Alzheimer’s

Introduction

If you have Alzheimer’s disease, it’s important to understand that your life is not over. Living with Alzheimer’s means dealing with some life changes sooner than you had anticipated.

You can live a meaningful and productive life by taking care of your physical and emotional health, by engaging in activities you enjoy and by spending time with family and friends.

Caring for Your Physical Health

Caring for your physical health can improve the quality of your life for years to come.

• Get regular checkups
• Take your medication
• Eat healthy foods
• Exercise every day
• Rest when you are tired
• Drink less alcohol

Coping With Your Feelings

After receiving a diagnosis, you may experience a range of emotions, including:

• denial about having dementia
• fear of losing people important to you
• loneliness because no one seems to understand what you are going through
• frustration with not making yourself understood
• loss of the way you used to see yourself
• depression or anger about the way your life is changing

The feelings you may be experiencing are normal. But it is important to find ways to deal with those feelings. The following suggestions may help you take care of your emotional needs:

• Write in a journal about your experiences and feelings.
• Join a support group. To find one in your area, check with your local Alzheimer’s Association office.
• Talk to your physician, who can determine if there is an appropriate treatment.
• See a counselor.
• Talk to a clergy member or other person who can help with your spiritual needs.
• Share your feelings with your friends and family.
• Do the activities you enjoy as long as you are able.
• Participate in our online community. Share experiences and advice with others on our message boards and live chat.

NIH-supported study suggests gender differences in cognition problems

Older men may be at risk of developing mild cognitive impairment (MCI), often a precursor to Alzheimer’s disease, earlier in life than older women, according to a study appearing today in Neurology.

Primarily funded by the National Institute on Aging (NIA), part of the National Institutes of Health, the study raises the question of whether there may be a gender difference in the development and progression of MCI.

Scientists evaluated the cognitive health of 1,969 dementia-free older people and found 16 percent showed signs of MCI, a condition usually marked by memory problems or other cognitive problems greater than those expected for their age. Prevalence was greater among the older participants, and it was consistently higher in men than women across all age ranges.

Ronald C. Petersen, Ph.D., M.D., and his team at the Mayo Clinic, Rochester, Minn., conducted the research, which was also supported by the National Institute of Mental Health (NIMH), also part of the NIH. Additional funding was provided by the Robert H. and Clarice Smith and Abigail van Buren Alzheimer’s Disease Research Program and the Rochester Epidemiology Project, also supported by NIA.

“Because evidence indicates that Alzheimer’s disease may cause changes in the brain one or two decades before the first symptoms appear, there is intense interest in investigating MCI and the earliest stages of cognitive decline,” said NIA Director Richard J. Hodes, M.D. “While more research is needed, these findings indicate that we may want to investigate differences in the way men and women develop MCI, similar to the way stroke and cardiovascular disease risk factors and outcomes vary between the sexes.”

The researchers conducted in-person evaluations of 1,969 randomly selected people from all 70- to 89-year-olds living in Olmsted County, Minn. The group was evenly split between men and women. Each individual received a neurological evaluation and neuropsychological testing. A panel then reviewed those data plus other information, such as health history and occupation/education levels, to reach a diagnosis. Sixteen percent were diagnosed with MCI; these individuals displayed either amnestic MCI, where memory is impaired, or non-amnestic MCI, where different cognitive problems arise, such as with language.

Results of the study indicated that:

• Overall, MCI was more prevalent in men (19 percent) than in women (14 percent), even after adjusting for several demographic variables and clinical factors, such as hypertension and coronary artery disease.
• Of the 16 percent affected with MCI, over twice as many people had the amnestic form that usually progresses to Alzheimer’s disease and the prevalence rate was higher in men than in women.
• MCI prevalence was higher among people with the APOE e4 gene, a known risk factor for late-onset Alzheimer’s, a form of the disease that usually occurs at age 65 or older.
• A greater number of years spent in school was significantly associated with decreased MCI prevalence, from 30 percent among participants with less than nine years of education to just 11 percent in those with more than 16 years of education.
• MCI prevalence was higher in participants who never married, as opposed to those currently or previously married.

The researchers noted that estimates of MCI prevalence vary in studies conducted around the world but generally fall into a range of 11 to 20 percent. The Mayo team’s evaluation of participants included detailed in-person assessments that helped to capture the subtle changes in daily function that may mark the onset of MCI, Petersen said. The researchers also noted that the study’s limitations include a relatively low participation rate by Olmstead County residents and the fact that the population is predominantly white. Thus, these findings may not apply to other ethnic groups.

The NIA leads the federal government effort conducting and supporting research on the biomedical, social and behavioral issues of older people. For more information on aging-related research and the NIA, go to www.nia.nih.gov. The NIA provides information on age-related cognitive change and neurodegenerative disease specifically at its Alzheimer’s Disease Education and Referral (ADEAR) Center site at www.nia.nih.gov/Alzheimers. To sign up for e-mail alerts about new findings or publications, please visit either website.

The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit www.nimh.nih.gov.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Introduction

Alzheimer’s disease will bring significant changes in your day-to-day experiences. Things you once did easily will become increasingly difficult. The following suggestions may help you cope with changes in your daily life and plan for changes that will occur in the future.

Doing difficult tasks

You may find familiar activities such as balancing your checkbook, preparing a meal or doing household chores more difficult. Try the following tips:

• Do difficult tasks during the times of the day when you normally feel best.
• Give yourself time to accomplish a task, and don’t let others rush you.
• Take a break if something is too difficult.
• Arrange for others to help you with tasks that are too difficult.

Communicating with others

You may begin to experience difficulty understanding what people are saying or finding the right words to express your thoughts. The following tips are important in communicating:

• Take your time.
• Ask the person to repeat a statement, speak slowly or write down words if you do not understand.
• Find a quiet place if there is too much distracting noise.

Driving

• Understand that at some point it may no longer be safe for you to drive. Discuss with your family and physician about how and when you will make decisions about driving.
• Make plans for other transportation options, such as family members, friends or community services.
• Contact your local chapter of the Alzheimer’s Association to learn what local transportation services are available.

Dealing with memory changes

• Post a schedule of the things you do every day, such as meal times, exercise, a medication schedule and bed time.
• Have someone call to remind you of meal times, appointments or your medication schedule.
• Keep a book containing important notes, such as phone numbers, people’s names, any thoughts or ideas you want to hold on to, appointments, your address and directions to your home.
• Post important phone numbers in large print next to the phone.
• Have someone help you label and store medications in a pill organizer.
• Mark off days on a calendar to keep track of time.
• Label photos with the names of those you see most often.
• Label cupboards and drawers with words or pictures that describe their contents.
• Have someone help you organize closets and drawers to make it easier to find what you need.
• Post reminders to turn off appliances and lock doors.

Living alone

Many individuals manage on their own during the earliest stages of Alzheimer’s disease, with support and assistance from others. The following suggestions may help if you live by yourself.

• Arrange for someone to help you with housekeeping, meals, transportation and other daily chores. To get information about assistance available in your community, talk to your local chapter of the Alzheimer’s Association.
• Make arrangements for direct deposit of checks, such as your retirement pension or Social Security benefits.
• Make arrangements for help in paying bills. You can give a trusted individual the legal authority to handle money matters.
• Plan for home-delivered meals if they are available in your community.
• Leave a set of house keys with a neighbor you trust.
• Make arrangements for someone to regularly check your smoke alarm.
• Have family, friends or a community service program call or visit daily.
  • Keep a list of questions and concerns to discuss with them during your time together.

Keep a list of things for them to check out around the house, such as electrical appliances, mail and food items.

This information is provided by the Alzheimer’s Organization (alz.org).

Experts have documented common patterns of symptom progression that occur in many individuals with Alzheimer’s disease and developed several methods of “staging” based on these patterns.

Staging systems provide useful frames of reference for understanding how the disease may unfold and for making future plans. But it is important to note that not everyone will experience the same symptoms or progress at the same rate. People with Alzheimer’s die an average of four to six years after diagnosis, but the duration of the disease can vary from three to 20 years.

The framework for this section is a system that outlines key symptoms characterizing seven stages ranging from unimpaired function to very severe cognitive decline. This framework is based on a system developed by Barry Reisberg, M.D., Clinical Director of the New York University School of Medicine’s Silberstein Aging and Dementia Research Center.

Within this framework, we have noted which stages correspond to the widely used concepts of mild, moderate, moderately severe and severe Alzheimer’s disease. We have also noted which stages fall within the more general divisions of early-stage, mid-stage and late-stage categories.