Introduction
Alzheimer’s disease is a brain disorder named for German physician Alois Alzheimer, who first described it in 1906. Scientists have learned a great deal about Alzheimer’s disease in the century since Dr. Alzheimer first drew attention to it. Today we know that Alzheimer’s:

Just like the rest of our bodies, our brains change as we age (grow). Most of us notice some slowed thinking and occasional problems remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work are not a normal part of aging. They may be a sign that brain cells are failing.

The brain has 100 billion nerve cells (neurons). Each nerve cell communicates with many others to form networks. Nerve cell networks have special jobs. Some are involved in thinking, learning and remembering. Others help us see, hear and smell. Still others tell our muscles when to move.

To do their work, brain cells operate like tiny factories. They take in supplies, generate energy, construct equipment and get rid of waste. Cells also process and store information. Keeping everything running requires coordination as well as large amounts of fuel and oxygen.

In Alzheimer’s disease, parts of the cell’s factory stop running well. Scientists are not sure exactly where the trouble starts. But just like a real factory, backups and breakdowns in one system cause problems in other areas. As damage spreads, cells lose their ability to do their jobs well. Eventually, they die.

The role of plaques and tangles:
Two abnormal structures called plaques and tangles are prime suspects in damaging and killing nerve cells. Plaques and tangles were among the abnormalities that Dr. Alois Alzheimer saw in the brain of Auguste D., although he called them different names.

Plaques build up between nerve cells. They contain deposits of a protein fragment called beta-amyloid (BAY-tuh AM-uh-loyd). Tangles are twisted fibers of another protein called tau (rhymes with “wow”). Tangles form inside dying cells. Though most people develop some plaques and tangles as they age, those with Alzheimer’s tend to develop far more. The plaques and tangles tend to form in a predictable pattern, beginning in areas important in learning and memory and then spreading to other regions.

Scientists are not absolutely sure what role plaques and tangles play in Alzheimer’s disease. Most experts believe they somehow block communication among nerve cells and disrupt activities that cells need to survive.

History:
At a scientific meeting in November 1906, German physician Alois Alzheimer presented the case of “Frau Auguste D.,” a 51-year-old woman brought to see him in 1901 by her family. Auguste had developed problems with memory, unfounded suspicions that her husband was unfaithful, and difficulty speaking and understanding what was said to her. Her symptoms rapidly grew worse, and within a few years she was bedridden. She died in spring 1906, of overwhelming infections from bedsores and pneumonia.

Dr. Alzheimer had never before seen anyone like Auguste D., and he gained the family’s permission to perform an autopsy. In Auguste’s brain, he saw dramatic shrinkage, especially of the cortex, the outer layer involved in memory, thinking, judgment and speech. Under the microscope, he also saw widespread fatty deposits in small blood vessels, dead and dying brain cells, and abnormal deposits in and around cells.

The condition entered the medical literature in 1907, when Alzheimer published his observations about Auguste D. In 1910, Emil Kraepelin, a psychiatrist noted for his work in naming and classifying brain disorders, proposed that the disease be named after Alzheimer.
                              
Diagnosing Alzheimer's:
Consult a doctor when you have concerns about memory loss, thinking skills and behavior changes in yourself or a loved one. For people with dementia and their families, an early diagnosis has many advantages:

It is also important for a physician to determine the cause of memory loss or other symptoms. Some dementia-like symptoms can be reversed if they are caused by treatable conditions, such as depression.

Alzheimer's versus Dementia
Alzheimer's disease is a progressive, degenerative disease of the brain that results in dementia.

The terms Alzheimer's and dementia are often used interchangeably, but there's a distinct difference between them. Dementia is a broader term than Alzheimer's and refers to any brain syndrome resulting in problems with memory, orientation, judgment, executive functioning, and communication.

Reversible Conditions that Resemble Alzheimer's
Sometimes symptoms that look like Alzheimer's are actually due to a reversible medical condition, such as depression or delirium. These conditions aren't types of dementia -- they're reversible problems that mimic Alzheimer's disease and other dementias.

Symptoms of Alzheimer's
People with Alzheimer's exhibit different symptoms as the disease progresses, but most symptoms are either cognitive or behavioral.

Diagnosis of Alzheimer's
No single test can prove that a person has Alzheimer's disease, although imaging technology is rapidly becoming more precise. Still experts estimate that a comprehensive evaluation by a skilled physician can pinpoint the cause of Alzheimer's-like symptoms with over 90% accuracy.

Treatment of Alzheimer's
There is currently no cure for Alzheimer's, but several drug and non-drug treatments are available. Cognitive symptoms are treated with one or more of the FDA-approved prescription medications for Alzheimer's disease. Behavioral symptoms are sometimes treated with medications, but non-drug approaches such as behavior management are also successful.

Memory
Definition: The storage and retrieval of information.

In order for memory to work properly, facts, experiences, and understandings must be stored properly before they can be accessed later. In Alzheimer's disease, some people have difficulty storing information; others have trouble retrieving it; still others cannot complete either task.

Memory is often divided into:

Alzheimer's disease tends to compromise short-term memory more significantly than long-term memory.

Memory can also be categorized as procedural (remembering how to do things), semantic (remembering concepts and meanings), and episodic (remembering experiences, such as where you left your purse or who was your supervisor at factory job).

Minor memory problems can be due to stress, distraction, or fatigue. More serious memory problems may signal a disease such as Alzheimer's.

Orientation
Definition: The state of a person's situational awareness.
Extent of orientation is usually tested by asking about:

Health care professionals often assess orientation as part of a larger diagnostic work-up for Alzheimer's. People in the early stages of the disease may be disoriented to place and/or time, but are still oriented to person. As the disease progresses, some lose orientation to person as well.

Executive Functioning
Definition: The ability to carry out familiar tasks, such as getting dressed or balancing a checkbook. Executive functioning includes the ability to plan projects, formulate goals and objectives, prioritize, apply self-discipline, and remember steps involved in complex tasks.

Alzheimer's disease gradually deteriorates executive functioning; making it increasingly difficult to carry out daily tasks and lives independently. Because it's hard to assess during a medical visit, health professionals usually rely on reports from the caregiver and the person with Alzheimer's to evaluate executive functioning.

How Does Alzheimer's disease affect Communication?
Whether you have Alzheimer's or you're caring for someone with the disease, you may have noticed that communication with loved ones and friends has become more difficult.

How does Alzheimer's affect communication as the disease progresses?
Answer: People with Alzheimer’s lose particular communication abilities during the early, middle, and late stages of the disease. Here's what to expect and what kinds of communication challenges can occur during each stage of Alzheimer's:

Early Stage

Middle Stage

• difficulty understanding long conversations
• difficulty understanding reading material
• decreased ability to interpret facial expressions
• trouble explaining abstract concepts
• decreased vocal expression and ability to raise or lower voice
• difficulty finishing sentences
• apathy, including reduced interest in communication
• may speak in vague and rambling sentences

Late Stage

• inability to understand the meaning of most words
• problems realizing when being addressed
• diminished use of proper grammar
• in some cases, the person may become totally mute stage

Myths and Realities of Alzheimer's disease

Here are five common myths about Alzheimer's disease

Myth: If you're forgetful, you're getting Alzheimer's disease.

Reality: Memory loss is a key symptom of Alzheimer's, but forgetfulness doesn't mean you have the disease. Even if your forgetfulness is due to more than simple aging, there are still many causes for dementia that lead to a decrease in cognitive function; physicians will make an Alzheimer's diagnosis only after other conditions have been ruled out.

Myth: If you have a family member with Alzheimer's, you'll get it, too.
Reality: In rare cases, early-onset Alzheimer's is inherited through genes. This familial form of Alzheimer's causes just 7% of all Alzheimer's cases. Genetics plays a small role for those people who don't have this form of Alzheimer's but who do get the disease later in life. If you have a parent, brother or sister with the disease, you have a slightly higher risk of getting it.

Myth: Aluminum in products we use causes Alzheimer's.

Reality: Most of us use products every day that contain aluminum. Food prepared in aluminum pots and pans carries trace amounts of the metal. There is no scientific evidence that aluminum exposure causes Alzheimer's. Although the disease's exact cause is unknown, most research suggests that several factors, such as age, genetic susceptibility and overall quality of health, ultimately contribute to whether or not someone develops the disease.

Myth: All old people have Alzheimer's disease.

Reality: Even though age is an important risk factor for Alzheimer's, most older people do not have the disease. It's important to note that normal aging doesn't necessarily include dementia or Alzheimer's.

Myth: Life with Alzheimer's disease isn't worth living.

Reality: There is no single course for Alzheimer's disease, which typically can be a part of a person's life for many years. Memory loss and communication problems can cause frustration and anger. With help, though, a person with Alzheimer's can have a meaningful and productive life. According to the National Institute of Neurological Disorders(USA), several medications have been approved for early- and middle-stage Alzheimer's, including Exelon (rivastigimine), STIR-UP(memantine), A number of other medications can be used to control anxiety, depression, sleeplessness, and agitation, any or all of which may accompany the disease.

Alzheimer's Symptoms
The Seven Stages of Alzheimer's Symptoms

Alzheimer's symptoms progressively worsen, affecting communication and daily functioning.

Alzheimer's disease is a progressive neurological disorder that leads to personality changes, memory loss, intellectual slowing, and other Alzheimer's symptoms. Although each person with Alzheimer's is different, most progress through a series of stages, each of which is characterized by more serious Alzheimer's symptoms.

The following seven stages were developed by researchers and physicians to describe how you or your loved one will change over time. Your doctor might collapse the seven stages into early/middle/late or mild/moderate/severe, so these classifications are provided as well.

Stage 1 (Absence of Impairment)
There are no problems with memory, orientation, judgment, communication, or daily activities. You or your loved one is a normally functioning adult.

Stage 2 (Minimal Impairment)
you or your loved one might be experiencing some lapses in memory or other cognitive problems, but neither family nor friends are able to detect any changes. A medical exam would not reveal any problems either.

Stage 3 (Noticeable Cognitive Decline)
Family members and friends recognize mild changes in memory, communication patterns, or behavior. A visit to the doctor might result in a diagnosis of early-stage or mild Alzheimer's disease, but not always. Common symptoms in this stage include:

Stage 4 (Early-Stage/Mild Alzheimer's)
Cognitive decline is more evident. You or your loved one may become more forgetful of recent events or personal details. Other problems include impaired mathematical ability (for instance, difficulty counting backwards from 100 by 9s), a diminished ability to carry out complex tasks like throwing a party or managing finances, moodiness, and social withdrawal.

Stage 5 (Middle-Stage/Moderate Alzheimer's)
some assistance with daily tasks is required. Problems with memory and thinking are quite noticeable, including symptoms such as:

Even though symptoms are worsening, people in this stage usually still know their own name and the names of key family members and can eat and use the bathroom without assistance.

Stage 6 (Middle-Stage/Moderate to Late-Stage/Severe Alzheimer's)
this is often the most difficult stage for caregivers because it's characterized by personality and behavior changes. In addition, memory continues to decline, and assistance is required for most daily activities. The most common symptoms associated with this stage include:

Stage 7 (Late-Stage/Severe Alzheimer's)
in the final stage, it is usually no longer possible to respond to the surrounding environment. You or your loved one may be able to speak words or short phrases, but communication is extremely limited. Basic functions begin to shut down, such as motor coordination and the ability to swallow. Total care is required around the clock.

Although the stages provide a blueprint for the progression of Alzheimer's symptoms, not everyone advances through the stages similarly. Caregivers report that their loved ones sometimes seem to be in two or more stages at once, and the rate at which people advance through the stages is highly individual. Still, the stages help us understand Alzheimer's symptoms and prepare for their accompanying challenges.