Alzheimer’s disease is the most common cause of dementia, a progressive decline in cognitive function usually associated with older adults. Approximately 5.8 million people in the United States live with Alzheimer’s, and that number is expected to reach 13.8 million by 2050.
Not everyone who struggles with memory loss and cognitive decline has Alzheimer’s disease. If you’re worried that you or someone you care about might be showing early signs, the following paragraphs will help you to understand what to look for.
What Is Alzheimer’s?
Alzheimer’s is a degenerative brain disease, meaning that it gets worse over time. It develops due to structural changes in the brain, specifically the neurons responsible for the signaling that lets us think, remember and generally function.
A healthy brain contains about 100 billion neurons and 100 trillion synaptic connections. When a person develops Alzheimer’s, two significant changes occur:
- A protein fragment – called beta-amyloid plaques – develop around some neurons
- An abnormal form of the tau protein develops inside neurons
These plaques interfere with the synaptic communications between neurons and block the transport of nutrients that keep neurons alive. At the same time, the tissue in the brain becomes inflamed, possibly in response to the presence of abnormal proteins.
Inflammation and protein buildup cause brain cells to die and tissues to shrink. The process is known as atrophy, and it’s one of the main detectable signs of Alzheimer’s. Brain changes can happen up to 20 years before a person starts to experience the memory and cognitive changes that are the characteristic signs of the disease.
Symptoms of Alzheimer’s Disease
The symptoms of Alzheimer’s disease develop gradually. Probably the best-known symptom is a progressive memory loss.
Memory Loss: Alzheimer’s vs Normal Aging
The memory loss associated with Alzheimer’s disease is different than the occasional forgetfulness that all older adults experience. Approximately 40% of everyone 65 or older will experience age-related memory impairment, but only 1% of that age group each year will go on to have Alzheimer’s or other forms of dementia.
Age-related memory impairment is inconvenient and frustrating, but it doesn’t interfere with daily life in the same way that the memory loss of Alzheimer’s does. For example:
- Someone experiencing normal aging might forget the name of a new acquaintance but be able to remember it with prompting
- Someone with Alzheimer’s might hear the name many times and still not be able to remember
- Someone experiencing normal aging might forget an appointment and remember it later
- Someone with Alzheimer’s could lose all memory of ever making the appointment
Short-term memories are the first loss to Alzheimer’s, but in time, people begin to lose older memories and even forget the names of loved ones.
Other Alzheimer’s Symptoms
In addition to memory loss, Alzheimer’s disease makes it harder for people to think clearly, communicate with others and function in everyday life. Common symptoms include:
- Difficulty performing everyday tasks
- Getting lost in familiar places
- Confusion about time or place
- New problems finding words and following conversations
- Poor judgment calls (unusual social missteps, dressing for the wrong weather, etc.)
- Losing track of the day, month or season
Because Alzheimer’s is progressive, symptoms tend to start as mild and grow more severe over time, until a person needs help with even the most basic of tasks.
Alzheimer’s Stages and Disease Progression
The progression of Alzheimer’s disease is gradual. Over the years, a person goes from being independent to needing round-the-clock care.
Early Stage Alzheimer’s
In the early stages of Alzheimer’s disease, most people can still function independently. A person will start to show signs of memory and thinking difficulties, such as:
- Trouble planning and organizing
- Forgetting recently learned information
- Losing objects and not being able to retrace steps to find them
Often, these changes aren’t evident to anyone but close friends and family, who might struggle to understand how much help they should provide. In general, the best approach is to assume that the person can do something for themselves unless there’s a safety concern.
Understand that people with Alzheimer’s often need more time to figure things out. That said, it’s okay to step in if the person is becoming frustrated, has stopped making progress with the task or is in danger. It’s good to establish a “help cue,” like a nod or word, that the person can use to show that they would welcome assistance.
It’s also helpful to know that some people with early-stage Alzheimer’s get frustrated by their symptoms and start to withdraw from social connections and activities. Friends and family may notice mood and personality changes like depression, anxiety, fearfulness and suspicion of others. It’s important to be understanding and supportive when these feelings arise.
During the middle stage of Alzheimer’s disease, a person starts to need more and more care. They might:
- Forget information about themselves like their address, phone number or life milestones
- Become disoriented as to where they are or which day it is
- Wander and become lost in familiar surroundings
- Lose the ability to complete routine tasks like bathing or using the bathroom
A person can live with middle-stage Alzheimer’s, also known as remote decline, for many years. At first, the person can still live independently with some basic modifications, but as time goes on, they need more full-time care.
This transition is difficult for many people because they notice the loss of independence and privacy. Care partners need to be sensitive to this self-consciousness and allow as much autonomy as is safe.
Eventually, a person with Alzheimer’s will need full-time care. It’s important to talk as early as possible about care options. Where does the person want to live when they can’t safely be alone?
A person in late-stage Alzheimer’s needs intensive help with even the most basic tasks like eating, drinking and using the bathroom. Self-feeding and self-toileting may be possible at the beginning of the transitions into late-stage Alzheimer’s, but eventually, the person will be completely dependent.
A person with late-stage Alzheimer’s may not remember their loved ones, but they can still feel cherished and cared for. Friends and family can express their love by:
- Playing the person’s favorite music
- Brushing the person’s hair
- Massaging lotion into their skin
- Looking at photos or artwork
Emotional and physical comfort are very important for people with late-stage Alzheimer’s. People in this stage of decline are vulnerable to infections and may not be as able to communicate pain, so caregivers need to be extremely vigilant and proactive about things like hygiene, dental care and first aid.
It’s also important for caregivers to move the person’s body often so the skin and joints stay as healthy as possible. As the person becomes less able to move, others need to be available to change their position.
Causes and Risk Factors
Scientists aren’t sure what causes Alzheimer’s disease. They don’t know if abnormal proteins in the brain are a cause or an effect. What they do know is that certain factors increase the risk of developing the disease. Risk factors include:
- Age – About 80% of the people who have Alzheimer’s are 75 or older, and a person’s risk doubles every five years after age 65
- Family history – If you have a parent or sibling with Alzheimer’s disease, you’re more likely to get it yourself
- Poor heart health – If you have a history of heart disease, stroke or other cardiovascular diseases, you’re more likely to get Alzheimer’s
- History of head injury
On the other hand, people may reduce the risk of developing Alzheimer’s by making healthy choices like:
- Eating well
- Exercising mind and body
- Having strong social connections
- Avoiding smoking and excess drinking
There is no cure for Alzheimer’s, but some medications can slow the progression of memory-related symptoms and help people to maintain independence for longer. Examples include galantamine and rivastigmine for mild to moderate Alzheimer’s and memantine for moderate to severe disease.
Some people with Alzheimer’s disease may also take psychiatric medications like anti-anxiety or antidepressant drugs to help with mood and behavioral changes. If you or someone you care about has Alzheimer’s, talk to your doctor about the best course of action.
Caring for someone with Alzheimer’s mostly means maintaining the balance between safety and independence. Family and friends can often provide enough support in the earlier stages of the disease but in time, a person usually ends up needing round-the-clock care.
Choosing residential care for a person with middle- to late-stage Alzheimer’s can be difficult, but it’s also an enormous act of love. If possible, take some time while the disease is still in its early stages to look at communities and find one where the person with Alzheimer’s feels comfortable and at ease.
Look for places where residents are encouraged to participate in life and engage with others. The Valeo™ memory care neighborhood at Spring Creek in Plano, Texas, is one of those places.
At Spring Creek, community members enjoy unique programming designed around the four components of wellness: physical, social, intellectual and spiritual. Community leaders customize the program to suit the needs and interests of each individual, so everyone can fill their days with meaning.