Alzheimer’s disease is a complex disease that affects the brain. Although many things about Alzheimer’s remain a mystery, research continues to bring us a better understanding of the disease, more accurate diagnoses, and more effective treatments.
What Is Alzheimer’s?
Alzheimer’s disease (pronounced AHLZ-hi-merz) is one of several disorders that cause the gradual loss of brain cells. The disease was first described in 1906 by German physician Dr. Alois Alzheimer. Although the disease was once considered rare, research has shown that it is the leading cause of dementia.
What is Dementia?
Dementia is an umbrella term for several symptoms related to a decline in thinking skills. Common symptoms include a gradual loss of memory, problems with reasoning or judgment, disorientation, difficulty in learning, loss of language skills, and decline in the ability to perform routine tasks.
People with dementia also experience changes in their personalities and behavioral problems, such as agitation, anxiety, delusions (believing in a reality that does not exist), and hallucinations (seeing things that do not exist).
Disorders that cause dementia
Several disorders that are similar to Alzheimer’s disease can cause dementia. These include fronto-temporal dementia, dementia with Lewy bodies, Parkinson’s disease, Creutzfeldt-Jakob disease, and Huntington’s disease. All of these disorders involve disease processes that destroy brain cells.
Vascular dementia is a disorder caused by the disruption of blood flow to the brain. This may be the result of a massive stroke or several tiny strokes.
Some treatable conditions such as depression, drug interactions, and thyroid problems can cause dementia. If treated early enough, this dementia may be effectively treated and even reversed.
Causes and Risk Factor
No one knows yet exactly what causes Alzheimer’s disease. Researchers are learning about what happens to the brain as we grow older, what happens to brain cells in Alzheimer’s disease, genes associated with Alzheimer’s, and many other factors that may be important. Most researchers agree that the cause may be a complex set of factors.
Ten Warning Signs
Some change in memory is normal as we grow older, but the symptoms of Alzheimer’s disease are more than simple lapses in memory. People with Alzheimer’s experience difficulties communicating, learning, thinking, and reasoning — problems severe enough to have an impact on an individual’s work, social activities, and family life.
The Alzheimer’s Association believes that it is critical for people with dementia and their families to receive information, care, and support as early as possible. To help family members and health care professionals recognize warning signs of Alzheimer’s disease, the Association has developed a checklist of common symptoms.
- Memory loss. One of the most common early signs of dementia is forgetting recently learned information. While it’s normal to forget appointments, names, or telephone numbers, those with dementia will forget such things more often and not remember them later.
- Difficulty performing familiar tasks. People with dementia often find it hard to complete everyday tasks that are so familiar we usually do not think about how to do them. A person with Alzheimer’s may not know the steps for preparing a meal, using a household appliance, or participating in a lifelong hobby.
- Problems with language. Everyone has trouble finding the right word sometimes, but a person with Alzheimer’s disease often forgets simple words or substitutes unusual words, making his or her speech or writing hard to understand. If a person with Alzheimer’s is unable to find his or her toothbrush, for example, the individual may ask for “that thing for my mouth.”
- Disorientation to time and place. It’s normal to forget the day of the week or where you’re going. But people with Alzheimer’s disease can become lost on their own street, forget where they are and how they got there, and not know how to get back home.
- Poor or decreased judgment. No one has perfect judgment all of the time. Those with Alzheimer’s may dress without regard to the weather, wearing several shirts or blouses on a warm day or very little clothing in cold weather. Individuals with dementia often show poor judgment about money, giving away large amounts of money to telemarketers or paying for home repairs or products they don’t need.
- Problems with abstract thinking. Balancing a checkbook may be hard when the task is more complicated than usual. Someone with Alzheimer’s disease could forget completely what the numbers are and what needs to be done with them.
- Misplacing things. Anyone can temporarily misplace a wallet or key. A person with Alzheimer’s disease may put things in unusual places: an iron in the freezer or a wristwatch in the sugar bowl.
- Changes in mood or behavior. Everyone can become sad or moody from time to time. Someone with Alzheimer’s disease can show rapid mood swings—from calm to tears to anger—for no apparent reason.
- Changes in personality. People’s personalities ordinarily change somewhat with age. But a person with Alzheimer’s disease can change a lot, becoming extremely confused, suspicious, fearful, or dependent on a family member.
- Loss of initiative. It’s normal to tire of housework, business activities, or social obligations at times. The person with Alzheimer’s disease may become very passive, sitting in front of the television for hours, sleeping more than usual, or not wanting to do usual activities.
If you recognize any warning signs in yourself or a loved one, the Alzheimer’s Association recommends consulting a physician. Early diagnosis of Alzheimer’s disease or other disorders causing dementia is an important step in getting appropriate treatment, care, and support services.
Getting a Diagnosis
A physician should be consulted about concerns with memory, thinking skills, and changes in behavior. For people with dementia and their families, an early diagnosis has many advantages:
- Time to make choices that maximize quality of life
- Lessened anxieties about unknown problems
- A better chance of benefiting from treatment
- More time to plan for the future
It is also important for a physician to determine the cause of memory loss or other symptoms. Some dementia or dementia-like symptoms can be reversed if they are caused by treatable conditions, such as depression, drug interaction, thyroid problems, and certain vitamin deficiencies.
There is no cure for Alzheimer’s disease. However, there are several drug treatments that may improve or stabilize symptoms and several care strategies and activities that may minimize or prevent behavioral problems. Researchers continue to look for new treatments to alter the course of the disease and other strategies to improve the quality of life for people with dementia.
Standard Prescriptions for Alzheimer’s
The primary symptoms of Alzheimer’s disease include memory loss, disorientation, confusion, and problems with reasoning and thinking. These symptoms worsen as brain cells die and the connections between cells are lost. Although current drugs cannot alter the progressive loss of cells, they may help minimize or stabilize symptoms. These medications may also delay the need for nursing home care.
The U.S. Food and Drug Administration (FDA) has approved two classes of drugs to treat cognitive symptoms of Alzheimer’s disease. The first Alzheimer medications to be approved were cholinesterase (KOH luh NES ter ays) inhibitors. Three of these drugs are commonly prescribed—donepezil (Aricept®), approved in 1996; rivastigmine (Exelon®), approved in 2000; and galantamine (Reminyl®), approved in 2001. Tacrine (Cognex®), the first cholinesterase inhibitor, was approved in 1993 but is rarely prescribed today because of associated side effects, including possible liver damage.
All of these drugs are designed to prevent the breakdown of acetylcholine (pronounced a SEA til KOH lean), a chemical messenger in the brain that is important for memory and other thinking skills. The drugs work to keep levels of the chemical messenger high, even while the cells that produce the messenger continue to become damaged or die. About half of the people who take cholinesterase inhibitors experience a modest improvement in cognitive symptoms.
Treating Behavioral Symptoms
A number of behavioral problems may be associated with Alzheimer’s disease. The word agitation is often used as an umbrella term to describe these behaviors. As Alzheimer’s progresses, most people with the disease experience agitation in addition to memory loss and other thinking problems.
Overview on agitation
In the early stages of the disease, people with Alzheimer’s may experience personality changes such as irritability, anxiety, or depression. As the disease progresses, other symptoms may occur, including sleep disturbances, delusions (firmly held belief in things that are not real), hallucinations (seeing, hearing, or feeling things that are not there), pacing, constant movement or restlessness, checking and rechecking door locks or appliances, tearing tissues, general emotional distress, and uncharacteristic cursing or threatening language.
Agitation may be caused by a number of different medical conditions and drug interactions or by any circumstances that worsen the person’s ability to think. Situations that may lead to agitated behavior include moving to a new residence or nursing home, other changes in the environment or caregiver arrangements, misperceived threats, or fear and fatigue resulting from trying to make sense out of a confusing world.
Agitated behavior can be disruptive and painful to both the person with the disease and the caregiver. Agitation may interfere with the ability of the person with the disease to carry out the activities of daily living, and it may increase the risk of harm to the affected individual and others. Caregivers may be frightened, upset, or simply exhausted by the demands of caring for a person who is agitated.
Medical evaluation for agitation
A person exhibiting agitated behavior should receive a thorough medical evaluation, especially when agitation comes on suddenly. The treatment of agitation depends on a careful diagnosis, determination of the possible causes, and the types of agitated behavior the person is experiencing. With proper treatment and intervention, significant reduction or stabilization of the symptoms can often be achieved.
The symptoms of agitation often reflect an underlying infection or medical illness. For example, the pain or discomfort caused by pneumonia or a urinary tract infection can result in agitation. An untreated ear or sinus infection can cause dizziness and pain that affects behaviors. In some cases, prescription medication can cause agitation. This is most likely to occur when multiple medications are used, and the medications interact. Uncorrected visual or hearing loss may also lead to agitated behaviors. Treating the underlying medical condition may lessen the agitation.
Behavioral interventions for agitation
There are two distinct types of treatments for agitation: behavioral interventions and prescription medications. Behavioral interventions should be tried first. In general, steps to managing agitation include (1) identifying the behavior, (2) understanding its cause, and (3) adapting the caregiving environment to remedy the situation.
Correctly identifying what has triggered agitated behavior can often help in selecting the best behavioral intervention. Often the trigger is some sort of change in the person’s environment:
- Change in caregiver
- Change in living arrangements
- Presence of house guests
- Being asked to change clothing
A key principle of intervention is redirecting the affected individual’s attention, rather than arguing, disagreeing, or being confrontational with the person. Additional intervention strategies include the following:
- Simplifying the environment
- Simplifying tasks and routines
- Allowing adequate rest between stimulating events
- Using labels to cue or remind the person
- Equipping doors and gates with safety locks
- Removing guns
- Using lighting to reduce confusion and restlessness at night
Medications to treat agitation
Medications can be effective in the management of some symptoms of agitation, but they must be used carefully and are most effective when combined with behavioral or environmental changes. Medications should target specific symptoms so that improvement can be monitored. People with Alzheimer’s disease are susceptible to side effects that require close observation. In general, it is best to begin treatment with a single medication and with low doses.
Several herbal remedies and other dietary supplements are promoted as effective treatments for Alzheimer’s disease and related disorders. Claims about the safety and effectiveness of these products, however, are based largely on testimonials, tradition, and a rather small body of scientific research. The rigorous scientific research required by the U.S. Food and Drug Administration for the approval of a prescription drug is not required by law for the marketing of dietary supplements.
Concern about alternative therapies
Although many 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:
Effectiveness and safety are unknown. The maker of a dietary supplement is not required to provide the U.S. Food and Drug Administration (FDA) with the evidence on which it bases its claims for safety and effectiveness.
Purity is unknown. The FDA has no authority over supplement production. It is a manufacturer’s 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.
Bad reactions are not routinely monitored. Manufacturers are not required to report to the FDA any problems that consumers experience after taking their products. The agency does provide voluntary reporting channels for manufacturers, health care professionals, and consumers, and will issue warnings about products when there is cause for concern.
Dietary supplements can have serious interactions with prescribed medications. No supplement should be taken without first consulting a physician.
Research and Clinical Trials
Alzheimer research is advancing at an accelerating pace and is being tackled from many sides. Pharmaceutical companies, the U.S. federal government, and the Alzheimer’s Association are funding research to learn more about the disease process and to find compounds that will alleviate symptoms and prevent the disease. Individuals may elect to participate in research efforts by enrolling in clinical drug studies. If you are interested in enrolling in a clinical drug study, you should discuss the matter with your physician and understand what to consider and expect.
Talking with Your Physician
The medications currently approved by the U.S. Food and Drug Administration for treating mild to moderate Alzheimer’s disease belong to a single class of drugs. This means that although the key ingredient is different in each of the drugs, they are all designed to perform the same function in the body. Therefore, it is not always easy to answer the question, “Which Alzheimer medication is the best?”
Variation in outcomes and side effects
Responses to most medications vary for reasons that we do not fully understand. This circumstance is common in all drug treatments. For example, many common over-the-counter pain medications belong to the same class of drugs. Ibuprofen may work better for one individual, while naproxen may be better for another, and neither of these drugs may be as effective for a third individual.
These same variations also happen with Alzheimer medications. If a drug has little or no effect on a patient’s symptoms, a physician may recommend trying one of the others.
Side effects can also vary from one patient to the next. For one individual, one drug may be more effective but have greater side effects. For another patient, the same drug may be less effective but have no side effects.
Questions for your physician
Clear communication between the physician and the patient or caregiver is essential. Ask your physician the following questions when you discuss any treatment options.
- What kind of assessment will you use to determine if the drug is effective?
- How much time will pass before you will be able to assess the drug’s effectiveness?
- How will you monitor for possible side effects?
- What effects should we watch for at home?
- When should we call you?
- Is one treatment option more likely than another to interfere with medications for other conditions?
- What are the concerns with stopping one drug treatment and beginning another?
- At what stage of the disease would you consider it appropriate to stop using the drug?
These questions will not address all treatment needs, but the answers to these questions will help you understand the options and make informed decisions.
Stages of Alzheimer’s Disease
Experts have documented common patterns of symptom progression that occur in many individuals with Alzheimer’s disease and developed several methods of “staging” based on these patterns. Progression of symptoms corresponds in a general way to the underlying nerve cell degeneration that takes place in Alzheimer’s disease. Nerve cell damage typically begins with cells involved in learning and memory and gradually spreads to cells that control every aspect of thinking, judgment, and behavior. The damage eventually affects cells that control and coordinate movement.
Staging systems provide useful frames of reference for understanding how the disease may unfold and for making future plans. But it is important to note that all stages are artificial benchmarks in a continuous process that can vary greatly from one person to another. Not everyone will experience every symptom and symptoms may occur at different times in different individuals. People with Alzheimer’s live an average of 8 years after diagnosis, but may survive anywhere from 3 to 20 years.
The framework of this section is the Global Deterioration Scale, a system that outlines key symptoms characterizing seven stages ranging from unimpaired function to very severe cognitive decline.
Within this framework, we have noted which Global Deterioration Scale stages correspond to the widely used concepts of mild, moderate, moderately severe, and severe Alzheimer’s disease. We have also noted which stages fall within the more general divisions of early-stage, mid-stage, and late-stage categories.
Stage 1: No cognitive impairment
Unimpaired individuals experience no memory problems and none are evident to a health care professional during a medical interview.
Stage 2: Very mild cognitive decline
Individuals at this stage feel as if they have memory lapses, especially in forgetting familiar words or names or the location of keys, eyeglasses, or other everyday objects. But these problems are not evident during a medical examination or apparent to friends, family, or co-workers.
Stage 3: Mild cognitive decline
Early-stage Alzheimer’s can be diagnosed in some, but not all, individuals with these symptoms:
- Friends, family, or co-workers begin to notice deficiencies. Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical interview. Common difficulties include:
- Word- or name-finding problems noticeable to family or close associates
- Decreased ability to remember names when introduced to new people
- Performance issues in social or work settings noticeable to family, friends, or co-workers
- Reading a passage and retaining little material
- Losing or misplacing a valuable object
- Decline in ability to plan or organize
Stage 4: Moderate cognitive decline
(Mild or early-stage Alzheimer’s disease)
At this stage, a careful medical interview detects clear-cut deficiencies in the following areas:
- Decreased knowledge of recent occasions or current events
- Impaired ability to perform challenging mental arithmetic-for example, to count backward from 100 by 7s
- Decreased capacity to perform complex tasks, such as marketing, planning dinner for guests, or paying bills and managing finances
- Reduced memory of personal history
- The affected individual may seem subdued and withdrawn, especially in socially or mentally challenging situations
Stage 5: Moderately severe cognitive decline
(Moderate or mid-stage Alzheimer’s disease)
Major gaps in memory and deficits in cognitive function emerge. Some assistance with day-to-day activities becomes essential. At this stage, individuals may:
- Be unable during a medical interview to recall such important details as their current address, their telephone number, or the name of the college or high school from which they graduated
- Become confused about where they are or about the date, day of the week, or season
- Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s
- Need help choosing proper clothing for the season or the occasion
- Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children
- Usually require no assistance with eating or using the toilet
Stage 6: Severe cognitive decline
(Moderately severe or mid-stage Alzheimer’s disease)
Memory difficulties continue to worsen, significant personality changes may emerge, and affected individuals need extensive help with customary daily activities. At this stage, individuals may:
- Lose most awareness of recent experiences and events as well as of their surroundings
- Recollect their personal history imperfectly, although they generally recall their own name
- Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces
- Need help getting dressed properly; without supervision, may make such errors as putting pajamas over daytime clothes or shoes on wrong feet
- Experience disruption of their normal sleep/waking cycle
- Need help with handling details of toileting (flushing toilet, wiping, and disposing of tissue properly)
- Have increasing episodes of urinary or fecal incontinence
- Experience significant personality changes and behavioral symptoms, including suspiciousness and delusions (for example, believing that their caregiver is an impostor); hallucinations (seeing or hearing things that are not really there; or compulsive, repetitive behaviors such as hand-wringing or tissue shredding
- Tend to wander and become lost
Stage 7: Very severe cognitive decline
(Severe or late-stage Alzheimer’s disease)
This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak, and, ultimately, the ability to control movement:
- Frequently individuals lose their capacity for recognizable speech, although words or phrases may occasionally be uttered
- Individuals need help with eating and toileting and there is general incontinence of urine
- Individuals lose the ability to walk without assistance, then the ability to sit without support, the ability to smile, and the ability to hold their head up. Reflexes become abnormal and muscles grow rigid.
- Swallowing is impaired.
Myth: Memory loss is a natural part of aging.
Reality: In the past people believed memory loss was a normal part of aging, often regarding even Alzheimer’s as natural age-related decline. Experts now recognize severe memory loss as a symptom of serious illness.
Whether memory naturally declines to some extent remains an open question. Many people feel that their memory becomes less sharp as they grow older, but determining whether there is any scientific basis for this belief is a research challenge still being addressed.
Myth: Alzheimer’s disease is not fatal.
Reality: Alzheimer’s is a fatal disease. It begins with the destruction of cells in regions of the brain that are important for memory. However, the eventual loss of cells in other regions of the brain leads to the failure of other essential systems in the body. Also, because many people with Alzheimer’s have other illnesses common in older age, the actual cause of death may be no single factor
Myth: Head injury can lead to Alzheimer’s disease.
Reality: Several studies have found that Alzheimer’s disease is more common among individuals who have sustained a severe head injury (accompanied by loss of consciousness) during the course of their lives. Additional research is needed, however, to understand what happens to the brain in such injuries and how those changes in the brain are related to Alzheimer’s disease.
Myth: Drinking out of aluminum cans or cooking in aluminum pots and pans can lead to Alzheimer’s disease.
Reality: Based on current research, getting rid of aluminum cans, pots, and pans will not protect you from Alzheimer’s disease. The exact role (if any) of aluminum in Alzheimer’s disease is still being researched and debated. However, most researchers believe that not enough evidence exists to consider aluminum a risk factor for Alzheimer’s or a cause of dementia
Myth: Aspartame causes memory loss.
Reality: Aspartame’s role in memory loss is a health concern that has been associated with artificial sweeteners. Several studies have been conducted on aspartame’s effect on cognitive function in both animals and humans. These studies found no scientific evidence of a link between aspartame and memory loss.
Aspartame was approved by the U.S. Food and Drug Administration (FDA) in 1996 for use in all foods and beverages. The sweetener, marketed as Nutrasweet® and Equal®, is made by joining two protein components, aspartic acid and phenylalanine, with 10 percent methanol. Methanol is widely found in fruits, vegetables, and other plant foods.
Myth: There are therapies available to stop the progression of Alzheimer’s disease.
Reality: At this time, there is no medical treatment to cure or stop the progression of Alzheimer’s disease. FDA-approved drugs may temporarily improve or stabilize memory and thinking skills in some individuals.
I have Alzheimer’s
A diagnosis of Alzheimer’s disease may be the last thing you wanted to hear. But the first thing you should know is that you are not alone. There is a lot of help and support available, and our Web site is a great place for you to learn about the disease and what you can expect as it progresses.In this section, you will find tips and resources to increase your comfort, allow you to remain active, and help you cope. But more important, we hope you will find the inspiration to make your years ahead the best that they can be.
Taking Care of Yourself
If you have Alzheimer’s disease, it’s important to understand that your life is not over. Living with Alzheimer’s means dealing with some life changes sooner than you had anticipated. You can live a meaningful and productive life by taking care of your physical and emotional health, by engaging in activities you enjoy, and by spending time with family and friends. This page has suggestions for how you can take care of yourself.
Caring for your physical health can improve the quality of your life for years to come:
- Get regular checkups.
- Take your medication.
- Eat healthy foods.
- Exercise every day.
- Rest when you are tired.
- Drink less alcohol.
After receiving a diagnosis, you may experience a range of emotions, including:
- Denial about having dementia
- Fear of losing people important to you
- Loneliness because no one seems to understand what you are going through
- Frustration with not making yourself understood
- Loss of the way you used to see yourself
- Depression or anger about the way your life is changing
The feelings you may be experiencing are normal. But it is important to find ways to deal with those feelings. The following suggestions may help you take care of your emotional needs:
- Write in a journal about your experiences and feelings.
- Join a support group.
- Talk to your physician, who can determine if there is an appropriate treatment.
- See a counselor.
- Talk to a clergy member or other person who can help with your spiritual needs.
- Share your feelings with your friends and family.
- Do the activities you enjoy as long as you are able.
Helping Family and Friends
When you learn that you have a diagnosis of Alzheimer’s disease, you may hesitate to tell others. You may be coming to terms with the diagnosis yourself or fear that others may feel uncomfortable around you. It is true that your relationship with family and friends will change. But it is important to talk to the people in your life about Alzheimer’s disease and about the changes you will all experience together.
Talking about your diagnosis is important for helping people understand Alzheimer’s disease and learning about how they can continue to be a part of your life. The following suggestions may be helpful:
- Explain that Alzheimer’s disease is not a normal part of aging but a disease of the brain that results in impaired memory, thinking, and behavior.
- Share educational information on Alzheimer’s disease or invite family and friends to attend Alzheimer education programs.
- Be honest about how you feel about your diagnosis and allow other family members to do the same.
- Assure friends that although the disease will change your life, you want to continue enjoying their company.
- Let family and friends know when and how you may need their help and support.
If you have Alzheimer’s disease, you will find that eventually there will be many changes in your relationships with family members and friends. Planning for these changes and talking about them honestly will help everyone.
Working with your spouse
Most people with Alzheimer’s disease continue to live at home even as the disease progresses. As a result, your spouse may have to manage the household and your care. He or she may feel a sense of loss because of the changes the disease brings to your relationship. The following suggestions may benefit your relationship:
- Continue to participate in as many activities as you can.
- Modify activities to your changing abilities.
- Talk with your spouse about how he or she can assist you.
- Work together to gather information about caregiver services and their costs, such as housekeeping and respite care, and start a file you can consult when they are needed.
- Seek professional counseling to discuss new factors in your relationship and changes in sexual relations.
- Continue to find ways in which you and your spouse can fulfill the need for intimacy.
- Encourage your spouse to attend a support group for caregivers.
Helping children and teens
Children often experience a wide range of emotions when a parent or grandparent has Alzheimer’s disease. Younger children may be fearful that they will get the disease or that they did something to cause it. Teenagers may become resentful if they must take on more responsibilities or feel embarrassed that their parent or grandparent is “different.” College-bound children may be reluctant to leave home.
- Reassure young children that they cannot “catch” the disease from you.
- Be straightforward about personality and behavior changes. For example, you may forget things, such as their names, and say and do things that may embarrass them. Assure them that this is not their fault or intentional but a result of the disease.
- Find out what their emotional needs are and find ways to support them, such as meeting with a counselor who specializes in children who have a loved one diagnosed with Alzheimer’s.
- School social workers and teachers can be notified about what the children may be experiencing and be given information about the disease.
- Encourage children and teens to attend support group meetings and include them in counseling sessions.
- Record your thoughts, feelings, and wisdom to “be with them” as they experience important events in their lives (graduations, dating, marriage, births, and deaths).
To help children and teens learn more about Alzheimer’s disease and understand how it affects you and them, we have a special Kids & Teens section. It includes printed resources, book reviews and links to sites that explain how the brain works.
Coping with Changes in Daily Life
Alzheimer’s disease will bring significant changes in your day-to-day experiences. Things you once did easily will become increasingly difficult. The following suggestions may help you cope with changes in your daily life and plan for changes that will occur in the future.
You may find familiar activities such as balancing your checkbook, preparing a meal, or doing household chores more difficult. Try the following tips:
- Do difficult tasks during the times of the day when you normally feel best.
- Give yourself time to accomplish a task, and don’t let others rush you.
- Take a break if something is too difficult.
- Arrange for others to help you with tasks that are too difficult
- You may begin to experience difficulty understanding what people are saying or finding the right words to express your thoughts. The following tips are important in communicating:
- Take your time.
- Ask the person to repeat a statement, speak slowly, or write down words if you do not understand.
- Find a quiet place if there is too much distracting noise.
Understand that at some point it may no longer be safe for you to drive. Discuss with your family and physician about how and when you will make decisions about driving.
Make plans for other transportation options, such as family members, friends, or community services.
Dealing with memory changes
- Post a schedule of the things you do every day, such as meal times, regular exercise, a medication schedule, and bedtime.
- Have someone call to remind you of meal times, appointments, or your medication schedule.
- Keep a book containing important notes, such as phone numbers, people’s names, any thoughts or ideas you want to hold on to, appointments, your address, and directions to your home.
- Post important phone numbers in large print next to the phone.
- Have someone help you label and store medications in a pill organizer.
- Mark off days on a calendar to keep track of time.
- Label photos with the names of those you see most often.
- Label cupboards and drawers with words or pictures that describe their contents.
- Have someone help you organize closets and drawers to make it easier to find what you need.
- Post reminders to turn off appliances and lock doors.
Many individuals manage on their own during the earliest stages of Alzheimer’s disease, with support and assistance from others. The following suggestions may help if you live by yourself.
Arrange for someone to help you with housekeeping, meals, transportation, and other daily chores. To get information about assistance available in your community, talk to your local chapter of the Alzheimer’s Association or your physician.
- Make arrangements for direct deposit of checks, such as your retirement pension or Social Security benefits.
- Make arrangements for help in paying bills. You can give a trusted individual the legal authority to handle money matters.
- Plan for home-delivered meals if they are available in your community.
- Leave a set of house keys with a neighbor you trust.
- Make arrangements for someone to regularly check your smoke alarm.
- Have family, friends, or a community service program call or visit daily.
- Keep a list of questions and concerns to discuss with them during your time together.
- Keep a list of things for them to check out around the house, such as electrical appliances, mail, and food items.
Making Job Decisions
If you are still working when you are diagnosed with Alzheimer’s disease, you will need to make decisions about eventual changes in work life. The following suggestions may help you make decisions and discuss options with your employer.
- Talk to your employer about your diagnosis. You may want to provide educational materials and bring someone with you to help explain your situation.
- Discuss with your employer the possibility of switching to a position that better matches your abilities and strengths or of reducing your work hours.
- Continue to work as long as you and your physician feel you are able.
- Decide with your employer who else will need to know about your diagnosis, such as co-workers and clients with whom you work.
- Tell co-workers that you may become frustrated with yourself, or frustrating to them, when you have trouble recalling information or finding the right words.
- Use reminders, memos, and a calendar to help you perform your job effectively.
- Research early-retirement options.
- Educate yourself and family about employee benefits that may be available to you. Find out how to make benefit claims.
- When you stop working, find an activity to take the place of your job. Consider volunteer work or a new hobby.
Planning for the Future
After a diagnosis of Alzheimer’s, you may worry about the impact the disease will have on you and your family. Planning ahead is one way to deal with those fears. By participating in decisions now, you can determine the kind of life you want for the years ahead. In this section, you will find information and tips to help you begin planning.
- Choosing Health Care Providers and Facilities
- Financial Matters
You may be worried about the cost of your future care and if you will have enough money to cover these costs. Discussing your immediate and future financial needs and goals will help protect you, the people who depend on you financially, and the people who will care for you. Work with a financial adviser and trusted family member or friend to determine the following:
- Potential care expenses, such as follow-up physician visits, prescription medications, care services, and housing
- Current sources of income, such as insurance, personal savings, investments, and employee or retirement benefits
- Other financial resources available through government assistance or community based organizations
It is important to obtain legal advice and services from an attorney. You may want to hire an attorney who practices elder law, a specialized area of law focusing on issues that typically affect older adults. Bring a family member with you when you see your attorney.
Free legal advice may be available in your community. Contact your local Legal Aid Society, Area Agency on Aging, or nonprofit legal assistance organizations. Your local chapter of the Alzheimer’s Association may be able to provide referrals for legal advice and services.
Legal documents called advance directives enable you to document your preferences regarding treatment and care, including end-of-life wishes. Talk with your family and your doctor about your preferences for end-of-life care. If you do not decide on your care now, your family may have to later. With advance directives, your family will know your preferences.
Two common forms of advance directives are a living will and a durable power of attorney for health care.
A living will states your choices for future medical care decisions, including the use of artificial life support systems. You have the legal right to limit or forgo medical or life-sustaining treatment, including the use of mechanical ventilators, cardiopulmonary resuscitation, antibiotics, feeding tubes, and artificial hydration.
A durable power of attorney for health care allows you to appoint an agent (usually a trusted family member) to make all decisions regarding health care. These decision may be about health care providers, medical treatment, and end-of-life decisions. The term durable means that this agent can act on your behalf after you are unable to make decisions yourself.
Other legal documents
A durable power of attorney gives you an opportunity to authorize an agent (usually a trusted family member or friend) to make legal and financial decisions for you when you no longer can make them on your own. The term durable means that this agent can act on your behalf after you are unable to make decisions yourself.
Living trusts allow you to create a trust and to appoint someone else as trustee (usually a trusted individual or bank) to carefully invest and manage your assets.
A will is a document you create that names an executor (the person who will manage your estate) and beneficiaries (those who will receive the estate at the time of your death).
Once you have filled out these documents, make sure that you, your caregiver or a trusted family member, your attorney, and your doctor all have a copy.
Everyone forgets things now and then. Everyone gets moody. Everyone makes poor decisions, but Alzheimer’s behaviors are a little more out-of-the-ordinary, and they get progressively worse.
Visit the Alzheimer’s Disease International (ADI) website for more info.
If you need additional information, contact the ADAP Secretariat at:
Room 410, Medical Arts Bldg., St. Luke’s Medical CenterQuezon City, Metro Manila, Philippines. Tel. No. +632723-1039