An Update on Alzheimer’s Disease

June is Alzheimer’s and Brain Awareness Month. An estimated 6.5 million Americans ages 65 and older have Alzheimer’s dementia as of 2022. Here’s an update on what is currently known about Alzheimer’s disease, including symptoms, treatments and research efforts to prevent it.

What is Alzheimer’s disease?

Alzheimer’s is the most common cause of dementia in older adults. Dementia is defined as the loss of cognitive functioning and behavioral abilities to the point of interfering with a person’s daily activities.

Symptoms of Alzheimer’s

While symptoms of Alzheimer’s can vary, for many the early stages involve a decline in non-memory aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment. In mild Alzheimer’s disease, symptoms include:

• Greater memory loss
• Wandering and getting lost
• Problems handling money or paying bills
• Repeating questions
• Longer times to complete routine tasks
• Behavioral and personality changes
• Losing track of time
• Impaired judgment or decision-making
• Misplacing things and unable to retrace steps to find them
• Vision problems that make it hard to judge distance or determine color or contrast

It is often in the mild stage that people are diagnosed with Alzheimer’s. It is believed that damage to the brain starts 20 or more years before memory and other cognitive problems appear, making it difficult to prevent and treat the disease.

How does Alzheimer’s disease change the brain?

Abnormal clumps, called “amyloid plaques” and tangled bundles of fibers, called “neurofibrillary,” or “tau,” tangles are present in the brain tissue of a person with Alzheimer’s. Another feature is the loss of connections between nerve cells (neurons) in the brain. Normal neurons transmit messages between different parts of the brain and from the brain to muscles and organs in the body.

When abnormal deposits of proteins form amyloid plaques and tau tangles throughout the brain, once-healthy neurons stop functioning, lose connections with other neurons, and die. The initial damage appears to take place in the hippocampus, an area of the brain essential in forming memories. As neurons die, brain tissue in affected areas begins to shrink. By the final stage of Alzheimer’s, the damage is widespread and brain tissue has shrunk significantly.

Symptoms of Mild Cognitive Impairment (MCI)

Some people with memory problems have “mild cognitive impairment” (MCI). People with MCI may have more memory problems than normal for their age, but the symptoms do not interfere with their daily lives. Older people with MCI are at greater risk for developing Alzheimer’s, but not all of them do; some may actually go back to normal cognition.

Diagnosing Alzheimer’s

Physicians, neuropsychologists, geriatric psychiatrists and other specialists use a variety of tools and approaches to make an accurate diagnosis of Alzheimer’s and what’s causing it. They look at a patient’s:

• Medical history
• Mental cognitive status test results
• Physical exam and diagnostic test results
• Brain imaging results
• Neurological exam results

Please note that there is no proven accuracy in dementia home screening tests. A patient must be screened and diagnosed only by qualified healthcare professionals at designated medical institutions.

Treating Alzheimer’s

Current treatments for Alzheimer’s disease focus on helping people maintain mental function, manage behavioral symptoms and slow down the symptoms. Medications called cholinesterase inhibitors are prescribed for mild to moderate Alzheimer’s. For moderate to severe cases of Alzheimer’s, a drug may be prescribed which can help some people maintain certain daily functions a little longer than they would without the medication.

The US Food and Drug Administration (FDA) has approved six Alzheimer’s disease drugs:

• Donepezil
• Rivastigmine
• Galantamine
• Memantine
• Memantine combined with donepezil
• Aducanumab

The first three medicines can improve Alzheimer’s symptoms by increasing brain neurotransmitters. Memantine can protect the brain from glutamate, a neurotransmitter that can overstimulate neurons and damage them. However, the first five medicines treat Alzheimer’s symptoms only temporarily.

The FDA-approved aducanumab is the only drug that can reduce beta-amyloid plaques which are a characteristic of an Alzheimer’s brain. This drug is not a cure for Alzheimer’s and may not be appropriate for all patients with this disease. Aducanumab may be appropriate for people with mild dementia or MCI due to Alzheimer’s disease.

Approaching Memory Concerns in Others

If you notice changes in the thinking, behavior or memory of friends or family, here’s a guide to help you assess the situation:

1. What thinking, behavior or memory changes do you see? What is the person doing or not doing that is unusual?
2. What other health conditions does this person have?
3. Learn more about the 10 early signs of Alzheimer’s and see if you notice any of these signs in a person.
4. Who else among the person’s friends or family has noticed these changes? And what are these changes?
5. Determine if it’s best to discuss your concerns with the person one on one or you may need to include a trusted friend or family member.
6. Set the best time and place to have the conversation.
7. Open up about the changes you’ve noticed in the person. You can say something like: “I noticed you [specific example] and it worried me. Has anything else like that happened before?”
8. Offer to take the person to a doctor. “The sooner we know what’s causing these problems, the sooner we can address it.” “Let’s see if the doctor can help us figure out what’s going on.”
9. Have as much conversation as possible. Note the following:
   1. When and where the discussion happened
   2. What worked well and what didn’t?
   3. What was the result?
   4. What can be done differently next time?
10. Ask for information and support from the Alzheimer’s Association via 800-272-3900.

Research and Clinical Trials

Besides treating Alzheimer’s symptoms, scientists are looking at ways to address underlying disease processes. A recent study published in June of 2018, funded by the National Institute of Health, suggested that certain viruses may be linked to Alzheimer’s disease biology.

To help advance knowledge of the disease, including ways to help diagnose, treat and even prevent Alzheimer’s, on-going clinical trials are being conducted which monitor healthy individuals, those with early on-set Alzheimer’s and those at risk for developing Alzheimer’s. To learn more about clinical trials for Alzheimer’s disease, contact the National Institute on Aging.

The following registries are an opportunity for people to sign up for Alzheimer’s disease prevention trials:

• Alzheimer’s Prevention Registry
• TrialMatch by Alzheimer’s Association
• ResearchMarch
• BrainHealth Registry

If someone you know may be at risk, click here to locate a specialist in brain and neurological conditions.