In the United States, an estimated 5.8 million people older than 65 years old live with Alzheimer’s disease. The likelihood of developing Alzheimer’s increases with age — 17% of people age 75 to 84 live with the disease, compared to 32% of people ages 85 and older.
People with Alzheimer’s disease experience dementia, a type of cognitive impairment that starts with mild memory loss and advances to include confusion, disorientation and difficulty functioning day-to-day. A person with Alzheimer’s needs increasing levels of care as the disease progresses, usually over years.
When you love someone who is older and starting to have difficulty with memory, it’s common to worry about Alzheimer’s. Read on to learn more about the disease, including its warning signs and what you can do if you, a family member or friend might need help coping with it.
What is Alzheimer’s Disease?
Alzheimer’s disease is a progressive disorder caused by structural changes in the brain. Specifically, it happens due to the buildup of protein pieces, called beta-amyloid plaques, which develop around neurons in the brain. There’s also a growth of strands called tau proteins, which build up inside neurons.
As these proteins build up in the brain, they cause neuron death and brain tissue damage. The symptoms of Alzheimer’s are the manifestation of this damage.
Symptoms of Alzheimer’s Disease
The hallmark symptoms of Alzheimer’s disease are memory loss and confusion. The experience is different than the occasional forgetfulness of normal aging.
A person who ages normally might forget where they put their purse, but they can walk themselves through their day and figure out where they put it. A person with Alzheimer’s would have trouble with that process. Normal aging means forgetting the name of someone you met recently or a movie you just watched. Alzheimer’s means needing to hear that name again and again.
Alzheimer’s disease also causes confusion and disorientation. As the disease progresses, people have increasing trouble finding their way around, completing daily tasks and remembering how to take care of themselves.
Most people with Alzheimer’s will live years before they need full-time help. During the early phases of the disease, what the person needs most is emotional support and gentle reminders.
In time, those reminders and supports will become more frequent and safety will become a bigger concern. Family and friends should know what to expect as time goes on and what is most necessary in terms of care.
1. Pre-Alzheimer’s (Mild Cognitive Impairment)
Alzheimer’s disease usually presents first with very mild symptoms that family and friends can easily mistake for normal aging. Experiences may include:
- Forgetting appointments and social engagements
- Losing track of conversations
- Difficulty following instructions or completing complex tasks
- Difficulty making decisions
This stage is known as mild cognitive impairment, or MCI, which is a general term for cognitive issues that may lead to dementia. There are many different causes of MCI and not everyone who experiences it will go on to develop Alzheimer’s.
A person with MCI can still live independently with minimal assistance, usually no more than anyone of the same age would need.
2. Early-stage (Mild) Alzheimer’s Disease
A person who does go on to develop Alzheimer’s will have increasing trouble with memory, focus and organization. Family and friends may notice symptoms like:
- Difficulty remembering recent events or newly learned information
- Misplacing things and not being able to retrace steps to find them
- Getting lost in familiar environments
- Struggling to complete multi-step tasks (balancing a checkbook, shopping for groceries, etc.)
- Lapses in judgment (poor financial decisions, dressing wrong for the weather, etc.)
Dealing with these symptoms can make many people withdrawn, irritable or depressed. The care partner’s challenge is to provide enough support that the person with Alzheimer’s doesn’t become frustrated or overwhelmed, without making them feel self-conscious by offering too much help.
Communication is key. When care partners ask what they can do to help, the person with Alzheimer’s still feels in control. Naturally, the care partner also needs to be able to step in if there’s a safety risk – for example, if the person forgets that they started boiling a pot of water.
3. Middle-stage (Moderate) Alzheimer’s Disease
As time goes on, a person with Alzheimer’s will become increasingly confused and will have trouble caring for themselves. They may lose more of their earlier memories and start to forget the names of family members and friends. Completing simple tasks becomes extremely difficult and the person will need help getting dressed, using the bathroom and eating.
Assisting with these tasks can be difficult because many people feel their loss of independence very keenly. The care partner should be willing to stand back and let the person do as much for themselves as possible, while still being ready to step in and help if necessary.
Communication can also be challenging during this middle stage. People start to have more trouble finding words and can easily get lost during a conversation. They need patient and understanding care partners who will keep conversation simple and straightforward, while still letting the person maintain their dignity.
Safety becomes increasingly concerning during the middle stage of Alzheimer’s disease. Many people in this phase of decline start to wander, possibly getting lost in their own neighborhoods. At this point, many families and friends start to consider residential care.
4. Late-stage (Severe) Alzheimer’s Disease
In late-stage Alzheimer’s disease, a person can do very little for themselves, if anything. They need round-the-clock care and depend on others for all basic activities of daily living including eating, dressing and bathing. In time, they lose the ability to communicate and need significant assistance with movement.
Causes and Risk Factors
Age is the most common risk factor for Alzheimer’s disease. According to the Alzheimer’s Association, the risk of developing the disease doubles with every five years of life, starting at age 65. By the time a person is 85, the chances are about one in three that they will have Alzheimer’s.
Overall, approximately 95% of people who have Alzheimer’s are 65 years old or older. The other five percent have what doctors call early-onset Alzheimer’s. These individuals are usually in their 40s or 50s when they start to show symptoms.
Family history increases a person’s risk of developing Alzheimer’s by about 30%. It’s a relative risk, so if your risk before family history is two percent — the average risk for a 65-year-old, according to one Harvard Medical School physician — a family history would add 30% of two percent, bringing your total risk to 2.6%. It’s not a huge jump, but it does exist.
Other Risk Factors
Scientists have also identified past head injuries and poor cardiovascular health as risk factors for Alzheimer’s disease. If you’ve had a concussion, or if you have heart disease, high blood pressure or high cholesterol, you may be more likely to develop Alzheimer’s.
The flip side is that healthy behaviors like eating well, having good social support and exercising both mind and body may help to reduce your risk of Alzheimer’s disease.
Diagnosis and Treatment
To diagnose Alzheimer’s disease, a physician typically starts by interviewing the person who is experiencing symptoms, as well as one of their close family members or friends. The doctor will ask about what kinds of symptoms the person is experiencing and how those symptoms are affecting daily life.
Testing also involves a basic mental status exam and/or other types of neuropsychological testing. These tests provide information about a person’s cognitive functioning. There also tends to be a physical exam that includes tests of coordination, balance and movement.
A blood test and/or brain imaging may be involved as well, primarily to rule out other causes of dementia.
Treating Alzheimer’s Disease
The treatment options for Alzheimer’s disease are limited. There are two drugs — cholinesterase inhibitors and memantine — that may help to slow the progression, but improvement is usually slight. Some patients may take antidepressants or anti-anxiety medication to lessen the psychological impacts of the disease.
Because there is no significant way to slow the progression of the disease or alleviate its symptoms, Alzheimer’s care focuses much more on helping the person to navigate daily life.
Alzheimer’s Care Options
In the first stages of Alzheimer’s disease, a person can usually continue to live independently. As the person starts to have more trouble navigating daily life, family members and friends can implement basic supports like keeping the person’s schedule consistent, using checklists to keep them on track and helping with medication.
One option for Alzheimer’s care is to keep the person at home and hire home health aides and skilled nursing providers to help. This model may work best in the disease’s earlier stages before 24-hour supervision is necessary.
Assisted living is best for people who need support with daily personal care tasks but don’t yet need 24-hour help. Eventually, most people with Alzheimer’s need to transition out of assisted living and into memory care.
People who need more supervision and support may be best suited for a memory care unit. Often hosted as part of a larger assisted living or skilled nursing community, memory care neighborhoods usually feature extra safety measures and specially trained staff.
The Cabana at Jensen Dunes offers memory care neighborhoods and assisted living, both of which focus on helping each resident live life to the fullest. At Jensen Dunes, people with and without Alzheimer’s receive the care that they need and the activities that help them to stay active, well and engaged to the highest degree possible.