Alzheimer's Disease

Alzheimer's disease (AD) is the most common form of dementia among older people. Dementia is a brain disorder that seriously affects a person's ability to carry out daily activities.

AD begins slowly. It first involves the parts of the brain that control thought, memory and language. People with AD may have trouble remembering things that happened recently or names of people they know. A related problem, mild cognitive impairment (MCI), causes more memory problems than normal for people of the same age. Many, but not all, people with MCI will develop AD.

In AD, over time, symptoms get worse. People may not recognize family members. They may have trouble speaking, reading or writing. They may forget how to brush their teeth or comb their hair. Later on, they may become anxious or aggressive, or wander away from home. Eventually, they need total care. This can cause great stress for family members who must care for them.

AD usually begins after age 60. The risk goes up as you get older. Your risk is also higher if a family member has had the disease.

No treatment can stop the disease. However, some drugs may help keep symptoms from getting worse for a limited time.

NIH: National Institute on Aging

Alzheimer's Caregivers

A caregiver gives care to someone who needs help taking care of themselves. It can be rewarding. It may help to strengthen connections to a loved one. You may feel fulfillment from helping someone else. But sometimes caregiving can be stressful and even overwhelming. This can be especially true when caring for someone with Alzheimer's disease (AD).

AD is an illness that changes the brain. It causes people to lose the ability to remember, think, and use good judgment. They also have trouble taking care of themselves. Over time, as the disease gets worse, they will need more and more help. As a caregiver, it is important for you to learn about AD. You will want to know what happens to the person during the different stages of the disease. This can help you plan for the future, so that you will have all of the resources you will need to be able to take care of your loved one.

As a caregiver for someone with AD, your responsibilities can include:

• Getting your loved one's health, legal, and financial affairs in order. If possible, include them in the planning while they can still make decisions. Later you will need to take over managing their finances and paying their bills.
• Evaluating their house and making sure it's safe for their needs
• Monitoring their ability to drive. You may want to hire a driving specialist who can test their driving skills. When it is no longer safe for your loved one to drive, you need to make sure that they stop.
• Encouraging your loved one to get some physical activity. Exercising together may make it more fun for them.
• Making sure that your loved one has a healthy diet
• Helping with daily tasks like bathing, eating, or taking medicine
• Doing housework and cooking
• Running errands such as shopping for food and clothes
• Driving them to appointments
• Providing company and emotional support
• Arranging medical care and making health decisions

As you care for your loved one with AD, don't ignore your own needs. Caregiving can be stressful, and you need to take care of your own physical and mental health.

At some point, you will not be able to do everything on your own. Make sure that you get help when you need it. There are many different services available, including:

• Home care services
• Adult day care services
• Respite services, which provide short-term care for the person with AD
• Federal and state government programs that can provide financial support and services
• Assisted living facilities
• Nursing homes, some of which have special memory care units for people with AD
• Palliative and hospice care

You might consider hiring a geriatric care manager. They are specially trained professionals who can help you to find the right services for your needs.

NIH: National Institute on Aging

Dementia

What is dementia?

Dementia is a loss of mental functions that is severe enough to affect your daily life and activities. These functions include:

• Memory
• Language skills
• Visual perception (your ability to make sense of what you see)
• Problem solving
• Trouble with everyday tasks
• The ability to focus and pay attention

It is normal to become a bit more forgetful as you age. But dementia is not a normal part of aging. It is a serious disorder which interferes with your daily life.

What are the types of dementia?

The most common types of dementia are known as neurodegenerative disorders. These are diseases in which the cells of the brain stop working or die. They include:

• Alzheimer's disease, which is the most common form of dementia among older people. People with Alzheimer's have plaques and tangles in their brain. These are abnormal buildups of different proteins. Beta-amyloid protein clumps up and forms plaques in between your brain cells. Tau protein builds up and forms tangles inside the nerve cells of your brain. There is also a loss of connection between nerve cells in the brain.
• Lewy body dementia, which causes movement symptoms along with dementia. Lewy bodies are abnormal deposits of a protein in the brain.
• Frontotemporal disorders, which cause changes to certain parts of the brain:
  • Changes in the frontal lobe lead to behavioral symptoms
  • Changes in the temporal lobe lead to language and emotional disorders
• Vascular dementia, which involves changes to the brain's blood supply. It is often caused by a stroke or atherosclerosis (hardening of the arteries) in the brain.
• Mixed dementia, which is a combination of two or more types of dementia. For example, some people have both Alzheimer's disease and vascular dementia.

Other conditions can cause dementia or dementia-like symptoms, including:

• Creutzfeldt-Jakob disease, a rare brain disorder
• Huntington's disease, an inherited, progressive brain disease
• Chronic traumatic encephalopathy (CTE), caused by repeated traumatic brain injury
• HIV-associated dementia (HAD)

Who is at risk for dementia?

Certain factors can raise your risk for developing dementia, including:

• Aging. This is the biggest risk factor for dementia.
• Smoking
• Uncontrolled diabetes
• High blood pressure
• Drinking too much alcohol
• Having close family members who have dementia

What are the symptoms of dementia?

The symptoms of dementia can vary, depending on which parts of the brain are affected. Often, forgetfulness is the first symptom. Dementia also causes problems with the ability to think, problem solve, and reason. For example, people with dementia may:

• Get lost in a familiar neighborhood
• Use unusual words to refer to familiar objects
• Forget the name of a close family member or friend
• Forget old memories
• Need help doing tasks that they used to do by themselves

Some people with dementia cannot control their emotions and their personalities may change. They may become apathetic, meaning that they are no longer interested in normal daily activities or events. They may lose their inhibitions and stop caring about other peoples' feelings.

Certain types of dementia can also cause problems with balance and movement.

The stages of dementia range from mild to severe. In the mildest stage, it is just beginning to affect a person's functioning. In the most severe stage, the person is completely dependent on others for care.

How is dementia diagnosed?

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A physical exam
• Tests of your thinking, memory, and language abilities
• Other tests, such as blood tests, genetic tests, and brain scans
• A mental health evaluation to see whether a mental disorder is contributing to your symptoms

What are the treatments for dementia?

There is no cure for most types of dementia, including Alzheimer's disease and Lewy body dementia. Treatments may help to maintain mental function longer, manage behavioral symptoms, and slow down the symptoms of disease. They may include:

• Medicines may temporarily improve memory and thinking or slow down their decline. They only work in some people. Other medicines can treat symptoms such as anxiety, depression, sleep problems, and muscle stiffness. Some of these medicines can cause strong side effects in people with dementia. It is important to talk to your health care provider about which medicines will be safe for you.
• Occupational therapy to help find ways to more easily do everyday activities
• Speech therapy to help with swallowing difficulties and trouble speaking loudly and clearly
• Mental health counseling to help people with dementia and their families learn how to manage difficult emotions and behaviors. It can also help them plan for the future.
• Music or art therapy to reduce anxiety and improve well-being

Can dementia be prevented?

Researchers have not found a proven way to prevent dementia. Living a healthy lifestyle might influence some of your risk factors for dementia.

Lewy Body Dementia

What is Lewy body dementia (LBD)?

Lewy body dementia (LBD) is one of the most common types of dementia in older adults. Dementia is a loss of mental functions that is severe enough to affect your daily life and activities. These functions include:

• Memory
• Language skills
• Visual perception (your ability to make sense of what you see)
• Problem solving
• Trouble with everyday tasks
• The ability to focus and pay attention

What are the types of Lewy body dementia (LBD)?

There are two types of LBD: dementia with Lewy bodies and Parkinson's disease dementia.

Both types cause the same changes in the brain. And, over time, they can cause similar symptoms. The main difference is in when the cognitive (thinking) and movement symptoms start.

Dementia with Lewy bodies causes problems with thinking ability that seem similar to Alzheimer's disease. Later, it also causes other symptoms, such as movement symptoms, visual hallucinations, and certain sleep disorders. It also causes more trouble with mental activities than with memory.

Parkinson's disease dementia starts as a movement disorder. It first causes the symptoms of Parkinson's disease: slowed movement, muscle stiffness, tremor, and a shuffling walk. Later on, it causes dementia.

What causes Lewy body dementia (LBD)?

LBD happens when Lewy bodies build up in parts of the brain that control memory, thinking, and movement. Lewy bodies are abnormal deposits of a protein called alpha-synuclein. Researchers don't know exactly why these deposits form. But they do know that other diseases, such as Parkinson's disease, also involve a build-up of that protein.

Who is at risk for Lewy body dementia (LBD)?

The biggest risk factor for LBD is age; most people who get it are over age 50. People who have a family history of LBD are also at higher risk.

What are the symptoms of Lewy body dementia (LBD)?

LBD is a progressive disease. This means that the symptoms start slowly and get worse over time. The most common symptoms include changes in cognition, movement, sleep, and behavior:

• Dementia, which is a loss of mental functions that is severe enough to affect your daily life and activities
• Changes in concentration, attention, alertness, and wakefulness. These changes usually happen from day to day. But sometimes they can also happen throughout the same day.
• Visual hallucinations, which means seeing things that are not there
• Problems with movement and posture, including slowness of movement, difficulty walking, and muscle stiffness. These are called parkinsonian motor symptoms.
• REM sleep behavior disorder, a condition in which a person seems to act out dreams. It may include vivid dreaming, talking in one's sleep, violent movements, or falling out of bed. This may be the earliest symptom of LBD in some people. It can appear several years before any other LBD symptoms.
• Changes in behavior and mood, such as depression, anxiety, and apathy (a lack of interest in normal daily activities or events)

In the early stages of LBD, symptoms can be mild, and people can function fairly normally. As the disease gets worse, people with LBD need more help due to problems with thinking and movement. In the later stages of the disease, they often cannot care for themselves.

How is Lewy body dementia (LBD) diagnosed?

There isn't one test that can diagnose LBD. It is important to see an experienced doctor to get a diagnosis. This would usually be specialist such as a neurologist. The doctor will:

• Do a medical history, including taking a detailed account of the symptoms. The doctor will talk to both the patient and caregivers.
• Do physical and neurological exams
• Do tests to rule out other conditions that could cause similar symptoms. These could include blood tests and brain imaging tests.
• Do neuropsychological tests to evaluate memory and other cognitive functions

LBD can be hard to diagnose, because Parkinson's disease and Alzheimer's disease cause similar symptoms. Scientists think that Lewy body disease might be related to these diseases, or that they sometimes happen together.

It's also important to know which type of LBD a person has, so the doctor can treat that type's particular symptoms. It also helps the doctor understand how the disease will affect the person over time. The doctor makes a diagnosis based on when certain symptoms start:

• If cognitive symptoms start within a year of movement problems, the diagnosis is dementia with Lewy bodies
• If cognitive problems start more than a year after the movement problems, the diagnosis is Parkinson's disease dementia

What are the treatments for Lewy body dementia (LBD)?

There is no cure for LBD, but treatments can help with the symptoms:

• Medicines may help with some of the cognitive, movement, and psychiatric symptoms
• Physical therapy can help with movement problems
• Occupational therapy may help find ways to more easily do everyday activities
• Speech therapy may help with swallowing difficulties and trouble speaking loudly and clearly
• Mental health counseling can help people with LBD and their families learn how to manage difficult emotions and behaviors. It can also help them plan for the future.
• Music or art therapy may reduce anxiety and improve well-being

Support groups can also be helpful for people with LBD and their caregivers. Support groups can give emotional and social support. They are also a place where people can share tips about how to deal with day-to-day challenges.

NIH: National Institute of Neurological Disorders and Stroke

Down Syndrome

What is Down syndrome?

Down syndrome is a condition in which a person has an extra chromosome or an extra piece of a chromosome. This extra copy changes how a baby's body and brain develop. It can cause both mental and physical challenges during their lifetime. Even though people with Down syndrome might act and look similar, each person has different abilities.

What causes Down syndrome?

Chromosomes are tiny "packages" in your cells that contain your genes. Genes carry information, called DNA, that controls what you look like and how your body works. People with Down syndrome have an extra copy of chromosome 21. In some cases, they may have an extra copy of part of the chromosome. Having an extra copy of a chromosome is called trisomy. So sometimes Down syndrome is also called trisomy 21.

Down syndrome is usually not inherited. It happens by chance, as an error when cells are dividing during early development of the fetus. It is not known for sure why Down syndrome occurs or how many different factors play a role.

One factor that increases the risk of having a baby with Down syndrome is the age of the mother. Women ages 35 and older are more likely to have a baby with Down syndrome.

What are the symptoms of Down syndrome?

The symptoms of Down syndrome are different in each person. And people with Down syndrome may have different problems at different times of their lives. They usually have mild to moderate intellectual disabilities. Their development is often delayed. For example, they may start talking later than other children.

Some of the common physical signs of Down syndrome include:

• A flat face
• Eyes that slant up
• A short neck
• Small hands and feet
• Poor muscle tone
• Loose joints

What other problems does Down syndrome cause?

Many people with Down syndrome have the common physical signs and have healthy lives. But some people with Down syndrome might have one or more birth defects or other health problems. Some of the more common ones include:

• Hearing loss
• Sleep apnea (a disorder that causes you to repeatedly stop breathing during sleep)
• Ear infections
• Eye diseases
• Congenital heart defects (heart defects that are present at birth)
• Digestive problems
• Problems with the upper part of the spine
• Obesity

How is Down syndrome diagnosed?

Health care providers can check for Down syndrome during pregnancy or after a child is born.

There are two basic types of tests that help find Down syndrome during pregnancy:

• Prenatal screening tests can show whether your unborn baby has a higher or lower chance of having Down syndrome. If a screening test shows that your baby could have Down syndrome, you'll need another test to find out for sure.
• Prenatal diagnostic tests can diagnose or rule out Down syndrome by checking the chromosomes in a sample of cells.

These tests have a small risk of causing a miscarriage, so they're often done after a screening test shows that an unborn baby could have Down syndrome.

After a baby is born, the provider may make an initial diagnosis of Down syndrome based on the physical signs of the syndrome. The provider can use a karyotype genetic test to confirm the diagnosis. The test can check for extra chromosomes in a sample of the baby's blood.

What are the treatments for Down syndrome?

There is no single, standard treatment for Down syndrome. Treatments are based on each person's physical and intellectual needs, strengths, and limitations.

Services early in life focus on helping children with Down syndrome develop to their full potential. These services include speech, occupational, and physical therapies. They are typically offered through early intervention programs in each state. Children with Down syndrome may also need extra help or attention in school, although many children are included in regular classes.

Since people with Down syndrome can have birth defects and other health problems, they will need regular medical care. They may need to have certain extra health screenings to check for problems that happen more often in people with Down syndrome.

Centers for Disease Control and Prevention