Alzheimer’s and Dementia

What We Know, What We Can Do

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A 121 page Alzheimer’s Association report, 2022 Alzheimer’s Disease Facts and Figures, provides information about Alzheimers, dementia and related topics including treatment, risks, statistics, caregivers and more. This article summarizes the report.

What is the difference between Alzheimer’s and Dementia?

Dementia is the overall term for a particular group of symptoms with several causes. One of these causes can be Alzheimer’s disease, which is a type of brain disease caused by damage to nerve cells (neurons) in the brain. The first neurons damaged are those in parts of the brain responsible for memory, language and thinking; these are the first symptoms of the disease. The brain changes that cause these symptoms may begin 20 years or more before the symptoms are visible.

Dementia exists on a continuum; it starts in limited ways and progresses in severity. Eventually, those with the condition require assistance with the activities of  daily living. Dementia, including dementia caused by Alzheimer’s disease, is not a normal part of aging.

Seniors aged 65 and older survive, on average, four to eight years after a diagnosis of Alzheimer’s dementia. Some, however, live as long as 20 years after a diagnosis.

Alzheimer’s causes and symptoms 

Alzheimer’s disease is the most common cause of dementia, but it is not the only one.

Other causes of dementia-like symptoms include depression, untreated sleep apnea, side effects of medications, Lyme disease, thyroid problems, certain vitamin deficiencies and excessive alcohol consumption. Those conditions, unlike Alzheimer’s dementia and other dementias, may be reversed with treatment. Individuals experiencing cognitive changes should seek medical help to determine if the changes are normal for their age, are reversible (for example, caused by a new medication or vitamin deficiency), or may be a symptom of Alzheimer’s or another dementia.

Great progress has been made in the scientific ability to measure brain changes. Biomarkers, biological changes that can be measured to indicate the presence or absence of a disease or the risk of developing a disease, while not the same as a diagnosis, might help to determine underlying brain changes that are causing dementia.

Alzheimer’s Compared to Typical Age-Related Changes

There are several examples of how Alzheimer’s differs from typical age-related changes. It often comes down to how severely everyday life is affected.

It’s common to, at times, forget names or appointments but remember them later. Alzheimer’s dementia is accompanied by memory loss that disrupts daily life, such as asking the same question multiple times and increased reliance on memory aids or other people for things that were previously handled independently.

Occasional errors when managing finances or household bills isn’t generally a sign of Alzheimer’s. However, diminishing ability to develop and follow a plan or work with numbers can be. It may be difficult to follow a familiar recipe or keep track of monthly bills. Difficulty with concentration and taking much longer to do things than previously are also potential symptoms.

Confusion with time or place is another possible sign. More than becoming temporarily confused about the day of the week, people living with Alzheimer’s can lose track of dates, seasons and the passage of time. Sometimes they forget where they are or how they got there.

Having trouble finding the right word to use is something that happens to all of us occasionally, regardless of age. New problems with word selection in speaking or writing can be another sign of Alzheimer’s. Experiencing difficulty with following a conversation, struggling with vocabulary or having trouble naming a familiar object are also signs. Those changes can lead to withdrawing from hobbies, social activities or other engagements.

It’s easy to become set in our ways as we age. Having very specific ways of doing things and feeling irritable when our routine is disrupted is typical. People living with Alzheimer’s can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or when out of their comfort zones.

Is there a treatment for Alzheimer’s?

There are multiple prescription drugs available for the treatment of Alzheimer’s disease. They may temporarily treat Alzheimer’s symptoms but do not change the underlying brain changes or alter the course of the disease. Most of them do this by increasing the chemicals, called neurotransmitters, in the brain. One drug protects the brain from a neurotransmitter called glutamate that over-stimulates neurons and can damage them.

A new drug, approved by the FDA in June 2021, address the underlying biology of Alzheimer’s disease rather than the symptoms. However, it is not a cure for Alzheimer’s and is not appropriate for all individuals living with the disease.

Non-drug treatments are also available. These treatments do not change the underlying biology of the disease, instead focusing on the goals of maintaining or improving cognitive function, overall quality of life and engagement, and the ability to perform activities of daily living.

These non-drug treatments include cognitive stimulation, music-based therapies and psychological treatment. They may be used with the goal of reducing symptoms such as depression, apathy, wandering, sleep disturbances, agitation and aggression. Non-drug treatments may be more effective than pharmacologic interventions for reducing aggression and agitation

Supplements such as vitamins C, D and E, omega-3 fatty acids and ginkgo biloba, provide little to no benefit in preventing cognitive decline or Alzheimer’s dementia.

Proactive management of Alzheimer’s and other dementias can improve the quality of life of affected individuals and their caregivers. These strategies include the appropriate use of available treatment options, including:

  • Effectively managing coexisting conditions.
  • Providing family caregivers with effective training in managing the day-to-day life of the care recipient.
  • Coordinating care among physicians, other health care professionals and lay caregivers.
  • Participating in activities that are meaningful to the individual with dementia.
  • Maintaining a sense of self identity and relationships with others.
  • Having opportunities to connect with others living with dementia, like support groups.
  • Becoming educated about the disease.
  • Planning for the future.
Credit: Tiramisu, Pixabay

Risk Factors

Most people who develop Alzheimer’s dementia are 65 or older. Like other common chronic diseases, Alzheimer’s probably develops as a result of multiple factors rather than a single cause.

The greatest risk factors are older age, genetics and a family history of Alzheimer’s, however older age alone does not cause Alzheimer’s dementia.

Although we cannot alter age, genetics or family history, other risk factors can be controlled, such as the level of physical activity, smoking, education, staying socially and mentally active, blood pressure and diet. In 2020, The Lancet Commission published an article on dementia prevention, intervention and care. The article suggests that addressing modifiable risk factors might prevent or delay up to 40% of dementia cases.

Reducing the risk of cognitive decline and dementia is not a guaranteed method for  preventing cognitive decline and dementia.  Those who reduce their risk may still develop dementia, but perhaps later in life than had they not taken proactive steps.

Taking Steps

For example, a healthy heart helps brain health as well. Although it makes up just 2% of body weight, the brain consumes 20% of the body’s oxygen and energy supplies. A healthy heart ensures that enough blood is pumped to the brain.

Factors that protect the heart may also protect the brain and reduce the risk of developing dementia. Physical activity and a heart-healthy diet may be associated with reduced dementia risk. A heart-healthy diet emphasizes fruits, vegetables, whole grains, fish, chicken, nuts, legumes and healthy fats such as olive oil while limiting saturated fats, red meat and sugar.

The number of years of formal education, having a mentally stimulating job and engaging in other mentally stimulating activities may also prolong better brain health.

Other risk factors are also being studied, including inadequate sleep or poor sleep quality, excessive alcohol use, depression, air pollution and hearing impairment.

Evidence also indicates that severe illness and medical encounters such as hospitalization in older people increase their risk of long-term cognitive impairment. The COVID-19 pandemic resulted in more than 1.3 million hospitalizations among U.S. adults aged 65 and older between January 1, 2020, and July 24, 2021. A number of these individuals received mechanical ventilation, which increases the risk of delirium, an acute state of short-term confusion that is a risk factor for dementia.

The relatively recent discovery that Alzheimer’s begins 20 years or more before visible symptoms helps explain why it has been difficult to prevent and treat it effectively. However, it also implies that there is a sizable window of time to intervene in the progression of the disease.

A fuller understanding of Alzheimer’s depends on other crucial factors, including the inclusion of participants from diverse racial and ethnic groups in all realms of research. This inclusion is more than a matter of simply enrolling more participants from underrepresented groups. Increasing diversity among researchers and engaging with and seeking input from communities are also important. Improving inclusion in all of these ways expands the range of lived experiences among participants. It also improves the extent to which those experiences are known and become topics of investigation.

What are the chances of getting Alzheimer’s?

Although 1 in 3 seniors dies with Alzheimer’s or another dementia, the rate of Alzheimer’s patients appears to be declining. This is probably due to improvements over the 20th century of Alzheimer’s risk factors, such as hypertension and low educational attainment. However, even with this potentially lower rate, the number of people with Alzheimer’s is expected to continue growing because of an increase in the number of adults aged 65 and over.

An estimated 6.5 million Americans age 65 and older are living with Alzheimer’s dementia in 2022. Seventy-three percent are 75 or older. About 1 in 9 people age 65 and older has Alzheimer’s dementia.

In spite of these numbers, a large portion of Americans with Alzheimer’s may not know they have it. Many of those who would meet the diagnostic criteria for Alzheimer’s and other dementias are not diagnosed with dementia by a physician. Furthermore, only about half of Medicare beneficiaries who have a diagnosis of Alzheimer’s or another dementia in their Medicare billing records report being told of the diagnosis.

Almost two-thirds of Americans with Alzheimer’s are women. Of the 6.5 million people aged 65 and older with Alzheimer’s in the United States, 4 million are women and 2.5 million are men. This represents 12% of women and 9% of men aged 65 and older in the United States. This might be because women live longer than men on average, and older age is the greatest risk factor for Alzheimer’s. Research into the risk of developing Alzheimer’s or other dementias for men and women of the same age has had mixed results.

Several studies indicate that older Blacks are about twice as likely to have Alzheimer’s or other dementias as older Whites. Some other studies indicate older Hispanic adults are about one and one-half times as likely to have Alzheimer’s or other dementias as older White adults. Obviously, race does not have a genetic basis, and genetic factors do not account for the large differences in prevalence and incidence among racial groups.

Research suggests that the difference in risk for Alzheimer’s and other dementias is explained by disparities produced by the historic and continued marginalization of Black and Hispanic people in the United States— disparities in life experiences, socioeconomic indicators, and ultimately health conditions. These disparities include environmental factors such as where people can live, the quality of schools in their communities, and exposure to harmful toxins and pollutants. It also influences access to quality health care, employment prospects, occupational safety, the ability to pass wealth to subsequent generations, treatment by the legal system and exposure to violence.

Not only is Alzheimer’s responsible for the deaths of more and more Americans, it also contributes to poor health and disability. The long duration of illness before death significantly affects the public health impact of Alzheimer’s; much of that time is spent in a state of severe disability and dependence.

Caregivers

Family members and friends provided more than $271 billion in unpaid care to people living with Alzheimer’s and other dementias in 2021.

Caregiving includes assistance with one or more activities of daily living, including bathing and dressing, taking medication, preparing meals, paying bills, dementia rehabilitation, shopping and using transportation. Managing behavioral symptoms such as aggressive behavior, wandering, depressive moods, agitation, anxiety, repetitive activity and nighttime disturbances also fall in the category of caregiving.

Caregivers also provide emotional support to people with Alzheimer’s as well as communicating and coordinating care with other family members and health care providers, ensuring safety at home and elsewhere, and managing health conditions.

Eighty-three percent of the help provided to older adults in the United States comes from family members, friends or other unpaid caregivers. Nearly half of all caregivers  who provide help to older adults do so for someone with Alzheimer’s or another dementia. More than 11 million Americans provide unpaid care for people with Alzheimer’s or other dementias.

In 2021, the total lifetime cost of care for someone with dementia was estimated at $377,621. Seventy percent of the lifetime cost of care is borne by family caregivers in the forms of unpaid caregiving and out-of-pocket expenses for items ranging from medications to food for the person with dementia.

A Caregiver Profile

Approximately two-thirds of dementia caregivers are women, and about 30% are 65 or older. Over 60% of caregivers are married, living with a partner or in a long-term relationship. More than half of caregivers are providing assistance to a parent or in-law with dementia, and about 10% of caregivers provide help to a spouse with Alzheimer’s disease or another form of dementia. About 40% of dementia caregivers have a college degree or more of education; a similar number have a household income of $50,000 or less.

Not all caregivers are certified certified dementia practitioners and many lack the information and resources necessary to manage complex medication regimens. The demands of caregiving may cause declines in their own health. Evidence suggests that the stress of providing dementia care increases caregivers’ susceptibility to disease and health complications. They are significantly more likely to experience depression and anxiety than non-caregivers. The stress levels can also negatively influence the quality of family caregivers’ sleep. A 2017 poll found that more than a quarter of dementia caregivers delayed or did not do things they should to maintain their own health.

However, there are ways to help caregivers. Providing education, helping them manage dementia-related symptoms, improving social support for them and providing them with respite from caregiving duties are all good examples. When these methods are implemented, they are generally successful at improving how caregiver services are delivered and have the potential to reach a large number of families while also helping caregivers cope with their responsibilities.

What is mild cognative imparement?

Mild cognitive impairment (MCI) is an early stage of memory loss. It causes cognitive changes that are serious enough to be noticed by the person affected and by family members and friends, but may not affect the individual’s ability to carry out everyday activities. Approximately 12% to 18% of people aged 60 or older are living with MCI. MCI is sometimes confused with normal aging, but it is not part of the typical aging process

Worsening or more frequent confusion or memory loss is one of the earliest warning signs of Alzheimer’s disease and may be a way to identify people who are at high risk of developing Alzheimer’s or other dementias as well as MCI. Not all those who experience subjective cognitive decline go on to develop MCI or dementia, but many do.

To diagnose MCI, physicians conduct a review of the patient’s medical history and use patient questionnaires, clinical exams and brief assessments to evaluate thinking and memory function. Cognitive assessment tools evaluate cognitive impairment by testing memory and measuring changes in reasoning, problem-solving, planning, naming, comprehension and other cognitive skills. Although patient-reported symptoms and the results from screening tools and clinical exams provide clues about whether a person has MCI, there is no test that can give a definitive diagnosis.

Though there is no specific treatment for MCI, physicians may be able to identify reversible causes of cognitive impairment, such as depression, medication side effects or sleep apnea. They may also recommend exercise and healthy lifestyle interventions to help improve cognitive function and quality of life.

Alzheimer’s disease will affect significant numbers of Americans in the coming years, even more so than it currently does due to our aging population. The more we know about Alzheimer’s and dementia, the better prepared we will be to deal with that future.

To read the complete report 2022 Alzheimer’s Disease Facts and Figures, click the link. For more information about Alzheimer’s disease, you can go to the Alzheimer’s Association.