UNDERSTANDING
ALZHEIMER’S
AND DEMENTIA
Geri T., living with Alzheimer’s, and
her husband and care partner, Jim
THE IMPACT OF ALZHEIMER’S
AND DEMENTIA
Currently, an estimated 50 million people
worldwide are living with dementia, including
more than 5 million Americans. Barring any
developments in prevention or treatment
methods, this number is projected to reach
nearly 14 million by 2050.
The disease also affects the 16 million
Americans who provide unpaid care for
people living with Alzheimer’s or another
dementia. More than 80 percent of care
provided at home is delivered by family
members, friends or other unpaid caregivers.
The Alzheimer’s Association® is available
in communities nationwide and online to
help individuals and families understand
Alzheimer’s and dementia, navigate the
disease and receive reliable information
and support.
CONTENTS
1. Alzheimer’s and dementia.................................. p.2
2. Alzheimer’s in the brain...................................... p.4
3. Risk factors................................................................ p.5
4. Stages of Alzheimer’s disease......................... p.7
5. FDA-approved treatments
for symptoms........................................................... p.10
6. Advancing Alzheimer’s research.................... p.12
1
1. ALZHEIMER’S
AND DEMENTIA
The terms “dementia” and “Alzheimer’s” are often
used interchangeably. While they are related,
there are distinct differences between the two.
Dementia
Dementia is the umbrella term for an individual’s
changes in memory, thinking or reasoning.
There are many possible causes of dementia,
including Alzheimer’s.
Alzheimer’s
Alzheimer’s disease is the most common cause
of dementia, accounting for 60 to 80 percent of
all dementia cases. Alzheimer’s is not a normal
part of aging — it is a progressive brain disease.
Two abnormal brain structures called plaques and
tangles are the hallmarks of Alzheimer’s disease,
and are thought to damage and kill nerve cells.
Plaques are deposits of a protein fragment called
beta-amyloid that build up in the spaces between
nerve cells. Tangles are twisted fibers of another
protein called tau that build up inside cells.
2
Other common dementias
» Vascular dementia is a decline in thinking
skills caused by conditions that block or
reduce blood flow to the brain, depriving
brain cells of vital oxygen and nutrients.
These changes sometimes occur suddenly
following strokes that block major brain
blood vessels. It is widely considered the
second most common cause of dementia
after Alzheimer’s disease.
» Dementia with Lewy bodies is a type
of progressive dementia associated
with abnormal deposits of the protein
alpha-synuclein that damage brain cells.
Early symptoms include hallucinations
and problems with sleep.
» Frontotemporal dementia (FTD) is a group
of disorders caused by progressive cell
degeneration in the brain’s frontal lobes
(the areas behind the forehead) or its
temporal lobes (the regions behind the ears).
Visit alz.org/dementia to learn about additional
types of dementia.
John W., living with dementia with Lewy
bodies, and his wife and care partner, Gail
3
2. ALZHEIMER’S
IN THE BRAIN
More than 100 years ago, Dr. Alois Alzheimer
described specific changes in the brain that are
now known as beta-amyloid plaques and tau
tangles. Today we know that Alzheimer’s is a
progressive brain disease that’s marked by these
key changes and thought to impact memory,
thinking and behavior.
What goes wrong in the brain
The brain has three main parts: the cerebrum,
cerebellum and brain stem. Each one plays a role
in how the body functions.
The cerebrum fills up most of the skull. It’s the
part of the brain most involved in remembering,
problem-solving and thinking. There are about
100 billion nerve cells (neurons) throughout
the brain that transmit messages in order for
us to create memories, feelings and thoughts.
Alzheimer’s disease causes nerve cells to die,
which leads to brain tissue loss, or shrinkage,
TAKE A CLOSER LOOK
Visit alz.org/brain to explore Inside the Brain:
A Tour of How the Mind Works.
4
and causes loss of function and communication
between cells. These changes can cause the
symptoms of Alzheimer’s disease, such as
memory loss; problems with thinking and planning;
behavioral issues; and, in the last stage, a further
decline in functioning, which can even include
difficulty swallowing.
3. RISK
FACTORS
While scientists know that Alzheimer’s disease
involves the failure of nerve cells, it’s still
unknown why this happens. However, they have
identified certain risk factors that increase the
likelihood of developing Alzheimer’s.
Age
The greatest known risk factor for Alzheimer’s
is increasing age. After age 65, an individual’s
risk of developing the disease doubles every five
years. Thirty-two percent of people age 85 or
older have Alzheimer’s.
Family history
Research has shown that those who have a
parent, brother or sister with Alzheimer’s are
more likely to develop it than individuals who do
not. The risk increases if more than one family
member has the disease.
Genetics
Two categories of genes influence whether
a person develops a disease: risk genes and
deterministic genes. Risk genes increase the
likelihood of developing a disease but do not
guarantee it will happen. Deterministic genes
cause a disease, meaning anyone who inherits
one will develop a disorder.
Rare deterministic genes cause Alzheimer’s in
a few hundred extended families worldwide.
5
These genes are estimated to account for less than
1 percent of cases. Individuals with these genes
usually develop symptoms in their 40s or 50s.
Hispanics, African Americans and women
Research shows that older Hispanics are about
one-and-a-half times as likely as older whites
to have Alzheimer’s and other dementias, while
older African Americans are about twice as likely.
The reason for these differences is not well
understood, but researchers believe that higher
rates of vascular disease in these groups may
put them at greater risk for Alzheimer’s.
Additionally, women live longer than men, making
them more likely to develop Alzheimer’s.
However, longevity and lower death rates can
only partially explain this difference. Researchers
are exploring how genetic differences may
impact disease risk.
Reducing risk of cognitive decline
Age, family history and genetics are all risk
factors we can’t change. However, research is
beginning to reveal clues about other risk factors
that we may be able to influence. There appears
to be a strong link between serious head injury
and future risk of Alzheimer’s. It’s important to
protect your head by buckling your seat belt,
wearing a helmet when participating in sports
and proofing your home to avoid falls.
Another promising line of research suggests that
strategies for overall healthy aging may help keep
the brain healthy and may even reduce the risk of
cognitive decline. These measures include eating
a healthy diet, staying socially active, avoiding
tobacco and excess alcohol, and exercising both
the body and mind.
Some of the strongest evidence links brain
health to heart health. The risk of developing
Alzheimer’s or vascular dementia appears to be
6
increased by many conditions that damage the
heart and blood vessels. These include heart
disease, diabetes, stroke, high blood pressure
and high cholesterol.
Based on this research, the Alzheimer’s
Association offers 10 Ways to Love Your Brain,
a collection of tips that can reduce the risk of
cognitive decline. Learn more at alz.org/10ways.
4. STAGES OF
ALZHEIMER’S DISEASE
Alzheimer’s typically progresses slowly in
three general stages: early, middle and late
(sometimes referred to as mild, moderate
and severe in a medical context).
The symptoms of Alzheimer’s worsen over
time, but because the disease affects people in
different ways, the rate of progression varies.
On average, a person with Alzheimer’s may live
four to eight years after diagnosis, but can live
as long as 20 years, depending on other factors.
The following stages provide an overall idea
of how abilities change and should be used as
a general guide. Stages may overlap, making it
difficult to place a person living with Alzheimer’s
in a specific stage.
7
Early-stage Alzheimer’s
In the early stage, a person may function
independently. Those close to the individual
may begin to notice difficulties, including:
» Problems coming up with the right word
or name.
» Trouble remembering names when
introduced to new people.
» Challenges performing familiar tasks.
» Forgetting material that was just read.
» G etting lost in familiar places.
» Increasing trouble with planning
or organizing.
Middle-stage Alzheimer’s
Middle-stage Alzheimer’s is typically the longest
stage and can last for many years. As the disease
progresses, the person living with Alzheimer’s will
require a greater level of care. At this point,
symptoms will be noticeable to others and may
include:
» Forgetfulness of events or about one’s own
personal history.
» Feeling frustrated, angry or withdrawn,
especially in socially or mentally challenging
situations.
» Confusion about where they are or what
day it is.
» The need for help choosing proper clothing
for the season or occasion.
» Trouble controlling bladder and bowels.
» Changes in sleep patterns, such as sleeping
during the day and restlessness at night.
» An increased risk of wandering and
becoming lost.
8
» Personality and behavioral changes,
including suspiciousness and delusions
or compulsive, repetitive behavior.
Late-stage Alzheimer’s
In the final stage of the disease, significant
personality changes may occur and extensive
help with daily activities and personal care will
be required. At this stage, individuals may:
» Lose awareness of recent experiences as
well as of their surroundings.
» Experience changes in physical abilities,
including walking, sitting and, eventually,
swallowing.
» Have greater difficulty communicating.
» Become increasingly vulnerable to
infections, especially pneumonia.
9
5.
FDA-APPROVED
TREATMENTS
FOR S YMPTOMS
Currently, there is no cure for Alzheimer’s and
no way to stop the underlying death of brain
cells. But non-drug treatments and medications
may help with both cognitive and behavioral
symptoms for a time. It’s important to discuss
appropriate treatments with your doctor,
starting with non-pharmacological options.
Non-drug treatments
Non-drug approaches to managing behavioral
symptoms promote physical and emotional
comfort. Many of these strategies aim to
identify and address needs that the person with
Alzheimer’s may have difficulty expressing as
the disease progresses.
Tips for coping with symptoms include:
» Monitor personal comfort. Check for pain,
hunger, thirst, constipation, full bladder,
fatigue, infections and skin irritation.
Maintain a comfortable room temperature.
» Avoid being confrontational or arguing
about facts. For example, if a person
would like to visit a parent who died years
ago, don’t point out that the parent is no
longer alive. Instead, say, “Your mother is
a wonderful person. I would like to see
her, too.”
» Redirect the person’s attention. Try to
remain flexible, patient and supportive by
responding to the emotion, not the behavior.
» Create a calm environment. Avoid noise,
glare, insecure space and too much
background distraction, including television.
» Allow rest between stimulating events.
10
» Provide a security object.
» Acknowledge and respond to requests.
» Look for reasons behind each behavior.
Consult a physician to identify causes
related to medications or illness.
» Explore various solutions.
Medications
Three types of drugs are currently approved
by the Food and Drug Administration (FDA) to
treat cognitive symptoms of Alzheimer’s disease.
The first, cholinesterase (KOH-luh-NES-
ter-ays) inhibitors, prevents the breakdown of
acetylcholine (a-SEA-til-KOH-lean), a chemical
messenger important for memory and learning.
By keeping levels of acetylcholine high, these
drugs support communication among nerve
cells. Three cholinesterase inhibitors commonly
prescribed are:
» Donepezil (Aricept®)
» Rivastigmine (Exelon®)
» Galantamine (Razadyne®)
The second type of drug works by regulating
the activity of glutamate, a different chemical
messenger involved in information processing:
» Memantine (Namenda®)
The third type is a combination of a cholinesterase
inhibitor and a glutamate regulator:
» Donepezil and memantine (Namzaric®)
11
The effectiveness of these treatments varies from
person to person. While they may temporarily
help symptoms, they do not slow or stop the brain
changes that cause Alzheimer’s to become more
severe over time.
6. ADVANCING
ALZHEIMER’S RESEARCH
Research advancements in the last decade have
helped us better understand the disease as a
continuum, meaning that the biological changes
associated with Alzheimer’s develop many years
before symptoms appear. This sets the stage for
possible prevention of the disease, because once
we have the tools to identify at-risk individuals early
and the medications to treat them, we will be able
to intervene and stop or slow the progression of
the disease.
To ensure that the effort to advance the
understanding of Alzheimer’s disease and find
better treatments receives the focus it deserves,
the Alzheimer’s Association funds researchers
looking at new treatment strategies and advocates
for more federal research funding.
Clinical studies drive progress
Participating in a clinical study is one way that
everyone can get involved, in a very direct way,
in the fight against Alzheimer’s disease. Without
clinical research and the help of human volunteers,
scientists will not be able to discover methods
of prevention, treatment and, ultimately, a cure.
Clinical trials test new drugs for their safety
and effectiveness. Clinical studies test non-drug
interventions for their impact on factors such
as improving quality of life. Every clinical trial or
study contributes valuable knowledge, regardless
if favorable results are achieved.
12
For people currently living with dementia, there
are some additional benefits to participating
in clinical trials, including access to very close
medical care and promising treatments.
Visit alz.org/TrialMatch to learn more about
Alzheimer’s Association TrialMatch®, a free,
easy-to-use clinical studies matching service for
individuals living with dementia, caregivers and
healthy volunteers without dementia. TrialMatch,
and its database with hundreds of studies taking
place across the country and online, is your
opportunity to learn about current Alzheimer’s
research opportunities.
I don't have a laboratory.
I have Alzheimer's disease.
And I'm helping
to discover a cure.
You can, too.
alz.org/TrialMatch
800.272.3900
Rebecca P., living with Alzheimer's,
TrialMatch® user
13
alz.org
Access reliable information and resources, such as:
» Alzheimer’s Navigator® – Assess your needs
and create customized action plans.
» Community Resource Finder – Find resources,
including your local Association chapter.
» ALZConnected® – Connect with other
caregivers or people with dementia.
» Online Caregiver Resources – Get information
for all stages of the disease.
alz.org/education
Free online workshops, including:
» Understanding Alzheimer’s and Dementia
800.272.3900
24/7 Helpline – Available all day, every day.
The Alzheimer’s Association is the leading voluntary health
organization in Alzheimer’s care, support and research.
Our mission is to eliminate Alzheimer’s disease through
the advancement of research; to provide and enhance
care and support for all affected; and to reduce the risk
of dementia through the promotion of brain health.
Our vision is a world without Alzheimer’s disease®.
800.272.3900 | alz.org®
This is an official publication of the Alzheimer’s Association but may be distributed
by unaffiliated organizations and individuals. Such distribution does not constitute
an endorsement of these parties or their activities by the Alzheimer’s Association.
© 2019 Alzheimer’s Association®. All rights reserved. Rev.Feb19 770-10-0003
