There are known factors that increase the risk for dementia. For example, people with Down’s syndrome are at very high risk of developing Alzheimer’s Disease while very young. However, on the whole, there is limited data on ideal strategies to lower an individual’s risk for Alzheimer’s Disease. Providing general guidelines for a healthy lifestyle and increasing the focus to cognitive health, rather than Alzheimer disease specifically, it becomes clear that exercise and lowering cardiovascular risk factors lowers risk for long term brain and heart disease. Cardiovascular risk factors include blood pressure control, lipid lowering strategies, exercise, avoiding obesity and a sedentary lifestyle. Tobacco use remains a major concern for cardiovascular wellness as a whole. Alcohol consumption has been plagued with both positive and negative reviews for possible health benefits. However, it is very clear from all available data that excess consumption of alcohol in any form is detrimental to brain health and general health as well, and should be avoided. For older adults, as they develop dementia, one concern is that they sometimes forget how much they are drinking, and this should be reviewed by family and medical providers when reviewing other factors like medication, that may be causing a decline in cognitive function.

Alzheimer’s disease is a clinical diagnosis. At this point in time, there is no definitive test to prove that a living patient has Alzheimer’s disease. The disease is usually diagnosed clinically when the physician evaluates the patient’s symptoms and rules out other neurological disorders. Alzheimer’s disease can only be suspected. It cannot be confirmed until an autopsy is performed. When an autopsy of the brain is performed, and the tissue is examined under the microscope, characteristic plaques and tangles can be observed. These are the classic hallmark signs of Alzheimer’s disease. At this point, a definitive diagnosis can be noted. Lumbar Puncture The physician may recommend a lumbar puncture as part of the workup for diagnosis of Alzheimer’s disease. If there are elevated levels of tau and phosphorylated tau within the cerebrospinal fluid, then it is suggestive of Alzheimer’s disease. Amyloid in the CSF is low in suspected Alzheimer’s patients. Imaging Imaging studies can be important in the diagnosis process, ecause other medical conditions that may mimic the same signs/symptoms as Alzheimer’s disease must be ruled out before a diagnosis of Alzheimer’s can be made. A specific study called the FDG-PET, with or without amyloid imaging, can be useful for early diagnosis of dementia.

Dementia Not all dementias are alike. The most common type of dementia is Alzheimer’s Disease. This was first described by a physician, Dr. Alois Alzheimer in 1906. He described some of the changes in the brain of a woman that examined after she died. Her brain had many abnormal clumps of amyloid (amyloid plaques) and tangled bundles of fibers (neurofibrillary tangles or tau). Alzheimer’s disease is diagnosed most frequently by a neurologist, geriatrician, or primary care physician with experience in diseases of memory. While the diagnosis is often clear once the patient has advanced symptoms, it is sometimes hard to make the diagnosis early on. Early on, when symptoms are unclear, the term “possible” or “probable” Alzheimer’s is frequently used. There are tests that have been used in clinical trials to ensure that the diagnosis is correct, however, these are not in common use in clinical settings for many reasons. The most common test remains a physician encounter, with a set of questions. The questions are typically asked in a set sequence and in a set way. Mild Cognitive Impairment Mild cognitive impairment or MCI, is a condition where the patient, and sometimes the clinician, can tell that there is some loss of memory function.

There are many signs and symptoms associated with Alzheimer’s disease. Which symptoms will occur, and when, depends on which of the three major stages of the disease the patient is currently in. These stages are classified as mild, moderate and severe.  Because this is a progressive disease, patients begin with mild symptoms and then progress to severe symptoms over time. When a patient begins to experience signs and symptoms that they are unable to explain, an evaluation by a physician can help to identify this disease. Mild Alzheimer disease presents with the following signs/symptoms: Memory loss.    Confusion.    Increased length of time to complete normal daily tasks.    Difficulty balancing a checkbook or paying bills.    Impaired judgment.    Loss of spontaneity.    Increased anxiety.    Mood/personality changes. Examples include, the patient may forget specific conversations or appointments that they would normally never forget.  Misplacing keys or other possessions may occur.  Getting lost in areas that they have been repeatedly. For example, the patient may have driven from the grocery store to the post office three times a week for the past 10 years – and then the last three times they have gotten lost, and unable to find their way to the post office from the grocery store.

While the exact reason individuals develop the disease is unknown, it is thought to depend on a multitude of factors. Those factors are a combination of genetic, environmental, and lifestyle factors. Genetics play a very small percentage in a patient’s development of this disease; however, if the individual does fall into one of the few percent of the population in which there is a genetic history, then those individuals have a significantly higher risk of developing the disease in the future. What are the Risk Factors associated with Alzheimer’s disease? Age Alzheimer’s disease is a disorder of the older population. Therefore, age is the greatest associated risk for patients developing Alzheimer’s disease. Patients greater than the age of 65 have an increased risk of developing Alzheimer’s disease; and with each decade above age 60, the risk increases two-fold. Genetics Genetics and family history also play key roles in determining which patient population is likely to develop this disease in the future. If there is a significant history of a parent or sibling having the disease, then the individual is at an increased risk of developing the disease. There are only a small percentage of patients who develop Alzheimer’s disease as a result of genetic mutations.One genetic mutation that researchers have identified as increasing the risk of individuals developing Alzheimer’s disease is the APoE4.