JAMA PATIENT PAGE | Neurology

Alzheimer Disease
Alzheimer disease is a common cause of dementia in older adults.
Causes of Alzheimer Disease Brain changes in Alzheimer disease
Development of Alzheimer disease is related to 2 abnormal proteins HEALTHY SEVERE ALZHEIMER
DISEASE
in the brain called -amyloid and tau, which are toxic to nerve cells
(neurons) in the brain. The buildup of these proteins in neurons even- Cerebral Shrinkage
tually leads to neuron death, worsened brain function, and symp- cortex of cortex

toms of dementia. Dementia is a term used to describe a decline in

mental abilities including memory, language, and logical thinking.
The exact trigger for Alzheimer disease is unknown. It tends to
Enlarged
run in families, meaning there is a genetic component. More than ventricles
30 genes have been identified that may be involved in Alzheimer
disease. Three genes have been found to be passed down from par-
ent to child in a dominant manner, with about half of children of
Shrinkage of
an affected parent also eventually developing Alzheimer disease. Hippocampus
hippocampus
Alzheimer disease symptoms usually occur after age 65 years,
Brain nerve cells Damaged and
but often, the types of Alzheimer disease that run in families occur dying nerve cells
earlier.
Tau
Symptoms tangles
The symptoms of dementia from Alzheimer disease range from mild
to very severe. Amyloid
Symptoms of mild Alzheimer disease include problems with plaque

memory of recent events (often the earliest symptom), misplac-

ing items, getting lost in a familiar place, trouble completing com-
plex tasks such as paying bills, and mood and personality changes.
Symptoms of moderate Alzheimer disease include worse memory
loss and confusion, worse mood and personality changes, which
can include hostility or paranoia, not recognizing family members
and friends, and needing help with activities such as getting dressed
or going to the bathroom.
Symptoms of severe Alzheimer disease include losing the ability
to speak and complete dependence on others for all day-to-day
activities.
Normal aging also causes some degree of memory loss. It is im-
portant not to confuse normal age-related changes in mental func-
tioning with dementia. Changes from normal aging should not cause
problems with day-to-day activities.
Testing for Alzheimer Disease
Diagnosis of Alzheimer disease involves various tests for brain func-
tion, referred to as neuropsychological testing. Brain imaging is usu-
ally also done, both to look for signs of Alzheimer disease and to rule
out other conditions that can cause similar symptoms. Blood tests are
usually done to rule out other problems, such as thyroid diseases or
vitamin deficiencies, that may cause symptoms of dementia. Blood
tests or tests of spinal fluid can also help detect the abnormal pro-
teins that collect in the brain, but these are not always done.
Treatment
There is currently no cure for Alzheimer disease. Current medica-
tions can slow the progression of the disease but cannot reverse it.
Other medications can be used to treat problems with sleep, anxi-
ety, or depression that develop along with Alzheimer disease.
This is an area of active research. Several clinical trials are cur-
rently under way to investigate new classes of medications, such as
antibodies targeted directly against the -amyloid protein.
FOR MORE INFORMATION
National Institute on Aging
www.nia.nih.gov/alzheimers
To find this and previous JAMA Patient Pages, go to the Patient
Page link on JAMAs website at jama.com. Many are available in
English and Spanish.

Author: Jill Jin, MD, MPH
Sources: National Institute on Aging
Stevens L. Alzheimer disease [JAMA Patient Page]. JAMA. 2001;286(17):2194.
Langa KM, Levine DA. The diagnosis and management of mild cognitive impairment: a
clinical review. JAMA. 2014;312(23):2551-2561.
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