Alzheimer’s & Dementia

According to the National Institute on Aging, dementia is a term that describes a group of symptoms related to thinking, memory and changes in personality. The symptoms are chronic (long-lasting) and severe enough to interfere with the person’s day-to-day activities. Although they vary considerably from one individual to another, these symptoms commonly include the following: 

• Problems with memory, especially short-term memory
• Difficulty performing familiar tasks, such as preparing breakfast or getting dressed
• Language difficulties
• Changes in visual perception
• Disorientation
• Diminished judgment
• Difficulty concentrating
• Changes in mood or behavior

Typically, these changes come about gradually and slowly worsen over time. They may also wax and wane — a person with dementia may seem very lucid in one moment, and quite confused in the next. 

Types of Dementia

Dementia is not a disease in its own right. Rather, it is a symptom of an underlying problem in the brain. In fact, according to the Alzheimer’s Society of Ireland, there are at least 400 different types of dementia, although a few disease processes account for the bulk of cases seen. These include the following: 

Alzheimer’s Disease

Alzheimer’s disease is a progressive, irreversible brain disease that gradually destroys memory and thinking skills. Symptoms usually begin when a person is in their mid-60s, although a subtype of Alzheimer’s disease, known as early-onset Alzheimer’s, can occur in people who are younger than 65. Alzheimer’s disease is named for Dr. Alois Alzheimer, who discovered the condition in 1906. It is the most common cause of dementia and accounts for between 60% to 80% of cases in the U.S. 

Today, Alzheimer’s disease is thought to be caused by the accumulation of abnormal proteins in the brain. These proteins — beta amyloid and tau — form characteristic plaques and tangles that are believed to interfere with communication between nerve cells and prevent the absorption of essential nutrients within the cells. Research suggests that these abnormal proteins begin accumulating many years before symptoms of dementia begin. 

Additionally, a number of medical conditions and lifestyle factors  have been identified as risk factors for Alzheimer’s disease. These include:

• High blood pressure 
• Obesity
• Cardiovascular disease 
• Diabetes
• Physical inactivity
• Smoking
• Alcohol misuse

Stages of Alzheimer’s & Associated Symptoms

Alzheimer’s disease progresses slowly but inexorably in fairly typical stages. As of this writing, seven stages have been identified. Below is an overview of the symptoms associated with each:

• Stage One:
  • Begins 10-15 years before symptoms develop
  • No cognitive decline 
  • No complaints of memory problems
• Stage Two: Mild forgetfulness
  • Mild memory problems, such as misplacing items or forgetting names. 
  • Memory lapses may increase in frequency
  • Social and work life are unaffected.
• Stage Three: Noticeable problems with memory
  • Impaired concentration
  • Trouble remembering recently read books or magazines
  • Trouble organizing or remembering plans
  • Some difficulty with work or household tasks
• Stage Four: Significant memory loss and other cognitive skills
  • Difficulty remembering what day it is
  • Wandering or getting lost
  • Sleep problems; “sundowning” (waking at night and sleeping during the day)
  • Inappropriate clothing choices
• Stage Five: Significant cognitive impairment
  • Difficulty remembering people close to them
  • Trouble completing basic tasks such as bathing and dressing
  • Psychological symptoms such as hallucinations, paranoia or delusions
• Stage six: Severe symptoms
  • Unable to complete activities of daily living independently
  • Difficulty communicating: may not be able to come up with the right word for items  or activities
  • Emotional and behavioral difficulties including anger, aggression, paranoia, and delusions
• Stage seven: Loss of physical control
  • Lack of strength or ability to move independently
  • Swallowing difficulty
  • Incontinence
  • Greater susceptibility to infections

It’s important to note that these stages often overlap, and mild to moderate memory loss may last many years. 

Vascular Dementia

Vascular dementia is a form of dementia associated with cerebrovascular disease, which causes damage to the blood vessels in the brain. It is often associated with the same risk factors — high blood pressure, high cholesterol, atherosclerosis, Type II diabetes and cigarette smoking — that are known to increase the risk of Alzheimer’s disease, suggesting a link between the two. In fact, it is not uncommon for a person with vascular dementia to also have brain changes consistent with Alzheimer’s disease.

Symptoms of Vascular Dementia

The symptoms of vascular dementia are very similar to those of Alzheimer’s disease, and include the following:

• Problems with memory, thinking and organization
• Difficulty concentrating
• Confusion
• Changes in behavior and mood

Lewy Body Dementia

The third most common form of dementia, Lewy body dementia or LBD affects about 1 million people in the U.S. and is characterized by an abnormal accumulation of the protein alpha-synuclein in the brain. In healthy people, alpha-synuclein plays a role in helping nerve cells communicate with one another. But in LBD, this same protein forms clumps inside nerve cells that interfere with normal function and eventually cause the cells to die. These clumps also cause disruption of various brain chemicals, causing widespread damage to different parts of the brain. They are named Lewy bodies after the German neurologist Dr. Friederich Lewy, who discovered them in the brains of people with Parkinson’s disease in 1912. 

According to the National Institute on Aging, there are two forms of Lewy body dementia:

• Dementia with Lewy bodies, in which the cognitive changes characteristic of Lewy body dementia appear before the onset of movement problems.
• Parkinson’s disease dementia, in which cognitive symptoms develop after the onset of movement problems. According to the Alzheimer’s Association, between 50% and 80% percent of people with a diagnosis of Parkinson’s disease will experience dementia as the disease progresses. Research suggests that the time between a Parkinson’s diagnosis and dementia onset is about 10 years.  

Symptoms of Lewy Body Dementia

Unlike people with Alzheimer’s disease, who typically have memory problems early in the course of the illness, people with LBD tend to have few memory problems initially, and instead present with symptoms such as the following: 

• Trouble paying attention/loss of concentration
• Visual and spatial disturbances (for instance, not being able to judge distances correctly or not recognizing familiar objects) 
• Difficulty planning and multitasking
• Trouble problem solving 
• Visual hallucinations 
• Parkinsonism, a movement disorder characterized by stiff, slow movements, tremors, muscle rigidity, a flat facial expression, trouble speaking or swallowing, balance problems and falls

Sleep disorders, particularly insomnia and REM sleep behavior disorder, in which a person physically acts out troubling dreams by flailing, kicking, punching their bed partner and/or falling out of bed, are also common, and are often paired with excessive sleepiness during the day. 

Additionally, LBD causes dysregulation of the body’s autonomic nervous system, which controls automatic functions such as temperature regulation, perspiration, digestion and blood pressure. As a result, people with LBD may suffer physical symptoms such as the following:

• Sensitivity to heat and cold
• Dizziness and/or fainting
• Constipation
• Urinary incontinence
• Diminished sense of smell

Frontotemporal Dementia 

Frontotemporal dementia, or FTD, is a term used to describe a group of disorders that cause changes in personality, language and motor skills. Although relatively uncommon, it is a significant cause of dementia in people between the ages of 40 and 65. 

Frontotemporal dementia is the result of damage to one or two portions of the brain — the frontal and temporal lobes. Its symptoms differ from those of most other forms of dementia and reflect the functions that these two areas of the brain perform. 

Specifically, the frontal lobe, which is located just behind the forehead, is responsible for behavior, emotions, problem solving and planning, as well as speech. By contrast, the temporal lobes, located on either side of the brain, are responsible for interpreting the meaning of words (on the left) and recognizing faces and objects (on the right). When these lobes are damaged as they are in FTD, a constellation of symptoms develop, depending on which portions of the brain are affected the most. 

Symptoms of Frontotemporal Dementia

Frontotemporal dementia is sometimes initially diagnosed as a psychiatric disorder because sufferers exhibit bizarre behavior that is totally out of sync with their former selves. Symptoms typically occur in predictable patterns depending on what parts of the brain are involved. According to Mayo Clinic, these include the following:

• Behavior changes
  • Impulsivity and inappropriate social behavior
  • Poor judgment
  • Lack of inhibition
  • Apathy
  • Loss of empathy/insensitivity to the feelings of others
  • Compulsive behaviors, such as tapping or clapping
  • Changes in eating habits, especially a craving for sweets
  • Pica — eating things that are not normally thought of as food

• Language difficulties
  • Trouble finding the right word or understanding written language
  • Difficulty naming common objects
  • Hesitant speech
  • New difficulties with grammar and syntax

• Movement disorders
  • Tremors
  • Stiffness
  • Muscle spasms
  • Lack of coordination
  • Muscle weakness
  • Trouble swallowing

This latter group of symptoms often resembles those of Parkinson’s disease or amyotrophic lateral sclerosis or ALS. And, in fact, research has confirmed that there are genetic and biological similarities between ALS and FTD, although the nature of the connection is unclear at this time.  

Mixed Dementia

As researchers become more familiar with the chemical and structural brain changes associated with dementia, it has become more apparent that the majority of people with symptoms of dementia have more than one underlying disease. Known as mixed dementia, this condition may be a combination of Alzheimer’s disease and vascular dementia, or vascular dementia and other neurodegenerative processes. According to a study of 1000 elderly brains led by Dr. Patrician Boyle, a Professor at the Rush Alzheimer’s Disease Center in Chicago, over 94% had at least one identifiable “neuropathology” (for example, plaques and tangles associated with Alzheimer’s disease, or abnormal deposits of alpha-synuclein as seen in Lewy body dementia.) What’s more, 78% had two or more, 58% had three or more, and 35% had four or more. Further, there was no consistent association between the type of pathology seen and the level of cognitive decline. (The participants had been assessed for cognitive changes over many years before their deaths.) 

Obviously, the medical community still has much to learn about the causes of dementia and the ways in which our brains change as we age. Mixed dementia is probably much more common than we realize, according to Boyle. “Most people who live to be in their 80s will have some combination of neuropathologies in the brain,” she said. “We need to understand how these neuropathologies work together to impair cognition in order to develop effective interventions to prevent cognitive decline in old age.”

Alzheimer’s and Dementia Research

The first major milestone in the history of modern dementia research came in the mid-18th century, when scientists first described cerebral atrophy (shrinking of the brain) in persons who had died at an advanced age (about 35 to 50 years at that time). Later, in 1907, Alois Alzheimer first identified plaques and tangles in the brain of a young woman who had died after developing progressively worsening confusion, memory loss and hallucinations. Alzheimer was reportedly unsure whether these abnormalities caused her symptoms or were a related finding at that time. 

Throughout much of the 20th century, the condition discovered by Alzheimer was considered a rare disorder of younger people, separate from age-related senility (as it was called at that time). But as research continued, the scientific community began to see many similarities between the brains of people with age-related senile dementia and those with Alzheimer’s disease. Eventually, the two were lumped together under the diagnosis of senile dementia of the Alzheimer type.

Today, research into Alzheimer’s disease and other forms of dementia has come a long way. For example, the development of the amyloid PET scan in 2004 now allows doctors to quantify the amount of amyloid deposits in the brains of Alzheimer’s sufferers, even before significant symptoms appear. Not only has this opened up new approaches to following the progress of the disease, it will also enable scientists to track the success of new therapies using objective criteria that heretofore didn’t exist. 

Other avenues of study include the contribution of aerobic exercise to brain health (it’s huge) and the benefits of lowering blood pressure in people at risk for dementia. Additionally, a host of new therapies, from monoclonal antibodies to a vaccine that prevents the formation of tau, are under investigation, and some have already entered clinical trials. 

Alzheimer’s and Dementia Treatment

As of this writing, effective therapies for Alzheimer’s disease and most kinds of dementia are limited, but a number of medicines are available that treat their symptoms. Additionally, The Food and Drug Administration recently approved two medicines that have been shown to slow the progression of early-stage Alzheimer’s disease. They are:

• Aducanumab (Aduhelm®)– Aduhem was the first anti-amyloid antibody approved by the FDA. However, due to concerns about its side effects and high cost, the FDA limited its use to clinical trials. Aduhelm’s manufacturer discontinued manufacturing it in 2023, but the drug will be available to some patients until late 2024. 

• Lecanemab (Leqembi®)– Lecanemab is an anti-amyloid antibody that is delivered via IV infusion every two weeks. It has received full FDA approval for the treatment of early Alzheimer’s disease and mild-cognitive impairment or dementia in people who have confirmed amyloid accumulation in the brain. Like Aduhelm, Legembi is costly (about $26,000 per year, not including administration costs) and its side effects can be severe. Patients receiving the drug require periodic imaging studies to look for side effects such as brain swelling and bleeding in the brain. 

Medications for Symptom Relief

Although no medicine currently available reverses the progression of dementia and Alzheimer’s disease, there are certain classes of drugs that may help with symptoms of memory loss and cognitive difficulties. These include:

• Cholinesterase inhibitors, which are indicated for the treatment of early- to moderate-stage Alzheimer’s disease. These medicines treat symptoms such as memory loss, impaired thinking, poor judgment and language difficulties by preventing the breakdown of the chemical acetylcholine, which helps transmit messages between nerve cells. Drugs in this class include:

• Donepezil (Aricept) 
• Galantamine (Razadyne)
• Rivastigmine (Exelon)

• Glutamate regulators are prescribed for dementia and Alzheimer’s symptoms such as memory loss, inattention, difficulties performing simple tasks, and difficulty with language and reasoning. They act by regulating the activity of the chemical messenger glutamate in the brain. There is only one drug in this class currently approved for moderate to severe Alzheimer’s disease, memantine (Namenda).

Additionally, the medication (Namzaric®), a combination of Donepezil and memantine, is approved for moderate-to-severe Alzheimer’s disease. 

Medications for Behavior and Sleep

In addition to medications to treat memory and cognitive issues, a few medicines are currently approved to address two common symptoms of Alzheimer’s disease and dementia, agitation and impaired sleep. These include:

• Suvorexant (Belsomra®) –  approved for treatment of insomnia in people with mild to moderate Alzheimer’s disease. Possible side effects include impaired alertness and motor coordination (including impaired driving), worsening of depression or suicidal thinking, sleep-walking, sleep-driving and/or sleep paralysis and compromised respiratory function. 

• Brexpiprazole (Rexulti®) –  approved for the treatment of agitation associated with dementia due to Alzheimer’s disease. Rexulti should be used with caution, since serious side effects, including increased risk of death in patients with dementia-related psychosis, may occur. Other unpleasant side effects include sleepiness, weight gain, cold symptoms, and restlessness. 

Conclusion

In conclusion, dementia and Alzheimer’s disease represent significant public health challenges in the U.S. and globally. With an aging population, the prevalence of these conditions continues to rise, placing a growing burden on healthcare systems and caregivers. Research efforts are critical in advancing our understanding of the disease process and developing effective treatments. While no cure currently exists, a few breakthrough medicines show promise in halting progression of the disease. Public awareness and advocacy are essential to improve diagnosis, care, and support for individuals and families affected by dementia and Alzheimer’s disease. 

Whether lifestyle can cause or prevent dementia is still largely unknown. Increasing age is the greatest known risk factor for Alzheimer’s and other dementias. According to the Alzheimer’s Association, the risk of Alzheimer’s doubles every five years after age 65.

Genetics may also play a role. National Institutes of Health research shows that those who have a parent or sibling with Alzheimer’s are more likely to develop the disease than those who do not have a first-degree relative with dementia. However, the majority of Alzheimer’s disease is not hereditary. chronic head injuries, as well as education, race, or gender may also increase a person’s risk for developing the disease.  

Although there is no conclusive evidence that lifestyle choices cause or prevent dementia, medical experts acknowledge both the risks and benefits associated with each. Enough evidence-based studies link poor lifestyle choices with increased risk, while healthier choices may lower your risk for the development of the disease. Healthier habits can also boost overall immunity and reduce inflammation while supporting cognitive health.

According to recent guidelines released by the World Health Organization, people can reduce their risk of Alzheimer’s or dementia by adopting the following healthy lifestyle habits:

• Increasing aerobic exercise 
• Quitting tobacco, or not starting use 
• Limiting use of alcohol
• Reducing excess weight
• Including foods like fish, legumes, nuts, and olive oil in your diet
• Eating fruits and vegetables high in folate, vitamin C, D, E and carotenoids
• Maintaining healthy blood pressure, cholesterol and blood sugar levels
• Management of hearing loss

A physically active lifestyle is linked to good brain health. No matter what your age or dementia risk, physical activity can improve your chances of preventing underlying processes related to cognitive decline in early adulthood.

WHO also provides guidelines for physical activity, dependent upon their level of intensity. A minimum of an hour and a half to three hours of activity per week is recommended. This activity should include periods of aerobic movement (raising heart rate) for at least 10 minutes at a time and muscle strengthening exercises. The less intense the activities, the more they should be completed throughout the week.

Researchers at Harvard University found evidence that eating foods with flavonoids can help to keep the mind sharp. Flavonoids are the chemicals that give plant foods their bright colors. The strongest protective effect came from yellow and orange vegetables and fruits.

High-flavonoid foods include:

• Apples
• Blackberries
• Blueberries
• Celery
• Cherries
• Grapefruit
• Kale
• Onions
• Oranges
• Parsley
• Pears
• Peppers
• Raspberries
• Red cabbage
• Strawberries
• Soybeans
• Tea
• Wine

Based on promising study results, the Alzheimer’s Association also recommends increasing your mental activity as a measure to prevent dementia. 

Mental activities and brain exercises include:

• Board games
• Crossword puzzles
• Crafts and hobbies
• Learning a new skill
• Reading
• Working
• Volunteering
• Socializing
• Gardening
• Dancing 
• Playing an instrument

Sources

“What are the Causes and Risk Factors of Alzheimer’s and Other Dementias?” Alzheimer’s Association. https://www.alz.org/alzheimers-dementia/what-is-alzheimers/causes-and-risk-factors 

“Alzheimer’s in extended family members increased risk of disease, study shows”. National Institute on Aging. https://www.nia.nih.gov/news/alzheimers-extended-family-members-increased-risk-disease-study-shows 

“Disparities Related to Education, Race, and Gender Compound Health Disadvantages at Older Ages”. PRB. https://www.prb.org/resources/disparities-related-to-education-race-and-gender-compound-health-disadvantages-at-older-ages/ 

“Risk reduction of cognitive decline and dementia: WHO guidelines”. World Health Organization. https://www.who.int/publications/i/item/9789241550543 

“Lifestyle changes can help prevent dementia”. Harvard T.H. Chan School of Public Health. https://hsph.harvard.edu/news/lifestyle-changes-can-help-prevent-dementia/ 

“Can I Prevent Dementia?” Alzheimers.gov. https://www.alzheimers.gov/life-with-dementia/can-i-prevent-dementia#what-do-we-know-about-reducing-risk-for-dementia 

Also known as alcohol-related brain injury, alcohol-related brain damage is a form of cognitive impairment that develops as a result of prolonged, heavy alcohol consumption, usually over many years. In some individuals, it manifests as only minor changes in thinking and memory known as mild cognitive impairment. Persons with this level of brain damage may develop symptoms such as:

• Trouble remembering important information, such as appointments
• Trouble with short-term memory
• Forgetting recent conversations
• Poor judgment or decision-making
• Difficulty remembering sequences of complex tasks
• Trouble processing visual information 

However, some individuals will develop more severe symptoms that are consistent with dementia, such as progressive memory loss, visual-spatial difficulties, problems managing simple tasks, and personality changes such as lack of interest, irritability, lack of empathy and aggression.

Unlike Alzheimer’s disease and other forms of dementia, alcohol-related brain damage is amenable to treatment as long as the afflicted person abstains from alcohol. 

Causes of ARBD

Alcohol-related brain damage is the result of alcohol’s toxic effects on the brain. These include the following:

• Damage to nerve cells: The brain is made up of billions of nerve cells, or neurons. Over time, excessive alcohol use can damage these cells, causing them to die and the brain to shrink. 
• Damage to blood vessels: Excessive alcohol consumption affects the ability of the blood vessels to expand and contract normally, causing decreased blood flow to the brain. It can also lead to high blood pressure and increased risk of stroke. 
• Thiamine deficiency: Thiamine (vitamin B1) is essential to the normal functioning of nerve cells in the brain. Chronic alcohol abuse causes decreased absorption of thiamine from foods and also impairs utilization of thiamine by the cells. Combined with poor nutrition, these factors cause thiamine deficiency, which leads to cell damage and cell death. In some people with severe thiamine deficiency, this ultimately causes acute brain inflammation (Wernicke’s encephalopathy) and a form of dementia known as Korsokov’s syndrome, which may be permanent. 

Research suggests that in most cases, these factors work together to cause alcohol-related brain damage.

Sources

“Alcohol-related brain damage (ARBD): what is it and who gets it?”. Alzheimer’s Society. https://www.alzheimers.org.uk/about-dementia/types-dementia/alcohol-related-brain-damage-arbd 

“Mild Cognitive Impairment (MCI)”. Alzheimer’s Association. https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/mild-cognitive-impairment 

“Wernicke–Korsakoff syndrome”. Alzheimer’s Society. https://www.alzheimers.org.uk/about-dementia/types-dementia/wernicke-korsakoff-syndrome 

“Alcohol-related dementia: an update of the evidence”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC3580328/

According to the CTE Center at Boston University, chronic traumatic encephalopathy is a neurological condition that stems from repetitive brain trauma, either due to multiple concussions or multiple subconcussive hits to the head. First identified in boxers in the 1920s, the disorder is now known to affect retired football players and other athletes who sustained multiple head traumas during their careers. These repeated traumas trigger progressive degeneration of brain tissue and the buildup of an abnormal protein known as tau in the brain. 

CTE typically progresses in four stages, according to a study published in the journal Brain in 2012. Typical symptoms at each stage include the following:

Stage I 

• Frequent headaches
• Loss of concentration
• Attention deficits

Stage II

• Depression
• Mood swings
• Explosive behavior
• Short-term memory loss
• Impulsivity
• Suicidal ideation
• Disruption in executive functions such as thinking, planning and organizing (less common in Stage II)

Stage III

• Increased difficulty with executive functions
• Increasing short-term memory loss
• Worsening impulsivity
• Worsening depression
• Suicidal ideation
• Visual-spatial deficits
• Explosivity 
• Aggression
• Cognitive decline (at this stage of the illness, about 75% of sufferers are “cognitively impaired”)

Stage IV 

• Severe memory loss and disruption of executive function
• Language difficulties
• Worsening visual-spatial deficits
• Gait disturbances
• Aggression, explosivity
• Paranoia
• Dementia 

A significant number of people with CTE will die from symptoms associated with dementia. Suicide and overdose are also among the common causes of death in those diagnosed with CTE. 

Thankfully, CTE awareness has increased in recent years, in part due to the work of Dr. Bennet Omalu, M.D., a neuropathologist who first discovered the characteristic physical changes in the brain of former Pittsburgh Steelers center Mike Webster, who died at the age of 50 after many years of progressive decline. The National Football League has responded to Omalu’s and others’ research by instituting 47 rule changes and a concussion protocol intended to protect players from the kinds of repeated head trauma that lead to CTE. Omalu’s efforts to bring awareness to the dangers of repeated head trauma in athletes are the basis of the 2015 film “Concussion,” starring Will Smith. 

Sources

“What is CTE?” BU Research. https://www.bu.edu/cte/about/frequently-asked-questions/ 

“The spectrum of disease in chronic traumatic encephalopathy”. Brain – Journal of Neurology. https://sites.bu.edu/mckeelab/files/2014/06/The-spectrum-of-disease-in-chronic-traumatic-encephalopathy.pdf 

“Executive Function Disorder”. WebMD. https://www.webmd.com/add-adhd/executive-function#1 

“Bennet Omalu”. Biography. https://www.biography.com/scientists/bennet-omalu 

“Health and Safety-Related Changes for the 2017 Season”. NFL. https://www.nfl.com/playerhealthandsafety/equipment-and-innovation/rules-changes/health-and-safety-related-changes-for-the-2017-season 

Medical researchers suspect that type 2 diabetes is linked to the progression of dementia, and there is some evidence that Alzheimer’s may be caused by insulin resistance in the brain. This neuroendocrine phenomenon has been clinically described as type 3 diabetes, or T3D. The symptoms of type 3 diabetes mirror the symptoms of dementia, such as those seen in early Alzheimer’s disease.

However, the classification of type 3 diabetes remains controversial. It is not yet widely accepted in the medical field, as there are no clinical tests available to confirm the diagnosis. But the label is gaining traction as research continues to show a strong link between diabetes and dementia.

For example, a current study conducted by the National Institutes in Health confirms the implication that type 2 diabetes contributes to the progression of Alzheimer’s disease. Researchers identified the relationship to impaired insulin signaling in the brain. A recent study conducted by Mayo Clinic shows that a type of gene associated with dementia risk may interfere with the brain’s ability to use insulin. 

What Is Type 2 Diabetes?

Type 2 diabetes is a serious long-term condition in which the body is unable to use sugar or glucose efficiently. There are two mechanisms at work in the disease. First, the pancreas does not produce enough insulin, the hormone that allows sugar ( glucose) to be absorbed by the cells. Second, the cells respond poorly to the amount of insulin available, resulting in too much sugar in the blood. High blood sugar levels associated with diabetes can cause circulatory, nervous, or immune system disorders when left unchecked.

Symptoms of type 2 diabetes may include:

• Blurry vision
• Extreme fatigue
• Increased thirst
• Frequent urination
• Increased hunger
• Sudden weight loss
• Slow wound healing
• Tingling, pain, or numbness in extremities 

The American Diabetes Association states that individuals with type 2 diabetes are at a 60% greater risk for the development of dementia compared with those without diabetes. Women with diabetes are at a higher risk for vascular dementia than men. Researchers believe this is because chronic high blood sugar levels damage blood vessels, reducing blood flow to the brain, which causes injury to brain cells over time. Other scientists reason that insulin resistance causes amyloid plaques and inflammation in the brain, which are associated with a diagnosis of Alzheimer’s disease.

Scientists agree that advancements in identifying and treating type 3 diabetes are warranted.   

For now, there are many ways in which you can reduce your risk of developing type 2 diabetes and possibly dementia by making healthy lifestyle choices, such as

• Lose extra weight
• Quit smoking, or don’t start
• Increase physical activity, including aerobic and strength training
• Maintain a balanced diet of fruits, vegetables, and healthy fats
• Manage blood sugar levels with medication, if needed

Sources

“What is the link between Alzheimer’s and Type 3 diabetes?” Mayo Clinic. https://newsnetwork.mayoclinic.org/discussion/researchers-link-alzheimers-gene-to-type-iii-diabetes/ 

“Type 3 Diabetes and Its Role Implications in Alzheimer’s Disease”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC7246646/ 

“Mayo Clinic Minute: Is Alzheimer’s Type 3 diabetes?” Mayo Clinic. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-is-alzheimers-type-3-diabetes/ 

“Type 2 Diabetes”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193 

“Type 2 Diabetes as a Risk Factor for Dementia in Women Compared With Men: A Pooled Analysis of 2.3 Million People Comprising More Than 100,000 Cases of Dementia”. American Diabetes Association. https://diabetesjournals.org/care/article/39/2/300/37175/Type-2-Diabetes-as-a-Risk-Factor-for-Dementia-in 

People with dementia tend to die from dementia-related complications versus the diagnosis itself. Although the World Health Organization lists dementia as the seventh leading cause of death among all diseases, experts estimate that number may be much higher. This is because the cause of death for those with dementia is often attributed to another medical condition or acute illness. Pneumonia, bacterial infection, and organ failure are often noted as the primary cause of death for those who die with dementia. 

Infection is the leading cause of death among people with dementia. National Institutes of Health research suggests that amyloid protein and the ApoE4 gene linked to Alzheimer’s disease can damage the blood-brain barrier. This allows for viruses and bacteria to more easily infiltrate the brain tissue. Coupled with inflammation and a weakened immune system, the effects are often life-threatening to those with dementia. 

Most of these medical complications are associated with end stages of the disease. An inability to swallow food or liquids can cause either of them to enter the windpipe rather than the esophagus. This can cause infection in the lungs ultimately leading to aspiration pneumonia. End stages of dementia may include other barriers to a hearty immune system including an inability to sit up or move around, increased rate of bed sores, frailty, blood clots, loss of bowel and bladder functions, and increased sleep. 

Comorbidities or chronic conditions like heart disease, hypertension, diabetes, or chronic respiratory disease can also cause medical complications or death for those with end stage dementia. NIH also reports that acute organ dysfunction and severe sepsis is a common cause of death among hospitalized patients with dementia although the underlying mechanism is not fully understood.

Sources

“Dementia”. World Health Organization.   https://www.who.int/news-room/fact-sheets/detail/dementia

“Systemic inflammation, blood-brain barrier vulnerability and cognitive/non-cognitive symptoms in Alzheimer disease: relevance to pathogenesis and therapy”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC4114193/ 

“Aspiration”. WebMD. https://www.webmd.com/lung/what-is-aspiration 

“The impact of dementia on hospital outcomes for elderly patients with sepsis: A population-based study”. PLOS One. https://pmc.ncbi.nlm.nih.gov/articles/PMC6380589/ 

Most forms of dementia are caused by irreversible changes in the brain, such as the accumulation of amyloid and tau proteins that are found in people with Alzheimer’s disease. The condition typically develops slowly, and most individuals will have periods when their symptoms subside for a time. But, despite a number of treatment options that may slow disease progression somewhat, the general trajectory is one of steady cognitive decline. 

With that being said, some forms of dementia are temporary and treatable. For example, thyroid disease can cause symptoms of dementia, but they typically go away once the underlying cause is addressed. Vitamin B12 deficiency can also cause dementia, especially in the elderly. This is most often the result of an underlying disorder known as pernicious anemia, in which the body is unable to absorb vitamin B12 from food. When people with pernicious anemia are given adequate vitamin B12 supplements, either by injection, nasal gel or pills, the symptoms of dementia will usually disappear. 

Symptoms of dementia may also be a reaction to certain drugs. This is especially true in the elderly, whose bodies are less able to metabolize medicines, which then build up quickly in the blood. Some medications that may cause dementia even when taken as directed include the following:

• Antidepressants
• Antihistamines
• Benzodiazepines (used to treat anxiety or insomnia)
• Medications to treat Parkinson’s disease
• Steroids
• Narcotics 
• Sedatives
• Some cardiovascular drugs
• Cancer therapy, especially chemotherapy (this is commonly called “chemo brain”)

In the case of drug reactions, stopping the medicine will usually allow symptoms to subside. However, the effects of some drugs, particularly cancer chemotherapy, can persist for some time. 

Another form of “dementia” that is at least partially reversible is associated with chronic alcohol use. Known as alcohol-related brain damage or, in some cases, Korsokov’s syndrome, this type of dementia can be slowed or reversed if the person stops drinking alcohol.

Sources

“Vitamin B12–Deficiency Anemia”. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/anemia/vitamin-b12-deficiency-anemia 

“Korsakoff’s Syndrome”. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/neurology-neurosurgery/specialty-areas/memory-disorders/korsakoffs-syndrome 

Doctors diagnose dementia and Alzheimer’s disease through a series of steps that include a thorough medical evaluation, tests to assess mental status and mood, imaging of the brain, and laboratory tests. According to Stanford Health Care, the evaluation usually includes the following:

• A thorough medical history, including a review of past illnesses, current symptoms, medication use, diet and alcohol use. The doctor may also ask about any family history of Alzheimer’s disease or dementia. In some cases, the doctor may speak with family members to get some background on behavioral or cognitive changes they may have seen. 
• A physical exam
• Depression screening, since the symptoms of depression can often mimic those of dementia
• Memory testing, in which the doctor asks the person simple questions, such as the date or who the president is. The person may also be asked to memorize a short list of words or participate in problem-solving tasks.
• Neurocognitive testing to evaluate mental status more extensively. This may include a series of tests that evaluate judgment, attention, executive function and language skills.
• Imaging studies, which may include the following:
  • A computerized tomography (CT) scan and magnetic resonance imaging (MRI). These tests can reveal shrinkage in the brain as well as any underlying conditions that may be causing the person’s symptoms, such as a brain tumor, an aneurysm or a stroke.
  • A positron emission tomography (PET) scan and single photon emission computed topography (SPECT) scan. These very sophisticated imaging studies can show how the brain is functioning and reveal discrete structural changes such as the buildup of tau proteins seen in Alzheimer’s disease. 
• Blood and urine tests to look for metabolic abnormalities, such as a thyroid hormone or vitamin deficiency, infection or liver or kidney disease. Depending on the patient’s history, the doctor may do blood tests for HIV, toxic substances such as lead and medications that could lead to an altered mental state. 

• Lumbar puncture (spinal tap) to obtain cerebrospinal fluid for testing
• An electroencephalogram (EEG) to measure electrical activity in the brain, which can help distinguish between dementia and delirium and the specific abnormalities seen in the rare disorder Creutzfeldt-Jakob disease

Sources

“Dementia Diagnosis”. Stanford Medicine. https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/dementia/diagnosis.html 

“Classic Creutzfeldt-Jakob Disease”. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/creutzfeldt-jakob/about/?CDC_AAref_Val=https://www.cdc.gov/prions/cjd/index.html 

Although the most common early sign of Alzheimer’s disease or dementia is memory loss, several other early signs and symptoms can indicate the presence of this disease. While it is normal to experience changes in the ability to retain and recall information with age progression, when memory loss disrupts daily life, it can be an indicator that Alzheimer’s disease has developed. Disruptive memory loss may include forgetting important dates and appointments or relying heavily on reminders. Other early signs and symptoms of Alzheimer’s disease or dementia can include:

• Difficulty in problem-solving or making plans
• Wandering and becoming lost 
• Difficulty completing common tasks
• Losing items or placing them in unusual places
• Repeating questions or statements 
• Taking longer to complete simple tasks
• Forgetting recently learned information
• Making poor decisions or struggling with judgment 
• Mood or personality changes
• Loss of initiative 
• Difficulty managing finances and paying bills
• Lack of awareness regarding current location 

Some individuals may experience language and communication difficulties. They may struggle to find the right words to describe objects, express their thoughts, or participate in conversations. They may have difficulty maintaining the conversation and become frustrated if they realize they cannot communicate effectively. This frustration can also impact their overall mood, personality, and behavior. As these changes emerge, an individual with the early signs of Alzheimer’s disease or dementia may withdraw from social situations, become more prone to aggression, or become noticeably depressed. 

Another common sign is experiencing difficulty in understanding spatial relationships and images. Someone in the early stage of Alzheimer’s or dementia may struggle to read or maintain their balance. Changes in visual acuity, such as the ability to discern color, distance, or contrast can occur. However, vision changes can also be a part of normal aging. Diminished vision may also be associated with cataracts, so having a formal examination from an optometrist can be helpful.

While many of these signs and symptoms are indicators of Alzheimer’s disease or dementia, it is crucial to understand that their presence is not equal to a diagnosis. As mentioned, some changes may be the signs of normal aging. However, if symptoms disrupt daily life or become concerning, contact a healthcare professional for a comprehensive evaluation and assessment. 

Sources

“What Are the Signs of Alzheimer’s Disease?” National Institute on Aging. https://www.nia.nih.gov/health/alzheimers-symptoms-and-diagnosis/what-are-signs-alzheimers-disease 

“Alzheimer’s disease”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447 

“10 Early Signs and Symptoms of Alzheimer’s and Dementia”. Alzheimer’s Association. https://www.alz.org/alzheimers-dementia/10_signs 

Monoclonal antibody treatment for Alzheimer’s disease represents an innovative field of research that focuses on utilizing monoclonal antibodies to reduce or eradicate characteristics associated with the disease’s progression. These antibodies are referred to as “monoclonal” because they’re lab-engineered to replicate the structure of natural antibodies produced and managed within the body. Monoclonal antibodies target tau and amyloid proteins, substances that have been the main focus of research due to their role in plaque formation in the brain.

Examples of monoclonal antibody therapies for Alzheimer’s disease include solanezumab, donanemab, lecanemab, and aducanumab. These antibodies work by preventing beta-amyloid and tau from forming plaques in the brain and by eliminating previously formed plaques. They aid the body in clearing these plaques by binding to the proteins and destroying them. The introduction of monoclonal antibodies stimulates both the immune system and the related responses in the body to react to these proteins.

Monoclonal antibodies are typically administered as intravenous (IV) solutions injected into the patient’s veins, which is a treatment known as an infusion. Each monoclonal antibody medication has a specific frequency for infusion administration, such as every four weeks for aducanumab. Infusion duration can vary and also includes additional observation time to monitor potential adverse reactions to the medication. There are also monoclonal antibodies that can be self-administered subcutaneously in the upper thigh or abdomen, but since some patients with Alzheimer’s disease may struggle with self-injection, a family member or caregiver usually takes on this responsibility. 

While monoclonal antibodies’ use in Alzheimer’s treatment shows promise, clinical trials have yielded mixed outcomes. For instance, phase 3 trials for bapineuzumab, solanezumab, gantenerumab, and crenezumab were discontinued due to a lack of efficacy. Despite these mixed results, other ongoing trials and dedicated development of monoclonal antibody treatments for Alzheimer’s disease continue. The outcomes for treatments like aducanumab and lecanemab, which was recently granted traditional approval by the FDA,  serve as a hopeful reminder that monoclonal antibodies may eventually provide an effective cure for Alzheimer’s disease.

Sources

“Aducanumab Discontinued as an Alzheimer’s Treatment”. Alzheimer’s Association. Retrieved from https://www.alz.org/alzheimers-dementia/treatments/aducanumab 

“FDA Converts Novel Alzheimer’s Disease Treatment to Traditional Approval”. U.S. Food and Drug Administration. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval 

“Understanding How Monoclonal Antibodies Work”. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK572118/ 

“Alzheimer’s Treatments: What’s on the Horizon?”. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers-treatments/art-20047780 

Early-onset Alzheimer’s disease is a form of dementia that develops prior to age 65. It generally strikes those in their 40s or 50s, but it can happen to someone as early as their 30s. It is estimated that 325,000 people, or one in 20 people with Alzheimer’s disease, have early-onset Alzheimer’s disease. However, a comprehensive compilation of studies released by Alzforum indicates prevalence may be higher.

For most people with early-onset Alzheimer’s disease, symptoms closely mirror those of other forms of Alzheimer’s disease, experts at Johns Hopkins Medicine note. The disease also progresses through the same stages of dementia as it does in people diagnosed after age 65.

Like the majority of dementias, the cause of early-onset Alzheimer’s is unknown. According to a study published in Oncotarget in 2018, genetic mutations may be a cause. But those mutations are rare, found in only 1% of people diagnosed with the disease. Genetic testing is available to those with a family history of early-onset Alzheimer’s. But the presence of abnormal genes does not always lead to development of the disease.

Early-Onset Alzheimer’s Diagnosis

Early-onset Alzheimer’s is often misdiagnosed. There are no diagnostic tools available to confirm it, and since it is uncommon among middle-aged adults, physicians can easily overlook it as a possible cause for cognitive decline. If you are experiencing cognitive symptoms, your doctor will administer cognitive testing of memory and other mental skills. They may also prescribe blood tests, urine tests, and CT or MRI scans of the brain. You may be referred to a neuropsychologist for further evaluation. 

If you suspect you or a loved one has early-onset Alzheimer’s disease, the Alzheimer’s Association recommends patients or caregivers contact a local chapter to find someone who specializes in Alzheimer’s disease in their area. Proper diagnosis is crucial for you and your family. Since most people diagnosed with early onset Alzheimer’s have a professional career, family obligations, and may be caregivers themselves, planning is essential. Financial and legal decisions must be made, as well as strategizing future care as the disease progresses.

With that being said, disease progression varies. Life expectancy for those with early-onset Alzheimer’s is unknown. But a wide range of 8 to 20 years of life is projected, similar to those with Alzheimer’s disease that develops later in life. As there may be a stigma attached to a diagnosis at such a young age, seek out family, friends, and your local Alzheimer’s Association chapter for support.  Clinical trials are underway to better understand the genetic, biological and clinical processes involved in younger-onset Alzheimer’s, so experts can develop better treatments in the future. Learn more about The Longitudinal Early-Onset Alzheimer’s Disease Study to see if you or a loved one may qualify to participate.

Sources

“Estimates of Young-Onset Dementia Prevalence Just Doubled”. AlzForum. https://www.alzforum.org/news/research-news/estimates-young-onset-dementia-prevalence-just-doubled 

“Early-Onset Alzheimer’s Disease”. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/alzheimers-disease/earlyonset-alzheimer-disease 

“The genes associated with early-onset Alzheimer’s disease”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC5871104/ 

“Get Involved with Your Local Chapter”. Alzheimer’s Association. https://www.alz.org/local_resources/find_your_local_chapter 

“LEADS Longitudinal Early-Onset Alzheimer’s Disease Study”. Alzheimer’s Association. https://www.alz.org/leads/overview.asp 

There is no sure way to prevent Alzheimer’s disease. However, taking steps to limit your risk of cardiovascular disease and diabetes may help lower your risk of Alzheimer’s disease as well. According to the Harvard School of Public Health, these lifestyle decisions can help ward off diabetes, lower blood pressure and improve heart health and, by extension, promote brain health. .

• Maintain a normal weight. Overweight individuals are seven times as likely to develop diabetes. If you are obese, your risk of diabetes is 20 to 40 times greater than someone who maintains a healthy weight. Obesity also increases the risk of heart disease and stroke.
• Exercise. Two large studies — the Nurses’ Health Study and Health Professionals Follow-up Study — indicate that walking briskly for 30 minutes a day reduces the risk of developing type 2 diabetes by 30%. The Black Women’s Health Study showed similar results from walking briskly for five hours per week. Additionally, according to the American Heart Association, regular aerobic exercise — at least 30 minutes of moderate-intensity physical activity five times per week — also improves cardiovascular health.
• Turn off the TV. Obviously, the more time you spend sitting in front of the TV, the less time you spend engaged in physical activity. This may be why research shows that for every two hours of TV a person watches, their risk of developing diabetes increases 20%, and their risk of cardiovascular disease increases by 15%. 
• Stop smoking. Smoking increases your risk of cognitive decline, but quitting appears to help restore brain function to the level of people who have never smoked. 
• Eat a healthier diet. In general, this means doing the following:
  • Eating more whole grains, fruits and vegetables
  • Swapping sugary drinks for water or unsweetened coffee or tea
  • Eating polyunsaturated fats, such as those found in vegetable oils, olive oil, nuts and seeds, and avoiding trans fats, which often lurk in margarine, baked goods and fast food. [Hint: anything that contains “partially hydrogenated vegetable oil” contains trans fat.]

• Eating “fatty fish” such as salmon, herring, sardines, mackerel, lake trout and albacore tuna. The omega-3 fatty acids in these fish will not decrease the risk of diabetes, but they can protect against heart disease.  

Additionally, the CDC recommends that older adults maintain social connections and stay mentally active to slow cognitive decline and decrease the risk of Alzheimer’s disease. Protecting your brain from trauma is important as well. Some steps that can decrease the risk of head injuries include the following: 

• Wear a helmet if you ride a bike or participate in contact sports
• Wear your seatbelt whenever you’re in an automobile
• Protect against falls: Wear sensible shoes and remove clutter, scatter rugs and other items that could cause you to slip and fall in your home. 

Finally, uncorrected hearing and/or vision loss are closely associated with dementia risk. According to the Alzheimer’s Society, people with age-related vision loss (for example, due to cataracts) were 50% more likely to develop dementia. However, those who had cataracts removed were 30% less likely to go on to develop dementia than those who did not. Diabetic retinopathy — vision loss caused by consistently elevated blood sugar — is also a recognized risk factor for developing dementia. 

 Similarly, even mild uncorrected hearing loss can double an individual’s risk of developing dementia, while severe uncorrected hearing loss can increase the risk by five times. The risk increases the longer hearing loss continues. 

In order to mitigate these risks, it is important to:

• Have your hearing and vision checked annually
• Wear hearing aids if they have been prescribed
• Wear glasses or contact lenses as needed
• Speak with your provider about surgery if you have developed cataracts
• If you are diabetic, keep blood sugar at recommended levels to lower the risk of diabetic retinopathy

Sources

“Simple Steps to Preventing Diabetes”. The Nutrition Source. https://nutritionsource.hsph.harvard.edu/disease-prevention/diabetes-prevention/preventing-diabetes-full-story/ 

“Impact of Smoking on Cognitive Decline in Early Old Age”. JAMA Psychiatry. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1151016 

“Hearing loss and the risk of dementia”. Alzheimer’s Society. https://www.alzheimers.org.uk/about-dementia/managing-the-risk-of-dementia/reduce-your-risk-of-dementia/hearing-loss 

“Vision loss and the risk of dementia”. Alzheimer’s Society. https://www.alzheimers.org.uk/about-dementia/managing-the-risk-of-dementia/reduce-your-risk-of-dementia/vision-loss-and-risk 

“Diabetic retinopathy”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/symptoms-causes/syc-20371611 

Yes, genetics can influence the development of Alzheimer’s, and it is linked to the early onset of the disease. However, multiple genes influence whether someone develops Alzheimer’s disease, and these genetic instances account for less than 1% of cases. Risk genes and deterministic genes determine whether someone develops a disease, and although there are Alzheimer’s genes found in both categories, identified cases of Alzheimer’s associated with genetics are attributed to deterministic genes. Additionally, many people who develop Alzheimer’s lack any previous family history of the disease.

Sometimes, genetic mutations can cause early-onset Alzheimer’s, resulting in what is known as early-onset familial Alzheimer’s disease. Mutations in the PSEN1, PSEN2, and APP genes are common in these cases. Early onset may also occur in cases with genetic changes that have yet to be identified. It is important to note that although genetics can increase the likelihood of developing Alzheimer’s, environmental and lifestyle factors can also exacerbate this likelihood.

While there is a genetic component involved in the development of Alzheimer’s disease, it is one of many factors involved rather than being the sole cause of the disease. It is crucial to understand both the genetic and non-genetic factors contributing to Alzheimer’s to develop appropriate preventative measures, as well as potential treatments. Ultimately, ongoing research in these areas is necessary for great insight into how to manage and prevent the disease in the future. 

Sources 

“Alzheimer’s disease.” Medline Plus. Retrieved from https://medlineplus.gov/genetics/condition/alzheimers-disease/#causes 

“Alzheimer’s disease genetics fact sheet.” National Institute on Aging. Retrieved from  https://www.nia.nih.gov/health/alzheimers-causes-and-risk-factors/alzheimers-disease-genetics-fact-sheet 

“What are the causes and risk factors of Alzheimer’s and other dementias?” Alzheimer’s Association. Retrieved from https://www.alz.org/alzheimers-dementia/what-is-alzheimers/causes-and-risk-factors

No one is certain why some people get Alzheimer’s disease. Research has identified certain common characteristics in the brains of people with the illness, but why these things happen is still unclear. However, doctors now know that certain factors increase the risk of getting Alzheimer’s disease. These include the following:

• Advancing age: Alzheimer’s disease is not a normal part of aging. However, as the Alzheimer’s Association explains, increasing age is the single biggest risk factor for developing the disease. The risk of getting Alzheimer’s disease doubles every five years after the age of 65. By the time a person reaches 85, the risk is nearly 50%. 

• Family history: Having a close relative who has or had Alzheimer’s disease is associated with an increased risk of developing the disease. The risk increases if more than one family member has Alzheimer’s disease. 

• Genetics: Scientists have identified a number of genes that have an impact on Alzheimer’s disease. Three of these genes, amyloid precursor protein (APP), presenilin-1 (PS-1) and presenilin-2 (PS-2), cause a rare, inherited form of Alzheimer’s disease that usually strikes people in their 40s and 50s. A fourth gene, apolipoprotein E-e4 (APOE-4), increases the risk of Alzheimer’s disease but doesn’t necessarily cause it. The risk is higher if a person carries two copies of the gene (inherited from both parents). 

• Cardiovascular disease: A history of cardiovascular disease increases the risk of both Alzheimer’s disease and vascular dementia, as well as the risk of stroke. 

• Type 2 diabetes: A great deal of research links type 2 diabetes and Alzheimer’s disease. Although the mechanism isn’t clear, people with type 2 diabetes have a 70% chance of developing Alzheimer’s disease later in life, according to Alzheimer’s.net. This may be related to increased levels of beta amyloid and tau protein in the brain, but may also be a function of obesity, high blood pressure and cardiovascular disease, all of which are common in people with type 2 diabetes/

Sources

“Earlier Diagnosis”. Alzheimer’s Association. https://www.alz.org/alzheimers-dementia/research_progress/earlier-diagnosis#apoe 

“How Alzheimer’s Could Be Type 2 Diabetes”. Alzheimers.net. https://www.alzheimers.net/2015-10-14-how-alzheimers-could-be-type-2-diabetes 

A memory cafe is a social gathering intended for individuals with memory loss, such as dementia or Alzheimer’s disease, and their respective caregivers. It provides a supportive and stigma-free space where these individuals can participate in activities, socialize, and foster a greater support network within their community. Memory cafes typically don’t require any assessments, referrals, or membership fees to participate. 

The concept of memory cafes originated in the Netherlands during the late 1990s and eventually spread to other countries around the world. They are conducted in common public spaces such as libraries, community centers, cafes, and many other places. It is estimated that there are at least 100 memory cafes present throughout the United States. Although most memory cafe gatherings are conducted in person, virtual and online memory cafes have also become popular in recent years. Memory cafes are typically hosted by independent groups, but online memory cafe directories make it easier to find a group that meets locally. 

Memory cafes provide a space where attendees can relax or participate in activities that promote social interaction and cognitive stimulation. Activities often vary and can range from dancing and painting to small potluck-style gatherings. The interaction helps reduce the level of isolation experienced by individuals with memory loss and also provides their caregivers with an opportunity to connect with others who are navigating similar experiences in the care of a loved one.

By providing a supportive community and enjoyable activities, memory cafes help to improve quality of life and overall well-being. They also serve as unique and valuable resources in the landscape of memory loss advocacy by providing an inclusive and positive space where individuals can feel validated and understood by others who are facing similar challenges. Memory cafes are ultimately an excellent way to enhance social connections and introduce a more playful approach to mental stimulation in patients with memory loss. 

Sources 

“So, what exactly is a Memory Cafe?”. Insight. https://www.insightmcc.org/blog/what-exactly-is-a-memory-cafe.html 

“What is a Memory Cafe?” Dementia Friendly America. https://dfamerica.org/memory-cafe-directory/ 

“Memory Cafés Offer Social Activities for Those Living With Dementia”. AARP. https://www.aarp.org/caregiving/basics/memory-cafe/ 

The monthly cost of memory care can vary significantly based on location, amenities, and the care required for your loved one. The median monthly cost for memory care in 2023 ranged from as low as $3,043 in South Dakota to as high as $10,080 in Vermont. These costs will usually cover meals, personal care, general accommodations, and any specialized care tailored to your loved one’s needs based on their diagnosis. For example, patients with dementia need extra structure and support in their daily routine, which often requires specialized training among healthcare professionals. Other services that typically add additional expense include transportation, therapy, and certain types of medication management. 

While the median cost of memory care per month differs significantly from state to state, these costs are also influenced by the region, with rural areas being less costly than urban areas. If your loved one has more advanced memory impairment, they may require more extensive supervision and care, which will typically increase projected expenses. Features and amenities such as independent and group activities, a high staff-to-resident ratio, general housekeeping and landscaping, and emergency monitoring can also influence the monthly amount paid. Some facilities also have specialized security measures to prevent and protect your loved one from wandering, such as tracking bracelets or elevators that require private access codes. If you prefer home care instead of a facility, charges are usually incurred by the hour and can range from $4,000 to $6,400 a month.

Since memory care can be costly, planning is usually required to cover the expenses. Possible options include long-term care insurance, state funds, reverse mortgages, or savings. Some individuals may also be able to cover the cost of care with assistance from the Veterans Administration, Medicare, or Medicaid. It is important to note that these options will only cover memory care in specific settings or circumstances. For example, Medicare will not cover the cost of a memory care facility, but will cover some of the costs associated with home health services. 

Individuals interested in pursuing memory care for a loved one are encouraged to research options to gain insight into the advantages and disadvantages of memory care facilities and home care in relation to potential financial impact. Additionally, working closely with a social worker or patient advocate can help find possible financial assistance options to cover care costs.

Sources

“How Much Does Memory Care Cost? A Complete State-by-State Guide”. A Place for Mom. https://www.aplaceformom.com/caregiver-resources/articles/cost-of-memory-care#median-memory-care-cost-by-state 

“Memory Care Costs in 2025”. Senior Living. https://www.seniorliving.org/memory-care/costs/ 

“How Much Does Memory Care Cost?”. Healthline. https://www.healthline.com/health/what-is-the-average-monthly-cost-for-memory-care 

“Does Medicare Cover Memory Care? A Comprehensive Guide”. National Council on Aging. https://www.ncoa.org/article/does-medicare-cover-memory-care-a-comprehensive-guide/ 

Memory care facilities, also known as memory support or memory care units, are living environments specially tailored for people with dementia or other forms of memory loss. They can be standalone communities or dedicated wings within traditional assisted living facilities or nursing homes. As opposed to assisted living, which provides a standard level of care, memory care provides a safe and secure environment 24 hours a day for people in need of more supervision due to cognitive decline.

One major difference between memory care facilities and regular nursing homes is increased security. Entrances and exits are typically secured or locked, or designed in such a way to prevent a patient from wandering off the property. Outdoor areas also tend to be supervised or secured, and layouts tend to be easy to navigate. 

There is typically a higher level of personalized care provided, too, often with a higher staff-to-patient ratio. Many memory care facilities have staff who’ve received specialized training in dementia and memory-related caregiving — though this isn’t always the case, so be sure to confirm with the specific location when looking on behalf of a loved one. Additionally, many locations offer activities specially geared toward people with cognitive issues that can include hands-on projects like crafts or gardening, games with a cognitive or therapeutic slant, and group exercise. Often, memory care facilities will have more communal spaces to encourage patients to socialize. For someone to be accepted into a memory care facility, they typically need an official dementia diagnosis.

Sources

“Assisted Living vs. Memory Care: What’s the Difference?”. Forbes. https://www.forbes.com/health/senior-living/assisted-living-vs-memory-care/ 

“What is Memory Care?” National Council on Aging. https://www.ncoa.org/adviser/local-care/memory-care/ 

Anyone can seek legal guardianship for someone with dementia when they may be a danger to themselves. If a Power of Attorney has not been previously established, petitioning the court for guardianship becomes the only legal choice.

Guardianship gives you the legal right to make decisions for the person with Alzheimer’s or dementia. The guardian, or conservator, will make all financial, health, and legal decisions for their loved one. This includes their daily living needs, where they will live, and what type of care they may need.

People with moderate or late-stage dementia may be considered a danger to themselves for various reasons. They may no longer have the ability to care for themselves. Perhaps they can no longer perform daily tasks safely. It is not uncommon for those living alone with dementia to forget to turn off the stove or wander off. Or they might make irrational decisions that can have catastrophic consequences. Many times, they will refuse help from others in an effort to maintain independence and autonomy. 

Legal guardianship for someone with dementia must be granted by a judge. The petitioner will need to provide proof that their loved one is incompetent due to Alzheimer’s disease or other types of dementia. This is usually facilitated by a physician’s statement after examination. Laws may vary depending on where you live. You can seek out an elder law attorney in your state bar association for assistance.

Emergency guardianship may be granted if your loved one is a victim of financial exploitation. This means predators have scammed them out of money on more than one occasion. Emergency guardianship may also be granted if the person lacks the ability to make any of their own decisions. The court can arbitrarily appoint a guardian or conservator if the family is unable to facilitate care or if there is no family.

Regardless of the circumstances, the court will scrutinize anyone seeking legal guardianship for someone with dementia. Taking away someone’s right to make decisions is a grave matter. The court must diligently ensure the physical and financial well-being of the person with dementia. The conservator will need to provide the court with documentation concerning their decisions throughout their guardianship.

Sources

“The American Bar Association”. US Bar Association. https://us-barassociation.org/ 

It is important that you take time to care for yourself while providing care for someone with dementia or Alzheimer’s disease. Assisting a loved one with day-to-day tasks like housekeeping, medications, bathing, grooming, dressing, toileting, and feeding can be physically and emotionally taxing. As their disease progresses, it can become an all-consuming role. Setting limits, seeking support, and adopting healthy lifestyle habits can ease the burden of daily demands on both your brain and your body.

Here are a few suggestions that may help caregivers to better maintain their overall well-being:

• Don’t overload your daily to-do list
• Find time to do something enjoyable each day
• Maintain a healthy diet
• Try a meditation or yoga app
• Take a bubble bath
• Practice relaxation techniques
• Incorporate aerobic physical activity into your daily routine
• Find something to laugh or smile about

Even with preventive measures, caregiving at home can become overwhelming for some. The CDC warns caregivers to watch for signs of caregiver burnout; a state of physical, emotional, and mental exhaustion.

Some symptoms of caregiver stress or burnout may include: 

• Feeling impatient or worrisome
• Withdrawal from friends and family
• Increased negative feelings
• Getting too much sleep or not enough sleep
• Noticeable changes in appetite or weigh
• Becoming irritated or angry more easily
• Losing interest in activities you used to enjoy
• Abusing alcohol or drugs, including prescription medications

Seek and accept help from friends, family members, and the community if you begin to experience symptoms of burnout or simply feel you need more support. Calendar applications such as www.lotsahelpinghands.com or www.caringvillage.com are available to help you to organize help, meals, and respite breaks. Additionally, the Alzheimer’s Association offers caregiver support groups both online and in person. You can search for a group in the Community Resource Finder on the AA website or call their 24/7 Helpline at 800.272.3900 for details.

The Family Caregiver Alliance says depression among caregivers is more common than you might think due to the constant demands of providing care for someone with dementia.

If you experience any of the following symptoms for longer than 2 weeks, you may want to seek medical attention to assess and treat depression: 

• Feelings of wanting to hurt yourself or the person you are providing care
• Feeling tired all the time, difficult to motivate yourself to do anything
• Feeling sad, tearful, helpless, numb, or hopeless
• Trouble focusing, thinking, or planning
• Neglecting your physical well-being and appearance
• Feeling that nothing you do is ever good enough
• Thoughts of escaping your situation without regard for consequences
• Complete loss of interest in people and/or activities that brought you joy

Your health insurance may provide coverage for one-on-one therapy either in person or online, or you may wish to seek care at one of the many online providers who now offer virtual therapy. A medical provider may also offer some medication to help you cope with your symptoms until they subside. 

Taking a longer break or respite may also be warranted. There are a few options to consider if you do not have ample support from family or friends. Hiring a certified home health aide to come into the home a few days a week may be helpful. The Alzheimer’s Association offers tips on finding adult day centers that accept patients with dementia. Short-term nursing home stays may also be an option for a longer respite from time to time. Visit the National Respite Network to find respite options in your area. Some of these services may even be covered by insurance or Medicaid.

Ongoing education and support are key to success in your role as caregiver, particularly as the disease progresses and daily needs change. Accept changes, be realistic, and most of all, know that you are providing the best care as is humanly possible for your loved one.

Sources

“Support Groups”. Alzheimer’s Association. https://www.alz.org/help-support/community/support-groups 

“Community Resource Finder”. https://www.communityresourcefinder.org

“Depression and Caregiving”. Family Caregiver Alliance. https://www.caregiver.org/resource/depression-and-caregiving/ 

“Adult Day Centers”. Alzheimer’s Association. https://www.alz.org/help-support/caregiving/care-options/adult-day-centers 

“Find a Respite Provider”. ARCH National Respite Network. https://archrespite.org/caregiver-resources/respitelocator/ 

“Recognizing Caregiver Burnout”. WebMD. https://www.webmd.com/healthy-aging/caregiver-recognizing-burnout 

Although providing care at home for someone with dementia can be challenging, it is possible to keep your loved one happy and safe. Once you understand and accept your loved one’s diagnosis, you can devise an initial care plan. Creating a safe environment, establishing daily routines, and employing professional services are good places to start. Patience and flexibility are key elements to successful caregiving, especially as your loved one’s disease progresses.

It is important to recognize that your loved one’s forgetfulness, impaired decision-making, and physical decline can cause danger to their well-being. Being proactive can help you to protect your loved one. Activities like driving may need to be reconsidered for the safety of your loved one.

Maintain a Safe Environment

Restrict use of oven, burners, or microwave that could be a fire hazard when used inappropriately or left unattended. Reducing fall risks in the home can prevent your loved one from injuries. Installing specialized locks can keep them from wandering off without supervision.  These lifestyle changes may lead to conflict, as your loved one may feel a loss of independence. Seek support from family members or professionals if you need help in keeping your loved one safe.

Stick with a Routine Whenever Possible

Routine can help those with dementia or Alzheimer’s to feel comfortable in their surroundings. Setting a schedule to complete daily tasks can help to reduce frustrations for both you and your loved one. Anticipate that tasks such as bathing, dressing, or eating may take longer when caring for someone with dementia.

Keep Communication Simple

Be sure to use only simple commands when assisting your loved one. Too many instructions at once can easily overwhelm them. Keep it simple, avoid distractions, and avoid criticizing or arguing with your loved one. Present simple choices to include their input, when possible, like “Do you want to wear the red or blue shirt today?” Be mindful of any distressed verbal or nonverbal cues and take a break if needed.

Seek Professional Help

Professional services or assistance may also be warranted in the home. The Alzheimer’s Association recommends a dementia care coordinator who can connect you with memory specialists and help you navigate care decisions. Forbes outlines medical alert systems that your loved one can use in an emergency for your peace of mind. Paid companions, certified home health aides, or skilled nursing care may also be valuable assets in helping you to care for someone with dementia. The National Institutes of Health provides additional home care tips and resources for families providing care at home for someone with dementia.

NIH studies show that caregiver stress can lead to burnout, fatigue, or depression to the point that you can no longer care for your loved one with dementia. It is imperative that you also care for yourself so that you remain physically, mentally, and emotionally well. At some point, you may also need to seek alternative care options or institutions to ensure your loved one with advanced dementia gets the best care.

Sources

“Preventing Falls at Home: Room by Room”. National Institute on Aging. https://www.nia.nih.gov/health/falls-and-falls-prevention/preventing-falls-home-room-room 

“7 Door Locks to Keep Dementia Patients Indoors”. Alzheimer’s Lab. https://alzheimerslab.com/door-locks-for-dementia-patients/ 

“Dementia Care Coordination”. Alzheimer’s Association. https://www.alz.org/manh/professionals/dementia-care-coordination 

“We Tested The Best Medical Alert Systems–Here’s Our Top 10”. Forbes. https://www.forbes.com/health/medical-alert-systems/best-medical-alert-systems/ 

“Tips for Caregivers and Families of People With Dementia”. Alzheimers.gov. https://www.alzheimers.gov/life-with-dementia/tips-caregivers#tips-for-everyday-care-for-people-with-dementia- 

“Caregiver burden: A concept analysis”. International Journal of Nursing Sciences. https://pmc.ncbi.nlm.nih.gov/articles/PMC7644552/ 

Although your primary care doctor should always be your first stop when seeking medical care, diagnosing and treating Alzheimer’s disease and dementia usually also requires the help of a specialist or two. In most cases, your primary care physician will refer you to the specialists they believe can be most helpful. However, many patients can also self-refer if they believe they need access to more specialized care (always check with your insurance provider first).

The following kinds of doctors are usually well-versed in the care of patients with memory problems and have the tools necessary to diagnose and treat dementia. 

Neurologists

Neurologists specialize in disorders of the nervous system, which includes the brain, spinal cord and peripheral nerves. Many, but not all, neurologists diagnose and treat patients with memory problems such as dementia and Alzheimer’s disease. So before you schedule an appointment for yourself or a loved one, call the practice and make sure this is their area of expertise. 

Neuropsychologists

Neuropsychologists are psychologists who are specially trained in diagnosing and treating an array of disorders that involve memory, attention, written and spoken language and problem-solving skills. You may be referred to a neuropsychologist for additional testing if your doctor needs help making a diagnosis of Alzheimer’s disease or another form of dementia. Neuropsychologists are usually not medical doctors, but most have a doctorate in either psychology, neuropsychology or both. 

Geriatricians

A geriatrician is a medical doctor who specializes in the treatment of adults over the age of 65. Many geriatricians are board-certified in internal medicine or family practice as well as geriatric medicine. They are typically very well-versed in diseases of aging and are able to diagnose and treat many conditions, including Alzheimer’s disease and dementia. 

Geriatric psychiatrists

A geriatric psychiatrist is a medical doctor who has been board-certified in general psychiatry and specializes in mental health care for aging adults. These specialists can be especially useful in ruling out other causes of cognitive issues, such as depression. They can also help manage behavioral issues in people with dementia and/or Alzheimer’s disease. 

Sources

“Neuropsychologist”. Healthline. https://www.healthline.com/health/neuropsychologist

Although Alzheimer’s disease progresses at different rates in different individuals, the average life expectancy after an Alzheimer’s diagnosis is 8 to 10 years. As the disease progresses, the person will become more confused and find it more difficult to articulate their needs. So it is up to the person’s loved ones to decide how and in what setting to provide ongoing care. 

Hopefully, your family member has already created an advance directive, which makes their wishes known about how and where they would like to be cared for at the end of life. If they did not do so while they still had decision-making capacity,  it will be up to you and your family to determine what’s best. As the person with dementia becomes progressively more debilitated, you may need to place them in a long-term care facility if you don’t have the resources to care for them at home. 

Home hospice care may also be an option as your loved one approaches the end of life. Hospice is usually available once the person’s doctor says the person has six months or less to live. Before the person reaches that point in their journey, you may wish to ask your doctor about involving a palliative care team to help manage symptoms and improve the person’s and your own quality of life. This team of professionals will typically include a physician, nurse, social worker, and chaplain and physical and occupational therapists who are skilled at helping manage symptoms such as sleeplessness, restlessness, anxiety and depression. They will also assess the Alzheimer’s sufferer for symptoms such as agitation and pain, which often go untreated in people with advanced Alzheimer’s disease. 

As the disease progresses, the palliative care team can assist the family in making end-of-life decisions, including decisions about placement, when to involve hospice and goals of care. They may also be able to assist in arranging respite care so that the family can attend to their own needs. 

Sources

“Alzheimer’s stages: How the disease progresses”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers-stages/art-20048448

“How do people with dementia die?”. Kevin MD. https://kevinmd.com/2009/11/people-dementia-die.html 

“What Is Respite Care?”. National Institute on Aging. https://www.nia.nih.gov/health/caregiving/what-respite-care

One of the most difficult decisions that will need to be made regarding someone with dementia is determining when they are no longer able to safely drive a car. Many people with early-stage dementia feel safe behind the wheel and view giving up the right to drive as a profound loss of independence and self-esteem. Nonetheless, it’s a given that at some point the symptoms of dementia will make driving, especially on freeways at high speeds, unsafe. 

According to guidance from Mayo Clinic, it’s best to discuss the issue of driving with your loved one while their dementia symptoms are still mild. At this stage of the illness, the person may be able to accept more readily that they will need to stop driving someday and agree to certain criteria that will indicate they should no longer be behind the wheel. Ideally, the person’s doctor or health care provider should take part in this discussion, since they are often viewed as an impartial third party by all concerned. Aim to negotiate a “driving contract” in which the person with dementia agrees to stop driving when certain conditions are met.

With that being said, knowing when a person’s dementia symptoms are severe enough to force them to stop driving isn’t always easy. According to guidelines from the American Academy of Neurology, the patient’s doctor may administer two tests — the Clinical Dementia Rating (CDR) scale and the Mini-Mental State Examination (MMSE) — which provide an objective measurement of the severity of dementia and can be helpful in identifying people who are at risk. In addition, family members should be alert to behavioral signs that may indicate that their loved one is unsafe behind the wheel. These include the following:

• Drifting in and out of lanes
• Erratic driving
• Confusing the brake and gas pedals
• Hitting the curb while driving
• Failing to observe traffic signs and stop lights
• Driving too fast or too slow
• Getting lost while traveling to familiar places
• Becoming angry or confused when driving
• Getting into fender benders or more serious accidents

As soon as you begin to notice any of these signs, have a discussion with your loved one, both to encourage them to give up driving and to discuss other options for getting around. You may want to put together a list of alternatives, such as home delivery of groceries and medicines, paratransit options, friends and relatives who are willing to help, and even rideshare companies such as Uber and Lyft. If the person is adamant that they will not give up the right to drive, you may have to resort to hiding the car keys or even disconnecting a battery cable so their car won’t start. These may seem like extreme measures, but they may be the only way you can prevent your loved one from harming themselves or someone else. 

Note: In some states, healthcare providers are required to report any diagnosis of dementia to the Department of Motor Vehicles or state Health Department, which will then evaluate the person’s ability to drive. At present, these include:

• California
• Delaware
• Nevada
• New Jersey
• Oregon
• Pennsylvania

Sources
“Alzheimer’s disease”. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447

“Update: Evaluation and Management of Driving Risk in Dementia”. American Academy of Neurology. https://www.aan.com/Guidelines/home/GuidelineDetail/396 

Organizations and Government Agencies

The Alzheimer’s Association
1-800-272-3900 (toll-free, 24/7) 
1-866-403-3073 (TTY/toll-free)
info@alz.org 

Alzheimer’s Foundation of America
1-866-232-8484 
info@alzfdn.org 

National Institute on Aging Alzheimer’s and Related Dementias Education and Referral (ADEAR) Center 
1-800-438-4380
adear@nia.nih.gov 

National Institute on Aging/Alzheimer’s Caregiving 
1-800-222-2225

ARCH National Respite Locator Service 

Well Spouse Association
1-800-838-0879 
info@wellspouse.org 

Eldercare Locator (offered by the Administration for Community Living)
1-800-677-1116 

Administration for Community Living
330 C. St. SW
Washington, DC 20201
202-401-4634

Find a list of regional offices on this page of the ACL website

Clinical Trials

U.S. Pointer 
Sponsored by the Alzheimer’s Association, U.S. Pointer is part of a worldwide consortium studying the effects of lifestyle interventions in supporting brain health and preventing cognitive decline. The program is open to people who

• Are between the ages of 60 and 79 
• Do not exercise regularly
• Have other risk factors such as a family history of memory problems, high cholesterol or high blood sugar, or mild hypertension. 
• Live in proximity to one of six study locations (Winston-Salem, North Carolina, Sacramento, California, Chicago, Illinois; Houston, Texas; Providence, Rhode Island).

For more information:
800-272-3900

Alzheimer’s Association TrialMatch
As of April 1, 2022, there are over 900 clinical trials in the U.S. that are currently recruiting participants. The trials are open to patients and caregivers and are studying a wide range of conditions, including mild cognitive impairment and specific forms of dementia such as dementia with Parkinson’s disease. To learn more about trials that may be suitable for you, visit the TrialMatch website or email TrialMatch@alz.org.

Alzheimer’s Disease Research Centers

The National Institute on Aging sponsors 33 Alzheimer’s Disease Research Centers across the U.S. These centers are working to translate ongoing research into improved diagnosis and care for people with Alzheimer’s disease and other dementias. The centers offer the public:

• Help with getting appropriate diagnosis and medical management 
• Information about Alzheimer’s and related dementias, including resources and services in your area
• Opportunities to participate in clinical trials and related research
• Support groups and other programs for patients and their families

To find a research center in your state, use this ADRC locator on the National Institute of Aging website

Alzheimer’s Experts and Researchers 

The following professionals are well known for their work in Alzheimer’s disease and dementia. This is by no means an exhaustive list of experts in the field, but we hope it may guide you in your search for a professional in your area.

Giulio Taglialatela, Ph.D. – University of Texas Medical Branch, Galveston, Texas
Dr. Taglialatela studies the molecular mechanisms of neurodegeneration and cognitive decline in Alzheimer’s disease and related disorders and is the Director of the Mitchell Center for Neurodegenerative Diseases at UTMB

Sara Banks, Ph.D. – U.C. San Diego Health
Dr. Banks is a board-certified neuropsychologist who treats patients with neurodegenerative conditions such as Alzheimer’s disease, frontotemporal dementia, primary progressive aphasia and mild cognitive impairment. She is currently the director of neuropsychology at the multidisciplinary Memory Disorders Clinic at UCSD.

Mark Bondi, Ph.D., U.C. San Diego
Dr. Bondi is a professor of psychology at UCSD and the director of the Neuropsychological Assessment Unit at the San Diego Veterans Affairs Healthcare System. He is board-certified in neuropsychology and has authored over 150 research papers on Alzheimer’s disease and dementia and is the co-author of the 2013 book Mild Cognitive Impairment and Dementia: Definitions, Diagnosis and Treatment.

Rudolph Castellani, M.D. – West Virginia School of Medicine
Dr. Castellani is a Professor and  the Vice-Chair of Pathology Research & Section Chief of Neuropathology at West Virginia School of Medicine in Morgantown, West Virginia. He has co-authored numerous articles on chronic traumatic encephalopathy, or CTE, and the pathology and pathogenesis of Alzheimer’s disease.

Esther Seunghee Oh, M.D., Ph.D. – Johns Hopkins Medicine
Dr. Oh is an Associate Professor of Medicine, Psychiatry and Behavioral Sciences and Pathology at the Johns Hopkins University School of Medicine and the Associate Director of the Johns Hopkins Memory and Alzheimer’s Treatment Center. She has extensive experience in evaluating and managing memory disorders in older adults with multiple chronic conditions. 

Victor W. Henderson, M.D. M.S. – Stanford Medicine
Dr. Henderson is the Director of the Stanford Alzheimer’s Disease Research Center and a Professor of Epidemiology & Population Health and of Neurology & Neurological Sciences at Stanford Medicine. He is a renowned researcher whose focus is on mild cognitive impairment and neurodegenerative dementia and interventions to help prevent and treat these conditions.