It is not just the elderly at risk of developing Alzheimer's disease; a third of younger people with dementia have Alzheimer's. Familial Alzheimer's Disease (FAD) usually develops before age 65 - most commonly in a person's 40s or 50s. Along with the genetics we're born with, disabilities like Down's Syndrome can make it more likely someone will develop Alzheimer's.
This type of dementia often progresses slowly and can initially be misdiagnosed as simply signs of normal ageing. Learning how to spot the early signs of Alzheimer's and other forms of dementia, such as vascular dementia - the second most common form of dementia - is crucial for slowing its development and providing the best care possible for family members.
A family history of dementia is one of the risk factors for developing Alzheimer's disease. However, it's not a foregone conclusion you will develop dementia if other family members have. Maintaining a high level of healthcare, enjoying regular exercise, ensuring a healthy diet with plenty of fruits, vegetables and whole grains, and reducing alcohol intake can help prevent this disease's development.
Recent research has found older people with high blood pressure are more likely to have biomarkers for Alzheimer's disease in their spinal fluid. This may be linked to the fact that high blood pressure can damage the smaller blood vessels in the brain, decreasing the oxygen available to brain cells. In addition, research by John Hopkins found using potassium-sparing diuretics reduced the risk of Alzheimer’s by almost 75% and medication to lower blood pressure could reduce the risk of Alzheimer's disease by approximately 33%.
Typically, the disease progresses in three separate stages:
- Early-stage Alzheimer's
- Middle stage, in which symptoms can become difficult for family members and caregivers to manage
- Finally, later symptoms, which can be very distressing to see and experience
The beginning of Alzheimer's disease
Changes in the brain that lead to the early signs of Alzheimer's occur as many as ten years before symptoms become apparent. Long before someone notices dementia-like symptoms, the brain cells see an abnormal build-up of proteins which form amyloid plaques and tau tangles. This causes neurons to lose their connections and stop functioning. Eventually, they die, and the brain begins to shrink. These proteins are one leading cause of Alzheimer's disease.
Alzheimer's damage begins in the hippocampus and entorhinal cortex. The hippocampus is essential for the forming of both short and long-term memories, while the entorhinal cortex works as a gatekeeper and is a major hub for spatial navigation. As Alzheimer's disease progresses, more brain cells die, and other parts of the brain also begin to shrink.
Modern brain scans may show areas of the brain with less activity or brain tissue. As such, early diagnosis, before people become symptomatic, may become possible in the coming years. In addition, several biomarkers such as tau proteins, genetic variants of the apoe gene, and imaging procedures that can detect brain atrophy may be used to indicate someone's risk of Alzheimer's. However, further research and clinical trials are needed before such tests become commonplace.
The early stages of Alzheimer's disease
To begin with, Alzheimer's may appear as becoming set in your ways or even comically forgetting things such as conversations with a neighbour or where you parked the car. It is important to note that these early signs of memory problems and mild cognitive impairment are also familiar with other conditions associated with our later years, such as menopause. Because of this, it's important not to jump to the conclusion that you or a loved one are experiencing early-onset Alzheimer's & dementia.
However, with all concerning changes to your mental or physical state, it is important to discuss symptoms with your GP. First symptoms that people notice include:
- Misplacing items and memory problems
- Difficulty finding the right word or remembering names of people, places and objects
- Repeating the same questions
- An unwillingness to try new things or change plans
- Poor judgement and difficulty making decisions
- Withdrawal from family and friends
- Confusion, disorientation and mood swings
Late-onset Alzheimer's disease typically means symptoms appear around someone's mid-60s. Alzheimer's disease progresses gradually, and this early stage can last for years. People are still able to take care of themselves and manage daily tasks. Although a diagnosis of Alzheimer's can be frightening, it is vital to use this time to plan for the future.
Early interventions and therapies don't always need to include medications. For example, group activities and exercises act as cognitive stimulation therapy and can support memory and problem-solving skills. Cognitive rehabilitation, reminiscence and life story work have also been shown to help someone through the early stages of Alzheimer's.
Finding a new balance between dependence and interdependence is essential. Sharing responsibility between family members and caregivers can create a support network for people with dementia. Ensuring people remain active socially, engaged with daily activities and keep fit ensures continued quality of life and can slow the progression to the next stages of the disease.
Later stages of Alzheimer's
The middle stage of Alzheimer's can last for many years and is usually the most prolonged phase of the disease. People may find daily life becomes increasingly complex, and carrying out everyday tasks such as dressing and expressing ideas and feelings, can be frustrating. As a consequence, our relationships will change. Support groups for carers and Alzheimer's sufferers can help people navigate this stage of the disease.
It's vital caregivers seek support for themselves so they can deliver the necessary dementia care while maintaining their wellbeing. In the mid-stages of Alzheimer's, encourage the person to do as much for themselves as possible but be available to help when needed. Remaining at home and visiting familiar places can help people with dementia cope better with their condition.
"Sadly, Alzheimer's, in its later stages, is a very physical disease in which the shrinking brain gradually loses control of different parts of the body," says Susan Elkin, whose husband died of Alzheimer's in 2019 and who has spoken very openly and widely about the disease. "This tends not to be understood by people who haven't lived with it. My advice is to enjoy every single moment while you can - this is particularly important for carers looking after people very close to them." Susan's book The Alzheimer's Diaries is to be published by Book Guild in November 2022.
The following symptoms mark this more prolonged period of Alzheimer's:
- Personality changes, increased anxiety, depression and physical or verbal outbursts
- Wandering and trouble sleeping
- Difficulty communicating such as losing your train of thought, repeating questions or having trouble finding the right word
- Needing assistance to eat, dress or carry out personal hygiene and grooming tasks
- Loss of independence - being unable to drive or visit friends on your own
Medications for Alzheimer's disease
Many different medications are available to treat Alzheimer's and help people with dementia manage the challenging behaviour that accompanies the later stages of dementia. Many of these medications must be prescribed by a specialist or a GP.
In the early stages of Alzheimer's, GPs may prescribe Donepezil, Galantamine or Rivastigmine. Each of these drugs increases levels of acetylcholine, which helps nerve cells to communicate with each other. While neither is better or worse than the other, some people will have fewer side effects with one than another.
Memantine is used in the mid to later stages of Alzheimer's and works to block the excessive amounts of glutamate in the brain. This can improve thinking and memory while slowing the decline of cognitive ability. Side effects tend to be temporary and can include dizziness, constipation and headaches.
Aducanumab is an antibody therapy that targets the amyloid-beta protein behind the build-up of plaques and tangles in brain cells. Currently unavailable in the UK due to insufficient evidence of its safety for users, trials for this medication continue and are scheduled to finish this year. The main known side effects noted so far include swelling in the brain and micro-bleeds following high-dose treatment.
In addition to medications specifically for treating Alzheimer's disease, other medicines may be prescribed, particularly in the later stages, to help manage challenging behaviours and psychological symptoms.
