What Is Dementia?

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Memory loss is an example. Alzheimer's is the most common type of dementia. About dementia Dementia is not a specific disease. It's an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities. Alzheimer's disease accounts for ! to "! percent of cases. #ascular dementia$ which occurs after a stroke$ is the second most common dementia type. %ut there are many other conditions that can cause symptoms of dementia$ including some that are reversible$ such as thyroid problems and vitamin deficiencies. Dementia is often incorrectly referred to as &senility& or &senile dementia$& which reflects the formerly widespread but incorrect belief that serious mental decline is a normal part of aging. Many people have memory loss issues this does not mean they have Alzheimer s or another dementia /here are many different causes of memory 'hile symptoms of dementia can vary greatly$ at least two of the following core problems. If you or a loved one is experiencing mental functions must be significantlytroubling symptoms$ visit a doctor to learn the reason. .ome causes of dementia-like symptoms impaired to be considered dementia( Memory loss and other symptoms of dementia Memory )ommunication and language Ability to focus and pay attention *easoning and +udgment #isual perception

,eople with dementia may have problems with short-term memory$ keeping track of a purse or wallet$ paying bills$ planning and preparing meals$ remembering appointments or traveling out of the neighborhood. Many dementias are progressive$ meaning symptoms start out slowly and gradually get worse. If you or a loved one is experiencing memory difficulties or other changes in thinking skills$ don't ignore them. .ee a doctor soon to determine the cause. ,rofessional evaluation may detect a treatable condition. And even if symptoms suggest dementia$ early diagnosis allows a person to get the maximum benefit from available treatments and provides an opportunity to volunteer for clinical trials or studies. It also provides time to plan for the future. Causes Dementia is caused by damage to brain cells. /his damage interferes with the ability of brain cells to communicate with each other. 'hen brain cells cannot communicate normally$ thinking$ behavior and feelings can be affected. /he brain has many distinct regions$ each of which is responsible for different functions 0for example$ memory$ +udgment and movement1. 'hen cells in a particular region are damaged$ that region cannot carry out its functions normally.

Different types of dementia are associated with particular types of brain cell damage in particular regions of the brain. 2or example$ in Alzheimer's disease$ high levels of certain proteins inside and outside brain cells make it hard for brain cells to stay healthy and to communicate with each other. /he brain region called the hippocampus is the center of learning and memory in the brain$ and the brain cells in this region are often the first to be damaged. /hat's why memory loss is often one of the earliest symptoms of Alzheimer's. 'hile most changes in the brain that cause dementia are permanent and worsen over time$ thinking and memory problems caused by the following conditions may improve when the condition is treated or addressed( Depression Medication side effects 3xcess use of alcohol /hyroid problems #itamin deficiencies Diagnosis of dementia /here is no one test to determine if someone has dementia. Doctors diagnose Alzheimer's and other types of dementia based on a careful medical history$ a physical examination$ laboratory tests$ and the characteristic changes in thinking$ day-to-day function and behavior associated with each type. Doctors can determine that a person has dementia with a high level of certainty. %ut it's harder to determine the exact type of dementia because the symptoms and brain changes of different dementias can overlap. In some cases$ a doctor may diagnose &dementia& and not specify a type. If this occurs it may be necessary to see a specialist such as a neurologist or gero-psychologist. !ypes of Dementia !ype of Dementia Alzheimer s disease Characteristics Most common type of dementia4 accounts for an estimated ! to "! percent of cases. "ymptoms# Difficulty remembering names and recent events is often an early clinical symptom4 apathy and depression are also often early symptoms. 5ater symptoms include impaired +udgment$ disorientation$ confusion$ behavior changes and difficulty speaking$ swallowing and walking. 6ew criteria and guidelines for diagnosing Alzheimer's were published in 7!88 recommending that Alzheimer's disease be considered a disease with three stages$ beginning well before the development of symptoms.

$rain changes# 9allmark abnormalities are deposits of the protein fragment beta-amyloid 0pla:ues1 and twisted strands of the protein tau 0tangles1 as well as evidence of nerve cell damage and death in the brain. %ascular dementia ,reviously known as multi-infarct or post-stroke dementia$ vascular dementia is the second most common cause of dementia after Alzheimer's disease. "ymptoms# Impaired +udgment or ability to plan steps needed to complete a task is more likely to be the initial symptom$ as opposed to the memory loss often associated with the initial symptoms of Alzheimer's. ;ccurs because of brain in+uries such as microscopic bleeding and blood vessel blockage. /he location of the brain in+ury determines how the individual's thinking and physical functioning are affected. $rain changes# %rain imaging can often detect blood vessel problems implicated in vascular dementia. In the past$ evidence for vascular dementia was used to exclude a diagnosis of Alzheimer's disease 0and vice versa1. /hat practice is no longer considered consistent with pathologic evidence$ which shows that the brain changes of several types of dementia can be present simultaneously. 'hen any two or more types of dementia are present at the same time$ the individual is considered to have &mixed dementia& 0see entry below1. Dementia &ith 'e&y bodies (D'$) "ymptoms# ,eople with dementia with 5ewy bodies often have memory loss and thinking problems common in Alzheimer's$ but are more likely than people with Alzheimer's to have initial or early symptoms such as sleep disturbances$ well-formed visual hallucinations$ and muscle rigidity or other parkinsonian movement features. $rain changes# 5ewy bodies are abnormal aggregations 0or clumps1 of the protein alpha-synuclein. 'hen they develop in a part of the brain called the cortex$ dementia can result. Alpha-synuclein also aggregates in the brains of people with ,arkinson's disease$ but the aggregates may appear in a pattern that is different from dementia with 5ewy bodies. /he brain changes of dementia with 5ewy bodies alone can cause dementia$ or they can be present at the same time as the brain changes of Alzheimer's disease and<or vascular

dementia$ with each abnormality contributing to the development of dementia. 'hen this happens$ the individual is said to have &mixed dementia.& Mi*ed dementia In mixed dementia abnormalities linked to more than one type of dementia occur simultaneously in the brain. *ecent studies suggest that mixed dementia is more common than previously thought. $rain changes# )haracterized by the hallmark abnormalities of more than one type of dementia =most commonly$ Alzheimer's and vascular dementia$ but also other types$ such as dementia with 5ewy bodies. +ar,inson s disease As ,arkinson's disease progresses$ it often results in a progressive dementia similar to dementia with 5ewy bodies or Alzheimer's. "ymptoms# ,roblems with movement are a common symptom early in the disease. If dementia develops$ symptoms are often similar to dementia with 5ewy bodies. $rain changes# Alpha-synuclein clumps are likely to begin in an area deep in the brain called the substantia nigra. /hese clumps are thought to cause degeneration of the nerve cells that produce dopamine. -rontotemporal dementia Includes dementias such as behavioral variant 2/D 0bv2/D1$ primary progressive aphasia$ ,ick's disease and progressive supranuclear palsy. "ymptoms# /ypical symptoms include changes in personality and behavior and difficulty with language. 6erve cells in the front and side regions of the brain are especially affected. $rain changes# 6o distinguishing microscopic abnormality is linked to all cases. ,eople with 2/D generally develop symptoms at a younger age 0at about age !1 and survive for fewer years than those with Alzheimer's. Creutzfeldt./a,ob disease )>D is the most common human form of a group of rare$ fatal brain disorders affecting people and certain other

mammals. #ariant )>D 0?mad cow disease@1 occurs in cattle$ and has been transmitted to people under certain circumstances. "ymptoms# *apidly fatal disorder that impairs memory and coordination and causes behavior changes. $rain changes# *esults from misfolded prion protein that causes a &domino effect& in which prion protein throughout the brain misfolds and thus malfunctions. 0ormal pressure hydrocephalus "ymptoms# .ymptoms include difficulty walking$ memory loss and inability to control urination. $rain changes# )aused by the buildup of fluid in the brain. )an sometimes be corrected with surgical installation of a shunt in the brain to drain excess fluid. 1untington s Disease 9untingtonAs disease is a progressive brain disorder caused by a single defective gene on chromosome B. "ymptoms( Include abnormal involuntary movements$ a severe decline in thinking and reasoning skills$ and irritability$ depression and other mood changes. $rain changes( /he gene defect causes abnormalities in a brain protein that$ over time$ lead to worsening symptoms. Wernic,e.2orsa,off "yndrome Corsakoff syndrome is a chronic memory disorder caused by severe deficiency of thiamine 0vitamin %-81. /he most common cause is alcohol misuse. "ymptoms( Memory problems may be strikingly severe while other thinking and social skills seem relatively unaffected. $rain changes( /hiamine helps brain cells produce energy from sugar. 'hen thiamine levels fall too low$ brain cells cannot generate enough energy to function properly.

Dementia ris, and prevention

.ome risk factors for dementia$ such as age and genetics$ cannot be changed. %ut researchers continue to explore the impact of other risk factors on brain health and prevention of dementia. .ome of the most active areas of research in risk reduction and prevention include cardiovascular factors$ physical fitness$ and diet. Cardiovascular ris, factors# Dour brain is nourished by one of your body's richest networks of blood vessels. Anything that damages blood vessels anywhere in your body can damage blood vessels in your brain$ depriving brain cells of vital food and oxygen. %lood vessel changes in the brain are linked to vascular dementia. /hey often are present along with changes caused by other types of dementia$ including Alzheimer's disease and dementia with 5ewy bodies. /hese changes may interact to cause faster decline or make impairments more severe. Dou can help protect your brain with some of the same strategies that protect your heart E don't smoke4 take steps to keep your blood pressure$ cholesterol and blood sugar within recommended limits4 and maintain a healthy weight.

What Is Alzheimer s?
Alzheimer's is a type of dementia that causes problems with memory$ thinking and behavior. .ymptoms usually develop slowly and get worse over time$ becoming severe enough to interfere with daily tasks. Alzheimer s and dementia basics 3 Alzheimer s is the most common form of dementia4 a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer's disease accounts for F! to "! percent of dementia cases. /here is a lot to know about living with Alzheimer's disease. .tay up-to-date on the latest advances in Alzheimer's$ plus get tips on managing daily life with the disease. 3 Alzheimer s is not a normal part of aging4 although the greatest known risk factor is increasing age$ and the ma+ority of people with Alzheimer's are F and older. %ut Alzheimer's is not +ust a disease of old age. Gp to F percent of people with the disease have early onset Alzheimer's 0also known as younger-onset1$ which often appears when someone is in their B!s or F!s. 3 Alzheimer s &orsens over time. Alzheimer's is a progressive disease$ where dementia symptoms gradually worsen over a number of years. In its early stages$ memory loss is mild$ but with late-stage Alzheimer's$ individuals lose the ability to carry on a conversation and respond to their environment. Alzheimer's is the sixth leading cause of death in the Gnited .tates. /hose with Alzheimer's live an average of eight years after their symptoms become noticeable to others$ but survival can range from four to 7! years$ depending on age and other health conditions. 3 Alzheimer s has no current cure4 but treatments for symptoms are available and research continues. Although current Alzheimer's treatments cannot stop Alzheimer's from progressing$ they can temporarily slow the worsening of dementia symptoms and improve :uality of life for those with Alzheimer's and their caregivers. /oday$ there is a worldwide effort under way to find better ways to treat the disease$ delay its onset$ and prevent it from developing.

Alzheimer s Myths Myth 5# Memory loss is a natural part of aging. 6eality# As people age$ it's normal to have occasional memory problems$ such as forgetting the name of a person you've recently met. 9owever$ Alzheimer's is more than occasional memory loss. It's a disease that causes brain cells to malfunction and ultimately die. 'hen this happens$ an individual may forget the name of a longtime friend or what roads to take to return to a home they've lived in for decades. It can be difficult to tell normal memory problems from memory problems that should be a cause for concern. /he Alzheimer's Association has developed information to help you tell the difference. If you or a loved one has memory problems or other problems with thinking and learning that concern you$ contact a physician. .ometimes the problems are caused by medication side effects$ vitamin deficiencies or other conditions and can be reversed with treatment. /he memory and thinking problems may also be caused by another type of dementia. Myth 7# Alzheimer8s disease is not fatal. 6eality# Alzheimer's disease has no survivors. It destroys brain cells and causes memory changes$ erratic behaviors and loss of body functions. It slowly and painfully takes away a person's identity$ ability to connect with others$ think$ eat$ talk$ walk and find his or her way home. Myth 9# :nly older people can get Alzheimer s 6eality# Alzheimer's can strike people in their H!s$ B!s and even F!s. /his is called youngeronset Alzheimer's. It is estimated that there are more than F million people living with AlzheimerAs disease in the Gnited .tates. /his includes F.7 million people age F and older and 7!!$!!! people younger than age F with younger-onset AlzheimerAs disease. Myth ;# Drin,ing out of aluminum cans or coo,ing in aluminum pots and pans can lead to Alzheimer8s disease. 6eality# During the 8I !s and 8IJ!s$ aluminum emerged as a possible suspect in AlzheimerAs. /his suspicion led to concern about exposure to aluminum through everyday sources such as pots and pans$ beverage cans$ antacids and antiperspirants. .ince then$ studies have failed to confirm any role for aluminum in causing AlzheimerAs. 3xperts today focus on other areas of research$ and few believe that everyday sources of aluminum pose any threat. Myth <# Aspartame causes memory loss. 6eality# /his artificial sweetener$ marketed under such brand names as 6utrasweet and 3:ual$ was approved by the G... 2ood and Drug Administration 02DA1 for use in all foods and beverages in 8II . .ince approval$ concerns about aspartame's health effects have been raised. According to the 2DA$ as of May 7!! $ the agency had not been presented with any scientific evidence that would lead to change its conclusions on the safety of aspartame for most people. /he agency says its conclusions are based on more than 8!! laboratory and clinical studies. *ead the May 7!! 2DA statement about aspartame. Myth =# -lu shots increase ris, of Alzheimer8s disease

6eality# A theory linking flu shots to a greatly increased risk of AlzheimerAs disease has been proposed by a G... doctor whose license was suspended by the .outh )arolina %oard of Medical 3xaminers. .everal mainstream studies link flu shots and other vaccinations to a reduced risk of Alzheimer's disease and overall better health. K A 6ov. 7J$ 7!!8$ )anadian Medical >ournal report suggests older adults who were vaccinated against diphtheria or tetanus$ polio$ and influenza seemed to have a lower risk of developing AlzheimerAs disease than those not receiving these vaccinations. /he full text of this report is posted on the +ournalAs 'eb site. K A report in the 6ov. H$ 7!!B$ >AMA found that annual flu shots for older adults were associated with a reduced risk of death from all causes. /he abstract of that report is posted on ,ubMed. Myth ># "ilver dental fillings increase ris, of Alzheimer s disease 6eality# According to the best available scientific evidence$ there is no relationship between silver dental fillings and Alzheimer's. /he concern that there could be a link arose because &silver& fillings are made of an amalgam 0mixture1 that typically contains about F! percent mercury$ HF percent silver and 8F percent tin. Mercury is a heavy metal that$ in certain forms$ is known to be toxic to the brain and other organs. Many scientists consider the studies below compelling evidence that dental amalgam is not a ma+or risk factor for Alzheimer's. ,ublic health agencies$ including the 2DA$ the G... ,ublic 9ealth .ervice and the 'orld 9ealth ;rganization$ endorse the continued use of amalgam as safe$ strong$ inexpensive material for dental restorations. K March 8II8$ the Dental Devices ,anel of the 2DA concluded there was no current evidence that amalgam poses any danger. K 6ational Institutes of 9ealth 06I91 in 8II8 funded a study at the Gniversity of Centucky to investigate the relationship between amalgam fillings and Alzheimer's. Analysis by Gniversity statisticians revealed no significant association between silver fillings and Alzheimer's. /he abstract for this study is posted on the >ournal of the American Dental Association 'eb site. K ;ctober H!$ 7!!H$ a 6ew 3ngland >ournal of Medicine article concluded that current evidence shows no connection between mercury-containing dental fillings and Alzheimer's or other neurological diseases. /he abstract for this study is posted on the 6ew 3ngland >ournal of Medicine 'eb site. Myth ?# !here are treatments available to stop the progression of Alzheimer s disease 6eality# At this time$ there is no treatment to cure$ delay or stop the progression of Alzheimer's disease. 2DA-approved drugs temporarily slow worsening of symptoms for about to 87 months$ on average$ for about half of the individuals who take them. 6is, -actors .cientists have identified factors that increase the risk of AlzheimerAs. /he most important risk factors=age$ family history and heredity=can't be changed$ but emerging evidence suggests there may be other factors we can influence. 5. Age /he greatest known risk factor for AlzheimerAs is advancing age. Most individuals with the disease are age F or older. /he likelihood of developing AlzheimerAs doubles about every five years after age F. After age "F$ the risk reaches nearly F! percent. ;ne of the greatest mysteries of Alzheimer's disease is why risk rises so dramatically as we grow older.

7. -amily history Another strong risk factor is family history. /hose who have a parent$ brother$ sister or child with AlzheimerAs are more likely to develop the disease. /he risk increases if more than one family member has the illness. 'hen diseases tend to run in families$ either heredity 0genetics1 or environmental factors$ or both$ may play a role. Aluminum not a cause During the 8I !s and 8IJ!s$ aluminum emerged as a possible suspect in causing AlzheimerAs disease. /his suspicion led to concerns about everyday exposure to aluminum through sources such as cooking pots$ foil$ beverage cans$ antacids and antiperspirants. .ince then$ studies have failed to confirm any role for aluminum in causing AlzheimerAs. Almost all scientists today focus on other areas of research$ and few experts believe that everyday sources of aluminum pose any 9. @enetics (heredity) .cientists know genes are involved in AlzheimerAs. /here are two types of genes that can play a role in affecting whether a person develops a disease=risk genes and deterministic genes. Alzheimer's genes have been found in both categories. @enetic testing Lenetic tests are available for both A,;3-eB and the rare genes that directly cause AlzheimerAs. 9owever$ health professionals do not currently recommend routine genetic testing for AlzheimerAs disease. /esting for A,;3-eB is sometimes 5. 6is, genes increase the likelihood of developing a disease$ but do not guarantee it will happen. .cientists have so far identified several risk genes implicated in Alzheimer's disease. /he risk gene with the strongest influence is called apolipoprotein 3-eB 0A,;3-eB1. .cientists estimate that A,;3-eB may be a factor in 7! to 7F percent of Alzheimer's cases. A,;3-eB is one of three common forms of the A,;3 gene4 the others are A,;3-e7 and A,;3-eH. 3veryone inherits a copy of some form of A,;3 from each parent. /hose who inherit A,;3-eB from one parent have an increased risk of AlzheimerAs. /hose who inherit A,;3-eB from both parents have an even higher risk$ but not a certainty. .cientists are not yet certain how A,;3-eB increases risk. In addition to raising risk$ A,;3-eB may tend to make Alzheimer's symptoms appear at a younger age than usual. 7. Deterministic genes directly cause a disease$ guaranteeing that anyone who inherits them will develop the disorder. .cientists have discovered variations that directly cause AlzheimerAs disease in the genes coding three proteins( amyloid precursor protein 0A,,1$ presenilin-8 0,.-81 and presenilin-7 0,.-71. 'hen AlzheimerAs disease is caused by these deterministic variations$ it is called ?autosomal dominant AlzheimerAs disease 0ADAD1@ or ?familial AlzheimerAs disease$@ and many family members in multiple generations are affected. .ymptoms nearly always develop before age !$ and may appear as early as a person's H!s or B!s. Deterministic Alzheimer's variations have been found in only a few hundred extended families worldwide. /rue familial AlzheimerAs

accounts for less than F percent of cases. A closer loo,# @enes lin,ed to Alzheimer s /he 7H human chromosome pairs contain all of the H!$!!! genes that code the biological blueprint for a human being. /his interactive illustration highlights the chromosomes containing each of the three genes that cause familial Alzheimer's and the gene 7H chromosome pairs. Amyloid precursor protein (A++)4 discovered in 8I"J$ is the first gene with mutations found to cause an inherited form of Alzheimer's. +resenilin.5 (+".5)4 identified in 8II7$ is the second gene with mutations found to cause early-onset of Alzheimer's. #ariations in this gene are the most common cause of early-onset Alzheimer's. ,resenilin-7 0,.-71$ 8IIH$ is the third gene with mutations found to cause early-onset Alzheimer's. Apolipoprotein A.e; (A+:A;)4 8IIH$ is the first gene variation found to increase risk of Alzheimer's and remains the risk gene with the greatest known impact. 9aving this mutation$ however$ does not mean that a person will develop the disease.with the greatest impact on Alzheimer's risk. What you can do no&# -actors you may be able to influence Most experts believe that the ma+ority of Alzheimer's disease occurs as a result of complex interactions among genes and other risk factors. Age$ family history and heredity are all risk factors we canAt change. 6ow$ research is beginning to reveal clues about other risk factors we may be able to influence through general lifestyle and wellness choices and effective management of other health conditions. 1ead trauma# /here may be a strong link between serious head in+ury and future risk of AlzheimerAs$ especially when trauma occurs repeatedly or involves loss of consciousness. ,rotect your brain by buckling your seat belt$ wearing your helmet when participating in sports$ and ?fall-proofing@ your home. 5earn more about traumatic brain in+ury. 1eart.head connection# Lrowing evidence links brain health to heart health. Dour brain is nourished by one of your bodyAs richest networks of blood vessels. 3very heartbeat pumps about 7! to 7F percent of your blood to your head$ where brain cells use at least 7! percent of the food and oxygen your blood carries. /he risk of developing AlzheimerAs or vascular dementia appears to be increased by many conditions that damage the heart or blood vessels. /hese include high blood pressure$ heart disease$ stroke$ diabetes and high cholesterol. 'ork with your doctor to monitor your heart health and treat any problems that arise.

.tudies of donated brain tissue provide 'atinos and African.Americans at ris, additional evidence for the heart-head %ecause 5atinos and African-Americans in the connection. /hese studies suggest that Gnited .tates have higher rates of vascular pla:ues and tangles are more likely to disease$ they also may be at greater risk for cause Alzheimer's symptoms if strokes developing AlzheimerAs. According to a growing or damage to the brainAs blood vesselsbody of evidence$ risk factors for vascular disease are also present. = including diabetes$ high blood pressure and high cholesterol = may also be risk factors for .@eneral healthy aging# ;ther lines of evidence suggest that strategies for overall healthy aging may help keep your brain as well as your body fit. /hese strategies may even offer some protection against developing AlzheimerAs or related disorders. /ry to keep your weight within recommended guidelines$ avoid tobacco and excess alcohol$ stay socially connected$ and exercise both your body and mind. .ign up for AlzheimerAs enews and stay informed on research investigating lifestyle factors and the risk of cognitive impairment. "ymptoms of Alzheimer s /he most common early symptom of Alzheimer's is difficulty remembering newly learned information. >ust like the rest of our bodies$ our brains change as we age. Most of us eventually notice some slowed thinking and occasional problems with remembering certain things. 9owever$ serious memory loss$ confusion and other ma+or changes in the way our minds work may be a sign that brain cells are failing. /he most common early symptom of Alzheimer's is difficulty remembering newly learned information because Alzheimer's changes typically begin in the part of the brain that affects learning. As Alzheimer's advances through the brain it leads to increasingly severe symptoms$ including disorientation$ mood and behavior changes4 deepening confusion about events$ time and place4 unfounded suspicions about family$ friends and professional caregivers4 more serious memory loss and behavior changes4 and difficulty speaking$ swallowing and walking. ,eople with memory loss or other possible signs of AlzheimerAs may find it hard to recognize they have a problem. .igns of dementia may be more obvious to family members or friends. Anyone experiencing dementia-like symptoms should see a doctor as soon as possible. If you need assistance finding a doctor with experience evaluating memory problems$ your local Alzheimer's Association chapter can help. 3arly diagnosis and intervention methods are improving dramatically$ and treatment options and sources of support can improve :uality of life. /wo helpful support resources you can tap into are A5M)onnected$ our messages boards and online social networking community$ and Alzheimer's 6avigator$ a web tool that creates customized action plans$ based on answers you provide through short$ online surveys. "even "tages of Alzheimer s Alzheimer's symptoms vary. /he stages below provide a general idea of how abilities change during the course of the disease. 6ot everyone will experience the same symptoms or progress at the same rate. /his sevenstage framework is based on a system developed by %arry *eisberg$ M.D.$ clinical director of

the 6ew Dork Gniversity .chool of Medicine's .ilberstein Aging and Dementia *esearch )enter. "tage 5# 0o impairment (normal function) /he person does not experience any memory problems. An interview with a medical professional does not show any evidence of symptoms of dementia. "tage 7# %ery mild cognitive decline (may be normal age.related changes or earliest signs of Alzheimer s disease) /he person may feel as if he or she is having memory lapses = forgetting familiar words or the location of everyday ob+ects. %ut no symptoms of dementia can be detected during a medical examination or by friends$ family or co-workers. "tage 9# Mild cognitive decline (early.stage Alzheimer s can be diagnosed in some4 but not all4 individuals &ith these symptoms) 2riends$ family or co-workers begin to notice difficulties. During a detailed medical interview$ doctors may be able to detect problems in memory or concentration. )ommon stage H difficulties include( K 6oticeable problems coming up with the right word or name K /rouble remembering names when introduced to new people K 9aving noticeably greater difficulty performing tasks in social or work settings forgetting material that one has +ust read K 5osing or misplacing a valuable ob+ect K Increasing trouble with planning or organizing "tage ;# Moderate cognitive decline (Mild or early.stage Alzheimer s disease) At this point$ a careful medical interview should be able to detect clear-cut symptoms in several areas( K 2orgetfulness of recent events K Impaired ability to perform challenging mental arithmetic = for example$ counting backward from 8!! by Js K Lreater difficulty performing complex tasks$ such as planning dinner for guests$ paying bills or managing finances K 2orgetfulness about one's own personal history K %ecoming moody or withdrawn$ especially in socially or mentally challenging situations "tage <# Moderately severe cognitive decline (Moderate or mid.stage Alzheimer s disease) Laps in memory and thinking are noticeable$ and individuals begin to need help with day-today activities. At this stage$ those with Alzheimer's may( K %e unable to recall their own address or telephone number or the high school or college from which they graduated K %ecome confused about where they are or what day it is K 9ave trouble with less challenging mental arithmetic4 such as counting backward from B! by subtracting Bs or from 7! by 7s K 6eed help choosing proper clothing for the season or the occasion K .till remember significant details about themselves and their family K .till re:uire no assistance with eating or using the toilet

"tage =# "evere cognitive decline (Moderately severe or mid.stage Alzheimer s disease) Memory continues to worsen$ personality changes may take place and individuals need extensive help with daily activities. At this stage$ individuals may( 6emember# It is difficult to place a person with Alzheimer's in a specific stage as stages may overlap. K 5ose awareness of recent experiences as well as of their surroundings K *emember their own name but have difficulty with their personal history K Distinguish familiar and unfamiliar faces but have trouble remembering the name of a spouse or caregiver K 6eed help dressing properly and may$ without supervision$ make mistakes such as putting pa+amas over daytime clothes or shoes on the wrong feet K 3xperience ma+or changes in sleep patterns = sleeping during the day and becoming restless at night K 6eed help handling details of toileting 0for example$ flushing the toilet$ wiping or disposing of tissue properly1 K 9ave increasingly fre:uent trouble controlling their bladder or bowels K 3xperience ma+or personality and behavioral changes$ including suspiciousness and delusions 0such as believing that their caregiver is an impostor1 or compulsive$ repetitive behavior like hand-wringing or tissue shredding K /end to wander or become lost "tage ># %ery severe cognitive decline ("evere or late.stage Alzheimer s disease) In the final stage of this disease$ individuals lose the ability to respond to their environment$ to carry on a conversation and$ eventually$ to control movement. /hey may still say words or phrases. At this stage$ individuals need help with much of their daily personal care$ including eating or using the toilet. /hey may also lose the ability to smile$ to sit without support and to hold their heads up. *eflexes become abnormal. Muscles grow rigid. .wallowing impaired. 5B &arning signs of Alzheimer s# Memory loss that disrupts daily life

One of the most common signs of Alzheimer's is memory loss, especially forgetting recently learned information. Others include forgetting important dates or events; asking for the same information over and over; increasingly needing to rely on memory aids (e.g., reminder notes or electronic devices) or family members for things they used to

handle on their o n. What's a typical age-related change? !ometimes forgetting names or appointments, but remembering them later.

Challenges in planning or solving problems

.ome people may experience changes in their ability to develop and follow a plan or work with numbers. /hey may have trouble following a familiar recipe or keeping track of monthly bills. /hey may have difficulty concentrating and take much longer to do things than they did before. What s a typical age.related change? Making occasional errors when balancing a checkbook.

Difficulty completing familiar tasks at home, at work or at leisure ,eople with Alzheimer's often find it hard to complete daily tasks. .ometimes$ people may have trouble driving to a familiar location$ managing a budget at work or remembering

the rules of a favorite game. What s a typical age. related change? ;ccasionally needing help to use the settings on a microwave or to record a television show.

Confusion with time or place

,eople with Alzheimer's can lose track of dates$ seasons and the passage of time. /hey may have trouble understanding something if it is not happening immediately. .ometimes they may forget where they are or how they got there. What s a typical age.related change? Letting confused about the day of the week but figuring it out later.

rouble understandi ng visual images and spatial relationships 2or some people$ having vision problems is a sign of Alzheimer's. /hey may have difficulty reading$ +udging distance and determining color or contrast$ which may

cause problems with driving. What s a typical age. related change? #ision changes related to cataracts.

!ew problems with words in speaking or writing

,eople with Alzheimer's may have trouble following or +oining a conversation. /hey may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. /hey may struggle with vocabulary$ have problems finding the right word or call things by the wrong name 0e.g.$ calling a &watch& a &handclock&1. What s a typical age.related change? .ometimes having trouble finding the right word.

Misplacing things and losing the ability to retrace steps

A person with Alzheimer's disease may put things in unusual places. /hey may lose things and be unable to go back over their steps to find them again. .ometimes$ they may accuse others of stealing. /his may occur more fre:uently over time. What s a typical age.related change? Misplacing things from time to time and retracing steps to find them.

Decreased or poor "udgment

,eople with Alzheimer's may experience changes in +udgment or decision-making. 2or example$ they may use poor +udgment when dealing with money$ giving large amounts to telemarketers. /hey may pay less attention to grooming or keeping themselves clean. What s a typical age.related change? Making a bad decision once in a while.

Withdrawal from work or social activities

A person with Alzheimer's may start to remove themselves from hobbies$ social activities$ work pro+ects or sports. /hey may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. /hey may also avoid being social because of the changes they have experienced. What s a typical age.related change? .ometimes feeling weary of work$ family and social obligations.

Changes in mood and personality

/he mood and personalities of people with Alzheimer's can change. /hey can become confused$ suspicious$ depressed$ fearful or anxious. /hey may be easily upset at home$ at work$ with friends or in places where they are out of their comfort zone. What s a typical age.related change? Developing very specific ways of doing things and becoming irritable when a routine is disrupted. Alzheimer s and the brain

Alzheimer s is not the only cause of Microscopic changes in the brain begin memory loss. long before the first signs of memory loss. /he brain has 8!! billion nerve cells Many people have trouble with memory = this 0neurons1. 3ach nerve cell connects with does 6;/ mean they have Alzheimer's. /here many others to form communicationare many different causes of memory loss. If networks. Lroups of nerve cells have special you or a loved one is experiencing symptoms +obs. .ome are involved in thinking$ learning of dementia$ it is best to visit a doctor so the and remembering. ;thers help us see$ hear and smell. /o do their work$ brain cells operate like tiny factories. /hey receive supplies$ generate energy$ construct e:uipment and get rid of waste. )ells also process and store information and communicate with other cells. Ceeping everything running re:uires coordination as well as large amounts of fuel and oxygen. .cientists believe Alzheimer's disease prevents parts of a cell's factory from running well. /hey are not sure where the trouble starts. %ut +ust like a real factory$ backups and breakdowns in one system cause problems in other areas. As damage spreads$ cells lose their ability to do their +obs and$ eventually die$ causing irreversible changes in the brain. !he role of plaCues and tangles

,la:ues and tangles tend to spread through the cortex as Alzheimer's progresses. /ake the %rain /our

!&o abnormal structures called plaCues and tangles are prime suspects in damaging and ,illing nerve cells. +laCues are deposits of a protein fragment called beta-amyloid 0%AD-tuh AM-uh-loyd1 that build up in the spaces between nerve cells. !angles are twisted fibers of another protein called tau 0rhymes with ?wow@1 that build up inside cells. /hough most people develop some pla:ues and tangles as they age$ those with Alzheimer's tend to develop far more. /hey also tend to develop them in a predictable pattern$ beginning in areas important for memory before spreading to other regions. .cientists do not know exactly what role pla:ues and tangles play in Alzheimer's disease. Most experts believe they somehow play a critical role in blocking communication among nerve cells and disrupting processes that cells need to survive. It's the destruction and death of nerve cells that causes memory failure$ personality changes$ problems carrying out daily activities and other symptoms of Alzheimer's disease. !reatments for Alzheimer s disease )urrently$ there is no cure for Alzheimer's. %ut drug and non-drug treatments may help with both cognitive and behavioral symptoms. *esearchers are looking for new treatments to alter the course of the disease and improve the :uality of life for people with dementia.

In this section( KMedications for Memory 5oss K/reatments for %ehavioral )hanges of Alzheimer's K/reatments for .leep )hanges KAlternative /reatments for Alzheimer's KNuestions for Dour Doctor K/reatment 9orizon K)linical /rials Medications for Memory 'oss Although current medications cannot cure AlzheimerAs or stop it from progressing$ they may help lessen symptoms$ such as memory loss and confusion$ for a limited time. !ypes of drugs /he G... 2ood and Drug Administration 02DA1 has approved two types of medications = cholinesterase inhibitors 0Aricept$ 3xelon$ *azadyne$ )ognex1 and memantine 06amenda1 = to treat the cognitive symptoms 0memory loss$ confusion$ and problems with thinking and reasoning1 of Alzheimer's disease. As AlzheimerAs progresses$ brain cells die and connections among cells are lost$ causing cognitive symptoms to worsen. 'hile current medications cannot stop the damage AlzheimerAs causes to brain cells$ they may help lessen or stabilize symptoms for a limited time by affecting certain chemicals involved in carrying messages among the brain's nerve cells. Doctors sometimes prescribe both types of medications together. .ome doctors also prescribe high doses of vitamin 3 for cognitive changes of Alzheimer's disease. Medications for early to moderate stages All of the prescription medications currently approved to treat Alzheimer8s symptoms in early to moderate stages are from a class of drugs called cholinesterase inhibitors. Cholinesterase inhibitors are prescribed to treat symptoms related to memory$ thinking$ language$ +udgment and other thought processes. Medication safety )holinesterase inhibitors( %efore beginning a new medication$ make sure K ,revent the breakdown of acetylcholine 0a- your physician and pharmacist are aware of all .3A-til-C;9-lean1$ a chemical messenger medications currently being taken 0including important for learning and memory. /his over-the-counter and alternative preparations1. supports communication among nerve cells /his is important to make certain medications by keeping acetylcholine levels high. will not interact with one another$ causing side K Delay worsening of symptoms for to 87 effects. months$ on average$ for about half the people who take them. K Are generally well tolerated. If side effects occur$ they commonly include nausea$ vomiting$ loss of appetite and increased fre:uency of bowel movements. /hree cholinesterase inhibitors are commonly prescribed( KDonepezil 0Aricept1 is approved to treat all stages of Alzheimer's. K*ivastigmine 03xelon1 is approved to treat mild to moderate Alzheimer's.

KLalantamine 0*azadyne1 is approved to treat mild to moderate Alzheimer's. /acrine 0)ognex1 was the first cholinesterase inhibitor approved. Doctors rarely prescribe it today because it's associated with more serious side effects than the other three drugs in this class. Medication for moderate to severe stages A second type of medication$ memantine 06amenda1 is approved by the 2DA for treatment of moderate to severe AlzheimerAs. Memantine is prescribed to improve memory$ attention$ reason$ language and the ability to perform simple tasks. It can be used alone or with other AlzheimerAs disease treatments. /here is some evidence that individuals with moderate to severe AlzheimerAs who are taking a cholinesterase inhibitor might benefit by also taking memantine. Donepezil 0Aricept1 is the only cholinesterase inhibitor approved to treat all stages of AlzheimerAs disease$ including moderate to severe. Memantine( K *egulates the activity of glutamate$ a different messenger chemical involved in learning and memory. K Delays worsening of symptoms for some people temporarily. Many experts consider its benefits similar to those of cholinesterase inhibitors. K )an cause side effects$ including headache$ constipation$ confusion and dizziness. !omorro&8s !reatments Gltimately$ the path to effective new treatments is through clinical trials. *ight now$ at least F!$!!! volunteers are urgently needed to participate in more than 8!! actively enrolling clinical trials about Alzheimer's and related dementias. /rials are recruiting people with Alzheimer's and mild cognitive impairment 0M)I1$ as well as healthy volunteers to be controls. 2ind out more about participating in a clinical study through the AlzheimerAs Association /rialMatch service $ a free tool for people with Alzheimer's$ caregivers$ families and physicians to locate clinical trials based on personal criteria 0diagnosis$ stage of disease1 and location.

%itamin A

Doctors sometimes prescribe vitamin 3 to treat cognitive Alzheimer's symptoms. 6o one should take vitamin 3 to treat AlzheimerAs disease except under the supervision of a physician. #itamin 3 is an antioxidant$ a substance that may protect brain cells and other body tissues from certain kinds of chemical wear and tear. Its use in AlzheimerAs disease is based chiefly on a 8IIJ study showing that high doses delayed loss of ability to carry out daily activities and placement in residential care for several months. /hat study was conducted by the AlzheimerAs Disease )ooperative .tudy 0AD).1$ the clinical research consortium of the

6ational Institute on Aging 06IA1. .ince the AD). study was carried out$ scientists have found evidence in other studies that high-dose vitamin 3 may slightly increase the risk of death$ especially for those with coronary artery disease. 6o one should take vitamin 3 to treat AlzheimerAs disease except under the supervision of a physician. #itamin 3 = especially at the high doses used in the AD). study = can negatively interact with other medications$ including those prescribed to keep blood from clotting or to lower cholesterol. !reatments.at.a.glance @eneric $rand Approved "ide Affects -or All stages 6ausea$ vomiting$ loss of appetite and increased fre:uency of bowel movements. 6ausea$ vomiting$ loss of appetite and increased fre:uency of bowel movements.

donepezil

Aricept

galantamine*azadyne Mild to moderate

memantine 6amenda Moderate to 9eadache$ constipation$ confusion and severe dizziness. rivastigmine 3xelon Mild to moderate Mild to moderate 6ausea$ vomiting$ loss of appetite and increased fre:uency of bowel movements. ,ossible liver damage$ nausea$ and vomiting. )an interact with medications prescribed to lower cholesterol or prevent blood clots4 may slightly increase risk of death.

tacrine

)ognex

vitamin 3

6ot 6ot applicable approved

!reatments for $ehavior In addition to affecting memory and other cognitive s,ills4 Alzheimer s disease often affects the &ay people feel and act. Common changes in behavior

Many people find the changes in behavior caused by Alzheimer s to be the most challenging and distressing effect of the disease. /he chief cause of behavioral symptoms is the progressive deterioration of brain cells. 9owever$ medication$ environmental influences and some medical conditions also can cause symptoms or make them worse. In early stages$ people may experience behavior and personality changes such as(

K Irritability K Anxiety K Depression In later stages$ other symptoms may occur including( K Anger K Agitation K Aggression K Leneral emotional distress K ,hysical or verbal outbursts K *estlessness$ pacing$ shredding paper or tissues K 9allucinations 0seeing$ hearing or feeling things that are not really there1 K Delusions 0firmly held belief in things that are not true1 K .leep disturbances !riggering situations 3vents or changes in a person's surroundings often play a role in triggering behavioral symptoms. )hange can be stressful for anyone and can be especially difficult for a person with Alzheimer's disease. It can increase the fear and fatigue of trying to make sense out of an increasingly confusing world. .ituations affecting behavior may include( K Moving to a new residence or nursing home K )hanges in a familiar environment or caregiver arrangements K Misperceived threats K Admission to a hospital K %eing asked to bathe or change clothes Identifying what has triggered a behavior can often help in selecting the best approach to deal with it. Medical evaluation for contributing factors Averyone &ho develops behavior changes should receive a thorough medical evaluation4 especially if symptoms appear suddenly. 3ven though the chief cause of behavioral symptoms is the effect of Alzheimer's disease on the brain$ an examination may reveal other treatable conditions that are contributing to the behavior. )ontributing conditions may include( Difficulty &ith communication

K Drug side effects. Many people with Alzheimer's take%ecause people with Alzheimer's prescription medications for other health issues. Drug gradually lose the ability to side effects or interactions among drugs can affect communicate$ it's important to regularly monitor their comfort and behavior. K Discomfort from infections or other conditions. Asanticipate their needs.

the disease gets worse$ those with Alzheimer's have increasing difficulty communicating with others about their experience. As a result$ they may be unable to report symptoms of common illnesses. ,ain from infections of the urinary tract$ ear or sinuses may lead to restlessness or agitation. Discomfort from a full bladder$ constipation$ or feeling too hot or too cold also may be expressed through behavior. K Dncorrected problems &ith hearing or vision. /hese can contribute to confusion and frustration and foster a sense of isolation. 0on.drug approaches 0on.drug approaches to managing behavior symptoms promote physical and emotional comfort. Many of these strategies aim to identify and address needs that the person with Alzheimer's may have difficulty expressing as the disease progresses. 6on-drug approaches should always be tried first. .teps to developing successful non-drug treatments include( K *ecognizing that the person is not +ust &acting mean or ornery$& but is having further symptoms of the disease K Identifying the cause and how the symptom may relate to the experience of the person with Alzheimer's K )hanging the environment to resolve challenges and obstacles to comfort$ security and ease of mind Coping tips K Monitor personal comfort. )heck for pain$ hunger$ thirst$ constipation$ full bladder$ fatigue$ infections and skin irritation. Maintain a comfortable room temperature. K Avoid being confrontational or arguing about facts. 2or example$ if a person expresses a wish to go visit a parent who died years ago$ don't point out that the parent is dead. Instead$ say$ &Dour mother is a wonderful person. I would like to see her too.& K *edirect the person's attention. /ry to remain flexible$ patient and supportive by responding to the emotion$ not the behavior. K )reate a calm environment. Avoid noise$ glare$ insecure space and too much background distraction$ including television. K Allow ade:uate rest between stimulating @uiding principles events. /he following general principles can help K ,rovide a security ob+ect. guide appropriate use of medications( K Acknowledge re:uests$ and respond to them. K 5ook for reasons behind each behavior. E 2no& the ris,s and benefits. It's important )onsult a physician to identify any causes to understand the potential benefits and risks of a medication before making treatment related to medications or illness. decisions. K 3xplore various solutions. K Don't take the behavior personally$ and share E !arget a specific symptom. 3ffective treatment of one core symptom may help your experiences with others. relieve other symptoms. 2or example$ some ;ur online social networking community can antidepressants may help people sleep better. also help you. >oin Alz)onnected and learn E "tart &ith a lo& dose of a single drug and tips for coping with a loved oneAs behavior and monitor closely for side effects. .ide effects can be serious$ and drugs can occasionally even worsen the symptom being treated. Dosage should not be increased without a careful evaluation by a healthcare

find support from other caregivers. Medications for behavioral symptoms If non.drug approaches fail after being applied consistently4 introducing medications may be appropriate for individuals with severe symptoms or who have the potential to harm themselves or others. 'hile prescription medications can be effective in some situations$ they must be used carefully and are most effective when combined with non-drug approaches. 'hen considering use of medications$ it is important to understand that no drugs are specifically approved by the G... 2ood and Drug Administration 02DA1 to treat behavioral and psychiatric dementia symptoms. .ome of the examples discussed below represent ?off label@ use$ a medical practice in which a physician may prescribe a drug for a different purpose than the ones for which it is approved. 5earn more( Antidepressants 0for mood1$ Anxiolytics 0for anxiety<restlessness1$ Antipsychotic medications 0for hallucinations1 Medication e*amples .ome medications commonly used to treat behavioral and psychiatric symptoms of Alzheimer's disease$ listed in alphabetical order by generic name$ include the following( Antidepressants for low mood and irritability( O K citalopram 0)elexa1 K fluoxetine 0,rozac1 K paroxeine 0,axil1 K sertraline 0Moloft1 K trazodone 0Desyrel1 Anxiolytics for anxiety$ restlessness$ verbally disruptive behavior and resistance( K lorazepam 0Ativan1 K oxazepam 0.erax1 Antipsychotic medications for hallucinations$ delusions$ aggression$ agitation$ hostility and uncooperativeness( K aripiprazole 0Abilify1 Antipsychotic Medications K clozapine 0)lozaril1 /he decision to use an antipsychotic drug K haloperidol 09aldol1 needs to be considered with extreme caution. K olanzapine 0Myprexa1 *esearch has shown that these drugs are K :uetiapine 0.ero:uel1 associated with an increased risk of stroke K risperidone 0*isperdal1 and death in older adults with dementia. /he K ziprasidone 0Leodon1 2DA has ordered manufacturers to label such drugs with a ?black box@ warning about their %ased on scientific evidence$ as well as risks and a reminder that they are not governmental warnings and guidance from approved to treat dementia symptoms. care oversight bodies$ individuals with dementia should use antipsychotic

medications only under one of the following conditions( 8. %ehavioral symptoms are due to mania or psychosis 7. /he symptoms present a danger to the person or others H. /he person is experiencing inconsolable or persistent distress$ a significant decline in function or substantial difficulty receiving needed care Antipsychotic medications should not be used to sedate or restrain persons with dementia. /he minimum dosage should be used for the minimum amount of time possible. Adverse side effects re:uire careful monitoring. Although antipsychotics are the most fre:uently used medications for agitation$ some physicians may prescribe a seizure medication<mood stabilizer$ such as( K carbamazepine 0/egretol1 !reatments for "leep Changes ,eople with AlzheimerAs often have problems with sleeping or may experience changes in their sleep schedule. .cientists do not completely understand why these sleep disturbances occur. As with changes in memory and behavior$ sleep changes somehow result from the impact of AlzheimerAs on the brain. 'hen managing sleep changes$ non-drug coping strategies should always be tried first. Common sleep changes Many people with AlzheimerAs experience changes in their sleep patterns. .cientists do not completely understand why this happens. As with changes in memory and behavior$ sleep changes somehow result from the impact of AlzheimerAs on the brain. Many older adults without dementia also notice changes in their sleep$ but these disturbances occur more fre:uently and tend to be more severe in AlzheimerAs. /here is evidence that sleep changes are more common in later stages of the disease$ but some studies have also found them in early stages. .leep changes in AlzheimerAs may include( K Difficulty sleeping. Many people with AlzheimerAs wake up more often and stay awake longer during the night. %rain wave studies show decreases in both dreaming and nondreaming sleep stages. /hose who cannot sleep may wander$ be unable to lie still$ or yell or call out$ disrupting the sleep of their caregivers. K Daytime napping and other shifts in the sleep.&a,e cycle. Individuals may feel very drowsy during the day and then be unable to sleep at night. /hey may become restless or agitated in the late afternoon or early evening$ an experience often called ?sundowning.@ 3xperts estimate that in late stages of AlzheimerAs$ individuals spend about B! percent of their time in bed at night awake and a significant part of their daytime sleeping. In extreme cases$ people may have a complete reversal of the usual daytime wakefulnessnighttime sleep pattern. 0on.drug treatments for sleep changes 6on-drug treatments aim to improve sleep routine and the sleeping environment and reduce daytime napping. 6on-drug coping strategies should always be tried before medications$

since some sleep medications can cause serious side effects. /o create an inviting sleeping environment and promote rest for a person with AlzheimerAs( K Maintain regular times for meals and for going to bed and getting up K .eek morning sunlight exposure K 3ncourage regular daily exercise$ but no later than four hours before bedtime K Avoid alcohol$ caffeine and nicotine K /reat any pain K If the person is taking a cholinesterase inhibitor 0tacrine$ donepezil$ rivastigmine or galantamine1$ avoid giving the medicine before bed K Make sure the bedroom temperature is comfortable K ,rovide nightlights and security ob+ects K If the person awakens$ discourage staying in bed while awake4 use the bed only for sleep K Discourage watching television during periods of wakefulness Cope &ith caregiving challenges and In some cases$ non-drug approaches fail to changes work or the sleep changes are accompanied by disruptive nighttime behaviors. 2or those ;ur AlzheimerAs R Dementia )aregiver )enter individuals who do re:uire medication$ experts brings our caregiving information and tools recommend that treatment ?begin low and go together into one easy-to-navigate site slow.@ featuring information on early-$ late- and /he risks of sleep-inducing medications for older people who are cognitively impaired are considerable. /hey include increased risk for falls and fractures$ confusion and a decline in the ability to care for oneself. If sleep medications are used$ an attempt should be made to discontinue them after a regular sleep pattern has been established. /he type of medication prescribed by a doctor is often influenced by behaviors that may accompany the sleep changes. /he decision to use an antipsychotic drug should be considered with extreme caution. *esearch has shown that these drugs are associated with an increased risk of stroke and death in older adults with dementia. /he 2DA has ordered manufacturers to label such drugs with a ?black box@ warning about their risks and a reminder that they are not approved to treat dementia symptoms. 5earn more PP *ead the 2DA's latest safety alert about this issue 3xamples of medications used to treat sleep changes include( K /ricyclic antidepressants$ such as nortriptyline and trazodone K %enzodiazepines$ such as lorazepam$ oxazepam and temazepam K ?.leeping pills@ such as zolpidem$ zaleplon and chloral hydrate K?Atypical@ antipsychotics such as risperidone$ onlanzapine and :uetiapine K ;lder ?classical@ antipsychotics such as haloperidol Any time you are prescribed a new medication$ make sure to ask your health care team( K 'hat are the benefits of this medicationQ K 'hat are the risks of this medicationQ K 'hat other treatment options are availableQ /reatment goals are likely to change during your +ourney with Alzheimer's disease. Make sure you understand all the available options and the benefits and risks of each choice as your

treatment plan evolves. Alternative !reatments A growing number of herbal remedies$ dietary supplements and &medical foods& are promoted as memory enhancers or treatments to delay or prevent AlzheimerAs disease and related dementias. )laims about the safety and effectiveness of these products$ however$ are based largely on testimonials$ tradition and a rather small body of scientific research. /he rigorous scientific research re:uired by the G... 2ood and Drug Administration 02DA1 for the approval of a prescription drug is not re:uired by law for the marketing of dietary supplements or &medical foods.& 5. Caprylic acid (clinically tested as 2etasyn FAC.57B7G4 mar,eted as a Hmedical foodI called A*onaJ) and coconut oil )aprylic acid is the active ingredient of Axona$ which is marketed as a ?medical food.@ )aprylic acid is a medium-chain triglyceride 0fat1 produced by processing coconut oil or palm kernel oil. /he body breaks down caprylic acid into substances called ?ketone bodies.@ /he theory behind Axona is that the ketone bodies derived from caprylic acid may provide an alternative energy source for brain cells that have lost their ability to use glucose 0sugar1 as a result of AlzheimerAs. Llucose is the brainAs chief energy source. Imaging studies show reduced glucose use in brain regions affected by AlzheimerAs. AxonaAs development was preceded by development of the chemically similar Cetasyn 0A)87!71. Cetasyn was tested in a ,hase II clinical study enrolling 8F7 volunteers with mild to moderate AlzheimerAs. Most participants were also taking 2DA-approved Alzheimer's drugs. /he manufacturer of Axona reports that study participants who took Cetasyn performed better on tests of memory and overall function than those who received a placebo 0a look-alike$ inactive treatment1. /he chief goal of ,hase II clinical studies is to provide information about the safety and best dose of an experimental treatment. ,hase II trials are generally too small to confirm that a treatment works. /o demonstrate effectiveness under the prescription drug approval framework$ the 2DA re:uires drug developers to follow ,hase II studies with larger ,hase III trials enrolling several hundred to thousands of volunteers. /he manufacturer of Cetasyn decided not to conduct ,hase III studies to confirm its effectiveness. /he company chose instead to use Cetasyn as the basis of Axona and promote Axona as a ?medical food.@ Medical foods do not re:uire ,hase III studies or any other clinical testing. /he AlzheimerAs Association Medical and .cientific Advisory )ouncil has expressed concern that there is not enough evidence to assess the potential benefit of medical foods for AlzheimerAs disease. 2or more information$ please see the Medical and .cientific Advisory )ouncil statement about medical foods. .ome people with AlzheimerAs and their caregivers have turned to coconut oil as a less expensive$ over-the-counter source of caprylic acid. A few people have reported that coconut oil helped the person with AlzheimerAs$ but thereAs never been any clinical testing of coconut oil for AlzheimerAs$ and thereAs no scientific evidence that it helps. 7. Coenzyme K5B )oenzyme N8!$ or ubi:uinone$ is an antioxidant that occurs naturally in the body and is

needed for normal cell reactions. /his compound has not been studied for its effectiveness in treating AlzheimerAs. A synthetic version of this compound$ called idebenone$ was tested for AlzheimerAs disease but did not show any benefit. 5ittle is known about what dosage of coenzyme N8! is considered safe$ and there could be harmful effects if too much is taken. 9. Coral calcium ?)oral@ calcium supplements have been heavily marketed as a cure for AlzheimerAs disease$ cancer and other serious illnesses. )oral calcium is a form of calcium carbonate claimed to be derived from the shells of formerly living organisms that once made up coral reefs. )oral calcium differs from ordinary calcium supplements only in that it contains traces of some additional minerals incorporated into the shells by the metabolic processes of the animals that formed them. It offers no extraordinary health benefits. Most experts recommend that individuals who need to take a calcium supplement for bone health take a purified preparation marketed by a reputable manufacturer. /he 2ederal /rade )ommission 02/)1 and the 2ood and Drug Administration 02DA1 have filed formal complaints against the promoters and distributors of coral calcium. /he agencies state that they are aware of no competent and reliable scientific evidence supporting the exaggerated health claims and that such unsupported claims are unlawful. ;. @in,go biloba Linkgo biloba is a plant extract containing several compounds that may have positive effects on cells within the brain and the body. Linkgo biloba is thought to have both antioxidant and anti-inflammatory properties$ to protect cell membranes and to regulate neurotransmitter function. Linkgo has been used for centuries in traditional )hinese medicine and currently is being used in 3urope to alleviate cognitive symptoms associated with a number of neurological conditions. 9owever$ results of a large$ multicenter ,hase H clinical trial conducted by several branches of the 6ational Institutes of 9ealth showed that ginkgo was no better than a placebo in preventing or delaying AlzheimerAs disease. /he Linkgo 3valuation and Memory 0L3M1 .tudy enrolled H$!!! individuals age JF or older who had no signs of dementia or had mild cognitive impairment 0M)I1. ,articipants were randomly assigned to receive twice daily doses of either a placebo or 87! milligrams of ginkgo biloba extract. /hey were followed up every six months for six years. *esearchers found no statistical difference in rates of dementia or AlzheimerAs disease between the ginkgo and placebo groups. 2or more information about the L3M study results$ click here. <. 1uperzine A 9uperzine A 0pronounced 9;;,-ur-zeen1 is a moss extract that has been used in traditional )hinese medicine for centuries. It has properties similar to those of cholinesterase inhibitors$ one class of 2DA-approved Alzheimer's medications. As a result$ it is promoted as a treatment for Alzheimer's disease.

/he Alzheimer's Disease )ooperative .tudy 0AD).1 conducted the first large-scale G... clinical trial of huperzine A as a treatment for mild to moderate AlzheimerAs disease. ,articipants taking huperzine A experienced no greater benefit than those taking a placebo. %ecause currently available formulations of huperzine A are dietary supplements$ they are unregulated and manufactured with no uniform standards. /aking these unregulated preparations could increase the risks of serious side effects$ especially if used in combination with 2DA-approved Alzheimer's drugs. =. :mega.9 fatty acids ;mega-Hs are a type of polyunsaturated fatty acid 0,G2A1. *esearch has linked certain types of omega-Hs to a reduced risk of heart disease and stroke. /he G... 2ood and Drug Administration 02DA1 permits supplements and foods to display labels with ?a :ualified health claim@ for two omega-Hs called docosahexaneoic acid 0D9A1 and eicosapentaenoic acid 03,A1. /he labels may state$ ?.upportive but not conclusive research shows that consumption of 3,A and D9A omega-H fatty acids may reduce the risk of coronary heart disease$@ and then list the amount of D9A or 3,A in the product. /he 2DA recommends taking no more than a combined total of H grams of D9A or 3,A a day$ with no more than 7 grams from supplements. *esearch has also linked high intake of omega-Hs to a possible reduction in risk of dementia or cognitive decline. /he chief omega-H in the brain is D9A$ which is found in the fatty membranes that surround nerve cells$ especially at the microscopic +unctions where cells connect to one another. /heories about why omega-Hs might influence dementia risk include their benefit for the heart and blood vessels4 anti-inflammatory effects4 and support and protection of nerve cell membranes. /wo studies reported at the 7!!I Alzheimer's Association International )onference on Alzheimer's Disease 0AAI)AD1 found mixed results for the possible benefits of D9A( K /he first study was a large federally funded clinical trial conducted by the Alzheimer's Disease )ooperative .tudy 0AD).1. In the AD). study$ participants with mild to moderate Alzheimer's disease taking 7 grams of D9A daily fared no better overall than those who took a placebo 0inactive$ lookalike treatment1. /he data indicated a &signal& 0preliminary but not conclusive evidence1 that participants without the A,;3-eB Alzheimer's risk gene might have experienced a slight benefit. More research is needed to confirm whether that preliminary signal is valid. *esults of this study also appeared in the 6ov. H$ 7!8!$ issue of the >ournal of the American Medical Association. K /he second study=Memory Improvement with D9A 0MIDA.1=enrolled older adults with normal age-related cognitive decline. /hose who took I!! milligrams of D9A daily scored slightly better on a computerized memory test than those receiving the placebo. MIDA. was conducted by Martek %iosciences$ the manufacturer of the D9A used in both studies. 3xperts agree that more research is needed$ and there is not yet sufficient evidence to recommend D9A or any other omega-H fatty acids to treat or prevent Alzheimer's disease. >. +hosphatidylserine

,hosphatidylserine 0pronounced 2;.-fuh-/I3-dil-sair-een1 is a kind of lipid$ or fat$ that is the primary component of the membranes that surround nerve cells. In AlzheimerAs disease and similar disorders$ nerve cells degenerate for reasons that are not yet understood. /he theory behind treatment with phosphatidylserine is its use may shore up the cell membrane and possibly protect cells from degenerating. /he first clinical trials with phosphatidylserine were conducted with a form derived from the brain cells of cows. .ome of these trials had promising results. 9owever$ most trials were with small samples of participants. /his line of investigation came to an end in the 8II!s over concerns about mad cow disease 0bovine spongiform encephalopathy1$ a fatal brain disorder believed to be caused by consuming foods or other products from affected cattle. .upplements containing phosphatidylserine are now derived from soy extracts. /he 2DA permits supplements containing very high-:uality soy-derived phosphatidylserine to display a &:ualified health claim& stating that &#ery limited and preliminary scientific research suggests that phosphatidylserine may reduce the risk of dementia in the elderly. 2DA concludes that there is little scientific evidence supporting this claim.& 2or more information about 2DA :ualified health claims$ please click here. 3xperts agree that more research is needed$ and do not currently recommend use of phosphatidylserine. ?. !ramiprosate (clinically tested as Alzhemed4 mar,eted as a Lmedical foodL called %iviMindM) /ramiprosate is a modified form of taurine$ an amino acid found naturally in seaweed. Amino acids are the chemical building blocks of proteins. /ramiprosate was tested in a large ,hase H clinical study as a possible Alzheimer's treatment. Analysis of the ,hase H trial data was initially inconclusive for a variety of reasons. Investigators tried to work with the 2DA to obtain clearer results$ but the manufacturer decided to abandon development of tramisprosate as a prescription drug and market it over the Internet a &medical food.& /ramiprosate currently has no proven benefits$ and &medical foods& are not sub+ect to the same level of 2DA regulation as prescription drugs. 2or more information$ please see the statement of the Alzheimer's Association Medical and .cientific Advisory )ouncil on medical foods. Concerns about alternative therapies Although some of these remedies may be valid candidates for treatments$ there are legitimate concerns about using these drugs as an alternative or in addition to physician-prescribed therapy( K Affectiveness and safety are un,no&n. /he rigorous scientific research re:uired by the G... 2ood and Drug Administration 02DA1 for the approval of a prescription drug is not re:uired by law for the marketing of dietary supplements. /he maker of a dietary supplement is not re:uired to provide the 2DA with the evidence on which it bases its claims for safety and effectiveness. +urity is un,no&n. /he 2DA has no authority over supplement production. It is a manufacturerAs responsibility to develop and enforce its own guidelines for ensuring that its products are safe and contain the ingredients listed on the label in the specified

amounts. K Dietary supplements can have serious interactions &ith prescribed medications. 6o one should take a supplement without first consulting a physician.

%ascular Dementia
#ascular dementia is a decline in thinking skills caused by conditions that block or reduce blood flow to the brain, depriving brain cells of vital o"ygen and nutrients.

$bout vascular dementia

Inade:uate blood flow can damage and eventually kill cells anywhere in the body. /he brain has one of the body's richest networks of blood vessels and is especially vulnerable.

Did you ,no&?

3very heartbeat pumps 7! to 7F percent of your blood to your brain$ where billions of cells use 7! percent of In vascular dementia$ changes in thinking skills the oxygen and nutrients your blood sometimes occur suddenly following strokes that carries. block ma+or brain blood vessels. /hinking problems also may begin as mild changes that worsen gradually as a result of multiple minor strokes or other conditions that affect smaller blood vessels$ leading to cumulative damage. A growing number of experts prefer the term &vascular cognitive impairment 0#)I1& to &vascular dementia& because they feel it better expresses the concept that vascular thinking changes can range from mild to severe. #ascular brain changes often coexist with changes linked to other types of dementia$ including Alzheimer's disease and dementia with 5ewy bodies. .everal studies have found that vascular changes and other brain abnormalities may interact in ways that increase the likelihood of dementia diagnosis. .ign up for our enews to receive updates about AlzheimerAs and dementia care and research. #ascular dementia is widely considered the second most common cause of dementia after Alzheimer's disease$ accounting for 7! to H! percent of cases. Many experts believe that vascular dementia remains underdiagnosed = like Alzheimer's disease = even though it's recognized as common.
%ymptoms

.ymptoms can vary widely$ depending on the severity of the blood vessel damage and the part of the brain affected. Memory loss may or may not be a significant symptom depending on the specific brain areas where blood flow is reduced.

6elated dementias common symptoms

share

some

#ascular changes that start in brain areas that play a key role in storing and retrieving information may cause #ascular dementia symptoms may be most obvious memory loss that looks very much like when they happen soon after a ma+or stroke. .udden Alzheimer's disease. post-stroke changes in thinking and perception may include( )onfusion Disorientation

/rouble speaking or understanding speech #ision loss /hese changes may happen at the same time as more familiar physical stroke symptoms$ such as a sudden headache$ difficulty walking$ or numbness or paralysis on one side of the face or the body. Multiple small strokes or other conditions that affect blood vessels and nerve fibers deep inside the brain may cause more gradual thinking changes as damage accumulates. )ommon early signs of widespread small vessel disease include impaired planning and +udgment4 uncontrolled laughing and crying4 declining ability to pay attention4 impaired function in social situations4 and difficulty finding the right words.
Diagnosis

%ecause vascular cognitive impairment may often go unrecognized$ many experts recommend professional screening with brief tests to assess memory$ thinking and reasoning for everyone considered to be at high risk for this disorder. Individuals at highest risk include those who have had a stroke or a transient ischemic attack 0/IA$ also known as a &ministroke&1. Additional high-risk groups include those with high blood pressure$ high cholesterol$ or other risk factors for heart or blood vessel disease. ,rofessional screening for depression is also recommended for high-risk groups. Depression commonly coexists with brain vascular disease and can contribute to cognitive symptoms. If brief screening tests suggest changes in thinking or reasoning$ a more detailed assessment is needed. )ore elements of a workup for vascular dementia typically include( A thorough medical history$ including family history of dementia 3valuation of independent function and daily activities Input from a family member or trusted friend In-office neurological examination assessing function of nerves and reflexes$ movement$ coordination$ balance and senses 5aboratory tests including blood tests and brain imaging According to a 7!88 scientific statement issued by the American 9eart Association 0A9A1 and the American .troke Association 0A.A1$ and endorsed by the Alzheimer's Association and the American Academy of 6eurology 0AA61$ the following three criteria suggest the greatest likelihood that mild cognitive impairment 0M)I1 or dementia is caused by vascular changes( 1./he diagnosis of dementia or mild cognitive impairment is confirmed by neurocognitive testing$ which involves several hours of written or computerized tests that provide detailed evaluation of specific thinking skills such as +udgment$ planning$ problem-solving$ reasoning and memory

7./here is brain imaging evidence$ usually with magnetic resonance imaging 0M*I1$ showing evidence of either( a.A recent stroke$ or b.;ther brain blood vessel changes whose severity and pattern of affected tissue are consistent with the types of impairment documented in neurocognitive testing H./here is no evidence that factors other than vascular changes are contributing to cognitive decline. /he guidelines also discuss cases where the diagnosis may be less clear-cut$ such as the common situation where vascular changes coexist with brain changes associated with other types of dementia.
Causes and risks

As with Alzheimer's disease$ advancing age is a ma+or risk factor for vascular cognitive impairment or dementia. Additional risk factors are the same ones that raise risk for heart problems$ stroke and other diseases that affect blood vessels. Many of these vascular factors also raise risk for Alzheimer's. /he following strategies may reduce your risk of diseases that affect your heart and blood vessels = and also may help protect your brain( Don't smoke Ceep your blood pressure$ cholesterol and blood sugar within recommended limits 3at a healthy$ balanced diet 3xercise Maintain a healthy weight 5imit alcohol consumption
reatment and outcomes

/he G... 2ood and Drug Administration 02DA1 has not approved any drugs specifically to treat symptoms of vascular dementia$ but there is some clinical trial evidence that certain drugs approved to treat Alzheimer's may also offer a modest benefit in people diagnosed with vascular dementia. )ontrolling risk factors that may increase the likelihood of further damage to the brain's blood vessels is an important treatment strategy. /here's substantial evidence that treatment of risk factors may improve outcomes and help postpone or prevent further decline. Individuals should work with their physicians to develop the best treatment plan for their symptoms and circumstances. 5ike other types of dementia$ vascular dementia shortens lifespan. .ome data suggest that those who develop dementia following a stroke survive three years$ on average. As with other stroke symptoms$ cognitive changes may sometimes improve during recovery and rehabilitation from the acute phase of a stroke as the brain generates new blood vessels and brain cells outside the damaged region take on new roles.

Dementia &ith 'e&y $odies

Dementia &ith 'e&y bodies (D'$) is a type of progressive dementia that leads to a decline in thin,ing4 reasoning and independent function because of abnormal microscopic deposits that damage brain cells over time.
$bout dementia with &ewy bodies

Most experts estimate that dementia with 5ewy bodies is the third most common cause of dementia after Alzheimer's disease and vascular dementia$ accounting for 8! to 7F percent of cases. /he hallmark brain abnormalities linked to D5% are named after 2rederick 9. 5ewy$ M.D.$ the neurologist who discovered them while working in Dr. Alois Alzheimer's laboratory during the early 8I!!s. Alpha-synuclein protein$ the chief component of 5ewy bodies$ is found widely in the brain$ but its normal function isn't yet known. 5ewy bodies are also found in other brain disorders$ including Alzheimer's disease and ,arkinson's disease dementia. Many people with ,arkinson's eventually develop problems with thinking and reasoning$ and many people with D5% experience movement symptoms$ such as hunched posture$ rigid muscles$ a shuffling walk and trouble initiating movement. /his overlap in symptoms and other evidence suggest that D5%$ ,arkinson's disease and ,arkinson's disease dementia may be linked to the same underlying #r. $rederick %e y, standing, right, and #r. abnormalities in how the brain processes the protein alpha- Alois Alzheimer, standing, third from right. synuclein. Many people with both D5% and ,arkinson's dementia also have pla:ues and tangles = hallmark brain changes linked to Alzheimer's disease. .ign up for our enews to receive updates about AlzheimerAs and dementia care and research.
%ymptoms

.ymptoms of dementia with 5ewy bodies include( )hanges in thinking and reasoning )onfusion and alertness that varies significantly from one time of day to another or from one day to the next ,arkinson's symptoms$ such as a hunched posture$ balance problems and rigid muscles #isual hallucinations Delusions /rouble interpreting visual information Acting out dreams$ sometimes violently$ a problem known as rapid eye movement 0*3M1 sleep disorder Malfunctions of the &automatic& 0autonomic1 nervous system Memory loss that may be significant but less prominent than in Alzheimer's

Diagnosis

As with other types of dementia there is no single test that can conclusively diagnose dementia with 5ewy bodies. /oday$ D5% is a &clinical& diagnosis$ which means it represents a doctor's best professional +udgment about the reason for a person's symptoms. /he only way to conclusively diagnose D5% is through a postmortem autopsy. Many experts now believe that D5% and ,arkinson's disease dementia are two different expressions of the same underlying problems with brain processing of the protein alphasynuclein. %ut most experts recommend continuing to diagnose D5% and ,arkinson's dementia as separate disorders. /he diagnosis is D5% when( Dementia symptoms consistent with D5% develop first 'hen both dementia symptoms and movement symptoms are present at the time of diagnosis 'hen movement symptoms develop within a year after D5% diagnosis. /he diagnosis is ,arkinson's disease dementia when a person is originally diagnosed with ,arkinson's based on movement symptoms$ and dementia symptoms don't appear until a year or more later. .ince 5ewy bodies tend to coexist with Alzheimer's brain changes$ it may sometimes be hard to distinguish D5% from Alzheimer's disease$ especially in the early stages. 2ey differences bet&een Alzheimer s and D'$ Memory loss tends to be a more prominent symptom in early Alzheimer's than in early D5%$ although advanced D5% may cause memory problems in addition to its more typical effects on +udgment$ planning and visual perception. Movement symptoms are more likely to be an important cause of disability early in D5% than in Alzheimer's$ although Alzheimer's can cause problems with walking$ balance and getting around as it progresses to moderate and severe stages. 1allucinations4 delusions$ and misidentification of familiar people are significantly more fre:uent in early-stage D5% than in Alzheimer's. 6AM sleep disorder is more common in early D5% than in Alzheimer's. Disruption of the autonomic nervous system4 causing a blood pressure drop on standing$ dizziness$ falls and urinary incontinence$ is much more common in early D5% than in Alzheimer's.
Causes and risks

*esearchers have not yet identified any specific causes of dementia with 5ewy bodies. Most people diagnosed with D5% have no family history of the disorder$ and no genes linked to D5% have been conclusively identified.

reatment and outcomes

/here are no treatments that can slow or stop the brain cell damage caused by dementia with 5ewy bodies. )urrent strategies focus on helping symptoms. If your treatment plan includes medications$ it's important to work closely with your physician to identify the drugs that work best for you and the most effective doses. /reatment considerations involving medications include the following issues( )holinesterase inhibitors drugs are the current mainstay for treating thinking changes in Alzheimer's. /hey also may help certain D5% symptoms. Find a clinical trial

Antipsychotic drugs should be used with extreme caution in D5%. Although physicians sometimes prescribe these drugs for behavioral symptoms that can occur in Alzheimer's$ they may cause serious side effects in as many as F! percent of those with D5%. .ide effects may include sudden changes in consciousness$ impaired swallowing$ acute confusion$ episodes of delusions or hallucinations$ or appearance or worsening of ,arkinson's symptoms. Antidepressants may be used to treat depression$ which is common with D5%$ ,arkinson's disease dementia and Alzheimer's./he most commonly used antidepressants are selective serotonin reuptake inhibitors 0..*Is1. )lonazepam may be prescribed to treat *3M sleep disorder. 5ike other types of dementia that destroy brain cells$ D5% gets worse over time and shortens lifespan.

&ore than '(( research studies pertaining to Alzheimer's and dementias are under ay. Alzheimer's Association )rial&atch lets you search these trials *uickly and easily. $ind a trial.

Mi*ed Dementia
Mi*ed dementia is a condition in &hich abnormalities characteristic of more than one type of dementia occur simultaneously. ,hysicians may also call mixed dementia &Dementia E multifactorial.&
$bout mi'ed dementia

In the most common form of mixed dementia$ the abnormal protein deposits associated with Alzheimer's disease coexist with blood vessel problems linked to vascular dementia. Alzheimer's brain changes also often coexist with 5ewy bodies. In some cases$ a person may have brain changes linked to all three conditions = Alzheimer's disease$ vascular dementiaand dementia with 5ewy bodies. *esearchers don't know exactly how many older adults currently diagnosed with a specific type of dementia actually have mixed dementia$ but autopsies show that the condition may be significantly more common than previously realized. Autopsy studies play a key role in shedding light on mixed dementia because scientists can't yet measure most dementia-related brain
)ake our interactive+rain )our.

changes in living individuals. In the most informative studies$ researchers correlate each participant's cognitive health and any diagnosed problems during life with analysis of the brain after death. .ign up for our enews to receive updates about AlzheimerAs and dementia care and research. 0IA.-unded Memory N Aging +roOect 6eveals Mi*ed Dementia Common Data from the first 8B8 volunteers in this research study show that more than F! percent of those whose brains met pathological criteria for Alzheimer's had pathologic evidence of one or more coexisting dementias. /his study is conducted by the *ush Alzheimer's Disease )enter and the *ush Institute for 9ealthy Aging in )hicago and funded by the 6ational Institute on Aging 06IA1.
%ymptoms

Mixed dementia symptoms may vary$ depending on the types of brain changes involved and the brain regions affected. In many cases$ symptoms may be similar to or even indistinguishable from those of Alzheimer's or another type of dementia. In other cases$ a person's symptoms may suggest that more than one type of dementia is present.
Diagnosis

A diagnosis of mixed dementia comes after a brain autopsy. Most individuals whose autopsies show they had mixed dementia were diagnosed with one specific type of dementia during life$ most commonly with Alzheimer's disease. 2or example$ in the Memory and Aging ,ro+ect study involving long-term cognitive assessments followed by eventual brain autopsy( IB percent of participants who were diagnosed with dementia were diagnosed with Alzheimer's./he autopsies of those diagnosed with Alzheimer's showed that FB percent had coexisting pathology. /he most common coexisting abnormality was previously undetected blood clots or other evidence of vascular disease. 5ewy bodies were the second most common coexisting abnormality.
Causes and risks

Although mixed dementia is infre:uently diagnosed during life$ many researchers believe it deserves more attention because the combination of two or more types of dementia-related brain changes may have a greater impact on the brain than one type alone. 3vidence suggests that the presence of more than one type of dementia-related change may increase the chances a person will develop symptoms.
reatment and outcomes

%ecause most people with mixed dementia are diagnosed with a single type of dementia$ physicians often base their prescribing decisions on the type of dementia that's been diagnosed. 6o drugs are specifically approved by the G... 2ood and Drug Administration 02DA1 to treat mixed dementia. ,hysicians who think that Alzheimer's disease is among the

conditions contributing to a person's dementia may consider prescribing the drugs that are 2DA-approved for Alzheimer's. Many researchers are convinced that growing understanding of mixed dementia$ coupled with recognition that vascular changes are the most common coexisting brain change$ may create an opportunity to reduce the number of people who develop dementia. )ontrolling overall risk factors for diseases of the heart and blood vessels may also protect the brain from vascular changes.

+ar,inson s Disease Dementia

+ar,inson s disease dementia is an impairment in thin,ing and reasoning that eventually affects many people with ,arkinson's disease.
$bout (arkinson's disease dementia

/he brain changes caused by ,arkinson's disease begin in a region that plays a key role in movement. As ,arkinson's brain changes gradually spread$ they often begin to affect mental functions$ including memory and the ability to pay attention$ make sound +udgments and plan the steps needed to complete a task. /he key brain changes linked to ,arkinson's disease and ,arkinson's disease dementia are abnormal microscopic deposits composed chiefly of alpha-synuclein$ a protein that's found widely in the brain but whose normal function isn't yet known. /he deposits are called &5ewy bodies&. 5ewy bodies are also found in several other brain disorders$ includingdementia with 5ewy bodies 0D5%1. 3vidence suggests that dementia with 5ewy bodies$ ,arkinson's disease and ,arkinson's disease dementia may be linked to the same underlying abnormalities in brain processing of alpha-synuclein. Another complicating factor is that many people with both dementia with 5ewy bodies and ,arkinson's disease dementia also have pla:ues and tangles = hallmark brain changes linked to Alzheimer's disease. ,arkinson's disease is a fairly common neurological disorder in older adults$ estimated to affect nearly 7 percent of those older than age F. /he 6ational ,arkinson 2oundation estimates that 8 million Americans have ,arkinson's disease. It is estimated that F! to "! percent of those with ,arkinson's disease eventually experience ,arkinson's disease dementia. .ign up for our enews to receive updates about AlzheimerAs and dementia care and research. What percentage of people &ith +ar,inson s develop dementia?
%ymptoms

An estimated F! to "! percent of those ,arkinson's disease dementia is a decline in thinking with ,arkinson's eventually experience and reasoning that develops in someone diagnosed dementia as their disease progresses. with ,arkinson's disease at least a year earlier. /he average time from onset of )ommon symptoms include( ,arkinson's to developing dementia is about 8! years.

)hanges in memory$ concentration and +udgement /rouble interpreting visual information Muffled speech #isual hallucinations Delusions$ especially paranoid ideas Depression Irritability and anxiety .leep disturbances$ including excessive daytime drowsiness and rapid eye movement 0*3M1 sleep disorder
Diagnosis

As with other types of dementia there is no single test = or any combination of tests = that conclusively determines that a person has ,arkinson's disease dementia. Many experts now believe that ,arkinson's disease dementia and dementia with 5ewy bodies are two different expressions of the same underlying problems with brain processing of the protein alpha-synuclein. %ut most experts recommend continuing to diagnose dementia with 5ewy bodies and ,arkinson's dementia as separate disorders. Luidelines for diagnosing ,arkinson's disease dementia and dementia with 5ewy bodies are( /he diagnosis is ,arkinson's disease dementia when a person is originally diagnosed with ,arkinson's based on movement symptoms and dementia symptoms don't appear until a year or more later /he diagnosis is dementia with 5ewy bodies when( Dementia symptoms consistent with dementia with 5ewy bodies develop first 'hen both dementia symptoms and movement symptoms are present at the time of diagnosis 'hen movement symptoms develop within a year of a dementia with 5ewy bodies diagnosis $rain Imaging .ince individuals with ,arkinson's are at high risk for dementia as their disease progresses$ doctors monitor those with ,arkinson's closely for signs of thinking changes. 'hen someone with ,arkinson's develops thinking changes$ doctors often order magnetic resonance imaging 0M*I1 of the brain to rule out tumors$ structural changes and evidence for vascular disease.

Causes and risks

)ertain factors at the time of ,arkinson's diagnosis may increase future dementia risk$ including older age$ greater severity of motor symptoms$ and having mild cognitive impairment 0M)I1. Additional risk factors may include(

9allucinations in a person who doesn't yet have other dementia symptoms 3xcessive daytime sleepiness ,arkinson's symptom pattern known as postural instability and gait disturbance 0,ILD1$ which includes &freezing& in mid-step$ difficulty initiating movement$ shuffling$ problems with balance and falling
reatment and outcomes

/here are no treatments to slow or stop the brain cell damage caused by ,arkinson's disease dementia. )urrent strategies focus on helping symptoms. If your treatment plan includes medications$ it's important to work closely with your physician to identify the drugs that work best for you and the most effective doses. /reatment considerations involving medications include the following issues( )holinesterase inhibitors drugs are the currentFind a clinical trial mainstay for treating thinking changes in Alzheimer's. /hey also may help ,arkinson's disease dementia symptoms. Antipsychotic drugs should be used with extreme caution in ,arkinson's disease dementia. Although physicians sometimes prescribe these drugs &ore than '(( research studies for behavioral symptoms that can occur in Alzheimer's$pertaining to Alzheimer's and other dementias are under ay. Alzheimer's they may cause serious side effects in as many as F! Association )rial&atch lets you search percent of those with ,arkinson's disease dementia these trials *uickly and easily. $ind a and dementia with 5ewy bodies. .ide effects may trial. include sudden changes in consciousness$ impaired swallowing$ acute confusion$ episodes of delusions or hallucinations$ or appearance or worsening of ,arkinson's symptoms. 5-dopa may be prescribed to treat ,arkinson's movement symptoms. 9owever$ it can sometimes aggravate hallucinations and confusion in those with ,arkinson's dementia or dementia with 5ewy bodies. Antidepressants may be used to treat depression$ which is common in both ,arkinson's disease dementia and dementia with 5ewy bodies. /he most commonly used antidepressants are selective serotonin reuptake inhibitors 0..*Is1. )lonazepam may be prescribed to treat *3M sleep disorder. 5ike other types of dementia that destroy brain cells$ ,arkinson's disease and ,arkinson's disease dementia get worse over time and speed of progression can vary.

-rontotemporal Dementia (-!D)

-rontotemporal dementia (-!D) is a group of disorders caused by progressive cell degeneration in the brain's frontal lobes 0the areas behind your forehead1 or its temporal lobes 0the regions behind your ears1.

$bout frontotemporal dementia /he cell damage caused by frontotemporal dementia leads to tissue shrinkage and reduced function in the brain's frontal and temporal lobes$ which control planning and +udgment4 emotions$ speaking and understanding speech4 and certain types of movement. 2/D includes a range of specific disorders with different core symptoms. %ut there's significant symptom overlap$ especially as these disorders progress. /he disorders grouped under 2/D fall into three broad categories 0discussed below1. .cientists have identified a range of microscopic brain abnormalities implicated in 2/D. /he overall term for the brain cell damage and tissue shrinkage associated with 2/D is frontotemporal lobar degeneration. 2/D used to be called ,ick's disease after Arnold ,ick$ a physician who in 8"I7 first described a patient with distinct symptoms affecting language. .ome doctors still use the term &,ick's disease.& ;ther terms you may see used to describe 2/D include frontotemporal disorders$ frontotemporal degeneration and frontal lobe disorders. 2/D was once considered rare$ but it's now thought to account for up to 8! to 8F percent of all dementia cases. It's still believed to be less common thanAlzheimer's disease$ vascular dementiaand 5ewy body dementia. In those younger than age F$ 2/D may account for up to 7! to F! percent of dementia cases. ,eople usually develop 2/D in their F!s or early !s$ making the disorder relatively more common in this younger age group. .ign up for our enews to receive updates about AlzheimerAs and dementia care and research.
%ymptoms

Arnold Pick, M.D., who described the first case of FTD.

3xperts group frontotemporal dementia into three main categories. Initially$ these groups tend to cause different core symptoms based on the first parts of the brain's frontal or temporal lobes they affect. %ut there's increasing overlap in symptoms as these disorders progress. .ymptoms related tothe three types of 2/D include(

%ehavioral variant frontotemporal dementia 0bv2/D1 takes its greatest toll on personality and behavior. It may begin with subtle changes that may be mistaken for depression. As bv2/D progresses people often develop disinhibition$ a striking loss of restraint in personal relations and social life. ,rimary progressive aphasia 0,,A1 affects language skills in early stages$ but often also affects behavior as it advances. /he two chief forms of ,,A have somewhat different symptoms( In semantic dementia$ people speak easily$ but their words convey less and less meaning. /hey tend to use broad general terms$ such as &animal& when

they mean &cat.& 5anguage comprehension also declines. In progressive nonfluent aphasia$ people lose their ability to generate words easily$ and their speech becomes halting$ &tongue-tied& and ungrammatical. Ability to read and write also may be impaired. 2/D movement disorders affect certain involuntary$ automatic muscle functions. /hese disorders also may impair language and behavior. /he two primary 2/D movement disorders are( )orticobasal degeneration 0)%D1$ which causes shakiness$ lack of coordination$ and muscle rigidity and spasms. ,rogressive supranuclear palsy 0,.,1$ which causes walking and balance problems$ fre:uent falls and muscle stiffness, especially in the neck and upper
body. ,t also affects eye movements.

Diagnosis

/here is no single test = or any combination of tests = that can conclusively diagnose frontotemporal dementia. 2/D is a &clinical& diagnosis representing a doctor's best professional +udgment about the reason for a person's symptoms. Magnetic resonance imaging 0M*I1 often plays a key role in diagnosis because it can detect shrinkage in the brain's frontal and temporal lobes$ which is a hallmark of 2/D. In some cases$ it may be hard to distinguish 2/D from Alzheimer's disease. In the future$ tests to detect specific protein abnormalities linked to Alzheimer's and 2/D may help clarify the diagnosis in difficult cases. 2ey Differences $et&een -!D and Alzheimer s Age at diagnosis may be an important clue. Most people with 2/D are diagnosed in their F!s and early !s. ;nly about 8! percent are diagnosed after age J!. Alzheimer's$ on the other hand$ grows more common with increasing age. Memory loss tends to be a more prominent symptom in early Alzheimer's than in early 2/D$ although advanced 2/D often causes memory loss in addition to its more characteristic effects on behavior and language. $ehavior changes are often the first noticeable symptoms in bv2/D$ the most common form of 2/D. %ehavior changes are also common as Alzheimer's progresses$ but they tend to occur later in the disease. +roblems &ith spatial orientation = for example$ getting lost in familiar places = are more common in Alzheimer's than in 2/D. +roblems &ith speech. Although people with Alzheimer's may have trouble thinking of the right word or remembering names$ they tend to have less difficulty making sense when they speak$ understanding the speech of others$ or reading than those with 2/D. 1allucinations and delusions are relatively common as Alzheimer's progresses$ but relatively uncommon in 2/D.
Causes and risks

*esearchers have identified abnormal deposits of several proteins inside the brain cells of

those who died with frontotemporal dementia. .cientists have not yet learned what causes these protein abnormalities or solved the mystery of why the damage associated with 2/D targets the brain's frontal and temporal lobes. /he only known risk factor for 2/D is a family history of the disease. .cientists have found several genes linked to 2/D. *ecent research suggests a possible connection between 2/D and 5ou Lehrig's disease$ also known as amyotrophic lateral sclerosis 0A5.1 and motor neuron disease. Although A5. primarily affects nerves controlling voluntary movement$ many people with A5. also develop symptoms affecting their behavior or language$ and some people with 2/D develop A5..
reatment and outcomes

)urrent frontotemporal dementia treatment focuses on managing symptoms$ primarily those affecting behavior. 3merging insights into specific protein abnormalities associated with 2/D may identify targets for new treatments aimed at underlying disease processes. Antidepressants and antipsychotic drugs are the chief medications used to treat behavioral 2/D symptoms. 6one of these drugs have been approved by the G... 2ood and Drug Administration 02DA1 for use in 2/D. 2/D inevitably gets worse$ usually over several years. In advanced 2/D$ people typically become mute and bedbound. 5ike other types of dementia$ 2/D shortens lifespan. .tudies suggest that most people with 2/D survive an average of six to eight years$ but survival can range from two to 7! years.

1untington s Disease
)untington's Disease *)D+ is a progressive brain disorder caused by a defective gene, )his disease causes changes in the central area of the brain, hich affect movement, mood and thinking skills.

$bout )untington's Disease

9untington's disease is a progressive brain disorder caused by a single defective gene on chromosome B = one of the 7H human chromosomes that carry a personAs entire genetic code. /his defect is &dominant$& meaning that anyone who inherits it from a parent with 9untington's will eventually develop the disease. /he disorder is named for Leorge 9untington$ the physician who first described it in the late 8"!!s. /he defective gene codes the blueprint for a protein called huntingtin. /his protein's normal function isn't yet known$ but it's called &huntingtin& because scientists identified its defective form as the cause of 9untington's disease. Defective huntingtin protein leads to brain changes that cause abnormal involuntary movements$ a severe decline in -eorge .untington, &.#., ho first thinking and reasoning skills$ and irritability$ depression and described the disease that bears his
name.

other mood changes.

%ymptoms

.ymptoms of 9untington's disease usually develop between ages H! and F!$ but they can appear as early as age 7 or as late as "!. /he hallmark symptom of 9untington's disease is uncontrolled movement of the arms$ legs$ head$ face and upper body. 9untington's disease also causes a decline in thinking and reasoning skills$ including memory$ concentration$ +udgment and ability to plan and organize. 9untington's disease brain changes lead to alterations in mood$ especially depression$ anxiety$ and uncharacteristic anger and irritability. Another common symptom is obsessivecompulsive behavior$ leading a person to repeat the same :uestion or activity over and over.
Diagnosis

.cientists identified the defective gene that causes 9untington's disease in 8IIH. A diagnostic genetic test is now available./he test can confirm that the defective gene for huntingtin protein is the cause of symptoms in people with suspected 9untington's disease and can detect the defective gene in people who don't yet have symptoms but are at risk because a parent has 9untington's.
Causes and risks

@enetic testing 3xperts strongly recommend professional genetic counseling both before and after genetic testing for 9untington's disease.

/he defective gene identified in 8IIH causes virtually all 9untingtonAs disease. /he huntingtin gene defect involves extra repeats of one specific chemical code in one small section of chromosome B. /he normal huntingtin gene includes 8J to 7! repetitions of this code among its total of more than H$8!! codes. /he defect that causes 9untington's disease includes B! or more repeats. Lenetic tests for 9untington's disease measure the number of repeats present in an individual's huntingtin protein gene. .cientists don't yet understand the normal function of huntingtin protein or how a few dozen extra repeats in its genetic blueprint lead to the devastating symptoms of 9untington's disease. *esearchers are eager to solve these mysteries to find the answer to 9untington's. /hese solutions also may offer important insights into a wide range of other brain disorders$ including Alzheimer's$ ,arkinson's disease and amyotrophic lateral sclerosis 0A5.1. .ign up for our enews to receive updates about AlzheimerAs and dementia care and research.
reatment and outcomes

/here is currently no cure for 9untington's disease and no way to slow or stop the brain changes it causes. /reatments focus on managing symptoms. A group of international experts recommended the following treatments as first-line strategies for three of the disease's most

troubling symptoms( )horea 0involuntary movements1( .ome experts begin treatment with an atypical antipsychotic drug. ;thers start with another type of drug approved by the G... 2ood and Drug Administration 02DA1 specifically for 9untington's. Irritability( 2or severe anger and threatening behavior$ experts agree that an atypical antipsychotic drug is the best first-line approach. 2or less severe$ nonthreatening irritability$ experts recommend first trying a selective serotonin reuptake inhibitor 0..*I1$ which is a type of antidepressant. ;bsessive-compulsive thoughts and actions( 3xperts also recommended ..*Is as the front-line treatment for obseesive-compulsive behaviors. ;ther 9untington's symptoms$ such as anxiety$ depression and insomnia$ also should be treated according to generally accepted guidelines. 3xperts encourage people with 9untington's to keep all their medical appointments and not to get discouraged if it takes their health care team some time to find the best drugs and the most effective doses.

2orsa,off "yndrome
2orsa,off syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin $.5).Corsakoff syndrome is most commonly caused by alcohol misuse$ but certain other conditions also can cause the syndrome.
$bout -orsakoff %yndrome

/hiamine 0vitamin %-81 helps brain cells produce energy from sugar. 'hen levels fall too low$ brain cells cannot generate enough energy to function properly. As a result$ Corsakoff syndrome may develop. Corsakoff syndrome is most commonly caused by alcohol misuse$ but can also be associated with AID.$ chronic infections$ poor nutrition and certain other conditions. .eecauses and risks below.

Alcohol decline

misuse

and

cognitive

Alcohol misuse also may lead to brain damage through( /he toxic effects of alcohol on brain cells /he biological stress of repeated intoxication and withdrawal Alcohol-related cerebrovascular disease 9ead in+uries from falls sustained when inebriated.

Corsakoff syndrome is often$ but not always$ preceded by an episode of 'ernicke encephalopathy$ which is an acute brain reaction to severe lack of thiamine. 'ernicke encephalopathy is a medical emergency that causes life-threatening brain disruption$ confusion$ staggering and stumbling$ lack of coordination$ and abnormal involuntary eye movements. %ecause the chronic memory loss of Corsakoff syndrome often follows an episode of 'ernicke encephalopathy$ the chronic disorder is sometimes known as 'ernicke-Corsakoff syndrome. %ut Corsakoff syndrome can also develop in individuals who have not had a prior episode of 'ernicke encephalopathy.

%ymptoms

Corsakoff syndrome causes problems learning new information$ inability to remember recent events and long-term memory gaps. Memory problems may be strikingly severe while other thinking and social skills are relatively unaffected. 2or example$ individuals may seem able to carry on a coherent conversation$ but moments later be unable to recall that the conversation took place or to whom they spoke. /hose with Corsakoff syndrome may &confabulate$& or make up$ information they can't remember. /hey are not &lying& but may actually believe their invented explanations. .cientists don't yet understand why Corsakoff syndrome may cause confabulation.
Diagnosis

Corsakoff syndrome is a clinical diagnosis representing a physician's best +udgment about the cause of a person's symptoms. /here are no specific lab tests or brain scan procedures to confirm that a person has this disorder. /he syndrome may sometimes be hard to identify because it may be masked by symptoms of other conditions common among those who misuse alcohol$ including intoxication or withdrawal$ infection or head in+ury. 3xperts recommend that a medical workup for memory loss or other cognitive changes always include :uestions about an individual's alcohol use. Anyone admitted to the hospital for an alcohol-related condition should be professionally screened for memory loss and cognitive change.
Causes and risks

.cientists don't yet know exactly how Corsakoff syndrome damages the brain. *esearch has shown that severe thiamine deficiency disrupts several biochemicals that play key roles in carrying signals among brain cells and in storing and retrieving memories. /hese disruptions destroy brain cells and cause widespread microscopic bleeding and scar tissue. Most cases of Corsakoff syndrome result from alcohol misuse. .cientists don't yet know why heavy drinking causes severe thiamine deficiency in some alcoholics$ while others may be affected primarily by alcohol's effects on the liver$ stomach$ heart$ intestines or other body systems. *esearchers have identified several genetic variations that may increase susceptibility to Corsakoff syndrome. ,oor nutrition also may raise risk. .ign up for our enews to receive updates about AlzheimerAs and dementia care and research. Corsakoff syndrome also can be caused by anorexia$ overly-stringent dieting$ fasting$ starvation or weight-loss surgery4 uncontrolled vomiting4 AID.4 kidney dialysis4 chronic infection4 or cancer that has spread throughout the body.
reatment and outcomes

.ome experts recommend that heavy drinkers and others at risk of thiamine deficiency take oral supplements of thiamine and other vitamins under their doctor's supervision. Many experts also recommend that anyone with a history of

heavy alcohol use who experiences symptoms associated with 'ernicke encephalopathy be given in+ectable thiamine until the clinical picture grows clearer. ;nce acute symptoms improve$ individuals should be carefully evaluated to determine if their medical history$ alcohol use and pattern of memory problems may be consistent with Corsakoff syndrome. 2or those who develop Corsakoff syndrome$ extended treatment with oral thiamine$ other vitamins and magnesium may increase chances of symptom improvement. Living up alcohol is also an effective treatment. In those who develop Corsakoff syndrome$ with or without a preceding episode of 'ernicke encephalopathy$ there are few studies on long-term outcomes. Available data suggest that about 7F percent of those who develop Corsakoff syndrome eventually recover$ about half improve but don't recover completely$ and about 7F percent remain unchanged. .ome research suggests that those who recover from an episode may have a normal life expectancy if they abstain from alcohol.