June is Alzheimer’s disease and Brain Awareness Month, a time to remember that Alzheimer’s, the most common form of irreversible dementia, touches so many people and their families. Alzheimer’s is a degenerative condition that affects a person’s memory, thinking, language and other cognitive abilities with a direct impact on daily functioning and ability to live independently. It is also a time to remember that there are healthy lifestyle strategies that may protect and maintain good brain health, especially as people age.
Over 5.4 million people in the U.S. are living with Alzheimer’s. This form of dementia is the sixth leading cause of death among all adults (CDC, 2016). The majority of people affected by Alzheimer’s are age 65 or older, however it is not just a disease affecting older adults. Approximately 200,000 people under the age of 65 have what is called early-onset Alzheimer’s.
It is estimated that in 2017, the costs associated with providing care to patients with Alzheimer’s will be $259 billion. Along with the financial burden, caregivers for people with dementia report that their own health has been affected negatively due to the heavy burden of caregiving responsibilities (Alzheimer’s Association, 2017).
Understanding the early signs and symptoms of Alzheimer’s is an important part of awareness, since early treatment can make a difference in improving symptoms. These include:
- Memory loss that affects daily life – this is most evident in a person’s ability to remember recent information.
- Problems with planning or problem solving – a person may have trouble following directions or keeping track of monthly bills.
- Difficulty completing familiar tasks – including getting lost even when driving to familiar places or forgetting how to use a common household appliance.
- Confusion with time or place – a person may lose track of dates, seasons, and the passage of time. At times, a person may forget where they are and how they got there.
- Visual spatial problems – including unusual visual changes and difficulty judging distances. This may also affect their driving ability; therefore they may be at risk for or have recent accidents.
- Word finding difficulties or problems writing – for example, having new problems with maintaining a conversation, finding the right words, or calling something by the wrong name.
- Misplacing personal items on a regular basis – a person may place an item in an unusual place. At times, they may accuse others of stealing items.
- Changes in judgment and decision-making – for example, having new problems managing money and paying less attention to dressing and bathing.
- Withdrawal from their usual social activities – this is usually due to memory loss and problems with planning.
- Changes in mood or personality – they may become suspicious of others, depressed, fearful or anxious.
These ten signs and symptoms are unique to Alzheimer’s and should be considered warning signs to look for, not just normal age-related changes. Alzheimer’s disease typically progresses starting with mild disease through moderate and eventually late stage disease over a period of four to eight years.
At this time, there is still no cure for Alzheimer’s, however, new drugs are available to help manage cognitive and behavioral symptoms. Patients with a diagnosis of Alzheimer’s may be prescribed cholinesterase inhibitors (Aricept, Exelon, or Razadyne) or Memantine (Namenda) to treat cognitive symptoms. A newer medication that combines the two therapies in one is called Namzaric.
Treating patients with early symptoms can improve cognitive function and lessen symptoms for a limited time. Research is ongoing to study new treatments with the goal of finding better ways to treat and eventually prevent the disease.
Understanding Risk Factors
Scientists continue to study factors that increase a person’s risk of Alzheimer’s disease. The most common risk factors include:
- Being age 65 or older (the risk increases with age).
- Having a family history – people with a first-degree relative who have the disease are also at an increased risk.
- Genetic inheritance. There are two categories of genes that may play a role in whether a person develops the disease: risk genes and deterministic genes.
- Risk genes increase the chance of getting the disease, but do not guarantee that it will occur. Researchers have discovered several genes that belong in this category. The apoliprotein E-e4 (or APOE-e4) has the strongest influence. Other common forms of the APOE gene are APOE-e2 and APOE-e3. Everyone inherits a copy of one form of APOE gene from each parent. People who inherit one copy of APOE-e4 have an increased risk of developing Alzheimer’s, and those who inherit two copies have an even higher risk. They may also have symptoms that appear at a younger age than usual.
- Deterministic genes will directly cause a disease, meaning people who inherit one of these genes will go on to develop the disease. Scientists discovered variations in the coding of certain proteins that cause Alzheimer’s. These include amyloid precursor protein (APP), presenilin-1 (PS-1), and Presenilin-2 (PS-2). People who have inherited these genes usually develop symptoms in their 40s or 50s. This is called familial Alzheimer’s and is quite rare, accounting for only 1 percent of cases (Alzheimer’s Association, 2017).
Genetic testing is available for both APOE-e4 and the rare genes that can directly cause Alzheimer’s. However, counseling is recommended prior to testing so that patients clearly understand the risks and benefits of testing for a condition that currently has no cure.
Practicing Good Brain Health
Lifestyle risk factors are being studied to understand what factors we may be able to influence and therefore prevent the onset of Alzheimer’s.
Head injuries have a strong link to future risk of Alzheimer’s. This is especially true when head trauma occurs repeatedly or with loss of consciousness. This means that it is important to protect the brain from injury by using safety helmets, wearing your seat belt and fall proofing the home.
Brain health has a strong link to heart health. A change in the way the blood is supplied to the brain can influence function. People who have heart disease, high blood pressure, and high cholesterol may have an increased risk for vascular dementia. Preventing heart disease and related conditions can directly affect brain function.
Making lifestyle and wellness changes may also translate to a healthier brain. Practicing good brain health can make a difference. Preventing brain injuries and practicing heart health can translate to healthy brain function as people age. In addition, incorporating general healthy aging strategies such as eating a healthy diet – such as the Mediterranean diet, exercising the body and mind regularly, staying socially active and avoiding tobacco and excess alcohol may have a protective effect on the brain (Harvard Health Publications, 2015).
WHAT CAN YOU DO?
Engage patients throughout the continuum of care. The right education, resources and information can help them make informed decisions about their health.
1. Help patients understand what they need to do to practice good brain health and prevent head injuries. Elsevier Interactive Patient Education titles that support this include:
- What You Need to Know About Traumatic Brain Injury
- Preventing Traumatic Brain Injury
- Bike Safety
- Stroke Prevention
- Managing Your Hypertension
- Heart-Healthy Eating Plan
- Vegetarian Eating and Nutrition
- Mediterranean Eating Plan
- What You Need to Know About Smoking Tobacco
- Smoking Hazards
- Exercising to Stay Healthy
2. Help patients understand their diagnosis and treatment options. Elsevier Interactive Patient Education titles that support this include:
- Alzheimer Disease
- Vascular Dementia
- Traumatic Brain Injury
- Genetic Counseling
3. Help patients understand what is involved in long-term management and caregiving. Elsevier Interactive Patient Education titles that support this include:
How to Increase My Level of Physical Activity
- Coping with Quitting Smoking
- Steps to Quitting Smoking
- Living with Alzheimer Disease
- Alzheimer Disease Caregiver Guide
To find out more about Elsevier Patient Engagement visit ElsevierPatientEngagement.com
Alzheimer’s Association. Alzheimer’s & Dementia.
Center for Disease Control and Prevention (CDC). Alzheimer’s Disease.
Center for Disease Control and Prevention (CDC). 2016. Alzheimer’s Disease. Retrieved June 9, 2017 from https://www.cdc.gov/chronicdisease/resources/publications/aag/alzheimers.htm
Alzheimer’s Association. (2017). What is Alzheimer’s? Retrieved June 9, 2017 from http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp
Harvard Health Publications. (2015). The 4 best ways to maintain your brain. Retrieved June 12, 2017 from http://www.health.harvard.edu/mind-and-mood/the-4-best-ways-to-maintain-your-brain
Meet the Authors:
Sheryl Ness, BSN, MA, RN is a Clinical Editor for Elsevier Patient Engagement. Previously she served 12 years as the manager of the cancer education program and associate professor of the cancer center within a large academic healthcare system. Her work experience includes practice as a manager, patient educator, faculty, nurse, researcher, blog writer and editor in the field of oncology, neurology and endocrinology. She currently holds a Master’s Degree in Nursing with a Post-Graduate Certification in Nursing Education. She has published and presented at both local and national conferences, and received awards for her work in patient education, curriculum design and oncology nursing. Sheryl supports the vision of engaging patients in a meaningful way that meets their individual needs as they navigate every step of the patient journey.
Julibeth Lauren, PhD, APRN, CNS is currently serving as the Vice-President and Editor-in-Chief for Elsevier Patient Engagement. Previously she served 8 years for a large healthcare system Level I Adult/Pediatric Trauma, Comprehensive Stroke and Burn Center in the Twin Cities as a Director of Practice, Education, and Research. Her work experience includes practice as an APRN Clinical Nurse Specialist, Nursing Faculty, Principal Instructor, Interdisciplinary Curriculum Development, and Staff Registered Nurse. She currently holds a Doctorate in Adult Education, Graduate Certification in Business, Organizational Leadership, and a Masters Degree in Nursing. Julibeth is extremely passionate about adult and patient education to provide the right information to patients in a way which is understandable, actionable, and delivered at the most teachable moments along the patient’s health care journey.