Alzheimer's disease is the most common form of dementia. The classic symptom of Alzheimer's disease is memory loss. At the beginning it is mostly new information that is easily forgotten. Gradually other skills such as language or the ability to think in an organised way may also be affected. Patients with mild to moderate forms of the disease are able to compensate for it quite well. For example they may develop strategies to allow them to work around problems or their partners may help when they find things difficult.
In the media and in public opinion, the term 'Alzheimer's' is often associated with the more advanced stages. In our memory clinic we monitor a large number of patients who are in the milder stages of Alzheimer's disease. Patients in the mild to moderately advanced stages of the disease are the largest group of patients at the memory clinic. Nevertheless, even at that stage these conditions raise many questions. We will consider here some of the questions that patients and family members often ask us when they are given a diagnosis of Alzheimer's disease.
What will happen to me?
Alzheimer's disease often progresses in what we call 'plateau stages'. Some patients remain relatively stable for many years after they receive a diagnosis and start their treatment.
Sooner or later a time will come when the patient deteriorates further. It is difficult to predict for an individual patient exactly when this will be. For some patients the deterioration happens quite quickly, and for others it happens in a slower and more subtle way.
Does medication help?
There are currently two groups of medications that have proven to be useful in the treatment of Alzheimer's disease: cholinesterase inhibitors and Memantine.
Both types are 'cognitive enhancers' and they often also have a beneficial effect on behavioural and personality changes (anxiety, depressive symptoms etc.).
Is it hereditary?
When we talk about inherited conditions it is important to distinguish between on the one hand genetic risk factors and genetic mutations on the other.
Genetic risk factors increase the risk of developing the disease, but that does not mean that the disease will actually occur. The most important genetic risk factor for Alzheimer's disease is the 'apolipoprotein E type 4 allele'. It is possible to be a carrier of this allele without ever developing the disease. For this reason it is never used in pre-symptomatic screening for Alzheimer's disease.
Genetic mutations are different from risk factors because they are causative factors. They can only rarely provide an explanation for cases of Alzheimer's disease (about 0.5%), and in those cases the disease usually appears before the age of 60. Specifically the mutations involved usually affect presenilin 1 and amyloid precursor protein (APP).