Doctors use several methods and tools to help determine if a person with thinking or memory problems has Alzheimer’s disease. To diagnose Alzheimer’s, doctors may:

• Ask the person experiencing symptoms, as well as a family member or friend, questions about overall health, use of prescription and over-the-counter medicines, diet, past medical problems, ability to carry out daily activities, and changes in behavior and personality.
• Conduct tests of memory, problem solving, attention, counting, and language.
• Order blood, urine, and other standard medical tests that can help identify other possible causes of the problem.
• Administer a psychiatric evaluation to determine if depression or another mental health condition is causing or contributing to a person’s symptoms.
• Collect cerebrospinal fluid (CSF) via a spinal tap and measure the levels of proteins associated with Alzheimer’s and related dementias.
• Perform brain scans, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET), to support an Alzheimer’s diagnosis or rule out other possible causes for symptoms.

Doctors may want to repeat these tests to help best determine how the person’s memory and other cognitive functions are changing over time. The tests can also help diagnose other causes of memory problems, such as stroke, tumor, Parkinson’s disease, sleep disturbances, side effects of medication, an infection, or another type of dementia. Some of these conditions may be treatable and possibly reversible.

People with memory problems should return to the doctor every six to 12 months.

Before the early 2000s, the only sure way to know whether a person had Alzheimer’s disease was through autopsy, a procedure that is performed after death. Thanks to advances in research, lab and imaging tests are now available to help a doctor or researcher see biological signs of the disease, or biomarkers, in a living person. For example, it is now possible for many doctors, dependent on state-specific availability reflecting U.S. Food and Drug Administration guidelines, to order a blood test to measure levels of beta-amyloid, a protein that accumulates abnormally in the brains of people with Alzheimer’s. Several other blood tests are in development. At present, blood test results alone should not be used to diagnose dementia but may be taken into consideration along with other tests. However, the availability of these diagnostic tests is still limited. NIA-supported research teams continue to study options for faster, less-expensive, and less-invasive ways to diagnose Alzheimer’s.

What happens if a doctor thinks it’s Alzheimer’s disease?

If a primary care doctor suspects Alzheimer’s, he or she may refer the patient to a specialist who can provide a detailed diagnosis or further assessment. Specialists include:

• Geriatricians, who manage health care in older adults and know how the body changes as it ages and whether symptoms indicate a serious problem.
• Geriatric psychiatrists, who specialize in the mental and emotional problems of older adults and can assess memory and thinking problems.
• Neurologists, who specialize in abnormalities of the brain and central nervous system and can conduct and review brain scans.
• Neuropsychologists, who can conduct tests of memory and thinking.

Memory clinics and centers, including Alzheimer’s Disease Research Centers, offer teams of specialists who work together to diagnose the problem. In addition, these specialty clinics or centers often have access to the equipment needed for brain scans and other advanced diagnostic tests.

What are the potential benefits of an early Alzheimer’s diagnosis?

Alzheimer’s disease slowly worsens over time. People living with this disease progress at different rates, from mild Alzheimer’s, when they first notice symptoms, to severe, when they are completely dependent on others for daily, routine care such as feeding oneself.

Early, accurate diagnosis may be beneficial to some people for several reasons. While there is no cure, medicines are emerging to treat the progression of Alzheimer’s. There are also medicines available to treat some symptoms of Alzheimer’s, along with coping strategies to manage behavioral issues. Most medicines currently available work best for people in the early or middle stages of the disease. Learn more about Alzheimer’s treatments.

In addition, having an early diagnosis helps people with Alzheimer’s and their families:

• Plan for the future
• Take care of financial and legal matters
• Address potential safety issues
• Learn about living arrangements
• Develop support networks

An early diagnosis can also provide people with more opportunities to participate in clinical trials or other research studies testing possible new treatments for Alzheimer’s.

To learn more, please visit https://www.nia.nih.gov/health/alzheimers-symptoms-and-diagnosis/how-alzheimers-disease-diagnosed.

People with Alzheimer’s need to be active and do things they enjoy. However, activities they used to enjoy may become challenging for them as the disease worsens. They may have trouble deciding what to do or starting tasks. As a caregiver, you can learn how to adapt activities to make them easier and more enjoyable.

General tips

Here are some ways to make activities easier and more enjoyable for a person with Alzheimer’s:

• Match the activity with what the person with Alzheimer’s can do.
• Choose activities that can be fun for everyone.
• Help the person get started with the activity.
• Decide if they can do the activity alone or need help.
• Watch to see if the person gets frustrated.
• Make sure they feel successful and have fun.
• Let them simply watch if they seem to enjoy that more.

At home

To help keep days interesting and engaging for people with Alzheimer’s, try coming up with different activities to do each day. Here are some daily activities people with Alzheimer’s may enjoy:

• Cooking and baking: Gather materials, measure ingredients, mix and pour, or tell someone else how to prepare a recipe.
• Exercise: Take a walk together, use a stationary bike, use stretching bands, throw a soft ball or balloon back and forth, lift weights or household items such as soup cans, or follow along with exercise videos or programs for older adults.
• Music and dancing: Play music, talk about the music and the artist, ask what the person with Alzheimer’s was doing when the song was popular, sing or dance to well-known songs, or attend a concert or musical program in the community.
• Pets: Feed, groom, walk, or sit and hold a pet.
• Gardening: Take care of indoor or outdoor plants, plant flowers and vegetables, water the plants when needed, or talk about how much the plants are growing.
• Household chores: Wash dishes, set the table, prepare food, sweep the floor, dust, sort mail and clip coupons, sort socks and fold laundry, or sort recycling materials or other items.
• Visiting with children: Play a simple board game, read stories or books, visit family members who have small children, walk in the park or near schools, or go to school events. If you don’t have children to visit, talk about fond memories from childhood.

Going out

Early in the disease, people with Alzheimer’s may still enjoy the same kinds of outings they enjoyed in the past. Keep going out as long as you both are comfortable. Plan outings for the time of day when the person is at their best. Keep your time away from home from becoming too long so the person with Alzheimer’s doesn’t get too tired. Some places your loved one might enjoy visiting include a:

• Favorite restaurant
• Zoo or aquarium
• Park or nature trail
• Shopping mall
• Swimming pool (during a slow time of day at the pool)
• Museum, theater, or art exhibits for short trips

The person with Alzheimer’s may also enjoy going to a senior center. This type of “going out” could also be considered a form of respite care because it provides an activity for the person with Alzheimer’s and gives the caregiver a break.

Eating at a restaurant

Going out to eat can be a welcome change, but it also poses some challenges. Below are some tips for eating out with a person who has Alzheimer’s:

• Choose a restaurant that the person likes, is quiet, and has quick service and an understanding staff.
• Visit restaurants during “off hours” when they’re less likely to be crowded.
• Consider going to the restaurant earlier in the day so the person is not too tired. Bring supplies such as utensils, a towel, and wipes that the person uses at home.
• At the restaurant, ask for a table near the bathroom.
• Help the person choose their meal, if needed. Read parts of the menu or show the person a picture of the food. Suggest food you know the person likes.
• Ask the server to fill glasses half full or leave the drinks for you to serve.
• Order some finger food or appetizers before the main meal to hold the attention of the person with Alzheimer’s.

Traveling

Taking a person with Alzheimer’s on a trip can be a challenge because it may make the person more worried and confused. Below are some tips that you may find helpful.

• Before you leave, talk with the person’s doctor about medicines to calm someone who gets upset while traveling.
• Think about the person’s unique needs and preferences when choosing transportation, such as a plane, train, or car. Go with the option that provides the most comfort and least anxiety.
• Pack an extra set of clothing and items they enjoy looking at or holding in a carry-on bag.
• Talk to the person about travel plans in advance, but not too far ahead if traveling makes them feel anxious.
• Do not plan too many activities, and plan rest periods.
• During the trip, follow a routine like the one you use at home. Try to have the person eat, rest, and go to bed at the same time as usual.
• Be prepared to cut your visit short if necessary.
• In case the person with Alzheimer’s gets lost, make sure they wear or have something with them that tells who they are, such as an ID bracelet.

Spiritual activities

Being part of a faith community may help someone with Alzheimer’s feel connected to others and remember pleasant times. Here are some ideas to help:

• Involve the person in spiritual activities that they have known well. These might include worship services, religious or other readings, sacred music, prayer, meditation, and holiday rituals.
• Tell people in the preferred faith community about the person’s Alzheimer’s. Encourage them to talk with the person and show they still care.
• Find worship services or readings online if the person is more comfortable at home.

Holidays

Caregivers of people with Alzheimer’s may worry about the extra demands that holidays make on their time and energy. Here are some suggestions to make holidays easier:

• Understand that things will be different, and be realistic about what you can do.
• Incorporate the holiday traditions of the person with Alzheimer’s.
• Create a quiet space in case the person with Alzheimer’s needs a break. Have their favorite activities or calming music in that space.
• Ask friends and family to visit. Limit the number of visitors at any one time.
• Avoid crowds, changes in routine, and strange places that may make the person with Alzheimer’s feel confused or nervous.
• Remember to enjoy yourself. Find time for the holiday activities you like to do. Ask a friend or family member to spend time with the person while you’re out.

To learn more, please visit https://www.nia.nih.gov/health/alzheimers-caregiving/adapting-activities-people-alzheimers-disease.

Someone with Alzheimer’s disease may start rummaging or searching through cabinets, drawers, closets, the refrigerator, and other places where things are stored. They may also hide items around the house.

In some cases, there might be a logical reason for this behavior. For instance, they may be looking for something specific but not able to tell you what it is. They may be hungry or bored. Try to understand what is causing the behavior so you can fit your response to the cause.

Tips to make rummaging safer

You can take steps that allow the person with Alzheimer’s to rummage while keeping the person safe. Try these tips:

• Lock up dangerous or toxic products or place them out of the person’s sight and reach.
• Remove spoiled food from the refrigerator and cabinets. Someone with Alzheimer’s may look for snacks but lack the judgment or sense of taste to stay away from foods that have gone bad.
• Remove valuable items that could be misplaced or hidden by the person, such as important papers, checkbooks, credit cards, jewelry, cellphones, and keys.
• People with Alzheimer’s often hide, lose, or throw away mail. If this is a serious problem, consider getting a post office box. If you have a yard with a fence and a locked gate, place your mailbox outside the gate.

More tips to cope with rummaging and hiding

Here are some more suggestions to help manage rummaging and hiding behavior:

• Keep the person with Alzheimer’s from going into any unused room. This limits their rummaging and hiding things.
• Search the house to learn where the person often hides things. Once you find these places, check them often when out of sight of the person.
• Keep all trash cans covered or out of sight. People with Alzheimer’s may not remember the purpose of the container or may rummage through it.
• Check trash containers before you empty them in case something has been hidden there or thrown away by accident.

For more information

NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
800-438-4380
adear@nia.nih.gov
www.nia.nih.gov/alzheimers
The NIA ADEAR Center offers information and publications for download (PDF) about Alzheimer’s and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.

Alzheimers.gov
www.alzheimers.gov
Explore the Alzheimers.gov website for information and resources on Alzheimer’s and related dementias from across the federal government.

Eldercare Locator
800-677-1116
eldercarelocator@USAging.org
https://eldercare.acl.gov

Alzheimer’s Association
800-272-3900 
866-403-3073 (TTY)
info@alz.org
www.alz.org 

Alzheimer’s Foundation of America
866-232-8484
info@alzfdn.org
https://alzfdn.org

Family Caregiver Alliance
800-445-8106
info@caregiver.org
www.caregiver.org

Several prescription drugs are approved by the U.S. Food and Drug Administration (FDA) for Alzheimer’s disease to help either manage the symptoms of or to treat the disease. Most FDA-approved drugs work best for people in the early or middle stages of Alzheimer’s. There are currently no known interventions that will cure Alzheimer’s.

Medications for mild to moderate Alzheimer’s disease

Treating the symptoms of Alzheimer’s can help provide people with comfort, dignity, and independence for a longer period of time and also assist their caregivers. Galantamine, benzgalantamine, rivastigmine, and donepezil are cholinesterase inhibitors that are prescribed for mild to moderate Alzheimer’s symptoms. These drugs may help reduce or control some cognitive and behavioral symptoms.

Cholinesterase inhibitors prevent the breakdown of acetylcholine, a brain chemical believed to be important for memory and thinking. As Alzheimer’s progresses, the brain produces less acetylcholine and, over time, these medicines lose their effectiveness. Because cholinesterase inhibitors work in a similar way, switching from one to another may not produce significantly different results, but a person living with Alzheimer’s may respond better to one drug versus another.

Lecanemab and donanemab are FDA-approved immunotherapy drugs for the treatment of early Alzheimer’s. These drugs target the protein beta-amyloid to help reduce amyloid plaques, one of the hallmark brain changes in Alzheimer’s. Clinical studies to determine the effectiveness of  lecanemab and donanemab were conducted in people with early-stage Alzheimer’s or mild cognitive impairment due to the disease. These studies showed that the drugs slowed the rate of cognitive decline among some study participants over the course of 18 months and reduced the levels of amyloid in the brain. Currently, insurance may only cover these medications in specific situations. Medicare Part B covers part of the cost of these medications for patients who meet certain medical criteria.

Before prescribing lecanemab or donanemab, doctors may order PET scans or an analysis of cerebrospinal fluid to evaluate whether amyloid deposits are present in the brain. Possible side effects of these medications include amyloid-related imaging abnormalities (ARIA), which can lead to fluid buildup or bleeding in the brain. In rare instances, the side effects may be serious or life-threatening. Due to these potential risks, doctors should monitor for side effects with MRIs.

Several other medications to treat Alzheimer’s are being tested in people with mild cognitive impairment or early Alzheimer’s.

Medications for moderate to severe Alzheimer’s disease

A medication known as memantine, an N-methyl-D-aspartate (NMDA) antagonist, can be prescribed for moderate to severe Alzheimer’s. This drug is prescribed to decrease symptoms, which could enable some people to maintain certain daily functions a little longer than they would without the medication. For example, memantine may help a person in the later stages of the disease maintain their ability to use the bathroom independently for several more months, a benefit for both people with Alzheimer’s and their caregivers.

Memantine is believed to work by regulating glutamate, an important brain chemical. When produced in excessive amounts, glutamate may lead to brain cell death. Because NMDA antagonists work differently from cholinesterase inhibitors, the two types of drugs can be prescribed in combination.

The FDA has also approved donepezil, the rivastigmine patch, and a combination medication of memantine and donepezil for moderate to severe Alzheimer’s.

Brexpiprazole is an atypical antipsychotic that has been approved to treat agitation associated with Alzheimer’s. See below for more information on managing behavioral symptoms and antipsychotics.

Dosage and side effects of Alzheimer’s disease medications

Doctors usually start patients at low drug doses and gradually increase the dosage based on how well a patient tolerates it. There is some evidence that certain people may benefit from higher doses of Alzheimer’s medications. However, the higher the dose, the more likely unwanted side effects will occur.

Patients should be monitored when a drug is started. All of these medicines have possible side effects that may include nausea, vomiting, diarrhea, allergic reactions, loss of appetite, headaches, confusion, dizziness, and falls. Report any unusual symptoms to the prescribing doctor right away.

It is important to follow your doctor’s instructions when taking any medication, including vitamins and herbal supplements. Talk with your doctor before adding or changing any medications.

Managing behavioral symptoms of Alzheimer’s disease

Common behavioral symptoms of Alzheimer’s include sleeplessness, wandering, agitation, anxiety, aggression, restlessness, and depression. Scientists are learning why these symptoms occur and are studying new treatments — drug and non-drug — to manage them. Research has shown that treating behavioral symptoms can provide comfort for people with Alzheimer’s and make things easier for caregivers.

Experts agree that medicines to treat these behavior problems should be used only after other non-drug strategies have been tried. Learn more about behavioral changes in people with Alzheimer’s disease and ways to cope.

Medicines to be used with caution in people with Alzheimer’s disease

Some medicines, such as sleep aids, anti-anxiety drugs, anticonvulsants, and antipsychotics warrant extra caution for people living with Alzheimer’s. These drugs should only be considered as options after:

• A doctor has explained all the risks and side effects of the medicine
• Other, safer non-drug options have not helped treat the problem

People living with Alzheimer’s and their caregivers must watch for side effects from these medications.

Sleep aids are used to help people get to sleep and stay asleep. People with Alzheimer’s should not use these drugs regularly because they make the person more confused and more likely to fall. There are lifestyle changes people can make to improve their sleep. Learn more about getting a good night’s sleep.

Anti-anxiety drugs are used to treat agitation. Certain types of anti-anxiety drugs, such as benzodiazepines, can cause sleepiness, dizziness, falls, and confusion. For this reason, doctors recommend they only be used for short periods of time, if at all.

Anticonvulsants are drugs sometimes used to treat severe aggression. Side effects may cause sleepiness, dizziness, mood swings, and confusion.

Antipsychotics are drugs used to treat hallucinations, delusions, and paranoia, and agitation and aggression. Their side effects can be serious, including increased risk of death in some older people with dementia. These medications should only be given to people with Alzheimer’s when the doctor agrees the symptoms are severe.

The future of Alzheimer’s disease treatments

Alzheimer’s researchers continue to explore a variety of innovative approaches to treat symptoms as well as underlying disease processes. In ongoing clinical trials, they are developing and testing several new possible interventions. These include additional immunotherapy and other drug therapies, cognitive training, diet, and physical activity.

To learn more, please visit https://www.nia.nih.gov/health/alzheimers-treatment/how-alzheimers-disease-treated.

Ask yourself the five questions below to help understand your risk factors for developing Alzheimer’s disease.

How old are you?

Age is the biggest known risk factor for Alzheimer’s. Most people with Alzheimer’s develop the disease when they are 65 or older, with less than 10% of cases occurring before then. As a person ages past 65, their risk of Alzheimer’s increases. About one in 13 people age 65 to 84 and one in three people 85 and older are living with Alzheimer’s.

Does Alzheimer’s run in your family?

Family history is also an important risk factor. People with a parent or sibling diagnosed with Alzheimer’s have a higher risk of developing the disease than those who don’t have family members with the disease. Families can have many things in common, including their genes, environment, and lifestyle, that all may play a role. For example, lifestyle habits such as diet and exercise, which can be influenced by family, can affect overall health and increase risk for Alzheimer’s. Importantly, not everyone with a history of Alzheimer’s in their family will develop the disease and vice versa — not everyone who develops Alzheimer’s has a family history of the disease.

What’s your lifestyle?

There are some risk factors, like age, that you cannot change. However, there may be ways to promote better brain health and reduce your risk of Alzheimer’s by addressing certain lifestyle factors, including:

• Unmanaged chronic health issues, such as high blood pressure or hearing loss
• Physical inactivity
• Unhealthy diet
• Alcohol misuse
• Smoking
• Not getting enough sleep or not sleeping well
• Social isolation
• Lack of mental stimulation

Researchers cannot yet say for certain whether making positive changes in these areas can prevent dementia, but doing so is beneficial to living a healthier lifestyle overall. Learn more about leading a healthy lifestyle that may help address risk factors associated with Alzheimer’s and related dementias.

What medical conditions do you have?

Having certain medical conditions may increase your risk of developing Alzheimer’s. For example, cardiovascular disease, which includes conditions such as heart disease, stroke, and coronary artery disease, affects the heart and blood vessels and has been linked to Alzheimer’s.

Several risk factors associated with developing cardiovascular disease are also associated with Alzheimer’s. For example, studies have shown that managing high blood pressure reduces the risk of mild cognitive impairment and the risk of dementia. Specifically, one large clinical trial showed that lowering systolic blood pressure to below 120 mmHg reduced the risk of mild cognitive impairment, and a review of observational studies showed that managing high blood pressure with medication reduced the risk of dementia compared to people with high blood pressure who didn’t take medication. Learn more about blood pressure and Alzheimer’s and ways to control your blood pressure.

Other risk factors associated with both cardiovascular disease and Alzheimer’s include diabetes, overweight or obesity, and high LDL (“bad”) cholesterol.

In addition, other medical conditions associated with a higher risk of Alzheimer’s include:

• Hearing loss
• Depression
• Mild cognitive impairment
• Concussion or other traumatic brain injury

Getting recommended health screenings and regularly checking in with a health care provider can help you learn about and manage medical conditions. Treat high blood pressure with healthy lifestyle changes and medications if prescribed by your doctor. Protect your ears from loud sounds and use hearing restorative devices, such as hearing aids, if needed. Make healthy food choices and get regular exercise to maintain a healthy weight.

What about biomarkers?

Biomarkers are characteristics we can measure that help show what’s happening inside the body. Scientists have identified several biomarkers associated with Alzheimer’s. While testing for biomarkers can provide some information about a person’s risk, these tests can’t tell for sure whether or not someone will develop the disease. Right now, many of these biomarkers are used mostly in research settings or to help doctors in diagnosing the disease.

Genetic variants are a type of biomarker that have been associated with Alzheimer’s risk. Variants in the apolipoprotein E (APOE) gene are one example. A variant called APOE ε4 has been associated with an increased risk of Alzheimer’s in certain populations, while a variant called APOE ε2 may offer some protection against Alzheimer’s in others.

At-home tests are available for a fee to test for APOE variants. People considering such tests will benefit from talking with a doctor or genetic counselor to better understand the test and what their results may mean. Learn more about Alzheimer’s and genetics.

Other biomarkers for Alzheimer’s include levels of the proteins beta-amyloid and tau. Doctors may use brain scans and cerebrospinal fluid tests that measure these protein levels to help determine whether a person’s cognitive difficulties are caused by Alzheimer’s or not. Blood tests are also now available that can measure levels of beta-amyloid. However, none of these tests are commonly used to indicate someone’s risk outside of a research setting.

Identifying who may or may not develop Alzheimer’s is complex. Researchers continue to investigate biomarkers and other risk factors for the disease. Learn more about biomarkers that help diagnose Alzheimer’s or a related dementia.

The bottom line

Scientists are still learning about what causes Alzheimer’s and what puts some people at higher risk than others. While we know some of the factors that influence a person’s risk, there are probably many other factors that have not yet been identified. Talk with a doctor if you have concerns or questions about your risk of developing the disease. The doctor may suggest changes in memory and thinking to watch out for. They may also recommend steps for staying healthy overall to help maintain cognitive health and reduce the risk of dementia.

To learn more, please visit https://www.nia.nih.gov/health/alzheimers-causes-and-risk-factors/thinking-about-your-risk-alzheimers-disease-five.