Don’t Mistake Illness for “Just Getting Old”: Recognizing, Preventing, and Treating Alzheimer’s Disease

When an older family member starts asking the same question over and over, forgets that they just ate, or even fails to recognize a familiar face, many people comfort themselves by saying, “It’s nothing. Getting a little forgetful is normal at this age.” But this seemingly kind explanation may be hiding a health problem that needs attention as early as possible—Alzheimer’s disease. It is not an inevitable part of aging, but a progressive brain disease. The earlier it is recognized and addressed, the better the chance of preserving valuable time and quality of life for the patient.

Alzheimer’s disease is a brain-degenerative disease with an insidious onset that gradually progresses. It is the most common cause of dementia in older adults. It is not part of normal aging, but a pathological brain disorder.

The core pathological features of Alzheimer’s disease are the abnormal deposition of beta-amyloid (Aβ) in the brain, which forms “senile plaques,”and the hyperphosphorylation of tau protein, which leads to “neurofibrillary tangles.”[1]These changes trigger neuronal damage, synaptic loss, and brain tissue atrophy, especially in the hippocampus and entorhinal cortex, areas closely related to memory and cognitive function.

As the disease progresses, patients develop memory loss, decline in thinking ability, and changes in behavior and personality, ultimately severely affecting their ability to perform daily activities and social functioning. For this reason, patients often seek care in neurology, psychiatry, and geriatrics.

Many people simply attribute memory decline to “just getting old” (normal aging) and regard it as a natural phenomenon of advancing age. However, Alzheimer’s disease is fundamentally different from normal age-related forgetfulness.

The most critical difference between the two is this: normal aging does not significantly affect social functioning or the ability to live independently, whereas Alzheimer’s disease causes progressive functional decline until the patient can no longer take care of themselves.

Diagnosis Requires Professional Evaluation

When you notice memory problems, changes in daily living abilities, or personality and behavioral changes in an older adult that others cannot understand, you should take the initiative to bring them to a memory clinic at a professional institution for cognitive function assessment and examination, so they can receive scientific diagnosis and treatment recommendations in a timely manner.

Doctors at a memory clinic usually listen to family members describe the condition in detail and also communicate carefully with the patient. After that, they arrange for professionals to help evaluate the patient’s neurocognitive function, psychiatric and behavioral symptoms, and daily living abilities, providing a scientific basis for diagnosis and differential diagnosis.

In addition, patients need to undergo some auxiliary examinations. For example, MRI can determine whether there is brain atrophy and identify its location and characteristics. The most typical finding in Alzheimer’s disease is hippocampal atrophy. In recent years, biomarker tests such as amyloid PET imaging have also been increasingly used for the precise diagnosis of Alzheimer’s disease.

What Risk Factors Should Be Avoided for Prevention?

The development of Alzheimer’s disease is the result of a combination of genetics, environment, and lifestyle. It can be divided into uncontrollable factors and controllable factors. According to a report in The Lancet, about 45% of dementia cases can be prevented or delayed by intervening in controllable risk factors. These controllable risk factors include the following.[2]

1.Lifestyle: smoking, excessive alcohol consumption, and lack of exercise.

2.Cardiovascular disease: high blood pressure, diabetes, obesity, and high LDL cholesterol.

3.Brain injury: a history of traumatic brain injury.

4.Mental and psychological conditions: social isolation and depression.

5.Sensory function: uncorrected hearing loss and vision loss in midlife.

6.Education level: low educational attainment.

Although there is currently no absolute way to prevent Alzheimer’s disease, a large body of research confirms that actively reducing controllable risk factors can significantly lower the risk of cognitive decline and prevent dementia. It is recommended to pay attention to brain health starting early in life and to build a full-process management system that integrates medical care and prevention, especially in the following five areas.

1.Maintain regular physical exercise: get at least 150 minutes of moderate-intensity aerobic exercise per week (such as brisk walking or swimming), combined with strength training.

2.Maintain a healthy lifestyle: quit smoking and limit alcohol, and avoid secondhand smoke. Eat more vegetables, fruits, whole grains, nuts, fish, and olive oil, and limit red meat, sugar, and processed foods.

3.Strengthen cognitive training: keep learning new skills (such as musical instruments or languages), read, play chess, do puzzles, and participate in cognitive activation activities to keep the brain active.

4.Actively participate in social activities: actively expand your social circle, take part in community activities and volunteer service, maintain good interpersonal relationships, avoid loneliness, and stay in a good mood.

5.Actively manage your health: control blood pressure, blood sugar, and blood lipids, and protect your hearing.

Treatment Requires a Three-Pronged Approach: Don’t Be Impatient

At present, no medication can cure Alzheimer’s disease. Hoping for a“one-shot cure,”a“single-dose miracle,”or a“magic bullet,”or lacking confidence in treatment and thinking,“It can’t be cured anyway, so I might as well not treat it,”are both unscientific attitudes. Alzheimer’s disease diagnosis and treatment guidelines worldwide all recommend a“three-pronged”treatment approach: first, adhere to appropriate medication to slow cognitive decline and reduce psychiatric and behavioral symptoms; second, provide scientific psychosocial intervention to increase social activity and reduce behavioral problems; and third, provide counseling and support for caregivers to improve the quality of family care.

Alzheimer’s disease is not simply“just getting old,”but a brain disease that must be faced scientifically. It cannot be brushed aside with the phrase“it’s just age,”nor should it be abandoned because of the pessimistic belief that“it can’t be treated.”Through early recognition, professional diagnosis, active prevention, and comprehensive treatment, we can still help patients slow decline, preserve dignity, and reduce the burden on families. Paying attention to changes in an older adult’s memory is paying attention to their future quality of life. Don’t mistake illness for“just getting old.”Taking timely action is the deepest expression of care for those we love.

[1] Ferrer I. Defining Alzheimer as a common age-related neurodegenerative process not inevitably leading to dementia. Prog Neurobiol. 2012 Apr;97(1):38-51. doi: 10.1016/j.pneurobio.2012.03.005. Epub 2012 Mar 21. PMID: 22459297.

https://pubmed.ncbi.nlm.nih.gov/22459297/#1

[2] Livingston G, Huntley J,et al.Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet. 2024 Aug 10;404(10452):572-628. doi: 10.1016/S0140-6736(24)01296-0. Epub 2024 Jul 31. PMID: 39096926.

https://pubmed.ncbi.nlm.nih.gov/39096926/