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Alzheimer's disease

The symptoms of Alzheimer's disease progress slowly over several years. They are often similar to those of other conditions and may initially be put down to old age.

The symptoms of Alzheimer's disease progress slowly over several years. They are often similar to those of other conditions and may initially be put down to old age.

The rate at which the symptoms progress differs for each individual and it is not possible to predict exactly how quickly it will get worse.

In some cases, infections or medications can be responsible for the worsening of symptoms. Anyone with Alzheimer's disease whose symptoms are rapidly getting worse should be seen by a doctor so these causes can be ruled out.

Stages of Alzheimer's disease

Generally, the symptoms of Alzheimer's disease are divided into three main stages.

Early symptoms

In the early stages, the main symptom of Alzheimer's disease is memory lapses. For example, someone with early Alzheimer's disease may:

  • forget about recent conversations or events
  • forget the names of places and objects
  • repeat themselves regularly, such as asking the same question several times
  • show poor judgement or find it harder to make decisions
  • become unwilling to try out new things or adapt to change

There may also be some early signs of mood changes, such as increasing anxiety or agitation, or periods of confusion.

Middle stage symptoms

As Alzheimer's disease develops, memory problems will get worse and someone with the condition may find it increasingly difficult to remember the names of people they know and may struggle to recognise their family and friends.

Other symptoms may also develop, such as:

  • increasing confusion and disorientation – for example, not knowing where they are and walking off and getting lost
  • obsessive, repetitive or impulsive behaviour
  • delusions (believing things that are untrue)
  • problems with speech or language (aphasia)
  • disturbed sleep
  • changes in mood, such as frequent mood swings, depression and feeling increasingly anxious, frustrated or agitated
  • difficulty performing spatial tasks, such as judging distances
  • problems with eyesight, such as poor vision or hallucinations (seeing things that are not there)

By this stage, someone with Alzheimer's disease will usually need support to help them with their everyday living. For example, they may need help eating, washing, getting dressed and using the toilet.

Later symptoms

In the later stages of Alzheimer's disease, the symptoms become increasingly severe and distressing for the person with the condition, as well as their carers, friends and family.

Hallucinations and delusions will often become worse and the person with the condition may start to become violent, demanding and suspicious of those around them.

A number of other symptoms may also develop as Alzheimer's disease progresses, such as:

  • difficulty eating and swallowing (dysphagia)
  • difficulty changing position or moving around without assistance
  • considerable weight loss (although some people eat too much and put on weight)
  • unintentional passing of urine (urinary incontinence) or stools (bowel incontinence)
  • gradual loss of speech
  • significant problems with short- and long-term memory

During the severe stage of Alzheimer's disease, people often start to neglect their personal hygiene. It is at this stage that most people with the condition will need to have full-time care because they will be able to do very little on their own.

Read more about how Alzheimer's disease is treated.

Seeking medical advice

If you are worried about your memory or think you may have dementia, it's a good idea to see your GP. If you're worried about someone else, you should encourage them to make an appointment and perhaps suggest that you go along with them.

Memory problems are not just caused by dementia – they can also be caused by depression, stress, medications or other health problems. Your GP will be able to carry out some simple checks to try to find out what the cause may be, and they can refer you to a specialist for further tests if necessary.

Read more about diagnosing Alzheimer's disease.


Content Supplied by NHS Choices

Alzheimer's disease

See your GP if you are worried about your memory or think you may have dementia.

See your GP if you are worried about your memory or think you may have dementia.

If you're worried about someone else, you should encourage them to make an appointment and perhaps suggest that you go along with them.

An early diagnosis gives you the best chance to prepare and plan for the future, as well as receive any treatment that may help.

Seeing your GP

Memory problems are not just caused by dementia – they can also be caused by depression, stress, medications or other health problems. Read about common causes of memory loss.

Your GP will be able to carry out some simple checks to try to find out what the cause may be. They can refer you to a specialist for further tests if necessary.

Your GP will ask about your symptoms and other aspects of your health, and will carry out a physical examination. They may also organise some blood tests and ask about any medication you are taking to rule out other possible causes of your symptoms.

You may also be asked some questions or be asked to carry out some simple activities to assess any problems with your memory or your ability to think clearly. This can help your GP decide if you need to be referred to a specialist for further assessment.

Referral to a specialist

Your GP may refer you to a specialist to help with your diagnosis. For example, you may be referred to:

  • a clinical psychologist – a healthcare professional who specialises in the assessment and treatment of mental health conditions
  • a psychiatrist – a qualified medical doctor who has further training in treating mental health conditions
  • a neurologist – a specialist in treating conditions that affect the nervous system (the brain and spinal cord)

The specialist may be based in a memory clinic alongside other professionals who are experts in diagnosing, caring for and advising people with dementia and their families.

There is no simple and reliable test for diagnosing Alzheimer's disease, but your specialist can help assess your memory and thinking skills, and arrange further tests to rule out other conditions.

Assessing your mental abilities 

A specialist will usually assess your mental abilities using a special questionnaire. 

One widely used test is the mini mental state examination (MMSE). This involves being asked to carry out activities such as memorising a short list of objects correctly and identifying the current day of the week, month and year.

The MMSE is not used to diagnose Alzheimer's disease, but it is useful for assessing the level of mental impairment that a person with the condition may have. This helps specialists make decisions about treatment and whether further tests are necessary.

Tests

To rule out other possible causes of your symptoms and look for possible signs of damage caused by Alzheimer's disease, your specialist may recommend having a brain scan. This could be a:

Read more about tests for diagnosing dementia

After diagnosis

It may take several appointments and tests over months, or even years, before a diagnosis of Alzheimer's disease can be confirmed.

For some people, a diagnosis of Alzheimer's disease is a huge shock, whereas for others it simply confirms what had been suspected for a long time.

If you've just had a diagnosis of dementia, you're probably feeling numb, scared and unable to take everything in, so give yourself a little time to adjust. It might help to talk things through with family and friends.

Once the initial feelings have passed, it's important to think about moving forward and creating an action plan for the future. Dementia is a progressive illness, so the sooner you take care of legal, financial and healthcare matters, the better.

Read more about what to do if you've just been diagnosed with dementia.


Content Supplied by NHS Choices

Alzheimer's disease

There is currently no cure for Alzheimer's disease, but treatments are available to help delay the condition's development.

There is currently no cure for Alzheimer's disease, although medication is available that can temporarily reduce some symptoms or slow down the progression of the condition in some people.

Support is also available to help someone with the condition cope with everyday life.

Care plan

Once you've been diagnosed with Alzheimer's disease, your future health and social care needs will need to be assessed and a care plan drawn up. 

A care plan is a way of ensuring you receive the right treatment for your needs. It involves identifying areas where you may need some assistance, such as:

  • what support you or your carer need for you to remain as independent as possible
  • whether there are any changes that need to be made to your home to make it easier to live in
  • whether you need any financial assistance

Healthcare professionals (such as your GP or psychiatrist) and social care services, which is normally your local council working in conjunction with the NHS, will usually both be involved in helping draw up and implement care plans.

Read more about care plans for long-term conditions.

Medication

A number of medications may be prescribed for Alzheimer's disease to help temporarily improve some symptoms and slow down the progression of the condition.

These include donepezil, galantamine, rivastigmine and memantine. Whether these medications are used will depend on the severity of the condition.

Donepezil, galantamine and rivastigmine (known as AChE inhibitors) can be prescribed for people with early to mid-stage Alzheimer's disease. Memantine may be prescribed for people with mid-stage disease who cannot take AChE inhibitors, or for those with late-stage disease.

There is no difference in the effectiveness of the three different AChE inhibitors, although some people respond better to certain types or have fewer side effects.

All of these medications should only be prescribed by specialists such as psychiatrists, neurologists and physicians specialising in the care of older people.

If you are caring for someone with Alzheimer's disease, your views should be taken into account when prescribing medication as well as at regular assessments. These assessments take place to ensure the medication is having a worthwhile effect. 

Read guidance from the National Institute for Health and Care Excellence (NICE) on donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease.

Side effects

Donepezil, galantamine and rivastigmine can cause side effects such as:

  • feeling and being sick
  • diarrhoea 
  • headache 
  • fatigue (extreme tiredness)
  • insomnia (difficulty getting to sleep or staying asleep)
  • muscle cramps

Common side effects of memantine include dizziness, headaches, tiredness, constipation, problems with balance, and shortness of breath.

For more information about the possible side effects of your specific medication, refer to the patient information leaflet that comes with it or look up your medication in the Alzheimer's disease medicines guide.

Supportive measures and treatments

In addition to medication, treatment for Alzheimer's disease involves a wide range of other measures and treatments to help people with dementia live as independently as possible.

For example:

  • an occupational therapist can identify problem areas in your everyday life, such as dressing yourself, and help you work out practical solutions
  • grab bars and handrails can be added around your home – for example, to help you get in and out of the bath
  • psychological treatments, such as cognitive stimulation, may be offered to help improve your memory, problem-solving skills and language ability

Medication, other psychological therapies, such as cognitive behavioural therapy, and relaxation therapies may also be offered to help reduce any depression, anxiety, agitation, hallucinations, delusions and challenging behaviour that often feature with Alzheimer's disease.

Read more about how dementia is treated.

Practical tips for people with Alzheimer's

If you have Alzheimer's disease, you may find it useful to:

  • keep a diary and write down things that you want to remember
  • pin a weekly timetable to the wall
  • put your keys in an obvious place, such as in a large bowl in your living room
  • have a daily newspaper delivered to remind you of the day and date
  • put labels on cupboards and drawers
  • keep useful telephone numbers by the phone
  • write yourself reminders – for example, put a note on the front door to remind you to take your keys with you if you go out
  • programme people's names and numbers into your telephone
  • set the alarm on your watch to act as a reminder
  • install safety devices such as gas detectors and smoke alarms throughout your home

It may also be helpful to get in touch with a local or national Alzheimer's or dementia support group such as the Alzheimer's Society for more information and advice about living with Alzheimer's disease.

Find Alzheimer's support services in your area and read more about living well with dementia.

Palliative care

People with dementia often live for many years after their diagnosis. However, as it is a progressive condition, it's wise to make plans well in advance of the end-of-life phase.

End-of-life care, or palliative care, provides support for people with an incurable illness so they are able to live as well as possible until their death. It also involves support for family members. Care can be provided at home, a hospice, a care home or hospital.

For people nearing the end of life, their care team should assess their needs, make them feel comfortable and enable them to die with dignity in a place of their choosing.

Read more about palliative care for dementia.


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