Senior Assisted Living Solutions will help you find the right Alzheimer's care community. We understand the disease and work with assisted living facilities who understand people with Alzheimer's and Dementia need special TLC.

As an Executive Director of Alzheimer's communities (assisted living facility) I became familiar with many different forms of Dementia. The differences in initial decline of my residents, varied depending on the type of Dementia. I had a dear resident who was a linguist (she taught 5 different languages).  She developed frontal lobe dementia and over the period of 3 years-- totally lost her ability to speak or walk.  Another had Pick’s (very rare form of Dementia) and whiles she did not loose motor skills, she became locked in her own head (she lost all social skills and could not communicate). All of my residents declined at different rates; however, there were remarkable similar behaviors with residents who had “like” Dementia’s.

The one and only thing that none of my residents lost was their ability to respond to human touch. Holding their hand, hugs, or stroking their face could always evoke a smile from them or calm them when they were agitated. The one thing that I can assure you is; in order to be successful in caring for a person with Alzheimer's you will need to have the ability to adapt to "their world". I f your loved one is 95 and waiting for her mom to pick her up, she really believes her mom is coming. Playing into her world will have amazing effects on her emotional state. i.e. Mom just called and said she will be here in 10 minutes; let's go wash our face and get pretty for her! This is called redirecting and is the most compassionate thing you can do for a person with alzheimer's. Telling her that her mom died 30 years ago will only upset her, besides she will not believe you anyway. In her world her mom is alive and on her way!

How common is Alzheimer's disease?

In the US, the most recent census has enabled researchers to give estimates of how many people have Alzheimer's disease. In 2010, some 4.7 million people of 65 years of age and older were living with Alzheimer's disease in the US. In 2015 that number has increased to 5.4 million.

The 2013 statistical report from the Alzheimer's Association gives a proportion of the population affected - just over a tenth of people in the over-65 age group have the disease in the US. In the over-85s, the proportion goes up to about a third.
Vascular dementia, which is caused by stroke not Alzheimer's, is the second most common type of dementia.

What causes Alzheimer's disease?

Like all types of dementia, Alzheimer's is caused by brain cell death. It is a neurodegenerative disease, which means there is progressive brain cell death that happens over a course of time.The total brain size shrinks with Alzheimer's - the tissue has progressively fewer nerve cells and connections.[brain neurons]
Nerve cells (neurons) in the brain. In Alzheimer's, there are microscopic 'plaques' and 'tangles' between and within brain cells.While they cannot be seen or tested in the living brain affected by Alzheimer's disease, postmortem/autopsy will always show tiny inclusions in the nerve tissue, called plaques and tangles.Plaques are found between the dying cells in the brain - from the build-up of a protein called beta-amyloid (you may hear the term "amyloid plaques").
The tangles are within the brain neurons - from a disintegration of another protein, called tau.

For a detailed visualization of what goes on in the Alzheimer's disease process, progressing from the normal brain to increasing dementia changes, the Alzheimer's Association has produced: Inside the brain: an interactive tour.

The abnormal protein clumps, inclusions, in the brain tissue are always present with the disease, but there could be another underlying process that is actually causing the Alzheimer's - scientists are not yet sure.This sort of change in brain nerves is also witnessed in other disorders,3 and researchers want to find out more than just that there are protein abnormalities - they also want to know how these develop so that a cure or prevention might be discovered.

Risk factors

Some things are more commonly associated with Alzheimer's disease - not seen so often in people without the disorder. These factors may therefore have some direct connection. Some are preventable or modifiable factors (for example, reducing the risk of diabetes or heart disease may in turn cut the risk of dementia).If researchers gain more understanding of the risk factors, or scientifically prove any "cause" relationships for Alzheimer's, this could help to find ways to prevent it or develop treatments.

Risk factors associated with Alzheimer's disease include:

Unavoidable risk factors and potentially avoidable or modifiable factors

  • Age - the disorder is more likely in older people, and a greater proportion of over-85-year-olds have it than of over-65
  • Family history (inheritance of genes) - having Alzheimer's in the family is associated with higher risk. This is the second biggest risk factor after age.
  • Having a certain gene (the apolipoprotein E or APOE gene) puts a person, depending on their specific genetics, at three to eight times more risk than a person without the gene.6 Numerous other genes have been found to be associated with Alzheimer's disease.
  • Being female (more women than men are affected).
  • Factors that increase blood vessel (vascular) risk - including diabetes, high cholesterol and high blood pressure. (These also increase the risk of stroke, which itself can lead to another type of dementia.)
  • Low educational and occupational attainment.
  • Prior head injury. (While a traumatic brain injury does not necessarily lead to Alzheimer's, some research links have been drawn, with increasing risk tied to the severity of trauma history.)
  • Sleep disorders (the breathing problem sleep apnea, for example).
  • Estrogen hormone replacement therapy.

Early-onset Alzheimer's disease

Genetics are behind early-onset familial Alzheimer's disease, which presents typically between the ages of 30 and 60 years and affects people who have a family history of it. Due to one of three inherited genes, it is also known as young-onset, and it is uncommon - accounting for under 5% of all Alzheimer's cases. The Alzheimer's Association says in its early-onset information that it can sometimes be "a long and frustrating process" to get this diagnosis confirmed since doctors do not expect to find Alzheimer's in younger people. For the younger age groups, doctors will look for other dementia causes first.
Healthcare professionals, the nonprofit says, may also "incorrectly attribute" symptoms to stress and so on, or may not agree on the diagnosis.

Eleven new Alzheimer's risk genes have been identified. The findings, published in Nature Genetics in October 2013, mean the total number of genes found to be associated with Alzheimer's disease was 21. Large research collaborations resulted in the breakthrough to help understand genetic factors behind the dementia. Just over 70,000 individuals were analyzed, comparing the genes of 25,580 people who had Alzheimer's against 48,466 healthy controls, enabling the scientists to pinpoint genes that may put people at higher risk.

  • Alzheimer's onset could be triggered by sleep disturbances - Chronic sleep problems can inflame a number of health problems, from widespread pain to speeding up cancer. Though sleep disturbances have been observed in people with Alzheimer's disease, whether this is a cause or effect has been unknown. Now, researchers say individuals with chronic sleep disruptions could face earlier onset of Alzheimer's. Their pre-clinical study was published in the journal Neurobiology of Aging.
  • DNA methylation in brain 'linked to Alzheimer's disease' - DNA methylation - the biochemical alteration of the building blocks of DNA - can indicate whether DNA is biologically active within a region of the human genome. Now, researchers at Brigham and Women's Hospital in Boston, MA, and Rush University Medical Center in Chicago, IL, have demonstrated how DNA methylation in the brain is implicated in Alzheimer's disease.
  • Increased Alzheimer's risk linked to long-term benzodiazepine use - Long-term users of benzodiazepines, drugs used to treat anxiety and insomnia, may be at increased risk of developing Alzheimer's disease, according to a new study published in the BMJ.
  • Brain network vulnerable to Alzheimer's and schizophrenia identified - New research has emerged that reveals a specific brain network - that is the last to develop and the first to show signs of neurodegeneration - is more vulnerable to unhealthy aging as well as to disorders that emerge in young people, shedding light on conditions such as Alzheimer's disease and schizophrenia.

Signs and symptoms

The cognitive decline is in at least TWO of the five symptom areas listed below (from guidelines jointly produced by the National Institute on Aging and the Alzheimer's Association):

1. Worsened ability to take in and remember new information, for example:

  • "Repetitive questions or conversations
  • Misplacing personal belongings
  • Forgetting events or appointments
  • Getting lost on a familiar route."

2. Impairments to reasoning, complex tasking, exercising judgment:

  • "Poor understanding of safety risks
  • Inability to manage finances
  • Poor decision-making ability
  • Inability to plan complex or sequential activities."

3. Impaired visuospatial abilities (but not, for example, due to eye sight problems):

  • "Inability to recognize faces or common objects or to find objects in direct view
  • Inability to operate simple implements, or orient clothing to the body."

4. Impaired speaking, reading and writing:

  • "Difficulty thinking of common words while speaking, hesitations
  • Speech, spelling, and writing errors."

5. Changes in personality and behavior, for example:

  • Out-of-character mood changes, including agitation; less interest, motivation or initiative; apathy; social withdrawal
  • Loss of empathy
  • Compulsive, obsessive or socially unacceptable behavior.

Once the number and severity of these example symptoms confirm dementia, the best certainty that they are because of Alzheimer's disease is given by:

  • A gradual onset "over months to years" rather than hours or days (the case with some other problems)
  • A marked worsening of the individual person's normal level of cognition in particular areas.
  • The most common presentation marking Alzheimer's dementia is where symptoms of memory loss are the most prominent, especially in the area of learning and recalling new information. But the initial presentation can also be one of mainly language problems, in which case the greatest symptom is struggling to find the right words.
  • If visuospatial deficits are most prominent, meanwhile, these would include inability to recognize objects and faces, to comprehend separate parts of a scene at once (simultanagnosia), and a type of difficulty with reading text (alexia). Finally, the most prominent deficits in "executive dysfunction" would be to do with reasoning, judgment and problem-solving.

Stages of Alzheimer's disease

The progression of Alzheimer's can be broken down into three basic stages:

  • Preclinical (no signs or symptoms yet)
  • Mild cognitive impairment
  • Dementia.

The Alzheimer's Association has broken this down further, describing seven stages along a continuum of cognitive decline based on symptom severity - from a state of no impairment, through mild and moderate decline, and eventually reaching "very severe decline." The association has published the seven stages online. It is not usually until stage four that a diagnosis is clear - here it is called mild or early-stage Alzheimer's disease, and "a careful medical interview should be able to detect clear-cut symptoms in several areas."

Test Questions 

The "abbreviated mental test score" (AMTS):

  •  What is your age?
  • What is the time, to the nearest hour?
  •  Repeat an address at the end of the test that I will give you now (e.g. "212 Central Ave")
  •  What is the year?
  •  What is the name of the hospital or town we are in?
  •  Can you recognize two people (e.g. the doctor, nurse, home help, etc.)?
  •  What is your date of birth?
  •  In what year did World Trade Center get hit by planes? (Other widely known dates in the past can be used.)
  •  Name the president/prime minister/monarch.
  •  Count backwards from 20 down to 1.

The mini mental state examination (MMSE) is a fuller cognitive test to help diagnose Alzheimer's disease. It is also sensitive to the severity of the disorder and helps to indicate when drug treatment could ease symptoms appearing later in the course of the disease:

  • Normal cognitive health - score above 26
  • Mild-to-moderate Alzheimer's - below 26
  • Moderate - below 20 but above 10
  • Severe - score under 10.

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