Alzheimer’s disease (or Alzheimer’s) is a condition that affects the brain.
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Learn more about the symptoms, what causes the condition, how it is diagnosed, and the treatments available.
Alzheimer’s disease is a progressive condition associated with a decline in the cognitive function of the brain. It affects people in different ways, but the symptoms may include memory loss and difficulties with thinking, problem-solving and language. Alzheimer’s is the most common cause of dementia.
There are two main types of Alzheimer’s disease:
Worldwide, nearly 50 million people have Alzheimer’s or related dementia. There are nearly 10 million new cases every year (1).
Alzheimer’s disease contributes to 60–70% of dementia cases and according to the World Health Organization, the total number of people with dementia globally is projected to reach 82 million in 2030 and 152 million in 2050.
The symptoms of Alzheimer’s disease progress slowly over several years. The rate at which they progress differs from individual to individual.
Research suggests that changes in the brain may occur 10 or more years before someone starts to show symptoms of Alzheimer’s disease.
The symptoms are generally mild to begin with and gradually worsen over time. They are sometimes confused with other conditions or initially put down to old age. Read the dedicated article on the 10 first symptoms of Alzheimer’s for early detection.
Alzheimer’s disease is generally divided into four main stages: prodromal stage, early-stage, middle-stage, and late-stage Alzheimer’s:
The prodromal stage of Alzheimer’s disease is the early form of Alzheimer’s. At this stage, people will have some mild cognitive impairment, such as a worsening memory. They may have difficulty remembering names or following conversations, but they can still perform their usual routine activities.
In the early stages of Alzheimer’s, people can lead an independent life. They may still be performing normal daily activities such as driving, working, or taking part in social activities.
The main symptom during early-stage Alzheimer’s disease is memory lapses. This may involve forgetting about recent conversations or events, having trouble thinking of the right word, forgetting the names of people and places, asking repetitive questions, or misplacing belongings.
There may also be some behavioural and personality changes such as mood swings, increasing agitation or anxiety, feeling confused, finding it harder to make decisions, or showing poor judgment.
During the early stage of the disease, these symptoms may not be widely apparent, but family and close friends may notice them.
Middle-stage Alzheimer’s is typically the longest stage of the disease. As it progresses, memory problems will get worse.
Someone with middle-stage Alzheimer’s disease may find it even more difficult to recall simple things such as the names of people they know, and they may struggle to recognise loved ones. They may require a greater level of care.
Other middle-stage symptoms that may develop include:
During the middle stage of Alzheimer’s, it is still possible for people to participate in daily activities, but they will increasingly need extra help and assistance.
In the late stages of Alzheimer’s disease, the symptoms are increasingly severe. It can be distressing for the person with the disease, as well as for their family and friends.
In the late stages, an individual may lose their ability to understand what is going on around them. Any hallucinations and delusions may become worse and they may feel angry and act aggressively.
Other late-stage symptoms that may be experienced include:
During the late stages of Alzheimer’s, full-time care, and round-the-clock assistance with washing, getting dressed, using the toilet, eating, drinking and moving may be required.
One of the earliest signs of Alzheimer’s is memory loss. Individuals may become more forgetful than usual. Examples include forgetting important dates, events, or recent conversations. Someone with the early symptoms of Alzheimer’s might ask for the same information several times and rely on memory aids like sticky notes and reminders on mobile phones.
Although it is still unknown what triggers Alzheimer’s disease, there are several factors that are known to increase the risk of developing the condition.
Alzheimer’s disease is thought to be caused by a build-up of proteins in the brain which form abnormal structures called ‘plaques’ and ‘tangles’. Scientists do not know exactly what causes the process to begin, but it starts many years before the symptoms appear.
As the disease progresses, nerve cells in the brain (neurons) are lost. As the neurons become affected, there is a reduction in chemical messengers (neurotransmitters) that are responsible for sending signals between brain cells. These progressive changes in the brain affect a person’s ability to remember, think, communicate and solve problems.
Life expectancy varies considerably depending on how old a person is when they develop Alzheimer’s disease. On average, a person with Alzheimer’s disease lives between three and 11 years after diagnosis, but some may survive 20 years or more. The length of time that someone with Alzheimer’s can expect to live depends on whether they were diagnosed early in the progression of the disease or later. The disease tends to develop slowly, and the symptoms gradually worsen over several years. The rate of progression varies widely from person to person.
If you have concerns about memory loss or issues with planning and organising, you should make an appointment to see a doctor. Getting an accurate and prompt diagnosis is the best way to come to terms with Alzheimer’s disease and to make plans. It also ensures timely access to suitable treatment and support that may help.
There is no single test for Alzheimer’s disease. Instead, the diagnosis is based on a combination of physical and mental assessments and tests.
In most cases, a local doctor is the first port of call. They will listen to you or your family member’s concerns and carry out some simple health checks and some thinking and memory tests to assess how different parts of your brain are working.
A common test used by local doctors in many countries is the General Practitioner Assessment of Cognition (GPCOG). Although it cannot make a diagnosis, the GPCOG may identify memory issues that require further investigation.
Blood tests may also be ordered to rule out other possible causes of the symptoms and a referral for a specialist assessment will be made if it is needed.
It is important to note that any simple tests your GP performs are only preliminary. If they suspect Alzheimer’s disease, they will refer you or your family member to a specialist at a hospital or memory clinic.
Currently, there is no single, reliable test to diagnose Alzheimer’s disease accurately. However, if you are referred to a specialist trained in brain and mental health conditions at a hospital or memory clinic, they will conduct a full neuropsychological assessment using several different questionnaires and tools to obtain an accurate diagnosis.
The specialist tests will assess your mental and cognitive capabilities such as memory, concentration, attention span, problem solving, and language skills.
In addition to a series of clinical assessments, the specialist may also want to have a closer look at what is happening inside your brain and may recommend a CT scan or an MRI scan. These scans take detailed images of the inside of your brain and will help the specialist assess whether there is any damage to the brain and, if so, where it is. This is important because an accurate diagnosis will determine the best course of treatment and support required. It may also help predict any future issues that may develop.
There is no cure for Alzheimer’s disease. Medication may help temporarily reduce the symptoms, but it cannot eradicate it completely or prevent the disease occurring in the first place.
Since the exact cause of Alzheimer’s disease is still unknown, there is no definitive way to prevent the condition entirely. However, maintaining as healthy a lifestyle as possible can help reduce the risk of Alzheimer’s disease developing.
Cardiovascular disease has been linked to an increased risk of Alzheimer’s, so steps to improve cardiovascular health may be beneficial. These include:
There is also some evidence to suggest that rates of dementia are lower in people who try to remain mentally and socially active. This could be achieved by volunteering in the local community, taking part in group activities, reading, socialising with friends, and trying new hobbies.
There is still much that needs to be understood about the risk factors, diagnosis and effective treatment of Alzheimer’s disease. Research is helping scientists, doctors, and the global healthcare community to build a more detailed picture of what happens in the brain when Alzheimer’s disease develops.
There is a significant number of ongoing research projects into Alzheimer’s disease throughout the world.
In 2020, there were 121 unique therapies in clinical trials for Alzheimer’s disease, as registered on the global database clinicaltrials.gov. The largest category of drugs in these clinical trials is disease‐modifying agents that target the onset or progression of Alzheimer’s disease. There is also a growing number of drugs known as repurposed agents which have been developed for other diseases that may also treat Alzheimer’s effectively (4).
Researchers are keen to find a way to stop or delay disease progression. More work needs to be done in this area, but there is increasing understanding of how Alzheimer’s disease disrupts the brain. This has led to potential treatment options that ‘short-circuit’ the disease process (1).
Future Alzheimer’s treatment developments may include a combination of different drugs. This is a similar approach to the treatment of certain cancers and HIV and AIDS which involve the administration of several medications.
Treatment strategies currently being investigated include:
The development of new treatments for Alzheimer’s disease is a slow process requiring painstaking detailed research and analysis (13). While the pace can be frustrating for people with the disease and their families, who are waiting for new treatment options, there is optimism that progress is being made into improving the diagnosis, treatment, and prevention of Alzheimer’s.