From the Guidelines
Alzheimer's disease typically presents with memory loss, particularly difficulty remembering recently learned information, as its earliest and most prominent symptom, with early onset possible in a person's 30s, 40s, or 50s, though this is rare, affecting only about 5-10% of all Alzheimer's patients. Other common signs include:
- Challenges in problem-solving
- Confusion with time or place
- Difficulty completing familiar tasks
- Trouble understanding visual images
- Problems with words in speaking or writing
- Misplacing things
- Decreased judgment
- Withdrawal from work or social activities
- Changes in mood or personality The disease progresses gradually, with symptoms worsening over time as brain cells deteriorate and die, and the mean survival time for people with Alzheimer disease was 7.6 ± 2.1 years from onset and 5.8 ± 2.0 years from diagnosis, with both of these figures approximately 1 year shorter for those who had non‐Alzheimer dementias 1. Early diagnosis is important as medications like cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and memantine may temporarily improve symptoms or slow progression in some patients 1.
Most cases are late-onset, appearing after age 65, with risk increasing significantly with age. The disease results from abnormal protein accumulations (amyloid plaques and tau tangles) that disrupt communication between neurons and eventually cause cell death, particularly in brain regions responsible for memory and thinking. Factors such as moderate dementia at onset of treatment, vascular risk factors, a younger age, a higher level of education, early appearance of hallucinations and psychosis or extrapyramidal symptoms can predict rapid cognitive decline 1.
High-quality, person-centered care, including psychosocial interventions, is now recognized as the first line of prevention and treatment for behavioral and psychological symptoms of dementia (BPSD) and for supporting quality of life generally in people with dementia, with medication used as a carefully monitored, short-term, last resort in specific cases 1. The progression of Alzheimer's disease can be categorized into early-stage/mild, middle-stage/moderate, and late-stage/advanced/severe dementia, with early-stage/mild dementia characterized by milder symptoms, such as difficulty thinking of the right word or name, and minimal functional impact.
From the Research
Signs and Symptoms of Alzheimer's Disease
- Alzheimer's disease (AD) is a kind of neuropsychiatric illness that affects the central nervous system 2
- The accumulation of amyloid-beta increases, and phosphorylated tau (P-tau) protein is one of the ways to treat this disease 2
- Current treatment for AD (donepezil, galantamine, rivastigmine and memantine) is only symptomatic and has modest benefits 3
Onset of Alzheimer's Disease
- Alzheimer's disease is predominantly a disease of later life, affecting 5% of those over 65 in the UK 4
- The disease severity can be measured by the Mini Mental State Examination (MMSE), with mild AD (MMSE 21-26), moderate AD (MMSE 10-20), and severe AD (MMSE < 10) 4
- The onset of AD can be slow, with symptoms such as cognitive decline, functional decline, and behavioral changes 5, 6
Treatment and Management
- Cholinesterase inhibitors (donepezil, galantamine, rivastigmine) and the NMDA receptor antagonist memantine are presently authorized therapies for AD 2
- These medications can stabilize or slow decline in cognition, function, behavior, and global change 5, 6
- However, the effectiveness of these medications can vary, and more research is needed to determine their long-term benefits and potential side effects 5, 6, 4