Is it Alzheimer’s?
It is quite common for middle-aged and older individuals who notice occasional memory lapses to wonder if they might be developing Alzheimer’s dementia (AD). Encountering someone with Alzheimer’s is increasingly common as our society’s elderly population grows. However, it’s essential to understand that forgetfulness is a normal part of aging and typically does not indicate impending dementia.
The word dementia comes from the Latin roots de- meaning “apart or away” and mentis meaning “mind.” Dementia involves a progressive decline in cognitive and behavioral abilities due to damage or disease affecting the brain, beyond what we expect with normal aging. Alzheimer’s dementia is the most common form, currently affecting approximately 6.9 million Americans aged 65 and older, though many more exhibit mild cognitive impairment yet remain fully functional. Most cases of Alzheimer’s disease occur sporadically, with only about seven percent linked to genetic factors.
As of 2024, about 1 in 9 people (10.8%) aged 65 and older have Alzheimer’s disease, with prevalence increasing significantly with age – 5% among those aged 65 to 74, 13.1% among ages 75 to 84, and 33.3% among those aged 85 and older. It is estimated that by 2060, 13.8 million Americans aged 65 or older will be living with AD, highlighting the disease’s growing impact. The cost of dementia care in the U.S. reached approximately $360 billion in 2024, with Medicare and Medicaid covering $231 billion of this amount and out-of-pocket expenses by patients and families reaching around $91 billion. Nursing home care costs for AD patients average $9,733 per month nationally.
Alzheimer’s dementia is associated with specific changes within the brain. Two primary features seen under microscopic examination are neurofibrillary tangles (NFTs) and senile plaques (SPs). These features were first described by German psychiatrist Alois Alzheimer in 1907. However, NFTs and SPs are not exclusive to Alzheimer’s; they can also occur in other brain disorders, such as Chronic Traumatic Encephalopathy (CTE), often associated with repeated concussions in athletes. A diagnosis of Alzheimer’s requires NFTs and SPs to be present in significant numbers and in specific brain locations.
Normally, nerve cells, or neurons, follow highly organized pathways that facilitate clear communication with other neurons. These pathways help us think clearly and form memories effectively. In Alzheimer’s, the neurons become disorganized and tangled, like strands of hair knotted and interwoven with bubble gum. These plaques and tangles disrupt neuronal communication, significantly impairing cognitive function.
Pinpointing the exact causes of Alzheimer’s disease remains challenging. Research has mainly focused on tau proteins, normal components of nerve cells that can fold abnormally, forming the tangles characteristic of Alzheimer’s. Researchers continue developing treatments designed to reduce these abnormal tau proteins or prevent their harmful aggregation. Additionally, recent advances have seen the approval of monoclonal antibody treatments aimed at reducing amyloid plaque formation, another hallmark of Alzheimer’s dementia.
Diagnosis of Alzheimer’s dementia involves a careful and complex process typically carried out by a team of medical experts. The process begins with a thorough medical history, physical examination, and basic blood tests to rule out other conditions that mimic dementia, such as infections, metabolic disorders, vitamin deficiencies, depression, or thyroid problems. Brain imaging, including CT or MRI scans, helps visualize structural brain changes, sometimes supplemented with special imaging agents that highlight the plaques and tangles. Additional assessments, including brain wave tests (EEG) and genetic testing, especially when a family history is present, may also be necessary. While researchers are exploring biomarkers detectable in blood or spinal fluid, these tests are still under development. Neuropsychological testing conducted by clinical psychologists can pinpoint specific brain areas affected by the disease.
Interestingly, recent research has highlighted preventive measures, such as vaccination. A notable recent study found a 20% reduction in relative risk for dementia among individuals who received the shingles vaccine compared to those who did not. This finding suggests that vaccines may offer an unexpected yet significant protective benefit against developing dementia, including Alzheimer’s disease.
Early Alzheimer’s dementia typically presents as slowly progressive memory loss, which understandably leads to worry. Routine forgetfulness, such as misplacing keys or forgetting a reason for entering a room, typically isn’t cause for concern. However, memory loss that consistently disrupts daily life indicates the need for medical evaluation. For detailed information, the Alzheimer’s Association website (bit.ly/3ajnKKV) provides a comprehensive list of ten warning signs and additional resources valuable for individuals and families seeking guidance about this disease.