Alzheimer's disease

In 1906, German psychiatrist and neurologist Alois Alzheimer, MD, observed abnormal changes in a patient’s brain following their death from an inexplicable illness. Their symptoms included memory loss, unusual behavior, confusion, and difficulty with language. The patient’s brain contained tangled bunches of fibers (now known as tau tangles) and clumps of proteins and cell fragments (now known as amyloid plaques). This was the first reported case of Alzheimer’s disease.

Alzheimer’s disease is a neurodegenerative disorder. This means it occurs when cells in the central nervous system (which includes the brain) stop working or die. Alzheimer’s also causes brain tissue to shrink. Eventually, Alzheimer’s leads to a complete loss of awareness. Death usually results from complications, such as aspiration pneumonia. (This form of pneumonia occurs when someone breathes food or liquid into the airways because they have difficulty chewing and swallowing.)

Symptoms of Alzheimer’s disease are subtle at first. For example, someone may have trouble remembering a recent conversation or finding the right words when speaking. Symptoms gradually progress to the point where they disrupt a person’s ability to perform everyday tasks. A person with Alzheimer’s may have difficulty understanding others, solving problems, learning new concepts, and remembering well-known people or places.

Researchers believe that Alzheimer’s disease starts affecting the brain around 10 years before symptoms appear. In the condition’s earliest stage (sometimes called the preclinical stage), amyloid plaques and tau tangles begin to form in the brain. Nerve cells called neurons start to malfunction, disconnect from other neurons, and die. Ordinarily, neurons transmit important messages and allow you to perform basic functions, such as thinking and talking.   

The changes that come with Alzheimer’s disease appear to originate in the entorhinal cortex and hippocampus. These are areas of the brain that regulate memory. Eventually, damage spreads throughout the brain and affects other functions, such as moving, making judgments, and socializing. Mood and personality are also affected, sometimes resulting in agitation, mood swings, and depression. 

Nearly 7 million people in the United States are living with Alzheimer’s disease. The condition is the seventh leading cause of death in the U.S. The Alzheimer’s Association also notes these facts about the disease:

• Around 1 person out of every 9 aged 65 and older has Alzheimer’s 
• Almost two thirds of those with Alzheimer’s are women or people assigned female at birth
• Around 12.7 million people in the U.S. ages 65 and older are anticipated to have Alzheimer’s by the year 2050 (if there is no cure or preventive treatment discovered before then)

What is the difference between Alzheimer's and dementia?

Alzheimer’s disease is the most common type of dementia. Dementia refers to a group of disorders that cause a progressive loss of cognitive function (a decline in someone’s ability to think, reason, and remember information). There are several other types of dementia, including vascular dementia, Parkinson’s disease dementia, and frontotemporal dementia. It’s possible to have two types of dementia at the same time, which is known as mixed dementia.

What is early-onset Alzheimer’s disease?

Early-onset Alzheimer’s disease causes symptoms in people younger than age 65, usually in their 40s or 50s. It’s also called younger-onset Alzheimer’s. (Alzheimer’s that occurs in people 65 and older is sometimes referred to as late-onset Alzheimer’s.)

Early-onset Alzheimer’s disease makes up fewer than 10 percent of Alzheimer’s cases. Healthcare providers (HCPs) aren’t certain what causes early-onset Alzheimer’s, but genetics appear to play a role in some cases. Genetics refers to certain factors or traits called genes that you inherit from your parents. Genes consist of molecules called DNA that carry a person’s genetic code.

Researchers have identified a few hundred families around the world who carry rare genes that cause Alzheimer’s, often in a person’s 30s, 40s, and 50s. This form of the disease can affect multiple family members across several generations. Such cases are sometimes referred to as familial Alzheimer’s disease because they run in families.

While early-onset Alzheimer’s disease is uncommon, some research indicates that numbers are on the rise. A 2020 study conducted by Blue Cross Blue Shield found that diagnosis rates of early-onset Alzheimer’s and dementia jumped 200 percent in people ages 30 through 64 between 2013 and 2017. The average age for someone living with early-onset Alzheimer’s or dementia in the study was 49.

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Alzheimer’s disease isn’t the same as temporary brain fog or age-related forgetfulness. It’s not unusual as you get older to occasionally misplace things, forget someone’s name, or have trouble finding words. But consistent difficulty with memory and performing daily tasks could be a sign of an underlying condition.

Warning signs of Alzheimer’s disease

Having trouble with memory is typically the first symptom of Alzheimer’s disease. The most common early signs of Alzheimer’s and other forms of dementia include:

Memory loss that interferes with everyday living: Someone may forget recently discussed information, ask the same question multiple times, become lost in a familiar place, or forget important appointments or dates. 

Trouble with familiar tasks: Someone may have a hard time completing routine tasks at work or home, such as compiling a grocery list or taking care of a pet.

New difficulty with language: Expressing thoughts in writing may become challenging, as can joining a conversation or following a discussion. Someone may completely lose their train of thought mid-conversation or be unable to finish a sentence. They may repeat things multiple times.

Having trouble with vocabulary can also occur. For example, someone may call a “chair” a “sitting thing,” a “newspaper” a “book,” or a “watch” a “hand clock.” (Everyone occasionally struggles to find the right words, but Alzheimer’s makes it increasingly difficult to carry out a simple conversation.)

Social withdrawal: Having difficulty with language can make someone want to avoid social situations, including work. Someone may lose interest in once-loved hobbies and activities.  

Trouble planning or solving problems: Someone may find it difficult to address a problem or create a plan and follow it. Examples may include developing a household budget, keeping track of expenses, remembering to make routine payments, or following a recipe.

Confusion regarding dates, times, or places: Someone may lose track of where they are or how they got there, fail to remember appointments, or forget what day it is. (Someone without Alzheimer’s may forget what day it is but remember shortly after.)

Changes in vision: Vision changes related to Alzheimer’s can make it difficult to judge how far away objects are. Someone may also find it increasingly hard to read, keep their balance, or identify colors.  

Misplacing items and being unable to retrace steps: Someone may repeatedly lose track of important items or put them in unusual places. They may be unable to retrace their steps or locate the item without another person’s help. As Alzheimer’s progresses, a person with the condition might accuse others of stealing or hiding items. 

Poor decision-making: Everyone makes questionable choices on occasion. But someone with Alzheimer’s may display a persistent lack of judgment or make decisions they previously wouldn’t. For example, they might purchase extravagant or needless items, fall victim to telephone or online scams, dress differently, or have worsening hygiene.

Changes to personality and mood: Someone may become unusually agitated, fearful, confused, or suspicious. Feeling anxious or depressed is also common. As a result, it may become increasingly difficult for someone with Alzheimer’s to spend time with friends or experience new places or activities.  

(Continue reading for information regarding symptoms of Alzheimer’s disease by stage.)

Alzheimer’s disease vs. mild cognitive impairment

Having mild cognitive impairment (MCI) means you can’t think as clearly or remember as well as other people your age. You may forget things, frequently lose items, or struggle to find the right words, but you can generally handle everyday responsibilities and take care of yourself.

For many people, the condition stays the same or even improves with time.

MCI is a relatively common issue among older adults. In fact, around 10 to 20 percent of people aged 65 and older experience MCI. Factors like genetics and conditions like depression, stroke, and diabetes can increase your chances of having MCI.

MCI is not Alzheimer’s disease, but it does raise your risk of eventually developing Alzheimer’s and other forms of dementia. It’s estimated that out of 10 people aged 65 and older with MCI, 1 to 2 will develop dementia over a one-year period.

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Alzheimer’s disease is a degenerative condition. That means it worsens over time. Most HCPs think of Alzheimer’s as occurring in three stages:

Mild Alzheimer's disease

Also called early-stage Alzheimer’s, the mild stage is usually characterized by forgetfulness and lapses in memory. The person may seem healthy and independent overall. Gradually, though, symptoms become more apparent to friends and family members. Alzheimer’s is commonly diagnosed in the mild stage.

Common signs of mild Alzheimer’s disease include:

• Not finding the right words when speaking
• Forgetting information that was just read or discussed
• Repeating questions
• Unusual difficulty with planning, organizing, or performing routine tasks at work or home  
• Misplacing or losing important items
• Increased agitation or anxiety
• Changes in mood or personality 
• New difficulty with paying bills or tracking expenses

Moderate Alzheimer’s disease

Moderate Alzheimer’s disease can last for several years. It’s also called middle-stage Alzheimer’s. Symptoms become more obvious and a greater level of care is required for the affected person. They might become more agitated, mix up words, or behave in unusual ways. Still, they may be able to perform everyday activities with assistance from a caregiver.

Symptoms of moderate Alzheimer’s can vary, but may include:

• Forgetting personal information and history, such as their phone number or where they were born 
• Difficulty learning new information
• A shorter attention span 
• Occasionally not recognizing friends or family members
• Confusion regarding location and time or date
• Reduced bladder and bowel control 
• Wandering or becoming lost in previously familiar places
• Withdrawing from social situations
• Changes in behavior, which may include increased suspiciousness, hallucinations (seeing things that aren’t there), or delusions (believing something is true despite evidence otherwise)
• Trouble picking out clothes and getting dressed 
• Sleeping more during the day and less at night
• Emotional outbursts or behaviors that are inappropriate or impulsive
• Increased agitation, sadness, or anxiety that may occur more frequently in the late afternoon or evening 

Severe Alzheimer's disease

Severe Alzheimer’s disease is the final stage of the condition. Also called late-stage Alzheimer’s, this stage indicates extensive cognitive decline and occurs near the end of life. The affected person requires full-time care and may spend most of their time in bed. Symptoms are debilitating and prevent them from communicating and moving as they normally would. 

Signs of severe Alzheimer’s may include:

• An overall decline in physical health
• Difficulty sitting up or walking
• Trouble swallowing
• Decreased appetite and loss of body weight
• Lack of awareness of people or surroundings
• Seizures 
• Trouble speaking in full sentences
• Grunting or moaning
• Increased risk of infections like pneumonia

The body begins to shut down during late-stage Alzheimer’s disease. It’s common for people with severe Alzheimer’s to die from aspiration pneumonia.

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Consider speaking with a healthcare provider (HCP) if you or a loved one is experiencing memory loss or increased forgetfulness, even if it’s mild. There are several issues besides dementia and MCI that can cause or contribute to these symptoms, including:

• Concussions and other types of head injuries
• An infection, blood clot, or tumor in the brain
• Anxiety and depression
• Kidney, liver, or thyroid conditions
• Sleep disorders, such as sleep apnea and insomnia
• Substance use disorders
• A lack of essential nutrients, such as vitamin B12
• Side effects of medications   

Some causes of memory loss and forgetfulness can be improved with treatment and healthy lifestyle changes. These include improving sleep habits, drinking less alcohol, and eating more healthy foods. Only HCPs can rule out serious conditions like Alzheimer’s disease, blood clots, and tumors, so don’t delay care if you’re concerned about symptoms.

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A brain affected by Alzheimer’s disease contains abnormal buildups of amyloid proteins and tau proteins, called amyloid plaques and tau tangles.

• Amyloid plaques are clumps of amyloid proteins and cell fragments. These disrupt how neurons (brain cells) communicate with other, causing them to die.
• Tau tangles (also called neurofibrillary tangles) are bundles of tau proteins. These proteins ordinarily help the brain by transporting important nutrients and materials, but when they form into tangles, they disrupt these processes and damage neurons.

It’s not fully understood what triggers the formation of amyloid plaques and tau tangles. Complicating matters, not everyone with a buildup of these proteins in their brain develops Alzheimer’s disease.

Most experts believe a combination of genetics, environmental influences, and lifestyle habits can lead to Alzheimer’s. Age-related changes in the brain like inflammation, blood vessel damage, and the presence of unstable molecules known as free radicals also contribute. The significance of each of these factors in the development of dementia likely varies from person to person.    

Is Alzheimer’s disease genetic?

Most cases of early-onset Alzheimer’s are linked to having changes (mutations) in certain genes. A variant of the apolipoprotein E (APOE) gene called APOE ε4 is associated with an increased risk of early-onset Alzheimer’s, as well as an elevated risk of the disease later in life. Meanwhile, having the APOE ε2 gene variation may lower your risk of Alzheimer’s.

Changes in APP, PSEN1, and PSEN2 genes are also linked to a greater likelihood of developing Alzheimer’s disease, especially before age 65. But these rare genetic changes are responsible for less than 1 percent of Alzheimer’s cases.

You can receive testing for gene changes that are associated with Alzheimer’s disease, but it’s important to remember that genes aren’t the only contributor to the condition. Many people with these genetic changes don’t get Alzheimer’s and most cases are not caused solely by genetics. Moreover, everyone—regardless of genetics—can lower their risk of Alzheimer’s by adopting a healthy lifestyle and managing other health conditions (such as diabetes and high blood pressure).

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While the precise cause of Alzheimer’s disease is unclear, researchers have identified several factors that can increase your risk of the condition.

Risk factors for Alzheimer’s disease include:

Age: Although Alzheimer’s isn’t a typical or inevitable part of aging, most people diagnosed with the disease are 65 or older. Your risk increases with age. The number of people living with Alzheimer’s doubles every 5 years after age 65. Among people aged 65 and older with Alzheimer’s, 73 percent are 75 and older.

Race: For reasons that aren’t well understood, older Hispanic people in the U.S. are up to one and a half times more likely to have Alzheimer’s or another type of dementia than older white people. Older Black people are around twice as likely to develop dementia as older white people.

Sex assigned at birth: Alzheimer’s affects more women and people assigned female at birth (AFAB) than men and people assigned male at birth (AMAB). The lifetime risk for Alzheimer’s at age 45 is 1 in 5 for people AFAB and 1 in 10 for people AMAB.

Family history: Your risk of Alzheimer’s increases by 10 to 30 percent if you have a first-degree blood relative (such as a sibling or parent) with the condition. If you have two or more siblings with late-onset Alzheimer’s (diagnosed at age 65 or later), you’re three times more likely to experience the condition than members of the general population. Some research indicates that the risk of Alzheimer’s is 60 to 80 percent dependent on hereditary factors like genes.

Down syndrome: A genetic condition that causes intellectual and developmental delays, Down syndrome results from having an extra chromosome 21. (Chromosomes are bundles of DNA that carry a person’s genetic code.) Chromosome 21 is involved in the creation of a protein that is found in fragments in amyloid plaques. Some research indicates that at least half of people with Down syndrome will experience symptoms of Alzheimer’s disease in their 50s or 60s.

Blood vessel conditions: Alzheimer’s is linked to conditions that can harm the brain and its blood vessels, including stroke, heart disease, high cholesterol, and high blood pressure (hypertension). Research suggests that tau tangles and amyloid plaques are more likely to cause Alzheimer’s symptoms if blood vessels in the brain are also damaged.

Metabolic conditions: Diabetes and obesity are metabolic conditions, meaning they affect a person’s metabolism (the processes that convert food into energy). These diseases are also linked to blood vessel damage and an increased risk of Alzheimer’s and cognitive decline.

Mild cognitive impairment: Having MCI increases your risk of Alzheimer’s and other types of dementia. MCI refers to a mild decline in memory and thinking skills that affects up to 20 percent of people aged 65 and older.

Head injury: Sustaining a traumatic brain injury (TBI) such as a concussion or brain bruise is associated with an increased risk of Alzheimer’s. The risk appears to be higher if you have repeated head injuries or a severe TBI.

Other lifestyle factors: Some unhealthy behaviors and scenarios can leave you more vulnerable to Alzheimer’s and other types of dementia. These include:

• Smoking and being exposed to secondhand smoke
• Living a sedentary lifestyle with little physical activity
• Having a diet with few vegetables and fruits
• Struggling to fall asleep or stay asleep (a condition known as insomnia)
• Being isolated or socially inactive
• Uncontrolled chronic conditions like diabetes
• Drinking alcohol in excess

You may be wondering how much alcohol is too much. There’s still more to learn about how alcohol influences brain health and Alzheimer’s disease risk, but the Centers for Disease for Control and Prevention (CDC) advises people to avoid alcohol or drink it in moderation.

For people AMAB, drinking in moderation means to limit consumption to two drinks or fewer per day. People AFAB should limit their intake to one drink per day. One drink is defined as:

• 12 ounces of beer
• 8 ounces of malt beverages, including malt liquor and malt-based seltzers
• 5 ounces of wine
• 1.5 ounces of distilled spirits, such as vodka, rum, whiskey, gin, and tequila

It’s important to remember that having one or more Alzheimer’s disease risk factors doesn’t mean you’re sure to be diagnosed. It’s also possible to develop Alzheimer’s without any known risk factors.

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In the past, Alzheimer’s disease could only be diagnosed for certain by examining a person’s brain after death. Advances in medicine now allow HCPs to test for biomarkers (biological evidence of disease) in a living person. These markers may suggest the presence of indicators of Alzheimer’s, such as amyloid plaques and tau tangles.  

Some primary care providers (such as internal medicine physicians, physician assistants, or nurse practitioners) may refer a person to a specialist for more advanced care if they suspect Alzheimer’s disease may be causing their symptoms. Specialists who can help diagnose Alzheimer’s include:

• Neurologists, who specialize in disorders of the brain and central nervous system
• Neuropsychologists, who specialize in evaluating how brain disorders affect cognitive abilities and behavior
• Geriatricians, who specialize in caring for older adults and helping them manage their health
• Geriatric psychiatrists, who specialize in evaluating and addressing mental and emotional issues that affect older adults

Diagnosing Alzheimer’s disease is a multi-step process. A combination of exams and tests may be used to evaluate symptoms and assess cognitive health. These may include the following:

Physical, neurological, and neuropsychological exams

An HCP may begin by performing a physical exam and asking questions about the person’s symptoms, lifestyle, overall health, and any medications or supplements they’re taking. The input of family and friends is often important, as some people may have trouble remembering their symptoms or finding the words to explain them. Loved ones can also describe changes in personality, behavior, and overall functioning the person may be experiencing.

Some HCPs may also recommend a psychiatric evaluation to screen for mental health concerns like depression, which can cause or contribute to memory issues. This testing usually involves answering a series of questions and discussing thoughts and emotions.

A neurological exam may then be performed to check for signs of brain conditions. This test involves assessing:

• Balance
• Reflexes
• Muscle strength and tone
• Coordination
• Sense of vision and hearing
• Ability to stand up and walk   

Depending on the person’s symptoms, a neuropsychological test may be conducted to measure brain function. Skills like language use, problem solving, learning, reasoning, remembering, and concentration are evaluated, as well as personality and mood. Neuropsychological testing can involve completing surveys, drawing pictures, writing, solving puzzles, and responding to images.   

Lab tests

Various blood and urine tests may be performed to help rule out other causes of memory issues, such as vitamin deficiencies, infections, and thyroid disorders. Advanced blood tests that assess levels of tau and amyloid proteins in the brain can be conducted, though this type of biomarker testing isn’t available everywhere.   

Another test examines cerebrospinal fluid, the fluid that surrounds the spinal cord and brain. Called a spinal tap, this test uses a needle to draw out a sample of cerebrospinal fluid from the lower spine. The sample is tested for proteins linked to Alzheimer’s disease and other types of dementia.

Brain imaging

Brain imaging can help support an Alzheimer’s disease diagnosis or rule out other possible causes of symptoms, such as head trauma or tumors. Many people with Alzheimer’s symptoms receive one or more of the following scans:

• Magnetic resonance imaging (MRI) scans: These use a magnetic field and radio waves to create images of the brain. An MRI can reveal brain tissue shrinkage in areas linked to Alzheimer’s and help rule out other conditions.
• Computer tomography (CT) scans: These are typically performed to screen for strokes, tumors, and head injuries. They use X-ray technology to create detailed pictures of the brain.
• Positron emission tomography (PET) scans: These can show how Alzheimer’s is progressing in the brain. A PET scan involves injecting a small amount of radioactive fluid into a vein to highlight specific areas of the brain on images. There are multiple types of PET scans, some of which are used for research purposes during clinical trials.  

The steps involved in diagnosing Alzheimer’s disease can vary from person to person. In some cases, HCPs may need to repeat tests to evaluate how symptoms have progressed over time. Several research initiatives are currently focused on streamlining the diagnostic process to ensure that people with Alzheimer’s can receive appropriate care as early as possible.

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If you or a loved one is diagnosed with Alzheimer’s disease, it’s important to be candid with your HCP about your questions and concerns. Some basic questions you may want to ask include:

• What stage of Alzheimer’s do I have? Is it mild, moderate, or severe?
• How quickly can I expect the disease to progress? 
• How is Alzheimer’s treated? How can I slow the disease’s progression?
• What are the risks and benefits associated with each treatment option?  
• Can changing my diet improve Alzheimer’s symptoms? What foods should I avoid or eat more of?
• Can Alzheimer’s cause issues like anxiety or depression? How can I manage these complications? 
• Should I stop driving?
• What clinical trials are available for Alzheimer’s? Should I participate in a research trial?
• How can I plan for the future?  

If you’re a caregiver for someone with Alzheimer’s disease, consider asking your HCP questions like:

• How can I best care for my loved one? Should I consider enrolling them in a memory care facility? 
• When should I contact you? When should I seek emergency care?
• How can I make their living space safer and more comfortable?
• Does Alzheimer’s run in families? Do I have an elevated risk?
• How can I protect my mental health during this process? What support groups and services do you recommend?

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There is currently no cure for Alzheimer’s disease. Treatment generally focuses on:

• Preserving brain health for as long as possible
• Slowing the progression of the disease
• Managing behavior changes and other symptoms

Multiple HCPs including primary care providers, neurologists, and psychiatrists work together as a team to help people with Alzheimer’s disease and their caregivers manage the condition.

Treatment for Alzheimer’s disease generally involves a combination of approaches, including:

Taking medication

Medications can’t reverse or cure Alzheimer’s disease, but starting medication shortly after the onset of Alzheimer’s may temporarily slow disease progression and improve comfort. Several types of medications are approved by the U.S. Food and Drug Administration (FDA) for Alzheimer’s treatment, including:

• Cholinesterase inhibitors: Drugs like donepezil, galantamine, and rivastigmine help prevent the decline of acetylcholine in the brain. This chemical is believed to play a key role in sustaining memory and thinking abilities. Cholinesterase inhibitors may be helpful for people with mild to moderate Alzheimer’s. The drugs are available as pills or skin patches. Common side effects include nausea, diarrhea, loss of appetite, and trouble sleeping.  
• N-methyl-D-aspartate (NMDA) antagonist: An NMDA antagonist pill called memantine may help slow the progression of symptoms in some people with moderate to severe Alzheimer’s disease. Memantine is believed to work by balancing levels of a brain chemical called glutamate. Too much glutamate in the brain may cause neurons to die. Possible side effects include confusion or dizziness, though these are uncommon.

A combination medication of memantine and donepezil (a cholinesterase inhibitor) is also approved for use in people with Alzheimer’s, as these drugs affect the brain in different ways.  

• Lecanemab: Approved by the FDA in 2023, lecanemab helps prevent amyloid proteins from sticking together and forming amyloid plaques in the brain. Studies show it can slow cognitive decline and preserve quality of life in some people with early-stage Alzheimer’s. In addition to helping people with mild Alzheimer’s, lecanemab is being explored as a preventive treatment for people who have a first-degree relative with the condition.

Lecanemab is a type of immunotherapy, which means it works through the immune system. Specifically, it belongs to a class of drugs called monoclonal antibodies. These can stimulate or change your immune response to help remove cells that cause disease or carry medicine to treat disease. 

An HCP administers lecanemab through a patient’s vein every two weeks. Complications of the drug are often related to the intravenous (IV) infusion process and may include vomiting, nausea, dizziness, shortness of breath, and flu-like symptoms. Rarely, lecanemab may cause brain swelling and bleeding. A brain MRI should be performed before starting the drug and periodically throughout treatment to check for signs of bleeding and swelling.  

• Brexpiprazole: Available in pill form, this is a type of medication called an atypical antipsychotic. It can help calm agitation related to Alzheimer’s disease. Possible side effects include dizziness, common cold symptoms, high blood sugar, stroke, and increased risk of death among elderly people with dementia-related psychosis (disconnection from reality due to memory loss and confusion).

While not approved by the FDA for Alzheimer’s disease treatment, several other medications can temporarily help manage symptoms. For example, an HCP may recommend:

• Sleep aids to improve sleep quality
• Anticonvulsants to reduce severe aggression
• Anti-anxiety drugs to ease agitation
• Antidepressants to improve anxiousness, restlessness, and depression
• Antipsychotic drugs to control delusions, hallucinations, paranoia, and aggression

These medications come with possible side effects that may exacerbate Alzheimer’s disease symptoms or increase the risk of falls. Because of this, many HCPs only recommend these drugs for use on a short-term or as-needed basis.

Developing medications to slow the progression of Alzheimer’s disease or treat the condition is a focus of many clinical trials and research initiatives. Promising new Alzheimer’s treatments, such as immunotherapies and anti-amyloid drugs, are on the horizon.  

Supplements for Alzheimer’s disease

There’s little to no evidence to suggest that supplements or herbal remedies can prevent or help treat Alzheimer’s disease. With that said, some common supplements provide anti-inflammatory properties that may boost brain health when taken under the guidance of an HCP.

If you’re interested in supplements to support brain health, consider speaking with your HCP about:

• Omega-3 fatty acids
• Curcumin (found in the spice turmeric)
• Vitamin E
• Ginkgo biloba

Improving home safety

Alzheimer’s disease causes changes in memory, physical ability, judgment, and behavior that will eventually make living in a typical home environment uncomfortable or unsafe. If you’re caring for someone with Alzheimer’s, adjusting their living space and routine can improve safety while helping them function better and feel more at ease. For example, try these approaches:

Clear tripping hazards and foster ease of movement

• Remove hazards such as loose rugs, unnecessary furniture, electrical cords, and large decorative items to reduce the risk of falls.
• Ensure all walkways and rooms have adequate lighting.
• Install handrails along stairs and in bathrooms.
• Provide non-slip sock and shoe options.    

Improve organization and home decor

• Hang up an easy-to-read calendar, whiteboard, or chalkboard with a daily schedule or to-do list. 
• Keep keys, wallets, phones, and other necessities in one easy-to-find place.
• Arrange for the person to have a cell phone with location tracking. Make sure important numbers are programmed into the phone and are easily accessible. 
• Keep pictures of loved ones and other cherished, meaningful items in an easy-to-find place.
• Remove most or all mirrors, as some people with Alzheimer’s may find them frightening or disorientating. 

Keep medication and household items safe and secure

• Keep all medications in one secure location.
• Have the person wear a medical identification bracelet or necklace.
• Make sure smoke detectors, fire extinguishers, and carbon monoxide detectors are in working order and keep a supply of fresh batteries.
• Store household cleaners and detergents in a secure place. Keep cleaning and personal products in their original packaging—not in decorative or plain containers.
• Remove guns, sharp items, and other weapons from the home or keep them locked in a safe place.   
• Remove any decorative fruit or toxic plants from the home.
• Place alarm sensors on windows and doors.
• Check the temperature of food, beverages, and bath water to help avoid burns.

Someone with Alzheimer’s disease may eventually require more intensive care than a friend or family member can provide on their own. An Alzheimer’s patient may also prefer to live in a community setting with professionals who can provide full-time assistance. In these instances, a long-term care facility such as an assisted living facility, nursing home, or memory care facility (also called an Alzheimer’s special care unit, or SCU) may be in the best interest of both the patient and the caregiver.

For more information regarding long-term Alzheimer’s disease care options, speak with your HCP or browse long-term care resources from the Alzheimer’s Association.

Participating in a clinical trial

A clinical trial is a research study that involves voluntary human participation. Hundreds of clinical trials are currently underway to improve how Alzheimer’s disease is diagnosed and treated—and perhaps even prevented. Opportunities to participate in a clinical trial are often available to people with or without the condition. For example, some research initiatives focus on better understanding the differences between a healthy brain and one affected by Alzheimer’s.

Because many Alzheimer’s disease clinical trials focus on evaluating new or unproven treatments, participation comes with some measure of risk. Speak with an HCP to learn more about the potential risks and benefits of participating in a clinical trial.

An HCP may be able to suggest an appropriate Alzheimer’s disease clinical trial for you or your loved one. You can also:

• Search for clinical trials on the Alzheimers.gov clinical trial finder.
• Find an Alzheimer’s Disease Research Center funded by the National Institute on Aging (NIA).

Sign up for a clinical trial registry or matching service. This can help you or a loved one find a clinical trial if you don’t know exactly what kind would be best.

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People with Alzheimer’s disease experience many of the same health issues that other older adults do. But Alzheimer’s-related changes in the brain can make it difficult for someone to describe their symptoms or communicate that they’re in pain or distress. Taking medications and following a treatment plan may also be challenging.

Caring for someone with Alzheimer’s disease involves watching for signs of health issues and promptly informing an HCP when they occur. Issues that are common among people with dementia include:

Fever: A fever is a body temperature that’s at least two degrees higher than a healthy temperature. It could be a sign of an infection, heat stroke, constipation, or dehydration. Use a plastic digital thermometer to check temperature, since a person with Alzheimer’s may accidentally bite down on a traditional glass thermometer.

Dehydration: An illness, diarrhea, vomiting, or not drinking enough fluids can lead to dehydration. Signs and symptoms of dehydration include dizziness, rapid heart rate, dry mouth, and hallucinations. 

Flu and pneumonia: These contagious illnesses commonly affect people with Alzheimer’s disease. Receiving an annual flu shot and at least one dose of a pneumococcal (pneumonia) vaccine after age 64 can help prevent these illnesses. Signs of flu or pneumonia may include fever (in some cases), chills, body aches, coughing, shortness of breath, and vomiting.

People with Alzheimer’s disease are prone to aspiration pneumonia, which occurs when food or liquid enters the lungs. In addition to typical pneumonia symptoms, signs of aspiration pneumonia can include bad breath, wheezing, trouble swallowing, heavy sweating, and coughing up phlegm that may be green or contain blood or pus.

Constipation: Changes in diet, medication, and physical activity related to Alzheimer’s disease may lead to constipation (defined as having fewer than three bowel movements per week). To help prevent constipation, it’s important to drink at least six glasses of fluid every day. Water is ideal, but other helpful fluids include soup, prune juice, decaffeinated tea or coffee, or milk. Eating more fiber (via fruits and vegetables and whole-grain foods like oatmeal) and getting safe physical activity can also help reduce constipation.

Diarrhea: Some common illnesses and medications for Alzheimer’s disease can cause diarrhea. If this occurs, make sure the person stays adequately hydrated to prevent dehydration.  

Incontinence: Some people with Alzheimer’s disease have trouble controlling their bladder or bowels. This is known as incontinence. Signs of incontinence include soiled underwear or bed sheets.

Bedsores: Also called pressure sores, bedsores are common among people with dementia who spend much of their day sitting or lying down. They commonly form over bony areas of skin and may appear in their early stages as red or discolored patches. Some sores feel hard or warm to the touch.

Dental issues: As Alzheimer’s disease worsens, it becomes more difficult for someone to take care of their teeth and gums and maintain good oral health. In between dental checkups, regularly check the person’s mouth for sores, lumps, decaying teeth, and food debris along the cheeks and roof of the mouth.

Falls: Falls are also common among people with Alzheimer’s disease, especially as the condition progresses. Using fall prevention strategies like clearing walkways, removing decorative rugs and clutter, and installing handrails in bathrooms and along stairs can help create a safer environment.

These aren’t all the possible complications associated with Alzheimer’s disease. Contact the person’s HCP if you notice any unusual or sudden changes in their health or behavior.

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There’s no sure way to prevent Alzheimer’s disease, but research shows that maintaining a healthy lifestyle may reduce the likelihood of cognitive decline and dementia—or at least delay its onset. To promote a healthy brain and help lower your risk of Alzheimer’s, work on establishing these habits:

Manage your health

Conditions like depression, high blood pressure, high cholesterol, diabetes, and sleep apnea are linked to an increased risk of Alzheimer’s. Treating or effectively managing such conditions may help lower your risk. Research shows that controlling high blood pressure is particularly important in preventing Alzheimer’s. Reach out to your HCP for assistance and be sure to attend all scheduled medical appointments.

Get physically active

Routine physical activity is associated with better cognitive function and a lower risk of conditions that are linked to Alzheimer’s, including obesity. Exercising boosts oxygen and blood flow in the brain, which may promote brain cell health.  

Your HCP can help you determine how much and what type of exercises are best for your individual needs. In general, the CDC encourages most adults to get around 150 minutes of moderate-intensity aerobic activity (also called cardiovascular or “cardio” exercise) every week. That’s around 30 minutes of exercise five days a week. If 30 minutes of daily physical activity sounds daunting, do what you can and work your way up. 

Examples of moderate-intensity aerobic activity include brisk walking, water aerobics, and even pushing a lawn mower. If you’d prefer to pick up the pace, you can aim for 75 minutes of vigorous-intensity aerobic activity per week. Vigorous exercises include running, swimming laps, and playing basketball. The CDC also encourages adults to incorporate at least two days of muscle-strengthening activities (such as using resistance bands or lifting light weights) into their exercise routines.  

Stimulate your brain

Continued learning is beneficial for people of all ages. Brain-stimulating activities like reading, researching topics that interest you, or learning a new language can lower your risk of cognitive decline. Solving puzzles, playing board games, and enjoying a craft (such as painting or knitting) can also help keep your memory strong and brain sharp.

Additionally, socializing with other people and establishing healthy relationships may offer protective effects against Alzheimer’s. Stay connected with friends and family and consider attending group activities such as book clubs, sports leagues, fitness classes, or volunteer initiatives. As much as possible, try to avoid living in isolation.

Eat for a healthy brain (and heart)

Research shows that following a heart-healthy eating plan such as the Mediterranean diet, the DASH (Dietary Approaches to Stop Hypertension) diet, or the hybrid MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet can support both heart and brain health.

These eating plans emphasize produce, whole foods, and healthy fats, including:

• Leafy green vegetables
• Legumes
• Olive oil
• Nuts
• Fruits, especially blueberries
• Whole grains
• Fish

Foods that contain added sugars, trans fats, and saturated fats (such as red meats, cheese, butter, eggs, desserts, and fried foods) are limited on these diets.  

The Mediterranean, DASH, and MIND diets may help lower the risk of cognitive decline and Alzheimer’s disease in several ways. Many foods emphasized in these diets offer protective anti-inflammatory and antioxidant properties. Their heart-healthy benefits can help prevent or manage high blood pressure, high cholesterol, and diabetes, all of which have strong links to Alzheimer’s. When combined with regular physical activity, these eating plans can also help you achieve and maintain a healthy body weight.

One 2023 study published in Neurology observed the brains of older adults who followed a Mediterranean or MIND diet that included plenty of leafy green vegetables before their death. Researchers found fewer changes associated Alzheimer’s disease in their brains, including fewer amyloid plaques and tau tangles.

Other possible ways to lower your Alzheimer’s disease risk  

In addition to the healthy habits listed above, researchers have identified other strategies that may help lower the risk of cognitive decline or Alzheimer’s disease. For example, including these habits in your life may be beneficial for your brain:  

• Drink coffee or tea (but not more than a few cups a day).
• Avoid or limit exposure to air pollution (especially car exhaust and smoke from burning wood) as much as possible.
• Quit smoking.
• Lose excess weight.
• Promptly treat hearing loss.
• Take care of your teeth and gums by practicing good oral hygiene.
• Avoid head injuries by wearing protective headgear when exercising, playing sports, working, or riding a bike or motorcycle.
• Try to manage stress levels.
• Prioritize sleep.
• If you drink alcohol, limit your consumption to one drink per day (for women and people assigned female at birth) or two drinks per day (for men and people assigned male at birth).

For personalized guidance on how to lower your risk of Alzheimer’s disease, speak with your HCP.

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The outlook for Alzheimer’s disease is currently poor. As a degenerative condition, Alzheimer’s worsens over time. The rate at which the disease progresses varies from person to person. On average, someone with Alzheimer’s lives four to eight years after diagnosis. But some people can live as long as 20 years, depending on factors like their age at diagnosis and overall health.  

Severe or late-stage Alzheimer’s disease causes the body to slowly shut down. Common causes of death among people with Alzheimer’s include aspiration pneumonia, infections, and dehydration.

Alzheimer’s disease is a complex condition that affects everyone differently. There’s no way to predict exactly how Alzheimer’s will affect you or your loved one.

While today’s Alzheimer’s treatments focus on slowing disease progression and improving symptoms, major breakthroughs in directly treating the disease may be on the horizon. Researchers are cautiously optimistic about several emerging drug therapies, including options that target amyloid plaques, stop tau proteins from tangling together, and prevent Alzheimer’s-related brain inflammation. These advances in research, combined with a better understanding of the disease, can help improve outcomes and quality of life for people with Alzheimer’s.

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Learning about your condition and staying in close communication with your healthcare team, caregivers, and loved ones can help you feel informed and supported after an Alzheimer’s disease diagnosis. Coping with Alzheimer’s can be challenging, but no disease can take away your identity and humanity. With support and adjustments, you can help preserve your independence and live a meaningful life with Alzheimer’s.

Life with Alzheimer’s disease—or with a loved one who has Alzheimer’s—can still be enjoyable. Alzheimer’s affects certain important parts of the brain, but many people are able to enjoy cherished activities for several years after their diagnosis. This can include:

• Sharing favorite memories and stories
• Reading books or listening to audiobooks
• Singing and playing musical instruments
• Drawing, painting, and pursuing other artistic hobbies
• Dancing  
• Playing games
• Gardening and spending time outdoors

Learning coping strategies can also help you navigate new and difficult situations. The Alzheimer’s Association encourages people to take these steps:

• Identify hurdles. Make a list of tasks that have become increasingly difficult. This might include managing medication, cooking big meals, or keeping laundry organized.
• Prioritize tasks. Ask yourself if a task is truly important or necessary. Identify and focus on what’s most important and ask for help when you need it.  
• Find a solution. Create a daily medication checklist or opt for meals that are easier to prepare. (For example, using a slow cooker may be helpful.) A caregiver or loved one can help you make checklists and find other possible solutions to problems.

Setting realistic goals for each day and creating a simplified routine can help you stay productive. Focus on one task at a time and show yourself compassion if you make a mistake. In most cases, you’ll have multiple opportunities to complete a chore or solve a problem.

It’s also important to care for your mental and physical health while living with Alzheimer’s disease. Your HCP is your best resource for advice, but it’s generally beneficial for people with Alzheimer’s to do the following:

• Stay connected with loved ones as much as possible and lean on friends and family members for support. You may find it helpful to join an Alzheimer’s support group, speak with a licensed mental health provider, or attend religious services or activities.
• Allow emotions to come and go—there’s no right or wrong way to feel. Accept that you’ll have a mix of positive days and more challenging days.
• Be open to help from others.
• Exercise, if possible. Mild to moderate exercises (such as brisk walking or stationary cycling) can help you stay nimble and improve your mood. Some research suggests that physical activity may even slow cognitive decline.
• Eat nourishing foods and keep alcohol consumption to a minimum.  
• Stay mentally active by learning new things, reading, or trying a new hobby (if you’d like to and if you find it enjoyable).

Taking care of caregivers  

Being a caregiver for someone with Alzheimer’s disease presents unique challenges. You may feel exhausted (both physically and mentally), discouraged, or simply sad. As you tend to your loved one, remember that it’s just as important to care for yourself. Caregiver burnout is a very real issue that should be recognized and addressed.

Prioritizing your physical and mental health can help you better care for those around you. To achieve and maintain your best health, try to:

• Attend your own regularly scheduled healthcare appointments and seek medical attention if you feel unwell.
• Accept offers of help from others. Consider creating a schedule with days or time slots where friends or family members can step in and give you a break.
• Get as much physical activity as you can, even if it’s a simple stroll around the block. The CDC encourages most adults to get at least 30 minutes of exercise five days a week.    
• Make time for hobbies and activities you enjoy. It’s okay if you need to write “fun time” into your schedule.   
• Help ease stress by practicing mindfulness, doing yoga or tai chi, breathing deeply, or keeping a journal. 
• Nourish your body with healthy foods. You may want to consider following the popular Mediterranean diet, which offers several benefits for heart and brain health and can be done in an affordable way.
• Join an online or in-person caregiver support group or share your feelings with a mental health provider. 
• Be realistic and allow yourself to grieve but celebrate the positive moments when they occur.   

Learn more about Alzheimer’s disease

Speak with your HCP to learn more about Alzheimer’s disease symptoms, risk factors, and treatment. If you or a loved one has Alzheimer’s, you can find helpful resources from organizations such as the Alzheimer’s Association and the National Institute on Aging.

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• What Are Good Activities for a Person with Alzheimer’s Disease?
• 4 Key Lessons About Alzheimer’s Disease  
• Home Safety Modifications for Alzheimer's Disease