Alzheimer's disease (AD) is a progressive, degenerative brain disease that
results in impaired memory, thinking, and behavior. It is the most common cause
of dementia in the elderly and affects at least three to four million people in
the United States. People with AD experience gradual memory loss as well as
impaired judgement, difficulty concentrating, loss of language skills,
personality changes, and a decline in the ability to learn new tasks. Memory
loss usually begins at about age 65 and symptoms tend to become severe within 8
to 10 years. In some cases, symptoms may appear earlier in life and advance at a
faster or slower rate, but most people who develop symptoms before the age of 60
tend to have more severe forms of the disease. Currently, there is no cure for
AD, but studies suggest that medications, herbs and supplements, and lifestyle
adjustments may all help to slow the progression and improve the symptoms of the
Signs and Symptoms
The early symptoms of AD are occasionally overlooked because they resemble
signs that many people attribute to "natural aging." The following are the most
common signs and symptoms of AD.
Memory loss, including not recognizing friends and family
Difficulty comprehending words, completing sentences, or finding the
Loss of familiarity with surroundings, wandering aimlessly
Hallucinations, delusions, and psychosis
Aggression, agitation, anxiety, restlessness
Accusatory behaviors (such as accusations of spousal
Withdrawal, disinterest, hostility, loss of
Impaired movement or coordination
Muscle rigidity, shuffling or dragging feet while walking
Insomnia or disturbances in sleep patterns
Muscle twitching or seizures
The causes of AD are not entirely known but are thought to include genetics
and environmental factors. New research indicates that free radicals (highly
reactive molecules that can cause oxidation, or damage to cells) may play a role
in the development of AD.
A gene for the protein epsilon apolipoprotein (Apo
E)—especially Apo E3 and Apo E4
varieties—is thought to accelerate the formation of
abnormal deposits (called plaques) in the brain and increase the risk for AD.
Reports indicate that between 50% and 90% of those with the Apo E4 gene develop
AD. However, even people without inherited genes for the disease can get AD.
Scientists also believe the environment may play a part in AD because people
in different regions of the world have widely varying risks of developing the
disease. For example, people living in Japan and West Africa have much less risk
for AD than Japanese and Africans living in the United States.
People with AD have abnormal deposits, or plaques, in their brain tissue.
These plaques contain beta amyloid, a protein that releases free radicals, or
highly reactive molecules that can cause damage to cells through a process
called oxidation. These free radicals are believed to lower levels of
acetylcholine (a brain chemical that helps transmit impulses in the nervous
system) and damage brain tissue, bringing on the symptoms of AD.
Although not confirmed by scientific studies, other factors that have been
speculated to contribute to the development of AD include infections (such as
herpesvirus type 1), exposure to metal ions (such as aluminum, mercury, zinc,
copper, and iron), or prolonged exposure to electromagnetic
The causes and risk factors contributing to the development of AD are not
entirely clear. The following all appear to have an association with AD to
Family history of AD
Older age—20% to 40% of people with AD are
older than 85
Female gender—while women tend to develop AD
more than men, this may be related to the tendency for women to live
Americans are more likely to get AD than Asians or Native
Long-term high blood pressure
History of head trauma—one or more serious
blows to the head may put a person at an increased risk
Elevated levels of homocysteine (a body chemical that contributes to
chronic illnesses such as heart disease, depression, and AD)
Aluminum or mercury poisoning
Prolonged exposure to electromagnetic
There is no definitive test for AD, and a true diagnosis of AD can only be
made after a person dies and an autopsy is performed on the brain. All
individuals with AD have an accumulation of abnormal deposits (called plaque)
and tangled nerve cells in their brains. The physician will try to narrow down a
diagnosis, however, by eliminating the possibility of other illnesses. He or she
will ask the individual (or a close family member) to describe the primary
symptoms, and how long they have been noticeable.
The following tests may also be used to aid in the diagnosis.
Psychological tests—assess the individual's
memory and attention span. They may also reveal difficulties in problem-solving,
social, and language skills.
Electroencephalograph (EEG)—traces brain-wave
activity. This test sometimes reveals "slow waves" in people with AD. Although
other diseases may reveal similar brain-wave activity, EEGs help distinguish a
person with AD from a severely depressed person, whose brain waves are
Imaging tests (such as CT, MRI, or
PET)—computerized tomography (CT) or magnetic resonance
imaging (MRI) can detect the presence of stroke, blood clots, and tumors
(problems that cause AD-like symptoms but are not themselves related to AD).
MRI, positron emission tomography (PET) scans, and other advanced imaging
techniques may eventually be able to diagnose AD by identifying altered blood
flow patterns in the brain.
Blood test for Apo E4—although the presence
of Apo E4 gene in the blood may suggest AD, it does not always make an accurate
Consuming a low-fat, low-calorie diet may reduce the risk for AD.
Higher intake of fatty, cold-water fish (such as tuna, salmon, and
mackerel) has been associated with a lower risk of dementia. This may be due to
the high level of omega-3 fatty acids found in such fish. Eating fish at least
two to three times per week provides a healthy amount of omega-3 fatty
Reducing intake of linoleic acid (found in margarine, butter, and
dairy products) may prevent cognitive decline.
Antioxidants, such as vitamins A, E, and C (found in darkly colored
fruits and vegetables) may help prevent damage caused by free
Maintaining normal blood pressure levels may reduce the risk for
Hormone-replacement therapy in postmenopausal women may decrease
production of chemicals that cause AD, stimulate growth of brain cells, and
improve blood flow in the brain. However, the role of hormones in the prevention
of AD is still controversial.
Some studies suggest that certain medications may prevent AD,
including "statin" drugs (such as pravastatin or lovastatin, used to lower
cholesterol) and nonsteroidal anti-inflammatories (NSAIDs), with the exception
of aspirin. More research is necessary, however, to determine how effective
these medications are in reducing the risk of the disease.
Keeping mentally and socially active may help delay the onset or slow
the progression of AD.
Unfortunately, there is no cure for AD. The goal in treating AD is to slow
the progression of the disease and improve symptoms. The most promising
treatments for AD include
medications that increase the amount of
acetylcholine in the brain (such as donepezil), antioxidants that scavenge free
radicals (such as
vitamin E and
ginkgo biloba), lifestyle modifications (such
as walking programs and relaxation training) to reduce anxiety and improve
behavior. Studies suggest that
music therapy, the use of music to
relax patients and bolster the immune system, may be healing for those with AD
as well. It is also important that family members of people with AD get
emotional support and assistance with the demanding tasks of
Research indicates that the following lifestyle modifications may help
improve behavior in people with AD.
A supervised walking program with a caregiver or other reliable
companion may improve communication skills and diminish the risk of
Bright light therapy may control insomnia and wandering.
Calming music may reduce wandering and restlessness, boost brain
chemicals, and improve behavior.
Pet dogs can increase appropriate social behaviors.
Relaxation training and other exercises that require focused attention
(often used with refreshments as rewards) can improve social interaction and the
ability to perform tasks.
The Safe Return Program, implemented by the Alzheimer's Association,
requires that a person with AD wear an identification bracelet. If he or she
wanders, the caregiver can contact the police and the national Safe Return
office, where information about the patient is stored and shared
Individuals with AD may also have particular dietary concerns. They may
Extra calories due to increased physical activity and restless
Supervised meals and assistance with feeding. People with AD often
forget to eat and drink, and, as a result, often become
The following medications increase the amount of acetylcholine, in the
nervous system and slow the progression of AD:
Donepezil—slows progression of AD in 30% to
50% of people with the disease; has few side effects
Tacrine—10% to 20% of people who develop AD
early in life show a positive response to this medication; not beneficial for
people in the late stages of the disease; serious side effects include nausea,
vomiting, diarrhea, and addiction
Rivastigmine—side effects include dizziness,
headache, nausea, vomiting, and diarrhea.
The following medications may ease the symptoms related to AD:
Selective serotonin reuptake inhibitors
(SSRIs)—increase activity of a brain chemical called
serotonin; used to treat depression; because symptoms of depression often
precede AD, SSRIs may slow the development of AD
Methylphenidate—stimulates the brain to
increase alertness; used to treat withdrawal and apathy
Risperidone, olanzapine, or haloperidol—act
as mood stabilizers and work on improving social interactions, mood, expression
of mood, delusions, and paranoia; decreases aggression; haloperidol has serious
side effects, including impaired control of movement
Carbamazepine (or other antiseizure
drugs)—stabilizes sodium levels in the brain; used to
Nutrition and Dietary Supplements
Damage caused by free radicals is thought to play a major role in the
development of AD. Many researchers have investigated whether antioxidants
(agents known to scavenge free radicals) may ease the symptoms of dementia,
increase the life span of those with AD, and help prevent the disease. Two
antioxidants in particular, vitamins E and C, have shown promise in both the
prevention and treatment of the disease. Research on other supplements is less
Vitamin E and Vitamin C
Vitamin E dissolves in fat, readily enters the brain, and helps slow down the
cell damage that occurs naturally with age. In a well-designed study involving
341 people with AD who were followed for 2 years, researchers found that people
who took vitamin E supplements had improvement in their symptoms and increased
survival rates compared to those who took placebo.
Two large trials suggest that vitamins E and C may prevent the onset of AD,
improve cognitive skills in healthy individuals, and decrease the symptoms of
dementia. In one of the studies, more than 600 healthy individuals were followed
for an average of 4 years. A total of 91 people developed AD, but none of the
participants who took vitamin E or C supplements developed the disease.
SAMe is a naturally occurring compound that increases the body's levels of
serotonin, melatonin, and dopamine. Clinical studies suggest that people with AD
and depression have depleted levels of SAMe in their brain tissue. While it has
been reported that some people with AD have improved cognitive function from
SAMe supplementation, further studies are needed to determine how safe and
effective this supplement may be for individuals with the disease.
Beta-carotene and Vitamin A
Preliminary studies suggest that levels of vitamin A and its precursor,
beta-carotene, may be significantly lower in people with AD compared to healthy
individuals, but the effects of supplementation have not been studied.
Vitamin B9 (Folate) and Vitamin B12
Folate is a substance critical to the health of the nervous system and to a
process that clears homocysteine from the blood. Homocysteine is a body chemical
that contributes to chronic illness such as heart disease, depression, and AD.
Elevated levels of homocysteine and decreased levels of both folate and vitamin
B12 have been found in people with AD, but again, the benefits of
supplementation for dementia are unknown.
In addition to being structurally similar to the brain chemical
acetylcholine, acetyl-L-carnitine is a scavenger of free radicals and is
involved in the growth of brain cells. Several studies have examined the role of
acetyl-L-carnitine in treating AD, but results have been conflicting. For
example, one trial suggests that this supplement may help prevent the
progression of AD in the early stages of the disease, but it may worsen symptoms
in later stages of the disease. Use of this supplement for AD should be avoided,
therefore, until more information is available. Reported side effects include
increased appetite, body odor, and rashes.
PS is a naturally occurring substance found in the body that promotes cell
health and boosts the activity of acetylcholine and other brain chemicals.
Animal and laboratory studies suggest that this supplement may protect the brain
from damage. Clinical trials have found that it may improve memory, ease
symptoms in those with mild to moderate dementia, and prevent cognitive decline
in middle-aged individuals.
Red Wine and Grape Juice
Resveratrol, a flavonoid or plant substance found in red wine and grape
juice, is an antioxidant that may benefit people with AD. Because the alcohol in
red wine may contribute to falls, interactions with medications, and sleepiness,
it is not recommended for those with the condition.
Ginkgo (Ginkgo biloba)
Ginkgo is widely used in Europe for treating dementia. It improves blood flow
in the brain and contains flavonoids (plant substances) that act as
antioxidants. Although many of the clinical trials have been scientifically
flawed, the evidence that ginkgo may improve thinking, learning, and memory in
people with AD has been highly promising.
Clinical studies indicate that gingko provides the following benefits for
people with AD:
Improvements in thinking, learning, and memory
Improvements in daily living
Improvements in social behavior
Delayed onset of symptoms
Reduced symptoms of depression
Recommended dosages for ginkgo range between 120 to 240 mg per day. Reported
side effects have been minor, but ginkgo should not be taken with blood-thinning
medications (such as warfarin), vitamin E, or a class of antidepressants called
monoamine oxidase inhibitors (MAOIs).
Preliminary studies indicate that the following herbs may also slow the
progression of AD and improve memory and behavior:
Asian ginseng(Panax ginseng)and American
Huperzine (Huperzia serrata)
Although the following herbs have not been investigated in clinical studies,
a professional herbalist may recommend the following for people with
Sage (Salvia officinalis)
Lemon balm (Melissa officinalis)
Rosemary (Rosmarinus officinalis)
Peony (Paeonia suffruticosa)
Guarana (Paullinia cupana)
Gotu kola (Centella
Small studies have shown that transcutaneous electrical nerve stimulation
(TENS), a technique used in physical therapy and certain types of acupuncture,
may improve memory and daily living skills in people with AD. Further studies
are needed to confirm whether acupuncture may be effective in the treatment of
Massage and Physical Therapy
The inability to communicate normally with language increases anxiety and
frustration in people with AD. Using touch, or massage, as a form of nonverbal
communication has been shown to benefit those with AD. In one study, people with
AD who received hand massages and were spoken to in a calming manner had a
reduction in pulse rate and in inappropriate behavior. Healthcare professionals
speculate that massage may be beneficial for people with AD not only because it
is relaxing, but because it provides a form of social interaction and a moderate
form of exercise.
Music therapy, the use of music to calm and heal an individual, cannot slow
or reverse dementia, but it may improve quality of life for both a person with
AD and his or her caregiver. Clinical reports suggest that music therapy may
reduce wandering and restlessness and increase chemicals in the brain that
enhance sleep and ease anxiety. For example, people with AD have been shown to
experience significant increases in levels of melatonin, norepinephrine, and
epinephrine after listening to live music regularly for a month. Mood also
improved after listening to the music.
Support for the Caregiver
Studies suggest that caregivers who receive emotional support tend to
experience an improvement in their quality of life, and those they are caring
for benefit as well.
The following Ayurvedic herbs are traditionally used to treat brain disorders
in elderly people:
Winter cherry (Withania
somnifera)—demonstrates antioxidant and
anti-inflammatory properties in the laboratory; enhances the tolerance of stress
Brahmi (Herpestis monniera)—improves
motor skills as well as the ability to learn and retain
Prognosis and Complications
A person with AD can experience the following complications:
Falls (from impaired coordination)
"Sundowning" (withdrawal or agitation in the evening)
Malnutrition and dehydration
Infection (from urinary tract infections or pneumonia)
Asphyxiation (stopped breathing)
Harmful or violent behavior toward self or others
Poor health and support due to caregiver burnout
Physical and emotional abuse, including neglect
There is no known cure for AD; the disease naturally progresses and worsens
over time. People with the disease can survive for many years, however. While
most people with AD die within 8 to 10 years, some live as long as 25 years.
Some people decline steadily during their disease, while others reach major
plateaus where their symptoms advance quite slowly. Men and people with a
long-standing history of high blood pressure are more likely to decline rapidly.
Additionally, the older a person with AD becomes, the more likely he or she is
to decline rapidly. An accurate, early diagnosis gives affected individuals a
greater chance of benefiting from existing treatments.
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Review Date: March 2001
Reviewed By: Participants in the review process include: John Balletto, LMT, NCTMB, Center
for Muscular Therapy, President, Providence, RI; Richard Glickman-Simon, MD,
Department of Family Medicine, New England Medical Center, Tufts University,
Boston, MA; Jacqueline A. Hart, MD, Department of Internal Medicine,
Newton-Wellesley Hospital, Harvard University and Senior Medical Editor
Integrative Medicine, Boston, MA.
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