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By Teresa Otto, MD
October 20, 2022
Most of us have misplaced our keys or forgotten what we went into another room for. Losing things or being forgetful happens to everyone. If you’re stressed, short on sleep, or in a hurry, you may notice even more lapses.
When do we chalk forgetfulness up to a hectic life, and when should we be concerned?
Let’s look at normal brain function as you age vs. Alzheimer’s disease and then dive into the stages, causes, treatments, and ways to save on prescription medications, including the only disease-modifying medication used to treat Alzheimer’s disease.
It can be difficult to know if early lapses in memory or occasional poor choices signal the beginning of Alzheimer’s disease. How can you tell the difference between normal aging and Alzheimer’s disease? Taking a self-assessment may be a place to start but should never replace a medical evaluation.
Here are some reasons to visit your healthcare provider:
Alzheimer’s disease is the most common form of dementia. It primarily affects people 65 years old or older, although up to 10% of people develop Alzheimer’s disease at a younger age.
Alzheimer’s disease worsens progressively, but the rate at which it worsens varies by individual. Alzheimer’s disease has several stages once symptoms begin.
With early or mild Alzheimer’s disease, you may live independently, work, and drive. However, you have:
The middle stage or moderate Alzheimer’s disease lasts the longest. Your memory and decision-making decline, and your personality and behavior begin to change. You need some help with daily activities and:
During the late stage or severe Alzheimer’s disease, you are significantly impaired:
Although some people with Alzheimer’s disease may live 20 years after the diagnosis, most die within four to eight years. The leading causes of death with Alzheimer’s disease are pneumonia, malnutrition, and dehydration.
Currently, there’s no cure, although early treatment with medication and therapy may slow the disease’s progression.
The exact cause of Alzheimer’s disease remains a mystery and may vary from individual to individual. Here are some factors that contribute to Alzheimer’s disease:
Although the causes of Alzheimer’s disease are still being studied, the changes that occur in your brain are known. Proteins accumulate within and between your brain cells. The proteins form neurofibrillary tangles in the brain cells and amyloid plaques between the cells that interfere with normal brain function.
With Alzheimer’s disease, your brain also fails to clean house. Waste products from metabolism, toxins, and amyloid plaques build up and cause chronic inflammation.
No single test exists to diagnose Alzheimer’s disease. Your healthcare provider will obtain a medical history and perform a physical exam. Suppose a loved one accompanies you to the visit. In that case, they will probably be asked about your memory, judgment, difficulties with daily living activities, and any change in your personality. Your healthcare provider will test your memory by asking a series of standard questions or referring you for a computer-based test. If you are younger than 60, you may have a genetic test looking for inherited Alzheimer’s disease.
With the medical history, physical exam, blood tests, and brain imaging, your healthcare provider will be looking for other reasons for memory loss, such as:
Even if your memory loss doesn’t stem from a treatable medical condition, early treatment can slow the progression of Alzheimer’s disease.
Along with memory loss, you are very likely to have behavior changes from the damage caused by amyloid plaques and tangles. Early in Alzheimer’s disease, depression, anxiety, and irritability are common. As the disease progresses, behavior changes include:
The Food and Drug Administration (FDA) has approved many drugs to relieve the symptoms of Alzheimer’s disease. But so far, only one drug is approved to treat the anatomical changes seen in your brain. That drug is aducanumab (Aduhelm).
Aducanumab (Aduhelm) reduces amyloid plaque and is the first drug to treat an underlying cause of Alzheimer's disease. The FDA approved Aduhelm early so people with mild Alzheimer's disease could enter clinical drug trials and reap the potential benefits. Ongoing studies are looking at how much Adulhelm reduces cognitive decline and improves day-to-day functioning.
If you've been diagnosed with early Alzheimer's disease, you may be qualified to participate in Aduhelm studies.
Other FDA-approved medications target the symptoms rather than the cause of Alzheimer’s disease. Medications for cognitive improvement include:
Insomnia frequently affects people with Alzheimer’s disease. Inadequate or poor sleep can make thinking and reasoning more difficult and worsen your mood. Suvorexant (Belsomra), a sleep aid, may break this vicious cycle and promote better sleep.
Depression and anxiety frequently accompany early Alzheimer’s disease. Symptoms may be reduced or relieved by non-medication therapies (see below). If depression doesn’t improve with non-medication therapy, antidepressants can help. Antidepressants include:
Medications used to treat anxiety, restlessness, pacing, and verbal outbursts include:
An anti-seizure medication, carbamazepine (Tegretol), may be prescribed for aggressive behavior that is hard for caregivers to manage. Likewise, antipsychotic medications, such as aripiprazole (Abilify), olanzapine (Zyprexa), or risperidone(Risperdal), may be prescribed for agitation, paranoia, hallucinations, and aggression. Both classes of drugs have significant side effects in people with Alzheimer’s disease so non-medicine approaches to modifying behavior should be tried first.
Normally Medicare covers FDA-approved medications. In an unprecedented move, Medicare added stipulations to its coverage of aducanumab (Aduhelm). For Medicare recipients, the prescription drug plan pays 80% of the Aduhelm’s cost only if you are enrolled in a clinical study using this medication.
If you aren’t part of an aducanumab study, Medicare won’t pay. And the medication can be prohibitively expensive if it isn’t covered by your health insurance.
Here’s how ScriptSave® WellRx can help. WellRx allows you to compare prescription prices at pharmacies near you by entering the prescription drug’s name and your zip code. If you are paying for aducanumab out of pocket, finding the lowest prescription price means more money left in your wallet.
To learn about how prescription discount cards work, compare your prescription and over-the-counter medication prices, claim your free Rx savings card, and receive coupons for medications, visit WellRx.
A variety of therapies may be part of a comprehensive treatment plan to improve quality of life and slow the progression of Alzheimer’s disease.
Art projects can stimulate brain function, boost your mood, allow for creativity, and promote social interaction.
Actual and virtual travel can bring joy and improve the symptoms of Alzheimer’s disease. Planning and anticipation, followed by experiencing the sights and sounds of a new environment and spending time with loved ones, can improve your quality of life and stimulate your brain.
Reminiscence therapy may improve depression and quality of life by remembering loved ones and pleasant events from the past. This may help a person with Alzheimer’s disease focus on what they can remember rather than dwell on what they can’t recall.
Memories triggered by listening to music and singing can reduce agitation and aggressive behavior in the middle and late stages of Alzheimer’s disease.
If you are a caregiver for a loved one with Alzheimer’s disease, you are in good company. In 2021, more than 11 million Americans provided upwards of 16 billion unpaid hours of care to loved ones with Alzheimer’s disease and other forms of dementia.
As Alzheimer’s disease progresses, behavior changes become more apparent and may make caregiving even more difficult. It’s important to remember that this is a manifestation of the disease, not a personal attack. Some coping strategies include:
Support groups and resources can help you with the caregiving journey. Those who’ve cared for loved ones with Alzheimer’s disease will tell you not to forget about caring for the caregiver. Please be sure to schedule time away for your emotional and physical well-being.
Teresa Otto, MD, is a freelance medical writer on a mission to inform readers about the positive impact of good nutrition and a healthy lifestyle. She is a retired anesthesiologist who practiced in Billings, Montana, for most of her career. She graduated from the University of Washington School of Medicine in Seattle and did her anesthesia residency and fellowship at New York University and Columbia-Presbyterian in New York.
Resources:
https://www.alz.org/help-support/caregiving/care-options/respite-care
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