# Alzheimer's Disease ## Healthify (Health Navigator) | Healthify He Puna Waiora **Source:** [https://healthify.nz/health-a-z/a/alzheimers-disease](https://healthify.nz/health-a-z/a/alzheimers-disease) **Capture Date:** 2026-06-07 --- ## Overview Alzheimer's disease is the most common form of dementia, accounting for 50–70% of all dementia cases. It is a progressive, degenerative brain disease that slowly destroys memory, thinking skills, and the ability to carry out everyday tasks. In New Zealand, approximately **70,000 people** are living with Alzheimer's disease and other forms of dementia. --- ## What Is Alzheimer's Disease? Alzheimer's disease is a **physical brain disease** caused by the abnormal build-up of proteins in and around brain cells: - **Amyloid plaques:** Clumps of beta-amyloid protein fragments that accumulate between nerve cells (neurons). - **Neurofibrillary tangles:** Twisted strands of tau protein that build up inside nerve cells. These changes damage and eventually kill brain cells (neurons), leading to progressive loss of brain tissue, particularly in areas involved in memory and thinking (the hippocampus, temporal lobes, and cortex). The brain of someone with Alzheimer's may show significant shrinkage (atrophy) visible on a brain scan. --- ## Prevalence in New Zealand - **~70,000 people** are currently living with dementia in NZ; Alzheimer's disease accounts for the majority of these. - Dementia is the **third leading cause of death** in New Zealand. - Due to the ageing population, these numbers are projected to **more than triple by 2050** (to over 170,000 people). - Māori and Pasifika populations are disproportionately affected due to higher rates of cardiovascular risk factors. - The condition affects people of all ethnicities and socioeconomic backgrounds. --- ## Symptoms Symptoms of Alzheimer's disease typically develop **gradually over about 10 years**, though the progression and timeline vary significantly from person to person. ### Early Stage (Mild) - **Memory loss:** Especially for recent events, conversations, and new information. May repeat questions or stories. - **Mild language problems:** Difficulty finding the right word, especially nouns. - **Mild disorientation:** Losing track of time or date; getting lost in unfamiliar places. - **Mood changes:** Anxiety, depression, irritability, or apathy. May become withdrawn. - **Difficulty with planning and organisation:** Trouble managing finances, following recipes, or making decisions. - **Reduced initiative:** Loss of interest in hobbies or social activities. - **Still functions fairly independently** with occasional support. ### Middle Stage (Moderate) — Often the Longest Stage - **Worsening memory loss:** May not recognise close family and friends. - **Increased language difficulty:** Trouble understanding conversation or expressing needs. - **Needs help with daily activities:** Dressing, bathing, toileting, grooming. - **Behavioural and psychological symptoms (BPSD):** - Agitation, aggression, or restlessness - Repetitive questioning or movements - Wandering and getting lost - Sleep disturbances (sundowning — worsening confusion in late afternoon/evening) - Suspicion, paranoia, or hallucinations (more common in middle stages) - **Loss of impulse control:** May exhibit inappropriate social behaviour. - **Needs supervision** for safety (unable to be left alone for long periods). ### Late Stage (Advanced / Severe) - **Severe memory loss:** Cannot recognise self, spouse, or children. - **Speech limited** to a few words or sounds; may be completely non-verbal. - **Complete dependence:** Requires total assistance with all personal care (eating, dressing, toileting, bathing). - **Physical decline:** - Difficulty eating and swallowing (dysphagia) — risk of choking, aspiration pneumonia, weight loss - Incontinence (bladder and bowel) - Loss of mobility — becomes bed-bound or chair-bound - Muscles may become rigid or contracted (contractures) - Increased vulnerability to infections (UTIs, pneumonia, skin infections) - **Palliative and end-of-life care** becomes the focus. --- ## Risk Factors ### Non-Modifiable Risk Factors - **Age:** The single biggest risk factor. Risk doubles every 5 years after age 65. About 1 in 10 people over 65 and 1 in 3 over 85 have Alzheimer's. - **Genetics:** - **APOE ε4 gene:** The strongest genetic risk factor for late-onset Alzheimer's. Carrying one copy increases risk 2–3 times; two copies increases risk 8–12 times. It is not a guarantee — many people with APOE ε4 never develop Alzheimer's. - **Rare familial genes** (APP, PSEN1, PSEN2): Cause early-onset familial Alzheimer's (before age 65) — accounts for less than 1% of all cases. - **Family history:** Having a first-degree relative (parent, sibling) with Alzheimer's increases risk. - **Sex:** More women than men have Alzheimer's (partly because women live longer, but there may also be biological factors). ### Modifiable Risk Factors (up to 40% of cases may be preventable) - **Cardiovascular risk factors:** - High blood pressure (especially mid-life hypertension) - Diabetes (type 2) - High cholesterol - Smoking - Obesity (especially mid-life) - Physical inactivity - **Hearing loss** — untreated hearing loss is one of the largest modifiable risk factors (may triple the risk). - **Low education / cognitive reserve** — less cognitive stimulation over the lifetime. - **Traumatic brain injury** (especially repeated head injuries). - **Depression** (especially late-life depression — may be both a risk factor and a prodromal symptom). - **Social isolation** and loneliness. - **Excessive alcohol consumption.** - **Air pollution** — emerging evidence links long-term exposure to increased risk. --- ## Diagnosis Pathway ### 1. GP Visit A GP is the first point of contact. They will: - Take a history (from the person and a family member) - Do a cognitive screening test (e.g., **Mini-ACE** — takes 5–10 minutes) - Perform a physical examination - Order **blood tests** to rule out other causes (thyroid, B12, infection, diabetes, kidney/liver function) - Refer for a **CT or MRI brain scan** ### 2. Specialist Assessment Referral to a **geriatrician** (older people's health), **psychiatrist of old age**, **neurologist**, or **memory clinic** for comprehensive assessment: - **Neuropsychological assessment:** Detailed 1–2 hour testing of memory, language, executive function, attention, and visuospatial skills. - **Brain imaging:** MRI is best for showing hippocampal atrophy (a key feature of Alzheimer's). CT is used to exclude other causes. - **Lumbar puncture** (in some cases): Measures amyloid-beta and tau proteins in cerebrospinal fluid — can confirm Alzheimer's pathology. - **Amyloid PET scan** (limited availability in NZ): Shows amyloid plaque build-up in the brain. ### 3. Diagnosis - Alzheimer's can be diagnosed with **high accuracy** (85–90%) using the combination of clinical assessment, cognitive testing, and brain imaging. - A definitive diagnosis (100% certainty) can only be made at autopsy, but modern clinical methods are highly reliable. - The diagnosis is explained to the person and their family, along with information about treatment, support services, and future planning. --- ## Treatments ### 1. Acetylcholinesterase Inhibitors (AChEIs) **First-line medication for mild to moderate Alzheimer's.** - **Donepezil (Aricept):** Most commonly prescribed, once daily - **Rivastigmine (Exelon):** Oral capsule or patch - **Galantamine (Reminyl):** Twice daily or extended-release once daily **How they work:** They increase levels of acetylcholine, a neurotransmitter involved in memory and learning, which is depleted in Alzheimer's disease. **What they do:** - Slow the progression of symptoms for 6–12 months in many people - Improve or stabilise memory, attention, and daily function for a time - May delay the need for full-time care **Side effects:** Nausea, vomiting, diarrhoea, loss of appetite, slow heart rate (bradycardia) — often temporary or managed by slow dose escalation. **In NZ:** These medications are **funded by Pharmac** (New Zealand's medicines funding agency) for people with mild to moderate Alzheimer's disease. A neurologist, geriatrician, or psychiatrist must initiate and monitor treatment. ### 2. Memantine (NMDA Receptor Antagonist) **For moderate to severe Alzheimer's**, sometimes used in combination with an AChEI. - **Memantine** regulates the activity of glutamate, another neurotransmitter involved in learning and memory. - It can help maintain function and reduce behavioural symptoms in later stages. - Side effects include dizziness, headache, and constipation. ### 3. Cognitive Stimulation Therapy (CST) - A structured, evidence-based group programme for people with mild to moderate dementia. - Involves themed sessions (e.g., word games, number games, current affairs, food, faces) designed to actively stimulate thinking, memory, and social engagement. - Typically runs for 7–14 weeks, with weekly sessions. - **Evidence:** CST is as effective as medication for cognitive symptoms and has lasting benefits. - Available through some DHBs / Health NZ districts, dementia services, and Alzheimer's NZ programmes. ### 4. Non-Pharmacological Approaches (Essential) - **Reminiscence therapy:** Using photos, music, and objects from the past to stimulate memory and engagement. - **Music therapy:** Listening to familiar music can reduce agitation and improve mood. - **Validation therapy:** Communicating by validating the person's feelings and reality (rather than correcting them). - **Behavioural interventions:** For managing BPSD — identify triggers, redirect, reassure, and maintain routines. - **Exercise:** Improves mood, sleep, cardiovascular health, and slows functional decline. - **Occupational therapy:** Home modifications, safety strategies, cognitive aids, and activity planning. - **Speech-language therapy:** For communication difficulties and swallowing problems (late stages). ### 5. Lifestyle Interventions - **Healthy diet:** Mediterranean diet (high in vegetables, fruit, whole grains, fish, healthy fats) is associated with slower cognitive decline. - **Physical activity:** Regular aerobic and strength exercise. - **Social engagement:** Maintaining connections and activities. - **Cognitive stimulation:** Puzzles, reading, learning new skills, staying mentally active. --- ## Future Planning An early diagnosis allows time for important decisions and planning while the person can still participate fully. ### Legal Planning - **Enduring Power of Attorney (EPOA):** Appoint someone to manage financial and property affairs (EPOA for Property) and personal care and welfare decisions (EPOA for Personal Care and Welfare). This continues if you lose mental capacity. - **Will:** Ensure it is up to date. - **Advance Care Directive (Living Will):** Write down your preferences for medical treatment and end-of-life care. ### Financial Planning - Review income, savings, and entitlements (NZ Superannuation, Residential Care Subsidy, etc.). - Consider how care will be funded (at home and, if needed, residential care). - Talk to a financial adviser if needed. ### Driving - Alzheimer's disease affects the ability to drive safely, even in early stages. - **In NZ, you must tell the NZ Transport Agency (Waka Kotahi) and your doctor** if you have a condition that may affect your ability to drive. - Your doctor may recommend a driving assessment (on-road test with an occupational therapist). - Many people with Alzheimer's will need to stop driving at some point. Planning alternatives (family, taxis, community transport) in advance reduces stress. ### Support Services - **Alzheimer's New Zealand / Dementia NZ:** Information, helpline (0800 004 001), support groups, education programmes. - **Carer support:** NASC assessment for carer support hours (respite). - **Home support:** Personal care, housework, meals. - **Day programmes:** Social and therapeutic activities. - **Respite care:** Short-term residential care to give carers a break. - **Support groups:** For both the person with dementia and their carers/family. --- ## Research and Future Directions - **Disease-modifying therapies** (e.g., aducanumab, lecanemab) are emerging — these target amyloid plaques directly and aim to slow progression. Some are approved overseas; availability in NZ is limited and funded access is not yet established. - **Blood biomarkers** (blood tests for amyloid and tau) are being developed — may make diagnosis faster and more accessible. - **Lifestyle and prevention trials** continue to explore the role of diet, exercise, cognitive training, and risk factor management. - **World Alzheimer's Day** is 21 September each year. --- ## Key Contacts | Organisation | Contact | | ----------------------- | ------------------------------------------ | | Alzheimer's NZ Helpline | 0800 004 001 | | Dementia NZ | [dementia.nz](https://dementia.nz) | | Healthline | 0800 611 116 | | Carer Support (NASC) | Contact local Health NZ district | | Pharmac (medicines) | [pharmac.govt.nz](https://pharmac.govt.nz) | --- ## Summary of Key Facts | Topic | Detail | | ----------------------- | -------------------------------------------------------------------------------------------- | | **Prevalence in NZ** | ~70,000 people with dementia (Alzheimer's is most common form) | | **Symptom progression** | Gradual over ~10 years (early → middle → late stages) | | **Key symptoms** | Memory loss, language decline, disorientation, behaviour changes, loss of independence | | **Risk factors** | Age, genetics (APOE ε4), cardiovascular health, hearing loss, lifestyle | | **Modifiable risk** | Up to 40% of cases linked to modifiable factors | | **Diagnosis** | GP → cognitive test (Mini-ACE) → blood tests → CT/MRI → specialist → neuropsych assessment | | **Medications** | Donepezil, rivastigmine, galantamine (funded for mild-moderate), memantine (moderate-severe) | | **CST** | Cognitive Stimulation Therapy — evidence-based group programme | | **Lifestyle** | Diet, exercise, social engagement, cognitive stimulation | | **Future planning** | EPOA, advance care directive, will, driving assessment, support services |