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Alzheimer's disease is the most common cause of dementia, which is the loss of intellectual and social abilities severe enough to interfere with daily functioning. Dementia occurs in people with Alzheimer's disease because healthy brain tissue degenerates, causing a steady decline in memory and mental abilities.

About 4.5 million older Americans have Alzheimer's, a disease that usually develops in people age 65 or older. This number is expected to quadruple by the year 2050 as the population ages.

Although there's no cure for Alzheimer's disease, researchers have made progress. Treatments are available that help improve the quality of life for some people with Alzheimer's. Also, more drugs are being studied, and scientists have discovered several genes associated with Alzheimer's, which may lead to new treatments to block progression of this complex disease.

In the meantime, caring for someone with Alzheimer's takes patience and a focus on the things a person can still do and enjoy. Those with Alzheimer's — as well as those who care for them — need support and affection from friends and family to cope.

Everyone has occasional lapses in memory. It's often quite normal to forget the names of people whom you rarely see. But it's not a normal part of aging to forget the names of familiar people and objects.

Alzheimer's disease — which is a progressive, degenerative brain disease — goes beyond simple forgetfulness. It may start with slight memory loss and confusion, but it eventually leads to irreversible mental impairment that destroys a person's ability to remember, reason, learn and imagine.

Most people with Alzheimer's share certain signs and symptoms of the disease. These may include:

• Increasing and persistent forgetfulness. At its onset, Alzheimer's disease is marked by periods of forgetfulness, especially of recent events or simple directions. But what begins as mild forgetfulness persists and worsens. People with Alzheimer's may repeat things and forget conversations or appointments. They routinely misplace things, often putting them in illogical locations. They frequently forget names, and eventually, they may forget the names of family members and everyday objects.
• Difficulties with abstract thinking. People with Alzheimer's may initially have trouble balancing their checkbook, a problem that progresses to trouble recognizing and dealing with numbers.
• Difficulty finding the right word. It may be a challenge for those with Alzheimer's to find the right words to express thoughts or even follow conversations. Eventually, reading and writing also are affected.
• Disorientation. People with Alzheimer's may lose a sense of time and dates. They may find themselves lost in familiar surroundings. Eventually, they may even wander from home.
• Loss of judgment. Solving everyday problems, such as knowing what to do if food on the stove is burning, becomes increasingly difficult, eventually impossible. Alzheimer's is characterized by greater difficulty in doing things that require planning, decision making and judgment.
• Difficulty performing familiar tasks. Once-routine tasks that require sequential steps, such as cooking, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer's may forget how to do even the most basic things.
• Personality changes. People with Alzheimer's may exhibit mood swings. They may express distrust in others, show increased stubbornness and withdraw socially. Early on, this may be a response to the frustration they feel as they notice uncontrollable changes in their memory. Depression often coexists with Alzheimer's disease. Restlessness also is a common sign. As the disease progresses, people with Alzheimer's may become anxious or aggressive and behave inappropriately.

Typically, loved ones notice very gradual — not sudden — changes in a person with Alzheimer's. As the disease progresses, signs and symptoms become serious and noticeable enough to cause people with Alzheimer's or their family members to seek medical help. Many people with Alzheimer's disease realize that something is happening to their memory, which is often frightening.

The course the disease takes and how rapidly changes occur vary from person to person. The average survival rate is eight years after being diagnosed with Alzheimer's, but some people live as few as three years after diagnosis, while others live as long as 20 years.

Alzheimer's generally progresses from mild to moderate to severe to, finally, profound impairment. People with mild Alzheimer's can usually live alone and function fairly well. Those with moderate Alzheimer's may have greater difficulty coping without supervision. People with advanced Alzheimer's generally can no longer care for themselves.

Alzheimer's and other cognitive conditions
Researchers have identified a state of memory loss called mild cognitive impairment, which could potentially be known as a pre-Alzheimer's period. This memory loss falls somewhere between what's associated with normal aging and what's common in Alzheimer's disease. People with mild cognitive impairment may experience forgetfulness beyond what's typical for their age, yet they don't have the dementia of Alzheimer's. Identification of this category of memory loss could help doctors more accurately diagnose, advise and treat these people. It could also alert these people to a greater risk of developing Alzheimer's disease.

In the past, people called dementia senility and considered it an inevitable part of aging. Doctors now know that dementia isn't a normal part of aging and that it's caused by some underlying condition affecting the brain.

While Alzheimer's is one of the most common causes, many different conditions can cause dementia. Some are treatable, such as depression. That makes it important to diagnose the particular signs and symptoms of dementia and attempt to identify its underlying cause.

The causes of Alzheimer's aren't well understood. But researchers have found that people with Alzheimer's have brain cells that become damaged and die for unknown reasons.

A healthy brain has about 100 billion nerve cells called neurons. Neurons generate electrical and chemical signals that are relayed from neuron to neuron to help you think, remember and feel. Chemicals called neurotransmitters help these signals flow seamlessly between neurons.

Initially in people with Alzheimer's, neurons in certain locations of the brain begin to die. As they die, lower levels of neurotransmitters are produced, creating signaling problems in the brain.

Plaques and tangles
Alzheimer's disease is named after Dr. Alois Alzheimer, a German neurologist. In 1906, he examined the brain of a woman who had died after years of progressive dementia. Her brain tissue showed abnormal clumps and irregular knots of brain cells. Today, these clumps (now called plaques) and knots (now called tangles) are considered hallmarks of Alzheimer's disease.

Researchers continue to study these abnormal structures — plaques and tangles — to better understand why brain cells slowly die in people with Alzheimer's. In the meantime, scientists have theories that may explain how these structures are involved in Alzheimer's disease:

• Plaques. Plaques are made up of a normally harmless protein called beta-amyloid. It's believed that deposits of plaques form between neurons early on in the disease process, before neurons begin to die and symptoms develop. Although the ultimate cause of neuron death in Alzheimer's isn't known, mounting evidence suggests that a form of beta-amyloid protein may be the culprit. Three genetic mutations — in amyloid precursor protein (APP) and presenilin 1 (PS1) and presenilin 2 (PS2) proteins — are known to cause a small number of early-onset forms of Alzheimer's disease. These mutations result in the production of amyloid plaques. Together, these three genetic mutations account for less than 10 percent of all Alzheimer's cases.
• Tangles. The internal support structure for brain neurons depends on the normal functioning of a protein called tau. In people with Alzheimer's, threads of tau protein undergo alterations that cause them to become twisted. Many researchers believe this may seriously damage neurons, causing them to die.

Inflammatory responses
Researchers have observed inflammation in the brains of some people with Alzheimer's disease. Inflammation is your body's response to injury or infection and a natural part of the healing process.

Even as beta-amyloid plaques develop in the spaces between neurons, immune cells (microglia) are at work getting rid of dead cells and other waste products in the brain. Scientists speculate that the microglia may view plaques as foreign substances in the body and try to destroy them, triggering the inflammatory response. Or the microglia may be trying to remove damaged neurons. The microglia may also activate other compounds that cause inflammation. Although researchers believe the inflammation occurs before plaques have fully formed, they aren't sure how this development relates to the disease process. There's also debate about whether inflammation has a damaging effect on neurons or whether it is beneficial in clearing away plaques.

Alzheimer's is a complex disease that's likely caused by a variety of influences. Although all of these influences may never be known, scientists have identified several risk factors that may increase the likelihood of developing Alzheimer's disease. They include:

• Age. Alzheimer's usually affects people older than 65, but can, rarely, affect those younger than 40. The average age at diagnosis is about 80. Less than 5 percent of people between 65 and 74 have Alzheimer's. For people 85 and older, that number jumps to nearly 50 percent.
• Heredity. Your risk of developing Alzheimer's appears to be slightly higher if a first-degree relative — parent, sister or brother — has the disease. Although the genetic mechanisms of Alzheimer's among families remain largely unexplained, researchers have identified a few genetic mutations that greatly increase risk in some families. Three genetic mutations are known to cause early-onset Alzheimer's. In addition, one form of the apolipoprotein E (APOE) gene increases your chance of developing late-onset Alzheimer's.
• Sex. Women are more likely than men are to develop the disease, in part because they live longer.
• Lifestyle. The same factors that put you at risk of heart disease, such as high blood pressure and high cholesterol, may also increase the likelihood that you'll develop Alzheimer's disease. And, keeping your body fit isn't your only concern — you've got to exercise your mind as well. Some studies have suggested that remaining mentally active throughout your life, especially in your later years, reduces the risk of Alzheimer's disease. Other studies have found an association between low education and the risk of Alzheimer's. These studies have supported the notion that people might be able to influence their risk of Alzheimer's based on their mental activity. Some researchers theorize that the more you use your brain, the more synapses you create, which provides a greater reserve as you age. It remains unclear, however, whether lower education and less mental activity create a risk of Alzheimer's or if it's simply harder to detect Alzheimer's in people who exercise their minds frequently or who have higher education.
• Environment. Researchers are studying environmental factors to discover both the possible causes and the prevention of Alzheimer's. For example, some people with Alzheimer's have deposits of aluminum in their brain. But scientists who've studied environmental sources of aluminum — everything from antiperspirants to drinking water — haven't found a link between aluminum exposure and Alzheimer's. At this point, there's no irrefutable evidence regarding any environmental factor increasing a person's risk of Alzheimer's.
• Head injury. The observation that some ex-boxers eventually develop dementia leads to the question of whether serious traumatic injury to the head (for example, with a prolonged loss of consciousness) may be a risk factor for Alzheimer's. Several studies indicated a definite link between the two, but others found no link.
• Hormone replacement therapy. The exact role hormone replacement therapy may play in the development of dementia isn't yet clear. Results from the large-scale study called the Women's Health Initiative Memory Study indicated an increased risk of dementia for women 65 years and older who had taken hormone replacement therapy. However, previous studies have suggested that estrogen supplements given after menopause could reduce the risk of dementia. Additionally, the Women's Health Initiative Memory Study didn't study the effect of estrogen on the risk of dementia if given to women younger than 65.

There's no one test to diagnose Alzheimer's disease. Instead, doctors diagnose Alzheimer's disease through a process of elimination — ruling out other diseases and conditions that also can cause memory loss.

Small, undetected strokes, for example, can cause dementia by temporarily interrupting blood flow to the brain. People with Parkinson's disease, a degenerative nerve disease, also can develop dementia. Depression can cause lapses in memory. In addition, many older adults are on multiple medications that may impair their ability to think clearly.

To help distinguish Alzheimer's disease from other causes of memory loss — which are often treatable — doctors typically rely on the following:

• Medical history. Doctors may ask about a person's general health and past medical problems. They'll want to know about any problems a person may have in carrying out daily activities. If possible, doctors will also want to speak with a person's family or friends to get more information.
• Basic medical tests. Blood and urine tests may be done to help doctors rule out other potential causes of the dementia. In some cases, testing a small amount of spinal fluid may help.
• Mental status evaluation. These tests screen memory, problem-solving abilities, attention spans, counting skills and language. They help doctors pinpoint specific problems a person may have with cognition. For instance, doctors might test recent and long-term memory by asking: What day is it today? Or: When was World War II? Recall tests are another example. Doctors may list familiar objects, and then ask a person to repeat them immediately, and again five minutes later.
• Neuropsychological testing. Sometimes doctors undertake a more extensive assessment of memory, problem-solving abilities, attention spans, counting skills and language. This is especially helpful in trying to detect Alzheimer's and other dementias at an early stage. Doctors use formal psychological tests to determine if a person's mental abilities are as expected for his or her age and education. The patterns of any mental deficits observed during neuropsychological testing can help doctors sort out possible causes of dementia.
• Brain scans. Doctors may want to take a picture of the brain using a brain scan. Several types of brain scans are available — including a computerized tomography (CT) scan, a magnetic resonance imaging (MRI) scan and a positron emission tomography (PET) scan. By looking at a picture of the brain, doctors may be able to pinpoint any visible abnormalities. Researchers are studying whether brain scans can eventually be used to detect an increased risk of Alzheimer's in healthy people before symptoms begin.

Using the methods above, doctors can accurately diagnose 90 percent of Alzheimer's cases. Alzheimer's can be diagnosed with complete accuracy only after death, using a microscopic examination of brain tissue, which checks for plaques and tangles.

Genetic testing for Alzheimer's is in its beginning stages. Blood tests are available that can tell whether a person carries the genetic mutations believed to be associated with Alzheimer's, but the tests can't tell who will or will not get the disease.

Most people with Alzheimer's don't die of the disease itself, but of a secondary illness, such as pneumonia.

In advanced Alzheimer's disease, people may lose all ability to care for themselves. They may have difficulty eating, become incontinent, or be unable to take a walk and find their way back home.

These inabilities can increase the risk of additional health problems such as:

• Pneumonia. Difficulty swallowing food and liquids may cause people with Alzheimer's to inhale some of what they eat and drink into their airways and lungs, which can lead to pneumonia.
• Infections. Urinary incontinence may require the placement of a urinary catheter, which increases the risk of urinary tract infections. Untreated urinary tract infections can lead to more serious, life-threatening infections.
• Falls and their complications. People with Alzheimer's may become disoriented, increasing their risk of falls. Falls can lead to fractures. In addition, falls are a common cause of serious head injuries, such as bleeding in the brain. Surgery to repair injury from a fall carries risks as well. For instance, prolonged immobilization — which may be necessary to recover from injuries related to a fall — increases the risk of a blood clot in the lungs (pulmonary embolism), which can be life-threatening.

Currently, there's no cure for Alzheimer's disease. Medications and caregiving are the primary treatments.

Medications
Current medications for Alzheimer's can't stop or reverse the underlying disease process. But they may slow it down, lessening signs and symptoms. Medications commonly recommended for people with mild to moderate Alzheimer's include:

• Cholinesterase inhibitors. This group of medications, which includes donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl), works by improving the levels of neurotransmitters in the brain. Research published in April 2005 in the New England Journal of Medicine indicates that donepezil (Aricept) additionally can delay, although not prevent, the onset of Alzheimer's disease. Researchers believe that delaying or slowing Alzheimer's is an important step in fighting the disease. About half of people taking cholinesterase inhibitors have some improvement in their signs and symptoms.
• Memantine (Namenda). In October 2003, the Food and Drug Administration approved the drug memantine (Namenda), the only medication specifically indicated for treatment of moderate to severe stages of Alzheimer's. Memantine seems to slow the loss of daily living skills, such as dressing and going to the bathroom. The drug works by protecting brain cells from damage caused by the chemical messenger glutamate.

Doctors also sometimes prescribe drugs to improve behavioral symptoms that often accompany Alzheimer's, including sleeplessness, wandering, anxiety, agitation and depression.

Today, treatment of Alzheimer's disease is still in its infancy. But researchers are hoping that new medications will be available that do more than treat the symptoms of Alzheimer's. Some recent studies have found success using immune globulins to reduce the amount of beta-amyloid in the brain, while other researchers have produced drugs that stop or at least inhibit the production of beta-amyloid.

Caregiving
Until there's a cure for Alzheimer's, people with the disease will need caregiving. According to the Alzheimer's Association, approximately one in 10 families has a relative with Alzheimer's disease. Of the 4 million people with Alzheimer's disease in the United States, the majority live at home — often receiving part- or full-time care from family members.

Caregiving can be a challenge. The slow and unpredictable decline that may last more than a decade requires caregivers to exercise patience, understanding, compassion, and often, creativity.

The key to caregiving is focusing on things that the person with Alzheimer's can still do and enjoy. In fact, learning ways to reduce the impact of impaired abilities and behavior problems can help avoid some of the most difficult aspects of the disease.

Each person with Alzheimer's disease experiences symptoms and progression differently. Consequently, the techniques to care for each person should vary. You may have to adapt the following tips to your specific caregiving situation:

• Use memory aids. Memory aids may help a friend or family member remain independent. Write out a list of the day's activities, the phone numbers that can be used to call for help, and instructions on how to do simple tasks, such as make a cup of tea or use the telephone.
• Provide structure. A home environment that provides serenity and stability reduces behavior problems. New situations, noise, large groups of people, being rushed or pressed to remember, or being asked to do a task that's too difficult can cause anxiety. As a person with Alzheimer's becomes upset, the ability to think clearly declines even more.
• Monitor wandering. Wandering is a common problem. In some cases, a pocket card with simple instructions, such as "Call home" (with a phone number below), may help. Make sure your loved one wears a bracelet with his or her name, phone number and a notation such as "Memory impaired." The Alzheimer's Association, which has a 24-hour hot line — (800) 272-3900 — offers this resource through its national Safe Return Program. Also try to determine the cause of wandering. It may simply be a signal that the person with Alzheimer's is looking for something, such as a bathroom, or is seeking a meaningful activity or reassurance. Some experts believe taking your loved one for a vigorous daily walk helps reduce wandering.
• Establish a nighttime ritual. Behavior is often worse at night. Try to establish going-to-bed rituals that are calming and away from the noise of television, meal cleanup and active family members. Leave night lights on to prevent disorientation. Limiting caffeine during the day, discouraging daytime napping and offering opportunities for exercise during the day may help prevent nighttime restlessness.
• Enhance communication. When talking with your loved one, stand where you can be seen and touch his or her arm or shoulder to focus attention. Speak slowly, in simple sentences and don't rush the response. Present only one idea or instruction at a time. Use gestures and cues, such as pointing to objects. Avoid asking questions or offering difficult choices because trying to come up with answers may prove frustrating.
• Create a safe environment. Make your home familiar and safe. Keep furniture in the same place to avoid clutter and help prevent falls. Install locks on cabinets containing medicines, alcohol, guns, toxic substances, and dangerous utensils and tools. Remove electrical appliances from your bathroom to prevent shocks, set your water heater no higher than 120 F to prevent scalding, and install grab rails to prevent falls.
• Encourage exercise. Exercise carries many benefits for someone with Alzheimer's disease. The fact that these benefits often are the same for people without Alzheimer's disease doesn't lessen their importance. In fact, it just makes exercise a more important activity for caregivers and people with Alzheimer's to engage in together. The main benefits of exercise include improved strength and cardiovascular health. Exercise can also lessen symptoms of depression and help retain motor skills, create a calming effect. It can also help sustain strength, flexibility and balance — which may lessen the risk of serious injury from a fall.

In addition to helping someone with Alzheimer's deal with daily challenges, family members and loved ones should begin to try to answer practical, long-term questions about caregiving as soon as possible. These questions may involve personal, legal and financial issues. Some examples might include:

• Level of self-sufficiency. How long can a person with Alzheimer's safely drive, work or live alone?
• Who's available and able to help. Can family or friends provide the care necessary for the current phase and during later progression of the disease?
• Financial resources. Is money available for professional in-home care or a care facility now or in the future if the need arises?

It's important for people with Alzheimer's, their doctors and their families to discuss these matters early on in the disease. In general, people with Alzheimer's should be afforded as much independence as is safely possible and for as long as possible.

Right now, there's no way to prevent the onset of Alzheimer's disease. Researchers had developed what looked to be a promising vaccine against Alzheimer's that worked by stopping deposits of beta-amyloid in the brain. Animal studies were so encouraging that human trials began in 2001. Unfortunately, they had to be quickly halted because some people experienced serious inflammation of the brain. While these results were disappointing, scientists learned from these experiments and many researchers continue to look for ways to reduce the risk of this disease. Several leads are hopeful, but preliminary. They include:

• Healthy aging. Some of the most recent research indicates that taking steps to improve your cardiovascular health, such as losing weight, exercising and controlling high blood pressure and cholesterol, may also help prevent Alzheimer's disease. Some studies have also suggested that eating a low-fat diet, as well as consuming foods rich in omega-3s, such as fatty fish, may be helpful.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Several studies have shown that the NSAIDs ibuprofen (Advil, Motrin, others), naproxen sodium (Aleve) and indomethacin (Indocin) may reduce the risk of developing Alzheimer's. This may be because inflammation appears to play a role in Alzheimer's. What isn't known, however, is whether inflammation is a cause of Alzheimer's or simply an effect of the disease. Because NSAIDs can cause serious gastrointestinal bleeding, clinical trials need to be completed before it's clear whether people should take NSAIDs solely to prevent Alzheimer's.
• Vitamin E and selegiline. Researchers have been studying whether the antioxidants vitamin E and selegiline (Eldepryl), a drug used to treat Parkinson's disease, may protect against the progression of Alzheimer's. However, research published in April 2005 in the New England Journal of Medicine indicates no benefit from taking vitamin E. The research showed no significant difference in the progression from mild cognitive impairment to Alzheimer's disease in a group of people taking vitamin E compared with a control group that was not taking vitamin E.
• Statins. These drugs are normally used to lower cholesterol levels, but recent studies have shown that they may also reduce the risk of Alzheimer's disease. More studies are being done to determine exactly what role statins may have in Alzheimer's prevention.
• Estrogen. This female hormone appears to help memory and cognitive function. Early studies suggested that estrogen might provide a protective effect against Alzheimer's, but more recent studies have failed to confirm a positive effect from estrogen in women who already had Alzheimer's. Research is under way, however, to see if taking estrogen supplements can prevent, or at least delay, Alzheimer's in women with a family history of the disease.
• Mental fitness. Maintaining mental fitness may delay onset of dementia. Some researchers believe that lifelong mental exercise and learning may promote the growth of additional synapses, the connections between neurons, and delay the onset of dementia. Other researchers argue that advanced education gives a person more experience with the types of memory and thinking tests used to measure dementia. This advanced level of education simply may help some people "cover up" their condition until later.

People with Alzheimer's disease often experience a mixture of emotions — confusion, frustration, anger, fear, uncertainty, grief and depression. You can help a person cope with the disease by being there to listen, reassuring the person that life can still be enjoyed, providing unconditional love and doing your best to help the person retain dignity and self-respect.

Caring for a person with Alzheimer's disease can be an all-absorbing experience. The physical and emotional demands of caregiving can be exhausting. Feelings of anger and guilt, frustration and discouragement, worry and grief, and social isolation are common. If you're a caregiver for someone with Alzheimer's disease, you can help yourself and help prevent caregiver burnout by:

• Asking friends or other family members for help when you need it.
• Taking care of your health.
• Learning as much about the disease as you can. Ask questions of doctors, social workers and others involved in the care of your loved one.
• Joining a support group.

Many people with Alzheimer's and their families can benefit from counseling or local support groups. Contact your local Alzheimer's Association affiliate to get connected with support groups, doctors, resources and referrals, home-care agencies, supervised living facilities, a telephone help line and educational seminars.

Some people have tried alternative medicines and therapies in the treatment of Alzheimer's. Among the alternative approaches are the following:

• Ginkgo. The herb ginkgo continues to be studied for its brain-enhancing effects both in healthy people and in people with Alzheimer's. For now, however, ginkgo isn't proved to improve memory or prevent Alzheimer's.
• Vitamin E. An antioxidant being studied as a treatment for Alzheimer's, vitamin E doesn't require a prescription. You can purchase vitamin E over-the-counter. But it's best taken under a doctor's supervision to monitor for possible side effects such as bleeding and gastrointestinal problems, especially if the person with Alzheimer's is taking blood-thinning medications.
• Huperzine A. One dietary supplement that appears to be similar in efficacy to the Alzheimer's drugs that are currently on the market is huperzine A. However, because huperzine A is a dietary supplement, it isn't regulated in the same manner that Alzheimer's drugs are and quality and purity can't be assured. The National Institute on Aging began studying huperzine A in the treatment of mild to moderate Alzheimer's disease in spring 2004.
• Coenzyme Q-10. This supplement has not been well studied in the treatment of Alzheimer's and will likely have no effect on the progression of the disease.
• Coral calcium. This supplement has not been well studied in the treatment of Alzheimer's and will likely have no effect on the progression of the disease.

Some limited studies suggest that aromatherapy — using fragrant plant oils to relax and affect the body — and massage can play a supportive role in Alzheimer's treatment by helping to reduce agitated or restless behavior.