Alzheimer’s is the sixth leading cause of death in the United States and, among the top 10 causes of death nationally, the only one that cannot be prevented, cured or even slowed. The accompanying graph illustrates mortality rates for Alzheimer’s versus other leading causes of death in the U.S.

What Is Happening to My Loved One?

Basic knowledge of this baffling and tragic disease

Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually even the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear after age 60. Estimates vary, but experts suggest that as many as 5.1 million Americans may have Alzheimer’s disease.

In all likelihood, the threat of Alzheimer’s disease has been lurking in the human DNA for millennia. But until the 19th century, most people did not live much past 60 years of age, so the medical condition which later became defined as Alzheimer’s was probably accorded a more general, age-related term such as “senility” or “hardening of the arteries.”

In 1906, Dr. Alois Alzheimer, a German physician and pathologist, noticed changes in the brain tissue of a woman who had died of an unusual mental illness at age 51. Her symptoms included memory loss, language problems and unpredictable behavior. After she died, he examined her brain and found two types of abnormal conditions: clumps which we now call amyloid plaques, and tangled bundles of fibers which we now call neurofibrillary tangles. These plaques and tangles are two of the main features of Alzheimer’s disease; the third feature is the loss of connections between nerve cells, or neurons, in the brain.

Today, Alzheimer’s disease is the most common cause of dementia among older people. Dementia is the loss of thinking, remembering, reasoning and behavioral abilities. Many older people may experience some episodic waning of cognitive functioning, but when it interferes with a person’s daily life and activities on a consistent basis, it is time for medical intervention. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when a person must depend completely on others for basic activities of daily life…as well as personal safety.

Although modern medical science is making inroads into the understanding of this baffling disease, experts still don’t know how Alzheimer’s begins. It is generally believed, however, that damage to the brain starts 10 years or more before problems become evident.

During this preclinical stage of the disease, victims do not exhibit symptoms but negative biological influences are taking place in the brain. Abnormal deposits of proteins form amyloid plaques and nerve tangles throughout the brain; healthy neuron function slowly breaks down and, over time, neurons lose the ability to function and communicate with each other. Eventually these neurons die and damage spreads to a nearby section of the brain called the hippocampus, a structure that is essential in forming memories. As more neurons die, damage spreads and brain tissue progressively shrinks.

Is It Really Alzheimer’s? Or Just “Old Age”?

Although some memory loss is typical with age, chronic memory problems are the most prevalent early warning signs of Alzheimer’s. Declines in other common cognitive functions–such as word-finding, vision and spatial judgments, and impaired reasoning or irrational decision-making–may also signal the very early stages of Alzheimer’s. The differences between Alzheimer’s and typical age-related changes in thinking and behavior may be subtle. A key pattern to look for is the increasing consistency and frequency of the changes.

The following checklists may help you determine the stage of Alzheimer’s that your loved one is experiencing.

Mild Alzheimer’s:

A Checklist of Common Changes

• Loses spark or zest for life; does not start anything new.
• Loses judgment about money.
• Exhibits difficulty with new learning and making new memories.
• Consistently has trouble finding words; may make up words that sound similar or mean something like the forgotten word.
• May stop talking to avoid making mistakes.
• Easily loses way going to familiar places.
• Resists change or new things.
• Has trouble organizing or thinking logically.
• Asks repetitive questions.
• Withdraws, loses interest, is irritable or uncharacteristically angry when frustrated or tired.
• Won’t make decisions.
• Takes longer to do routine chores; gets upset if rushed or something unexpected happens.
• Forgets to pay, pays too much or forgets how to pay (may hand the checkout person a wallet instead of correct amount of cash).
• Loses or misplaces things by hiding them in odd places.
• Forgets where things go, such as putting clothes in the dishwasher.
• Constantly checks, searches or hoards things of no value.

Moderate Alzheimer’s:

A Checklist of Common Changes

• More noticeable changes in behavior, appearance, hygiene and sleep patterns.
• Mixes up identity of people: a son is mistaken for a brother, etc.
• Safety becomes an issue when left alone: stove burner left on, poisoning from ingesting nonedibles, exploitation by strangers, etc.
• Has trouble recognizing familiar people and own objects.
• May take things that belong to others.
• Continuously repeats stories, favorite words or statements.
• Repeated motions, like tearing tissue paper.
• Late afternoon or evening exhibits of restless, repetitive movements like pacing, trying doorknobs, fingering draperies.
• Cannot organize thoughts or follow logical explanations.
• Trouble following written notes or completing tasks.
• May be able to read but cannot formulate correct response to a written request.
• May accuse, threaten, curse, fidget or behave inappropriately, such as kicking, biting, hitting or grabbing.
• May become sloppy or forget manners.
• May accuse spouse of an affair or family of stealing.
• May see, smell, hear or taste things that are not there.
• Naps too frequently or wakes at night believing it’s time to go to work.
• May think TV story is happening to her/him.
• Needs help finding toilet, using shower, dressing appropriately for weather