People with two ε4 alleles are at even greater risk of developing AD, perhaps with an earlier age of onset. There are considerable racial and ethnic differences in distribution of these pairs with 2 to 3% of the population inheriting the ε4/ε4 pairing. Importantly, some people with two ε4 alleles never get the disease and others who do develop AD do not have any ε4 alleles. Only about one-half of AD patients have one or more APOE ε4 allele genes. Detection of these genes is currently not helpful in identifying those who will and those who will not develop AD. If one has a mother, father, brother or sister with Alzheimer's disease, there is an increased risk of Alzheimer's disease, regardless of whether or not the affected person had an APOE ε4 gene. How much of an increased risk cannot be accurately predicted.

Does the artificial sweetener aspartame cause Alzheimer's disease?

A myth has arisen regarding aspartame. Artificial sweeteners, the main source of aspartame, are alleged by some to cause memory loss. Numerous careful studies in animals and humans have found no scientific evidence that aspartame causes memory loss or Alzheimer's disease.

Is there a connection between aluminum and Alzheimer's disease?

Some metals, such as mercury and lead, are known to cause brain injury. This has triggered speculation about other metals, particularly aluminum, causing Alzheimer's disease (AD). Everyone's brain contains tiny amounts of aluminum. Aluminum is concentrated in plaques and tangles in AD brains. Most experts believe that aluminum is harmless, but some suggest aluminum may be involved in Alzheimer's disease in some way. It could be that aluminum buildup occurs after Alzheimer's disease damages nerve cells rather than aluminum being the cause of damage to nerve cells.

Arguments suggesting that aluminum may play some role in the development of Alzheimer's disease include aluminum's role in reactive oxygen species (also called free radicals). We form free radicals in our bodies throughout life. Usually the cells in the body deactivate these toxic particles. Excess free radicals damage proteins and are implicated in several diseases. In Alzheimer's disease, these free radicals may damage nerve cells. Aluminum changes the functioning of enzymes in the central nervous system. Some studies have shown that high concentrations of aluminum in drinking water are associated with increased risk of Alzheimer's disease. In contrast to this concern, careful studies have shown that regular use of antacids that contain vastly greater amounts of aluminum than water are not associated with increased risk of Alzheimer's disease.

It's easy to see how myths could occur about increased risk of AD from exposure to aluminum or food cooked in aluminum utensils. Stated simply, the amount of exposure to aluminum from cooking utensils, antacids or deodorants (which also contain aluminum) is not enough to cause Alzheimer's disease.

What about other metals as a possible cause of Alzheimer's disease?

There are credible hypotheses, but not yet conclusive proofs, that copper, iron and zinc may be involved in causing or worsening AD. The theory holds that an excess of these metals induces beta-amyloid precipitation and neurotoxicity. Removing excess metals should slow or possibly reverse beta-amyloid accumulation and slow the development or progression of AD.

Chelating agents, chemical compounds that bind to metals, may prevent metals from interacting with beta-amyloid. Two placebo-controlled studies of the chelating agent clioquinol in mice that develop beta-amyloid plaques produced marked reductions in the formation of beta-amyloid plaques. Mice that received clioquinol showed improvements in motor activity, alertness and general health. A controlled trial of clioquinol in humans with AD is nearing completion and the results are awaited with keen interest.

How does depression relate to Alzheimer's disease?

In many ways. Depression can be mistaken for Alzheimer's disease (AD) and depression often occurs with AD.

As depressive symptoms can mimic dementia symptoms, depression is sometimes confused with dementia. Depression can interfere with memory, thinking and ability to concentrate, causing what is sometimes called pseudodementia. Effective treatment of depression will normalize these impairments.

Depression may be the first indication of AD, especially if depression occurs for the first time late in life. Depression may begin after other signs of AD appear if the person is aware of mental losses and their implications for work, relationships, loss of independence and stigma. A new episode of depression in someone who has had previous depressions when younger may signal onset of AD. This is particularly true if the current episode of depression is marked by more problems with memory than earlier episodes. AD clearly changes brain structure and functioning. Depressions that are so common in AD (affecting up to 50%) may result partly from these changes in the brain. Depression itself can also cause changes in brain structure and function. Regardless, depression only makes the suffering and dysfunction of AD worse and increases the burdens of those caring for persons with AD. Fortunately, depression can be treated, usually with well-tolerated medications or with certain psychotherapies.

Symptoms of depression, in addition to sad mood, include irritability and/or anger, lessened interest in previously important and pleasant activities. Other symptoms include sleep and appetite changes, problems with self-esteem often to the point of feeling worthless, difficulty concentrating and remembering, agitation or marked slowing of movements, and suicidal thoughts or behaviors. Some of these symptoms and signs are present in AD sufferers who are not depressed. A thoughtful assessment, sometimes over time, is necessary to decide whether treatment of depression is needed. At times it is unclear whether depression is superimposed on AD and under such circumstances a trial of depression treatment may be helpful.

How does anxiety relate to Alzheimer's disease?

A certain amount of anxiety is a normal part of everyone's makeup. When anxiety becomes more severe and persistent, it is not normal. Anxiety disorders cause disturbing distress or dysfunction and usually both. Once begun, anxiety disorders often continue lifelong. Alzheimer's disease (AD) causes changes in the brain that may affect anxiety in a variety of ways. New anxiety beginning in old age is sometimes related to changes in the brain associated with AD. Lessened anxiety may also be explained by AD brain changes. Anxiety is present in upwards of 90% of those suffering depression, so AD may be accompanied by both depression and anxiety. If anxiety is pronounced, treating it will benefit the person with AD and will reduce the burden for caregivers. Many times, antidepressant medications treat both depression and anxiety.

Symptoms of anxiety disorders include anxiety excessive to the risks of the situation (often the person appears fearful, even to the point of panic), irritability and/or anger, restlessness, agitation and insomnia. Many of these anxiety symptoms overlap with symptoms of depression.

Are there personality changes in Alzheimer's disease?

Often, lifelong personality characteristics become exaggerated as we age and this may be true for those with Alzheimer's disease (AD). As AD progresses, personality characteristics may fade and disappear, causing a change in lifelong ways of relating. Thus, a person with AD who was meticulous about possessions as a young person may first become annoyingly preoccupied about the location and condition of possessions but later lose interest in them.

What about sleep disorders?

Sleep disorders are common in Alzheimer's disease (AD). Some sleep more (hypersomnia), but less sleep (insomnia) in AD is a larger problem. When the person with AD sleeps less, caregivers also sleep less. Loss of the usual sleep cycle can occur so that the person sleeps during the day and is awake at night. Other sleep problems include restless legs (an unpleasant creeping sensation), loud snoring, irregular breathing and vivid nightmares that disturb the person with AD. Treatment of sleep disturbances is often quite effective and valuable for everyone involved.

What about agitation?

Agitation is an obvious indication of distress. Facial expressions often mirror underlying emotion. Fidgeting, hand wringing, picking at clothing or skin, pacing, and general restlessness are common signs of agitation. Common causes of agitation include depression, anxiety, anger, feelings of guilt, psychosis (loss of contact with reality), pain, other medical problems such as shortness of breath, fever or infection, and dementia itself. It is not surprising that agitation occurs in individuals with Alzheimer's disease (AD), who may experience all of these problems in addition to the disease itself. Agitated behavior may include wandering, verbal outbursts, paranoia and physical violence. Agitation makes caring for the individual more difficult, and it is often agitated behavior that leads to nursing home or other facility placement. Many times medications are helpful in controlling agitation. Behavioral measures such as reducing stimuli in general, identifying triggers for agitated behavior and making the environment more predictable are also helpful. Support groups have a wealth of valuable experience to share about specific steps that have been helpful in dealing with agitation and many other aspects of caring for AD sufferers.

What about aggressiveness, combativeness or violence?

New aggressiveness in a person with Alzheimer's disease (AD) should prompt a search for its cause. For most people with and without AD, irritation, anger, hostility and aggression are first expressed in words. With AD, aggressive talk can shift to physical combativeness and cause dangerous violence. In late-stage AD, behavior may be the only sign that something is wrong. Among causes of aggressiveness are:

Management of aggressiveness involves the following:

Safety first is a good motto. The time may come when safety for the caregiver and person with Alzheimer's disease require a different caregiving arrangement.

How are families affected by Alzheimer's disease?

Alzheimer's disease (AD) affects families in many ways and few of them are positive. Caregiver burden is a term that aptly describes the full range of emotional, physical and financial problems faced by those who care for individuals with disabling conditions. To watch the decline and death of a family member or friend caused by a disease that erodes and finally destroys the person's very essence can be a terrible trial. Life changes for all involved, first in minor and later in major ways.

Early planning for the inevitable downward course of AD is very helpful. If done early, the person with AD can participate in important financial and legal arrangements for power of attorney and in deciding on options for increasing care as AD progresses. Hope is surely appropriate that medications may temporarily arrest and then slow progression of AD, permitting a longer period of more independent functioning. Other medications and management approaches are helpful for specific behavioral problems that often arise. Because many issues new to most family members are already familiar to those who have cared for other AD sufferers, support groups are a valuable source of help. Visit find family services to locate support groups.

Family members spend substantial amounts of time and energy caring for an individual with AD. Many caregivers report feeling depressed and being stressed by new and seemingly overwhelming responsibilities. It is important to recognize symptoms of depression and warning signs of stress. Further information on caregiver depression and stress is provided in the caregiver section of this web site.

Can Alzheimer's disease be prevented?