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Alzheimer's Disease

Brief Overview: According to UpToDate, “Alzheimer disease (AD) is a neurodegenerative disease of uncertain cause and complex pathogenesis that primarily affects older adults and is the most common cause of dementia [1]. The earliest clinical manifestation of AD is usually selective memory impairment, although some patients present with symptoms in other cognitive domains (eg, executive function, language, visuospatial function). While treatments are available that can slow progression and ameliorate some symptoms of the illness, there is no cure and the disease inevitably progresses in all patients through moderate and severe dementia, requiring increasing levels of care and support for activities of daily living.”

Prevalence: According to UpToDate, “AD is increasingly prevalent with advancing age. In the United States in 2011, there were an estimated 4.5 million individuals over the age of 65 years living with clinical AD; this included 0.7 million people ages 65 to 74 years, 2.3 million ages 75 to 84, and 1.8 million 85 years and older.”

Etiology: According to the CDC, “We do not yet fully understand what causes Alzheimer's disease. There likely is not one single factor, but rather a combination of factors that cause the disease. These factors, which may affect each person differently, include:

  • genetics 
  • Family history.
  • Environmental factors.
  • Lifestyle behaviors.”

Risk Factors:

  • Increasing age (>65 years old)
  • Family history of dementia
  • Genetic factors
  • HTN
  • Dyslipidemia
  • CVD
  • Altered glucose metabolism, diabetes, obesity
  • Sedentary lifestyle
  • Brain trauma

Commonly Associated Conditions:

  • Mild cognitive impairment (often a prodromal stage)
  • Depression and anxiety
  • Sleep disturbances
  • Behavioral and psychological symptoms of dementia (BPSD)
  • Frailty and falls
  • Malnutrition and weight loss
  • Delirium (with illness or hospitalization)

Common Medications:

Medications do not cure Alzheimer’s disease but may help slow cognitive decline and manage symptoms. Medication choice and monitoring should balance modest benefits with side effect risk, especially in older adults.

  • Cholinesterase inhibitors – donepezil, rivastigmine, galantamine
  • NMDA receptor antagonist – memantine
  • Amyloid-targeted therapies – lecanemab, donanemab
  • Antioxidants – Vitamin E 1000iu BID
  • Behavioral symptom management (used cautiously):
    • Antidepressants (e.g., SSRIs) for depression/anxiety
    • Antipsychotics (short-term, severe agitation or psychosis only; increased risk in dementia)

Common Labs, Imaging, and Tests:

  • Mental status exam
  • Neuropsychological testing
  • Neuroimaging – MRI, CT
  • Biomarker testing

Common Symptoms:

  • Memory impairment
  • Impairment in executive function
  • Difficulty with problem-solving or planning
  • Word-finding difficulty
  • Disorientation to time or place
  • Impaired judgment
  • Mood or personality changes
  • Difficulty performing familiar tasks
  • Progressive loss of independence
  • Sleep disturbances
  • Apraxia
  • Olfactory dysfunction
  • Seizures

Common Treatments:

  • Medication (see above)
  • Minimize or abstain from alcohol
  • Exercise programs, as tolerated and approved by healthcare provider
  • Occupational therapy
  • Cognitive rehab
  • Caregiver education and support
  • Home safety modifications
  • Advance care planning and legal preparation
  • Coordination with neurology, geriatrics, and social services
  • Management of comorbid conditions

Physical Findings:

  • Often normal early in disease
  • Gait changes and frailty in later stages
  • Weight loss
  • Poor hygiene or self-care as disease progresses
  • Neurologic deficits usually mild until advanced stages

Potential Complications and Contraindications:

  • Potential complications:
    • Falls and fractures
    • Malnutrition and dehydration
    • Aspiration pneumonia
    • Behavioral disturbances leading to caregiver strain
    • Wandering and safety risks
    • Increased susceptibility to delirium
  • Contraindications / cautions:
    • Anticholinergic medications may worsen cognition
    • Antipsychotics carry increased mortality risk in dementia
    • Sedatives increase fall and confusion risk

General Health and Lifestyle Guidance:

  • Maintain structured daily routines
  • Encourage physical activity and social engagement as tolerated and approved by healthcare provider
  • Ensure adequate nutrition and hydration
  • Optimize sleep hygiene
  • Simplify environment to reduce confusion
  • Use calendars, labels, and reminders
  • Provide caregiver respite resources and education
  • Regular reassessment of driving and home safety

Suggested Questions to Ask Patients:

  • What memory or behavior changes have you noticed recently?
  • Are there any safety concerns (falls, wandering, driving)?
  • Is the patient taking medications as prescribed? Any side effects?
  • Have there been changes in sleep, appetite, or mood?
  • How is the caregiver coping? Any signs of burnout?
  • Has there been any recent illness or hospitalization?
  • Are advance directives or care plans in place?

Suggested Talking Points:

  • Alzheimer’s disease typically progresses gradually, and care plans will evolve over time.
  • Medications may help with symptoms but don’t stop the disease.
  • Routine, safety, and caregiver support are just as important as medication.
  • Early planning helps ensure the patient’s wishes are respected.
  • Caregivers are not alone—support and resources are available.

Sources:

This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.