June is Alzheimer’s & Brain Awareness Month providing the perfect opportunity for a discussion about what Alzheimer’s disease is, how it is treated, and what to expect if you or a loved one is diagnosed with the disease. Many of us know someone or have cared for someone with this devastating illness. Understanding the disease can help us navigate caring for loved ones with the diagnosis.

What is Alzheimer’s Disease and how is it diagnosed?

Alzheimer’s disease occurs when certain proteins deposit into the brain causing the brain to shrink and cells to die which leads to dementia. Symptoms of dementia include memory loss, behavioral changes, difficulty swallowing, changes in sleep patterns and difficulty with other activities of daily living including eating/feeding oneself, walking, and talking.

Diagnosing Alzheimer’s disease uses a multifaceted approach including a thorough history and physical/neurological exam, lab testing to rule out other causes of symptoms, neuropsychological testing, and an MRI or PET scan of the brain. There are other tests including a spinal tap to test the level of proteins and a blood test to measure beta-amyloid level in the body. These are more commonly used if someone is displaying symptoms at a young age or is having a very rapid progression of symptoms.

How is Alzheimer’s Disease Treated?

There is no cure for Alzheimer’s disease, but there are some medications that can help with memory loss. Cholinesterase inhibitors (donepezil/Aricept, galantamine/Razadyne, rivastigmine/Exelon) can help with behavior of those with Alzheimer’s disease. These are normally first line treatments and are most useful in those with mild to moderate disease but can be used at any stage. Side effects are common and can include nausea, diarrhea, vivid dreams, loss of appetite/weight loss.

Memantine/Namenda is another medication in a different class but can be used with the above medications and is used for moderate to severe dementia. The goal of this medication is to slow memory loss. Side effects include headaches, dizziness, hallucinations, agitation, and constipation.

A newer medication called Lecanemab is an IV infusion that decreases the amyloid in the brain. This was approved in 2023, so long term data is limited.

Multiple medications can be used to target symptoms of agitation in Alzheimer’s disease, including brexpiprazole. Many of these medications do, however, come with a black box warning as they can increase the risk of death in these patients.

What are the stages of Alzheimer’s disease/what can I expect?

Early/mild disease stage: This stage is exhibited by word finding difficulty, forgetting appointments/where valuables were put, trouble with planning/organizing, and remembering names. Individuals in this stage can usually still perform most ADLs independently.

Middle/moderate disease stage: Middle/moderate stage disease presents with mood changes, difficulty remembering personal history, trouble with social events, confusion about where they are or what day it is, changes in sleep patterns, wandering/getting lost, trouble with bowel/bladder control. These individuals tend to need some help with ADLs.

Late/severe disease stage: This stage is manifested by the loss of communication, difficulty swallowing leading to potential aspiration pneumonia, difficulty with walking, weight loss, decreased responsiveness. These individuals will require 24-hour care and are eligible for hospice services as this is end-stage disease.

Is there any genetic testing available?

Genetic testing is available and may predict one’s susceptibility to developing Alzheimer’s disease. In most cases of disease there is not one single cause. Rather, it can be multiple genetic factors along with environmental and lifestyle factors. A variance in the APOE gene has been linked to early onset Alzheimer’s disease. There is genetic testing available; however, testing positive for the genetic variant does not mean the individual will develop the disease in the future. It simply means the person is at higher risk for disease development than someone that does not carry this variance. It is important to weigh the pros and cons of testing and meet with a genetic counselor to discuss results if testing is completed.

Is there anything I can do to prevent Alzheimer’s Disease?

Increasing physical activity, eating a nutritious diet, not smoking, limiting/avoiding alcohol, managing other chronic illnesses such as diabetes or high blood pressure can all help prevent Alzheimer’s disease. Challenging the brain with puzzles and staying socially active can be helpful as well.

Alzheimer’s disease is incredibly challenging, but there are still ways to help those suffering the disease remain functioning at the peak of their ability throughout the disease course. The medications listed above may help with disease progression, while keeping these individuals socially active and mentally stimulated will feed their mental and emotional well-being. It is important to contact your primary care provider if you notice any cognitive changes as early detection will help you come up with an individualized plan of care.

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