In the spring of 2022, Marla Neise’s brother noticed she was experiencing memory issues and confusion at the company where they work.
“I couldn’t balance a checkbook, put things in an order or stay on one task and I was having a hard time with numbers,” recalls Neise, now 59.
She went to her primary care physician who gave her a short mental test, which she passed. Because she continued to have cognitive problems, she went to a neurologist who suggested she increase her dosage of attention-deficit/hyperactivity disorder (ADHD) medication. When that didn’t help, she saw another neurologist who sent her for an hour-long memory test, a three-hour neuropsychological exam, brain imaging scans and bloodwork.
The results of the neuropsychological test indicated she most likely had Alzheimer’s disease, and a PET scan revealed the presence of beta amyloid plaques in her brain, which confirmed the diagnosis: early-onset Alzheimer’s.
She began having infusions of lecanemab, a medicine to slow the progression of mild Alzheimer’s, every two weeks.
“It helps her with reasoning and coping with everyday life,” says her husband, Kevin. “It seems to have stabilized the disease and maybe even reversed some of the symptoms.”
Neise retired from working, but she continues to lead an active life — including running, gardening, playing pickleball, reading books, doing yoga and meditation and various brain exercises every day.
“I think I’m a lot better,” she says.
[READ: New Treatments for Alzheimer’s Disease.]
What Is Alzheimer’s Disease?
While Alzheimer’s and dementia are sometimes used interchangeably, dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Alzheimer’s disease is the most common type of dementia: It afflicts an estimated 6.9 million adults, ages 65 and older, in the U.S., according to the Alzheimer’s Association.
The disease gets its name from Dr. Alois Alzheimer who, in 1906, first noticed characteristic brain changes like abnormal clumps, or what are now termed beta-amyloid plaques — excessive accumulation of protein deposits, a hallmark of Alzheimer’s disease. Other characteristics of Alzheimer’s include the appearance of tangled fiber bundles called tau tangles, as well as damage and destruction of nerve cells (neurons). To date, there’s no way to reverse neurologic changes at the root of the devastating disorder.
It’s a difficult diagnosis for those who have it and for their loved ones, especially because the progression of this neurological disease is often uncertain.
The first symptoms of Alzheimer’s tend to be related to memory, language and thinking skills. While these symptoms may appear to be new to the individual, the neurological changes can begin to occur 20 years or more before symptoms present themselves. Later stages of Alzheimer’s can be characterized by inability to communicate, seizures, difficulty swallowing and loss of bowel and bladder control.
[See: How to Improve Memory: Expert Tips for Seniors]
Alzheimer’s Causes and Risk Factors
The exact causes of Alzheimer’s disease are unknown, but experts have identified certain risk factors that increase the risk of developing the disease.
These include:
Age
Getting older is the No. 1 risk factor for Alzheimer’s disease, notes Dr. Jeffrey Kaye, a professor of neurology and biomedical engineering and the director of the Layton Aging and Alzheimer’s Disease Center at Oregon Health & Science University in Portland. The majority of people who have Alzheimer’s and those who are at highest risk for the disease are over the age of 80.
In fact, the percentage of people with Alzheimer’s increases as people get older:
— 5% among people ages 65 to 74
— 13% among those ages 75 to 84
— 33% among adults ages 85 and older
A small number of people who get Alzheimer’s disease have the young-onset type. Symptoms of this type usually appear between ages 30 and 60. This type of Alzheimer’s disease is strongly linked to genes.
Genetic or family history
Someone who has a genetic or family history of the disease is at higher risk for developing Alzheimer’s. People with a first-degree family member — a parent, brother or sister with Alzheimer’s — are more likely to develop the disease.
When it comes to genetic risk for Alzheimer’s, there are two kinds of genes that influence whether someone develops the disease, according to the Alzheimer’s Association. Risk genes increase the odds of someone developing Alzheimer’s, but don’t guarantee it will happen. In 2022, researchers identified 31 new genes that appear to influence biological processes that play a role in Alzheimer’s disease. Of the many genes that increase risk, having a particular form of the apolipoprotein E (APOE) gene — specifically, APOE-e4 — has the strongest impact on someone’s risk for developing Alzheimer’s. Between 40% and 65% of people diagnosed with Alzheimer’s have this gene, researchers estimate. But even then, the presence of APOE-e4 doesn’t guarantee the person will go on to develop the disease.
Another type of gene, known as a deterministic gene, directly causes the disorder. These cases are rare, and account for 1% or less of Alzheimer’s cases, according to the Alzheimer’s Association.
Unhealthy lifestyle habits
Certain lifestyle factors have been shown to increase the risk of developing Alzheimer’s. These include:
— Unmanaged chronic health issues, such as high blood pressure, diabetes and heart disease
— Physical inactivity
— Unhealthy diet
— Smoking
— Not getting enough quality sleep
— Lack of mental stimulation
Obesity
Not only is obesity a major driver of many chronic physical health conditions, but it has increasingly been shown to be a risk factor for Alzheimer’s.
“Obesity increases the risk of developing Alzheimer’s because fat cells, particularly around the abdomen, promote inflammation,” says Dr. Gary Small, physician in chief for behavioral health at Hackensack Meridian Health in New Jersey and coauthor of “The Alzheimer’s Prevention Program.” “That’s why midlife obesity increases the risk of late-life dementia.”
Head trauma
Whether it’s from a car accident, a fall from a bike or skiing accident, trauma to the head — especially if you lose consciousness — increases the risk of developing Alzheimer’s. Research suggests that sustaining even a mild concussion could increase the risk of developing dementia later in life. In fact, older adults with a history of moderate and severe traumatic brain injuries (TBIs) had a 2.3 and 4.5 greater chance of Alzheimer’s, respectively, than those who had no TBIs, according to the Alzheimer’s Association.
“It may have to do with inflammation in the brain,” Small says.
Consider this added incentive to wear a seatbelt every time you get in a car and a helmet while biking and skiing.
Air pollution
Increasingly, scientific research suggests that exposure to environmental toxins, especially fine particulate matter in air pollution, may increase the risk of developing various forms of dementia including Alzheimer’s. There are many sources of fine particulate matter, however, and it isn’t clear whether pollution from some sources — traffic, agriculture, smoke — pose greater risks than others. The reason for the connection is not yet well understood.
Autoimmune disease
Autoimmune disease is associated with chronic inflammation, which is linked to Alzheimer’s. In fact, some researchers suggest that Alzheimer’s might be considered an autoimmune disease. A study published in the Journal of Epidemiology and Community Health suggests that people admitted to hospital with an autoimmune disease are 20% more likely to be admitted with dementia later on.
Other studies indicate that for people with rheumatoid arthritis, the risk of developing Alzheimer’s or another type of dementia is seven times higher than it is in people without this autoimmune disease.
Being Latino or Black
According to the Centers for Disease Control and Prevention, Hispanics and African Americans are at greater risk for Alzheimer’s disease as compared to non-Hispanic whites.
The reasons for these differences are not well understood, but researchers believe that higher rates of vascular disease among Latinos and African Americans may put them at greater risk for developing Alzheimer’s. The reason may not be solely race or ethnicity, research shows. Instead, those minority groups are more vulnerable because of lifelong inequities in socioeconomic factors such as income, health insurance and access to medical care that lead to an accumulation of vascular risk factors in midlife and late life, including diabetes, hypertension and obesity.
Alzheimer’s and aluminum
For years, aluminum has been suspected as potentially playing a role in the development of Alzheimer’s disease and other dementias, but conclusive evidence has been difficult to find. For example, several meta-analyses examined the association between aluminum levels in drinking water and dementia risk, and the evidence is inconclusive.
Aluminum can be a neurotoxin, and if you ingest it or get it into your brain, it can cause a dementia-like condition. In looking at the brains of people who had this sort of aluminum toxicity, researchers noted abnormal structures in the brain that looked quite similar to the tangles of tau proteins that are a hallmark sign of Alzheimer’s in the brain. But the aluminum tangles are somewhat different from those seen in Alzheimer’s.
[READ: Mental Exercises to Keep Your Brain Sharp.]
Signs and Symptoms
Various classic symptoms and subtler early signs could point to Alzheimer’s.
Signs and symptoms of Alzheimer’s include:
— Forgetfulness or memory loss that disrupts your daily life
— Challenges related to planning things or solving problems
— Difficulty performing familiar tasks
— Confusion regarding time or place (such as losing track of dates or forgetting how you got somewhere)
— Difficulty understanding visual images and spatial issues such as judging distances.
— Problems with language (such as trouble engaging in conversation)
— Misplacing items and being unable to retrace steps
— A decline in judgment or poor judgment, such as with money matters or grooming habits.
— Withdrawal from work, hobbies or social activities
— Changes in personality or mood, such as becoming depressed, apathetic or fearful
If you notice any of these changes, the Alzheimer’s Association suggests scheduling an appointment with your doctor.
[READ: What Is the SAGE Test for Dementia?]
Diagnosis
There isn’t a single test that can definitively diagnose Alzheimer’s disease, so doctors use a combination of approaches to determine whether a patient has the condition. These include:
— A medical history
— A physical exam
— A neurological exam
— Cognitive, functional and behavioral tests
— Brain imaging tests, such as MRI, CT and PET scans
— Cerebrospinal fluid tests
— Blood tests to measure biomarkers that may be associated with Alzheimer’s
Treatments
There are several treatments approved by the Food and Drug Administration to either treat Alzheimer’s disease or manage its symptoms.
While none of these drugs can prevent or cure Alzheimer’s, some can alter the underlying biology of Alzheimer’s and slow the progression of cognitive and functional decline.
Medications to treat Alzheimer’s include:
— Lecanemab, an anti-amyloid antibody intravenous (IV) infusion therapy that’s delivered every two weeks. It’s FDA-approved to treat early Alzheimer’s.
— Aducanumab, the first therapy to demonstrate that removing beta-amyloid from the brain decreases cognitive and functional decline in people with early Alzheimer’s. It’s being discontinued by its manufacturer and won’t be available after November 1, 2024.
Medications to manage Alzheimer’s symptoms include:
Cholinesterase inhibitors that are used to treat symptoms related to memory, cognitive function, language and judgment. These include:
— Donepezil, which is approved for all stages of Alzheimer’s
— Rivastigmine, which is approved for mild-to-moderate Alzheimer’s
— Galantamine, approved for mild-to-moderate stages of Alzheimer’s
Glutamate regulators, which are prescribed to improve memory, attention, reasoning abilities and language, such as:
— Memantine, which is approved for moderate-to-severe Alzheimer’s
— Memantine and donepezil, a combination of a cholinesterase inhibitor and a glutamate regulator that’s approved to treat moderate-to-severe Alzheimer’s
Atypical antipsychotic drugs are sometimes used in an “off-label” capacity to treat behavior changes that are related to Alzheimer’s.
— Brexpiprazole is the only atypical antipsychotic drug that’s FDA-approved to treat agitation associated with Alzheimer’s.
Lifestyle Interventions
While there’s nothing you can do to reverse Alzheimer’s disease, there are several lifestyle modifications that can benefit those with the disease, slow its progression or reduce the risk of someone developing it in the first place.
In fact, many lifestyle habits that promote heart health can also protect the brain.
“What’s good for your heart is generally good for your brain as well,” says Dr. Zaldy Tan, a professor of neurology and medical director of the Jona Goldrich Center for Alzheimer’s and Memory Disorders at Cedars-Sinai Medical Center in Los Angeles.
These measures include:
Controlling high blood pressure
Taking antihypertensive medications as directed can help protect the brain. A study in a 2023 issue of JAMA Network Open found that older adults with untreated hypertension had a 26% increased risk of developing dementia over four years, compared to those who had their hypertension treated.
Engaging in regular physical activity
Regular aerobic exercise may decrease dementia risk. In fact, just 30 minutes a day of physical activity — such as walking, jogging or swimming — can make a significant impact on your health and dementia risk.
“There’s a lot of evidence (suggesting) that people who are more active tend to have better brain health and survive without dementia perhaps longer,” Kaye says.
Consuming a healthy diet
Eating foods that are rich in antioxidants and that have anti-inflammatory properties — including fruits, vegetables, whole grains, legumes, nuts, seeds, fish, lean poultry, herbs and spices — is beneficial for your brain and your heart, Small says. These foods happen to be staples of a Mediterranean diet, which ranked No. 1 in U.S. News’s Best Heart-Healthy Diets category.
For a diet that specifically targets brain health, consider the MIND diet, which stands for Mediterranean-DASH Intervention for Neurodegenerative Delay and was developed through a study funded by the National Institute on Aging to lower the risk of cognitive decline.
Smoking cessation
Smoking is a significant risk factor for developing Alzheimer’s disease, partly because it compromises blood flow and increases oxidative stress to the brain, and because it’s associated with adverse effects on the neurobiology and function of the brain, research has found.
Staying connected and socializing
Staying socially plugged in is another helpful strategy for individuals who have Alzheimer’s and those who are hoping to reduce their risk of developing the disease.
“I encourage my patients to remain cognitively and socially engaged because social isolation and cognitive stagnation may confer an increased risk,” Tan says.
Getting plenty of sleep
While dementia can disrupt sleep and have a negative effect on cognition over time, getting good quality shut-eye on a regular basis may have a restorative impact on brain function. Among other positive effects, sleep supports the brain’s ability to remove beta-amyloid and other toxins.
Support for Caregivers
Loved ones of those who’ve been diagnosed with Alzheimer’s often discover that their roles shift from family members to caregivers as they strive to help the person remain at home as long as possible.
“This is a long journey,” Tan says. “It’s a marathon, not a sprint, so to speak. (Caregivers) need to be prepared for that.”
To ease the pressure, experts recommend:
Seeking support through local networks and organizations
Given the changes that occur in the months and years following a diagnosis, experts say it’s important to keep a long-term perspective, and seek support not just for those with Alzheimer’s but for caregivers too. That includes accessing resources on a local and national level through organizations like the Alzheimer’s Association.
For example, Kevin Neise participates in a caregiver group for people with younger-onset Alzheimer’s via Zoom and says it’s been helpful.
Sharing your experience with friends and loved ones
It’s important to discuss what you’re doing with other friends and loved ones, since caregiving can be isolating — especially when a person isn’t able to do as much socially. Sometimes people may be reluctant to speak up or disclose that a loved one has dementia due to perceived stigma or concern about how others may react.
But experts encourage being open about Alzheimer’s to get support. The alternative — risking burnout — is bad for the caregiver and the person with Alzheimer’s and may lead to neither person getting what they want or need.
Taking regular breaks
Given that many caregivers — including partners and grown children — are juggling other responsibilities such as working and raising kids, it’s critical to make arrangements for respite care. This way, caregivers can tend to their own mental health and take time to recharge.
Looking for assisted living facilities
Before they’re needed, caregivers should learn about assisted living facilities, such as memory care facilities, adult day care programs, senior centers and geriatric care managers. These will be helpful for the later stages of the disease, when round-the-clock monitoring, care and personal help are needed to help someone with Alzheimer’s manage various facets of life, including activities of daily living.
“You can’t do this on your own,” Tan says. “There’s a lot out there in the community, but (caregivers) need to find out what’s right for them and what they will have access to.”
Learn more about these facilities for seniors with U.S. News’s Best Assisted Living ratings.
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Alzheimer?s Disease: Treatments, Medications and More originally appeared on usnews.com
Update 05/29/24: This story was previously published at an earlier date and has been updated with new information.
