Alzheimer's disease is the most common form of dementia, which is the general term for the impaired ability to remember, think, or make decisions. Alzheimer's is the seventh leading cause of death in the United States. It is characterized by memory loss and other declines in mental function. While there isn't a way to prevent Alzheimer's, research has found some things you can do to reduce your risk of developing the disease. It's not a bad idea to establish these habits anyway because they offer many other health benefits as well.

Here's what to know about the risk of developing Alzheimer's and what you can do to lower your chances.

Who Is Most at Risk?

Alzheimer’s disease affects more than five million people in the United States. Your risk of developing it goes up with age. Most people who develop this disease don’t start seeing symptoms until about age 65 years. Known as late-onset Alzheimer’s, this type is the most common form.

The other type, early-onset Alzheimer's, is less common. It affects only about 10% of people with Alzheimer's. As you may have guessed from its name, early-onset Alzheimer's occurs earlier in life than age 65. Symptoms can show up anytime between a person's 30s and mid-60s.

How Alzheimer's Disease Progresses: From Diagnosis Through the 7 Stages

Genetics

While research is still ongoing in the field, genetics seems to be at least somewhat involved in both early-onset and late-onset Alzheimer's.

Genetic mutations appear to be the cause of early-onset Alzheimer’s, at least in some people. The causes of late-onset Alzheimer’s are less understood. Instead of having one cause, this form of Alzheimer’s is likely due to a combination of genetics, environmental factors, and lifestyle choices.

People with Down syndrome are more likely to develop Alzheimer's and may start to see symptoms in their 40s. Down syndrome is a genetic mutation resulting in three copies of chromosome 21 (instead of two). This chromosome is important because it is involved in the production of amyloid.

Amyloid is a protein that is found in sizeable clumps in the brain of people with Alzheimer's. These clumps are referred to as plaque. Its role may not yet be fully understood, but it is currently hypothesized that the presence of amyloid plaque is a brain change that occurs with Alzheimer's.

What To Know About Early Menopause and the Risk of Dementia

How To Reduce Risk

Alzheimer's isn't something that we know how to prevent based on our current understanding of the disease. There are certain risk factors, however, that may increase a person's chance of developing it.

Unfortunately, the biggest risk factor is one we can't control: our age. Our genetic makeup is another one we don't have any say over.

While there are no promises, we may be able to reduce our risk of developing Alzheimer’s by focusing on our lifestyle and behavior. Our chance of developing Alzheimer’s decreases when we work on preventing things like heart disease, stroke, high blood pressure, and diabetes. We can do this by making healthy lifestyle choices.

Lifestyle Habits

Leading a healthy lifestyle has many many health perks—including the possibility of keeping your brain sharp as you age. Specifically, here are the things you can do, or may already be doing, to lead a healthy lifestyle and potentially reduce your risk of Alzheimer's:

• Keep high blood pressure under control: High blood pressure has harmful effects on many parts of your body, including your brain. Your blood vessels and heart will also benefit from monitoring and managing your blood pressure.
• Manage blood sugar (glucose): Consistently having high blood sugar levels can increase your risk of various diseases and conditions, including problems with memory, learning, and concentration.
• Maintain a healthy weight: It’s clear that obesity is linked to cardiovascular disease, diabetes, and other conditions. What’s not so clear is how best to measure obesity. Several studies have shown that the ratio of your waist to your height may be one of the most accurate predictors we have of obesity-related diseases.
• Follow a healthy diet: Get a variety of fruits and vegetables, whole grains, lean meats and seafood, unsaturated fats like olive oil, and low-fat or nonfat dairy products. Cut back on foods that contain other fats and sugars, including ultra-processed foods.
• Be physically active: Exercise has many health benefits beyond possible Alzheimer’s prevention. It is recommended to get 150 minutes of moderate-intensity physical activity a week. That could be walking and/or cycling for 30 minutes five days a week.
• Keep your mind active: You can do this by playing games such as board games or word, logic, or number puzzles. Get creative by painting, writing, sculpting, or crafting. Stimulate your mind by reading a book, learning a new skill, working or volunteering, and socializing.
• Stay connected: Isolation and loneliness can increase your risk of Alzheimer’s. Getting in touch with loved ones or joining a club or another social activity can help you maintain social connectedness.
• Get treatment for hearing problems: Not being able to hear properly may make communicating with others more difficult. You can also protect your ears from loud noises to help prevent hearing loss.
• Sleep: Sleep is super important for our bodies and our minds. Aim for seven to eight hours a night, and see a healthcare provider if you are having any problems sleeping.
• Prevent falls and head injury: Head injuries are associated with a higher chance of developing Alzheimer’s. A common cause of head injuries to older adults are falls. To reduce falls, you can fall-proof your home, wear supportive shoes with nonskid soles, and participate in fall prevention programs.
• Limit alcohol consumption: Drinking too much alcohol can lead to falls and make other health conditions worse, including memory loss. Reducing consumption to one or two drinks a day (at most) can help.
• Don’t smoke: By not smoking, you’ll improve your health by reducing your risk for serious conditions including cardiovascular disease, stroke, and some cancers. You may be less likely to get Alzheimer’s as well.

Again, there are no promises that doing any of these things will prevent you from getting Alzheimer's. If you follow these recommendations, however, you will be helping yourself out in more ways than one. That's because you'll be reducing your chances of developing many other health problems at the same time. There is no harm done by checking off as many of these boxes as you can.

Brain Training and Memory: What To Know

Testing and Screenings

It’s important to take care of your mental and physical health. Getting your annual physical can help you and your healthcare provider monitor your health and conduct any additional testing as needed. They can also ensure that you’re getting all the screenings that are recommended for your age and sex.

If memory problems start to appear, healthcare providers will test you to determine whether those symptoms are due to Alzheimer's or something else. They'll talk to you (and perhaps a family member) to ask about general health, medications (including supplements), diet, medical problems, ability to perform daily tasks, and changes in behavior or personality. You may be hesitant to let them talk to a family member, but your loved ones may notice changes to your routine or personality (early signs of Alzheimer's) before you do, which can provide valuable insight to your provider.

If your provider thinks that you may have Alzheimer's or another form of dementia, they may test your memory, problem-solving skills, attention, counting, and language. Standard medical tests, like blood and urine tests, can also help identify potential causes of the problem.

In some cases, healthcare providers may suggest brain scans. Medical tests like computerized tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) are typically used to rule out other cognitive conditions, but can also be used to detect shrinkage that may be related to Alzheimer's disease. A special kind of PET scan called an Amyloid PET and an autopsy can be used to visualize amyloid plaques.

Discuss With Your Healthcare Provider

Alzheimer’s is a progressive disease. It starts gradually. So at first, it may be hard to tell the early symptoms of the disease apart from normal forgetfulness, for example.

Here are some of the common signs and symptoms to watch out for. Keep in mind, however, that everyone is different. Some people with Alzheimer’s show only a few of these signs. Others may have several of them.

• Having problems findings words or coming up with words compared to people of the same age
• Experiencing difficulty recognizing people and naming objects
• Having vision and spatial problems; getting lost or becoming confused even in a familiar setting
• Showing poor reasoning or judgment, which can affect decision-making skills
• Having difficulty managing money and paying bills
• Taking longer than usual to complete normal daily tasks
• Repeatedly asking the same questions
• Wandering and getting lost, even in places you're familiar with such as your neighborhood or the grocery store
• Misplacing things or putting them in odd places
• Displaying changes in mood and personality, including showing increased anxiety and/or aggression

Getting treatment as early as possible is especially important. A number of other conditions can cause the same symptoms as Alzheimer's. If detected early enough, some of these conditions can be reversed.

How To Tell the Difference Between Normal Age-Related Memory Changes and Dementia

A Quick Review

Characterized by memory loss and other cognitive decline, Alzheimer's is a disease that usually occurs around age 65 years. Although less common, it can also occur in a person's 30s or later. Unfortunately, the biggest risk factor—age—is something that you can't control.

You may be able to reduce your chances of developing Alzheimer's by leading a healthy lifestyle, even if genetic factors put you at higher risk. Establishing healthy habits will also lower your risk of other conditions, like cardiovascular disease, stroke, and diabetes.

If you have concerns that you or someone else may be showing signs of Alzheimer's, talk to a healthcare provider. Healthcare providers can run tests to determine what's causing the symptoms and provide appropriate treatment.

Menopause is a natural part of aging for about half the population. It marks the end of fertility, as the ovaries gradually reduce sex-hormone production and monthly periods cease. But menopause is also a focus for researchers who are trying to unravel one of medicine's ongoing mysteries: Why is it that almost two-thirds of people with Alzheimer's disease are women?¹

Alzheimer's disease (AD) is the most common type of dementia—which is the progressive loss of memory and other brain functions.^2,3 Symptoms of AD can interfere with daily life and include repeated memory loss, difficulty having conversations, and frequently making poor decisions.^4,5

Scientists don't yet fully know what causes Alzheimer's disease, but they have found that a combination of different factors, from biological to lifestyle, could increase your risk of developing it.⁴

"We have known for decades that, after getting older, simply being a woman is the major risk factor for Alzheimer's disease," said Lisa Mosconi, PhD, an associate professor of neuroscience in neurology and radiology at Weill Cornell Medicine. Scientists used to think this was because women tend to live longer than men, but now hormones are believed to play a major role, said Mosconi. "Our research points to menopause as an activating factor."

Menopause as a Potential Risk Factor for Alzheimer's Disease

Menopause transition, or perimenopause, often begins around ages 45–55 and can last up to 7–14 years.⁶ During this time, the ovaries gradually produce less sex hormones, such as estrogen and progesterone. These are the same hormones that rise and fall during a typical menstrual cycle. Once females reach menopause, about a year after their last menstrual period, the ovaries stop working.

But as the ovaries change during and after menopause transition, the brain changes as well.⁵

"Many of the symptoms of menopause—the hot flashes (a rise in body temperature), night sweats, anxiety, depression, insomnia, brain fog, memory lapses—don't start in the ovaries; they start in the brain," said Mosconi.

However, researchers don't know if symptoms of menopause can be used to predict Alzheimer's disease later in life, said Mosconi.

What scientists do know is that natural levels of estrogen and progesterone can help protect the brain. There are specific proteins in your brain that interact with these hormones, and your brain also produces its own estrogen and progesterone—just not as much as the ovaries do.^7,8 The decline of sex hormones in menopause transition can lead to changes in the brain.

Ideally, to study whether menopause is a risk factor for Alzheimer's disease, researchers would need to examine the same group of women from their early 50s (average start of perimenopause) up to their early 70s (average start of AD), explained Mosconi, who is also the director of the Alzheimer's Prevention Program at New York Presbyterian Hospital and Weill Cornell Medical Center. But that kind of long-term study is still to come.

Brain Changes with Menopause

Currently, several researchers are exploring signs of early dementia in the female brain which can show up years before AD symptoms surface, said Mosconi.

One of the signs of Alzheimer’s disease that they previously looked for was increased amounts of beta-amyloid proteins in brain regions that control memory. Researchers used to think these proteins played a primary role in AD, based on a 2006 breakthrough study published in Nature. However, this July, a Science investigation reported on the potential fabrication of evidence from this study. Further investigations are ongoing, and it’s currently unclear whether beta-amyloid proteins play a role in Alzheimer’s disease.⁹

Still, other signs of Alzheimer's disease may include reduced energy production in these regions, as well as loss of gray matter.^10,11 (Gray matter refers to areas in the brain that are highly concentrated in neurons, the brain's messenger cells.)¹²

Mosconi and other researchers have looked for these signs in brain imaging studies of people aged 40–60. For example, in a three-year study, women who were perimenopausal or postmenopausal showed more of these early signs of AD, compared to men of the same age.¹⁰

Estrogen and the Brain

Of the sex hormones, estrogen may play a greater role in protecting the female brain against dementia.^5,13 For example, estrogen-related proteins in the brain are located in regions that involve learning and memory, such as the prefrontal cortex, hippocampus, and amygdala.¹⁴

"Estrogen in particular, or more specifically estradiol (a type of estrogen), is the 'master regulator' of the female brain," said Mosconi. "It regulates brain energy levels, supports immunity, and promotes cellular growth and communication, among other things."

This estrogen loss during menopause transition might increase a person's risk of Alzheimer's disease and other dementias, said Christian Pike, PhD, a professor of Gerontology at the University of Southern California, whose research specializes in sex differences in Alzheimer's disease. Sometimes called the estrogen hypothesis, this theory is now more widely accepted among researchers as a possible explanation for why women are at greater risk of AD.⁵

Early Menopause and Risk for Alzheimer's Disease

While the average age of menopause transition is 51, the loss of estrogens from the ovaries can happen earlier. Some people can start perimenopause in their early to mid-40s, either naturally or even prematurely from a surgery.¹³

A surgery to remove the uterus or ovaries for medical reasons can lead to surgical menopause, which starts right away, unlike natural menopause transition, which is a gradual decline of hormones.⁶ Several studies have found that women with early menopause from a surgery have an increased risk of dementia.¹³

This is likely because with surgical menopause, estrogen loss happens much earlier in life and you spend more years without its protective effects on the brain.

People who enter menopause before age 45 may also be more likely to develop dementia earlier in life (before age 65), according to a preliminary study of data from over 150,000 UK women. (The study has yet to be peer-reviewed.)¹⁵

Currently, people who enter early menopause have the option of taking hormone medicine, including estrogen, to treat menopausal symptoms.¹⁶

"The use of estrogen-based hormone therapy for Alzheimer's disease is a rather controversial topic," said Pike. Taking estrogen therapy is likely only helpful for people near the start of menopause to possibly reduce their risk of dementia, explains Pike—but for people who actively have Alzheimer's disease, taking estrogen could actually worsen AD symptoms.

The FDA even warns that people aged 65 or older who take hormone therapy could increase their risk of dementia.¹⁶ In turn, more clinical trials are needed to explore how hormone therapy affects the brain, as well as to develop safer hormone formulations, said Mosconi.

Sex Differences with Alzheimer's Disease

All of this raises another question: What about men? After all, males produce estrogen as well, albeit in much smaller amounts than females do.¹⁷

For males and females, estrogen is involved with bone health, cell production, fertility, and liver and brain functions.^5,17 But males don't experience a major decline of estrogen.

Rather, males go through andropause, usually around their 40s, when the testes gradually produce less testosterone—the primary sex hormone in males.¹³ (Females produce testosterone as well, but not as much as males).¹⁷ This testosterone loss from andropause is associated with an increased risk of Alzheimer's disease in men.¹³

Sex differences can help researchers determine what brain changes are unique to menopause or andropause when comparing females and males of the same age.

But Pike points out, “Sex differences are more than just estrogen differences.” One example: women are more likely than men to have a major gene mutation (APOE4 gene) linked to Alzheimer’s disease.¹³ Though, Pike adds, it’s currently not known whether menopause is related to any genetic risk for AD. It’s another avenue that researchers are studying.

How to Reduce Your Risk of Alzheimer's Disease

There isn't yet a cure for Alzheimer's disease nor any known strategy for preventing this type of dementia.⁴ But experts recognize that the transition to menopause raises the risk of high blood pressure, heart disease, diabetes, and greater vulnerability to head injuries—which are all risk factors of Alzheimer's disease as well.⁵

And so, they recommend that a well-rounded healthy lifestyle may help reduce your risk of developing AD.⁴ This includes:

• Eating healthy: Nutritious diets typically have fruits, vegetables, and limited protein and whole grains.¹⁸
• Exercising regularly: At least 150 minutes of moderately intense exercise, such as brisk walking, each week can help you maintain a healthy weight.¹⁸ Routine vigorous exercise is associated with a reduced risk of AD and other dementias.¹⁹
• Getting enough sleep: For adults, this means at least 7 hours a day, and good quality sleep also contributes to your overall health.²⁰
• Reducing stress: Set aside time to relax and do things you enjoy.²¹ Menopause transition can cause excess stress, which can be harmful to your body and brain.²²
• Avoid environmental toxins: Reduce your exposure to harmful toxins like air pollution, which is correlated with greater and more rapid cognitive decline.²³
• Maintain social connections: Even as you get older, avoid being socially isolated, as it's associated with an increased risk of dementia.²⁴ Making frequent visits to loved ones may help reduce your risk.^19,24
• Stay mentally active: Keeping your brain active throughout adulthood, such as with mentally stimulating work, may help reduce your risk of dementia.^24,25
• Stay up to date with medical checkups: For people going through menopause, visit your obsterician-gynecologists (OB-GYN) to discuss ways to prepare for menopause and manage menopause symptoms.²⁶

"Currently the most effective approach to reducing Alzheimer's disease risk and increasing brain resilience is to maximize overall health," said Pike.

Mosconi adds, "Specifically for menopause, we need more information, more education, and way more research."

Sources

1. Alzheimer’s Association. Women and Alzheimer’s.
2. Emmady PD, Tadi P. Dementia. StatPearls. 2022.
3. Centers for Disease Control and Prevention. What is dementia?
4. Centers for Disease Control and Prevention. Alzheimer’s disease and related dementias.
5. Rahman A, Jackson H, Hristov H, et al. Sex and gender driven modifiers of Alzheimer’s: the role for estrogenic control across age, race, redical, and lifestyle risks. Front Aging Neurosci. 2019;11:315. doi:10.3389/fnagi.2019.00315
6. National Institute on Aging. What is menopause?
7. Bassani TB, Bartolomeo CS, Oliveira RB, Ureshino RP. Progestogen-mediated neuroprotection in central nervous system disorders. Neuroendocrinology. 2022. doi:10.1159/000525677
8. Russell JK, Jones CK, Newhouse PA. The role of estrogen in brain and cognitive aging. Neurotherapeutics. 2019;16(3):649–665. doi:10.1007/s13311-019-00766-9
9. Piller C. Blots on a field? Science. July 21, 2022. Accessed August 18, 2022.
10. Mosconi L, Rahman A, Diaz I, et al. Increased Alzheimer’s risk during the menopause transition: a 3-year longitudinal brain imaging study. PLoS One. 2018;13(12): e0207885. doi:10.1371/journal.pone.0207885
11. Mosconi L, Berti V, Dyke J, et al. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Sci Rep. 2021;11(1):10867. doi:10.1038/s41598-021-90084-y
12. Mercadante AA, Tadi P. Neuroanatomy, gray matter. StatPearls. 2021.
13. Pike CJ. Sex and the development of Alzheimer’s disease. J Neurosci Res. 2017; 95:671–680.
14. Scheyer O, Rahman A, Hristov H, et al. Female sex and Alzheimer’s risk: the menopause connection. J Prev Alzheimers Dis. 2018;5(4)225-230. doi:10.14283/jpad.2018.34
15. American Heart Association. Early menopause may raise risk of dementia later in life. Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Conference, Presentation EP67.
16. U.S. Food and Drug Administration. Menopause: medicines to help you.
17. Endocrine Society. Reproductive hormones.
18. National Institute of Diabetes and Digestive and Kidney Diseases. Keep active and eat healthy to improve well-being and feel great.
19. Zhu J, Ge F, Zheng Y, et al. Physical and mental activity, disease susceptibility, and risk of dementia. Neurology. 2022. doi:10.1212/WNL.0000000000200701
20. Centers for Disease Control and Prevention. Are you getting enough sleep?
21. Centers for Disease Control and Prevention. Coping with stress.
22. American Psychological Association. Stress effects on the body.
23. Kullick ER, Wellenius GA, Boehme AK, et al. Long-term exposure to air pollution and trajectories of cognitive decline among older adults. Neurology. 2020;94(17):e1782–e1792. doi:10.1212/WNL.0000000000009314
24. Centers for Disease Control and Prevention. Social determinants of health and Alzheimer’s disease and related dementias.
25. Kivimäki M, Walker KA, Pentti J, et al. Cognitive stimulation in the workplace, plasma proteins, and risk of dementia: three analyses of population cohort studies. BMJ. 2021;324:n1804. doi:10.1136/bmj.n1804
26. Mosconi L. The XX Brain: The Groundbreaking Science Empowering Women to Maximize Cognitive Health and Prevent Alzheimer’s Disease. Avery. 2020.

RELATED: Can Alzheimer's Be Stopped? Here's What the Latest Research Says

The doctor put me through a long memory test that lasted for hours, with prompts such as "Name as many animals as you can that begin with the letter 's.'" She also gave me words that I was to rhyme: "Brother," she said. "Mother," I replied, and so on. The verbal exam showed that I had cognitive impairment. After my verbal exam, I had an MRI. The results of that scan confirmed the diagnosis of Alzheimer's.

Alzheimer's is a progressive, neurologic disease caused by the abnormal functioning of brain proteins. It is the most common form of dementia and results in the steady decline of memory, thinking, behavior, and functional ability. Over time, memory impairment becomes severe enough that it interferes with daily tasks. The form of dementia is a fatal one.

After receiving the dreaded diagnosis of Alzheimer's disease, my daughter and I headed back home and made light of what was at heart awful news. But there was no crying. In fact, we laughed and told jokes. After a big hug, I went upstairs, sat at my desk, and stared at the wall for a long time. And then, for some reason, I took out a pen and paper and began to write what became a book: Like Falling Through a Cloud—A Lyrical Memoir of Coping with Forgetfulness, Confusion, and a Dreaded Diagnosis ($10, was $22; amazon.com). "Marbles," as well as the two poem snippets below, are from the book; they poured out of me, mostly in rhyme, over a period of about six months. Telling my story confirmed the fact that the diagnosis was not the end; writing the book showed me that I had the strength to remain creative and productive.

I'd say a lot of people are likely in denial about the possibility of receiving a terminal diagnosis: It won't ever happen to me. Not to us. Not my family. But I believe it is important to know the truth, if only to prepare yourself for what is to come. The reality is, more than six million Americans aged 65 and older are living with Alzheimer's right now. The Alzheimer's Association expects that number to reach 12.7 million by 2050. As it is, the disease already kills more people than breast cancer and prostate cancer combined. While some people with Alzheimer's can live 20 years or more after finding out they have it, on average, people with the disease live between three and 11 years after diagnosis. 

Getting It Together
I've made a date
with my
banker
because I hanker
to know where things stand
when it comes to what I'll hand
to my next of kin
so I should begin
to keep track of stuff
to see if there is enough
to pass around
when I'm under the ground
I'm not being dramatic
but I can no longer be static
about what lies ahead
when I'm dead
which oddly I do not dread
instead
I want to avoid leaving a mess
for the family to assess
I'd like them to say
she left it this way
to keep trouble at bay
and to avoid a fray

Hearing that you have Alzheimer's can be terrifying, and rightfully so. But as crushing as the news was at the time, I was thankfully able to look at my diagnosis in a more positive light. That's because the diagnosis pushes me to live every day to its fullest, because I now know that I don't have as many clear days left as I thought. And yes, it is very difficult to remain positive all of the time, but I wake up every morning thankful that I have another day to live life to its fullest.

RELATED: Here's How a Doctor Explains the Difference Between Alzheimer's and Dementia

What I’ve learned over the past three years

I have learned that Alzheimer's generally has three stages. The early stage, where I am now, is the longest, thank goodness. It ranges from three to seven years, and in this stage you live your life almost normally. In the second stage, most people continue to live at home but need help with daily functions. The third and final stage is most often spent in the memory unit of a hospital or skilled nursing facility and lasts generally one or two years.                                                                    

I say that I am living my life in stage one "almost normally" because I did have to make a few changes. I've given up driving a car. Not because I got lost, but because I lost my confidence in driving and knew that could be dangerous. There came a day where I was not sure which pedal was the brake or which was the gas. That was the moment of realization—I needed to stop driving.

I also no longer read a daily newspaper. In fact, I don't read many books either. I guess my mind just doesn't process words the way it used to.

I am constantly concerned that I am not as sharp as I used to be. I know I am making mistakes, and I cover that up the best I can. I need help spelling words. Yes, I even recently hesitated about how to sign my signature. I forget words and ask the same questions much more often than I did before.

My biggest fear is that I am becoming a burden to my caregiver, my husband. But I have learned that, unlike most fatal diseases, there is no physical pain. So I still play the flute every day. I still perform in concerts. And I am still artistic director of my local concert series.

I've learned that it is important to be very open about my diagnosis. When I meet new people, I say, "Before I forget, I want to tell you that I do forget. I have Alzheimer's." After some seconds of silence, the conversation usually continues in a normal way. I know some people who have chosen to cut ties with friends rather than share the news, too ashamed to open up about their diagnosis. I want to avoid that.

I have learned that fear is the worst enemy of those of us diagnosed with Alzheimer's. I believe talking about the disease is part of staying positive, allowing me to live the rest of my days in the sunshine, smiling instead of crying:

a super sunny Sunday
I do not embrace
my inevitable decline
but I'm determined
to find
a way to make the rest of my stay
on this problematic planet
filled with light
and love
and
music

I have also learned of the importance of the Alzheimer's Association. In addition to leading global research, the Alzheimer's Association provides support services to those living with this disease and our caregivers. Those services include information and referrals, consultations, support groups, educational classes, and engagement programs. Access to help is available 24 hours a day through the organization's helpline (800-272-3900) or website.

RELATED: Tony Bennett Reveals He Has Alzheimer's Disease—Here's How Music Has Helped Him Since His Diagnosis

Putting up a fight

A wonderful surprise in my life was discovering that my book was of help to people diagnosed with Alzheimer's. I realized this when approached by a gentleman at a book signing who told me that he could not find the words to tell his family what he was going through with Alzheimer's, and that I had found the perfect words for him to share.

So I immediately said yes when I was asked to read and discuss the book with members of Alzheimer's Association chapters in weekly readings. I hear comments like, "Your book lets me know that I am not alone."

That's the reason I'm spending time helping others who have Alzheimer's. Dealing with this deadly disease is like taking on a pernicious opponent. I am not one to give up without a fight, and I feel I can help others in my situation join me in this endeavor to be strong, to stay strong. This fight is internal. It comes from the deepest part of the heart, and for me, I try every day to show others that I cannot and will not go down without a fight.

While there are medications that can help lessen symptoms and change disease progression, there is currently no treatment to cure Alzheimer's. When I enter stage two of my disease, I will need help doing the easiest things. And in the final stage, like so many others with Alzhiemer's, I may need to go in a memory unit of a hospital or nursing facility.

I want my family to understand that I adore them and hope that they will remember that I've tried my very best to hold tight to things that matter the most to me—my amazing husband, my children, and grandchildren. And I want them to know that my fight is for all of us with this dreaded diagnosis. I will not go down without a fight, and hopefully in the near future the cure for Alzheimer's will be found.

To get more stories about health and wellness delivered to your inbox, sign up for the Healthy Living newsletter

Bennett and his family made the announcement through an in-depth interview with AARP that was published on February 1.

Bennett first started experiencing symptoms of his disease in 2015. Initially, he was having trouble remembering musicians' names onstage. Although he was 90 at the time, Bennett suspected it was more than just normal aging. And so, he went to have his concerns checked out and was eventually diagnosed with Alzheimer's in 2016 by Gayatri Devi, MD, a neurologist at Lenox Hill Hospital in Manhattan.

According to Dr. Devi, Bennett has some "cognitive issues, but multiple other areas of his brain are still resilient and functioning well."

"He is doing so many things, at 94, that many people without dementia cannot do. He really is the symbol of hope for someone with a cognitive disorder," she told AARP.

The news may come as a shock to many—after all, Bennett has continued to record and perform live, including with Lady Gaga, even after his diagnosis. But Dr. Devi says that, in addition to his medication, diet, exercise, and family support, it is singing that has actually helped keep Bennett in good health.

"(Singing and performing) kept him on his toes and also stimulated his brain in a significant way," Dr. Devi told AARP.

RELATED:Dementia Caregivers Are Struggling During the Coronavirus Pandemic—Here's What it's Like

According to Bennett's wife and son, "backstage, [Bennett] could seem utterly mystified about his whereabouts. But the moment he heard the announcer's voice boom 'Ladies and gentlemen—Tony Bennett!' he would transform himself into performance mode, stride out into the spotlight, smiling and acknowledging the audience's applause. And start singing."

With the pandemic putting an end to his live stage performances, Bennett has experienced a slip in his memory. To help prevent this, Dr. Devi is encouraging Bennett to rehearse twice a week.

So how is it possible that Bennett has been able to give live performances for four years without even a hint that he has Alzheimer's? The link between music and the disease is a connection that researchers continue to study.

Carolyn Fredericks, MD, assistant professor of neurology at Yale School of Medicine, says that the motor memory associated with music is less vulnerable than other parts of the brain heavily affected by Alzheimer's. "For some time, Alzheimer's researchers have hypothesized that the areas of the brain that help us with musical memory are not affected by Alzheimer's pathology until very, very late in the process," she previously told Health.

RELATED:Former Ballerina With Alzheimer's Remembers Swan Lake Choreography—Doctors Explain The Phenomenon

According to the Mayo Clinic, music can also help those with Alzheimer's relieve stress, reduce anxiety and depression, and reduce agitation.

Music may also be a useful therapy tool for those in the later stages of Alzheimer's.

"There's music therapy where you can take people in later stages of Alzheimer's who are seriously impaired and play music they're familiar with, giving them an electronic device that will let them revisit those songs," Greg Cole, PhD, a professor of neurology at the David Geffen School of Medicine at UCLA, previously told Health. "That helps them connect with the past more effectively than asking them if they remember it."

While he's not at that stage of Alzheimer's, music has certainly been some form of therapy for Bennett—even long before his diagnosis.

"Singing is everything to him," his wife, Susan, told AARP. "Everything. It has saved his life many times. Many times. Through divorces and things. If he ever stops singing, that's when we'll know …"

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

González was featured in a video filmed in 2019, and the clip has recently gone viral. It shows González, who lived with Alzheimer's disease before her death, recognizing Tchaikovsky’s "Swan Lake" and performing parts of the choreography that she once danced to back in the 1960s. Alzheimer's is the most common type of dementia that damages parts of the brain involved in memory, intelligence, judgment, language, and behavior.

RELATED: 25 Signs and Symptoms of Alzheimer's Disease

González, who died in 2019, is seen listening to the music with headphones, sitting next to Pepe Olmeda, the director and founder of Música para Despertar, an organization dedicated to music therapy for those with Alzheimer's. As the music plays, she sways her arms to the original routine as footage of another dancer performing the same choreography is interspersed throughout the video. The original video has reached over 1.2 million views.

How was González able to remember her ‘Swan Lake’ choreography after hearing the music?

It's important to remember that Alzheimer's and memory loss is different for everyone, but certain types of memories—like long-term memories and short-term memories—can be affected at different rates. Long-term memories, for instance, are generally less affected in earlier stages of disease because the older a memory is, the more firmly established it is in a person's mind, according to the Alzheimers Society.

"The memories that have been acquired before the onset of [Alzheimer's], for example childhood and first languages, are often retained quite well," Greg Cole, PhD, a professor of neurology at the David Geffen School of Medicine at UCLA, tells Health.

Cole also clarifies that, with Alzheimer's, memories aren't erased—they're just more difficult to remember. He compares compares memory loss with Alzheimer's to having data on a hard drive that you can't access. The issue isn't losing the memory itself, but rather the ability to recall the memory without a trigger.

RELATED:Dementia Caregivers Are Struggling During the Coronavirus Pandemic—Here's What it's Like

But while it's possible that González was able to recall her "Swan Lake" choreography because it was learned at a young age, there's another phenomenon at play here too: Alzheimer's disease's effect on musical memory.

Musical memory is considered to be "partly independent" from other memory systems, or how the brain organizes memories, according to a 2015 study in the journal Brain. The first part of the study focused on brain responses to music from "normal young human subjects," but the second part of the study focused on comparing patients with Alzheimer's disease and those without. The study ultimately found that, in those with Alzheimer's, regions of the brain associated with musical memory are "relatively spared" in Alzheimer's disease, and "may explain the surprising preservation of musical memory in this neurodegenerative disease."

Carolyn Fredericks, MD, assistant professor of neurology at Yale School of Medicine, adds that the motor memory associated with music is less vulnerable than other parts of the brain heavily affected by Alzheimer's. "For some time, Alzheimer’s researchers have hypothesized that the areas of the brain that help us with musical memory are not affected by Alzheimer’s pathology until very, very late in the process," she tells Health. So this too could've played a key role in González's recall of her "Swan Lake" choreography.

RELATED: Here's How a Doctor Explains the Difference Between Alzheimer's and Dementia

Music can also play a key role in therapy for those with Alzheimer's or other neurodegenerative diseases. According to the Alzheimer's Association, music "may reduce agitation and improve behavioral issues" in those with the disease, and can evoke happy memories.

"There's music therapy where you can take people in later stages of Alzheimer's who are seriously impaired and play music they're familiar with, giving them an electronic device that will let them revisit those songs," says Dr. Cole. "That helps them connect with the past more effectively than asking them if they remember it. When they play the music, she recognizes it. That's a well-established phenomenon that's employed to reach out to these people." The music acts as a trigger for the recall of the memory.

Regardless of the "why" here, González's memory of her "Swan Lake" choreography is still astounding—and it's an important bit of information for anyone who has a loved one dealing with the disease. "It's important to make every effort to connect with people for the quality of life of the patient, family members, and the caregiver," says Dr. Cole. "Music is one of the best ways to do it."

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

“I was really stressed,” JJ Flentke, a 50-year-old physical therapist who owns a clinic in Vancouver, Washington, tells Health of the incident. “I’m outside walking around, I’m caller number eighteen hundred—and suddenly, on the other end of the phone, is my mother. I’m like, Oh crap. I told her I’d give her a bath. I forgot…she remembered! I gotta tell you: I can’t count on that happening, but it does when I least expect it.”

More than 5 million Americans have Alzheimer's disease, the most common form of dementia, and 16 million Americans provide unpaid care for people with Alzheimer's. For these caregivers, who are typically family members (and usually female), the current crisis has introduced new challenges. Many, like Flentke, now find themselves working from home, caring for out-of-school children, and tending to a sick parent or spouse—all while being isolated from extended family, friends, and sanity-saving resources like in-home companion care and adult recreation centers. (Flentke temporarily suspended her use of Home Instead, a caregiving service, to reduce the risk of spreading the virus.) 

RELATED: 5 Common Challenges Caregivers Face, and How to Handle Them

“There’s so much on the news about parents staying home with the kids and what that’s like, but I haven’t heard anything about, ‘Well, what’s it like to take care of somebody with dementia and try to work from home?’” Sharon O’Connor, director of the adult day health program at IONA, a social services agency in Washington, DC, tells Health.

Programs like O’Connor’s give caregivers a much-needed break to work, run errands, or stay on top of their own mental and physical health. Without them, feelings of isolation and depression, which are already common among caregivers, are often amplified. “One caregiver said she feels like a caged tiger,” says O’Connor. “She can’t leave her loved one, and so she has this feeling of being trapped.” 

Bonnie Wattles, executive director of HFC, a nonprofit that provides caregiving relief grants to families of people with Alzheimer’s, has come across similar anecdotes. “I heard from one of our hospital partners that there was a family caregiver who was having to repeat details about the pandemic over and over, because the Alzheimer’s patient didn’t remember,” she tells Health. So not only was that caregiver providing emotional support to her loved one, she was also revisiting the pandemic multiple times a day herself. 

“When you have someone with cognitive impairment, they might not be able to keep it in the front of their mind that this is what’s going on,” Beth Kallmyer, vice president of care and support for the Alzheimer’s Association, tells Health. “And so then they keep asking, ‘Why can’t I do this? Why is this different?’ Unfortunately, that can create a spiraling effect, because when you get asked the same question multiple times a day as the caregiver, that can be frustrating.”

RELATED: Here's How a Doctor Explains the Difference Between Alzheimer's and Dementia

People with dementia are not at greater risk of contracting the coronavirus (although they tend to be older and therefore more susceptible), but they are more affected than the average person by the everyday sacrifices the circumstances have demanded. “People with dementia do very well when they have a regular routine,” says O’Connor, “and when their routine is disrupted, that often has an effect on their behavior.”

Linda H., a paid companion with Right at Home, has noticed a considerable difference in her 83-year-old client’s demeanor since the onset of the pandemic. “The agitation has increased two, three times,” she tells Health. “She didn’t used to pace; now she paces.”

Before COVID-19, Linda and her client might start their day with a walk through the local mall or in their city park in Fort Collins, Colorado. “Then we’d go to a restaurant, which she really enjoyed, and have lunch before we went back to the house,” says Linda. “Now, of course, restaurants are closed, the mall is closed.” There’s also more chaos in the house: her client’s son-in-law is telecommuting and her granddaughter is home from college, vying for what little quiet space there is in the house to complete her online coursework. 

“The stress level has increased a great deal, and I’m watching [my client’s] cognitive abilities disintegrate,” says Linda. “I think above anything else, the anxiety increase has impacted her ability to think better. Kind of like it does with any of us, right? But it’s magnified.”

Similarly, Annette Adams-Brown, who lives in a two-bedroom apartment with her 87-year-old mother in Lakeland, New York, worries that her mom’s dip in physical activity has caused her mind to slip. “She’ll come out of her room and just look around,” she explains to Health. “She’s like, ‘Where am I?’ Or she’ll say, ‘I’m going to the bathroom,’ but she’ll head to the front door. So I see more confusion.”

RELATED: My Dad Was Diagnosed With Early-Onset Alzheimer's and I'm Only 26—Here's What Taking Care of Him Is Really Like

For caregivers whose loved ones are living in a facility, regaining any semblance of control can feel impossible, especially since a report came out that found nearly 1 in 10 nursing homes have publicly reported cases of coronavirus. That's left caregivers to wonder if their relative is even safe. “One of the things we’ve heard a lot about is the distress that family members [experience] not being able to visit their family member,” says Kallmyer. “But what we’re telling those caregivers is, ‘This is the safest thing. This disease can get transmitted so easily in assisted living communities or a nursing home.'” 

RELATED: Did You Already Have Coronavirus Without Knowing It? Experts Explain Why That's Possible

Dan Goerke, whose wife, Denise, is in a memory-care facility in Marietta, Georgia, is getting by with what he calls “window visits.” (Denise was diagnosed with early onset Alzheimer’s in 2012, at 56 years old, and has been living in the facility for almost four years.)

“At first, all the residents there could come out into a common area, and there’s a big picture window there, so we could walk right up to that and [the staff] would bring Denise over in a wheelchair and we’d do a visit that way,” Goerke, 61, tells Health. “It’s a lot more difficult now, because they have to be confined to their rooms. To see her [like that] is like visiting someone in a prison cell.”

Still, Goerke talks to his wife from the other side of the glass. “I tell her what’s going on, talk to her about the grandkids,” he says. “I laugh, because if I were to step back and see myself doing this, [it would be] like, ‘What is that idiot doing screaming through a window?’ That’s probably what it looks like. But it’s the best we can do right now, and I’m going to keep doing it.”

He also continues to work, hike, and bike ride, and he limits his news intake to two 10-minute power reads a day: “I’m looking for, ‘What are the statistical updates, and what am I being told to do or not do?’” he says. “And then I turn it off. I just don’t want to be absorbed in all the doom and gloom.”

RELATED: Can Alzheimer's Be Stopped? Here's What the Latest Research Says

Kallmyer recommends that approach to caregivers in general. “While the person living with dementia might not always have the context of what's going on, they are going to react to the stress levels of the caregiver,” she says. “It’s always important for caregivers to think about how they’re taking care of themselves and monitoring their own stress, but in this case it’s even more important.” 

With the stress levels of caregivers in mind, many organizations have ramped up their support programs. The Alzheimer's Association offers a 24/7 helpline, which caregivers can call for confidential assistance or counselor recommendations. Some Medicare plans also offer 24/7 nurse helplines. Other groups are holding meetings over Zoom, FaceTime, or phone multiple times a week. HFC, for instance, added twice weekly “drop-ins” to its menu (“I sort of see it as emergency relief,” Wattles says. “If you wake up and you’re like, ‘I just need a little boost,’ you can just pop into a phone call”) as well as weekly webinars on topics like mindfulness and self-care."

“What we’re doing through our support groups is reminding [caregivers] how important self-care is,” says O’Connor. “I think for caregivers, that is very difficult. They’re so concerned about meeting the needs of their loved one, we have to remind them that they need to do things to take care of themselves.” 

For Adams-Brown, managing the anxiety that comes with being a caregiver has become second nature. “I’m very aware of stress and how it manifests in my body, [because] I’ve had a lot of practice with it,” she says. If she’s feeling overwhelmed, she’ll cook or meditate or retreat to her room to practice yoga or Tai Chi. 

Above all, she works on shifting her perspective. “I’m always trying to see the 'lesson and the blessin,’” she says. In this case, “I find the blessin’ is me being here for my mother. I’m comforted in knowing I comfort her.”

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

"It is with great sadness that my daughter Dana and I announce the passing of my wife, Barbara Elaine Smith," her husband, Dan Gasby, said in a statement shared to Facebook. "B. died peacefully Saturday, February 22, 2020, at 10:50 pm, of Early-Onset Alzheimer’s Disease in our home in Long Island, New York."

Gasby went on to thank Smith's caregivers, along with her family and friends for their support in her final days. "Thank you to everyone for respecting our privacy during this agonizing time," he wrote.

During her seven decades on earth, the lifestyle guru put together a vibrant resumé. From becoming one of the first African American women to grace the cover of Mademoiselle magazine in 1976 and hosting a popular syndicated talk show, to running three high-profile restaurants and publishing multiple best-selling cookbooks, her accomplishments were varied and impressive. 

However, in 2013 at the age of 64, she lost her train of thought during a cooking demonstration on NBC’s Today. Because she had been experiencing forgetfulness for two or three years, she decided to see a doctor, who diagnosed her with early-onset Alzheimer’s disease. She went public with her diagnosis the next year.

"It feels like crying," she told CBS in a 2014 interview when she was asked how it felt to not remember details such as the date, year, or month. "Things like that make me very sad."

RELATED: Here's How a Doctor Explains the Difference Between Alzheimer's and Dementia

What is early-onset Alzheimers?

According to the Centers for Disease Control and Prevention (CDC), Alzheimer’s disease is the most common type of dementia, or a loss of memory, language, problem-solving and other thinking skills. Alzheimer's is a progressive disease that starts with mild memory loss, but eventually leads to the loss of ability to carry on a conversation and respond to the environment.

Unfortunately, there is no cure for Alzheimer’s. On average, a person with Alzheimer's will live four to eight years after diagnosis, but may live as long as 20 years after, depending on other factors, per the CDC.

Age, gender, and race are all factors when it comes to the likelihood of developing Alzheimer’s. Per the Alzheimer's Association, almost two-thirds of those who suffer from Alzheimer’s are women, and older African Americans are twice as likely to get it as older caucasians. 

RELATED: My Dad Was Diagnosed With Early-Onset Alzheimer's and I’m Only 26—Here’s What Taking Care of Him Is Really Like

In regards to age, the majority of people—5.6 million—are first diagnosed with the disease over the age of 65. Just 200,000 under 65 are diagnosed with it. “Early-onset Alzheimer's disease is Alzheimer's disease that strikes before the age of 65 (meaning, the person has their first symptoms by then),” Carolyn Fredericks, MD, a Yale Medicine neurologist who specializes in diagnosing and treating Alzheimer’s disease and memory disorders, explains to Health. While the symptoms are similar to later-onset disease—including memory loss, and over time severe dementia and disability—the disease tends to hit harder and faster. “Symptoms progress more quickly in people who develop early-onset disease,” says Dr. Fredericks. 

This was the case with B., whose health diminished quickly, according to NPR. Instead of hiding behind her diagnosis, she decided to use her fate to educate others about Alzheimer's, especially those within the African American community. She even managed to collaborate on a book with her husband, Before I Forget, to share about her experience with the disease and to help others with it as well as their loved ones on their own journeys, and also make public service announcements about it. 

The last years of Smith's life were spent at her weekend home in Long Island Sound with Gasby and his girlfriend, Alex Lerner, who both cared for her. Gasby ended his Facebook post saying, "heaven is shining even brighter now that it is graced with B.'s dazzling and unforgettable smile."

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter

In more than 90% of cases, Alzheimer’s affects people 65 or older. About 6.2 million people age 65 or older in the US had Alzheimer’s in 2021, according to a March 2021 report published in Alzheimer’s & Dementia. Because the population continues to rise, without a medical breakthrough, 13.8 million people in the US may have the disease by 2060. It’s essential to understand Alzheimer’s disease signs, causes, and risk factors.

What Is Alzheimer's Disease?

People sometimes confuse Alzheimer’s with dementia. Dementia is a term that refers to cognitive decline symptoms—such as loss of thinking, remembering, and reasoning—that have progressed enough to disrupt daily activities, per the NIA. Alzheimer’s leads to brain changes and is the most common cause of dementia. About 60–90% of people with dementia have Alzheimer’s, per a May 2021 paper published in Nature Reviews Disease Primers.

As a person ages, they can experience natural cognitive changes. Occasionally, they may forget an appointment, misplace an item, or have trouble finding the right word. People with Alzheimer’s dementia have symptoms that alter their memory, learning ability, decision-making, and personality. These signs interfere with daily lives, per the March 2021 report. As the disease progresses, people may start having hallucinations and eventually become unable to take care of themselves, per the NIA.

There are two types of Alzheimer’s: early-onset and late-onset. People with early-onset Alzheimer’s get symptoms between their 30s and mid-60s. This occurs in fewer than 10% of Alzheimer’s cases, per the NIA. Late-onset Alzheimer’s signs first appear when a person is in their mid-60s. A person diagnosed with late-onset Alzheimer’s lives for about 4–8 years, though some may live for up to 20 years, per StatPearls. The time from diagnosis to death is longer when a person is diagnosed younger, per the NIA.

Alzheimer’s may also present as mild cognitive impairment (MCI)—a condition that affects one or more cognitive abilities (such as memory) but not enough to interfere with daily life. MCI doesn’t always progress to dementia and can occur due to temporary causes such as medication, alcohol, or a head injury. Some people with the condition may recover, per Alzheimers.gov. About half of MCI cases are due to Alzheimer’s, per the May 2021 paper.

Former Ballerina With Alzheimer's Remembers Swan Lake Choreography—Neurologists Explain Music Therapy

9 Surprising Memory Loss Causes Later in Life

Causes

Alzheimer's is a neurodegenerative disease, which means it causes damage to neurons (nerve cells) in the brain. Changes in neurons and loss of connections between them cause the brain to shrink and inflame. This process can start decades before any symptoms show up, per the March 2021 report.

Previously, researchers believed that the two biological brain changes, amyloid plaques and tau tangles, were key to understanding Alzheimer’s disease. Amyloid plaques are clumps of a toxic beta-amyloid 42 protein that form outside neurons. Beta-amyloid 42 occurs in the body naturally but rises to abnormal levels in Alzheimer’s disease. Tau tangles form when tau molecules abnormally bind together to form tangles inside neurons. Tau molecules usually stabilize neuronal microtubules—structures that give shape to and guide nutrients through the neuron—per the NIA.

However, an investigation published in July 2022 found that fabricated research data might have overemphasized the importance of beta-amyloid proteins as a primary predictor of Alzheimer’s disease. Generally, Alzheimer’s disease researchers still agree that beta-amyloid proteins are fundamental in understanding the condition. This finding, however, may influence the field to study other protein theories.

Why these biochemical changes occur and how they affect cognition is a mystery, per the NIA. There are some known genetic, environmental, and lifestyle risk factors, but no way to determine how exactly they can affect a person or how to prevent the disease.

Risk Factors

More than 90% of Alzheimer’s cases occur in people 65 or older, making age the most significant risk factor. About 10% of people after age 65 and about 40% of people after age 85 have Alzheimer’s, per StatPearls. Other risk factors include:

Genetics and family history: While having a family history of Alzheimer’s doesn’t necessarily mean you’ll get it, you may be at a higher risk. Genetics is usually the cause of early-onset Alzheimer’s, per the NIA.

Vascular (blood vessel) conditions include high blood pressure (hypertension), heart disease, and stroke, per the NIA. The brain uses 20% of the body’s oxygen supply, so a healthy heart is necessary for the brain’s normal function, per the March 2021 report. You can reduce your risk of heart disease through, for example, regular physical activity or a heart-healthy diet.

Metabolic conditions such as diabetes, midlife obesity, and low HDL cholesterol (the “good” cholesterol) can affect your risk, per the May 2021 paper. Metabolism is how your body processes the food you eat to make energy, per MedlinePlus. Late-life obesity is not a risk factor, and obesity may be caused by Alzheimer’s rather than being a risk factor for it, per the March 2021 report.

Depression can increase the risk of Alzheimer’s, per a July 2020 report published in the journal Lancet Commissions. Antidepressant treatment may reduce the risk, but there isn’t definitive evidence. Symptoms of depression can sometimes resemble dementia symptoms or signify an early stage of Alzheimer’s.

Social isolation and loneliness lead to a higher risk of Alzheimer’s and other conditions such as high blood pressure, heart disease, and depression, per the NIA. On the other hand, participating in more activities with others may improve cognitive function.

Traumatic brain injury (TBI) is a “disruption of normal brain function caused by a blow or jolt to the head or penetration of the skull by a foreign object,” per the March 2021 report. Mild TBI is also known as a concussion. A history of TBI increases the risk of Alzheimer’s, especially when the TBI is severe or after multiple TBIs, per an April 2018 study published in the journal Lancet Psychiatry.

Heavy alcohol use is associated with changes in the brain and cognitive issues, including dementia. Still, it’s unclear whether alcohol use can cause Alzheimer’s, per a January 2019 paper published in Alzheimer’s Research & Therapy.

Smoking can increase risk, but quitting smoking reduces that risk, especially for older people, per a September 2018 study published in Annals of Clinical and Translational Neurology.

Hearing loss may be associated with Alzheimer’s, though the mechanism for that is unclear, per an August 2019 review published in the International Tinnitus Journal.

Symptoms

Alzheimer’s typically presents with memory problems first, per the NIA. People may have difficulties remembering recent conversations, names, or events, per the March 2021 report. These changes can begin subtly but are more drastic than natural aging. They interfere with daily activities. It becomes progressively harder for a person with Alzheimer’s to make sense of the world around them, per the NIA. Eventually, they become unable to function independently.

Early symptoms of Alzheimer's disease include, per the March 2021 report:

• Memory loss that's progressed enough to interfere with daily life
• Inability to follow through with tasks such as paying bills or playing games
• Losing track of times and dates
• Impaired reasoning and judgment, resulting in issues with problem-solving, decision-making, and activities such as shopping or cooking
• Visual and spatial issues that may affect balance
• New problems with speaking or writing, such as having trouble finding the right word or repeating themselves
• Isolating from work, hobbies, and social life
• Mood changes that resemble depression or anxiety
• Personality changes, such as increased impulsivity and aggression

Alzheimer's has three stages, classified by symptom severity and the level of care required. The signs of each stage include:

Mild disease: Friends and family may notice disruptions to everyday function, memory loss, and confusion, typically leading to a diagnosis. Most people can remain independent at this stage. However, they may show increasingly poor judgment, anxiety, aggression, and mood and personality changes, per the NIA.

Moderate disease: During this stage of the disease, people typically require more supervision because damage spreads to new brain areas, per the NIA. As a result, people begin to have problems learning new things and performing multistep activities such as getting dressed. They may also experience hallucinations and paranoia, impulsive behavior, wandering, and repetitive statements or movements, per the NIA.

Severe disease: As damage spreads throughout the brain, people lose their ability to communicate and care for themselves. They may have difficulties swallowing and controlling their bowel and bladder, per the NIA. The most common cause of death for Alzheimer’s is aspiration pneumonia, which occurs when a person loses their ability to swallow properly, per StatPearls.

15 Possible Causes of Brain Fogginess

Diagnosis

Early diagnosis of Alzheimer’s is crucial because most available medications work for earlier stages of the disease, per the NIA. Healthcare providers typically use multiple evaluations to confirm the diagnosis, such as:

• Questions about a person’s medical history, symptoms, and changes: Providers will also ask others who know the person, such as friends or family members.
• Psychiatric evaluation: Mental health conditions can mimic Alzheimer’s symptoms and must be ruled out.
• Cognitive tests: These can evaluate memory, problem-solving, attention, counting, and language.
• Lab tests: These include blood and urine tests for thyroid hormone and vitamin B12, per StatPearls.
• Imaging tests: A CT scan, MRI, PET scan, or EEG can also help rule out other conditions.

Dementia-like symptoms aren't always due to brain-changing diseases. Some conditions that cause cognitive issues can be treated to reverse symptoms. Your healthcare provider can help rule out the following causes of cognitive decline, per the March 2021 report:

• Depression
• Untreated sleep apnea—a disorder that causes your breathing to stop during sleep, per MedlinePlus
• Medication side effects
• Lyme disease—a bacterial infection transmitted through ticks
• Thyroid conditions
• Lacking some vitamins, such as vitamin B12, per a February 2020 paper published in the journal Cureus
• Drinking too much alcohol

Following The Mind Diet Could Cut Your Risk of Disease and Help You Lose Weight

9 Foods That May Help Save Your Memory

Treatment

There is no cure for Alzheimer’s. Treatment focuses on managing symptoms and slowing down disease progression. Options vary based on the person’s situation, per the NIA:

Medications to treat symptoms: Most medications approved by the US Food and Drug Administration (FDA) treat Alzheimer's symptoms at different stages. They're only effective for a limited time because they can't slow the neuron damage, and they don't work for everyone, per the NIA. Healthcare providers sometimes prescribe medications for behavioral and psychiatric symptoms such as aggression and hallucinations but do so with caution due to potentially serious side effects such as stroke, per the March 2021 report.

Medication to treat brain damage: Aduhelm (aducanumab) is the first medication approved by the FDA that targets an Alzheimer’s mechanism. However, it’s in follow-up trials with results expected by early 2030, per the NIA. As of April 2022, Medicare only covered aducanumab for people participating in clinical trials, per the Centers for Medicare & Medicaid Services (CMS).

Non-medication therapies: For some symptoms, such as aggression and agitation, non-medication therapies may be more effective, per the March 2021 report. Non-medication interventions can also help improve quality of life and cognitive function. Exercise (including cardio) has been shown to slow the rate of cognitive decline. Music-based therapies, psychological therapies, and memory training may also help.

Prevention

There is no way to prevent Alzheimer's, but you can reduce some risks, per the March 2021 report:

• Manage heart disease: Regulate blood pressure and keep your cholesterol in check. Eat a heart-healthy diet.
• Quit smoking and reduce alcohol use
• Exercise regularly: Physical activity, especially cardio, may slow disease progression.
• Stay cognitively active: Reading, playing games, and crafting may help keep the brain healthy. Education is important, whether formal or informal.
• Stay socially active

Getting a diagnosis of Alzheimer's for yourself or your loved one can be scary. But there's a lot of research in progress to figure out what causes the disease and what can help slow, prevent, or cure it. If you notice any cognitive changes in yourself or someone you care about, speak to a healthcare provider about a possible cognitive evaluation.

But new research suggests that certain lifestyle habits might be able to offset your genetic risk of developing Alzheimer’s. The research was presented at the Alzheimer’s Association International Conference in Los Angeles yesterday.

And changing up a few of your daily habits to lessen your risk could be well worth your trouble. The new research finds that people with a high genetic risk were a third less likely to develop dementia if they followed a healthy lifestyle, compared to their counterparts who lead unhealthy lifestyles.

Health spoke to an expert to find out what you need to know about this new research.

What is Alzheimer’s?

Alzheimer’s disease is the most common form of dementia. Sixty to 80% of people with dementia have Alzheimer’s, the Alzheimer’s Association says.

Age is the biggest risk factor; the majority of Alzheimer’s patients are over 65. A number of genes can increase one’s risk of having Alzheimer’s.

Researchers believe that between 40 and 65% of people diagnosed with Alzheimer’s have a gene called APOE-e4, which was the first gene identified as capable of increasing Alzheimer’s risk. Researchers are constantly studying new genes that influence Alzheimer’s risk, Rebecca Edelmayer, PhD, director of scientific engagement at the Alzheimer’s Association, tells Health.

RELATED: Here's How a Doctor Explains the Difference Between Alzheimer's and Dementia

RELATED: 7 Ways to Protect Your Memory

How can you lower your risk?

As Sano stated, there’s no real downside to maintaining a healthy diet and exercise routine, going easy on alcohol, and refraining from smoking cigarettes. All of these healthy lifestyle habits will positively impact other areas of your wellbeing as well as your brain health.

If you’re already watching your weight and substance-use habits closely, there’s more you can do to decrease your risk, Edelmayer says.

She suggests incorporating cognitively stimulating activities into your daily routine to keep your brain on its toes. These can be “activities related to strategy [that are] outside of your normal routine,” Edelmayer says.

Sano echoes this, saying, “Intellectual and social stimulation have a positive benefit.”

She adds one more tip: “Managing stress, anxiety, and depression can be helpful.” So you can add decreasing your risk of having Alzheimer’s to the list of reasons you should prioritize your mental health.

RELATED: 25 Signs and Symptoms of Alzheimer's Disease

That's because dementia isn’t a disease. Rather, it’s an umbrella term used to describe a group of symptoms related to decline in memory, social abilities, and everyday function, says Kristin Addison-Brown, PhD, dementia specialist and owner of NEA Neuropsychology in Arkansas. We asked Addison-Brown how she explains the difference to patients. Here's what we learned.

RELATED: 25 Signs and Symptoms of Alzheimer's Disease

Alzheimer’s disease is the most common cause of dementia, though there are many conditions that can bring about this group of symptoms. Others include Parkinson’s disease, Huntington's disease, traumatic brain injury, and damage to the vessels that supply blood to the brain, which can be the result of stroke or other conditions.

Depending on the cause, dementia can manifest in different ways, Addison-Brown says, and the earliest signs can be easily overlooked. Early-stage dementia symptoms include things like forgetting recent conversations, getting lost in familiar places, and personality changes, like being uncharacteristically impatient.

As dementia progresses, cognitive symptoms can include difficulty communicating, planning, reasoning, problem solving, and, of course, remembering, according to the Mayo Clinic. Psychological symptoms include agitation, inappropriate behavior, paranoia, hallucinations, anxiety, depression, and more. At its worst, dementia can cause a person to forget who their loved ones are and make them completely unable to care for themselves.

RELATED: 7 Warning Signs of Dementia to Look For in Loved Ones

The cause of the dementia—whether it be Alzheimer's, Parkinson's, or something else—will not only affect how the symptoms present themselves, but also “treatment, outcome, planning, and implications for the family members,” Addison-Brown says.

Alzheimer’s disease is an irreversible, progressive brain disorder that causes brain cells to waste away and die, slowly destroying memory and thinking skills. A person living with Alzheimer’s will likely show typical dementia symptoms like a decline in memory, social abilities, and everyday function, in addition to confusion, wandering, aggressiveness, loss of inhibitions, changes in sleeping habits, distrust in others, and social withdrawal.

The exact cause of Alzheimer’s itself isn’t completely understood. Researchers believe it’s the result of a combination of genetic, lifestyle, and environmental factors that affect the brain over time and cause specific proteins to malfunction. There’s no cure for Alzheimer’s, but there are options to help manage the symptoms, such as antipsychotic and memory loss medication. But before prescribing treatment, doctors will investigate whether or not a person truly has Alzheimer’s disease—or if there's another cause of their cognitive decline.

RELATED: 8 Weird Things Linked to Memory Loss Later in Life

This typically involves neuropsychological testing, Addison-Brown says, but early symptoms can also provide clues. For example, patients with dementia caused by Parkinson’s disease are more likely to experience involuntary movements in the early stages of the disease, while those with Lewy body dementia are more likely to experience visual hallucinations early on.

It’s also possible for a person to have more than one condition contributing to the dementia at the same time, Addison-Brown says. “Usually a person will have just one type of dementia, but it’s certainly not unheard of for someone to have something like Alzheimer’s disease and vascular dementia at the same time. When those co-occur, we call that mixed dementia.”

RELATED: Coffee May Protect Against Dementia and Parkinson's, and Scientists Finally Think They Know Why

Regardless of the diagnosis, ensuring an appropriate healthcare plan is in place will help alleviate any financial burdens of proper care.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter