Health Topics A-Z

How Is It Diagnosed?

Diagnosis by a professional is particularly important because a number of other ailments — many of which are treatable — share symptoms associated with Alzheimer's disease. These include respiratory infections, inadequate nutrition, vitamin B-12 deficiency, anemia, hypoglycemia, depression, and cerebral vascular insufficiency (decreased blood flow to the brain due to constricted or obstructed arteries).

An adverse reaction to prescribed medication or a harmful combination of medicines can sometimes cause Alzheimer's-like symptoms. Other diseases and conditions sometimes confused with Alzheimer's disease are Parkinson's disease, stroke, thyroid problems, brain tumors, advanced syphilis and Huntington's chorea — an inherited degenerative nerve disease.

To check for Alzheimer's disease, the doctor will probably begin with physical and psychological tests designed to eliminate other possible causes of mental impairment. Verbal tests and interviews of the family are the usual next steps, but they will not produce a definitive diagnosis. Today, only an examination of brain tissue after death can yield absolute proof of Alzheimer's disease — the telltale evidence of nerve tangles, protein plaques, and general brain shrinkage from cell death.

What Is the Treatment?

Alzheimer's disease is incurable: Nothing can halt or reverse it. However, certain medications seem to slow its general progress to some degree in the early stages and others can help with mood changes and other specific behavioral problems of the disease.

• Cognex. In 1993, Cognex became the first drug approved by the FDA for treatment of Alzheimer's disease. The drug works by slowing the breakdown of acetylcholine, a chemical that helps nerve cells in the brain communicate. Cognex does not cure Alzheimer's disease or keep it from getting worse, but it can help relieve some of the memory impairment associated with the disease. Side effects of the drug include nausea, vomiting, diarrhea, abdominal pain and indigestion. In addition, Cognex can damage the liver, so your doctor will need to perform tests regularly to make sure this isn't happening. Due to its potential effects on the liver and need for frequent blood tests it is rarely used.
• Aricept Exelon and Razadyne(formerly known as Reminyl). These medications work by the same mechanism as Cognex but are better tolerated. They can improve mental functioning in early cases and perhaps delay the need for nursing home care, but do not seem to delay the actual progression of the disease
• Namenda. This is a newer drug approved in October 2003 that works by blocking a substance called glutamate which may be overactive in someone with Alzheimer's disease. I t improves mental function and may be more effective in moderate to severe symptoms, but is not a cure for Alzheimer's disease.

Other Therapies

Although hormone replacement therapy was initially thought to be beneficial, more recent studies actually show an increased risk in developing Alzheimer's for those taking combination hormone replacement (both estrogen and progesterone) and to a lesser degree estrogen replacement alone.

A number of drugs are prescribed for specific symptoms associated with Alzheimer's disease:

• Antipsychotic drugs such as Haldol, Risperdal, and Zyprexa may be used to treat the paranoia, confusion, hallucinations, and aggressive behavior experienced by Alzheimer's patients.
• Antidepressants such as Prozac, Paxil, Effexor, and Zoloft can be used to treat depression.
• Sleep medications such as Ambien may be used for insomnia, and antianxiety drugs such as Ativan and BuSpar may be used to treat agitation.
• The herbal medication, Ginko Biloba appears to increase blood flow to the brain and may be beneficial in treating the symptoms of Alzheimer's disease, however, there are several reports of serious side effects including coma, bleeding and seizures.

Caring for an Alzheimer's patient is often stressful for family members. Support organizations can help caregivers cope with problems and feelings. Eventually, full-time nursing care will be necessary. Some families are able to provide this full-time care at home, while others turn to professional caregivers.

At-Home Care

• To help an Alzheimer's patient cope with episodes of disorientation and mental lapses, promote a feeling of safety in every way possible: Maintain a stable, familiar living environment; stick to routine; when you must be absent, leave reminder notes and simple directions.
• Wandering and getting lost is a common problem with Alzheimer's patients. Have the patient wear an ID bracelet with a phone number on it.
• To encourage someone with Alzheimer's to talk more, go for a walk. Studies suggest that walking may stimulate areas of the brain linked to speech.

To help an Alzheimer's patient develop a more positive outlook on the present, try to help them remember good times. Often, long-term memories are not initially impaired and pleasant recollections can create feelings of happiness and well-being. This can be effectively done in a group. Good nostalgia-promoting materials include old magazines, photo albums, and favorite family stories. Avoid pressuring the patient to remember. A subtle question or two may provide the key to a memory.