Expert Advice

Alzheimer's disease, which causes memory loss and changes in thinking and behavior, affects more than 5 million Americans (and more than 24 million people worldwide), according to Alzheimer's Disease International.

The disease also has a profound impact on the lives of those who live with and care for Alzheimer's patients. Although the disease is not yet curable, there are many treatments, including medications and support, that can aid patient and caregiver, says ConstantineLyketsos, chairman of the psychiatry department at Johns Hopkins Bayview Medical Center.

What is Alzheimer's disease?

Alzheimer's is a brain disease. It causes brain damage that can be seen under the microscope called amyloid plaques (or clumps of a protein called amyloid), nerve cell tangles, inflammation and the death of nerve cells, which are the workhorses of the brain.

What are the symptoms of the disease?

Alzheimer's probably damages the brain for several decades before we see any symptoms. We also know that some people die with Alzheimer's in their brains but with no symptoms. Symptoms include memory loss, trouble with planning and organizing, difficulty with some high-level functioning like navigating around the neighborhood. And we now are appreciating that some symptoms also are apathy, depression, irritability or delusions. We sometimes see symptoms of Alzheimer's in people as early as in their 30s, 40s and 50s, but that is very rare.

Many people seem to have some of these symptoms - such as irritability or forgetfulness. How does a person know when to consult a doctor?

If you have these symptoms and they are affecting your functioning and you are young, you should go see a doctor. However, in all likelihood, you are suffering from depression. If you are 65 and over, you are at the age of high risk. At this point, if these symptoms represent a change, it is a good idea to talk them over with your primary care doctor. ... If the symptoms are really affecting your functioning - causing what we call dementia, in which people can't drive or properly manage money or live alone, or worse, have trouble arranging for their clothing - then you should go see a specialist right away.

How is Alzheimer's treated?

Treatment for the disease without symptoms does not exist. ... Treatment for the Alzheimer's early phase called "MCI," or mild cognitive impairment, is controversial. For this, you should talk to a specialist.

What about treatment for those with severe Alzheimer's?

The treatment for full-blown dementia has four parts. They include treatment of the disease with a drug that may very slightly slow progression of the disease in moderate or severe stages (but not the mild stage). This is helpful in some patients.

The second part targets two broad groups of symptoms, depending upon what the patient has. We might target, [for example], the memory loss with drugs. In maybe 10 to 15 percent of cases, this can be really helpful.

In the case of neuropsychiatric symptoms such as depression, apathy, sleep disorder, irritability and sometimes delusions, we supply supportive care measures for the patient. And we also sometimes suggest medications, which can be very effective for these symptoms.

And what is the fourth part?

We help the caregivers. We teach them skills such as how to manage different aspects of daily life, administer medications and make sure they get respite. Caregivers of Alzheimer's patients have a higher mortality rate [than other caregivers].

What causes Alzheimer's disease?

A complex interaction between certain genes and certain environmental factors. Some people are genetically predisposed to get Alzheimer's; they tend to get it younger and to die younger from it. This is in 5 to 10 percent of those who get Alzheimer's.

But in most cases, it is a combination of environmental and genetic factors. A head injury is thought to be an important environmental factor. Inactivity is also thought to be one. (There is some thought that retiring early may be a risk factor.)

Depression appears to be a risk factor, but we aren't clear if it is a risk factor - or a very early symptom.

There has been a lot of buzz about working crossword puzzles to keep your brain healthy; should we all be doing crosswords?

Well, it is sort of good practice. But crosswords aren't proven to prevent Alzheimer's and saying that is nonsense. We want people to be active, but we don't want people to think if they work really hard at it, they will prevent Alzheimer's. We aren't saying that.

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