Helen & Robert Appel Alzheimer’s Disease Research Institute

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Frequently Asked Questions

Q: What are the first signs of Alzheimer’s disease?

A: Memory problems are typically one of the first signs of Alzheimer’s disease. A person in the early (mild) stage of Alzheimer’s disease may 

  • find it increasingly difficult to remember things or tasks
  • repetitiously ask the same questions
  • frequently get lost, confused or disoriented
  • misplace/lose things or store them in odd places
  • have difficulty handling money and paying bills
  • take longer to finish daily tasks and chores.

Other memory issues that arise besides memory loss may be the first sign of Alzheimer’s disease. A person may have difficulty communicating and trying to find the right words, visual and spatial issues, or impaired reasoning or judgment assessments. This can cause irritability and frustration and contribute greatly to mood or personality changes.

Q: Are there stages of progression in Alzheimer’s disease? If so, what are they?

A: Alzheimer's disease generally has three stages: early (mild), middle (moderate), and late (severe).

Symptoms of early stage Alzheimer’s disease include

  • difficulty remembering things or tasks
  • repetitiously ask the same questions
  • misplace/lose things or store them in odd places
  • have difficulty handling money and paying bills.

As Alzheimer’s disease progresses to the middle stage, memory loss, cognition and confusion grow increasingly worse. People start to have problems recognizing family members and friends. Other symptoms are this stage include

  • trouble learning new tasks and managing with new situations
  • difficulty in implementing tasks that include multiple steps, such as getting dressed, brushing teeth, driving, etc.
  • forgetting the names of common things
  • becoming easily disoriented and wandering away from home.

As Alzheimer’s disease becomes more severe and enters into the final stages, people lose the abiity to communicate. They may sleep more, lose weight, and have difficulty eating and swallowing. Often they become incontinent and eventually require living assistance.

Q: What changes in the brain occur to people with Alzheimer’s disease?

A: Although we still don’t know how Alzheimer’s disease begins, it seems likely that damage to the brain commences 10 years or more before symptoms arise and become apparent. During the earliest stage of Alzheimer’s, people are free of symptoms, but harmful yet undetected changes are occurring in the brain especially in the hippocampus, the part of the brain responsible for learning and memory. Abnormal protein deposits start to form amyloid plaques and neurofibrillary tangles throughout the brain. Healthy nerve cells begin to lose their ability to function and communicate with each other, and ultimately die. As nerve cells in the brain die, parts of the brain eventually shrink bringing the disease to its final stages where the shrinkage spreads throughout the entire brain regions irreversibly damaging the remaining nerve cells.

Q: What causes Alzheimer's disease?

A: Scientists do not yet fully understand what causes Alzheimer's disease but attribute it to genetic, environmental, and possibly lifestyle factors. These causes affect people inversely.

One of the main attributes of Alzheimer's disease is increasing age, the most important known risk factor. Nutrition, exercise, and long-term adverse health conditions such as high blood pressure and diabetes, have also been linked in increasing one’s risk of developing this disease. 

Q: Is Alzheimer's disease hereditary?

A: Not necessarily. A rare form of Alzheimer's disease, called early-onset familial Alzheimer's, is hereditary and predominantly occurs in younger people, typically between the ages of 30 and 60. Early-onset familial Alzheimer’s is caused by gene mutations in certain genes. As most cases of Alzheimer's disease are late-onset, occurring after age 60, there aren’t any striking or obvious family patterns. However, genetic factors appear to increase a person's risk of developing late-onset Alzheimer's.

Q: If you become forgetful as you age, does that mean you will get or already have Alzheimer’s disease?

A: Not all memory problems are attributed to Alzheimer’s disease. Mild forgetfulness is be a normal part of the aging process. Sometimes memory problems can be linked to health issues that are treatable. At times medications can lead to side effects effecting memory, vitamin B12 deficiency, or liver or kidney disorders can also lead to memory loss or possibly dementia. Emotional and environmental problems, such as stress, anxiety, or depression, can also contribute to forgetfulness and may be mistaken or misdiagnosed for dementia.

Q: How is Alzheimer’s disease diagnosed?

A: The only absolute way to detect Alzheimer's disease is to find out whether plaques and neurofibrillary tangles exist in brain tissue. Doctors can only make a diagnosis of "possible" or “probable” Alzheimer’s disease while a person is alive. Doctors with specialized training such as geriatricians, geriatric psychiatrists, and neurologists can diagnose Alzheimer's disease correctly up to 90 percent of the time.

To diagnose Alzheimer's disease, specialists must 

  • inquire about the person’s overall health condition, past medical problems, ability to carry out routine activities, and changes in behavior and mood
  • conduct examinations that precisely measure and quantify memory, problem solving, attention, counting, and language skills
  • perform standard medical tests, such as blood analysis and urine tests
  • perform brain scans to check if anything in the brain does not look normal.

Q: Why is early detection important?

A: An early, precise diagnosis of Alzheimer's disease affords people and their families to plan accordingly for the future. It allows them time to process the diagnosis, discuss care options, find support, and make legal and financial arrangements while the person with Alzheimer’s can still take part in the decision making process.

Q: Are there any medicines to treat Alzheimer’s disease?

A: Currently, there’s no treatment that can prevent or treat Alzheimer's disease. However, there are four medications that are used to treat Alzheimer’s symptoms. These drugs may help maintain thinking, memory, and speaking skills for a limited time. They work by regulating certain chemicals in the brain. Most of these medicines work best for people in the early or middle stages of the disease.

For people with mild or moderate Alzheimer's, donepezil (Aricept®), rivastigmine (Exelon®), or galantamine (Razadyne®) may help. Donepezil is also approved to treat symptoms of moderate to severe Alzheimer's. Another drug, memantine (Namenda®), is used to treat symptoms of moderate to severe Alzheimer's, although it also has limited effects. All of these medicines have possible side effects.

Certain medicines and other approaches can help control the behavioral symptoms of Alzheimer's disease. These symptoms include sleeplessness, agitation, wandering, anxiety, anger, and depression.

Q: What’s the average life span after getting diagnosed with Alzheimer’s disease?

A: The time from diagnosis of Alzheimer’s disease to death varies from person to person and depends on the stage of the disease and the age of the person. It can be as little as 3 or 4 years if the person is over 80 years old when diagnosed or as long as 10 years or more if the person is younger.

Q: What can I do to prevent Alzheimer’s disease?

A: Currently, no medicines or treatments are known to prevent Alzheimer's disease, but scientists are studying many possibilities. These possibilities include lifestyle factors such as exercise and physical activity, a healthy diet, and mentally stimulating activities.

In addition to lifestyle factors, scientists have found clues that some long-term health conditions, like heart disease, high blood pressure, and diabetes, are related to Alzheimer's disease. It’s possible that controlling these conditions will reduce the risk of developing Alzheimer’s.

Q: Can exercise prevent Alzheimer’s disease? If so, what kind of exercises?

A: Research suggests that exercise may play a role in reducing risk for Alzheimer’s disease. Animal studies show that exercise increases both the number of small blood vessels that supply blood to the brain and the number of connections between nerve cells in older rats and mice. In addition, researchers have found that exercise raises the level of a nerve growth factor (a protein key to brain health) in an area of the brain that is important to memory and learning. Researchers have also shown that exercise can stimulate the human brain’s ability to maintain old network connections and make new ones.

Q: Can eating certain foods prevent Alzheimer’s disease?

A: Age-related diseases and conditions-such as vascular disease, high blood pressure, heart disease, and diabetes-may increase the risk of Alzheimer’s. Many studies are looking at whether this risk can be reduced by preventing or controlling these diseases and conditions.

For example, one clinical trial is looking at how lowering blood pressure to or below current recommended levels may affect cognitive decline and the development of MCI (mild cognitive impairment) and Alzheimer’s disease. Participants are older adults with high systolic (upper number) blood pressure who have a history of heart disease or stroke, or are at risk for those conditions.

Diabetes is another disease that has been linked to Alzheimer’s. Past research suggests that abnormal insulin production contributes to Alzheimer’s-related brain changes. (Insulin is the hormone involved in diabetes.) Diabetes treatments have been tested in people with Alzheimer’s, but the results have not been conclusive.

Q: What is basic research and why is it an important part of Alzheimer’s disease research?

A: Basic research helps scientists gain new knowledge about a disease process, including how and why it starts and progresses. In Alzheimer’s disease, basic search seeks to identify the cellular, molecular, and genetic processes that lead to the disease. For example, scientists are studying

  • the ways in which plaques and tangles damage nerve cells in the brain
  • the very earliest brain changes in the disease process
  • the role of Alzheimer’s risk-factor genes in the development of the disease
  • how risk-factor genes interact with other genes and lifestyle or environmental factors to affect Alzheimer’s risk.

Q: What is translational research and why is it an important part of Alzheimer’s disease research?

A: Translational research grows out of basic research. It creates new medicines, devices, or behavioral interventions aimed at preventing, diagnosing, or treating a disease. An important goal of Alzheimer’s translational research is to increase the number and variety of potential new medicines and other interventions that are approved for testing in humans. Scientists also examine medicines approved to treat other diseases to see they might be effective in people with Alzheimer’s.

The most promising interventions are tested in test-tube and animal studies to make sure they are safe and effective. Currently, a number of different substances are under development that may one day be used to treat the symptoms of Alzheimer’s disease or mild cognitive impairment.

Q: What is clinical research and why is it an important part of Alzheimer’s disease research?

A: Clinical research is medical research involving people. It includes clinical studies, which observe and gather information about large groups of people. It also includes clinical trials, which test a medicine, therapy, medical device, or behavior in people to see if it is safe and effective.

Clinical trials are the best way to find out whether a particular intervention actually slows, delays, or prevents Alzheimer’s disease. Trials may compare a potential new treatment with a standard treatment or placebo (mock treatment). Or, they may study whether a certain behavior or condition affects the progress of Alzheimer’s or the chances of developing it.

Weill Cornell Medicine Helen & Robert Appel Alzheimer’s Disease Research Institute 413 East 69th Street New York, NY 10021 Phone: (646) 962-6323 Fax: (646) 962-0579