Alzheimer’s disease

Alzheimer’s disease is a progressive memory disorder that causes degeneration in the brain. It is the most common cause of dementia and is associated with many symptoms that progress in stages. It is advisable to seek care as early as possible because, although Alzheimer’s disease cannot be cured, medication can slow the progression of symptoms.

• What is Alzheimer’s disease?
• Risk factors for Alzheimer’s disease
• Is Alzheimer’s disease hereditary?
• Symptoms of Alzheimer’s disease
• When should you see a doctor?
• What should family members and loved ones know?
• Treatment of Alzheimer’s disease
• Prognosis of Alzheimer’s disease
• Prevention of Alzheimer’s disease
• Booking an appointment at Aava

What is Alzheimer’s disease?

Alzheimer’s disease is the most common neurodegenerative disease. In Alzheimer’s disease, nerve cells in the brain begin to be destroyed, particularly in the medial temporal lobe, where the brain’s memory centre, the hippocampus, is located.

The underlying cause of Alzheimer’s disease is not fully understood, but it is linked to the abnormal build-up of two proteins in the brain: beta-amyloid and tau protein. This damages neural pathways and brain cells, weakening memory and information processing. As the disease progresses, areas of the brain begin to shrink and symptoms worsen.

Risk factors for Alzheimer’s disease

Alzheimer’s disease typically develops after the age of 65, and older age is the most significant risk factor for the disease. In people of working age, the disease is less common, but not exceptional: around 7,000 people in Finland under the age of 65 live with Alzheimer’s disease that began during working age.

Certain diseases also increase the risk of Alzheimer’s disease and accelerate its progression. These include cardiovascular diseases, high blood pressure, high cholesterol and diabetes. People who have had severe episodes of depression or serious head injuries also have an increased likelihood of developing Alzheimer’s disease.

Many lifestyle-related factors can also increase the risk of developing Alzheimer’s disease. These include:

• Lack of physical activity: Regular exercise supports brain health and helps with weight management. This is also important because excess weight increases the risk of Alzheimer’s disease.
• Unhealthy diet: A diet high in saturated fats, sugar and processed foods increases inflammation in the brain.
• Smoking: Smoking weakens blood circulation in the brain and promotes cell damage.
• Heavy alcohol use: Long-term heavy alcohol use damages brain cells.
• Low level of mental and social activity: The brain needs continuous stimulation. Limited education, loneliness and a lack of social networks may increase susceptibility to the disease.
• Sleep problems: Poor sleep quality and sleep apnoea can impair the brain’s ability to clear harmful substances.

Poor dental health and infections in the mouth also increase the risk of developing Alzheimer’s disease and may speed up the progression of the disease. The likely reason is the inflammatory state they can cause in the body.

According to the latest research, untreated hearing loss is also a risk factor for memory disorders.

Is Alzheimer’s disease hereditary?

Alzheimer’s disease is not strongly hereditary. Lifestyle factors play a much larger role in the onset of the disease. However, in some families, there may be rare genetic mutations associated with a high risk of Alzheimer’s disease. In these cases, the disease usually develops at a younger age, even before the age of 50.

The apolipoprotein E4 gene, or ApoE4 gene, also increases the risk of developing the disease. It does not cause Alzheimer’s disease itself, but is a single risk factor. Around one third of Finns carry this gene. However, not everyone who has the gene develops the disease.

Symptoms of Alzheimer’s disease

The symptoms of Alzheimer’s disease can be divided into three stages.

1. Early stage

• Decline in short-term memory: difficulty remembering recent events or names
• Difficulty finding words
• Problems with concentration and decision-making
• Decline in sense of time and orientation
• Mood changes and mild anxiety

At the beginning of the disease, working memory still functions well and the person with Alzheimer’s disease can have a normal conversation. After a short time, however, things are forgotten. Remembering old events does not usually cause difficulties.

A person does not necessarily lose their driving licence immediately if Alzheimer’s disease is mild. As the disease progresses, driving ability declines, which is why the situation must be monitored regularly.

2. Middle stage

• Difficulties with daily tasks
• Problems with dressing and household chores
• Difficulties with perception and motor problems
• Behavioural symptoms, such as restlessness, irritability, apathy and depression. Hallucinations, such as visual hallucinations, may also occur, or the person’s personality may change.
• Getting lost in familiar places

For some people, the main symptom may be fatigue, as everyday routines no longer go as smoothly as before. Weight loss can also be part of the clinical picture, often because the person forgets to eat.

3. Late stage

• Memory loss may extend far into the past
• Inability to recognise loved ones
• Mobility and speech deteriorate
• Complete dependence on help from others
• Incontinence and swallowing difficulties

When should you see a doctor?

If important things are constantly forgotten, learning new things becomes difficult or behaviour becomes passive, it is advisable to see a doctor. Passive behaviour means that a person stops doing certain things when they notice that they can no longer manage them as before.

When investigating memory problems, it is essential that the patient, and preferably also a close family member, are interviewed carefully at an appointment with a neurologist or a geriatrician who treats memory problems in older people. Based on this, any necessary further examinations are planned. These include:

• Memory tests. These are carried out first. They are quick, short tests that measure cognitive brain function. The tasks have defined score limits.
• Blood tests. These help rule out other diseases and vitamin deficiencies that can cause memory problems. At the same time, they help determine whether there is another underlying reason for the symptoms, such as sleep problems, depression or stress.
• Brain imaging with MRI or CT. Imaging shows whether there are changes in the brain that may indicate Alzheimer’s disease.
• Cerebrospinal fluid tests. Certain biomarkers in the cerebrospinal fluid support the diagnosis. These tests are carried out when needed.

The latest test available at Aava is a blood test for a biomarker of Alzheimer’s disease, plasma pTau217. An elevated plasma pTau217 result suggests that there are changes in the brain associated with Alzheimer’s disease, although these changes do not always lead to illness. The test is not recommended for people without symptoms. The person must have memory or cognitive problems confirmed through examinations. The treating doctor decides whether the test is needed.

What should family members and loved ones know?

When the doctor tells the patient about Alzheimer’s disease and its treatment, it is important that a close family member attends the appointment. The person with the disease may not remember what was discussed.

During the appointment, the usual course of Alzheimer’s disease is reviewed so that loved ones know what is likely to happen over the years. It is typical of Alzheimer’s disease that symptoms vary from day to day. The person may therefore have moments of clarity from time to time. However, it is important to understand that the person will need more help as the disease progresses.

It is also good for loved ones to know that support is available for family members. For example, temporary care can be arranged for the patient so that family members can rest from time to time.

Treatment of Alzheimer’s disease

There is no curative treatment for Alzheimer’s disease. However, it is important that the disease is diagnosed as early as possible. This allows medication to slow the progression of symptoms.

• Alzheimer’s medication usually starts at a low dose. It improves memory and reduces behavioural problems.
• Physical activity, a healthy diet and good treatment of other diseases can slow the progression of Alzheimer’s disease.
• A nutritional supplement has been developed for Alzheimer’s disease. High-quality studies have found that it can slow shrinkage in the memory-related structures of the brain.
• A new drug treatment targets the biological mechanism of the disease for the first time. The new medicine targets amyloid plaques that accumulate in the brain and are linked to the progression of the disease.

Prognosis of Alzheimer’s disease

Alzheimer’s disease progresses individually. On average, life expectancy after diagnosis is 8 to 12 years. The rate of progression depends on the person’s age, general health and any other diseases they may have.

Prevention of Alzheimer’s disease

The risk of Alzheimer’s disease can be reduced in the following ways:

• Exercise regularly. According to some studies, even brisk walking a few times a week may have a protective effect.
• Maintain a healthy weight and eat brain-friendly food. People who follow a Mediterranean diet appear to have a lower risk of memory disorders than others. The Mediterranean diet includes plenty of vegetables, olive oil, seeds and nuts, as well as moderate amounts of fish, eggs and dairy products.
• Avoid smoking and excessive alcohol use.
• Stay socially active and keep your brain active. Meet friends, do crosswords, play games and learn new things. Do crafts, sing, play an instrument or listen to music.
• Take care of good and sufficient sleep.
• Keep long-term conditions, such as high blood pressure and diabetes, well controlled. Seek help for depression as early as possible.
• Protect your brain from injuries. Wear a helmet when cycling and when doing other high-speed activities.
• Use a hearing aid if you have hearing loss.
• Take care of your oral health. Brush your teeth morning and evening and floss daily. Visit the dentist regularly for check-ups.

Booking an appointment at Aava

If you have memory problems or are concerned about the memory of someone close to you, book an appointment with a neurologist for memory assessments through online booking or by calling Aava’s customer service on 010 380 3838. Memory problems in older people are also treated by geriatricians.