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Could it be Alzheimer’s disease?

It’s normal for our loved ones to become a bit forgetful as they get older. So how can we separate a harmless "senior moment" from a more serious problem like Alzheimer’s disease? An estimated one in 14 people, aged 65 and older in the UK are thought to have this devastating form of dementia. In its first stages, Alzheimer’s may not be obvious to friends and family, but there are some early warning signs to watch out for.

Warning signs: Memory and speech

In early Alzheimer’s disease, long-term memories usually remain intact while short-term memories become sketchy. Your loved one may forget conversations you had. He or she may repeat questions that were already answered. The disease also disrupts speech, so patients may struggle to remember common words.

Don't ignore the signs

While it's difficult to face the possibility that a loved one could have Alzheimer’s disease, it's better to see a doctor sooner rather than later. First, the diagnosis might not be Alzheimer’s disease after all. The symptoms could be caused by a highly treatable problem, such as a thyroid imbalance. If it is Alzheimer’s disease, today’s treatments work best when they are used early in the course of the disease.

Alzheimer’s Warning signs: Behaviour

In addition to memory loss, Alzheimer’s disease can cause confusion and behaviour changes. Your loved one may get lost in familiar places. Mood swings and poor judgement are also common, as is poor hygiene. People who once dressed with style may resort to wearing stained clothes and have unwashed hair.

Diagnosing Alzheimer’s disease

There is no simple test for Alzheimer’s, so doctors will rely on you to describe the changes in your loved one. A mental status test, Mini Mental State Examination (MMSE) or other screening tests can help evaluate the patient’s mental function and short-term memory. In addition, neurological tests and CT or MRI brain scans may be used to rule out other problems, such as a stroke or tumour, and they can help provide other information about the brain.

Alzheimer’s disease and the brain

Alzheimer’s disease leads to nerve cell death and tissue loss throughout the brain. As the disease progresses, brain tissue shrinks and the ventricles (chambers within the brain that contain cerebrospinal fluid) become larger. The damage disrupts communication between brain cells, affecting memory, speech and comprehension.

Alzheimer’s disease progression: What to expect

Alzheimer’s disease takes a different path in every patient. In some people the symptoms worsen quickly, leading to severe memory loss and confusion within a few years. In others, the changes may be more gradual with the disease taking 20 years to run its course. The average length of survival after a diagnosis of Alzheimer’s is three to nine years.

How Alzheimer’s disease affects daily life

Because Alzheimer’s disease affects concentration, patients may lose the ability to manage ordinary tasks like cooking or paying the bills. One study suggests difficulty with money is often one of the first effects of Alzheimer’s disease. As the symptoms get worse, your loved one may not recognise familiar people or places. He or she may get lost easily, or use utensils improperly, such as combing hair with a fork. Incontinence, balance problems and loss of language are common in the advanced stages.

Alzheimer’s disease and driving

Poor coordination, memory loss and confusion make for a dangerous combination behind the wheel. If you feel your loved one should not be driving, explain why. Alzheimer’s disease is a condition the DVLA must be told about and a questionnaire filled out by the patient and their GP. If your loved one won’t listen to you about driving concerns, ask the doctor to step in. Then make alternative plans with lifts from friends and relatives, buses and taxis.

Alzheimer’s disease and exercise

Exercise can help people with Alzheimer’s maintain some muscle strength and coordination. It also improves mood and may reduce anxiety. Seek medical advice about which types of exercise are appropriate. Repetitive activities, such as walking, weeding or even folding washing may be effective at promoting a sense of calm.

Alzheimer’s disease medicine

There is no cure for Alzheimer’s disease, and no known way to stop the nerve damage within the brain. However, there are a variety of medicines that appear to help maintain mental function and slow progress of the disease. If these treatments are given during the early stages of Alzheimer’s disease, your loved one may be able to remain independent and get on with normal life for longer.

The carer’s role

As the carer of someone with Alzheimer’s disease, you will probably wear many hats: cook, chauffeur, accountant. While you may have to look after meal planning and finances, encourage the patient to do some activities independently. It may help to label cabinets with their contents and put up sticky notes with reminders of daily tasks. A weekly pill box for medicines may help.

Challenges in caring

In the early stages of Alzheimer’s disease, patients often understand what is happening and may be ashamed or anxious. Look out for signs of depression because this can often be managed with medicine. In the more advanced stages, your loved one may become paranoid or violent and could even turn on you. Remember that the disease is responsible for this change. Tell your doctor about any violent behaviour.

Sundown syndrome

Some people with Alzheimer’s disease become distressed when the sun goes down. This agitation tends to last through the evening and sometimes all through the night. The cause is not known, but there are some way to help ease the tension. Keep the house well lit and close the curtains before sunset. Try distracting your loved one with a favourite activity or TV programme. Also, try restricting caffeine after breakfast.

When your loved one doesn’t know you

Many people with Alzheimer’s disease have trouble remembering names, even those of close family members. Putting up pictures of friends and relatives with their names printed underneath may help. Eventually, the patient may no longer recognise faces and may react to loved ones as if they are strangers. This can be a distressing time for family members, especially the main carer.

Warning signs of carer stress

Caring for someone with Alzheimer’s disease can be physically and mentally taxing. Signs of carer stress include:

Anger, sadness and mood swings
Headaches or back pain
Difficulty concentrating
Difficulty sleeping

Taking care of the carer

To avoid carer burnout, make sure you take at least a few minutes to do something you enjoy every day. Stay in touch with friends and keep up with hobbies whenever possible. Find a friend or relative to be your support person. You can also join an online or local carer support group through the Alzheimer’s Society or your doctor's surgery, who can also help you find out about carer breaks.

Essential documents

While your loved one is still able to make important decisions, the Alzheimer’s Society recommends you organise their financial and legal affairs. This ensures that in the future, things like medical treatments and end of life care are handled in a way they have chosen. The patient should designate someone to make health care decisions and manage finances on his or her behalf. Make sure important papers, like bank statements, mortgage deeds, a will and pension details are in order and you know where to find them.

Home health care

Many patients want to stay in their own homes as long as possible. Unfortunately, they may have trouble getting dressed or using the toilet on their own as the disease advances. Local authorities will assess whether people qualify for services like home care, home adapations or meals on wheels. Most local authorities charge for home care, but charges must be "reasonable". Anyone with savings over a certain limit will be asked to pay all their home care costs. The Alzheimer’s Society has published a booklet with information on what care is paid for by the NHS.

Residential care

There may come a day when your loved one can no longer be cared for at home. If he or she does not need 24-hour nursing in a residential care home, an assisted living or sheltered housing scheme may be an appropriate choice. Assisted living allows residents to continue to live independently in a home-like setting. Sheltered housing provides a range of facilities including self-contained flats, houses or rooms with a warden on site in case of emergency. Councils offering sheltered housing have differing criteria for elegibility and there can often be a waiting list.

End-stage Alzheimer’s disease

People with advanced Alzheimer’s disease may lose the ability to walk, talk, or respond to others. Eventually, the disease can hinder vital functions, such as the ability to swallow. Patients in this stage may benefit from hospice care, which provides pain relief and comfort for the terminally ill.

Helping children cope

Children may feel confused, afraid, or even resentful when a family member is affected by Alzheimer’s disease. Let the child know these feelings are normal and answer his or her questions about the illness honestly. Help the child celebrate happy memories of the patient, perhaps by making a scrapbook.

Reducing your risk of Alzheimer’s disease

If you’re caring for a relative with Alzheimer’s disease, you might be wondering if there’s anything you can do to reduce your own risk. Research in this area is ongoing, but diet and exercise may be important. Studies indicate a lower risk among people who eat a Mediterranean diet rich in vegetables, oily fish and nuts. Research also suggests those who are the most physically active are the least likely to get Alzheimer’s disease.