Patient information from the BMJ Group
Alzheimer's disease and other kinds of

Many of us forget things as we get older. But if someone has Alzheimer’s or another
type of dementia, this forgetfulness gets very bad. The symptoms get worse over
time and it can be a great strain to care for someone with Alzheimer's.

We've looked at the best and most up-to-date research to produce this information.
You can use it to talk to your doctor and decide which treatments are right for you.

What is Alzheimer's disease?
Alzheimer’s disease is the most common type of dementia. Dementia is a term doctorsuse to describe what happens when someone’s brain stops working properly. Othercommon types of dementia are vascular dementia, which can happen to someone who'shad a stroke, and Lewy body dementia.
Dementia is an illness. It's not a normal part of getting older. But dementia is morecommon in older people. It's possible for younger people to get Alzheimer's, but it’s rare.
What are the symptoms?
The first sign of Alzheimer's disease is usually mild forgetfulness. At first, someone mayhave trouble remembering small things, like what they did yesterday. They may get lostor confused easily. Eventually, they may forget how to do important, everyday things,like cooking meals, getting dressed, or using the toilet. They may not recognise evenclose family members. This can make it very hard for someone with Alzheimer's to lookafter themselves.
The symptoms usually come on gradually. It's often a friend or relative who notices theillness and suggests seeing a doctor. But for someone who's had a stroke, dementia canstart suddenly.
The problems someone gets because of dementia can make it seem as if that person'spersonality has changed. They may become agitated or moody, pace about, or wanderoff. They may have trouble talking or understanding you. Some people imagine thatthings are happening to them (they have delusions) or see things that aren't really there(they have hallucinations). This can be upsetting. For example, someone may think thatpeople are trying to hurt them or steal their things. Some people become aggressive.
Looking after someone with Alzheimer's disease
It can be very difficult seeing someone you love change because of their illness. Therewill probably be times when it seems as if they're being deliberately difficult. But it’simportant to remember that your relative or loved one can't help their behaviour. Often,someone with Alzheimer's won't realise that anything's wrong.
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Alzheimer's disease and other kinds of dementia
It may help to try to relate to what the person is feeling, rather than what they're saying.
For example, if someone thinks their things are being stolen, they may be anxious aboutforgetting where they've put things.You could try putting labels on things, or making surethings are always put away in the same place.
If your loved one or relative has delusions or hallucinations, there's no point in trying topersuade them that the things they think are happening aren't real. It's better to gentlydistract or reassure them than argue. Simple things, like going for a drive or listening tomusic, may help.
You also need to make sure you have some time to yourself. It may help to have a fewdays away every so often, if possible. You may feel guilty about doing this. But lookingafter your own needs will help you take care of your loved one better.
What treatments work?
Unfortunately, there's no cure for Alzheimer's disease and most other kinds of dementia.
There are medicines that can help a little with forgetfulness and confusion. But they don'twork for everyone.
Drug treatments are only a part of the care that people with dementia and their familiesneed. People with dementia will eventually need lots of help looking after themselves.
Treatments to help with memory and thinking
Several drugs are designed to help people with Alzheimer's disease. These are donepezil
(brand name Aricept), galantamine (Reminyl), rivastigmine (Exelon), and memantine
(Ebixa). Studies show that people remember things a bit better and are a little less
confused after taking these drugs. And some research has found that these drugs may
help people with dementia look after themselves for longer.
However, these drugs don't help everyone, and you're unlikely to see a big improvement.
We don't know how long they keep working for, although some research on donepezilhas found it may still help after two years.
In the UK, there are guidelines for NHS doctors about when they should prescribe thesemedicines. The guidelines say that donepezil, galantamine, and rivastigmine should beprescribed for people with mild to moderate Alzheimer's disease. Memantine isrecommended for severe Alzheimer's disease, although it can also be taken by peoplewith moderate Alzheimer's if they can't take one of the other drugs.
All these drugs have side effects. Some of the most common are feeling sick, gettingdiarrhoea, or not feeling like eating. You or your loved one don't have to put up with sideeffects. A different drug or a change of dose may help, so talk to your doctor. For example,donepezil and galantamine seem to cause fewer side effects than rivastigmine.
Non-drug treatments
Some studies show that a herbal remedy called Ginkgo biloba may help people with
Alzheimer's disease and other kinds of dementia. In these studies, people who took it
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Alzheimer's disease and other kinds of dementia
could think more clearly and got on with other people better. However, some newer andbetter quality studies found that Ginkgo didn't help. Any benefits from this treatment arelikely to be small.
You can buy Ginkgo biloba from health food shops and chemists, and on the internet.
Bear in mind that herbal products aren't tested in the same way as medicines. You can'talways be sure how pure a product is.
Ginkgo biloba doesn't have many side effects. However, people who take Ginkgo shouldtell their doctor. That's because it can be harmful if taken with some medicines, especiallydrugs to prevent blood clots (such as aspirin or warfarin).
Getting the most out of life
Doing things they enjoy and being as independent as possible can help someone withAlzheimer's continue to get the most out of life. There are several ways that therapiststry to do this. If you’re close to someone with Alzheimer’s, you may wish to try some ofthese ideas yourself.
Some therapists use things like word or number games, practising with money, or looking
at pictures of famous faces. This is called cognitive stimulation. To help someone with
dementia feel involved with life, they may be encouraged to talk about people in family
photographs, play games, or do jigsaws. A large calendar or a blackboard can be used
to remind people about what's happening that day. This kind of approach is called reality
. Music therapy can also be used to try to help someone with Alzheimer's
feel happier or more relaxed. It can involve listening to a CD, going to a concert, or even
dancing, or playing instruments. Some research suggests music can help people feel
less restless and upset.
Occupational therapy aims to help people stay independent. An occupational therapist
can give advice on how to make day-to-day things easier. They can also suggest how
to adapt someone's home to help them cope.
A treatment called reminiscence therapy aims to help people exercise their memory.
People with Alzheimer's can often remember things that happened a long time ago better
than things that happened recently. A therapist might ask someone questions about their
childhood, or suggest they handle objects from their past. There’s not much research,
but it may help.
Even simple things, like aromatherapy, playing with a pet, or listening to music, may helpsomeone with Alzheimer's feel happier about life.
Treatments for people who are agitated or distressed
Some people with Alzheimer's disease become very distressed at times. They may getupset and anxious, or become convinced that unpleasant things are happening aroundthem. Some people become angry or even aggressive. If these things happen to yourrelative or loved one, there are several treatments that their doctor may suggest.
BMJ Publishing Group Limited 2012. All rights reserved.
Alzheimer's disease and other kinds of dementia
Before considering medicines, it may help to think whether any changes to someone'scare could help them be less distressed. For example, someone might like more privacy,or want to be kept busy more of the time. Poor eyesight can make hallucinations morelikely, so an eye test might be a good idea.
Drug treatments for agitation can have dangerous side effects, and older people tend tobe particularly vulnerable to the side effects of drugs. Some of the drugs we talk abouthere aren't suitable for some types of dementia. Drowsiness is a common side effect ofdrugs for people who are agitated, even to the point where someone passes out. Makesure you talk to your doctor about side effects. A different drug or a change of dose mayhelp to prevent them. If a doctor prescribes drugs for someone who's agitated, thetreatment should be reviewed regularly. It should be stopped if it's no longer needed ordoesn't help any more.
Antipsychotic drugs like haloperidol (brand name Haldol), olanzapine (Zyprexa), andrisperidone (Risperdal) are designed to help people who get delusions. (That's whensomeone thinks that something they've imagined is really happening.) There's researchto show that these drugs can help, but there's also a risk of severe side effects.
Antipsychotic drugs increase the risk of a stroke when they're used to treat elderly peoplewith dementia. There's also a risk of dying sooner, compared with people who don't takethese drugs. Doctors have been told not to prescribe antipsychotic drugs for people withdementia.
An epilepsy drug called carbamazepine (Tegretol) is sometimes used to treat peoplewho are agitated.
What will happen?
It's hard to know how quickly someone's symptoms will get worse. Everyone's different.
Some people stay the same for a long time. Others have some good days and somebad days. Eventually, most people with Alzheimer's need help with everyday things, likegetting washed and dressed.
People with mild Alzheimer's may wish to plan for the future and discuss their treatmentwith relatives. Some people write an advance directive describing the care they'd prefer.
People with dementia can lose the ability to keep track of money. So it's important todecide who should help with decisions about money and health care.
If you're on your own and caring for someone with Alzheimer's or another kind of dementia,there will be a time when it becomes hard to cope. You may be able to get help at home,or think about full-time care in a nursing home. Remember that there may be a chargefor these services. Decisions about caring for someone you love can be difficult andupsetting. It's probably wise to think about these things sooner rather than later. Thisgives you plenty of time to look at the options and make the right choice.
You also need to make sure your own health and wellbeing don't suffer. It's important toremember that your loved one will probably need full-time care, possibly in a nursinghome, at some point. It may help to prepare for this in good time, even if you think you'llbe able to cope for a while yet.
BMJ Publishing Group Limited 2012. All rights reserved.
Alzheimer's disease and other kinds of dementia
Where to get more help
It can be very difficult to care for someone with the later stages of Alzheimer's or anothertype of dementia. Some family carers go on coping alone for a long time, and the straincan be enormous. Make sure you get all the help you can, for example from your family,the NHS, and social services. There are also local carers' groups that may be able togive you support. For advice, you can contact the Alzheimer's Society(http://www.alzheimers.org.uk), Alzheimer Scotland (http://www.alzscot.org), and CarersUK (http://www.carersuk.org). Your doctor will be also able to suggest where you cango for help.
This information is aimed at a UK patient audience. This information however does not replace medical advice.
If you have a medical problem please see your doctor. for this content.
For more information about this condition and sources of the information contained in this leaflet please visit the BestHealth websiteThese leaflets are reviewed annually.
BMJ Publishing Group Limited 2012. All rights reserved.
Last published: Oct 31, 2012

Source: http://www.clinicalevidence.co.uk/x/pdf/clinical-evidence/en-gb/summary/531448.pdf

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Meaning of p-value in Medical Research Corresponding Author: Dr. Brijesh Sathian, Assistant Professor & Managing and Chief Editor NJE, Community Medicine, Manipal College of Medical Sciences, Department of Community Medicine, Manipal College of Medical Sciences, 155 - Nepal Submitting Author: Dr. Brijesh Sathian, Assistant Professor & Managing and Chief Editor NJE, Community

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