At first, increasing forgetfulness or mild confusion may be the only symptoms of Alzheimer's disease that you notice. But over time, the disease robs you of more of your memory, especially recent memories. The rate at which symptoms worsen varies from person to person.
If you have Alzheimer's, you may be the first to notice that you're having unusual difficulty remembering things and organizing your thoughts. Or you may not recognize that anything is wrong, even when changes are noticeable to your family members, close friends or co-workers.
Brain changes associated with Alzheimer's disease lead to growing trouble with:
Everyone has occasional memory lapses. It's normal to lose track of where you put your keys or forget the name of an acquaintance. But the memory loss associated with Alzheimer's disease persists and worsens, affecting your ability to function at work and at home. People with Alzheimer's may:
- Repeat statements and questions over and over, not realizing that they've asked the question before
- Forget conversations, appointments or events, and not remember them later
- Routinely misplace possessions, often putting them in illogical locations
- Eventually forget the names of family members and everyday objects
Disorientation and misinterpreting spatial relationships
People with Alzheimer's disease may lose their sense of what day it is, the season, where they are or even their current life circumstances. Alzheimer's may also disrupt your brain's ability to interpret what you see, making it difficult to understand your surroundings. Eventually, these problems may lead to getting lost in familiar places.
Speaking and writing
Those with Alzheimer's may have trouble finding the right words to identify objects, express thoughts or take part in conversations. Over time, the ability to read and write also declines.
Thinking and reasoning
Alzheimer's disease causes difficulty concentrating and thinking, especially about abstract concepts like numbers. It may be challenging to manage finances, balance checkbooks, and keep track of bills and pay them on time. These difficulties may progress to inability to recognize and deal with numbers.
Making judgments and decisions
Responding effectively to everyday problems, such as food burning on the stove or unexpected driving situations, becomes increasingly challenging.
Planning and performing familiar tasks
Once-routine activities that require sequential steps, such as planning and cooking a meal or playing a favorite game, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer's may forget how to perform basic tasks such as dressing and bathing.
Changes in personality and behavior
Brain changes that occur in Alzheimer's disease can affect the way you act and how you feel. People with Alzheimer's may experience:
- Social withdrawal
- Mood swings
- Distrust in others
- Irritability and aggressiveness
- Changes in sleeping habits
- Loss of inhibitions
- Delusions, such as believing something has been stolen
Many important skills are not lost until very late in the disease. These include the ability to read, dance and sing, enjoy old music, engage in crafts and hobbies, tell stories, and reminisce.
This is because information, skills and habits learned early in life are among the last abilities to be lost as the disease progresses. Capitalizing on these abilities can allow you to continue to have successes and maintain a high quality of life even when you are into the moderate phase of the disease.
Scientists believe that for most people, Alzheimer's disease results from a combination of genetic, lifestyle and environmental factors that affect the brain over time.
Less than 5 percent of the time, Alzheimer's is caused by specific genetic changes that virtually guarantee a person will develop the disease.
Although the causes of Alzheimer's are not yet fully understood, its effect on the brain is clear. Alzheimer's disease damages and kills brain cells. A brain affected by Alzheimer's disease has many fewer cells and many fewer connections among surviving cells than does a healthy brain.
As more and more brain cells die, Alzheimer's leads to significant brain shrinkage. When doctors examine Alzheimer's brain tissue under the microscope, they see two types of abnormalities that are considered hallmarks of the disease:
- Plaques. These clumps of a protein called beta-amyloid may damage and destroy brain cells in several ways, including interfering with cell-to-cell communication. Although the ultimate cause of brain-cell death in Alzheimer's isn't known, the collection of beta-amyloid on the outside of brain cells is a prime suspect.
Tangles. Brain cells depend on an internal support and transport system to carry nutrients and other essential materials throughout their long extensions. This system requires the normal structure and functioning of a protein called tau.
In Alzheimer's, threads of tau protein twist into abnormal tangles inside brain cells, leading to failure of the transport system. This failure is also strongly implicated in the decline and death of brain cells.
Increasing age is the greatest known risk factor for Alzheimer's. Alzheimer's is not a part of normal aging, but your risk increases greatly after you reach age 65. Nearly half of those older than age 85 have Alzheimer's.
People with rare genetic changes that virtually guarantee they'll develop Alzheimer's begin experiencing symptoms as early as their 30s.
Family history and genetics
Your risk of developing Alzheimer's appears to be somewhat higher if a first-degree relative — your parent or sibling — has the disease. Scientists have identified rare changes (mutations) in three genes that virtually guarantee a person who inherits them will develop Alzheimer's. But these mutations account for less than 5 percent of Alzheimer's disease.
Most genetic mechanisms of Alzheimer's among families remain largely unexplained. The strongest risk gene researchers have found so far is apolipoprotein e4 (APOE e4). Other risk genes have been identified but not conclusively confirmed.
Women may be more likely than are men to develop Alzheimer's disease, in part because they live longer.
Mild cognitive impairment
People with mild cognitive impairment (MCI) have memory problems or other symptoms of cognitive decline that are worse than might be expected for their age, but not severe enough to be diagnosed as dementia.
Those with MCI have an increased risk — but not a certainty — of later developing dementia. Taking action to develop a healthy lifestyle and strategies to compensate for memory loss at this stage may help delay or prevent the progression to dementia.
Past head trauma
People who've had a severe head trauma or repeated head trauma appear to have a greater risk of Alzheimer's disease.
Lifestyle and heart health
There's no lifestyle factor that's been conclusively shown to reduce your risk of Alzheimer's disease.
However, some evidence suggests that the same factors that put you at risk of heart disease also may increase the chance that you'll develop Alzheimer's. Examples include:
- Lack of exercise
- High blood pressure
- High blood cholesterol
- Elevated homocysteine levels
- Poorly controlled diabetes
- A diet lacking in fruits and vegetables
These risk factors are also linked to vascular dementia, a type of dementia caused by damaged blood vessels in the brain. Working with your health care team on a plan to control these factors will help protect your heart — and may also help reduce your risk of Alzheimer's disease and vascular dementia.
Lifelong learning and social engagement
Studies have found an association between lifelong involvement in mentally and socially stimulating activities and reduced risk of Alzheimer's disease.
Factors that may reduce your risk of Alzheimer's include:
- Higher levels of formal education
- A stimulating job
- Mentally challenging leisure activities, such as reading, playing games or playing a musical instrument
- Frequent social interactions
Scientists can't yet explain this link. One theory is that using your brain develops more cell-to-cell connections, which protects your brain against the impact of Alzheimer-related changes.
Memory and language loss, impaired judgment, and other cognitive changes caused by Alzheimer's can complicate treatment for other health conditions. A person with Alzheimer's disease may not be able to:
- Communicate that he or she is experiencing pain — for example, from a dental problem
- Report symptoms of another illness
- Follow a prescribed treatment plan
- Notice or describe medication side effects
As Alzheimer's disease progresses to its last stages, brain changes begin to affect physical functions, such as swallowing, balance, and bowel and bladder control. These effects can increase vulnerability to additional health problems such as:
Pneumonia and other infections. Difficulty swallowing may cause people with Alzheimer's to inhale (aspirate) food or liquid into their airways and lungs, which can lead to pneumonia.
Inability to control emptying of the bladder (urinary incontinence) may require placement of a tube to drain and collect urine (urinary catheter). Having a catheter increases your risk of urinary tract infections, which can lead to more-serious, life-threatening infections.
- Injuries from falls. People with Alzheimer's become increasingly vulnerable to falling. Falls can lead to fractures. In addition, falls are a common cause of serious head injuries.
Right now, there's no proven way to prevent Alzheimer's disease. Research into prevention strategies is ongoing. The strongest evidence so far suggests that you may be able to lower your risk of Alzheimer's disease by reducing your risk of heart disease.
Many of the same factors that increase your risk of heart disease can also increase your risk of Alzheimer's disease and vascular dementia. Important factors that may be involved include high blood pressure, high blood cholesterol, excess weight and diabetes.
New programs targeted to people at high risk of dementia are being developed. These multicomponent programs encourage physical activity, cognitive stimulation, social engagement and a healthy diet.
They also teach memory compensation strategies that help optimize daily function even if brain changes progress. Keeping active — physically, mentally and socially — may make your life more enjoyable and may also help reduce the risk of Alzheimer's disease.