What are the signs and symptoms of Alzheimer’s disease?
The signs and symptoms of Alzheimer’s disease (AD) vary based on the stage of the condition. In general, the symptoms of AD involve a gradual decline in some, most or all of the following:
- Memory.
- Reasoning and handling of complex tasks.
- Language.
- Understanding visual form and space relationship.
- Behavior and personality.
People with memory loss or other signs of Alzheimer’s may have difficulty recognizing their mental decline. These signs may be more obvious to loved ones. Anyone experiencing dementia-like symptoms should see a healthcare provider as soon as possible.
Symptoms of the mild stage of Alzheimer’s dementia
Symptoms of AD become noticeable in the mild stage. The most common early symptom is forgetting newly learned information, especially recent events, places and names.
Other signs and symptoms of mild Alzheimer’s include:
- Having difficulty finding the right words to express thoughts.
- Losing or misplacing objects more than usual.
- Having difficulty making plans or organizing.
- Having difficulty problem-solving.
- Taking longer to complete routine daily tasks.
Most people in the mild stage of AD have no problem recognizing familiar faces and can usually travel to familiar places.
Symptoms of the moderate stage of Alzheimer’s
Moderate Alzheimer’s is typically the longest stage and can last many years. People in the moderate stage of Alzheimer’s often require care and assistance.
People in this stage may:
- Have increased memory loss and confusion, often forgetting events or details about their life, such as their telephone number or where they went to school.
- Have growing confusion about which day of the week it is, which season they’re in and where they are.
- Have poor short-term memory.
- Have some difficulty recognizing friends and family.
- Repeat stories, thoughts or events that are on their minds.
- Have difficulty with simple math.
- Need help with self-care, such as bathing, grooming, showering and using the bathroom.
- Experience more personality changes, including being agitated or acting out. They may show depression, apathy or anxiety as the disease progresses.
- Develop groundless suspicions about family, friends and caregivers (delusions).
- Develop urinary incontinence and/or fecal (bowel) incontinence.
- Have sleep disturbances.
- Begin to wander from their living area.
Symptoms of the severe stage of Alzheimer’s
In the final stage of Alzheimer’s, dementia symptoms are severe. People in this stage need extensive care.
In the severe stage of Alzheimer’s disease, the person often:
- Has almost total memory loss.
- Is unaware of their surroundings.
- Needs help with all basic activities of everyday living, such as eating, sitting up and walking.
- Loses their ability to communicate. Their speech becomes limited to a few words or phrases.
- Becomes vulnerable to infections, especially pneumonia and skin infections.
Hospice care may be appropriate at this time for comfort.
What is the treatment for Alzheimer’s disease?
There’s no cure for Alzheimer’s disease, but certain medications can temporarily slow the worsening of dementia symptoms. Medications and other interventions can also help with behavioral symptoms.
Beginning treatment as early as possible for Alzheimer’s could help maintain daily functioning for a while. However, current medications won’t stop or reverse AD.
As AD affects everyone differently, treatment is highly individualized. Healthcare providers work with people with Alzheimer’s and their caregivers to determine the best treatment plan.
The U.S. Food and Drug Administration (FDA) has approved two types of drugs to treat the symptoms of Alzheimer’s disease:
- Cholinesterase inhibitors.
- NMDA antagonists.
The FDA has given accelerated approval for aducanumab (Aduhelm™), the first disease-modifying therapy for Alzheimer’s disease. The medication helps to reduce amyloid deposits in your brain.
Aducanumab is a new medication, and researchers studied its effects in people living with early Alzheimer’s disease. Because of this, it may only help people in the early stage.
Cholinesterase inhibitors
The following cholinesterase inhibitors can help treat the symptoms of mild to moderate Alzheimer’s disease:
These drugs work by blocking the action of acetylcholinesterase, the enzyme responsible for destroying acetylcholine. Acetylcholine is one of the chemicals that help nerve cells communicate. Researchers believe that reduced levels of acetylcholine cause some of the symptoms of Alzheimer’s disease.
These drugs can improve some memory problems and reduce some behavioral symptoms of Alzheimer’s disease.
These medications don’t cure Alzheimer’s disease or stop the progression of the disease.
NMDA antagonists
Memantine (Namenda®) is FDA-approved for treating moderate to severe Alzheimer’s disease. It helps keep certain brain cells healthier.
Studies have shown that people with Alzheimer’s who take memantine perform better in common activities of daily living such as eating, walking, toileting, bathing and dressing.
Managing behavior changes
If your loved one has been diagnosed with Alzheimer’s disease, you can take steps to keep them comfortable in their environment and help manage behavior changes. You can:
- Maintain a familiar environment for them. Don’t change the layout or organization of their living space.
- Monitor their comfort.
- Provide comfort objects, such as a favorite stuffed animal or blanket.
- Try to redirect their attention if they’re under stress.
- Try to avoid confrontation.
No medication has been approved for the management of behavioral symptoms in Alzheimer’s dementia. Certain medications may help in some people, including:
- Antidepressants: These drugs can treat anxiety, restlessness, aggression and depression.
- Anti-anxiety drugs: These medications can treat agitation.
- Anticonvulsant drugs: These medications can sometimes treat aggression.
- Antipsychotics (neuroleptics): These drugs can treat paranoia, hallucinations and agitation.
These medications can cause unpleasant or potentially dangerous side effects (like dizziness, which could lead to falls), so healthcare providers typically only prescribe them for short periods when behavioral problems are severe. Or only after your loved one has tried safer non-drug therapies first.
Clinical trials
Scientists are actively researching Alzheimer’s disease and possible treatments. Ask your provider if there are any clinical trials that could benefit you or your loved one.
An early diagnosis often provides people with more opportunities to participate in clinical trials or other research studies.
How is Alzheimer’s disease diagnosed?
Healthcare providers use several methods to determine if a person with memory issues has Alzheimer’s disease. This is because many other conditions, especially neurological conditions, can cause dementia and other symptoms of Alzheimer’s.
In the beginning steps of an Alzheimer’s diagnosis, a provider will ask questions to better understand your health and daily living. Your provider may also ask someone close to you, like a family member or caregiver, for insight into your symptoms. They’ll ask about:
- Overall health.
- Current medications.
- Medical history.
- Ability to carry out daily activities.
- Changes in mood, behavior and personality.
A provider will also:
- Perform a physical exam and a neurological exam.
- Perform a mental status exam, which includes tests to assess memory, problem-solving, attention, basic math and language.
- Order standard medical tests, such as blood and urine tests, to rule out other possible causes of the symptoms.
- Order brain imaging tests, such as a brain CT, brain MRI or positron emission tomography, to support an Alzheimer’s diagnosis or to rule out other possible conditions.
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