Dementia, Memory Loss, & Healthy Aging

Forgetfulness and Brain Diseases

Do Memory Problems Always Mean Alzheimer's Disease?

Many people worry about becoming forgetful. They think forgetfulness is the first sign of Alzheimer's disease. But not all people with memory problems have Alzheimer's.

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Other causes for memory problems can include aging, medical conditions, emotional problems, mild cognitive impairment, or another type of dementia.

Age-Related Changes in Memory

Forgetfulness can be a normal part of aging. As people get older, changes occur in all parts of the body, including the brain. As a result, some people may notice that it takes longer to learn new things, they don't remember information as well as they did, or they lose things like their glasses. These usually are signs of mild forgetfulness, not serious memory problems, like Alzheimer's disease.

Differences Between Normal Aging and Alzheimer's Disease
Normal Aging	Alzheimer's Disease
Making a bad decision once in a while	Making poor judgments and decisions a lot of the time
Missing a monthly payment	Problems taking care of monthly bills
Forgetting which day it is and remembering it later	Losing track of the date or time of year
Sometimes forgetting which word to use	Trouble having a conversation
Losing things from time to time	Misplacing things often and being unable to find them

Memory Loss Related to Medical Conditions

Certain medical conditions can cause serious memory problems. These problems should go away once a person gets treatment. Medical conditions that may cause memory problems include:

Tumors, blood clots, or infections in the brain
Some thyroid, kidney, or liver disorders
Drinking too much alcohol
Head injury, such as a concussion from a fall or accident
Medication side effects
Not eating enough healthy foods, or too few vitamins and minerals in a person's body (like vitamin B12)

A doctor should treat serious medical conditions like these as soon as possible.

Memory Loss Related to Emotional Problems

Emotional problems, such as stress, anxiety, or depression, can make a person more forgetful and can be mistaken for dementia. For instance, someone who has recently retired or who is coping with the death of a spouse, relative, or friend may feel sad, lonely, worried, or bored. Trying to deal with these life changes leaves some people feeling confused or forgetful.

The confusion and forgetfulness caused by emotions usually are temporary and go away when the feelings fade. Emotional problems can be eased by supportive friends and family, but if these feelings last for more than 2 weeks, it is important to get help from a doctor or counselor. Treatment may include counseling, medication, or both. Being active and learning new skills can also help a person feel better and improve his or her memory.

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Cognitive Health

Memory and Thinking: What's Normal and What's Not?

Many older people worry about their memory and other thinking abilities. For example, they might be concerned about taking longer than before to learn new things, or they might sometimes forget to pay a bill. These changes are usually signs of mild forgetfulness—often a normal part of aging—not serious memory problems. Older woman talking to her doctor about memory problems

Talk with your doctor to determine if memory and other thinking problems are normal or not, and what is causing them.

What's Normal and What's Not?

What's the difference between normal, age-related forgetfulness and a serious memory problem? Serious memory problems make it hard to do everyday things like driving and shopping. Signs may include:

Asking the same questions over and over again
Getting lost in familiar places
Not being able to follow instructions
Becoming confused about time, people, and places

Mild Cognitive Impairment

Some older adults have a condition called mild cognitive impairment, or MCI, in which they have more memory or other thinking problems than other people their age. People with MCI can take care of themselves and do their normal activities. MCI may be an early sign of Alzheimer's, but not everyone with MCI will develop Alzheimer's disease.

Signs of MCI include:

Losing things often
Forgetting to go to important events or appointments
Having more trouble coming up with desired words than other people of the same age

If you have MCI, visit your doctor every 6 to 12 months to see if you have any changes in memory and other thinking skills over time. There may be things you can do to maintain your memory and mental skills. No medications have been approved to treat MCI.

Dementia

Dementia is the loss of cognitive functioning—thinking, remembering, learning and reasoning—and behavioral abilities to such an extent that it interferes with daily life and activities. Memory loss, though common, is not the only sign. A person may also have problems with language skills, visual perception, or paying attention. Some people have personality changes. Dementia is not a normal part of aging.

There are different forms of dementia. Alzheimer's disease is the most common form in people over age 65. The chart below explains some differences between normal signs of aging and Alzheimer's disease.

Differences Between Normal Aging and Alzheimer's Disease
Normal Aging	Alzheimer's Disease
Making a bad decision once in a while	Making poor judgments and decisions a lot of the time
Missing a monthly payment	Problems taking care of monthly bills
Forgetting which day it is and remembering it later	Losing track of the date or time of year
Sometimes forgetting which word to use	Trouble having a conversation
Losing things from time to time	Misplacing things often and being unable to find them

When to Visit the Doctor

If you, a family member, or friend has problems remembering recent events or thinking clearly, talk with a doctor. He or she may suggest a thorough checkup to see what might be causing the symptoms

The annual Medicare wellness visit includes an assessment for cognitive impairment. This visit is covered by Medicare for patients who have had Medicare Part B insurance for at least 1 year.

Memory and other thinking problems have many possible causes, including depression, an infection, or a medication side effect. Sometimes, the problem can be treated, and the thinking problems disappear. Other times, the problem is a brain disorder, such as Alzheimer's disease, which cannot be reversed. Finding the cause of the problems is important to determine the best course of action.

A note about unproven treatments: Some people are tempted by untried or unproven "cures" that claim to make the brain sharper or prevent dementia. Check with your doctor before trying pills, supplements or other products that promise to improve memory or prevent brain disorders. These "treatments" might be unsafe, a waste of money, or both. They might even interfere with other medical treatments. Currently there is no drug or treatment that prevents Alzheimer's disease or other dementias.

Dementia and Memory Loss

What Is Dementia?

Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it interferes with a person's daily life and activities. These functions include memory, language skills, visual perception, problem solving, self-management, and the ability to focus and pay attention. Some people with dementia cannot control their emotions, and their personalities may change. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person's functioning, to the most severe stage, when the person must depend completely on others for basic activities of living.

Older woman with glasses wearing a sari

Signs and symptoms of dementia result when once-healthy neurons (nerve cells) in the brain stop working, lose connections with other brain cells, and die. While everyone loses some neurons as they age, people with dementia experience far greater loss.

While dementia is more common as people grow older (up to half of all people age 85 or older may have some form of dementia), it is not a normal part of aging. Many people live into their 90s and beyond without any signs of dementia. One type of dementia, frontotemporal disorders, is more common in middle-aged than older adults.

The causes of dementia can vary, depending on the types of brain changes that may be taking place. Alzheimer's disease is the most common cause of dementia in older adults. Other dementias include Lewy body dementia, frontotemporal disorders, and vascular dementia. It is common for people to have mixed dementia—a combination of two or more types of dementia. For example, some people have both Alzheimer's disease and vascular dementia.

Learn more about dementia from MedlinePlus.

Read about this topic in Spanish. Lea sobre esta tema en español.

For More Information About Dementia

NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
1-800-438-4380 (toll-free)
adear@nia.nih.gov
www.nia.nih.gov/alzheimers
The National Institute on Aging’s ADEAR Center offers information and free print publications about Alzheimer’s disease 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.

Types of Dementia

Various disorders and factors contribute to the development of dementia. Neurodegenerative disorders result in a progressive and irreversible loss of neurons and brain functioning. Currently, there are no cures for these types of disorders. They include:

Hispanic man with dementia sitting in a park

Alzheimer's disease
Frontotemporal disorders
Lewy body dementia

Other types of progressive brain disease include:

Vascular contributions to cognitive impairment and dementia
Mixed dementia, a combination of two or more types of dementia

Other conditions that cause dementia-like symptoms can be halted or even reversed with treatment. For example, normal pressure hydrocephalus, an abnormal buildup of cerebrospinal fluid in the brain, often resolves with treatment.

In addition, certain medical conditions can cause serious memory problems that resemble dementia. These problems should go away once the conditions are treated. These conditions include:

Side effects of certain medicines
Emotional problems, such as stress, anxiety, or depression
Certain vitamin deficiencies
Drinking too much alcohol
Blood clots, tumors, or infections in the brain
Delirium
Head injury, such as a concussion from a fall or accident
Thyroid, kidney, or liver problems

Doctors have identified many other conditions that can cause dementia or dementia-like symptoms. These conditions include:

Argyrophilic grain disease, a common, late-onset degenerative disease
Creutzfeldt-Jakob disease, a rare brain disorder
Huntington's disease, an inherited, progressive brain disease
Chronic traumatic encephalopathy (CTE), caused by repeated traumatic brain injury
HIV-associated dementia (HAD)

The overlap in symptoms of various dementias can make it hard to get an accurate diagnosis. But a proper diagnosis is important to get the right treatment. Seek help from a neurologist—a doctor who specializes in disorders of the brain and nervous system—or other medical specialist who knows about dementia.

Learn more about dementia from MedlinePlus.

Read about this topic in Spanish. Lea sobre esta tema en español.

For More Information About Types of Dementia

National Institute of Neurological Disorders and Stroke
1-800-352-9424 (toll-free)
braininfo@ninds.nih.gov
www.ninds.nih.gov

What Is Mixed Dementia?

It is common for people with dementia to have mixed dementia—a combination of two or more types of dementia. A number of combinations are possible. For example, some people have both Alzheimer's disease and vascular dementia. Older woman with mixed dementia

Some studies indicate that mixed dementia is the most common cause of dementia in the elderly. For example, autopsy studies looking at the brains of people who had dementia indicate that most people age 80 and older probably had mixed dementia caused by a combination of brain changes related to Alzheimer's disease, vascular disease-related processes, or another neurodegenerative condition. Some studies suggest that mixed vascular-degenerative dementia is the most common cause of dementia in older adults.

In a person with mixed dementia, it may not be clear exactly how many of a person's symptoms are due to Alzheimer's or another disease. In one study, researchers who examined older adults' brains after death found that 78 percent had two or more pathologies (disease characteristics in the brain) related to neurodegeneration or vascular damage. Alzheimer's was the most common pathology but rarely occurred alone.

Researchers are trying to better understand how underlying disease processes in mixed dementia influence each other. In the study described above, the researchers found that the degree to which Alzheimer's pathology contributed to cognitive decline varied greatly from person to person. In other words, the impact of any given brain pathology differed dramatically depending on which other pathologies were present.

For More Information About Mixed Dementia

Content reviewed: December 31, 2017

Biomarkers for Dementia Detection and Research

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What Are Biomarkers?

Biomarkers are measures of what is happening inside the living body, shown by the results of laboratory and imaging tests. Biomarkers can help doctors and scientists diagnose diseases and health conditions, find health risks in a person, monitor responses to treatment, and see how a person's disease or health condition changes over time. For example, an increased level of cholesterol in the blood is a biomarker for heart-attack risk.

Many types of biomarker tests are used for research on Alzheimer's disease and related dementias. Changes in the brains of people with these disorders may begin many years before memory loss or other symptoms appear. Researchers use biomarkers to help detect these brain changes in people, who may or may not have obvious changes in memory or thinking. Finding these changes early in the disease process helps identify people who are at the greatest risk of Alzheimer's or another dementia and may help determine which people might benefit most from a particular treatment.

Use of biomarkers in clinical settings, such as a doctor's office, is limited at present. Some biomarkers may be used to identify or rule out causes of symptoms for some people. Researchers are studying many types of biomarkers that may one day be used more widely in doctors' offices and other clinical settings.

Types of Biomarkers and Tests

In Alzheimer's disease and related dementias, the most widely used biomarkers measure changes in the size and function of the brain and its parts, as well as levels of certain proteins seen on brain scans and in cerebrospinal fluid and blood.

Brain Imaging

male medical technician with older woman about to get brain imaging test

Brain imaging, also called brain scans, can measure changes in the size of the brain, identify and measure specific brain regions, and detect biochemical changes and vascular damage (damage related to blood vessels). In clinical settings, doctors can use brain scans to find evidence of brain disorders, such as tumors or stroke, that may aid in diagnosis. In research settings, brain imaging is used to study structural and biochemical changes in the brain in Alzheimer's disease and related dementias. There are several types of brain scans.

Computerized Tomography

What is it?

CT scanner

A computerized tomography (CT) scan is a type of x ray that uses radiation to produce images of the brain. A CT can show the size of the brain and identify a tumor, stroke, head injury, or other potential cause of dementia symptoms. CT scans provide greater detail than traditional x rays, but a less detailed picture than magnetic resonance imaging (MRI) and cannot easily measure changes over time. Sometimes a CT scan is used when a person can't get MRI due to metal in their body, such as a pacemaker.

What's the procedure like?

During a CT, a person lies in a scanner for 10 to 20 minutes. A donut-shaped device moves around the head to produce the image.

What does it show?

A head CT can show shrinkage of brain regions that may occur in dementia, as well as signs of a stroke or tumor.

When is it used?

A CT is sometimes used to help a doctor diagnose dementia based on changes in the size of particular brain regions, compared either to an earlier scan or to what would be expected for a person of the same age and size. It is rarely used in the research arena to study Alzheimer's disease and related dementias.

Magnetic Resonance Imaging

What is it?

Doctor talking with patient before MRI

Magnetic resonance imaging (MRI) uses magnetic fields and radio waves to produce detailed images of body structures, including the size and shape of the brain and brain regions. MRI may be able to identify some causes of dementia symptoms, such as a tumor, stroke, or head injury. MRI may also show whether areas of the brain have atrophied, or shrunk.

What's the procedure like?

During an MRI, a person lies still in a tunnel-shaped scanner for about 30 minutes for diagnostic purposes and up to 2 hours for research purposes. MRI is a safe, painless procedure that does not involve radioactivity. The procedure is noisy, so people are often given earplugs or headphones to wear. Some people become claustrophobic and anxious inside an MRI machine, which can be addressed with anxiety-relieving medication taken shortly before the scan.

Because MRI uses strong magnetic fields to obtain images, people with certain types of metal in their bodies, such as a pacemaker, surgical clips, or shrapnel, cannot undergo the procedure.

What does it show?

MRI scans provide pictures of brain structures and whether abnormal changes, such as shrinkage of areas of the brain, are present. Evidence of shrinkage may support a diagnosis of Alzheimer's or another neurodegenerative dementia but cannot indicate a specific diagnosis. Researchers use different types of MRI scans to obtain pictures of brain structure, chemistry, blood flow, and function, as well as the size of brain regions. MRI also provides a detailed picture of any vascular damage in the brain—such as damage due to a stroke or small areas of bleeding—that may contribute to changes in cognition. Repeat scans can show how a person's brain changes over time.

When is it used?

Doctors often use MRI scans to identify or rule out causes of memory loss, such as a stroke or other vascular brain injury, tumors, or hydrocephalus. These scans also can be used to assess brain shrinkage.

In the research arena, various types of MRI scans are used to study the structure and function of the brain in aging and Alzheimer's disease. In clinical trials, MRI can be used to monitor the safety of novel drugs and to examine how treatment may affect the brain over time.

Positron Emission Tomography

What is it?

Examples of brain imaging scans from PET, CT, MRI

Positron emission tomography (PET) uses small amounts of a radioactive substance, called a tracer, to measure specific activity—such as glucose (energy) use—in different brain regions. Different PET scans use different tracers. PET is commonly used in dementia research but less frequently in clinical settings.

What's the procedure like?

The person having a PET scan receives an injection of a radioactive tracer into a vein in the arm, then lies on a cushioned table, which is moved into a donut-shaped scanner. The PET scanner takes pictures of the brain, revealing regions of normal and abnormal chemical activity. A PET scan is much quieter than an MRI. The entire process, including the injection and scan, takes about 1 hour.

The amount of radiation exposure during a PET scan is relatively low. People who are concerned about radiation exposure or who have had many x rays or imaging scans should talk with their doctor.

What does it show?

Fluorodeoxyglucose (FDG) PET scans measure glucose use in the brain. Glucose, a type of sugar, is the primary source of energy for cells. Studies show that people with dementia often have abnormal patterns of decreased glucose use in specific areas of the brain. An FDG PET scan can show a pattern that may support a diagnosis of a specific cause of dementia.

Amyloid PET scans measure abnormal deposits of a protein called beta-amyloid. Higher levels of beta-amyloid are consistent with the presence of amyloid plaques, a hallmark of Alzheimer's disease. Several tracers may be used for amyloid PET scans, including florbetapir, flutemetamol, florbetaben, and Pittsburgh compound B.

Tau PET scans detect abnormal accumulation of a protein, tau, which forms tangles in nerve cells in Alzheimer's disease and many other dementias. Several tau tracers, such as AV-1451, PI-2620, and MK-6240, are being studied in clinical trials and other research settings.

When is it used?

In clinical care, FDG PET scans may be used if a doctor strongly suspects frontotemporal dementia as opposed to Alzheimer's dementia based on the person's symptoms, or when there is an unusual presentation of symptoms.

Amyloid PET imaging is sometimes used by medical specialists to help with a diagnosis when Alzheimer's disease is suspected but uncertain, even after a thorough evaluation. Amyloid PET imaging may also help with a diagnosis when people with dementia have unusual or very mild symptoms, an early age of onset (under age 65), or any of several different conditions, such as severe depression, that may contribute to dementia symptoms. A negative amyloid PET scan rules out Alzheimer's disease.

In research, amyloid and tau PET scans are used to determine which individuals may be at greatest risk for developing Alzheimer's disease, to identify clinical trial participants, and to assess the impact of experimental drugs designed to affect amyloid or tau pathways.

Cerebrospinal Fluid Biomarkers

Cerebrospinal fluid (CSF) is a clear fluid that surrounds the brain and spinal cord, providing protection and insulation. CSF also supplies numerous nutrients and chemicals that help keep brain cells healthy. Proteins and other substances made by cells can be detected in CSF, and their levels may change years before symptoms of Alzheimer's and other brain disorders appear.

Lumbar Puncture

What is it?

CSF is obtained by a lumbar puncture, also called a spinal tap, an outpatient procedure used to diagnose several types of neurological problems.

What's the procedure like?

People either sit or lie curled up on their side while the skin over the lower part of the spine is cleaned and injected with a local anesthetic. A very thin needle is then inserted into the space between the bones of the spine. CSF either drips out through the needle or is gently drawn out through a syringe. The entire procedure typically takes 30 to 60 minutes.

After the procedure, the person lies down for a few minutes and may receive something to eat or drink. People can drive themselves home and resume regular activities, but they should refrain from strenuous exercise for about 24 hours.

Some people feel brief pain during the procedure, but most have little discomfort. A few may have a mild headache afterward, which usually disappears after taking a pain reliever and lying down. Sometimes, people develop a persistent headache that gets worse when they sit or stand. This type of headache can be treated with a blood patch, which involves injecting a small amount of the person's blood into his or her lower back to stop a leak of CSF.

Certain people cannot have a lumbar puncture, including people who take medication such as warfarin (Coumadin®, Jantoven®) to thin their blood, have a low platelet count or an infection in the lower back, or have had major back surgery.

What does it show?

The most widely used CSF biomarkers for Alzheimer's disease measure certain proteins: beta-amyloid 42 (the major component of amyloid plaques in the brain), tau, and phospho-tau (major components of tau tangles in the brain). In Alzheimer's disease, beta-amyloid 42 levels in CSF are low, and tau and phospho-tau levels are high, compared with levels in people without Alzheimer's or other causes of dementia.

When is it used?

In clinical practice, CSF biomarkers may be used to help diagnose Alzheimer's, for example, in cases involving an unusual presentation of symptoms or course of progression. CSF also can be used to evaluate people with unusual types of dementia or with rapidly progressive dementia.

In research, CSF biomarkers are valuable tools for early detection of a neurodegenerative disease. They are also used in clinical trials to assess the impact of experimental medications.

Other Types of Biomarkers

Blood Tests

Proteins that originate in the brain, such as tau and beta-amyloid 42, may be measured with sensitive blood tests. Levels of these proteins may change as a result of Alzheimer's, a stroke, or other brain disorders. These blood biomarkers are less accurate than CSF biomarkers for identifying Alzheimer's and related dementias. However, new methods to measure these brain-derived proteins, particularly beta-amyloid 42, have improved, suggesting that blood tests may be used in the future for screening and perhaps diagnosis.

Many other proteins, lipids, and other substances can be measured in the blood, but so far none has shown value in diagnosing Alzheimer's.

Currently, dementia researchers use blood biomarkers to study early detection, prevention, and the effects of potential treatments. They are not used in doctors' offices and other clinical settings.

Genetic Testing

Genes are structures in a body's cells that are passed down from a person's birth parents. They carry information that determines a person's traits and keep the body's cells healthy. Problems with genes can cause diseases like Alzheimer's.

A genetic test is a type of medical test that analyzes DNA from blood or saliva to determine a person's genetic makeup. A number of genetic combinations may change the risk of developing a disease that causes dementia.

Genetic tests are not routinely used in clinical settings to diagnose or predict the risk of developing Alzheimer's or a related dementia. However, a neurologist or other medical specialist may order a genetic test in rare situations, such as when a person has an early age of onset or a strong family history of Alzheimer's or a related brain disease. A genetic test is typically accompanied by genetic counseling for the person before the test and when results are received. Genetic counseling includes a discussion of the risks, benefits, and limitations of test results.

Genetic testing for APOE ε4, the main genetic risk factor for late-onset Alzheimer's disease, is available as a direct-to-consumer or commercial test. It is important to understand that genetic testing provides only one piece of information about a person's risk. Other genetic and environmental factors, lifestyle choices, and family medical history also affect a person's risk of developing Alzheimer's disease.

In research studies, genetic tests may be used, in addition to other assessments, to predict disease risk, help study early detection, explain disease progression, and study whether a person's genetic makeup influences the effects of a treatment.

Read more about Alzheimer's disease genetics.

Biomarkers in Development

Researchers are studying other biomarker tests for possible use in diagnosing and tracking Alzheimer's disease and other types of dementia. These biomarkers include reduced ability to smell, the presence of certain proteins in the retina of the eye, and other proteins that indicate the health of neurons. At this point, doctors do not use these biomarkers to diagnose dementia.

Biomarkers in Dementia Diagnosis

Some biomarkers may be part of a diagnostic assessment for people with symptoms of Alzheimer's or a related dementia. Other parts of the assessment typically include a medical history; physical exam; laboratory tests; neurological tests of balance, vision, and other cognitive functions; and neuropsychological tests of memory, problem solving, language skills, and other mental functions.

Different biomarkers provide different types of information about the brain and may be used in combination with each other and with other clinical tests to improve the accuracy of diagnosis—for example, in cases where the age of onset or progression of symptoms is not typical for Alzheimer's or a related brain disorder.

Physicians with expertise in Alzheimer's disease and related dementias are the most appropriate clinicians to order biomarker tests and interpret the results. These physicians include neurologists, geriatric psychiatrists, neuropsychologists, and geriatricians.

Currently, Medicare and other health insurance plans cover only certain, limited types of biomarker tests for dementia symptoms, and their use must be justified based on the person's symptoms and specific criteria.

Read more about diagnosing dementia.

Biomarkers in Dementia Research

Research on biomarkers for Alzheimer's disease and other dementias has shown rapid progress. Biomarkers provide detailed measures of abnormal changes in the brain, which can aid in early detection of possible disease in people with very mild or unusual symptoms. People with Alzheimer's disease and related dementias progress at different rates, and biomarkers may help predict and monitor their progression.

In addition, biomarker measures may help researchers:

Better understand how risk factors and genetic variants are involved in Alzheimer's disease
Identify participants who meet particular requirements, such as having certain genes or amyloid levels, for clinical trials and studies
Track study participants' responses to a test drug or other intervention, such as physical exercise

Read about the new NIA-AA Research Framework focusing on biomarkers to help define and study Alzheimer's disease.

The Future of Biomarkers

Advances in biomarkers during the past decade have led to exciting new findings. Researchers can now see Alzheimer's-related changes in the brain while people are alive, track the disease's onset and progression, and test the effectiveness of promising drugs and other potential treatments. To build on these successes, researchers hope to further biomarker research by:

Developing and validating a full range of biomarkers, particularly those that are less expensive and/or less invasive, to help test drugs that may prevent, treat, and improve diagnosis of Alzheimer's and related dementias
Advancing the use of novel PET imaging, CSF, and blood biomarkers to identify specific changes in the brain related to Alzheimer's and other neurodegenerative dementias
Using new MRI methods to measure brain structure, function, and connections
Developing and refining sensitive clinical and neuropsychological assessments to help detect and track early-stage disease
Using biomarkers in combination to build a model of Alzheimer's disease progression over decades, from its earliest, presymptomatic stage through dementia

How You Can Help

The use of biomarkers is allowing scientists to make great strides in identifying potential new treatments and ways to prevent or delay dementia. These advances are possible because thousands of people have participated in clinical trials and studies. Clinical trials need participants of all different ages, sexes, races, and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them. Major medical breakthroughs could not happen without the generosity of research participants who become partners in these scientific discoveries.

Learn more about participating in clinical research.

To find clinical trials and studies on Alzheimer's and related dementias, visit:

NIA Alzheimer's and Related Dementias Clinical Trials Finder
National Institute of Neurological Disorders and Stroke
Alzheimer's Disease Neuroimaging Initiative (ADNI)
National Institutes of Health

For More Information About Dementia Biomarkers

Content reviewed: April 01, 2018

Dementia Research and Clinical Trials

Common Questions About Participating in Alzheimer's and Related Dementias Research

How Can I Find Out About Alzheimer’s Trials and Studies?

Check the resources below:

Ask your doctor, who may know about local research studies that may be right for you.
Sign up for a registry or a matching service to be invited to participate in studies or trials when they are available in your area.
Contact Alzheimer’s research centers or memory or neurology clinics in your community. They may be conducting trials.
Visit the Alzheimer’s and related Dementias Education and Referral (ADEAR) Center clinical trials finder.
Look for announcements in newspapers and other media.
Search www.clinicaltrials.gov.

Why Would I Participate in a Clinical Trial?

There are many reasons why you might choose to join an Alzheimer’s or dementia clinical trial. You may want to:

Help others, including future family members, who may be at risk for Alzheimer’s disease or a related dementia
Receive regular monitoring by medical professionals
Learn about Alzheimer’s and your health
Test new treatments that might work better than those currently available
Get information about support groups and resources

What Else Should I Consider?

Consider both benefits and risks when deciding whether to volunteer for a clinical trial.

While there are benefits to participating in a clinical trial or study, there are some risks and other issues to consider as well.

Risk. Researchers make every effort to ensure participants’ safety. But, all clinical trials have some risk. Before joining a clinical trial, the research team will explain what you can expect, including possible side effects or other risks. That way, you can make an informed decision about joining the trial.

Expectations and motivations. Single clinical trials and studies generally do not have miraculous results, and participants may not benefit directly. With a complex disease like Alzheimer’s, it is unlikely that one drug will cure or prevent the disease.

Uncertainty. Some people are concerned that they are not permitted to know whether they are getting the experimental treatment or a placebo (inactive treatment), or may not know the results right away. Open communication with study staff can help you understand why the study is set up this way and what you can expect.

Time commitment and location. Clinical trials and studies last days to years. They usually require multiple visits to study sites, such as private research facilities, teaching hospitals, Alzheimer’s research centers, or doctors’ offices. Some studies pay participants a fee and/or reimburse travel expenses.

Study partner requirement. Many Alzheimer’s trials require a caregiver or family member who has regular contact with the person to accompany the participant to study appointments. This study partner can give insight into changes in the person over time.

What Happens When a Person Joins a Clinical Trial or Study?

Once you identify a trial or study you are interested in, contact the study site or coordinator. You can usually find this contact information in the description of the study, or you can contact the ADEAR Center. Study staff will ask a few questions on the phone to determine if you meet basic qualifications for the study. If so, they will invite you to come to the study site. If you do not meet the criteria for the study, don’t give up! You may qualify for a future study.

What Is Informed Consent?

It is important to learn as much as possible about a study or trial to help you decide if you would like to participate. Staff members at the research center can explain the study in detail, describe possible risks and benefits, and clarify your rights as a participant. You and your family should ask questions and gather information until you understand it fully.

After the research is explained and you decide to participate, you will be asked to sign an informed consent form, which states that you understand and agree to participate. This document is not a contract. You are free to withdraw from the study at any time if you change your mind or your health status changes.

Researchers must consider whether the person with Alzheimer’s disease or another dementia is able to understand and consent to participate in research. If the person cannot provide informed consent because of problems with memory and thinking, an authorized legal representative, or proxy (usually a family member), may give permission for the person to participate, particularly if the person’s durable power of attorney gives the proxy that authority. If possible, the person with Alzheimer’s should also agree to participate.

How Do Researchers Decide Who Will Participate?

Researchers carefully screen all volunteers to make sure they meet a study's criteria.

After you consent, you will be screened by clinical staff to see if you meet the criteria to participate in the trial or if anything would exclude you. The screening may involve cognitive and physical tests.

Inclusion criteria for a trial might include age, stage of dementia, gender, genetic profile, family history, and whether or not you have a study partner who can accompany you to future visits. Exclusion criteria might include factors such as specific health conditions or medications that could interfere with the treatment being tested.

Many volunteers must be screened to find enough people for a study. Generally, you can participate in only one trial or study at a time. Different trials have different criteria, so being excluded from one trial does not necessarily mean exclusion from another.

What Is Alzheimer's Disease?

Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. In most people with the disease—those with the late-onset type—symptoms first appear in their mid-60s. Early-onset Alzheimer’s occurs between a person’s 30s and mid-60s and is very rare. Alzheimer’s disease is the most common cause of dementia among older adults.

Older woman with Alzheimer's looking out of a window

The disease is named after Dr. Alois Alzheimer. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. Her symptoms included memory loss, language problems, and unpredictable behavior. After she died, he examined her brain and found many abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary, or tau, tangles).

These plaques and tangles in the brain are still considered some of the main features of Alzheimer’s disease. Another feature is the loss of connections between nerve cells (neurons) in the brain. Neurons transmit messages between different parts of the brain, and from the brain to muscles and organs in the body. Many other complex brain changes are thought to play a role in Alzheimer’s, too.

This damage initially appears to take place in the hippocampus, the part of the brain essential in forming memories. As neurons die, additional parts of the brain are affected. By the final stage of Alzheimer’s, damage is widespread, and brain tissue has shrunk significantly.

How Many Americans Have Alzheimer’s Disease?

Estimates vary, but experts suggest that as many as 5.5 million Americans age 65 and older may have Alzheimer’s. Many more under age 65 also have the disease. Unless Alzheimer's can be effectively treated or prevented, the number of people with it will increase significantly if current population trends continue. This is because increasing age is the most important known risk factor for Alzheimer’s disease.

What Does Alzheimer’s Disease Look Like?

Memory problems are typically one of the first signs of Alzheimer’s, though initial symptoms may vary from person to person. A decline in other aspects of thinking, such as finding the right words, vision/spatial issues, and impaired reasoning or judgment, may also signal the very early stages of Alzheimer’s disease. Mild cognitive impairment (MCI) is a condition that can be an early sign of Alzheimer’s, but not everyone with MCI will develop the disease.

People with Alzheimer’s have trouble doing everyday things like driving a car, cooking a meal, or paying bills. They may ask the same questions over and over, get lost easily, lose things or put them in odd places, and find even simple things confusing. As the disease progresses, some people become worried, angry, or violent.

How Long Can a Person Live with Alzheimer’s Disease?

The time from diagnosis to death varies—as little as 3 or 4 years if the person is older than 80 when diagnosed, to as long as 10 or more years if the person is younger.

Alzheimer’s disease is currently ranked as the sixth leading cause of death in the United States, but recent estimates indicate that the disorder may rank third, just behind heart disease and cancer, as a cause of death for older people.

Although treatment can help manage symptoms in some people, currently there is no cure for this devastating disease.

Learn more about Alzheimer's disease from MedlinePlus.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Alzheimer's Disease

How Is Alzheimer's Disease Diagnosed?

Doctors use several methods and tools to help determine whether a person who is having memory problems has “possible Alzheimer’s dementia” (dementia may be due to another cause), “probable Alzheimer’s dementia” (no other cause for dementia can be found), or some other problem.

Doctor examining brain scans

To diagnose Alzheimer’s, doctors may:

Ask the person and 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
Carry out standard medical tests, such as blood and urine tests, to identify other possible causes of the problem
Perform brain scans, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET), to rule out other possible causes for symptoms

These tests may be repeated to give doctors information about how the person’s memory and other cognitive functions are changing over time. They can also help diagnose other causes of memory problems, such as stroke, tumor, Parkinson’s disease, sleep disturbances, side effects of medication, an infection, mild cognitive impairment, or a non-Alzheimer’s dementia, including vascular dementia. Some of these conditions may be treatable and possibly reversible.

People with memory problems should return to the doctor every 6 to 12 months.

It’s important to note that Alzheimer’s disease can be definitively diagnosed only after death, by linking clinical measures with an examination of brain tissue in an autopsy. Occasionally, biomarkers—measures of what is happening inside the living body—are used to diagnose Alzheimer's.

What Happens Next?

If a primary care doctor suspects mild cognitive impairment or possible 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. Tests often are done at the clinic or center, which can speed up diagnosis.

What Are the Benefits of Early Diagnosis?

Early, accurate diagnosis is beneficial for several reasons. Beginning treatment early in the disease process may help preserve daily functioning for some time, even though the underlying Alzheimer’s process cannot be stopped or reversed.

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

In addition, an early diagnosis gives people greater opportunities to participate in clinical trials that are testing possible new treatments for Alzheimer’s disease or in other research studies.

Learn more about Alzheimer's disease from MedlinePlus.

Noticing Memory Problems? What to Do Next

We’ve all forgotten a name, where we put our keys, or if we locked the front door. It’s normal to forget things once in a while. But serious memory problems make it hard to do everyday things. Forgetting how to make change, use the telephone, or find your way home may be signs of a more serious memory problem.

For some older people, memory problems are a sign of mild cognitive impairment, Alzheimer’s disease, or a related dementia. People who are worried about memory problems should see a doctor. Signs that it might be time to talk to a doctor include:

Asking the same questions over and over again
Getting lost in places a person knows well
Not being able to follow directions
Becoming more confused about time, people, and places
Not taking care of oneself—eating poorly, not bathing, or being unsafe

People with memory complaints should make a follow-up appointment to check their memory after 6 months to a year. They can ask a family member, friend, or the doctor’s office to remind them if they’re worried they’ll forget.

Learn more about Alzheimer's disease from MedlinePlus.

Basics of Alzheimer’s Disease and Dementia

Frequently Asked Questions About Alzheimer's Disease

On this page:

What is the difference between Alzheimer's disease and dementia?
What are the early signs of Alzheimer's disease?
What are the stages of Alzheimer's disease?
What are the causes of Alzheimer's disease?
Is Alzheimer's disease hereditary?
Is there a cure for Alzheimer's disease?
Is there a way to prevent Alzheimer's disease?
Are there any sources of financial help for people with Alzheimer's or their caregivers?

What is the difference between Alzheimer's disease and dementia?

Alzheimer's disease is a type of dementia. Dementia is a loss of thinking, remembering, and reasoning skills that interferes with a person's daily life and activities. Alzheimer's disease is the most common cause of dementia among older people. Other types of dementia include frontotemporal disorders and Lewy body dementia.

Learn more about Alzheimer's disease and dementia.

What are the early signs of Alzheimer's disease?

Memory problems are typically one of the first signs of Alzheimer's disease, though different people may have different initial symptoms. A decline in other aspects of thinking, such as finding the right words, vision/spatial issues, and impaired reasoning or judgment, may also signal the very early stages of Alzheimer's disease.

Mild cognitive impairment, or MCI, is a condition that can also be an early sign of Alzheimer's disease—but not everyone with MCI will develop Alzheimer's. In addition to memory problems, movement difficulties and problems with the sense of smell have been linked to MCI.

Learn more about the signs of Alzheimer's disease.

What are the stages of Alzheimer's disease?

Alzheimer's disease progresses in several stages: preclinical, early (also called mild), middle (moderate), and late (severe). During the preclinical stage of Alzheimer's disease, people seem to be symptom-free, but toxic changes are taking place in the brain. A person in the early stage of Alzheimer's may exhibit the signs listed above. As Alzheimer's disease progresses to the middle stage, memory loss and confusion grow worse, and people may have problems recognizing family and friends. As Alzheimer's disease becomes more severe, people lose the ability to communicate. They may sleep more, lose weight, and have trouble swallowing. Eventually, they need total care.

Learn more about the stages of Alzheimer's disease.

What are the causes of Alzheimer's disease?

Scientists do not yet fully understand what causes Alzheimer's disease in most people. In early-onset Alzheimer's, which occurs between a person's 30s and mid-60s, there may be a genetic component. Late-onset Alzheimer's, which usually develops in a person's mid-60s, arises from a complex series of brain changes that occur over decades. The causes probably include a mix of genetic, environmental, and lifestyle factors. These factors affect each person differently.

Learn more about the factors that influence Alzheimer's disease.

Is Alzheimer's disease hereditary?

If a family member has alzheimer's disease, will I have it too? infographic icon. Click through for full text. — Read and share this infographic to learn more about how Alzheimer's disease runs in families.

Just because a family member has Alzheimer's disease does not mean that you will get it, too.

A rare form of Alzheimer's disease, called early-onset familial Alzheimer's, or FAD, is inherited (passed down through families). It is caused by mutations, or changes, in certain genes. If one of the gene mutations is passed down, the child will usually—but not always—have FAD. In other cases of early-onset Alzheimer's, research suggests there may be a genetic component related to other factors.

Most cases of Alzheimer's are late-onset. This form of the disease occurs in a person's mid-60s and usually has no obvious family pattern. However, genetic factors appear to increase a person's risk of developing late-onset Alzheimer's.

Learn more about assessing risk for Alzheimer's disease.

Is there a cure for Alzheimer's disease?

Some sources claim that products such as coconut oil or dietary supplements such as Protandim® can cure or delay Alzheimer's. However, there is no scientific evidence to support these claims. Currently, there is no cure for Alzheimer's disease.

The U.S. Food and Drug Administration (FDA) has approved several drugs to treat the symptoms of Alzheimer's disease, and certain medicines and other approaches can help control behavioral symptoms.

Learn more about how Alzheimer's disease is treated.

Scientists are developing and testing possible new treatments for Alzheimer's. Learn more about taking part in clinical trials that help scientists learn about the brain in healthy aging and what happens in Alzheimer's and other dementias. Results of these trials are used to improve prevention and treatment methods.

Is there a way to prevent Alzheimer's disease?

Currently, there is no definitive evidence about what can prevent Alzheimer's disease or age-related cognitive decline. What we do know is that a healthy lifestyle—one that includes a healthy diet, physical activity, appropriate weight, and no smoking—can lower the risk of certain chronic diseases and boost overall health and well-being. Scientists are very interested in the possibility that a healthy lifestyle might delay, slow down, or even prevent Alzheimer's. They are also studying the role of social activity and intellectual stimulation in Alzheimer's disease risk.

Learn more about cognitive health and older adults.

Are there any sources of financial help for people with Alzheimer's or their caregivers?

Yes, there are several possible sources of help, depending on your situation. Read Paying for Care for information on government programs and other payment sources.

The following organizations also offer assistance with finding financial help:

Family Caregiver Alliance
1-800-445-8106 (toll-free)
www.caregiver.org/family-care-navigator

For More Information About Alzheimer's

Basics of Alzheimer’s Disease and Dementia Cognitive Health

Preventing Alzheimer’s Disease: What Do We Know?

As they get older, many people worry about developing Alzheimer's disease or a related dementia. If they have a family member with Alzheimer's, they may wonder about their family history and genetic risk. As many as 5.5 million Americans age 65 and older live with Alzheimer's. Many more are expected to develop the disease as the population ages—unless ways to prevent or delay it are found.

Although scientists have conducted many studies, and more are ongoing, so far nothing has been proven to prevent or delay dementia caused by Alzheimer's disease. But researchers have identified promising strategies and are learning more about what might—and might not—work.

We know that changes in the brain can occur many years before the first symptoms of Alzheimer's appear. These early brain changes point to a possible window of opportunity to prevent or delay debilitating memory loss and other symptoms of dementia. While research may identify specific interventions that will prevent or delay the disease in some people, it's likely that many individuals may need a combination of treatments based on their own risk factors.

Researchers are studying many approaches to prevent or delay Alzheimer's. Some focus on drugs, some on lifestyle or other changes. Let's look at the most promising interventions to date and what we know about them.

Can Increasing Physical Activity Prevent Alzheimer's Disease?

older woman walking by lake with walking sticks

Physical activity has many health benefits, such as reducing falls, maintaining mobility and independence, and reducing the risk of chronic conditions like depression, diabetes, and high blood pressure. Based on research to date, there's not enough evidence to recommend exercise as a way to prevent Alzheimer's dementia or mild cognitive impairment (MCI), a condition of mild memory problems that often leads to Alzheimer's dementia.

Years of animal and human observational studies suggest the possible benefits of exercise for the brain. Some studies have shown that people who exercise have a lower risk of cognitive decline than those who don't. Exercise has also been associated with fewer Alzheimer's plaques and tangles in the brain and better performance on certain cognitive tests.

While clinical trials suggest that exercise may help delay or slow age-related cognitive decline, there is not enough evidence to conclude that it can prevent or slow MCI or Alzheimer's dementia. One study compared high-intensity aerobic exercise, such as walking or running on a treadmill, to low-intensity stretching and balance exercises in 65 volunteers with MCI and prediabetes. After 6 months, researchers found that the aerobic group had better executive function—the ability to plan and organize—than the stretching/balance group, but not better short-term memory.

Several other clinical trials are testing aerobic and nonaerobic exercise to see if they may help prevent or delay Alzheimer's dementia. Many questions remain to be answered: Can exercise or physical activity prevent age-related cognitive decline, MCI, or Alzheimer's dementia? If so, what types of physical activity are most beneficial? How much and how often should a person exercise? How does exercise affect the brains of people with no or mild symptoms?

Until scientists know more, experts encourage exercise for its many other benefits. To learn more about exercise and physical activity for older adults, visit NIA's Go4Life campaign.

Can Controlling High Blood Pressure Prevent Alzheimer's Disease?

Controlling high blood pressure is known to reduce a person's risk for heart disease and stroke. The NASEM committee of experts concluded that managing blood pressure when it's high, particularly for middle-aged adults, also might help prevent or delay Alzheimer's dementia.

older man getting blood pressure checked by doctor

Many types of studies show a connection between high blood pressure, cerebrovascular disease (a disease of the blood vessels supplying the brain), and dementia. For example, it's common for people with Alzheimer's-related changes in the brain to also have signs of vascular damage in the brain, autopsy studies show. In addition, observational studies have found that high blood pressure in middle age, along with other cerebrovascular risk factors such as diabetes and smoking, increase the risk of developing dementia.

Clinical trials—the gold standard of medical proof—are underway to determine whether managing high blood pressure in individuals with hypertension can prevent Alzheimer's dementia or cognitive decline.

One large clinical trial—called SPRINT-MIND (Systolic Blood Pressure Intervention Trial–Memory and Cognition in Decreased Hypertension)—found that lowering systolic blood pressure (the top number) to less than 120 mmHg, compared to a target of less than 140 mmHg, did not significantly reduce the risk of dementia. Participants were adults age 50 and older who were at high risk of cardiovascular disease but had no history of stroke or diabetes.

However, the multiyear study did show that this intensive blood pressure lowering significantly reduced the risk of MCI, a common precursor of Alzheimer’s, in the participants. In addition, researchers found that it was safe for the brain.

The results of SPRINT-MIND provide further evidence of the connection between cardiovascular health and brain health. Further studies are needed to determine which people, at what age, might benefit most from particular blood pressure management approaches, and how these approaches affect the risk of dementia, including Alzheimer’s disease.

While research continues, experts recommend that people control high blood pressure to lower their risk of serious health problems, including heart disease and stroke. Learn more about ways to control your blood pressure.

Can Cognitive Training Prevent Alzheimer's?

Cognitive training involves structured activities designed to enhance memory, reasoning, and speed of processing. There is encouraging but inconclusive evidence that a specific, computer-based cognitive training may help delay or slow age-related cognitive decline. However, there is no evidence that it can prevent or delay Alzheimer's-related cognitive impairment.

man in cap using computer with a group of people

Studies show that cognitive training can improve the type of cognition a person is trained in. For example, older adults who received 10 hours of practice designed to enhance their speed and accuracy in responding to pictures presented briefly on a computer screen ("speed of processing" training) got faster and better at this specific task and other tasks in which enhanced speed of processing is important. Similarly, older adults who received several hours of instruction on effective memory strategies showed improved memory when using those strategies. The important question is whether such training has long-term benefits or translates into improved performance on daily activities like driving and remembering to take medicine.

Some of the strongest evidence that this might be the case comes from the NIA-sponsored Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. In this trial, healthy adults age 65 and older participated in 10 sessions of memory, reasoning, or speed-of-processing training with certified trainers during 5 to 6 weeks, with "booster sessions" made available to some participants 11 months and 3 years after initial training. The sessions improved participants' mental skills in the area in which they were trained (but not in other areas), and improvements persisted years after the training was completed. In addition, participants in all three groups reported that they could perform daily activities with greater independence as many as 10 years later, although there was no objective data to support this.

Findings from long-term observational studies—in which researchers observed behavior but did not influence or change it—also suggest that informal cognitively stimulating activities, such as reading or playing games, may lower risk of Alzheimer's-related cognitive impairment and dementia. For example, a study of nearly 2,000 cognitively normal adults 70 and older found that participating in games, crafts, computer use, and social activities for about 4 years was associated with a lower risk of MCI.

Scientists think that some of these activities may protect the brain by establishing "reserve," the brain's ability to operate effectively even when it is damaged or some brain function is disrupted. Another theory is that such activities may help the brain become more adaptable in some mental functions so it can compensate for declines in others. Scientists do not know if particular types of cognitive training—or elements of the training such as instruction or social interaction—work better than others, but many studies are ongoing.

Can Eating Certain Foods Prevent Alzheimer's Disease?

People often wonder if a certain diet or specific foods can help prevent Alzheimer's disease. The recent NASEM review of research did not find enough evidence to recommend a certain diet to prevent cognitive decline or Alzheimer's. Despite observational studies that link Mediterranean-style diets to brain health, clinical trials have not shown strong evidence. Many trials have focused on individual foods rather than comprehensive diets. Newer studies of diets, such as the MIND diet—a combination of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets—are underway. In general, a healthy diet is an important part of healthy aging.

What Else Might Prevent Alzheimer's Disease?

Researchers are exploring these and other interventions that may help prevent, delay, or slow Alzheimer's dementia or age-related cognitive decline. Other research targets include:

New drugs to delay onset or slow disease progression
Diabetes treatment
Depression treatment
Blood pressure- and lipid-lowering treatments
Sleep interventions
Social engagement
Vitamins such as B12 plus folic acid supplements and D
Combined physical and mental exercises

What's the Bottom Line on Alzheimer's Prevention?

Alzheimer's disease is complex, and the best strategy to prevent or delay it may turn out to be a combination of measures. In the meantime, you can do many things that may keep your brain healthy and your body fit.

You also can help scientists learn more by volunteering to participate in research. Clinical trials and studies are looking for all kinds of people—healthy volunteers, cognitively normal participants with a family history of Alzheimer's, people with MCI, and people diagnosed with Alzheimer's disease or a related dementia.

To find study sites near you, contact NIA's Alzheimer's and related Dementias Education and Referral (ADEAR) Center at 1-800-438-4380 or email the ADEAR Center. Or, visit NIA's clinical trials finder to search for trials and studies.

For More Information About Alzheimer's Prevention

Alzheimer's Association
1-800-272-3900 (toll-free)
1-866-403-3073 (TTY/toll-free)
info@alz.org
www.alz.org

Basics of Alzheimer’s Disease and Dementia Cognitive Health

Preventing Alzheimer’s Disease: What Do We Know?

Evaluating the Latest Prevention Research

A recent review of research looked carefully at the evidence on ways to prevent or delay Alzheimer's dementia or age-related cognitive decline. Led by a committee of experts from the National Academies of Sciences, Engineering, and Medicine (NASEM), the review found "encouraging but inconclusive" evidence for three types of interventions:

Increased physical activity
Blood pressure control for people with high blood pressure (also called hypertension)
Cognitive training

The evidence for other interventions, such as medications and diet, was not as strong. However, scientists are continuing to explore these and other possible preventions.

Alzheimer’s Caregiving

Healthy Eating and Alzheimer's Disease

Eating healthy foods helps everyone stay well. It’s even more important for people with Alzheimer’s disease. Here are some tips for healthy eating.

bag of healthy groceries

Buying and Preparing Food

When the person with Alzheimer’s disease lives with you:

Buy healthy foods such as vegetables, fruits, and whole-grain products. Be sure to buy foods that the person likes and can eat.
Give the person choices about what to eat—for example, “Would you like green beans or salad?”
Buy food that is easy to prepare, such as premade salads and single food portions.

It may be helpful to have someone else make meals or use a service such as Meals on Wheels America, which brings meals right to your home. For more information, contact Meals on Wheels America at 1-888-998-6325 or www.mealsonwheelsamerica.org.

When a person with early-stage Alzheimer’s disease lives alone, you can buy foods that the person doesn’t need to cook. Call to remind him or her to eat.

Maintain Familiar Routines

Change can be difficult for a person with Alzheimer’s disease. Maintaining familiar routines and serving favorite foods can make mealtimes easier. They can help the person know what to expect and feel more relaxed. If a home health aide or other professional provides care, family members should tell this caregiver about the person’s preferences.

Try these tips:

View mealtimes as opportunities for social interaction. A warm and happy tone of voice can set the mood.
Be patient and give the person enough time to finish the meal.
Respect personal, cultural, and religious food preferences, such as eating tortillas instead of bread or avoiding pork.
If the person has always eaten meals at specific times, continue to serve meals at those times.
Serve meals in a consistent, familiar place and way whenever possible.
Avoid new routines, such as serving breakfast to a person who has never routinely eaten breakfast.

As Alzheimer’s progresses, familiar routines and food choices may need to be adapted to meet the person’s changing needs. For example, a family custom of serving appetizers before dinner can be preserved, but higher-calorie items might be offered to help maintain the person’s weight.

Stay Safe

In the early stage of Alzheimer’s, people’s eating habits usually do not change. When changes do occur, living alone may not be safe anymore. Look for these signs to see if living alone is no longer safe for the person with Alzheimer’s:

The person forgets to eat.
Food has burned because it was left on the stove.
The oven isn’t turned off.

Other difficulties, such as not sitting down long enough for meals and refusing to eat, can arise in the middle and late stages of the disease. These changes can lead to poor nourishment, dehydration, abnormally low blood pressure, and other problems.

Caregivers should monitor the person’s weight and eating habits to make sure he or she is not eating too little or too much. Other things to look for include appetite changes, the person’s level of physical activity, and problems with chewing or swallowing. Talk with the person’s doctor about changes in eating habits.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Healthy Eating for a Person with Alzheimer's

Choose My Plate
www.choosemyplate.gov

Family Caregiver Alliance
1-800-445-8106 (toll-free)
info@caregiver.org
www.caregiver.org

Meals on Wheels America
1-888-998-6325 (toll-free)
info@mealsonwheelsamerica.org
www.mealsonwheelsamerica.org

Content reviewed: May 18, 2017

Featured Research

Alzheimer’s protein higher in women, may mean higher risk of symptoms

February 28, 2019

Alzheimer's Disease Neuroscience

Older women with normal cognition had higher measures of tau, an Alzheimer’s-related protein, than men, a new study finds, indicating that women have a possible higher risk of developing symptoms of the serious brain disease. The NIA-supported study was published online Feb. 4, 2019, in JAMA Neurology.

group of women talking

Previous studies have shown that women are at greater risk for developing Alzheimer’s, and that a greater share of women than men have the disease. However, the reasons for this difference are not well understood. The new study, led by researchers at Massachusetts General Hospital, Boston, found that levels of one defining protein seen in Alzheimer’s disease—tau in the entorhinal cortex, an area of the brain involved in memory—were higher in women than in men. The findings add to growing evidence of sex differences in the biological underpinnings of Alzheimer’s.

The researchers examined positron emission tomography (PET) brain scans from two studies, the Harvard Aging Brain Study and the Alzheimer’s Disease Neuroimaging Initiative, with a total of 296 older adults, including 173 women (average age, 74). All subjects demonstrated normal cognitive function when they first received a brain scan to measure tau. They also had PET scans to measure beta-amyloid, another Alzheimer’s-related protein.

Experts believe that people with more beta-amyloid also have more tau, and that these proteins interact early in Alzheimer’s disease progression—years before memory loss and other symptoms appear. The study suggests that this interaction may be stronger in women than in men. Compared to the men’s scans, the women’s scans showed significantly higher tau deposits in the entorhinal cortex in individuals with high beta-amyloid levels. There were neither strong male-female differences in beta-amyloid levels alone nor evidence that APOE ?4, a genetic risk factor for Alzheimer’s, interacts with sex to influence tau.

More work is needed to gain a better understanding of sex differences in the biological processes of Alzheimer’s. Small studies such as this one are limited by recruitment procedures and survivor bias (the effects of women generally outliving men). But having similar results across two studies is intriguing and a promising direction for future research.

This research was funded in part by NIA grants PO1AG036694, RO1AG053509, P50AG005134, K23AG049087, and K24AG035007.

Reference: Buckley RF, et al. Sex differences in the association of global amyloid and regional tau deposition measured by positron emission tomography in clinical normal older adults. JAMA Neurology. doi: Published online Feb. 4, 2019.

Featured Research

Breakdowns in mitochondrial housekeeping provide another clue to Alzheimer’s culprit

March 13, 2019

Alzheimer's DiseaseNeuroscience

Researchers have zeroed in on the role of defects in mitophagy—a process in which cells clean out damaged or defective mitochondria—as a potential new treatment target for Alzheimer’s disease in experiments with animal models and lab specimens of human neurons. An international team of scientists led by NIA Intramural Research Program investigators in the Laboratory of Molecular Gerontology published their results in the March issue of Nature Neuroscience.

The brain is a high-octane machine, accounting for up to 25 percent of the body’s total energy consumption despite being only about two percent of body weight. Since mitochondria are the powerhouses of cells, a breakdown in mitophagy impairs neurons’ metabolism and makes them more vulnerable to cell dysfunction and death.

Puzzle piece illustration with mitochondria

The scientific team wanted to better understand whether the large accumulations of damaged mitochondria found in post-mortem brain samples from people who had Alzheimer’s disease might be further evidence for mitophagy malfunctions as a major factor in the disease. Confirming their hypothesis, the research team also found significant amounts of damaged mitochondria in neuron samples from Alzheimer’s models in mice and in the worm C. elegans, indicating a dramatic reduction in mitophagy.

Next, the team worked to identify drug compounds that would stimulate and reinvigorate the mitophagy process, hoping to see improvements in dementia symptoms and pathology. They found three promising candidates: nicotinamide mononucleotide (NMN), a precursor of nicotinamide adenine dinucleotide NAD+, which is crucial for cellular energy metabolism; Urolithin A, a compound found in pomegranate that induces muscular mitophagy; and Actinonin, a naturally occurring antibacterial agent.

Alzheimer’s mice treated with these compounds performed much better in memory tests and showed reduced neuroinflammation and lower accumulation of amyloid-beta and phosphorylated tau in their brains. The compounds also improved the quality of neurons generated from induced pluripotent stem cells (iPSC) grown from skin cell samples of people with Alzheimer’s disease.

These results point to mitophagy’s importance in the development and progression of Alzheimer’s disease and help open doors for potential drug development into mitophagy regulators as an intervention for Alzheimer’s.

Additionally, investigators believe their unique cross-species drug development platform—encompassing C. elegans, mice, and Alzheimer's disease patient iPSC-derived neurons—can increase the likelihood of finding robust drug candidates for Alzheimer’s disease clinical trials.

References:

Fang EF, et al. Mitophagy inhibits Aβ and p-Tau pathologies and cognitive deficits in experimental models of Alzheimer’s disease. Nature Neuroscience. 2019;22(3):401-412.

Kingwell K. Turning up mitophagy in Alzheimer disease. Nature Reviews Drug Discovery. Published online March 4, 2019.

Featured Research

Breakdowns in mitochondrial housekeeping provide another clue to Alzheimer’s culprit

March 13, 2019

Alzheimer's DiseaseNeuroscience

Puzzle piece illustration with mitochondria

References:

Fang EF, et al. Mitophagy inhibits Aβ and p-Tau pathologies and cognitive deficits in experimental models of Alzheimer’s disease. Nature Neuroscience. 2019;22(3):401-412.

Kingwell K. Turning up mitophagy in Alzheimer disease. Nature Reviews Drug Discovery. Published online March 4, 2019.

Featured Research

Sleep loss encourages spread of toxic Alzheimer’s protein

February 12, 2019

Alzheimer's DiseaseClinical ResearchNeuroscience

From the NIH Director’s Blog by Dr. Francis Collins

In addition to memory loss and confusion, many people with Alzheimer’s disease have trouble sleeping. Now an NIH-funded team of researchers has evidence that the reverse is also true: a chronic lack of sleep may worsen the disease and its associated memory loss.

man sleeping — *Credit: iStock/bowdenimages*

The new findings center on a protein called tau, which accumulates in abnormal tangles in the brains of people with Alzheimer’s disease. In the healthy brain, active neurons naturally release some tau during waking hours, but it normally gets cleared away during sleep. Essentially, your brain has a system for taking the garbage out while you’re off in dreamland.

The latest findings in studies of mice and people further suggest that sleep deprivation upsets this balance, allowing more tau to be released, accumulate, and spread in toxic tangles within brain areas important for memory. While more study is needed, the findings suggest that regular and substantial sleep may play an unexpectedly important role in helping to delay or slow down Alzheimer’s disease.

It’s long been recognized that Alzheimer’s disease is associated with the gradual accumulation of beta-amyloid peptides and tau proteins, which form plaques and tangles that are considered hallmarks of the disease. It has only more recently become clear that, while beta-amyloid is an early sign of the disease, tau deposits track more closely with disease progression and a person’s cognitive decline.

Such findings have raised hopes among researchers including David Holtzman, Washington University School of Medicine, St. Louis, that tau-targeting treatments might slow this devastating disease. Though much of the hope has focused on developing the right drugs, some has also focused on sleep and its nightly ability to reset the brain’s metabolic harmony.

In the new study published in Science, Holtzman’s team set out to explore whether tau levels in the brain naturally are tied to the sleep-wake cycle¹. Earlier studies had shown that tau is released in small amounts by active neurons. But when neurons are chronically activated, more tau gets released. So, do tau levels rise when we’re awake and fall during slumber?

The Holtzman team found that they do. The researchers measured tau levels in brain fluid collected from mice during their normal waking and sleeping hours. (Since mice are nocturnal, they sleep primarily during the day.) The researchers found that tau levels in brain fluid nearly double when the animals are awake. They also found that sleep deprivation caused tau levels in brain fluid to double yet again.

These findings were especially interesting because Holtzman’s team had already made a related finding in people. The team found that healthy adults forced to pull an all-nighter had a 30 percent increase on average in levels of unhealthy beta-amyloid in their cerebrospinal fluid (CSF).

The researchers went back and reanalyzed those same human samples for tau. Sure enough, the tau levels were elevated on average by about 50 percent.

Once tau begins to accumulate in brain tissue, the protein can spread from one brain area to the next along neural connections. So, Holtzman’s team wondered whether a lack of sleep over longer periods also might encourage tau to spread.

To find out, mice engineered to produce human tau fibrils in their brains were made to stay up longer than usual and get less quality sleep over several weeks. Those studies showed that, while less sleep didn’t change the original deposition of tau in the brain, it did lead to a significant increase in tau’s spread. Intriguingly, tau tangles in the animals appeared in the same brain areas affected in people with Alzheimer’s disease.

Another report by Holtzman’s team appearing early last month in Science Translational Medicine found yet another link between tau and poor sleep. That study showed that older people who had more tau tangles in their brains by PET scanning had less slow-wave, deep sleep².

Together, these new findings suggest that Alzheimer’s disease and sleep loss are even more intimately intertwined than had been realized. The findings suggest that good sleep habits and/or treatments designed to encourage plenty of high-quality Zzzz’s might play an important role in slowing Alzheimer’s disease. On the other hand, poor sleep also might worsen the condition and serve as an early warning sign of Alzheimer’s.

For now, the findings come as an important reminder that all of us should do our best to get a good night’s rest on a regular basis. Sleep deprivation really isn’t a good way to deal with overly busy lives (I’m talking to myself here). It isn’t yet clear if better sleep habits will prevent or delay Alzheimer’s disease, but it surely can’t hurt.

References:

¹Holth JK, Fritschi SK, Wang C, et al. The sleep-wake cycle regulates brain interstitial fluid tau in mice and CSF tau in humans. Science. 2019 Jan 24. [Epub ahead of print]

²Lucey BP, McCullough A, Landsness EC, et al. Reduced non-rapid eye movement sleep is associated with tau pathology in early Alzheimer’s disease. Science Translational Medicine. 2019 Jan 9;11(474).

NIH Support: National Institute on Aging; National Institute of Neurological Disorders and Stroke; National Center for Advancing Translational Sciences; National Cancer Institute; National Institute of Biomedical Imaging and Bioengineering

Featured Research

Daytime sleepiness linked to elevated brain amyloid

October 11, 2018

Alzheimer's DiseaseCognitive HealthDementiasNeuroscience

Everyone loves a good nap now and then, but feeling excessively sleepy during the day could be a sign of increased risk for the brain pathology of Alzheimer’s disease, a new NIA-supported study found.

Older adults who felt sleepy during the daytime when they wanted to be awake were almost three times more likely to have deposits of beta-amyloid, the protein that clumps in the brain as part of Alzheimer’s pathology, according to the study published in the Sept. 25, 2018 issue of the journal Sleep. The research team was led by Dr. Adam Spira of Johns Hopkins University and included Dr. Murat Bilgel, Dr. Luigi Ferrucci, Dr. Susan Resnick and Dr. Eleanor Simonsick of NIA’s Intramural Research Program.

Tired man at computer

The team used Baltimore Longitudinal Study of Aging Neuroimaging Substudy data to take a closer look at the reported daytime sleepiness levels and napping habits of 124 cognitively healthy men and women participants. They then matched that information with PET and MRI scan results from an average of 16 years later.

They found that people who said they often felt sleepy during the day were nearly three times more likely to have deposits of beta-amyloid, the protein that clumps in the brain as part of Alzheimer’s disease pathology, than their peers who didn’t report daytime sleepiness. Napping habits, the team found, were not significantly connected to beta-amyloid deposits.

While not a direct correlation, the researchers see the results as further evidence that sleep problems and Alzheimer’s pathology may be connected. The exact mechanism that connects disturbed sleep with beta-amyloid buildup is unclear, but multiple studies have shown that people with dementia often experience sleep disturbances, and other studies have shown buildups of beta-amyloid in the brains of animals whose sleep was disturbed.

The authors noted that while healthy diet and mental and physical exercise habits have been identified as smart strategies that may help reduce dementia risk, getting the right quantity and quality of sleep hasn’t been emphasized as much. The study showed that a simple yes or no question on if people felt drowsy or fell asleep in the daytime when they wanted to be awake was effective to screen those at risk for having beta-amyloid deposits in their brains. While not everyone who has Alzheimer’s disease pathology goes on to develop cognitive problems, adding this question to routine clinical screenings could help identify people who should consider follow-up testing for Alzheimer’s and related dementias risk.

Future steps for this research include examining if sleep apnea and similar disorders, medications or other health conditions that often affect sleep quality in older adults may be a factor in beta-amyloid accumulation.

This study was supported in part by NIA grants AG050507, AG050745, AG049872, AG050507-02S1 and NIA IRP funding.

Reference: Spira AP et al. Excessive daytime sleepiness and napping in cognitively normal adults: Associations with subsequent amyloid deposition measured by PiB PET. Sleep. 2018 Sep 25. doi: 10.1093/sleep/zsy152. [Epub ahead of print]

Featured Research

Some Alzheimer's biomarkers differ by race, NIA-funded study finds

February 01, 2019

Alzheimer's DiseaseBiomarkersClinical Research

Nurse and female patient looking at a chart

A new study funded by NIA points to differences in some biological markers underlying Alzheimer’s disease in African Americans and non-Hispanic whites. The results, published online Jan. 7 in JAMA Neurology, add to growing evidence of different biological mechanisms when considering race and Alzheimer’s. An accompanying editorial emphasizes that gathering biological data from African Americans is essential to furthering research in Alzheimer’s health disparities.

It’s been difficult to explain why Alzheimer’s disproportionately affects African Americans, in part because they are under-represented in studies of dementia. The new study from researchers at Washington University School of Medicine, St. Louis, looked at biomarkers, using the largest set of fluid biomarker data from African Americans to date, collected for more than a decade.

The researchers analyzed biomarker data for 1,255 participants (average age, 70), including 173 African Americans, who had enrolled in studies at the Washington University’s Knight Alzheimer’s Disease Research Center. In each racial group, 67 percent of participants had normal cognition, and the rest were mildly impaired. All had undergone at least one Alzheimer’s biomarker test, including brain scans to measure brain shrinkage and harmful forms of the amyloid protein, as well as lumbar punctures to collect cerebrospinal fluid (CSF), which reveals levels of amyloid and another protein, tau, indicating the disease processes.

Although there were no differences between African Americans and whites on some measures, including amyloid levels in the brain and CSF, other test results showed differences. Compared with whites, African Americans with a family history of dementia had a smaller hippocampus, a brain structure important for learning and memory.

Also, African Americans had significantly lower levels of tau in CSF than whites when both had the APOE ?4 gene form, a genetic risk factor for Alzheimer’s. Generally, lower tau—which forms damaging tangles inside neurons—means a person is less likely to be cognitively impaired, but African Americans were just as impaired as whites. It’s possible that CSF tau levels found to be abnormal in whites are not abnormal in African Americans because APOE ?4 exerts a weaker effect in African Americans, the authors suggested.

“The authors conclude that racial differences in AD biomarkers suggest possible race-dependent biological mechanisms that contribute to expression of disease,” wrote Lisa L. Barnes, Ph.D., of the Rush Alzheimer’s Disease Center, Chicago, in her editorial.

Future studies of Alzheimer’s biomarkers in African Americans should consider the influence of other diseases and social factors such as discrimination and education, the researchers wrote. Also, because there are relatively few lumbar puncture results from African Americans, it would be helpful to combine data from several centers and projects to generate a larger sample, Dr. Barnes suggested.

This research was funded in part by NIA grants P50AG05681, P01AG03991, and P01AG026276.

References:

Morris JC, et al. Assessment of racial disparities in biomarkers for Alzheimer’s disease. JAMA Neurology. doi:10.1001/jamaneurol.2018.4249. Published online Jan. 7, 2019.

Barnes LB. Biomarkers for Alzheimer dementia in diverse racial and ethnic minorities—a public health priority. JAMA Neurology. doi:10.1001/jamaneurol.2018.3444. Published online Jan. 7, 2019.

Blood-brain barrier test may predict dementia

February 07, 2019

Alzheimer's DiseaseBiomarkersClinical ResearchDementiasNeuroscience

From NIH Research Matters

Cognitive impairment is when a person has problems remembering, learning, concentrating, or making decisions that affect everyday life. Millions of people in the U.S. show some sort of cognitive impairment. People with cognitive impairment are at higher risk for developing dementia, which is the loss of cognitive functioning. Alzheimer's disease is the most common dementia diagnosis.

Nurse with patient in front of MRI — *Skynesher / E+ / Getty Images*

Researchers have been looking for ways to test for early signs of cognitive impairment and dementia. Early detection could open the door to strategies that prevent disease progression. Potential biomarkers include changes in the size and function of the brain and its parts, as well as levels of certain proteins seen on brain scans, in cerebrospinal fluid, and in blood. People with Alzheimer's disease, for example, have abnormally high levels of plaques made up of beta-amyloid and tangles made of tau proteins.

To look for earlier biomarkers of cognitive decline, a team led by Dr. Berislav V. Zlokovic at the University of Southern California, Los Angeles, examined two markers involved in the breakdown of the blood-brain barrier. This barrier controls the movement of cells and molecules between the blood and the fluid that surrounds the brain's nerve cells. Past studies have found that abnormalities in the small blood vessels (capillaries) of the brain often contribute to dementia.

The team enrolled more than 160 people with and without cognitive impairment. They measured levels of the soluble form of a protein called platelet-derived growth factor receptor beta (PDGFRβ). PDGFRβ is found in the capillaries that maintain the blood-brain barrier's integrity. Levels of the soluble form rise in cerebrospinal fluid when the blood-brain barrier is compromised. The team also tracked the integrity of the blood-brain barrier in 73 participants using an MRI-based technique they'd previously developed. The study was supported in part by NIH's National Institute on Aging (NIA) and National Institute of Neurological Disorders and Stroke (NINDS). Results were published online on January 14, 2018, in Nature Medicine.

The researchers found that, compared with those without cognitive impairment, those with cognitive impairment had higher levels of soluble PDGFRβ and a greater breakdown in the blood-brain barrier of certain brain regions. Notably, both these measures were independent of beta-amyloid and tau protein levels. The findings suggest these measurements could pave the way for an early diagnostic test for cognitive impairment from Alzheimer's disease as well as other causes.

"This is a solid step towards an accurate and reliable test that could be an earliest sign of critical brain damage in some people with Alzheimer's disease and related dementias" says Dr. Roderick Corriveau, a program director at NINDS.

"Because of our aging population and growing public health concerns, efforts to find a reliable and accurate predictor of cognitive impairment and dementia are very important to researchers and the public," explains Dr. Suzana Petanceska, a program director at NIA. "These early results are showing one possible, promising way to quantify risk."

The researchers are planning to further validate these results by conducting a second trial with more participants.

This paper was funded in part by NIA grants R01AG023084, R01AG039452, P01AG052350, P50AG005142, RO1AG054434, R01AG055770, R21AG055034, P50AG05681, P01AG03991, and P01AG026276.

Reference: Nation DA, Sweeney MD, Montagne A, et al. Blood-brain barrier breakdown is an early biomarker of human cognitive dysfunction. Nature Medicine. 2019 Jan 14. doi: 10.1038/s41591-018-0297-y. [Epub ahead of print]

Can Increasing Physical Activity Prevent Alzheimer's Disease?

older woman walking by lake with walking sticks

Until scientists know more, experts encourage exercise for its many other benefits. To learn more about exercise and physical activity for older adults, visit NIA's Go4Life campaign.

Can Controlling High Blood Pressure Prevent Alzheimer's Disease?

older man getting blood pressure checked by doctor

Can Cognitive Training Prevent Alzheimer's?

man in cap using computer with a group of people

Can Eating Certain Foods Prevent Alzheimer's Disease?

What Else Might Prevent Alzheimer's Disease?

Researchers are exploring these and other interventions that may help prevent, delay, or slow Alzheimer's dementia or age-related cognitive decline. Other research targets include:

New drugs to delay onset or slow disease progression
Diabetes treatment
Depression treatment
Blood pressure- and lipid-lowering treatments
Sleep interventions
Social engagement
Vitamins such as B12 plus folic acid supplements and D
Combined physical and mental exercises

What's the Bottom Line on Alzheimer's Prevention?

For More Information About Alzheimer's Prevention

Alzheimer's Association
1-800-272-3900 (toll-free)

Talking with Older Patients About Cognitive Problems

Primary care clinicians often have long-established relationships with their patients and are in an ideal position to observe potential signs of a cognitive problem. And, when patients are worried about changes in their memory or thinking, they often bring that concern to their primary care doctor first. It is important to take these concerns seriously and to assess the patient as early as possible to determine the potential cause of impairment.

Older woman taking an Alzheimer's questionnaire

Learn more: Assessing Cognitive Impairment in Older Patients

Cognitive Impairment

It is important not to ignore changes in an older person's memory or personality, or assume it's just a normal part of aging. Whether memory and cognition problems are reported by the patient or a family member or observed by you, the issues should be noted in the patient's chart and followed up with screening and assessment.

Not all cognitive problems are caused by Alzheimer's disease. There are a variety of other possible causes such as side effects from medications, metabolic and/or endocrine changes, delirium caused by other illnesses, or untreated depression. Some of these causes can be temporary and reversed with proper treatment. Other causes of cognitive problems, such as dementia, cannot be reversed, but symptoms can be treated for a period of time and families can be prepared for the future.

Some older people have mild cognitive impairment (MCI). People with MCI have more memory problems than normal for their age, but their symptoms do not interfere with their everyday lives. Older people with MCI are at greater risk for developing Alzheimer's, but not all of them do. Some may even go back to normal cognition.

Conveying Findings

Some patients may prefer a cautious, reserved explanation. You might consider saying something like, "You have a memory disorder, and I believe it will get worse as time goes on. It's not your fault. It may not help for you to try harder. Now is an opportunity for you to start making financial and legal plans. It is best to do this before your memory and thinking get worse." Some patients may prefer more precise language and appreciate it when a doctor uses specific words like Alzheimer's disease.

The American College of Physicians Foundation and Alzheimer's Association have produced an 11-minute video, Disclosing an Alzheimer's Diagnosis, that might be helpful. Written materials can also be helpful. NIA's Alzheimer's Disease Education and Referral Center has free tools and publications you can give to your patients, including a patient checklist, Now What? Next Steps After a Diagnosis of Alzheimer's Disease. Local resources can be found using the Eldercare Locator.

Following Up

If possible, schedule additional time for the appointment so that you can listen and respond to the patient's or caregiver's concerns. The Alzheimer's Association or other supportive organizations can provide information about planning, social services, and care.

Ask the patient if there is a family member or friend who can help with medical, legal, and financial concerns going forward. Make these arrangements early, and assure that the patient has given you formal authorization to include the care partner in the conversation about your patient's care. Keep that person's name and contact information in your notes for future reference.

Informing family members or others that the patient may have Alzheimer's disease or any cognitive impairment may be done in a telephone conference or group meeting, which should be arranged with the consent of the patient. Let everyone know that you will continue to be available for care, information, guidance, and support.

Consider how your practice can coordinate and integrate care for the person and family across the many specialists and services that will be involved.

Learn more: Managing Older Patients with Cognitive Impairment

Working with Family Caregivers

All family caregivers face challenges, but these challenges are compounded for people caring for patients with Alzheimer's disease and other dementias. How Can I Include Families and Caregivers of Older Patients? has suggestions that can help. Here are some approaches that are especially useful:

Explain that much can be done to improve the patient's quality of life. Measures such as modifications in daily routine and medications may help control symptoms. If appropriate, bring in a palliative care consultant to help the patient with symptom management.
Let caregivers know there is time to adapt. Decline is rarely rapid. Provide information about the consumer resources and services available from local organizations, as well as support groups.
Help caregivers plan for the possibility that they eventually may need more help at home or may have to look into residential care.
Encourage caregivers to get regular respite especially when patients require constant attention. Ask if the caregiver, who is at considerable risk for stress-related disorders, is receiving adequate health care.

For More Information About Patients with Cognitive Problems

Content reviewed: May 17, 2017

Treatment of Alzheimer’s Disease

How Is Alzheimer's Disease Treated?

Alzheimer’s disease is complex, and it is unlikely that any one drug or other intervention will successfully treat it. Current approaches focus on helping people maintain mental function, manage behavioral symptoms, and slow down the symptoms of disease.

Older woman and her doctor having a serious conversation

Several prescription drugs are currently approved by the U.S. Food and Drug Administration (FDA) to treat people who have been diagnosed with Alzheimer’s disease. Treating the symptoms of Alzheimer’s can provide people with comfort, dignity, and independence for a longer period of time and can encourage and assist their caregivers as well.

Most medicines work best for people in the early or middle stages of Alzheimer’s. For example, they can slow down some symptoms, such as memory loss, for a time. It is important to understand that none of these medications stops the disease itself.

Treatment for Mild to Moderate Alzheimer’s

Medications called cholinesterase inhibitors are prescribed for mild to moderate Alzheimer’s disease. These drugs may help reduce some symptoms and help control some behavioral symptoms. The medications are Razadyne® (galantamine), Exelon® (rivastigmine), and Aricept® (donepezil).

Scientists do not yet fully understand how cholinesterase inhibitors work to treat Alzheimer’s disease, but research indicates that they prevent the breakdown of acetylcholine, a brain chemical believed to be important for memory and thinking. As Alzheimer’s progresses, the brain produces less and less acetylcholine; therefore, cholinesterase inhibitors may eventually lose their effect.

No published study directly compares these drugs. Because they work in a similar way, switching from one of these drugs to another probably will not produce significantly different results. However, an Alzheimer’s patient may respond better to one drug than another.

Treatment for Moderate to Severe Alzheimer’s

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

The FDA has also approved Aricept®, the Exelon® patch, and Namzaric®, a combination of Namenda® and Aricept®, for the treatment of moderate to severe Alzheimer’s disease.

Namenda® 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.

Drug Name	Drug Type and Use	How It Works	Common Side Effects
Aricept® (donepezil)	Cholinesterase inhibitor prescribed to treat symptoms of mild, moderate, and severe Alzheimer's	Prevents the breakdown of acetylcholine in the brain	Nausea, vomiting, diarrhea, muscle cramps, fatigue, weight loss
Exelon® (rivastigmine)	Cholinesterase inhibitor prescribed to treat symptoms of mild to moderate Alzheimer's (patch is also for severe Alzheimer's)	Prevents the breakdown of acetylcholine and butyrylcholine (a brain chemical similar to acetylcholine) in the brain	Nausea, vomiting, diarrhea, weight loss, indigestion, muscle weakness
Namenda® (memantine)	N-methyl D-aspartate (NMDA) antagonist prescribed to treat symptoms of moderate to severe Alzheimer's	Blocks the toxic effects associated with excess glutamate and regulates glutamate activation	Dizziness, headache, diarrhea, constipation, confusion
Namzaric® (memantine and donepezil)	NMDA antagonist and cholinesterase inhibitor prescribed to treat symptoms of moderate to severe Alzheimer’s	Blocks the toxic effects associated with excess glutamate and prevents the breakdown of acetylcholine in the brain	Headache, nausea, vomiting, diarrhea, dizziness, anorexia
Razadyne® (galantamine)	Cholinesterase inhibitor prescribed to treat symptoms of mild to moderate Alzheimer's	Prevents the breakdown of acetylcholine and stimulates nicotinic receptors to release more acetylcholine in the brain	Nausea, vomiting, diarrhea, decreased appetite, dizziness, headache

Drug Name	Manufacturer's Recommended Dosage	For More Information
Aricept® (donepezil)	Tablet: Initial dose of 5 mg once a day; may increase dose to 10 mg/day after 4-6 weeks if well tolerated, then to 23 mg/day after at least 3 months Orally disintegrating tablet: Same dosage as above (not available in 23 mg)	For current information about this drug's safety and use, visit www.aricept.com.
Exelon® (rivastigmine)	Capsule: Initial dose of 3 mg/day (1.5 mg twice a day); may increase dose to 6 mg/day (3 mg twice a day), 9 mg/day (4.5 mg twice a day), and 12 mg/day (6 mg twice a day) at minimum 2-week intervals if well tolerated Patch: Initial dose of 4.6 mg once a day; may increase dose to 9.5 mg once a day and 13.3 mg once a day at minimum 4-week intervals if well tolerated	For current information about this drug’s safety and use, visit the www.fda.gov/Drugs. Click on "Search Drugs@FDA," search for Exelon, and click on drug-name links to see label information.
Namenda® (memantine)	Tablet: Initial dose of 5 mg once a day; may increase dose to 10 mg/day (5 mg twice a day), 15 mg/day (5 mg and 10 mg as separate doses), and 20 mg/day (10 mg twice a day) at minimum 1-week intervals if well tolerated Oral solution: Same dosage as above Extended-release capsule*: Initial dose of 7 mg once a day; may increase dose to 14 mg/day, 21 mg/day, and 28 mg/day at minimum 1-week intervals if well tolerated	For current information about this drug's safety and use, visit www.namenda.com and www.namendaxr.com. Click on "Full Prescribing Information" to see the drug label.
Namzaric® (memantine and donepezil)	Extended-release capsule*: Initial dose of 28 mg memantine/10 mg donepezil once a day if stabilized on memantine and donepezil If stabilized on donepezil only, initial dose of 7 mg memantine/10 mg donepezil once a day; may increase dose to 28 mg memantine/10 mg donepezil in 7 mg increments at minimum 1-week intervals if well tolerated Only 14 mg memantine/10 mg donepezil and 28 mg memantine/10 mg donepezil available as generic	For current information about this drug’s safety and use, visit www.namzaric.com. Click on “Full Prescribing Information” to see the drug label.
Razadyne® (galantamine)	Tablet: Initial dose of 8 mg/day (4 mg twice a day); may increase dose to 16 mg/day (8 mg twice a day) and 24 mg/day (12 mg twice a day) at minimum 4-week intervals if well tolerated Extended-release capsule: Same dosage as above but taken once a day	For current information about this drug’s safety and use, visit www.janssenmd.com/razadyne. Click on "Full Prescribing Information" to see the drug label.

* Available as a generic drug.

Dosage and Side Effects

Doctors usually start patients at low drug doses and gradually increase the dosage based on how well a patient tolerates the drug. There is some evidence that certain people may benefit from higher doses of the cholinesterase inhibitors. However, the higher the dose, the more likely side effects are to occur.

Patients should be monitored when a drug is started. All of these medicines have possible side effects, including nausea, vomiting, diarrhea, and loss of appetite. Report any unusual symptoms to the prescribing doctor right away. It is important to follow the doctor’s instructions when taking any medication, including vitamins and herbal supplements. Also, let the doctor know before adding or changing any medications.

Managing Behavior

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 nondrug—to manage them. Research has shown that treating behavioral symptoms can make people with Alzheimer’s more comfortable and makes things easier for caregivers.

Examples of medicines used to help with depression, aggression, restlessness, and anxiety include:

Celexa® (citalopram)
Remeron® (mirtazapine)
Zoloft® (sertraline)
Wellbutrin® (bupropion)
Cymbalta® (duloxetine)
Tofranil® (imipramine)

Experts agree that medicines to treat these behavior problems should be used only after other strategies that don’t use medicine have been tried.

Medicines to Be Used with Caution

There are some medicines, such as sleep aids, anti-anxiety drugs, anticonvulsants, and antipsychotics, that a person with Alzheimer’s disease should take only:

After the doctor has explained all the risks and side effects of the medicine
After other, safer non-medication options have not helped treat the problem

You will need to watch closely for side effects from these medications.

Sleep aids are used to help people get to sleep and stay asleep. People with Alzheimer’s disease should NOT use these drugs regularly because they make the person more confused and more likely to fall. Examples of these medicines include:

Ambien® (zolpidem)
Lunesta® (eszopiclone)
Sonata® (zaleplon)

Anti-anxiety drugs are used to treat agitation. These drugs can cause sleepiness, dizziness, falls, and confusion. For this reason, doctors recommend using them only for short periods of time. Examples of these medicines include:

Ativan® (lorazepam)
Klonopin® (clonazepam)

Anticonvulsants are drugs sometimes used to treat severe aggression. Side effects may cause sleepiness, dizziness, mood swings, and confusion. Examples of these medicines include:

Depakote® (sodium valproate)
Tegretol® (carbamazepine)
Trileptal® (oxcarbazepine)

Antipsychotics are drugs used to treat paranoia, hallucinations, agitation, and aggression. Side effects of using these drugs can be serious, including increased risk of death in some older people with dementia. They should only be given to people with Alzheimer’s disease when the doctor agrees that the symptoms are severe. Examples of these medicines include:

Risperdal® (risperidone)
Seroquel® (quetiapine)
Zyprexa® (olanzapine)

Looking for New Treatments

Alzheimer’s disease research has developed to a point where scientists can look beyond treating symptoms to think about addressing underlying disease processes. In ongoing clinical trials, scientists are developing and testing several possible interventions, including immunization therapy, drug therapies, cognitive training, physical activity, and treatments for cardiovascular disease and diabetes.

Learn more about Alzheimer's disease from MedlinePlus.

Read about this topic in Spanish. Lea sobre esta tema en español.

For More Information About Treating Alzheimer's

Eldercare Locator
1-800-677-1116 (toll-free)

Treatment

Treatment of Alzheimer’s Disease

Early-Onset Alzheimer's Disease: A Resource List

Early-onset Alzheimer's disease occurs between a person's 30s to mid-60s. It is rare, representing less than 10 percent of all people who have Alzheimer's. People with this disorder are younger than those with late-onset Alzheimer’s and face different issues, such as dealing with disability at work, raising children, and finding the right support groups.

Older mon looking sad

This resource list offers a selection of materials that may help people with early-onset Alzheimer’s disease, their families, and caregivers. All of the resources on this list are free and accessible online.

Visit the National Institute on Aging’s (NIA’s) Alzheimer’s and related Dementias Education and Referral Center for free publications, caregiving resources, and more information about Alzheimer’s.

The items on this list are organized by these categories:

General Resources
Living with Early-Onset Alzheimer’s
Legal and Financial Planning
Caregiving
Clinical Studies and Trials

General Resources

Alzheimer’s Disease Genetics Fact Sheet (2011)

This fact sheet explains basic genetics and the genetic mutations and risk factors involved in early- and late-onset Alzheimer’s disease. It describes NIA-supported genetics research and includes a glossary and list of resources.

Published by the NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center. Phone: 1-800-438-4380. Email: adear@nia.nih.gov.

Early-Onset Alzheimer’s Disease

This short overview explains the differences between early- and late-onset Alzheimer’s, common symptoms, and how the disease is diagnosed. It provides tips for managing early-onset Alzheimer’s through drug and nondrug approaches.

Published by Johns Hopkins Medicine.

Early-Onset Alzheimer's: When Symptoms Begin Before Age 65 (2014)

In this online fact sheet, a neuropsychologist answers questions about early-onset Alzheimer’s disease. Topics covered include how and why the disease often runs in families, the advisability of genetic testing, coping at work, and changes in family relationships.

Published by the Mayo Foundation for Medical Education and Research.

Early Onset Familial AD

This special section of the science website Alzforum features several articles about familial Alzheimer’s disease, an inherited form of early-onset Alzheimer’s. Written for affected individuals, family members, doctors, and care providers, the articles offer reliable, up-to-date information about diagnosis, treatment, genetic counseling and testing, and life issues related to the disorder.

Published by Alzforum.

Early-Onset Familial Alzheimer Disease (2012)

A comprehensive article summarizes the genetics of early-onset familial Alzheimer’s disease, with details about the PSEN1, APP, and PSEN2 genetic mutations. Age of onset for each mutation, prevalence, disease management, and genetic testing issues are discussed.

Available from the National Center for Biotechnology Information, National Library of Medicine.

What You Should Know About Early-Onset Alzheimer’s (2015)

Although early-onset Alzheimer’s has a different age of onset and genetic profile than the late-onset form of the disease, the symptoms and treatment are much the same, this article explains. Dr. Mary Sano, director of Alzheimer’s disease research at Mount Sinai School of Medicine, New York, discusses the difference between normal middle-aged forgetfulness and a serious memory problem.

Published by Health.com.

Younger/Early Onset Alzheimer's & Dementia

This web page briefly explains the disorder, providing information about diagnosis, causes, and sources of help.

Published by the Alzheimer’s Association. Phone: 1-800-272-3900. Email: info@alz.org.

Younger-Onset Dementia: An Overview (2013, 2 p.)

Different types of dementia can affect people under age 65, so it’s important to get a careful diagnostic evaluation, states this online fact sheet. Challenging personal issues, such as loss of income and changes in family relationships, can be expected.

Published by Alzheimer’s Australia.

Living with Early-Onset Alzheimer’s

If You Have Younger-Onset Alzheimer’s Disease

This online article offers advice about living with early-onset Alzheimer’s. It discusses how the disease may impact families and employment, the need to plan ahead, and different types of insurance and benefits that can help people with the disease.

Published by the Alzheimer’s Association. Phone: 1-800-272-3900. Email: info@alz.org.

Young Onset Dementia

This online tip sheet suggests ways to live well with early-onset Alzheimer’s. Accepting the disease and making changes at home and at work are key. Tips are given for financial planning, health and safety, and relationships.

Published by Alzheimer’s Society Canada. Phone: 1-800-616-8816. Email: info@alzheimer.ca.

HealthCare.gov

People with early-onset Alzheimer’s who don’t have access to employer-sponsored health insurance may be able to buy insurance through a federal or state exchange. This federal government website explains the Affordable Care Act, including provisions on pre-existing conditions, and allows consumers to shop for and compare health insurance plans.

Available from the U.S. Department of Health and Human Services. Phone: 1-800-318-2596.

Legal and Financial Planning

Legal and Financial Planning for People with Alzheimer's

Ideally, advance planning should take place soon after a diagnosis of early-stage Alzheimer’s disease, while the person can think clearly and make decisions. This web page explains the basics of legal and financial planning and links to helpful NIA publications.

Published by the NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center. Phone: 1-800-438-4380. Email: adear@nia.nih.gov.

Social Security Compassionate Allowances Program

This program allows people with designated serious diseases and disorders, including early-onset Alzheimer’s, to have their applications for Social Security disability benefits reviewed quickly. See the Compassionate Allowances information on early-onset Alzheimer’s disease.

Published by the Social Security Administration. Phone: 1-800-772-1213. Email: compassionate.allowances@ssa.gov.

Caregiving

Alzheimer's Caregiving Information from the National Institute on Aging

Get Alzheimer’s care information and advice from NIA, including information on daily care, sundowning and other behaviors, and more.

Published by the NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center. Phone: 1-800-438-4380. Email: adear@nia.nih.gov.

Early Onset Dementia: Advice for Caregivers

Partners of people with early-onset dementia must often take on added responsibilities in addition to caring for the person with dementia. This fact sheet offers advice on changes to expect and ways to reduce stress.

Published by the National Initiative for the Care of the Elderly (Canada).

Clinical Studies and Trials

Participating in Alzheimer’s Disease Research

Learn what’s involved in volunteering for Alzheimer’s research. Read about benefits and risks, questions to ask, participant safety, and placebos.

Published by the NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center. Phone: 1-800-438-4380. Email: adear@nia.nih.gov.

Dominantly Inherited Alzheimer Network (DIAN)

Adult children with a biological parent who has a known genetic mutation for Alzheimer’s are invited to sign up for the DIAN registry. The purpose of this study is to identify potential biomarkers that may predict the development of Alzheimer's in people who carry an Alzheimer's mutation.

To search for more clinical studies and trials, visit NIA's clinical trials finder.

Content reviewed: June 27, 2017

HEALTHY AGING

Healthy Aging

What Do We Know About Healthy Aging?

What factors influence healthy aging? Research has identified action steps we can take to maintain our health and function as we get older. From improving our diet and levels of physical activity to getting health screenings and managing risk factors for disease, these actions may influence different areas of health.

On this page:

Get Moving: Exercise and Physical Activity

Sneakers Some people love it, some people hate it, but regardless of your personal feelings, exercise and physical activity are good for you—period. In fact, exercise and physical activity are considered a cornerstone of almost every healthy aging program. Scientific evidence suggests that people who exercise regularly not only live longer, they live better. And, being physically active—doing everyday activities that keep your body moving, such as gardening, walking the dog, and taking the stairs instead of the elevator—can help you continue to do the things you enjoy and stay independent as you age.

Specifically, regular exercise and physical activity can reduce your risk of developing some diseases and disabilities that often occur with aging. For instance, balance exercises help prevent falls, a major cause of disability in older adults. Strength exercises build muscles and reduce the risk of osteoporosis. Flexibility or stretching exercises help keep your body limber and give you the freedom of movement you need to do everyday activities.

Exercise may even be an effective treatment for certain chronic conditions. People with arthritis, high blood pressure, or diabetes can benefit from regular exercise. Heart disease, a problem for many older adults, may also be alleviated by exercise. Scientists have long known that regular exercise causes certain changes in the hearts of younger people. These changes, which include lowering resting heart rate and increasing stroke volume (the amount of blood pumped with each heartbeat), make the heart a better pump.

Evidence now suggests that people who begin exercise training in later life, for instance in their 60s and 70s, can also experience improved heart function. In one study, researchers with the Baltimore Longitudinal Study of Aging (BLSA) observed a decreased risk of a coronary event, like a heart attack, in older male BLSA participants who took part in high-intensity, leisure-time physical activities like lap swimming or running.

In addition to benefits for the heart, studies show that exercise helps breathlessness and fatigue in older people. Endurance exercises—activities that increase your breathing and heart rate, such as dancing, walking, swimming, or bicycling—increase your stamina and improve the health of your lungs and circulatory system as well as your heart.

There are many ways to be active. You can be active in short spurts throughout the day, or you can set aside specific times of the day or specific days of the week to exercise. Many physical activities, such as brisk walking or raking leaves, are free or low-cost and do not require special equipment.

For more information about how to get started and stick with an exercise and physical activity program, visit Go4Life, NIA’s exercise and physical activity campaign for adults 50+.

Pay Attention to Weight and Shape

Three rocks of increasing size balanced one on top of the other Weight is a very complex issue. For older people, the health problems associated with obesity may take a back seat to problems associated with body composition (fat-to-muscle ratio) and location of fat (hip or waist) on the body.

Many health problems are connected to being overweight or obese. People who are overweight or obese are at greater risk for type 2 diabetes, high blood pressure, heart disease, stroke, some types of cancer, sleep apnea, and osteoarthritis. But data show that for older adults, thinner is not always healthier, either. In one study, researchers found that older adults who are thin (a body-mass index or BMI of less than 19) have a higher mortality rate compared with those who are obese or of normal weight. In another study, women with low BMI had an increased risk of mortality. Being, or becoming, thin as an older adult can be a symptom of disease or an indication of developing frailty. Those are possible reasons why some scientists think maintaining a higher BMI may not necessarily be bad as we age.

Red apple and green pear Body-fat distribution, specifically waist circumference and waist-to-hip ratio, can also be a serious problem for older adults. We know that the "pear" shape, with body fat in peripheral areas such as the hips and thighs, is generally healthier than the "apple" shape, with fat around the waist. Being apple-shaped can increase risk for heart disease and possibly breast cancer. With age, the pattern for body fat can shift from safer peripheral areas to the abdominal area of the body. BLSA researchers examined 547 men and women over a 5-year period to observe body measurement changes. They found that men predominantly shifted in waist size, while women showed nearly equal changes in waist and hip measurements. The men developed a more dangerous body-fat distribution, even though women carried more total body fat. This may help explain why men generally have a higher incidence of certain diseases and a shorter lifespan.

So, is there a "normal" weight range or pattern for healthy aging? For older adults, one size does not fit all. Although we have learned a lot about patterns of weight and aging, watching your weight as you age is very much an individual matter. Talk with your doctor about any weight concerns, including decisions to lose weight or any unexplained weight changes.

Learn more about maintaining a healthy weight.

Healthy Food for Thought: Think About What You Eat

Vegetables on a cutting board Food has been shown to be an important part of how people age. In one study, scientists investigated how dietary patterns influenced changes in BMI and waist circumference, which are risk factors for many diseases. Scientists grouped participants into clusters based on which foods contributed to the greatest proportion of calories they consumed. Participants who had a "meat and potatoes" eating pattern had a greater annual increase in BMI, and participants in the "white-bread" pattern had a greater increase in waist circumference compared with those in the "healthy" cluster. "Healthy" eaters had the highest intake of foods like high-fiber cereal, low-fat dairy, fruit, nonwhite bread, whole grains, beans and legumes, and vegetables, and low intake of red and processed meat, fast food, and soda. This same group had the smallest gains in BMI and waist circumference.

Scientists think there are likely many factors that contribute to the relationship between diet and changes in BMI and waist circumference. One factor may involve the glycemic index value (sometimes called glycemic load) of food. Foods with a low glycemic index value (such as most vegetables and fruits and high-fiber, grainy breads) decrease hunger but have little effect on blood sugar and therefore are healthier. Foods like white bread have a high glycemic index value and tend to cause the highest rise in blood sugar.

Another focus of research is the relationship between physical problems and micronutrient or vitamin deficiency. Low concentrations of micronutrients or vitamins in the blood are often caused by poor nutrition. Not eating enough fruits and vegetables can lead to a low carotenoid concentration, which is associated with a heightened risk of skeletal muscle decline among older adults. Low concentrations of vitamin E in older adults, especially in older women, is correlated with a decline in physical function. Compared with other older adults, those with low vitamin D levels had poorer results on two physical performance tests. Women with a low vitamin D concentration were more likely to experience back pain. These studies support the takeaway message: the nutrients you get from eating well can help keep muscles, bones, organs, and other parts of the body strong throughout life.

So, eating well is not just about your weight. It can also help protect you from certain health problems that occur more frequently among older adults. And, eating unhealthy foods can increase your risk for some diseases. If you are concerned about what you eat, talk with your doctor about ways you can make better food choices.

Learn more about healthy eating and smart food choices for healthy aging.

Participate in Activities You Enjoy

Granddaughter and grandfather gardening

Sure, engaging in your favorite activities can be fun or relaxing, but did you know that doing what you like to do may actually be good for your health? It's true. Research studies show that people who are sociable, generous, and goal-oriented report higher levels of happiness and lower levels of depression than other people.

People who are involved in hobbies and social and leisure activities may be at lower risk for some health problems. For example, one study followed participants for up to 21 years and linked leisure activities like reading, playing board games, playing musical instruments, and dancing with a lower risk for dementia. In another study, older adults who participated in social activities (for example, played games, belonged to social groups, attended local events, or traveled) or productive activities (for example, had paid or unpaid jobs, cooked, or gardened) lived longer than people who did not report taking part in these types of activities.

Other studies have found that older adults who participate in what they see as meaningful activities, like volunteering in their community, reported feeling healthier and happier.

Learn more about participating in activities you enjoy.

The National Institute on Aging’s Baltimore Longitudinal Study on Aging (BLSA) is the longest-running longitudinal study of aging in the world. BLSA researchers, participants, and study partners have contributed immeasurably to our understanding of healthy aging. Learn more about the lessons from the BLSA.

For more information on healthy aging, search our A-Z Health Topics.

Content reviewed: June 25, 2018

Balance Problems and Disorders

Have you ever felt dizzy, lightheaded, or as if the room were spinning around you? These can be troublesome sensations. If the feeling happens often, it could be a sign of a balance problem.

Balance problems are among the most common reasons that older adults seek help from a doctor. They are often caused by disturbances of the inner ear. Vertigo, the feeling that you or the things around you are spinning, is a common symptom.

Having good balance means being able to control and maintain your body's position, whether you are moving or remaining still. Good balance helps you walk without staggering, get up from a chair without falling, climb stairs without tripping, and bend over without falling. Good balance is important to help you get around, stay independent, and carry out daily activities.

Balance disorders are one reason older people fall. Learn more about falls and falls prevention from NIA. Visit the website of the National Institute on Deafness and Other Communication Disorders for information on specific balance disorders.

Causes of Balance Problems

People are more likely to have problems with balance as they get older. But age is not the only reason these problems occur. In some cases, you can help reduce your risk for certain balance problems.

Some balance disorders are caused by problems in the inner ear. The part of the inner ear that is responsible for balance is the vestibular system, also known as the labyrinth. A condition called labyrinthitis occurs when the labyrinth becomes infected or swollen. It is typically accompanied by vertigo and imbalance. Upper respiratory infections, other viral infections, and, less commonly, bacterial infections can also lead to labyrinthitis.

Some diseases of the circulatory system, such as stroke, can cause dizziness and other balance problems. Low blood pressure can also cause dizziness. Head injury and many medicines may also lead to balance problems.

Check with your doctor if you notice a problem while taking a medication. Ask if other medications can be used instead. If not, ask if the dosage can be safely reduced. Sometimes it cannot. However, your doctor will help you get the medication you need while trying to reduce unwanted side effects.

Symptoms of Balance Disorders

If you have a balance disorder, you may stagger when you try to walk, or teeter or fall when you try to stand up. You might experience other symptoms such as:

Older woman using a walker on a sidewalk

Dizziness or vertigo (a spinning sensation)
Falling or feeling as if you are going to fall
Lightheadedness, faintness, or a floating sensation
Blurred vision
Confusion or disorientation

Other symptoms might include nausea and vomiting; diarrhea; changes in heart rate and blood pressure; and fear, anxiety, or panic. Symptoms may come and go over short time periods or last for a long time, and can lead to fatigue and depression.

Do I Have a Balance Problem? Questions to Ask Yourself

You can help identify a balance problem by asking yourself some key questions. If you answer "yes" to any of these questions, discuss the symptom with your doctor.

Do I feel unsteady?
Do I feel as if the room is spinning around me, even only for brief periods of time?
Do I feel as if I'm moving when I know I'm standing or sitting still?
Do I lose my balance and fall?
Do I feel as if I'm falling?
Do I feel lightheaded, or as if I might faint?
Does my vision become blurred?
Do I ever feel disoriented, losing my sense of time, place, or identity?

If you think that you have a balance disorder, schedule an appointment with your doctor. Your doctor may refer you to an otolaryngologist, a doctor with special training in problems of the ear, nose, throat, head, and neck.

Balance disorders can be signs of other health problems, such as an ear infection, stroke, or multiple sclerosis. In some cases, you can help treat a balance disorder by seeking medical treatment for the illness that is causing the disorder.

Some exercises help make up for a balance disorder by moving the head and body in certain ways. The exercises are developed especially for a patient by a professional (often a physical therapist) who understands the balance system and its relationship with other systems in the body.

Balance problems due to high blood pressure can be managed by eating less salt (sodium), maintaining a healthy weight, and exercising. Balance problems due to low blood pressure may be managed by drinking plenty of fluids, such as water, avoiding alcohol, and being cautious regarding your body's posture and movement, such as standing up slowly and avoiding crossing your legs when you’re seated.

Coping with a Balance Disorder

Some people with a balance disorder may not be able to fully relieve their dizziness and will need to find ways to cope with it. A vestibular rehabilitation therapist can help you develop an individualized treatment plan.

If you have trouble with your balance, talk to your doctor about whether it’s safe to drive, and about ways to lower your risk of falling during daily activities, such as walking up or down stairs, using the bathroom, or exercising. To reduce your risk of injury from dizziness, avoid walking in the dark. You should also wear low-heeled shoes or walking shoes outdoors. If necessary, use a cane or walker, and modify conditions at your home and workplace, such as by adding handrails.

Read about this topic in Spanish. Lea sobre este tema en español.

Prevent Falls and Fractures

A simple thing can change your life—like tripping on a rug or slipping on a wet floor. If you fall, you could break a bone, like thousands of older men and women do each year. For older people, a break can be the start of more serious problems, such as a trip to the hospital, injury, or even disability.

If you or an older person you know has fallen, you're not alone. More than one in three people age 65 years or older falls each year. The risk of falling—and fall-related problems—rises with age.

Many Older Adults Fear Falling

The fear of falling becomes more common as people age, even among those who haven't fallen. It may lead older people to avoid activities such as walking, shopping, or taking part in social activities.

But don't let a fear of falling keep you from being active. Overcoming this fear can help you stay active, maintain your physical health, and prevent future falls. Doing things like getting together with friends, gardening, walking, or going to the local senior center helps you stay healthy. The good news is, there are simple ways to prevent most falls.

Causes and Risk Factors for Falls

Older man using a walker to prevent falls

Many things can cause a fall. Your eyesight, hearing, and reflexes might not be as sharp as they were when you were younger. Diabetes, heart disease, or problems with your thyroid, nerves, feet, or blood vessels can affect your balance. Some medicines can cause you to feel dizzy or sleepy, making you more likely to fall. Other causes include safety hazards in the home or community environment.

Scientists have linked several personal risk factors to falling, including muscle weakness, problems with balance and gait, and blood pressure that drops too much when you get up from lying down or sitting (called postural hypotension). Foot problems that cause pain and unsafe footwear, like backless shoes or high heels, can also increase your risk of falling.

Confusion can sometimes lead to falls. For example, if you wake up in an unfamiliar environment, you might feel unsure of where you are. If you feel confused, wait for your mind to clear or until someone comes to help you before trying to get up and walk around.

Some medications can increase a person's risk of falling because they cause side effects like dizziness or confusion. The more medications you take, the more likely you are to fall.

Take the Right Steps to Prevent Falls

If you take care of your overall health, you may be able to lower your chances of falling. Most of the time, falls and accidents don't "just happen." Here are a few tips to help you avoid falls and broken bones:

Stay physically active. Plan an exercise program that is right for you. Regular exercise improves muscles and makes you stronger. It also helps keep your joints, tendons, and ligaments flexible. Mild weight-bearing activities, such as walking or climbing stairs, may slow bone loss from osteoporosis.
Have your eyes and hearing tested. Even small changes in sight and hearing may cause you to fall. When you get new eyeglasses or contact lenses, take time to get used to them. Always wear your glasses or contacts when you need them If you have a hearing aid, be sure it fits well and wear it.
Find out about the side effects of any medicine you take. If a drug makes you sleepy or dizzy, tell your doctor or pharmacist.
Get enough sleep. If you are sleepy, you are more likely to fall.
Limit the amount of alcohol you drink. Even a small amount of alcohol can affect your balance and reflexes. Studies show that the rate of hip fractures in older adults increases with alcohol use.
Stand up slowly. Getting up too quickly can cause your blood pressure to drop. That can make you feel wobbly. Get your blood pressure checked when lying and standing.
Use an assistive device if you need help feeling steady when you walk. Appropriate use of canes and walkers can prevent falls. If your doctor tells you to use a cane or walker, make sure it is the right size for you and the wheels roll smoothly. This is important when you're walking in areas you don't know well or where the walkways are uneven. A physical or occupational therapist can help you decide which devices might be helpful and teach you how to use them safely.
Be very careful when walking on wet or icy surfaces. They can be very slippery! Try to have sand or salt spread on icy areas by your front or back door.
Wear non-skid, rubber-soled, low-heeled shoes, or lace-up shoes with non-skid soles that fully support your feet. It is important that the soles are not too thin or too thick. Don't walk on stairs or floors in socks or in shoes and slippers with smooth soles.
Always tell your doctor if you have fallen since your last checkup, even if you aren't hurt when you fall. A fall can alert your doctor to a new medical problem or problems with your medications or eyesight that can be corrected. Your doctor may suggest physical therapy, a walking aid, or other steps to help prevent future falls.

What to Do If You Fall

Whether you are at home or somewhere else, a sudden fall can be startling and upsetting. If you do fall, stay as calm as possible.

Take several deep breaths to try to relax. Remain still on the floor or ground for a few moments. This will help you get over the shock of falling.

Decide if you are hurt before getting up. Getting up too quickly or in the wrong way could make an injury worse.

If you think you can get up safely without help, roll over onto your side. Rest again while your body and blood pressure adjust. Slowly get up on your hands and knees, and crawl to a sturdy chair.

Put your hands on the chair seat and slide one foot forward so that it is flat on the floor. Keep the other leg bent so the knee is on the floor. From this kneeling position, slowly rise and turn your body to sit in the chair.

If you are hurt or cannot get up on your own, ask someone for help or call 911. If you are alone, try to get into a comfortable position and wait for help to arrive.

Carrying a mobile or portable phone with you as you move about your house could make it easier to call someone if you need assistance. An emergency response system, which lets you push a button on a special necklace or bracelet to call for help, is another option.

Keep Your Bones Strong to Prevent Falls

Falls are a common reason for trips to the emergency room and for hospital stays among older adults. Many of these hospital visits are for fall-related fractures. You can help prevent fractures by keeping your bones strong.

Having healthy bones won't prevent a fall, but if you fall, it might prevent breaking a hip or other bone, which may lead to a hospital or nursing home stay, disability, or even death. Getting enough calcium and vitamin D can help keep your bones strong. So can physical activity. Try to get at least 150 minutes per week of physical activity.

Other ways to maintain bone health include quitting smoking and limiting alcohol use, which can decrease bone mass and increase the chance of fractures. Also, try to maintain a healthy weight. Being underweight increases the risk of bone loss and broken bones.

Osteoporosis is a disease that makes bones weak and more likely to break. For people with osteoporosis, even a minor fall may be dangerous. Talk to your doctor about osteoporosis.

Learn how to fall-proof your home.

Read about this topic in Spanish. Lea sobre este tema en español.

Talking with Your Doctor

Fall-Proofing Your Home

Six out of every 10 falls happen at home, where we spend much of our time and tend to move around without thinking about our safety. There are many changes you can make to your home that will help you avoid falls and ensure your safety.

Fall hazards in the home, including a scatter rug, dog, and empty slippers

In Stairways, Hallways, and Pathways

Have handrails on both sides of the stairs, and make sure they are tightly fastened. Hold the handrails when you use the stairs, going up or down. If you must carry something while you're on the stairs, hold it in one hand and use the handrail with the other. Don't let what you're carrying block your view of the steps.
Make sure there is good lighting with light switches at the top and bottom of stairs and on each end of a long hall. Remember to use the lights!
Keep areas where you walk tidy. Don't leave books, papers, clothes, and shoes on the floor or stairs.
Check that all carpets are fixed firmly to the floor so they won't slip. Put no-slip strips on tile and wooden floors. You can buy these strips at the hardware store.
Don't use throw rugs or small area rugs.

In Bathrooms and Powder Rooms

Mount grab bars near toilets and on both the inside and outside of your tub and shower.
Place non-skid mats, strips, or carpet on all surfaces that may get wet.
Remember to turn on night lights.

In Your Bedroom

Put night lights and light switches close to your bed.
Keep a flashlight by your bed in case the power is out and you need to get up.
Keep your telephone near your bed.

In Other Living Areas

Keep electric cords and telephone wires near walls and away from walking paths.
Secure all carpets and large area rugs firmly to the floor.
Arrange your furniture (especially low coffee tables) and other objects so they are not in your way when you walk.
Make sure your sofas and chairs are the right height for you to get in and out of them easily.
Don't walk on newly washed floors—they are slippery.
Keep items you use often within easy reach.
Don't stand on a chair or table to reach something that's too high—use a "reach stick" instead or ask for help. Reach sticks are special grabbing tools that you can buy at many hardware or medical-supply stores. If you use a step stool, make sure it is steady and has a handrail on top. Have someone stand next to you.
Don't let your cat or dog trip you. Know where your pet is whenever you're standing or walking.
Keep emergency numbers in large print near each telephone.

If you have fallen, your doctor might suggest that an occupational therapist, physical therapist, or nurse visit your home. These healthcare providers can assess your home's safety and advise you about making changes to prevent falls.

Your Own Medical Alarm

If you’re concerned about falling, think about getting an emergency response system. If you fall or need emergency help, you push a button on a special necklace or bracelet to alert 911. There is a fee for this service, and it is not usually covered by insurance.

Home Improvements Prevent Falls

Many State and local governments have education and/or home modification programs to help older people prevent falls. Check with your local health department, or local Area Agency on Aging to see if there is a program near you.

Read more about falls and falls prevention.

Read about this topic in Spanish. Lea sobre este tema en español.

Tips on Discussing Sensitive Topics with Your Doctor

On this page:

Much of the communication between doctor and patient is personal. To have a good partnership with your doctor, it is important to talk about sensitive subjects, like sex or memory problems, even if you are embarrassed or uncomfortable. Most doctors are used to talking about personal matters and will try to ease your discomfort. Keep in mind that these topics concern many older people. You can use booklets and other materials from NIA or the organizations listed at the end of the article to help you bring up sensitive subjects when talking with your doctor.

Illustration of a doctor and patient talking to each other

It is important to understand that problems with memory, depression, sexual function, and incontinence are not necessarily normal parts of aging. A good doctor will take your concerns about these topics seriously and not brush them off. If you think your doctor isn’t taking your concerns seriously, talk to him or her about your feelings or consider looking for a new doctor. Read on for examples of ways to bring up these subjects during your appointment.

Alcohol

Anyone at any age can have a drinking problem. Alcohol can have a greater effect as a person grows older because the aging process affects how the body handles alcohol. People can also develop a drinking problem later in life due to major life changes like the death of loved ones. Talk with your doctor if you think you may be developing a drinking problem. You could say: “Lately, I’ve been wanting to have a drink earlier and earlier in the afternoon, and I find it’s getting harder to stop after just one or two. What kind of treatments could help with this?”

Falling and Fear of Falling

A fall can be a serious event, often leading to injury and loss of independence, at least for a while. For this reason, many older people develop a fear of falling. Studies show that fear of falling can keep people from going about their normal activities and, as a result, they may become frailer, which actually increases their risk of falling again. If fear of falling is affecting your day-to-day life, let your doctor know. He or she may be able to recommend some things to do to reduce your chances of falling. Exercises can help you improve your balance and strengthen your muscles, at any age. Read about how to prevent falls and fractures.

Regular exercise makes you stronger and can help you prevent falls. NIA's exercise and physical activity campaign, Go4Life®, was designed for older adults and can help you fit exercise and physical activity into your daily life.

Feeling Unhappy with Your Doctor

Talking with your doctor infographic icon — Share this infographic to spread the word about ways older adults can get the most out of their medical visits.

Misunderstandings can come up in any relationship, including between a patient and doctor or the doctor’s staff. If you feel uncomfortable with something your doctor or his or her staff has said or done, be direct. For example, if the doctor does not return your telephone calls, you may want to say something like this: “I realize that you care for a lot of patients and are very busy, but I feel frustrated when I have to wait for days for you to return my call. Is there a way we can work together to improve this?”

Being honest is much better for your health than avoiding the doctor. If you have a long-standing relationship with your doctor, working out the problem may be more useful than looking for a new doctor.

Grief, Mourning, and Depression

As people grow older, they may lose significant people in their lives, including spouses and cherished friends. Or, they may have to move away from home or give up favorite activities. A doctor who knows about your losses is better able to understand how you are feeling. He or she can make suggestions that may be helpful to you.

There is no right or wrong way to grieve. Read how you can take care of yourself while you are mourning the death of a spouse.

Although it is normal to mourn when you have a loss, later life does not have to be a time of ongoing sadness. If you feel sad all the time or for more than a few weeks, let your doctor know. Also, tell your doctor about symptoms such as lack of energy, poor appetite, trouble sleeping, or little interest in life. These could be signs of depression, which is a medical condition.

Depression is a common problem among older adults, but it is NOT a normal part of aging. Depression may be common, especially when people experience losses, but it is also treatable. It should not be considered normal at any age. Let your doctor know about your feelings and ask about treatment.

Read more about depression in older adults.

HIV/AIDS

After divorce, separation, or the death of a spouse, some older people may find themselves dating again, and possibly having sex with a new partner. It’s a good idea to talk with your doctor about how safe sex can reduce your risk of sexually transmitted diseases such as HIV/AIDS. It’s important to practice safe sex, no matter what your age.

Incontinence

Older people sometimes have problems controlling their bladder. This is called urinary incontinence and it can often be treated. If you have trouble controlling your bladder or bowels, it is important to let the doctor know. To bring up the topic, you could say something like: “Since my last visit there have been several times when I couldn’t control my bladder.”

Learn more about bladder health.

Memory Problems

Many older people worry about their ability to think and remember. For most older adults, thinking and memory remain relatively intact in later years. However, if you or your family notice that you are having problems remembering recent events or thinking clearly, let your doctor know. Be specific about the changes you’ve noticed. For example, you could say: “I’ve always been able to balance my checkbook without any problems, but lately I’m very confused.” Your doctor will probably want you to have a thorough checkup to see what might be causing your symptoms.

Problems with Family

Even strong and loving families can have problems, especially under the stress of illness. Although family problems can be painful to discuss, talking about them can help your doctor help you.

If you feel that a family member or caregiver is taking advantage of you or mistreating you, let your doctor know. Some older people are abused by family members or others. Abuse can be physical, verbal, emotional, or even financial in nature. Your doctor may be able to provide resources or referrals to other services that can help if you are being mistreated.

Learn more about how to recognize elder abuse.

Sexuality

Most health professionals now understand that sexuality remains important in later life. If you are not satisfied with your sex life, don’t just assume it’s due to your age. In addition to talking about age-related changes, you can ask your doctor about the effects of an illness or a disability on sexual function. Also, ask your doctor about the influence medications or surgery may have on your sex life.

If you aren’t sure how to bring the topic up, try saying: “I have a personal question I would like to ask you...” or “I understand that this condition or medication can affect my body in many ways. Will it affect my sex life at all?”

Learn more about how growing older might affect your sex life.

For More Information to Help You Discuss Sensitive Subjects with Your Doctor

National Center on Elder Abuse
1-855-500-3537 (toll-free)
ncea-info@aoa.hhs.gov
https://ncea.acl.gov

National Institute on Alcohol Abuse and Alcoholism
National Institutes of Health
1-888-696-4222
niaaaweb-r@exchange.nih.gov
www.niaaa.nih.gov

Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE)
1-212-741-2247
info@sageusa.org
www.sageusa.org

Online Health Information: Is It Reliable?

On this page:

Many older adults share a common concern: “How can I trust the health information I find on the Internet?”

There are thousands of medical websites. Some provide reliable health information. Some do not. Some of the medical news is current. Some of it is not. Choosing which websites to trust is an important step in gathering reliable health information.

2 older men looking for health information online

Where Can I Find Reliable Health Information Online?

The National Institutes of Health website is a good place to start for reliable health information.

As a rule, health websites sponsored by Federal Government agencies are good sources of information. You can reach all Federal websites by visiting www.usa.gov. Large professional organizations and well-known medical schools may also be good sources of health information.

Questions to Ask Before Trusting a Website

As you search online, you are likely to find websites for many health agencies and organizations that are not well-known. By answering the following questions, you should be able to find more information about these websites. A lot of these details might be found in the website’s “About Us” section.

1. Who sponsors/hosts the website? Is that information easy to find?

Websites cost money to create and update. Is the source of funding (sponsor) clear? Knowing who is funding the website may give you insight into the mission or goal of the site. Sometimes, the website address (called a URL) is helpful. For example:

.gov identifies a U.S. government agency
.edu identifies an educational institution, like a school, college, or university
.org usually identifies nonprofit organizations (such as professional groups; scientific, medical, or research societies; advocacy groups)
.com identifies commercial websites (such as businesses, pharmaceutical companies, and sometimes hospitals)

2. Who wrote the information? Who reviewed it?

Authors and contributors are often, but not always, identified. If the author is listed, ask yourself—is this person an expert in the field? Does this person work for an organization and, if so, what are the goals of the organization? A contributor’s connection to the website, and any financial stake he or she has in the information on the website, should be clear.

Is the health information written or reviewed by a healthcare professional? Dependable websites will tell you where their health information came from and how and when it was reviewed.

Trustworthy websites will have contact information that you can use to reach the site’s sponsor or authors. An email address, phone number, and/or mailing address might be listed at the bottom of every page or on a separate “About Us” or “Contact Us” page.

Be careful about testimonials. Personal stories may be helpful and comforting, but not everyone experiences health problems the same way. Also, there is a big difference between a website, blog, or social media page developed by a single person interested in a topic and a website developed using strong scientific evidence (that is, information gathered from research).

No information should replace seeing a doctor or other health professional who can give you advice that caters to your specific situation.

3. When was the information written?

Look for websites that stay current with their health information. You don’t want to make decisions about your care based on out-of-date information. Often, the bottom of the page will have a date. Pages on the same site may be updated at different times—some may be updated more often than others. Older information isn’t useless, but using the most current, evidence-based information is best.

4. What is the purpose of the site?

Why was the site created? Know the motive or goal of the website so you can better judge its content. Is the purpose of the site to inform or explain? Or is it trying to sell a product? Choose information based on scientific evidence rather than one person’s opinion.

5. Is your privacy protected? Does the website clearly state a privacy policy?

Read the website’s privacy policy. It is usually at the bottom of the page or on a separate page titled “Privacy Policy” or “Our Policies.” If a website says it uses “cookies,” your information may not be private. While cookies may enhance your web experience, they can also compromise your online privacy—so it is important to read how the website will use your information. You can choose to disable the use of cookies through your Internet browser settings.

6. How can I protect my health information?

If you are asked to share personal information, be sure to find out how the information will be used. Secure websites that collect personal information responsibly have an “s” after “http” in the start of their website address (https://) and often require that you create a username and password.

BE CAREFUL about sharing your Social Security number. Find out why your number is needed, how it will be used, and what will happen if you do not share this information. Only enter your Social Security number on secure websites. You might consider calling your doctor’s office or health insurance company to give this information over the phone, rather than giving it online.

These precautions can help better protect your information:

Use common sense when browsing the Internet. Do not open unexpected links. Hover your mouse over a link to confirm that clicking it will take you to a reputable website.
Use a strong password. Include a variation of numbers, letters, and symbols. Change it frequently.
Use two-factor authentication when you can. This requires the use of two different types of personal information to log into your mobile devices or accounts.
Do not enter sensitive information over public Wi-Fi that is not secure. This includes Wi-Fi that is not password protected.

Be careful what information you share over social media sites. This can include addresses, phone numbers, and email addresses. Learn how you can keep your information private.

7. Does the website offer quick and easy solutions to your health problems? Are miracle cures promised?

Be careful of websites or companies that claim any one remedy will cure a lot of different illnesses. Question dramatic writing or cures that seem too good to be true. Make sure you can find other websites with the same information. Even if the website links to a trustworthy source, it doesn’t mean that the site has the other organization’s endorsement or support.

Health and Medical Apps

Mobile medical applications (“apps”) are apps you can put on your smartphone. Health apps can help you track your eating habits, physical activity, test results, or other information. But, anyone can develop a health app—for any reason— and apps may include inaccurate or misleading information. Make sure you know who made any app you use.

When you download an app, it may ask for your location, your email, or other information. Consider what the app is asking from you—make sure the questions are relevant to the app and that you feel comfortable sharing this information. Remember, there is a difference between sharing your personal information through your doctor’s online health portal and posting on third-party social media or health sites.

Social Media and Health Information

Social media sites, such as Facebook, Twitter, and Instagram, are online communities where people connect with friends, family, and strangers. Sometimes, you might find health information or health news on social media. Some of this information may be true, and some of it may not be. Recognize that just because a post is from a friend or colleague it does not necessarily mean it’s true or scientifically accurate.

Check the source of the information, and make sure the author is credible. Fact-checking websites can also help you figure out if a story is reliable.

A Quick Checklist

You can use the following checklist to help make sure that the health information you are reading online can be trusted. You might want to keep this checklist by your computer.

Is the sponsor/owner of the website a Federal agency, medical school, or large professional or nonprofit organization, or is it related to one of these?
If not sponsored by a Federal agency, medical school, or large professional or nonprofit organization, is the website written by a healthcare professional or does it reference one of these trustworthy sources for its health information?
Why was the site created? Is the mission or goal of the website sponsor clear?
Can you see who works for the agency or organization and who authored the information? Is there a way to contact the sponsor of the website?
When was the information written or webpage last updated?
Is your privacy protected?
Does the website offer unbelievable solutions to your health problem(s)? Are quick, miracle cures promised?

Trust Yourself and Talk to Your Doctor

Use common sense and good judgment when looking at health information online. There are websites on nearly every health topic, and many have no rules overseeing the quality of the information provided. Use the information you find online as one tool to become more informed. Don’t count on any one website and check your sources. Discuss what you find with your doctor before making any changes to your health care.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Reliable Health Websites

Centers for Medicare & Medicaid Services
1-800-633-4227 (toll-free)
1-877-486-2048 (TTY/toll-free)
www.medicare.gov

Centers for Disease Control and Prevention (CDC)
1-800-232-4636 (toll-free)
1-888-232-6348 (TTY/toll-free)
cdcinfo@cdc.gov

U.S. Food and Drug Administration
1-888-463-6332 (toll-free)
druginfo@fda.hhs.gov
www.fda.gov

Content reviewed: October 31, 2018

Healthy Eating

Sample Menus: Healthy Eating for Older Adults

Planning a day’s worth of meals using smart food choices might seem overwhelming at first. Here are some sample menus to show you how easy it can be. These menus provide 2,000 calories a day. You might need to eat fewer or more calories, depending on your activity level and whether you are a man or a woman.

The U.S. Department of Agriculture's ChooseMyPlate offers 2-week sample menus. Although it might look like the recommended amounts for a food group are not met, or are exceeded, in a single day, the average over a week meets recommendations.

Learn more about healthy food choices for healthy aging:

Shopping for Food That's Good for You

Serving and Portion Sizes: How Much Should I Eat?

10 Tips for Eating Healthy on a Budget

Sample Menu 1
Breakfast	Lunch
Breakfast burrito 1 flour tortilla (8-inch diameter) 1 scrambled egg 1/3 cup black beans 2 tablespoons salsa 1/2 large grapefruit 1 cup water, coffee, or tea	Roast beef sandwich 1 small whole-grain hoagie bun 2 ounces lean roast beef 1 slice part-skim mozzarella cheese 2 slices tomato 1/4 cup mushrooms (cooked in 1 teaspoon corn/canola oil) 1 teaspoon mustard Baked potato wedges 1 cup potato wedges (cooked in 1 teaspoon canola oil) 1 tablespoon ketchup 1 cup fat-free milk
Dinner	Snack
Baked salmon on beet greens 4 ounce salmon filet 1 teaspoon olive oil 2 teaspoons lemon juice 1/3 cup cooked beet greens (cooked in 2 teaspoons canola oil) Quinoa with almonds 1/2 cup quinoa 1/2 cup silvered almonds 1 cup fat-free milk	1 cup cantaloupe balls

Sample Menu 2
Breakfast	Lunch
Whole wheat French toast 2 slices whole wheat bread 3 tablespoons fat-free milk 2/3 egg 2 teaspoons tub margarine 1 tablespoon pancake syrup 1/2 large grapefruit 1 cup fat-free milk	3-bean vegetarian chili on baked potato 1/4 cup each cooked kidney beans, navy beans, and black beans 1/2 cup tomato sauce 1/4 cup chopped onion 2 tablespoons chopped jalapeno peppers 1 teaspoon corn/canola oil (to cook onion and peppers) 1/4 cup cheese sauce 1 large baked potato 1/2 cup cantaloupe 1 cup water, coffee, or tea
Dinner	Snack
Hawaiian pizza 2 slices cheese pizza, thin crust 1 ounce lean ham 1/4 cup pineapple 1/4 cup mushrooms, cooked in 1 teaspoon safflower oil Green salad 1 cup mixed salad greens 4 teaspoons oil and vinegar dressing 1 cup fat-free milk	3 tablespoon hummus 5 whole wheat crackers

Sample Menu 3
Breakfast	Lunch
Cold cereal 1 cup shredded wheat 1/2 cup sliced banana 1/2 cup fat-free milk 1 slice whole wheat toast 2 teaspoons all-fruit preserves 1 cup fat-free chocolate milk	Tuna salad sandwich 2 slices rye bread 2 ounces tuna 1 tablespoon mayonnaise 1 tablespoon chopped celery 1/2 cup shredded lettuce 1 medium peach 1 cup fat-free milk
Dinner	Snack
Roasted chicken 3 ounces cooked chicken breast 1 large sweet potato, roasted 1/2 cup succotash (lima beans & corn) 1 teaspoon tub margarine 1 ounce whole wheat roll 1 teaspoon tub margarine 1 cup water, coffee, or tea	1/4 cup dried apricots 1 cup flavored yogurt (chocolate)

Sample Menu 4
Breakfast	Lunch
Creamy oatmeal (cooked in milk) 1/2 cup uncooked oatmeal 1 cup fat-free milk 2 tablespoons raisins 2 teaspoons brown sugar 1 cup orange juice 2 teaspoons all-fruit preserves 1 cup fat-free chocolate milk	Taco salad 2 ounces tortilla chips 2 ounces cooked ground turkey (cooked in 2 teaspoons corn oil) 1/4 cup kidney beans 1/2 ounce low-fat cheddar cheese 1/2 cup chopped lettuce 1/2 cup avocado 1 teaspoon lime juice (on avocado) 2 tablespoons salsa 1 cup water, coffee, or tea
Dinner	Snack
Spinach lasagna roll-ups 1 cup lasagna noodles (2 ounces dry) 1/2 cup cooked spinach 1/2 cup ricotta cheese 1 ounce part-skim mozzarella cheese 1/2 cup tomato sauce 1 ounce whole wheat roll 1 teaspoon tub margarine 1 cup fat-free milk	2 tablespoons raisins 1 ounce unsalted almonds

Download sample menus (PDF, 117K)

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on Healthy Eating Plans

Choose My Plate
www.choosemyplate.gov

USDA Food and Nutrition Information Center
National Agricultural Library
1-301-504-5414
fnic@ars.usda.gov
www.nal.usda.gov/fnic

USDA Center for Nutrition Policy and Promotion
1-703-305-7600
www.cnpp.usda.gov

Healthy Eating

Food Safety

On this page:

Avoid Getting Sick From Your Food
Food Safety When Cooking
Food Safety When Eating Out

Food can be unsafe for many reasons. It might be contaminated by germs—microbes such as bacteria, viruses, or fungi-like molds. These microbes might have been present before the food was harvested or collected, or they could have been introduced during handling or preparation. In either case, the food might look fine but could make you very sick. Food can also be unsafe because it has “gone bad.” Sometimes, you may see mold growing on the surface.

Avoid Getting Sick From Your Food

For an older person, a food-related illness can be life threatening. As you age, you have more trouble fighting off microbes. Health problems, like diabetes or kidney disease, also make you more likely to get sick from eating foods that are unsafe. So, if you are over age 65, be very careful about how food is prepared and stored.

Some foods can be dangerous for an older person no matter what—so, if you are over 65, the U.S. Department of Agriculture recommends you avoid:

Raw or undercooked fish, shellfish, meat, and poultry
Refrigerated smoked fish (for example, lox)
Hot dogs, deli meats, and luncheon meats (unless these are reheated to 165 °F)
Raw or unpasteurized milk and milk products
Soft cheeses made from unpasteurized milk, including feta, brie, camembert, blue, and queso fresco
Raw or undercooked eggs or egg product, as found in cookie dough, eggnog, and some salad dressings
Raw sprouts
Unwashed fresh vegetables, including lettuce
Unpasteurized juice from fruits and vegetables

Changing Taste and Smell

As you grow older, your senses of taste and smell might change. Or medicines might make things taste different. If you can’t rely on your sense of taste or smell to tell that food is spoiled, be extra careful about how you handle your food. If something doesn’t look, smell, or taste right, throw it out—don’t take a chance with your health.

Smart Storage

Food safety starts with storing your food properly. Sometimes that’s as simple as following directions on the container. For example, if the label says “refrigerate after opening,” do that! It’s also a good idea to keep any canned and packaged items in a cool place.

When you are ready to use a packaged food, check the date on the label. That bottle of juice might have been in your cabinet so long it is now out of date. (See Reading Food Labels to understand the date on the food label.)

Try to use refrigerated leftovers within 3 or 4 days to reduce your risk of food poisoning. Throw away foods older than that or those that show moldy areas.

For recommended refrigerator and freezer storage times for common foods, download our Storing Cold Food tip sheet (PDF, 75K).

Food Safety When Cooking

When preparing foods, follow four basic steps—clean, separate, cook, and chill.

Clean

Wash your hands and the counter with hot soapy water, and make sure your utensils are clean before you start to prepare food. Clean the lids of cans before opening. Rinse fruits and vegetables under running water, but do not use soap or detergent. Do not rinse raw meat or poultry before cooking—you might contaminate other things by splashing disease-causing microbes around without realizing it.

Keep your refrigerator clean, especially the vegetable and meat bins. When there is a spill, use hot soapy water to clean it up.

Separate

Keep raw meat, poultry, seafood, and eggs (and their juices and shells) away from foods that won’t be cooked. That begins in your grocery cart—put raw vegetables and fruit in one part of the cart, maybe the top part.

Things like meat should be put in the plastic bags the store offers and placed in a separate part of the cart. At check-out, make sure the raw meat and seafood aren’t mixed with other items in your bags.

When you get home, keep things like raw meat separate from fresh fruit and vegetables (even in your refrigerator). Don’t let the raw meat juices drip on foods that won’t be cooked before they are eaten.

When you are cooking, it is also important to keep ready-to-eat foods like fresh produce or bread apart from food that will be cooked. Make sure your hands, counter, and cutting boards are clean before you begin. Use a different knife and cutting board for fresh produce than you use for raw meat, poultry, and seafood. Or, use one set, and cut all the fresh produce before handling foods that will be cooked.

Wash your utensils and cutting board in hot soapy water or the dishwasher, and clean the counter and your hands afterwards. If you put raw meat, poultry, or seafood on a plate, wash the plate in hot soapy water before reusing it for cooked food.

Cook

Use a food thermometer, put in the thickest part of the food you are cooking, to check that the inside has reached the right temperature. The chart below shows what the temperature should be inside food before you stop cooking it. No more runny fried eggs or hamburgers that are pink in the middle.

Bring sauces, marinades, soups, and gravy to a boil when reheating.

U.S. Department of Agriculture-Recommended Safe Minimum Internal Temperatures
Type of Food	Minimum Internal Temperature
All meats and seafood	145°F (with a 3-minute rest time)
All ground meats	160°F
Egg dishes	160°F
All poultry	165°F
Hot dogs and luncheon meats	165°F

No matter what temperature you set your oven at, the temperature inside your food needs to reach the level shown here to be safe.

Chill

Keeping foods cold slows the growth of microbes, so your refrigerator should always be at 40°F or below. The freezer should be at 0°F or below. But just because you set the thermostat for 40°F doesn't mean it actually reaches that temperature. Use refrigerator/freezer thermometers to check.

Put food in the refrigerator within 2 hours of buying or cooking it. If the outside temperature is over 90°F, refrigerate within 1 hour. Put leftovers in a clean, shallow container that is covered and dated. Use or freeze leftovers within 3 to 4 days. For recommended refrigerator and freezer storage times for common foods, download our Storing Cold Food tip sheet (PDF, 75K).

Food Safety When Eating Out

It's nice to take a break from cooking or get together with others for a meal at a restaurant. But, do you think about food safety when you eat out? You should.

Pick a place that looks clean.
If your city or state requires restaurants to post a cleanliness rating near the front door, check it out.
Don't be afraid to ask the waiter or waitress how items on the menu are prepared. For example, could you have the tuna cooked well instead of seared? Or, if you find out the Caesar salad dressing is made with raw eggs, ask for another salad dressing.
Consider avoiding buffets. Sometimes food in buffets sits out for a while and might not be kept at the proper temperature—whether hot or cold.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on Food Safety

National Association of Nutrition and Aging Services Programs
1-202-682-6899
www.nanasp.org

USDA Food and Nutrition Information Center
National Agricultural Library
1-301-504-5414
fnic@ars.usda.gov
www.nal.usda.gov/fnic

Healthy Eating

Vitamins and Minerals

Vitamins

Vitamins help your body grow and work the way it should. There are 13 vitamins—vitamins C, A, D, E, K, and the B vitamins (thiamine, riboflavin, niacin, pantothenic acid, biotin, B6, B12, and folate).

Vitamins have different jobs--helping you resist infections, keeping your nerves healthy, and helping your body get energy from food or your blood to clot properly. By following the Dietary Guidelines, you will get enough of most of these vitamins from food.

Vitamins and minerals are measured in a variety of ways. The most common are:

mg – milligram
mcg – microgram
IU – international unit

Your doctor might suggest that, like some older adults, you need extra of a few vitamins, as well as the mineral calcium. It is usually better to get the nutrients you need from food, rather than a pill. That’s because nutrient-dense foods contain other things that are good for you, like fiber. Look for foods fortified with certain vitamins and minerals, like some B vitamins, calcium, and vitamin D. That means those nutrients are added to the foods to help you meet your needs.

Minerals

Minerals also help your body function. Some minerals, like iodine and fluoride, are only needed in very small quantities. Others, such as calcium, magnesium, and potassium, are needed in larger amounts. As with vitamins, if you eat a varied diet, you will probably get enough of most minerals.

Vitamin and Mineral Supplements for People Over Age 50
Vitamin D	If you are age 50–70, you need at least 600 IU, but not more than 4,000 IU. If you are age 70 and older, you need at least 800 IU, but not more than 4,000 IU. You can get vitamin D from fatty fish, fish-liver oils, fortified milk and milk products, and fortified cereals.
Vitamin B6	Men need 1.7 mg every day. Women need 1.5 mg every day. You can get vitamin B6 from fortified cereals, whole grains, organ meats like liver, and fortified soy-based meat substitutes.
Vitamin B12	You need 2.4 mcg every day. Some people over age 50 have trouble absorbing the vitamin B12 found naturally in foods, so make sure you get enough of the supplement form of this vitamin, such as from fortified foods. You can get vitamin B12 from fortified cereals, meat, fish, poultry, and milk.
Folate	You need 400 mcg each day. Folic acid is the form used to fortify grain products or added to dietary supplements. You can get folate from dark-green leafy vegetables like spinach, beans and peas, fruit like oranges and orange juice, and folic acid from fortified flour and fortified cereals.

Calcium

Calcium is a mineral that is important for strong bones and teeth, so there are special recommendations for older people who are at risk for bone loss. You can get calcium from milk and milk products (remember to choose fat-free or low-fat whenever possible), some forms of tofu, dark-green leafy vegetables (like collard greens and kale), soybeans, canned sardines and salmon with bones, and calcium-fortified foods.

There are several types of calcium supplements. Calcium citrate and calcium carbonate tend to be the least expensive.

Calcium for People Over 50
Women age 51 and older	Men age 51 to 70	Men age 71 and older
1,200 mg each day	1,000 mg each day	1,200 mg each day
Women and men age 51 and older: Don’t take more than 2,000 mg of calcium in a day.

Sodium

Sodium is another mineral. In most Americans’ diets, sodium primarily comes from salt (sodium chloride), though it is naturally found in some foods. Sodium is also added to others during processing, often in the form of salt. We all need some sodium, but too much over time can contribute to raising your blood pressure or put you at risk for heart disease, stroke, or kidney disease.

How much sodium is okay? People 51 and older should reduce their sodium to 1,500 mg each day—that includes sodium added during manufacturing or cooking as well as at the table when eating. That is about 2/3 teaspoon of salt. Look for the word sodium, not salt, on the Nutrition Facts panel. The amount of sodium in the same kind of food can vary greatly among brands, so check the label.

Preparing your own meals at home without using a lot of processed foods or adding salt will allow you to control how much sodium you get. Look for grocery products marked “low sodium,” “unsalted,” “no salt added,” “sodium free,” or “salt free.”

To limit sodium to 1,500 mg daily, try using less salt when cooking, and don’t add salt before you take the first bite. Spices, herbs, and lemon juice add flavor to your food, so you won’t miss the salt. If you make this change slowly, you will get used to the difference in taste. Eating more vegetables and fruit also helps—they are naturally low in sodium and provide more potassium. Talk to your doctor before using salt substitutes. Some contain sodium. And most have potassium, which some people also need to limit.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on Vitamins and Minerals

Office of Dietary Supplements
National Institutes of Health
1-301-435-2920
ods@nih.gov
www.ods.od.nih.gov

Healthy Eating

DASH Eating Plan

A number of major research studies have shown that following the Dietary Approaches to Stop Hypertension (DASH) Plan can lower blood pressure.

Quinoa salad with black beans and vegetables

This plan emphasizes whole grains, fruits, vegetables, fat-free or low-fat dairy, seafood, poultry, beans, seeds, and nuts. It contains less salt and sodium, sweets, added sugars, fats, and red meats than the typical American eats.

DASH recommendations are spread over eight food groups. If you need to, refer to How Many Calories Do You Need? Then, see the appropriate column below for the amounts you should eat each day, unless given as weekly amounts:

DASH Plan Recommendations for Several Daily Calorie Count Examples
	1,600 calories	2,000 calories	2,600 calories
Grains	6 servings	6-8 servings	10-11 servings
Fruits	4 servings	4-5 servings	5-6 servings
Vegetables	3-4 servings	4-5 servings	5-6 servings
Fat-free or low-fat milk and milk products	2-3 servings	2-3 servings	3 servings
Lean meat, poultry, and fish	3-4 ounces or less	6 ounces or less	6 ounces or less
Nuts, seeds, and legumes	3-4 servings per week	4-5 servings per week	1 serving per day
Fats and oils	2 servings	2-3 servings	3 servings
Sweets and added sugars	3 servings or less per week	5 servings or less per week	less than 2 servings per day

DASH is organized by servings for most food groups. A DASH serving equals:

Grains—one ounce or equivalent

Fruits—half cup cut-up fruit or equivalent

Vegetables—half cup cooked vegetables or equivalent

Meats, poultry, and fish—one ounce cooked meats, poultry, or fish or one egg

Nuts, seeds, and legumes—foods like two tablespoons peanut butter, third cup or 1-1/2 ounces of nuts, half cup cooked beans, or one cup bean soup

Fats and oils—one teaspoon soft margarine or vegetable oil, one tablespoon mayonnaise, and one tablespoon regular salad dressing or two tablespoons low-fat dressing

Sugars—one tablespoon jam or jelly, half cup regular Jell-O, or one cup regular lemonade

Learn more about the food groups.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on the DASH Eating Plan

National Heart, Lung, and Blood Institute
1-301-592-8573
nhlbiinfo@nhlbi.nih.gov
www.nhlbi.nih.gov

Content reviewed: June 29, 2017

Healthy Eating

Getting Enough Fluids

It’s important for your body to have plenty of fluids each day. Water helps you digest your food, absorb nutrients, and then get rid of the unused waste.

Grandmother drinking water with her grandson

With age, some people may lose their sense of thirst. To further complicate matters, some medicines might make it even more important to have plenty of fluids.

Drinking enough fluids every day also is essential. Check with your doctor, however, if you’ve been told to limit how much you drink.

Try these tips for getting enough fluids:

Try to add liquids throughout the day.
Take sips from a glass of water, milk, or juice between bites during meals.
Have a cup of low-fat soup as an afternoon snack.
Drink a full glass of water if you need to take a pill.
Have a glass of water before you exercise or go outside to garden or walk, especially on a hot day.
Remember, water is a good way to add fluids to your daily routine without adding calories.
Drink fat-free or low-fat milk, or other drinks without added sugars.
If you drink alcoholic beverages, do so sensibly and in moderation. That means up to one drink per day for women and up to two drinks for men.
Don’t stop drinking liquids if you have a urinary control problem. Talk with your doctor about treatment.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on Fluids and Nutrition

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
1-800-860-8747 (toll-free)
1-866-569-1162 (TTY/toll-free)
healthinfo@niddk.nih.gov
www.niddk.nih.gov

National Heart, Lung, and Blood Institute
(Instituto Nacional del Corazón, los Pulmones y la Sangre)
1-301-592-8573
nhlbiinfo@nhlbi.nih.gov
www.nhlbi.nih.gov

National Association of Nutrition and Aging Services Programs
1-202-682-6899
www.nanasp.org

President’s Council on Fitness, Sports, and Nutrition
1-240-276-9567
fitness@hhs.gov
www.fitness.gov

Content reviewed: June 09, 2017

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Dementia, Memory Loss, & Healthy Aging

Forgetfulness and Brain Diseases

Do Memory Problems Always Mean Alzheimer's Disease?

Many people worry about becoming forgetful. They think forgetfulness is the first sign of Alzheimer's disease. But not all people with memory problems have Alzheimer's.

Other causes for memory problems can include aging, medical conditions, emotional problems, mild cognitive impairment, or another type of dementia.

Age-Related Changes in Memory

Differences Between Normal Aging and Alzheimer's Disease
Normal Aging	Alzheimer's Disease
Making a bad decision once in a while	Making poor judgments and decisions a lot of the time
Missing a monthly payment	Problems taking care of monthly bills
Forgetting which day it is and remembering it later	Losing track of the date or time of year
Sometimes forgetting which word to use	Trouble having a conversation
Losing things from time to time	Misplacing things often and being unable to find them

Memory Loss Related to Medical Conditions

Certain medical conditions can cause serious memory problems. These problems should go away once a person gets treatment. Medical conditions that may cause memory problems include:

Tumors, blood clots, or infections in the brain
Some thyroid, kidney, or liver disorders
Drinking too much alcohol
Head injury, such as a concussion from a fall or accident
Medication side effects
Not eating enough healthy foods, or too few vitamins and minerals in a person's body (like vitamin B12)

A doctor should treat serious medical conditions like these as soon as possible.

Memory Loss Related to Emotional Problems

Read about this topic in Spanish. Lea sobre este tema en español.

Cognitive Health

Memory and Thinking: What's Normal and What's Not?

Talk with your doctor to determine if memory and other thinking problems are normal or not, and what is causing them.

What's Normal and What's Not?

What's the difference between normal, age-related forgetfulness and a serious memory problem? Serious memory problems make it hard to do everyday things like driving and shopping. Signs may include:

Asking the same questions over and over again
Getting lost in familiar places
Not being able to follow instructions
Becoming confused about time, people, and places

Mild Cognitive Impairment

Signs of MCI include:

Losing things often
Forgetting to go to important events or appointments
Having more trouble coming up with desired words than other people of the same age

Dementia

Differences Between Normal Aging and Alzheimer's Disease
Normal Aging	Alzheimer's Disease
Making a bad decision once in a while	Making poor judgments and decisions a lot of the time
Missing a monthly payment	Problems taking care of monthly bills
Forgetting which day it is and remembering it later	Losing track of the date or time of year
Sometimes forgetting which word to use	Trouble having a conversation
Losing things from time to time	Misplacing things often and being unable to find them

When to Visit the Doctor

If you, a family member, or friend has problems remembering recent events or thinking clearly, talk with a doctor. He or she may suggest a thorough checkup to see what might be causing the symptoms

The annual Medicare wellness visit includes an assessment for cognitive impairment. This visit is covered by Medicare for patients who have had Medicare Part B insurance for at least 1 year.

Dementia and Memory Loss

What Is Dementia?

Older woman with glasses wearing a sari

Learn more about dementia from MedlinePlus.

Read about this topic in Spanish. Lea sobre esta tema en español.

For More Information About Dementia

Types of Dementia

Hispanic man with dementia sitting in a park

Alzheimer's disease
Frontotemporal disorders
Lewy body dementia

Other types of progressive brain disease include:

Vascular contributions to cognitive impairment and dementia
Mixed dementia, a combination of two or more types of dementia

In addition, certain medical conditions can cause serious memory problems that resemble dementia. These problems should go away once the conditions are treated. These conditions include:

Side effects of certain medicines
Emotional problems, such as stress, anxiety, or depression
Certain vitamin deficiencies
Drinking too much alcohol
Blood clots, tumors, or infections in the brain
Delirium
Head injury, such as a concussion from a fall or accident
Thyroid, kidney, or liver problems

Doctors have identified many other conditions that can cause dementia or dementia-like symptoms. These conditions include:

Argyrophilic grain disease, a common, late-onset degenerative disease
Creutzfeldt-Jakob disease, a rare brain disorder
Huntington's disease, an inherited, progressive brain disease
Chronic traumatic encephalopathy (CTE), caused by repeated traumatic brain injury
HIV-associated dementia (HAD)

Learn more about dementia from MedlinePlus.

Read about this topic in Spanish. Lea sobre esta tema en español.

For More Information About Types of Dementia

National Institute of Neurological Disorders and Stroke
1-800-352-9424 (toll-free)
braininfo@ninds.nih.gov
www.ninds.nih.gov

What Is Mixed Dementia?

For More Information About Mixed Dementia

Content reviewed: December 31, 2017

Biomarkers for Dementia Detection and Research

On this page:

What Are Biomarkers?

Types of Biomarkers and Tests

Brain Imaging

male medical technician with older woman about to get brain imaging test

Computerized Tomography

What is it?

CT scanner

What's the procedure like?

During a CT, a person lies in a scanner for 10 to 20 minutes. A donut-shaped device moves around the head to produce the image.

What does it show?

A head CT can show shrinkage of brain regions that may occur in dementia, as well as signs of a stroke or tumor.

When is it used?

Magnetic Resonance Imaging

What is it?

Doctor talking with patient before MRI

What's the procedure like?

Because MRI uses strong magnetic fields to obtain images, people with certain types of metal in their bodies, such as a pacemaker, surgical clips, or shrapnel, cannot undergo the procedure.

What does it show?

When is it used?

Positron Emission Tomography

What is it?

Examples of brain imaging scans from PET, CT, MRI

What's the procedure like?

The amount of radiation exposure during a PET scan is relatively low. People who are concerned about radiation exposure or who have had many x rays or imaging scans should talk with their doctor.

What does it show?

When is it used?

Cerebrospinal Fluid Biomarkers

Lumbar Puncture

What is it?

CSF is obtained by a lumbar puncture, also called a spinal tap, an outpatient procedure used to diagnose several types of neurological problems.

What's the procedure like?

What does it show?

When is it used?

In research, CSF biomarkers are valuable tools for early detection of a neurodegenerative disease. They are also used in clinical trials to assess the impact of experimental medications.

Other Types of Biomarkers

Blood Tests

Many other proteins, lipids, and other substances can be measured in the blood, but so far none has shown value in diagnosing Alzheimer's.

Currently, dementia researchers use blood biomarkers to study early detection, prevention, and the effects of potential treatments. They are not used in doctors' offices and other clinical settings.

Genetic Testing

Read more about Alzheimer's disease genetics.

Biomarkers in Development

Biomarkers in Dementia Diagnosis

Read more about diagnosing dementia.

Biomarkers in Dementia Research

In addition, biomarker measures may help researchers:

Better understand how risk factors and genetic variants are involved in Alzheimer's disease
Identify participants who meet particular requirements, such as having certain genes or amyloid levels, for clinical trials and studies
Track study participants' responses to a test drug or other intervention, such as physical exercise

Read about the new NIA-AA Research Framework focusing on biomarkers to help define and study Alzheimer's disease.

The Future of Biomarkers

Developing and validating a full range of biomarkers, particularly those that are less expensive and/or less invasive, to help test drugs that may prevent, treat, and improve diagnosis of Alzheimer's and related dementias
Advancing the use of novel PET imaging, CSF, and blood biomarkers to identify specific changes in the brain related to Alzheimer's and other neurodegenerative dementias
Using new MRI methods to measure brain structure, function, and connections
Developing and refining sensitive clinical and neuropsychological assessments to help detect and track early-stage disease
Using biomarkers in combination to build a model of Alzheimer's disease progression over decades, from its earliest, presymptomatic stage through dementia

How You Can Help

Learn more about participating in clinical research.

To find clinical trials and studies on Alzheimer's and related dementias, visit:

NIA Alzheimer's and Related Dementias Clinical Trials Finder
National Institute of Neurological Disorders and Stroke
Alzheimer's Disease Neuroimaging Initiative (ADNI)
National Institutes of Health

For More Information About Dementia Biomarkers

Content reviewed: April 01, 2018

Dementia Research and Clinical Trials

Common Questions About Participating in Alzheimer's and Related Dementias Research

How Can I Find Out About Alzheimer’s Trials and Studies?

Check the resources below:

Ask your doctor, who may know about local research studies that may be right for you.
Sign up for a registry or a matching service to be invited to participate in studies or trials when they are available in your area.
Contact Alzheimer’s research centers or memory or neurology clinics in your community. They may be conducting trials.
Visit the Alzheimer’s and related Dementias Education and Referral (ADEAR) Center clinical trials finder.
Look for announcements in newspapers and other media.
Search www.clinicaltrials.gov.

Why Would I Participate in a Clinical Trial?

There are many reasons why you might choose to join an Alzheimer’s or dementia clinical trial. You may want to:

Help others, including future family members, who may be at risk for Alzheimer’s disease or a related dementia
Receive regular monitoring by medical professionals
Learn about Alzheimer’s and your health
Test new treatments that might work better than those currently available
Get information about support groups and resources

What Else Should I Consider?

Consider both benefits and risks when deciding whether to volunteer for a clinical trial.

While there are benefits to participating in a clinical trial or study, there are some risks and other issues to consider as well.

What Happens When a Person Joins a Clinical Trial or Study?

What Is Informed Consent?

How Do Researchers Decide Who Will Participate?

Researchers carefully screen all volunteers to make sure they meet a study's criteria.

What Is Alzheimer's Disease?

Older woman with Alzheimer's looking out of a window

How Many Americans Have Alzheimer’s Disease?

What Does Alzheimer’s Disease Look Like?

How Long Can a Person Live with Alzheimer’s Disease?

The time from diagnosis to death varies—as little as 3 or 4 years if the person is older than 80 when diagnosed, to as long as 10 or more years if the person is younger.

Although treatment can help manage symptoms in some people, currently there is no cure for this devastating disease.

Learn more about Alzheimer's disease from MedlinePlus.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Alzheimer's Disease

How Is Alzheimer's Disease Diagnosed?

Doctor examining brain scans

To diagnose Alzheimer’s, doctors may:

Ask the person and 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
Carry out standard medical tests, such as blood and urine tests, to identify other possible causes of the problem
Perform brain scans, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET), to rule out other possible causes for symptoms

People with memory problems should return to the doctor every 6 to 12 months.

What Happens Next?

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

What Are the Benefits of Early Diagnosis?

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

In addition, an early diagnosis gives people greater opportunities to participate in clinical trials that are testing possible new treatments for Alzheimer’s disease or in other research studies.

Learn more about Alzheimer's disease from MedlinePlus.

Noticing Memory Problems? What to Do Next

Asking the same questions over and over again
Getting lost in places a person knows well
Not being able to follow directions
Becoming more confused about time, people, and places
Not taking care of oneself—eating poorly, not bathing, or being unsafe

Learn more about Alzheimer's disease from MedlinePlus.

Basics of Alzheimer’s Disease and Dementia

Frequently Asked Questions About Alzheimer's Disease

On this page:

What is the difference between Alzheimer's disease and dementia?
What are the early signs of Alzheimer's disease?
What are the stages of Alzheimer's disease?
What are the causes of Alzheimer's disease?
Is Alzheimer's disease hereditary?
Is there a cure for Alzheimer's disease?
Is there a way to prevent Alzheimer's disease?
Are there any sources of financial help for people with Alzheimer's or their caregivers?

What is the difference between Alzheimer's disease and dementia?

Learn more about Alzheimer's disease and dementia.

What are the early signs of Alzheimer's disease?

Learn more about the signs of Alzheimer's disease.

What are the stages of Alzheimer's disease?

Learn more about the stages of Alzheimer's disease.

What are the causes of Alzheimer's disease?

Learn more about the factors that influence Alzheimer's disease.

Is Alzheimer's disease hereditary?

Just because a family member has Alzheimer's disease does not mean that you will get it, too.

Learn more about assessing risk for Alzheimer's disease.

Is there a cure for Alzheimer's disease?

The U.S. Food and Drug Administration (FDA) has approved several drugs to treat the symptoms of Alzheimer's disease, and certain medicines and other approaches can help control behavioral symptoms.

Learn more about how Alzheimer's disease is treated.

Is there a way to prevent Alzheimer's disease?

Learn more about cognitive health and older adults.

Are there any sources of financial help for people with Alzheimer's or their caregivers?

Yes, there are several possible sources of help, depending on your situation. Read Paying for Care for information on government programs and other payment sources.

The following organizations also offer assistance with finding financial help:

Family Caregiver Alliance
1-800-445-8106 (toll-free)
www.caregiver.org/family-care-navigator

For More Information About Alzheimer's

Basics of Alzheimer’s Disease and Dementia Cognitive Health

Preventing Alzheimer’s Disease: What Do We Know?

Can Increasing Physical Activity Prevent Alzheimer's Disease?

older woman walking by lake with walking sticks

Until scientists know more, experts encourage exercise for its many other benefits. To learn more about exercise and physical activity for older adults, visit NIA's Go4Life campaign.

Can Controlling High Blood Pressure Prevent Alzheimer's Disease?

older man getting blood pressure checked by doctor

Can Cognitive Training Prevent Alzheimer's?

man in cap using computer with a group of people

Can Eating Certain Foods Prevent Alzheimer's Disease?

What Else Might Prevent Alzheimer's Disease?

Researchers are exploring these and other interventions that may help prevent, delay, or slow Alzheimer's dementia or age-related cognitive decline. Other research targets include:

New drugs to delay onset or slow disease progression
Diabetes treatment
Depression treatment
Blood pressure- and lipid-lowering treatments
Sleep interventions
Social engagement
Vitamins such as B12 plus folic acid supplements and D
Combined physical and mental exercises

What's the Bottom Line on Alzheimer's Prevention?

For More Information About Alzheimer's Prevention

Alzheimer's Association
1-800-272-3900 (toll-free)
1-866-403-3073 (TTY/toll-free)
info@alz.org
www.alz.org

Basics of Alzheimer’s Disease and Dementia Cognitive Health

Preventing Alzheimer’s Disease: What Do We Know?

Evaluating the Latest Prevention Research

Increased physical activity
Blood pressure control for people with high blood pressure (also called hypertension)
Cognitive training

The evidence for other interventions, such as medications and diet, was not as strong. However, scientists are continuing to explore these and other possible preventions.

Alzheimer’s Caregiving

Healthy Eating and Alzheimer's Disease

Eating healthy foods helps everyone stay well. It’s even more important for people with Alzheimer’s disease. Here are some tips for healthy eating.

bag of healthy groceries

Buying and Preparing Food

When the person with Alzheimer’s disease lives with you:

Buy healthy foods such as vegetables, fruits, and whole-grain products. Be sure to buy foods that the person likes and can eat.
Give the person choices about what to eat—for example, “Would you like green beans or salad?”
Buy food that is easy to prepare, such as premade salads and single food portions.

When a person with early-stage Alzheimer’s disease lives alone, you can buy foods that the person doesn’t need to cook. Call to remind him or her to eat.

Maintain Familiar Routines

Try these tips:

View mealtimes as opportunities for social interaction. A warm and happy tone of voice can set the mood.
Be patient and give the person enough time to finish the meal.
Respect personal, cultural, and religious food preferences, such as eating tortillas instead of bread or avoiding pork.
If the person has always eaten meals at specific times, continue to serve meals at those times.
Serve meals in a consistent, familiar place and way whenever possible.
Avoid new routines, such as serving breakfast to a person who has never routinely eaten breakfast.

Stay Safe

The person forgets to eat.
Food has burned because it was left on the stove.
The oven isn’t turned off.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Healthy Eating for a Person with Alzheimer's

Choose My Plate
www.choosemyplate.gov

Family Caregiver Alliance
1-800-445-8106 (toll-free)
info@caregiver.org
www.caregiver.org

Meals on Wheels America
1-888-998-6325 (toll-free)
info@mealsonwheelsamerica.org
www.mealsonwheelsamerica.org

Content reviewed: May 18, 2017

Featured Research

Alzheimer’s protein higher in women, may mean higher risk of symptoms

February 28, 2019

Alzheimer's Disease Neuroscience

group of women talking

This research was funded in part by NIA grants PO1AG036694, RO1AG053509, P50AG005134, K23AG049087, and K24AG035007.

Featured Research

Breakdowns in mitochondrial housekeeping provide another clue to Alzheimer’s culprit

March 13, 2019

Alzheimer's DiseaseNeuroscience

Puzzle piece illustration with mitochondria

References:

Fang EF, et al. Mitophagy inhibits Aβ and p-Tau pathologies and cognitive deficits in experimental models of Alzheimer’s disease. Nature Neuroscience. 2019;22(3):401-412.

Kingwell K. Turning up mitophagy in Alzheimer disease. Nature Reviews Drug Discovery. Published online March 4, 2019.

Featured Research

Breakdowns in mitochondrial housekeeping provide another clue to Alzheimer’s culprit

March 13, 2019

Alzheimer's DiseaseNeuroscience

Puzzle piece illustration with mitochondria

References:

Fang EF, et al. Mitophagy inhibits Aβ and p-Tau pathologies and cognitive deficits in experimental models of Alzheimer’s disease. Nature Neuroscience. 2019;22(3):401-412.

Kingwell K. Turning up mitophagy in Alzheimer disease. Nature Reviews Drug Discovery. Published online March 4, 2019.

Featured Research

Sleep loss encourages spread of toxic Alzheimer’s protein

February 12, 2019

Alzheimer's DiseaseClinical ResearchNeuroscience

From the NIH Director’s Blog by Dr. Francis Collins

The researchers went back and reanalyzed those same human samples for tau. Sure enough, the tau levels were elevated on average by about 50 percent.

References:

¹Holth JK, Fritschi SK, Wang C, et al. The sleep-wake cycle regulates brain interstitial fluid tau in mice and CSF tau in humans. Science. 2019 Jan 24. [Epub ahead of print]

Featured Research

Daytime sleepiness linked to elevated brain amyloid

October 11, 2018

Alzheimer's DiseaseCognitive HealthDementiasNeuroscience

Tired man at computer

This study was supported in part by NIA grants AG050507, AG050745, AG049872, AG050507-02S1 and NIA IRP funding.

Featured Research

Some Alzheimer's biomarkers differ by race, NIA-funded study finds

February 01, 2019

Alzheimer's DiseaseBiomarkersClinical Research

Nurse and female patient looking at a chart

This research was funded in part by NIA grants P50AG05681, P01AG03991, and P01AG026276.

References:

Morris JC, et al. Assessment of racial disparities in biomarkers for Alzheimer’s disease. JAMA Neurology. doi:10.1001/jamaneurol.2018.4249. Published online Jan. 7, 2019.

Barnes LB. Biomarkers for Alzheimer dementia in diverse racial and ethnic minorities—a public health priority. JAMA Neurology. doi:10.1001/jamaneurol.2018.3444. Published online Jan. 7, 2019.

Blood-brain barrier test may predict dementia

February 07, 2019

Alzheimer's DiseaseBiomarkersClinical ResearchDementiasNeuroscience

From NIH Research Matters

The researchers are planning to further validate these results by conducting a second trial with more participants.

This paper was funded in part by NIA grants R01AG023084, R01AG039452, P01AG052350, P50AG005142, RO1AG054434, R01AG055770, R21AG055034, P50AG05681, P01AG03991, and P01AG026276.

Can Increasing Physical Activity Prevent Alzheimer's Disease?

older woman walking by lake with walking sticks

Until scientists know more, experts encourage exercise for its many other benefits. To learn more about exercise and physical activity for older adults, visit NIA's Go4Life campaign.

Can Controlling High Blood Pressure Prevent Alzheimer's Disease?

older man getting blood pressure checked by doctor

Can Cognitive Training Prevent Alzheimer's?

man in cap using computer with a group of people

Can Eating Certain Foods Prevent Alzheimer's Disease?

What Else Might Prevent Alzheimer's Disease?

Researchers are exploring these and other interventions that may help prevent, delay, or slow Alzheimer's dementia or age-related cognitive decline. Other research targets include:

New drugs to delay onset or slow disease progression
Diabetes treatment
Depression treatment
Blood pressure- and lipid-lowering treatments
Sleep interventions
Social engagement
Vitamins such as B12 plus folic acid supplements and D
Combined physical and mental exercises

What's the Bottom Line on Alzheimer's Prevention?

For More Information About Alzheimer's Prevention

Alzheimer's Association
1-800-272-3900 (toll-free)

Talking with Older Patients About Cognitive Problems

Older woman taking an Alzheimer's questionnaire

Learn more: Assessing Cognitive Impairment in Older Patients

Cognitive Impairment

Conveying Findings

Following Up

Consider how your practice can coordinate and integrate care for the person and family across the many specialists and services that will be involved.

Learn more: Managing Older Patients with Cognitive Impairment

Working with Family Caregivers

Explain that much can be done to improve the patient's quality of life. Measures such as modifications in daily routine and medications may help control symptoms. If appropriate, bring in a palliative care consultant to help the patient with symptom management.
Let caregivers know there is time to adapt. Decline is rarely rapid. Provide information about the consumer resources and services available from local organizations, as well as support groups.
Help caregivers plan for the possibility that they eventually may need more help at home or may have to look into residential care.
Encourage caregivers to get regular respite especially when patients require constant attention. Ask if the caregiver, who is at considerable risk for stress-related disorders, is receiving adequate health care.

For More Information About Patients with Cognitive Problems

Content reviewed: May 17, 2017

Treatment of Alzheimer’s Disease

How Is Alzheimer's Disease Treated?

Older woman and her doctor having a serious conversation

Treatment for Mild to Moderate Alzheimer’s

Treatment for Moderate to Severe Alzheimer’s

The FDA has also approved Aricept®, the Exelon® patch, and Namzaric®, a combination of Namenda® and Aricept®, for the treatment of moderate to severe Alzheimer’s disease.

Drug Name	Drug Type and Use	How It Works	Common Side Effects
Aricept® (donepezil)	Cholinesterase inhibitor prescribed to treat symptoms of mild, moderate, and severe Alzheimer's	Prevents the breakdown of acetylcholine in the brain	Nausea, vomiting, diarrhea, muscle cramps, fatigue, weight loss
Exelon® (rivastigmine)	Cholinesterase inhibitor prescribed to treat symptoms of mild to moderate Alzheimer's (patch is also for severe Alzheimer's)	Prevents the breakdown of acetylcholine and butyrylcholine (a brain chemical similar to acetylcholine) in the brain	Nausea, vomiting, diarrhea, weight loss, indigestion, muscle weakness
Namenda® (memantine)	N-methyl D-aspartate (NMDA) antagonist prescribed to treat symptoms of moderate to severe Alzheimer's	Blocks the toxic effects associated with excess glutamate and regulates glutamate activation	Dizziness, headache, diarrhea, constipation, confusion
Namzaric® (memantine and donepezil)	NMDA antagonist and cholinesterase inhibitor prescribed to treat symptoms of moderate to severe Alzheimer’s	Blocks the toxic effects associated with excess glutamate and prevents the breakdown of acetylcholine in the brain	Headache, nausea, vomiting, diarrhea, dizziness, anorexia
Razadyne® (galantamine)	Cholinesterase inhibitor prescribed to treat symptoms of mild to moderate Alzheimer's	Prevents the breakdown of acetylcholine and stimulates nicotinic receptors to release more acetylcholine in the brain	Nausea, vomiting, diarrhea, decreased appetite, dizziness, headache

Drug Name	Manufacturer's Recommended Dosage	For More Information
Aricept® (donepezil)	Tablet: Initial dose of 5 mg once a day; may increase dose to 10 mg/day after 4-6 weeks if well tolerated, then to 23 mg/day after at least 3 months Orally disintegrating tablet: Same dosage as above (not available in 23 mg)	For current information about this drug's safety and use, visit www.aricept.com.
Exelon® (rivastigmine)	Capsule: Initial dose of 3 mg/day (1.5 mg twice a day); may increase dose to 6 mg/day (3 mg twice a day), 9 mg/day (4.5 mg twice a day), and 12 mg/day (6 mg twice a day) at minimum 2-week intervals if well tolerated Patch: Initial dose of 4.6 mg once a day; may increase dose to 9.5 mg once a day and 13.3 mg once a day at minimum 4-week intervals if well tolerated	For current information about this drug’s safety and use, visit the www.fda.gov/Drugs. Click on "Search Drugs@FDA," search for Exelon, and click on drug-name links to see label information.
Namenda® (memantine)	Tablet: Initial dose of 5 mg once a day; may increase dose to 10 mg/day (5 mg twice a day), 15 mg/day (5 mg and 10 mg as separate doses), and 20 mg/day (10 mg twice a day) at minimum 1-week intervals if well tolerated Oral solution: Same dosage as above Extended-release capsule*: Initial dose of 7 mg once a day; may increase dose to 14 mg/day, 21 mg/day, and 28 mg/day at minimum 1-week intervals if well tolerated	For current information about this drug's safety and use, visit www.namenda.com and www.namendaxr.com. Click on "Full Prescribing Information" to see the drug label.
Namzaric® (memantine and donepezil)	Extended-release capsule*: Initial dose of 28 mg memantine/10 mg donepezil once a day if stabilized on memantine and donepezil If stabilized on donepezil only, initial dose of 7 mg memantine/10 mg donepezil once a day; may increase dose to 28 mg memantine/10 mg donepezil in 7 mg increments at minimum 1-week intervals if well tolerated Only 14 mg memantine/10 mg donepezil and 28 mg memantine/10 mg donepezil available as generic	For current information about this drug’s safety and use, visit www.namzaric.com. Click on “Full Prescribing Information” to see the drug label.
Razadyne® (galantamine)	Tablet: Initial dose of 8 mg/day (4 mg twice a day); may increase dose to 16 mg/day (8 mg twice a day) and 24 mg/day (12 mg twice a day) at minimum 4-week intervals if well tolerated Extended-release capsule: Same dosage as above but taken once a day	For current information about this drug’s safety and use, visit www.janssenmd.com/razadyne. Click on "Full Prescribing Information" to see the drug label.

* Available as a generic drug.

Dosage and Side Effects

Managing Behavior

Examples of medicines used to help with depression, aggression, restlessness, and anxiety include:

Celexa® (citalopram)
Remeron® (mirtazapine)
Zoloft® (sertraline)
Wellbutrin® (bupropion)
Cymbalta® (duloxetine)
Tofranil® (imipramine)

Experts agree that medicines to treat these behavior problems should be used only after other strategies that don’t use medicine have been tried.

Medicines to Be Used with Caution

There are some medicines, such as sleep aids, anti-anxiety drugs, anticonvulsants, and antipsychotics, that a person with Alzheimer’s disease should take only:

After the doctor has explained all the risks and side effects of the medicine
After other, safer non-medication options have not helped treat the problem

You will need to watch closely for side effects from these medications.

Ambien® (zolpidem)
Lunesta® (eszopiclone)
Sonata® (zaleplon)

Ativan® (lorazepam)
Klonopin® (clonazepam)

Anticonvulsants are drugs sometimes used to treat severe aggression. Side effects may cause sleepiness, dizziness, mood swings, and confusion. Examples of these medicines include:

Depakote® (sodium valproate)
Tegretol® (carbamazepine)
Trileptal® (oxcarbazepine)

Risperdal® (risperidone)
Seroquel® (quetiapine)
Zyprexa® (olanzapine)

Looking for New Treatments

Learn more about Alzheimer's disease from MedlinePlus.

Read about this topic in Spanish. Lea sobre esta tema en español.

For More Information About Treating Alzheimer's

Eldercare Locator
1-800-677-1116 (toll-free)

Treatment

Treatment of Alzheimer’s Disease

Early-Onset Alzheimer's Disease: A Resource List

Older mon looking sad

The items on this list are organized by these categories:

General Resources
Living with Early-Onset Alzheimer’s
Legal and Financial Planning
Caregiving
Clinical Studies and Trials

General Resources

Alzheimer’s Disease Genetics Fact Sheet (2011)

Published by the NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center. Phone: 1-800-438-4380. Email: adear@nia.nih.gov.

Early-Onset Alzheimer’s Disease

Published by Johns Hopkins Medicine.

Early-Onset Alzheimer's: When Symptoms Begin Before Age 65 (2014)

Published by the Mayo Foundation for Medical Education and Research.

Early Onset Familial AD

Published by Alzforum.

Early-Onset Familial Alzheimer Disease (2012)

Available from the National Center for Biotechnology Information, National Library of Medicine.

What You Should Know About Early-Onset Alzheimer’s (2015)

Published by Health.com.

Younger/Early Onset Alzheimer's & Dementia

This web page briefly explains the disorder, providing information about diagnosis, causes, and sources of help.

Published by the Alzheimer’s Association. Phone: 1-800-272-3900. Email: info@alz.org.

Younger-Onset Dementia: An Overview (2013, 2 p.)

Published by Alzheimer’s Australia.

Living with Early-Onset Alzheimer’s

If You Have Younger-Onset Alzheimer’s Disease

Published by the Alzheimer’s Association. Phone: 1-800-272-3900. Email: info@alz.org.

Young Onset Dementia

Published by Alzheimer’s Society Canada. Phone: 1-800-616-8816. Email: info@alzheimer.ca.

HealthCare.gov

Available from the U.S. Department of Health and Human Services. Phone: 1-800-318-2596.

Legal and Financial Planning

Legal and Financial Planning for People with Alzheimer's

Published by the NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center. Phone: 1-800-438-4380. Email: adear@nia.nih.gov.

Social Security Compassionate Allowances Program

Published by the Social Security Administration. Phone: 1-800-772-1213. Email: compassionate.allowances@ssa.gov.

Caregiving

Alzheimer's Caregiving Information from the National Institute on Aging

Get Alzheimer’s care information and advice from NIA, including information on daily care, sundowning and other behaviors, and more.

Published by the NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center. Phone: 1-800-438-4380. Email: adear@nia.nih.gov.

Early Onset Dementia: Advice for Caregivers

Published by the National Initiative for the Care of the Elderly (Canada).

Clinical Studies and Trials

Participating in Alzheimer’s Disease Research

Learn what’s involved in volunteering for Alzheimer’s research. Read about benefits and risks, questions to ask, participant safety, and placebos.

Published by the NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center. Phone: 1-800-438-4380. Email: adear@nia.nih.gov.

Dominantly Inherited Alzheimer Network (DIAN)

To search for more clinical studies and trials, visit NIA's clinical trials finder.

Content reviewed: June 27, 2017

HEALTHY AGING

Healthy Aging

What Do We Know About Healthy Aging?

On this page:

Get Moving: Exercise and Physical Activity

For more information about how to get started and stick with an exercise and physical activity program, visit Go4Life, NIA’s exercise and physical activity campaign for adults 50+.

Pay Attention to Weight and Shape

Learn more about maintaining a healthy weight.

Healthy Food for Thought: Think About What You Eat

Learn more about healthy eating and smart food choices for healthy aging.

Participate in Activities You Enjoy

Granddaughter and grandfather gardening

Other studies have found that older adults who participate in what they see as meaningful activities, like volunteering in their community, reported feeling healthier and happier.

Learn more about participating in activities you enjoy.

For more information on healthy aging, search our A-Z Health Topics.

Content reviewed: June 25, 2018

Balance Problems and Disorders

Have you ever felt dizzy, lightheaded, or as if the room were spinning around you? These can be troublesome sensations. If the feeling happens often, it could be a sign of a balance problem.

Causes of Balance Problems

People are more likely to have problems with balance as they get older. But age is not the only reason these problems occur. In some cases, you can help reduce your risk for certain balance problems.

Symptoms of Balance Disorders

If you have a balance disorder, you may stagger when you try to walk, or teeter or fall when you try to stand up. You might experience other symptoms such as:

Older woman using a walker on a sidewalk

Dizziness or vertigo (a spinning sensation)
Falling or feeling as if you are going to fall
Lightheadedness, faintness, or a floating sensation
Blurred vision
Confusion or disorientation

Do I Have a Balance Problem? Questions to Ask Yourself

You can help identify a balance problem by asking yourself some key questions. If you answer "yes" to any of these questions, discuss the symptom with your doctor.

Do I feel unsteady?
Do I feel as if the room is spinning around me, even only for brief periods of time?
Do I feel as if I'm moving when I know I'm standing or sitting still?
Do I lose my balance and fall?
Do I feel as if I'm falling?
Do I feel lightheaded, or as if I might faint?
Does my vision become blurred?
Do I ever feel disoriented, losing my sense of time, place, or identity?

Coping with a Balance Disorder

Read about this topic in Spanish. Lea sobre este tema en español.

Prevent Falls and Fractures

If you or an older person you know has fallen, you're not alone. More than one in three people age 65 years or older falls each year. The risk of falling—and fall-related problems—rises with age.

Many Older Adults Fear Falling

Causes and Risk Factors for Falls

Older man using a walker to prevent falls

Some medications can increase a person's risk of falling because they cause side effects like dizziness or confusion. The more medications you take, the more likely you are to fall.

Take the Right Steps to Prevent Falls

Stay physically active. Plan an exercise program that is right for you. Regular exercise improves muscles and makes you stronger. It also helps keep your joints, tendons, and ligaments flexible. Mild weight-bearing activities, such as walking or climbing stairs, may slow bone loss from osteoporosis.
Have your eyes and hearing tested. Even small changes in sight and hearing may cause you to fall. When you get new eyeglasses or contact lenses, take time to get used to them. Always wear your glasses or contacts when you need them If you have a hearing aid, be sure it fits well and wear it.
Find out about the side effects of any medicine you take. If a drug makes you sleepy or dizzy, tell your doctor or pharmacist.
Get enough sleep. If you are sleepy, you are more likely to fall.
Limit the amount of alcohol you drink. Even a small amount of alcohol can affect your balance and reflexes. Studies show that the rate of hip fractures in older adults increases with alcohol use.
Stand up slowly. Getting up too quickly can cause your blood pressure to drop. That can make you feel wobbly. Get your blood pressure checked when lying and standing.
Use an assistive device if you need help feeling steady when you walk. Appropriate use of canes and walkers can prevent falls. If your doctor tells you to use a cane or walker, make sure it is the right size for you and the wheels roll smoothly. This is important when you're walking in areas you don't know well or where the walkways are uneven. A physical or occupational therapist can help you decide which devices might be helpful and teach you how to use them safely.
Be very careful when walking on wet or icy surfaces. They can be very slippery! Try to have sand or salt spread on icy areas by your front or back door.
Wear non-skid, rubber-soled, low-heeled shoes, or lace-up shoes with non-skid soles that fully support your feet. It is important that the soles are not too thin or too thick. Don't walk on stairs or floors in socks or in shoes and slippers with smooth soles.
Always tell your doctor if you have fallen since your last checkup, even if you aren't hurt when you fall. A fall can alert your doctor to a new medical problem or problems with your medications or eyesight that can be corrected. Your doctor may suggest physical therapy, a walking aid, or other steps to help prevent future falls.

What to Do If You Fall

Whether you are at home or somewhere else, a sudden fall can be startling and upsetting. If you do fall, stay as calm as possible.

Take several deep breaths to try to relax. Remain still on the floor or ground for a few moments. This will help you get over the shock of falling.

Decide if you are hurt before getting up. Getting up too quickly or in the wrong way could make an injury worse.

If you think you can get up safely without help, roll over onto your side. Rest again while your body and blood pressure adjust. Slowly get up on your hands and knees, and crawl to a sturdy chair.

If you are hurt or cannot get up on your own, ask someone for help or call 911. If you are alone, try to get into a comfortable position and wait for help to arrive.

Keep Your Bones Strong to Prevent Falls

Osteoporosis is a disease that makes bones weak and more likely to break. For people with osteoporosis, even a minor fall may be dangerous. Talk to your doctor about osteoporosis.

Learn how to fall-proof your home.

Read about this topic in Spanish. Lea sobre este tema en español.

Talking with Your Doctor

Fall-Proofing Your Home

Fall hazards in the home, including a scatter rug, dog, and empty slippers

In Stairways, Hallways, and Pathways

Have handrails on both sides of the stairs, and make sure they are tightly fastened. Hold the handrails when you use the stairs, going up or down. If you must carry something while you're on the stairs, hold it in one hand and use the handrail with the other. Don't let what you're carrying block your view of the steps.
Make sure there is good lighting with light switches at the top and bottom of stairs and on each end of a long hall. Remember to use the lights!
Keep areas where you walk tidy. Don't leave books, papers, clothes, and shoes on the floor or stairs.
Check that all carpets are fixed firmly to the floor so they won't slip. Put no-slip strips on tile and wooden floors. You can buy these strips at the hardware store.
Don't use throw rugs or small area rugs.

In Bathrooms and Powder Rooms

Mount grab bars near toilets and on both the inside and outside of your tub and shower.
Place non-skid mats, strips, or carpet on all surfaces that may get wet.
Remember to turn on night lights.

In Your Bedroom

Put night lights and light switches close to your bed.
Keep a flashlight by your bed in case the power is out and you need to get up.
Keep your telephone near your bed.

In Other Living Areas

Keep electric cords and telephone wires near walls and away from walking paths.
Secure all carpets and large area rugs firmly to the floor.
Arrange your furniture (especially low coffee tables) and other objects so they are not in your way when you walk.
Make sure your sofas and chairs are the right height for you to get in and out of them easily.
Don't walk on newly washed floors—they are slippery.
Keep items you use often within easy reach.
Don't stand on a chair or table to reach something that's too high—use a "reach stick" instead or ask for help. Reach sticks are special grabbing tools that you can buy at many hardware or medical-supply stores. If you use a step stool, make sure it is steady and has a handrail on top. Have someone stand next to you.
Don't let your cat or dog trip you. Know where your pet is whenever you're standing or walking.
Keep emergency numbers in large print near each telephone.

Your Own Medical Alarm

Home Improvements Prevent Falls

Read more about falls and falls prevention.

Read about this topic in Spanish. Lea sobre este tema en español.

Tips on Discussing Sensitive Topics with Your Doctor

On this page:

Illustration of a doctor and patient talking to each other

Alcohol

Falling and Fear of Falling

Feeling Unhappy with Your Doctor

Grief, Mourning, and Depression

There is no right or wrong way to grieve. Read how you can take care of yourself while you are mourning the death of a spouse.

Read more about depression in older adults.

HIV/AIDS

Incontinence

Learn more about bladder health.

Memory Problems

Problems with Family

Even strong and loving families can have problems, especially under the stress of illness. Although family problems can be painful to discuss, talking about them can help your doctor help you.

Learn more about how to recognize elder abuse.

Sexuality

Learn more about how growing older might affect your sex life.

For More Information to Help You Discuss Sensitive Subjects with Your Doctor

National Center on Elder Abuse
1-855-500-3537 (toll-free)
ncea-info@aoa.hhs.gov
https://ncea.acl.gov

National Institute on Alcohol Abuse and Alcoholism
National Institutes of Health
1-888-696-4222
niaaaweb-r@exchange.nih.gov
www.niaaa.nih.gov

Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE)
1-212-741-2247
info@sageusa.org
www.sageusa.org

Online Health Information: Is It Reliable?

On this page:

Many older adults share a common concern: “How can I trust the health information I find on the Internet?”

2 older men looking for health information online

Where Can I Find Reliable Health Information Online?

The National Institutes of Health website is a good place to start for reliable health information.

Questions to Ask Before Trusting a Website

1. Who sponsors/hosts the website? Is that information easy to find?

.gov identifies a U.S. government agency
.edu identifies an educational institution, like a school, college, or university
.org usually identifies nonprofit organizations (such as professional groups; scientific, medical, or research societies; advocacy groups)
.com identifies commercial websites (such as businesses, pharmaceutical companies, and sometimes hospitals)

2. Who wrote the information? Who reviewed it?

Is the health information written or reviewed by a healthcare professional? Dependable websites will tell you where their health information came from and how and when it was reviewed.

No information should replace seeing a doctor or other health professional who can give you advice that caters to your specific situation.

3. When was the information written?

4. What is the purpose of the site?

5. Is your privacy protected? Does the website clearly state a privacy policy?

6. How can I protect my health information?

These precautions can help better protect your information:

Use common sense when browsing the Internet. Do not open unexpected links. Hover your mouse over a link to confirm that clicking it will take you to a reputable website.
Use a strong password. Include a variation of numbers, letters, and symbols. Change it frequently.
Use two-factor authentication when you can. This requires the use of two different types of personal information to log into your mobile devices or accounts.
Do not enter sensitive information over public Wi-Fi that is not secure. This includes Wi-Fi that is not password protected.

Be careful what information you share over social media sites. This can include addresses, phone numbers, and email addresses. Learn how you can keep your information private.

7. Does the website offer quick and easy solutions to your health problems? Are miracle cures promised?

Health and Medical Apps

Social Media and Health Information

Check the source of the information, and make sure the author is credible. Fact-checking websites can also help you figure out if a story is reliable.

A Quick Checklist

You can use the following checklist to help make sure that the health information you are reading online can be trusted. You might want to keep this checklist by your computer.

Is the sponsor/owner of the website a Federal agency, medical school, or large professional or nonprofit organization, or is it related to one of these?
If not sponsored by a Federal agency, medical school, or large professional or nonprofit organization, is the website written by a healthcare professional or does it reference one of these trustworthy sources for its health information?
Why was the site created? Is the mission or goal of the website sponsor clear?
Can you see who works for the agency or organization and who authored the information? Is there a way to contact the sponsor of the website?
When was the information written or webpage last updated?
Is your privacy protected?
Does the website offer unbelievable solutions to your health problem(s)? Are quick, miracle cures promised?

Trust Yourself and Talk to Your Doctor

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Reliable Health Websites

Centers for Medicare & Medicaid Services
1-800-633-4227 (toll-free)
1-877-486-2048 (TTY/toll-free)
www.medicare.gov

Centers for Disease Control and Prevention (CDC)
1-800-232-4636 (toll-free)
1-888-232-6348 (TTY/toll-free)
cdcinfo@cdc.gov

U.S. Food and Drug Administration
1-888-463-6332 (toll-free)
druginfo@fda.hhs.gov
www.fda.gov

Content reviewed: October 31, 2018

Healthy Eating

Sample Menus: Healthy Eating for Older Adults

Learn more about healthy food choices for healthy aging:

Shopping for Food That's Good for You

Serving and Portion Sizes: How Much Should I Eat?

10 Tips for Eating Healthy on a Budget

Sample Menu 1
Breakfast	Lunch
Breakfast burrito 1 flour tortilla (8-inch diameter) 1 scrambled egg 1/3 cup black beans 2 tablespoons salsa 1/2 large grapefruit 1 cup water, coffee, or tea	Roast beef sandwich 1 small whole-grain hoagie bun 2 ounces lean roast beef 1 slice part-skim mozzarella cheese 2 slices tomato 1/4 cup mushrooms (cooked in 1 teaspoon corn/canola oil) 1 teaspoon mustard Baked potato wedges 1 cup potato wedges (cooked in 1 teaspoon canola oil) 1 tablespoon ketchup 1 cup fat-free milk
Dinner	Snack
Baked salmon on beet greens 4 ounce salmon filet 1 teaspoon olive oil 2 teaspoons lemon juice 1/3 cup cooked beet greens (cooked in 2 teaspoons canola oil) Quinoa with almonds 1/2 cup quinoa 1/2 cup silvered almonds 1 cup fat-free milk	1 cup cantaloupe balls

Sample Menu 2
Breakfast	Lunch
Whole wheat French toast 2 slices whole wheat bread 3 tablespoons fat-free milk 2/3 egg 2 teaspoons tub margarine 1 tablespoon pancake syrup 1/2 large grapefruit 1 cup fat-free milk	3-bean vegetarian chili on baked potato 1/4 cup each cooked kidney beans, navy beans, and black beans 1/2 cup tomato sauce 1/4 cup chopped onion 2 tablespoons chopped jalapeno peppers 1 teaspoon corn/canola oil (to cook onion and peppers) 1/4 cup cheese sauce 1 large baked potato 1/2 cup cantaloupe 1 cup water, coffee, or tea
Dinner	Snack
Hawaiian pizza 2 slices cheese pizza, thin crust 1 ounce lean ham 1/4 cup pineapple 1/4 cup mushrooms, cooked in 1 teaspoon safflower oil Green salad 1 cup mixed salad greens 4 teaspoons oil and vinegar dressing 1 cup fat-free milk	3 tablespoon hummus 5 whole wheat crackers

Sample Menu 3
Breakfast	Lunch
Cold cereal 1 cup shredded wheat 1/2 cup sliced banana 1/2 cup fat-free milk 1 slice whole wheat toast 2 teaspoons all-fruit preserves 1 cup fat-free chocolate milk	Tuna salad sandwich 2 slices rye bread 2 ounces tuna 1 tablespoon mayonnaise 1 tablespoon chopped celery 1/2 cup shredded lettuce 1 medium peach 1 cup fat-free milk
Dinner	Snack
Roasted chicken 3 ounces cooked chicken breast 1 large sweet potato, roasted 1/2 cup succotash (lima beans & corn) 1 teaspoon tub margarine 1 ounce whole wheat roll 1 teaspoon tub margarine 1 cup water, coffee, or tea	1/4 cup dried apricots 1 cup flavored yogurt (chocolate)

Sample Menu 4
Breakfast	Lunch
Creamy oatmeal (cooked in milk) 1/2 cup uncooked oatmeal 1 cup fat-free milk 2 tablespoons raisins 2 teaspoons brown sugar 1 cup orange juice 2 teaspoons all-fruit preserves 1 cup fat-free chocolate milk	Taco salad 2 ounces tortilla chips 2 ounces cooked ground turkey (cooked in 2 teaspoons corn oil) 1/4 cup kidney beans 1/2 ounce low-fat cheddar cheese 1/2 cup chopped lettuce 1/2 cup avocado 1 teaspoon lime juice (on avocado) 2 tablespoons salsa 1 cup water, coffee, or tea
Dinner	Snack
Spinach lasagna roll-ups 1 cup lasagna noodles (2 ounces dry) 1/2 cup cooked spinach 1/2 cup ricotta cheese 1 ounce part-skim mozzarella cheese 1/2 cup tomato sauce 1 ounce whole wheat roll 1 teaspoon tub margarine 1 cup fat-free milk	2 tablespoons raisins 1 ounce unsalted almonds

Download sample menus (PDF, 117K)

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on Healthy Eating Plans

Choose My Plate
www.choosemyplate.gov

USDA Food and Nutrition Information Center
National Agricultural Library
1-301-504-5414
fnic@ars.usda.gov
www.nal.usda.gov/fnic

USDA Center for Nutrition Policy and Promotion
1-703-305-7600
www.cnpp.usda.gov

Healthy Eating

Food Safety

On this page:

Avoid Getting Sick From Your Food
Food Safety When Cooking
Food Safety When Eating Out

Avoid Getting Sick From Your Food

Some foods can be dangerous for an older person no matter what—so, if you are over 65, the U.S. Department of Agriculture recommends you avoid:

Raw or undercooked fish, shellfish, meat, and poultry
Refrigerated smoked fish (for example, lox)
Hot dogs, deli meats, and luncheon meats (unless these are reheated to 165 °F)
Raw or unpasteurized milk and milk products
Soft cheeses made from unpasteurized milk, including feta, brie, camembert, blue, and queso fresco
Raw or undercooked eggs or egg product, as found in cookie dough, eggnog, and some salad dressings
Raw sprouts
Unwashed fresh vegetables, including lettuce
Unpasteurized juice from fruits and vegetables

Changing Taste and Smell

Smart Storage

Try to use refrigerated leftovers within 3 or 4 days to reduce your risk of food poisoning. Throw away foods older than that or those that show moldy areas.

For recommended refrigerator and freezer storage times for common foods, download our Storing Cold Food tip sheet (PDF, 75K).

Food Safety When Cooking

When preparing foods, follow four basic steps—clean, separate, cook, and chill.

Clean

Keep your refrigerator clean, especially the vegetable and meat bins. When there is a spill, use hot soapy water to clean it up.

Separate

Cook

Bring sauces, marinades, soups, and gravy to a boil when reheating.

U.S. Department of Agriculture-Recommended Safe Minimum Internal Temperatures
Type of Food	Minimum Internal Temperature
All meats and seafood	145°F (with a 3-minute rest time)
All ground meats	160°F
Egg dishes	160°F
All poultry	165°F
Hot dogs and luncheon meats	165°F

No matter what temperature you set your oven at, the temperature inside your food needs to reach the level shown here to be safe.

Chill

Food Safety When Eating Out

It's nice to take a break from cooking or get together with others for a meal at a restaurant. But, do you think about food safety when you eat out? You should.

Pick a place that looks clean.
If your city or state requires restaurants to post a cleanliness rating near the front door, check it out.
Don't be afraid to ask the waiter or waitress how items on the menu are prepared. For example, could you have the tuna cooked well instead of seared? Or, if you find out the Caesar salad dressing is made with raw eggs, ask for another salad dressing.
Consider avoiding buffets. Sometimes food in buffets sits out for a while and might not be kept at the proper temperature—whether hot or cold.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on Food Safety

National Association of Nutrition and Aging Services Programs
1-202-682-6899
www.nanasp.org

USDA Food and Nutrition Information Center
National Agricultural Library
1-301-504-5414
fnic@ars.usda.gov
www.nal.usda.gov/fnic

Healthy Eating

Vitamins and Minerals

Vitamins

Vitamins and minerals are measured in a variety of ways. The most common are:

mg – milligram
mcg – microgram
IU – international unit

Minerals

Vitamin and Mineral Supplements for People Over Age 50
Vitamin D	If you are age 50–70, you need at least 600 IU, but not more than 4,000 IU. If you are age 70 and older, you need at least 800 IU, but not more than 4,000 IU. You can get vitamin D from fatty fish, fish-liver oils, fortified milk and milk products, and fortified cereals.
Vitamin B6	Men need 1.7 mg every day. Women need 1.5 mg every day. You can get vitamin B6 from fortified cereals, whole grains, organ meats like liver, and fortified soy-based meat substitutes.
Vitamin B12	You need 2.4 mcg every day. Some people over age 50 have trouble absorbing the vitamin B12 found naturally in foods, so make sure you get enough of the supplement form of this vitamin, such as from fortified foods. You can get vitamin B12 from fortified cereals, meat, fish, poultry, and milk.
Folate	You need 400 mcg each day. Folic acid is the form used to fortify grain products or added to dietary supplements. You can get folate from dark-green leafy vegetables like spinach, beans and peas, fruit like oranges and orange juice, and folic acid from fortified flour and fortified cereals.

Calcium

There are several types of calcium supplements. Calcium citrate and calcium carbonate tend to be the least expensive.

Calcium for People Over 50
Women age 51 and older	Men age 51 to 70	Men age 71 and older
1,200 mg each day	1,000 mg each day	1,200 mg each day
Women and men age 51 and older: Don’t take more than 2,000 mg of calcium in a day.

Sodium

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on Vitamins and Minerals

Office of Dietary Supplements
National Institutes of Health
1-301-435-2920
ods@nih.gov
www.ods.od.nih.gov

Healthy Eating

DASH Eating Plan

A number of major research studies have shown that following the Dietary Approaches to Stop Hypertension (DASH) Plan can lower blood pressure.

Quinoa salad with black beans and vegetables

DASH Plan Recommendations for Several Daily Calorie Count Examples
	1,600 calories	2,000 calories	2,600 calories
Grains	6 servings	6-8 servings	10-11 servings
Fruits	4 servings	4-5 servings	5-6 servings
Vegetables	3-4 servings	4-5 servings	5-6 servings
Fat-free or low-fat milk and milk products	2-3 servings	2-3 servings	3 servings
Lean meat, poultry, and fish	3-4 ounces or less	6 ounces or less	6 ounces or less
Nuts, seeds, and legumes	3-4 servings per week	4-5 servings per week	1 serving per day
Fats and oils	2 servings	2-3 servings	3 servings
Sweets and added sugars	3 servings or less per week	5 servings or less per week	less than 2 servings per day

DASH is organized by servings for most food groups. A DASH serving equals:

Grains—one ounce or equivalent

Fruits—half cup cut-up fruit or equivalent

Vegetables—half cup cooked vegetables or equivalent

Meats, poultry, and fish—one ounce cooked meats, poultry, or fish or one egg

Nuts, seeds, and legumes—foods like two tablespoons peanut butter, third cup or 1-1/2 ounces of nuts, half cup cooked beans, or one cup bean soup

Fats and oils—one teaspoon soft margarine or vegetable oil, one tablespoon mayonnaise, and one tablespoon regular salad dressing or two tablespoons low-fat dressing

Sugars—one tablespoon jam or jelly, half cup regular Jell-O, or one cup regular lemonade

Learn more about the food groups.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on the DASH Eating Plan

National Heart, Lung, and Blood Institute
1-301-592-8573
nhlbiinfo@nhlbi.nih.gov
www.nhlbi.nih.gov

Content reviewed: June 29, 2017

Healthy Eating

Getting Enough Fluids

It’s important for your body to have plenty of fluids each day. Water helps you digest your food, absorb nutrients, and then get rid of the unused waste.

Grandmother drinking water with her grandson

With age, some people may lose their sense of thirst. To further complicate matters, some medicines might make it even more important to have plenty of fluids.

Drinking enough fluids every day also is essential. Check with your doctor, however, if you’ve been told to limit how much you drink.

Try these tips for getting enough fluids:

Try to add liquids throughout the day.
Take sips from a glass of water, milk, or juice between bites during meals.
Have a cup of low-fat soup as an afternoon snack.
Drink a full glass of water if you need to take a pill.
Have a glass of water before you exercise or go outside to garden or walk, especially on a hot day.
Remember, water is a good way to add fluids to your daily routine without adding calories.
Drink fat-free or low-fat milk, or other drinks without added sugars.
If you drink alcoholic beverages, do so sensibly and in moderation. That means up to one drink per day for women and up to two drinks for men.
Don’t stop drinking liquids if you have a urinary control problem. Talk with your doctor about treatment.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on Fluids and Nutrition

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
1-800-860-8747 (toll-free)
1-866-569-1162 (TTY/toll-free)
healthinfo@niddk.nih.gov
www.niddk.nih.gov

National Heart, Lung, and Blood Institute
(Instituto Nacional del Corazón, los Pulmones y la Sangre)
1-301-592-8573
nhlbiinfo@nhlbi.nih.gov
www.nhlbi.nih.gov

National Association of Nutrition and Aging Services Programs
1-202-682-6899
www.nanasp.org

President’s Council on Fitness, Sports, and Nutrition
1-240-276-9567
fitness@hhs.gov
www.fitness.gov

Content reviewed: June 09, 2017

Most Searched Diseases & Conditions

Related Centers & Programs

CDC Home

Popular Health Links

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Dementia, Memory Loss, & Healthy Aging

Forgetfulness and Brain Diseases

Do Memory Problems Always Mean Alzheimer's Disease?

Many people worry about becoming forgetful. They think forgetfulness is the first sign of Alzheimer's disease. But not all people with memory problems have Alzheimer's.

Other causes for memory problems can include aging, medical conditions, emotional problems, mild cognitive impairment, or another type of dementia.

Age-Related Changes in Memory

Differences Between Normal Aging and Alzheimer's Disease
Normal Aging	Alzheimer's Disease
Making a bad decision once in a while	Making poor judgments and decisions a lot of the time
Missing a monthly payment	Problems taking care of monthly bills
Forgetting which day it is and remembering it later	Losing track of the date or time of year
Sometimes forgetting which word to use	Trouble having a conversation
Losing things from time to time	Misplacing things often and being unable to find them

Memory Loss Related to Medical Conditions

Certain medical conditions can cause serious memory problems. These problems should go away once a person gets treatment. Medical conditions that may cause memory problems include:

Tumors, blood clots, or infections in the brain
Some thyroid, kidney, or liver disorders
Drinking too much alcohol
Head injury, such as a concussion from a fall or accident
Medication side effects
Not eating enough healthy foods, or too few vitamins and minerals in a person's body (like vitamin B12)

A doctor should treat serious medical conditions like these as soon as possible.

Memory Loss Related to Emotional Problems

Read about this topic in Spanish. Lea sobre este tema en español.

Cognitive Health

Memory and Thinking: What's Normal and What's Not?

Talk with your doctor to determine if memory and other thinking problems are normal or not, and what is causing them.

What's Normal and What's Not?

What's the difference between normal, age-related forgetfulness and a serious memory problem? Serious memory problems make it hard to do everyday things like driving and shopping. Signs may include:

Asking the same questions over and over again
Getting lost in familiar places
Not being able to follow instructions
Becoming confused about time, people, and places

Mild Cognitive Impairment

Signs of MCI include:

Losing things often
Forgetting to go to important events or appointments
Having more trouble coming up with desired words than other people of the same age

Dementia

Differences Between Normal Aging and Alzheimer's Disease
Normal Aging	Alzheimer's Disease
Making a bad decision once in a while	Making poor judgments and decisions a lot of the time
Missing a monthly payment	Problems taking care of monthly bills
Forgetting which day it is and remembering it later	Losing track of the date or time of year
Sometimes forgetting which word to use	Trouble having a conversation
Losing things from time to time	Misplacing things often and being unable to find them

When to Visit the Doctor

If you, a family member, or friend has problems remembering recent events or thinking clearly, talk with a doctor. He or she may suggest a thorough checkup to see what might be causing the symptoms

The annual Medicare wellness visit includes an assessment for cognitive impairment. This visit is covered by Medicare for patients who have had Medicare Part B insurance for at least 1 year.

Dementia and Memory Loss

What Is Dementia?

Older woman with glasses wearing a sari

Learn more about dementia from MedlinePlus.

Read about this topic in Spanish. Lea sobre esta tema en español.

For More Information About Dementia

Types of Dementia

Hispanic man with dementia sitting in a park

Alzheimer's disease
Frontotemporal disorders
Lewy body dementia

Other types of progressive brain disease include:

Vascular contributions to cognitive impairment and dementia
Mixed dementia, a combination of two or more types of dementia

In addition, certain medical conditions can cause serious memory problems that resemble dementia. These problems should go away once the conditions are treated. These conditions include:

Side effects of certain medicines
Emotional problems, such as stress, anxiety, or depression
Certain vitamin deficiencies
Drinking too much alcohol
Blood clots, tumors, or infections in the brain
Delirium
Head injury, such as a concussion from a fall or accident
Thyroid, kidney, or liver problems

Doctors have identified many other conditions that can cause dementia or dementia-like symptoms. These conditions include:

Argyrophilic grain disease, a common, late-onset degenerative disease
Creutzfeldt-Jakob disease, a rare brain disorder
Huntington's disease, an inherited, progressive brain disease
Chronic traumatic encephalopathy (CTE), caused by repeated traumatic brain injury
HIV-associated dementia (HAD)

Learn more about dementia from MedlinePlus.

Read about this topic in Spanish. Lea sobre esta tema en español.

For More Information About Types of Dementia

National Institute of Neurological Disorders and Stroke
1-800-352-9424 (toll-free)
braininfo@ninds.nih.gov
www.ninds.nih.gov

What Is Mixed Dementia?

For More Information About Mixed Dementia

Content reviewed: December 31, 2017

Biomarkers for Dementia Detection and Research

On this page:

What Are Biomarkers?

Types of Biomarkers and Tests

Brain Imaging

male medical technician with older woman about to get brain imaging test

Computerized Tomography

What is it?

CT scanner

What's the procedure like?

During a CT, a person lies in a scanner for 10 to 20 minutes. A donut-shaped device moves around the head to produce the image.

What does it show?

A head CT can show shrinkage of brain regions that may occur in dementia, as well as signs of a stroke or tumor.

When is it used?

Magnetic Resonance Imaging

What is it?

Doctor talking with patient before MRI

What's the procedure like?

Because MRI uses strong magnetic fields to obtain images, people with certain types of metal in their bodies, such as a pacemaker, surgical clips, or shrapnel, cannot undergo the procedure.

What does it show?

When is it used?

Positron Emission Tomography

What is it?

Examples of brain imaging scans from PET, CT, MRI

What's the procedure like?

The amount of radiation exposure during a PET scan is relatively low. People who are concerned about radiation exposure or who have had many x rays or imaging scans should talk with their doctor.

What does it show?

When is it used?

Cerebrospinal Fluid Biomarkers

Lumbar Puncture

What is it?

CSF is obtained by a lumbar puncture, also called a spinal tap, an outpatient procedure used to diagnose several types of neurological problems.

What's the procedure like?

What does it show?

When is it used?

In research, CSF biomarkers are valuable tools for early detection of a neurodegenerative disease. They are also used in clinical trials to assess the impact of experimental medications.

Other Types of Biomarkers

Blood Tests

Many other proteins, lipids, and other substances can be measured in the blood, but so far none has shown value in diagnosing Alzheimer's.

Currently, dementia researchers use blood biomarkers to study early detection, prevention, and the effects of potential treatments. They are not used in doctors' offices and other clinical settings.

Genetic Testing

Read more about Alzheimer's disease genetics.

Biomarkers in Development

Biomarkers in Dementia Diagnosis

Read more about diagnosing dementia.

Biomarkers in Dementia Research

In addition, biomarker measures may help researchers:

Better understand how risk factors and genetic variants are involved in Alzheimer's disease
Identify participants who meet particular requirements, such as having certain genes or amyloid levels, for clinical trials and studies
Track study participants' responses to a test drug or other intervention, such as physical exercise

Read about the new NIA-AA Research Framework focusing on biomarkers to help define and study Alzheimer's disease.

The Future of Biomarkers

Developing and validating a full range of biomarkers, particularly those that are less expensive and/or less invasive, to help test drugs that may prevent, treat, and improve diagnosis of Alzheimer's and related dementias
Advancing the use of novel PET imaging, CSF, and blood biomarkers to identify specific changes in the brain related to Alzheimer's and other neurodegenerative dementias
Using new MRI methods to measure brain structure, function, and connections
Developing and refining sensitive clinical and neuropsychological assessments to help detect and track early-stage disease
Using biomarkers in combination to build a model of Alzheimer's disease progression over decades, from its earliest, presymptomatic stage through dementia

How You Can Help

Learn more about participating in clinical research.

To find clinical trials and studies on Alzheimer's and related dementias, visit:

NIA Alzheimer's and Related Dementias Clinical Trials Finder
National Institute of Neurological Disorders and Stroke
Alzheimer's Disease Neuroimaging Initiative (ADNI)
National Institutes of Health

For More Information About Dementia Biomarkers

Content reviewed: April 01, 2018

Dementia Research and Clinical Trials

Common Questions About Participating in Alzheimer's and Related Dementias Research

How Can I Find Out About Alzheimer’s Trials and Studies?

Check the resources below:

Ask your doctor, who may know about local research studies that may be right for you.
Sign up for a registry or a matching service to be invited to participate in studies or trials when they are available in your area.
Contact Alzheimer’s research centers or memory or neurology clinics in your community. They may be conducting trials.
Visit the Alzheimer’s and related Dementias Education and Referral (ADEAR) Center clinical trials finder.
Look for announcements in newspapers and other media.
Search www.clinicaltrials.gov.

Why Would I Participate in a Clinical Trial?

There are many reasons why you might choose to join an Alzheimer’s or dementia clinical trial. You may want to:

Help others, including future family members, who may be at risk for Alzheimer’s disease or a related dementia
Receive regular monitoring by medical professionals
Learn about Alzheimer’s and your health
Test new treatments that might work better than those currently available
Get information about support groups and resources

What Else Should I Consider?

Consider both benefits and risks when deciding whether to volunteer for a clinical trial.

While there are benefits to participating in a clinical trial or study, there are some risks and other issues to consider as well.

What Happens When a Person Joins a Clinical Trial or Study?

What Is Informed Consent?

How Do Researchers Decide Who Will Participate?

Researchers carefully screen all volunteers to make sure they meet a study's criteria.

What Is Alzheimer's Disease?

Older woman with Alzheimer's looking out of a window

How Many Americans Have Alzheimer’s Disease?

What Does Alzheimer’s Disease Look Like?

How Long Can a Person Live with Alzheimer’s Disease?

The time from diagnosis to death varies—as little as 3 or 4 years if the person is older than 80 when diagnosed, to as long as 10 or more years if the person is younger.

Although treatment can help manage symptoms in some people, currently there is no cure for this devastating disease.

Learn more about Alzheimer's disease from MedlinePlus.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Alzheimer's Disease

How Is Alzheimer's Disease Diagnosed?

Doctor examining brain scans

To diagnose Alzheimer’s, doctors may:

Ask the person and 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
Carry out standard medical tests, such as blood and urine tests, to identify other possible causes of the problem
Perform brain scans, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET), to rule out other possible causes for symptoms

People with memory problems should return to the doctor every 6 to 12 months.

What Happens Next?

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

What Are the Benefits of Early Diagnosis?

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

In addition, an early diagnosis gives people greater opportunities to participate in clinical trials that are testing possible new treatments for Alzheimer’s disease or in other research studies.

Learn more about Alzheimer's disease from MedlinePlus.

Noticing Memory Problems? What to Do Next

Asking the same questions over and over again
Getting lost in places a person knows well
Not being able to follow directions
Becoming more confused about time, people, and places
Not taking care of oneself—eating poorly, not bathing, or being unsafe

Learn more about Alzheimer's disease from MedlinePlus.

Basics of Alzheimer’s Disease and Dementia

Frequently Asked Questions About Alzheimer's Disease

On this page:

What is the difference between Alzheimer's disease and dementia?
What are the early signs of Alzheimer's disease?
What are the stages of Alzheimer's disease?
What are the causes of Alzheimer's disease?
Is Alzheimer's disease hereditary?
Is there a cure for Alzheimer's disease?
Is there a way to prevent Alzheimer's disease?
Are there any sources of financial help for people with Alzheimer's or their caregivers?

What is the difference between Alzheimer's disease and dementia?

Learn more about Alzheimer's disease and dementia.

What are the early signs of Alzheimer's disease?

Learn more about the signs of Alzheimer's disease.

What are the stages of Alzheimer's disease?

Learn more about the stages of Alzheimer's disease.

What are the causes of Alzheimer's disease?

Learn more about the factors that influence Alzheimer's disease.

Is Alzheimer's disease hereditary?

Just because a family member has Alzheimer's disease does not mean that you will get it, too.

Learn more about assessing risk for Alzheimer's disease.

Is there a cure for Alzheimer's disease?

The U.S. Food and Drug Administration (FDA) has approved several drugs to treat the symptoms of Alzheimer's disease, and certain medicines and other approaches can help control behavioral symptoms.

Learn more about how Alzheimer's disease is treated.

Is there a way to prevent Alzheimer's disease?

Learn more about cognitive health and older adults.

Are there any sources of financial help for people with Alzheimer's or their caregivers?

Yes, there are several possible sources of help, depending on your situation. Read Paying for Care for information on government programs and other payment sources.

The following organizations also offer assistance with finding financial help:

Family Caregiver Alliance
1-800-445-8106 (toll-free)
www.caregiver.org/family-care-navigator

For More Information About Alzheimer's

Basics of Alzheimer’s Disease and Dementia Cognitive Health

Preventing Alzheimer’s Disease: What Do We Know?

Can Increasing Physical Activity Prevent Alzheimer's Disease?

older woman walking by lake with walking sticks

Until scientists know more, experts encourage exercise for its many other benefits. To learn more about exercise and physical activity for older adults, visit NIA's Go4Life campaign.

Can Controlling High Blood Pressure Prevent Alzheimer's Disease?

older man getting blood pressure checked by doctor

Can Cognitive Training Prevent Alzheimer's?

man in cap using computer with a group of people

Can Eating Certain Foods Prevent Alzheimer's Disease?

What Else Might Prevent Alzheimer's Disease?

Researchers are exploring these and other interventions that may help prevent, delay, or slow Alzheimer's dementia or age-related cognitive decline. Other research targets include:

New drugs to delay onset or slow disease progression
Diabetes treatment
Depression treatment
Blood pressure- and lipid-lowering treatments
Sleep interventions
Social engagement
Vitamins such as B12 plus folic acid supplements and D
Combined physical and mental exercises

What's the Bottom Line on Alzheimer's Prevention?

For More Information About Alzheimer's Prevention

Alzheimer's Association
1-800-272-3900 (toll-free)
1-866-403-3073 (TTY/toll-free)
info@alz.org
www.alz.org

Basics of Alzheimer’s Disease and Dementia Cognitive Health

Preventing Alzheimer’s Disease: What Do We Know?

Evaluating the Latest Prevention Research

Increased physical activity
Blood pressure control for people with high blood pressure (also called hypertension)
Cognitive training

The evidence for other interventions, such as medications and diet, was not as strong. However, scientists are continuing to explore these and other possible preventions.

Alzheimer’s Caregiving

Healthy Eating and Alzheimer's Disease

Eating healthy foods helps everyone stay well. It’s even more important for people with Alzheimer’s disease. Here are some tips for healthy eating.

bag of healthy groceries

Buying and Preparing Food

When the person with Alzheimer’s disease lives with you:

Buy healthy foods such as vegetables, fruits, and whole-grain products. Be sure to buy foods that the person likes and can eat.
Give the person choices about what to eat—for example, “Would you like green beans or salad?”
Buy food that is easy to prepare, such as premade salads and single food portions.

When a person with early-stage Alzheimer’s disease lives alone, you can buy foods that the person doesn’t need to cook. Call to remind him or her to eat.

Maintain Familiar Routines

Try these tips:

View mealtimes as opportunities for social interaction. A warm and happy tone of voice can set the mood.
Be patient and give the person enough time to finish the meal.
Respect personal, cultural, and religious food preferences, such as eating tortillas instead of bread or avoiding pork.
If the person has always eaten meals at specific times, continue to serve meals at those times.
Serve meals in a consistent, familiar place and way whenever possible.
Avoid new routines, such as serving breakfast to a person who has never routinely eaten breakfast.

Stay Safe

The person forgets to eat.
Food has burned because it was left on the stove.
The oven isn’t turned off.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Healthy Eating for a Person with Alzheimer's

Choose My Plate
www.choosemyplate.gov

Family Caregiver Alliance
1-800-445-8106 (toll-free)
info@caregiver.org
www.caregiver.org

Meals on Wheels America
1-888-998-6325 (toll-free)
info@mealsonwheelsamerica.org
www.mealsonwheelsamerica.org

Content reviewed: May 18, 2017

Featured Research

Alzheimer’s protein higher in women, may mean higher risk of symptoms

February 28, 2019

Alzheimer's Disease Neuroscience

group of women talking

This research was funded in part by NIA grants PO1AG036694, RO1AG053509, P50AG005134, K23AG049087, and K24AG035007.

Featured Research

Breakdowns in mitochondrial housekeeping provide another clue to Alzheimer’s culprit

March 13, 2019

Alzheimer's DiseaseNeuroscience

Puzzle piece illustration with mitochondria

References:

Fang EF, et al. Mitophagy inhibits Aβ and p-Tau pathologies and cognitive deficits in experimental models of Alzheimer’s disease. Nature Neuroscience. 2019;22(3):401-412.

Kingwell K. Turning up mitophagy in Alzheimer disease. Nature Reviews Drug Discovery. Published online March 4, 2019.

Featured Research

Breakdowns in mitochondrial housekeeping provide another clue to Alzheimer’s culprit

March 13, 2019

Alzheimer's DiseaseNeuroscience

Puzzle piece illustration with mitochondria

References:

Fang EF, et al. Mitophagy inhibits Aβ and p-Tau pathologies and cognitive deficits in experimental models of Alzheimer’s disease. Nature Neuroscience. 2019;22(3):401-412.

Kingwell K. Turning up mitophagy in Alzheimer disease. Nature Reviews Drug Discovery. Published online March 4, 2019.

Featured Research

Sleep loss encourages spread of toxic Alzheimer’s protein

February 12, 2019

Alzheimer's DiseaseClinical ResearchNeuroscience

From the NIH Director’s Blog by Dr. Francis Collins

The researchers went back and reanalyzed those same human samples for tau. Sure enough, the tau levels were elevated on average by about 50 percent.

References:

¹Holth JK, Fritschi SK, Wang C, et al. The sleep-wake cycle regulates brain interstitial fluid tau in mice and CSF tau in humans. Science. 2019 Jan 24. [Epub ahead of print]

Featured Research

Daytime sleepiness linked to elevated brain amyloid

October 11, 2018

Alzheimer's DiseaseCognitive HealthDementiasNeuroscience

Tired man at computer

This study was supported in part by NIA grants AG050507, AG050745, AG049872, AG050507-02S1 and NIA IRP funding.

Featured Research

Some Alzheimer's biomarkers differ by race, NIA-funded study finds

February 01, 2019

Alzheimer's DiseaseBiomarkersClinical Research

Nurse and female patient looking at a chart

This research was funded in part by NIA grants P50AG05681, P01AG03991, and P01AG026276.

References:

Morris JC, et al. Assessment of racial disparities in biomarkers for Alzheimer’s disease. JAMA Neurology. doi:10.1001/jamaneurol.2018.4249. Published online Jan. 7, 2019.

Barnes LB. Biomarkers for Alzheimer dementia in diverse racial and ethnic minorities—a public health priority. JAMA Neurology. doi:10.1001/jamaneurol.2018.3444. Published online Jan. 7, 2019.

Blood-brain barrier test may predict dementia

February 07, 2019

Alzheimer's DiseaseBiomarkersClinical ResearchDementiasNeuroscience

From NIH Research Matters

The researchers are planning to further validate these results by conducting a second trial with more participants.

This paper was funded in part by NIA grants R01AG023084, R01AG039452, P01AG052350, P50AG005142, RO1AG054434, R01AG055770, R21AG055034, P50AG05681, P01AG03991, and P01AG026276.

Can Increasing Physical Activity Prevent Alzheimer's Disease?

older woman walking by lake with walking sticks

Until scientists know more, experts encourage exercise for its many other benefits. To learn more about exercise and physical activity for older adults, visit NIA's Go4Life campaign.

Can Controlling High Blood Pressure Prevent Alzheimer's Disease?

older man getting blood pressure checked by doctor

Can Cognitive Training Prevent Alzheimer's?

man in cap using computer with a group of people

Can Eating Certain Foods Prevent Alzheimer's Disease?

What Else Might Prevent Alzheimer's Disease?

Researchers are exploring these and other interventions that may help prevent, delay, or slow Alzheimer's dementia or age-related cognitive decline. Other research targets include:

New drugs to delay onset or slow disease progression
Diabetes treatment
Depression treatment
Blood pressure- and lipid-lowering treatments
Sleep interventions
Social engagement
Vitamins such as B12 plus folic acid supplements and D
Combined physical and mental exercises

What's the Bottom Line on Alzheimer's Prevention?

For More Information About Alzheimer's Prevention

Alzheimer's Association
1-800-272-3900 (toll-free)

Talking with Older Patients About Cognitive Problems

Older woman taking an Alzheimer's questionnaire

Learn more: Assessing Cognitive Impairment in Older Patients

Cognitive Impairment

Conveying Findings

Following Up

Consider how your practice can coordinate and integrate care for the person and family across the many specialists and services that will be involved.

Learn more: Managing Older Patients with Cognitive Impairment

Working with Family Caregivers

Explain that much can be done to improve the patient's quality of life. Measures such as modifications in daily routine and medications may help control symptoms. If appropriate, bring in a palliative care consultant to help the patient with symptom management.
Let caregivers know there is time to adapt. Decline is rarely rapid. Provide information about the consumer resources and services available from local organizations, as well as support groups.
Help caregivers plan for the possibility that they eventually may need more help at home or may have to look into residential care.
Encourage caregivers to get regular respite especially when patients require constant attention. Ask if the caregiver, who is at considerable risk for stress-related disorders, is receiving adequate health care.

For More Information About Patients with Cognitive Problems

Content reviewed: May 17, 2017

Treatment of Alzheimer’s Disease

How Is Alzheimer's Disease Treated?

Older woman and her doctor having a serious conversation

Treatment for Mild to Moderate Alzheimer’s

Treatment for Moderate to Severe Alzheimer’s

The FDA has also approved Aricept®, the Exelon® patch, and Namzaric®, a combination of Namenda® and Aricept®, for the treatment of moderate to severe Alzheimer’s disease.

Drug Name	Drug Type and Use	How It Works	Common Side Effects
Aricept® (donepezil)	Cholinesterase inhibitor prescribed to treat symptoms of mild, moderate, and severe Alzheimer's	Prevents the breakdown of acetylcholine in the brain	Nausea, vomiting, diarrhea, muscle cramps, fatigue, weight loss
Exelon® (rivastigmine)	Cholinesterase inhibitor prescribed to treat symptoms of mild to moderate Alzheimer's (patch is also for severe Alzheimer's)	Prevents the breakdown of acetylcholine and butyrylcholine (a brain chemical similar to acetylcholine) in the brain	Nausea, vomiting, diarrhea, weight loss, indigestion, muscle weakness
Namenda® (memantine)	N-methyl D-aspartate (NMDA) antagonist prescribed to treat symptoms of moderate to severe Alzheimer's	Blocks the toxic effects associated with excess glutamate and regulates glutamate activation	Dizziness, headache, diarrhea, constipation, confusion
Namzaric® (memantine and donepezil)	NMDA antagonist and cholinesterase inhibitor prescribed to treat symptoms of moderate to severe Alzheimer’s	Blocks the toxic effects associated with excess glutamate and prevents the breakdown of acetylcholine in the brain	Headache, nausea, vomiting, diarrhea, dizziness, anorexia
Razadyne® (galantamine)	Cholinesterase inhibitor prescribed to treat symptoms of mild to moderate Alzheimer's	Prevents the breakdown of acetylcholine and stimulates nicotinic receptors to release more acetylcholine in the brain	Nausea, vomiting, diarrhea, decreased appetite, dizziness, headache

Drug Name	Manufacturer's Recommended Dosage	For More Information
Aricept® (donepezil)	Tablet: Initial dose of 5 mg once a day; may increase dose to 10 mg/day after 4-6 weeks if well tolerated, then to 23 mg/day after at least 3 months Orally disintegrating tablet: Same dosage as above (not available in 23 mg)	For current information about this drug's safety and use, visit www.aricept.com.
Exelon® (rivastigmine)	Capsule: Initial dose of 3 mg/day (1.5 mg twice a day); may increase dose to 6 mg/day (3 mg twice a day), 9 mg/day (4.5 mg twice a day), and 12 mg/day (6 mg twice a day) at minimum 2-week intervals if well tolerated Patch: Initial dose of 4.6 mg once a day; may increase dose to 9.5 mg once a day and 13.3 mg once a day at minimum 4-week intervals if well tolerated	For current information about this drug’s safety and use, visit the www.fda.gov/Drugs. Click on "Search Drugs@FDA," search for Exelon, and click on drug-name links to see label information.
Namenda® (memantine)	Tablet: Initial dose of 5 mg once a day; may increase dose to 10 mg/day (5 mg twice a day), 15 mg/day (5 mg and 10 mg as separate doses), and 20 mg/day (10 mg twice a day) at minimum 1-week intervals if well tolerated Oral solution: Same dosage as above Extended-release capsule*: Initial dose of 7 mg once a day; may increase dose to 14 mg/day, 21 mg/day, and 28 mg/day at minimum 1-week intervals if well tolerated	For current information about this drug's safety and use, visit www.namenda.com and www.namendaxr.com. Click on "Full Prescribing Information" to see the drug label.
Namzaric® (memantine and donepezil)	Extended-release capsule*: Initial dose of 28 mg memantine/10 mg donepezil once a day if stabilized on memantine and donepezil If stabilized on donepezil only, initial dose of 7 mg memantine/10 mg donepezil once a day; may increase dose to 28 mg memantine/10 mg donepezil in 7 mg increments at minimum 1-week intervals if well tolerated Only 14 mg memantine/10 mg donepezil and 28 mg memantine/10 mg donepezil available as generic	For current information about this drug’s safety and use, visit www.namzaric.com. Click on “Full Prescribing Information” to see the drug label.
Razadyne® (galantamine)	Tablet: Initial dose of 8 mg/day (4 mg twice a day); may increase dose to 16 mg/day (8 mg twice a day) and 24 mg/day (12 mg twice a day) at minimum 4-week intervals if well tolerated Extended-release capsule: Same dosage as above but taken once a day	For current information about this drug’s safety and use, visit www.janssenmd.com/razadyne. Click on "Full Prescribing Information" to see the drug label.

* Available as a generic drug.

Dosage and Side Effects

Managing Behavior

Examples of medicines used to help with depression, aggression, restlessness, and anxiety include:

Celexa® (citalopram)
Remeron® (mirtazapine)
Zoloft® (sertraline)
Wellbutrin® (bupropion)
Cymbalta® (duloxetine)
Tofranil® (imipramine)

Experts agree that medicines to treat these behavior problems should be used only after other strategies that don’t use medicine have been tried.

Medicines to Be Used with Caution

There are some medicines, such as sleep aids, anti-anxiety drugs, anticonvulsants, and antipsychotics, that a person with Alzheimer’s disease should take only:

After the doctor has explained all the risks and side effects of the medicine
After other, safer non-medication options have not helped treat the problem

You will need to watch closely for side effects from these medications.

Ambien® (zolpidem)
Lunesta® (eszopiclone)
Sonata® (zaleplon)

Ativan® (lorazepam)
Klonopin® (clonazepam)

Anticonvulsants are drugs sometimes used to treat severe aggression. Side effects may cause sleepiness, dizziness, mood swings, and confusion. Examples of these medicines include:

Depakote® (sodium valproate)
Tegretol® (carbamazepine)
Trileptal® (oxcarbazepine)

Risperdal® (risperidone)
Seroquel® (quetiapine)
Zyprexa® (olanzapine)

Looking for New Treatments

Learn more about Alzheimer's disease from MedlinePlus.

Read about this topic in Spanish. Lea sobre esta tema en español.

For More Information About Treating Alzheimer's

Eldercare Locator
1-800-677-1116 (toll-free)

Treatment

Treatment of Alzheimer’s Disease

Early-Onset Alzheimer's Disease: A Resource List

Older mon looking sad

The items on this list are organized by these categories:

General Resources
Living with Early-Onset Alzheimer’s
Legal and Financial Planning
Caregiving
Clinical Studies and Trials

General Resources

Alzheimer’s Disease Genetics Fact Sheet (2011)

Published by the NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center. Phone: 1-800-438-4380. Email: adear@nia.nih.gov.

Early-Onset Alzheimer’s Disease

Published by Johns Hopkins Medicine.

Early-Onset Alzheimer's: When Symptoms Begin Before Age 65 (2014)

Published by the Mayo Foundation for Medical Education and Research.

Early Onset Familial AD

Published by Alzforum.

Early-Onset Familial Alzheimer Disease (2012)

Available from the National Center for Biotechnology Information, National Library of Medicine.

What You Should Know About Early-Onset Alzheimer’s (2015)

Published by Health.com.

Younger/Early Onset Alzheimer's & Dementia

This web page briefly explains the disorder, providing information about diagnosis, causes, and sources of help.

Published by the Alzheimer’s Association. Phone: 1-800-272-3900. Email: info@alz.org.

Younger-Onset Dementia: An Overview (2013, 2 p.)

Published by Alzheimer’s Australia.

Living with Early-Onset Alzheimer’s

If You Have Younger-Onset Alzheimer’s Disease

Published by the Alzheimer’s Association. Phone: 1-800-272-3900. Email: info@alz.org.

Young Onset Dementia

Published by Alzheimer’s Society Canada. Phone: 1-800-616-8816. Email: info@alzheimer.ca.

HealthCare.gov

Available from the U.S. Department of Health and Human Services. Phone: 1-800-318-2596.

Legal and Financial Planning

Legal and Financial Planning for People with Alzheimer's

Published by the NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center. Phone: 1-800-438-4380. Email: adear@nia.nih.gov.

Social Security Compassionate Allowances Program

Published by the Social Security Administration. Phone: 1-800-772-1213. Email: compassionate.allowances@ssa.gov.

Caregiving

Alzheimer's Caregiving Information from the National Institute on Aging

Get Alzheimer’s care information and advice from NIA, including information on daily care, sundowning and other behaviors, and more.

Published by the NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center. Phone: 1-800-438-4380. Email: adear@nia.nih.gov.

Early Onset Dementia: Advice for Caregivers

Published by the National Initiative for the Care of the Elderly (Canada).

Clinical Studies and Trials

Participating in Alzheimer’s Disease Research

Learn what’s involved in volunteering for Alzheimer’s research. Read about benefits and risks, questions to ask, participant safety, and placebos.

Published by the NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center. Phone: 1-800-438-4380. Email: adear@nia.nih.gov.

Dominantly Inherited Alzheimer Network (DIAN)

To search for more clinical studies and trials, visit NIA's clinical trials finder.

Content reviewed: June 27, 2017

HEALTHY AGING

Healthy Aging

What Do We Know About Healthy Aging?

On this page:

Get Moving: Exercise and Physical Activity

For more information about how to get started and stick with an exercise and physical activity program, visit Go4Life, NIA’s exercise and physical activity campaign for adults 50+.

Pay Attention to Weight and Shape

Learn more about maintaining a healthy weight.

Healthy Food for Thought: Think About What You Eat

Learn more about healthy eating and smart food choices for healthy aging.

Participate in Activities You Enjoy

Granddaughter and grandfather gardening

Other studies have found that older adults who participate in what they see as meaningful activities, like volunteering in their community, reported feeling healthier and happier.

Learn more about participating in activities you enjoy.

For more information on healthy aging, search our A-Z Health Topics.

Content reviewed: June 25, 2018

Balance Problems and Disorders

Have you ever felt dizzy, lightheaded, or as if the room were spinning around you? These can be troublesome sensations. If the feeling happens often, it could be a sign of a balance problem.

Causes of Balance Problems

People are more likely to have problems with balance as they get older. But age is not the only reason these problems occur. In some cases, you can help reduce your risk for certain balance problems.

Symptoms of Balance Disorders

If you have a balance disorder, you may stagger when you try to walk, or teeter or fall when you try to stand up. You might experience other symptoms such as:

Older woman using a walker on a sidewalk

Dizziness or vertigo (a spinning sensation)
Falling or feeling as if you are going to fall
Lightheadedness, faintness, or a floating sensation
Blurred vision
Confusion or disorientation

Do I Have a Balance Problem? Questions to Ask Yourself

You can help identify a balance problem by asking yourself some key questions. If you answer "yes" to any of these questions, discuss the symptom with your doctor.

Do I feel unsteady?
Do I feel as if the room is spinning around me, even only for brief periods of time?
Do I feel as if I'm moving when I know I'm standing or sitting still?
Do I lose my balance and fall?
Do I feel as if I'm falling?
Do I feel lightheaded, or as if I might faint?
Does my vision become blurred?
Do I ever feel disoriented, losing my sense of time, place, or identity?

Coping with a Balance Disorder

Read about this topic in Spanish. Lea sobre este tema en español.

Prevent Falls and Fractures

If you or an older person you know has fallen, you're not alone. More than one in three people age 65 years or older falls each year. The risk of falling—and fall-related problems—rises with age.

Many Older Adults Fear Falling

Causes and Risk Factors for Falls

Older man using a walker to prevent falls

Some medications can increase a person's risk of falling because they cause side effects like dizziness or confusion. The more medications you take, the more likely you are to fall.

Take the Right Steps to Prevent Falls

Stay physically active. Plan an exercise program that is right for you. Regular exercise improves muscles and makes you stronger. It also helps keep your joints, tendons, and ligaments flexible. Mild weight-bearing activities, such as walking or climbing stairs, may slow bone loss from osteoporosis.
Have your eyes and hearing tested. Even small changes in sight and hearing may cause you to fall. When you get new eyeglasses or contact lenses, take time to get used to them. Always wear your glasses or contacts when you need them If you have a hearing aid, be sure it fits well and wear it.
Find out about the side effects of any medicine you take. If a drug makes you sleepy or dizzy, tell your doctor or pharmacist.
Get enough sleep. If you are sleepy, you are more likely to fall.
Limit the amount of alcohol you drink. Even a small amount of alcohol can affect your balance and reflexes. Studies show that the rate of hip fractures in older adults increases with alcohol use.
Stand up slowly. Getting up too quickly can cause your blood pressure to drop. That can make you feel wobbly. Get your blood pressure checked when lying and standing.
Use an assistive device if you need help feeling steady when you walk. Appropriate use of canes and walkers can prevent falls. If your doctor tells you to use a cane or walker, make sure it is the right size for you and the wheels roll smoothly. This is important when you're walking in areas you don't know well or where the walkways are uneven. A physical or occupational therapist can help you decide which devices might be helpful and teach you how to use them safely.
Be very careful when walking on wet or icy surfaces. They can be very slippery! Try to have sand or salt spread on icy areas by your front or back door.
Wear non-skid, rubber-soled, low-heeled shoes, or lace-up shoes with non-skid soles that fully support your feet. It is important that the soles are not too thin or too thick. Don't walk on stairs or floors in socks or in shoes and slippers with smooth soles.
Always tell your doctor if you have fallen since your last checkup, even if you aren't hurt when you fall. A fall can alert your doctor to a new medical problem or problems with your medications or eyesight that can be corrected. Your doctor may suggest physical therapy, a walking aid, or other steps to help prevent future falls.

What to Do If You Fall

Whether you are at home or somewhere else, a sudden fall can be startling and upsetting. If you do fall, stay as calm as possible.

Take several deep breaths to try to relax. Remain still on the floor or ground for a few moments. This will help you get over the shock of falling.

Decide if you are hurt before getting up. Getting up too quickly or in the wrong way could make an injury worse.

If you think you can get up safely without help, roll over onto your side. Rest again while your body and blood pressure adjust. Slowly get up on your hands and knees, and crawl to a sturdy chair.

If you are hurt or cannot get up on your own, ask someone for help or call 911. If you are alone, try to get into a comfortable position and wait for help to arrive.

Keep Your Bones Strong to Prevent Falls

Osteoporosis is a disease that makes bones weak and more likely to break. For people with osteoporosis, even a minor fall may be dangerous. Talk to your doctor about osteoporosis.

Learn how to fall-proof your home.

Read about this topic in Spanish. Lea sobre este tema en español.

Talking with Your Doctor

Fall-Proofing Your Home

Fall hazards in the home, including a scatter rug, dog, and empty slippers

In Stairways, Hallways, and Pathways

Have handrails on both sides of the stairs, and make sure they are tightly fastened. Hold the handrails when you use the stairs, going up or down. If you must carry something while you're on the stairs, hold it in one hand and use the handrail with the other. Don't let what you're carrying block your view of the steps.
Make sure there is good lighting with light switches at the top and bottom of stairs and on each end of a long hall. Remember to use the lights!
Keep areas where you walk tidy. Don't leave books, papers, clothes, and shoes on the floor or stairs.
Check that all carpets are fixed firmly to the floor so they won't slip. Put no-slip strips on tile and wooden floors. You can buy these strips at the hardware store.
Don't use throw rugs or small area rugs.

In Bathrooms and Powder Rooms

Mount grab bars near toilets and on both the inside and outside of your tub and shower.
Place non-skid mats, strips, or carpet on all surfaces that may get wet.
Remember to turn on night lights.

In Your Bedroom

Put night lights and light switches close to your bed.
Keep a flashlight by your bed in case the power is out and you need to get up.
Keep your telephone near your bed.

In Other Living Areas

Keep electric cords and telephone wires near walls and away from walking paths.
Secure all carpets and large area rugs firmly to the floor.
Arrange your furniture (especially low coffee tables) and other objects so they are not in your way when you walk.
Make sure your sofas and chairs are the right height for you to get in and out of them easily.
Don't walk on newly washed floors—they are slippery.
Keep items you use often within easy reach.
Don't stand on a chair or table to reach something that's too high—use a "reach stick" instead or ask for help. Reach sticks are special grabbing tools that you can buy at many hardware or medical-supply stores. If you use a step stool, make sure it is steady and has a handrail on top. Have someone stand next to you.
Don't let your cat or dog trip you. Know where your pet is whenever you're standing or walking.
Keep emergency numbers in large print near each telephone.

Your Own Medical Alarm

Home Improvements Prevent Falls

Read more about falls and falls prevention.

Read about this topic in Spanish. Lea sobre este tema en español.

Tips on Discussing Sensitive Topics with Your Doctor

On this page:

Illustration of a doctor and patient talking to each other

Alcohol

Falling and Fear of Falling

Feeling Unhappy with Your Doctor

Grief, Mourning, and Depression

There is no right or wrong way to grieve. Read how you can take care of yourself while you are mourning the death of a spouse.

Read more about depression in older adults.

HIV/AIDS

Incontinence

Learn more about bladder health.

Memory Problems

Problems with Family

Even strong and loving families can have problems, especially under the stress of illness. Although family problems can be painful to discuss, talking about them can help your doctor help you.

Learn more about how to recognize elder abuse.

Sexuality

Learn more about how growing older might affect your sex life.

For More Information to Help You Discuss Sensitive Subjects with Your Doctor

National Center on Elder Abuse
1-855-500-3537 (toll-free)
ncea-info@aoa.hhs.gov
https://ncea.acl.gov

National Institute on Alcohol Abuse and Alcoholism
National Institutes of Health
1-888-696-4222
niaaaweb-r@exchange.nih.gov
www.niaaa.nih.gov

Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE)
1-212-741-2247
info@sageusa.org
www.sageusa.org

Online Health Information: Is It Reliable?

On this page:

Many older adults share a common concern: “How can I trust the health information I find on the Internet?”

2 older men looking for health information online

Where Can I Find Reliable Health Information Online?

The National Institutes of Health website is a good place to start for reliable health information.

Questions to Ask Before Trusting a Website

1. Who sponsors/hosts the website? Is that information easy to find?

.gov identifies a U.S. government agency
.edu identifies an educational institution, like a school, college, or university
.org usually identifies nonprofit organizations (such as professional groups; scientific, medical, or research societies; advocacy groups)
.com identifies commercial websites (such as businesses, pharmaceutical companies, and sometimes hospitals)

2. Who wrote the information? Who reviewed it?

Is the health information written or reviewed by a healthcare professional? Dependable websites will tell you where their health information came from and how and when it was reviewed.

No information should replace seeing a doctor or other health professional who can give you advice that caters to your specific situation.

3. When was the information written?

4. What is the purpose of the site?

5. Is your privacy protected? Does the website clearly state a privacy policy?

6. How can I protect my health information?

These precautions can help better protect your information:

Use common sense when browsing the Internet. Do not open unexpected links. Hover your mouse over a link to confirm that clicking it will take you to a reputable website.
Use a strong password. Include a variation of numbers, letters, and symbols. Change it frequently.
Use two-factor authentication when you can. This requires the use of two different types of personal information to log into your mobile devices or accounts.
Do not enter sensitive information over public Wi-Fi that is not secure. This includes Wi-Fi that is not password protected.

Be careful what information you share over social media sites. This can include addresses, phone numbers, and email addresses. Learn how you can keep your information private.

7. Does the website offer quick and easy solutions to your health problems? Are miracle cures promised?

Health and Medical Apps

Social Media and Health Information

Check the source of the information, and make sure the author is credible. Fact-checking websites can also help you figure out if a story is reliable.

A Quick Checklist

You can use the following checklist to help make sure that the health information you are reading online can be trusted. You might want to keep this checklist by your computer.

Is the sponsor/owner of the website a Federal agency, medical school, or large professional or nonprofit organization, or is it related to one of these?
If not sponsored by a Federal agency, medical school, or large professional or nonprofit organization, is the website written by a healthcare professional or does it reference one of these trustworthy sources for its health information?
Why was the site created? Is the mission or goal of the website sponsor clear?
Can you see who works for the agency or organization and who authored the information? Is there a way to contact the sponsor of the website?
When was the information written or webpage last updated?
Is your privacy protected?
Does the website offer unbelievable solutions to your health problem(s)? Are quick, miracle cures promised?

Trust Yourself and Talk to Your Doctor

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Reliable Health Websites

Centers for Medicare & Medicaid Services
1-800-633-4227 (toll-free)
1-877-486-2048 (TTY/toll-free)
www.medicare.gov

Centers for Disease Control and Prevention (CDC)
1-800-232-4636 (toll-free)
1-888-232-6348 (TTY/toll-free)
cdcinfo@cdc.gov

U.S. Food and Drug Administration
1-888-463-6332 (toll-free)
druginfo@fda.hhs.gov
www.fda.gov

Content reviewed: October 31, 2018

Healthy Eating

Sample Menus: Healthy Eating for Older Adults

Learn more about healthy food choices for healthy aging:

Shopping for Food That's Good for You

Serving and Portion Sizes: How Much Should I Eat?

10 Tips for Eating Healthy on a Budget

Sample Menu 1
Breakfast	Lunch
Breakfast burrito 1 flour tortilla (8-inch diameter) 1 scrambled egg 1/3 cup black beans 2 tablespoons salsa 1/2 large grapefruit 1 cup water, coffee, or tea	Roast beef sandwich 1 small whole-grain hoagie bun 2 ounces lean roast beef 1 slice part-skim mozzarella cheese 2 slices tomato 1/4 cup mushrooms (cooked in 1 teaspoon corn/canola oil) 1 teaspoon mustard Baked potato wedges 1 cup potato wedges (cooked in 1 teaspoon canola oil) 1 tablespoon ketchup 1 cup fat-free milk
Dinner	Snack
Baked salmon on beet greens 4 ounce salmon filet 1 teaspoon olive oil 2 teaspoons lemon juice 1/3 cup cooked beet greens (cooked in 2 teaspoons canola oil) Quinoa with almonds 1/2 cup quinoa 1/2 cup silvered almonds 1 cup fat-free milk	1 cup cantaloupe balls

Sample Menu 2
Breakfast	Lunch
Whole wheat French toast 2 slices whole wheat bread 3 tablespoons fat-free milk 2/3 egg 2 teaspoons tub margarine 1 tablespoon pancake syrup 1/2 large grapefruit 1 cup fat-free milk	3-bean vegetarian chili on baked potato 1/4 cup each cooked kidney beans, navy beans, and black beans 1/2 cup tomato sauce 1/4 cup chopped onion 2 tablespoons chopped jalapeno peppers 1 teaspoon corn/canola oil (to cook onion and peppers) 1/4 cup cheese sauce 1 large baked potato 1/2 cup cantaloupe 1 cup water, coffee, or tea
Dinner	Snack
Hawaiian pizza 2 slices cheese pizza, thin crust 1 ounce lean ham 1/4 cup pineapple 1/4 cup mushrooms, cooked in 1 teaspoon safflower oil Green salad 1 cup mixed salad greens 4 teaspoons oil and vinegar dressing 1 cup fat-free milk	3 tablespoon hummus 5 whole wheat crackers

Sample Menu 3
Breakfast	Lunch
Cold cereal 1 cup shredded wheat 1/2 cup sliced banana 1/2 cup fat-free milk 1 slice whole wheat toast 2 teaspoons all-fruit preserves 1 cup fat-free chocolate milk	Tuna salad sandwich 2 slices rye bread 2 ounces tuna 1 tablespoon mayonnaise 1 tablespoon chopped celery 1/2 cup shredded lettuce 1 medium peach 1 cup fat-free milk
Dinner	Snack
Roasted chicken 3 ounces cooked chicken breast 1 large sweet potato, roasted 1/2 cup succotash (lima beans & corn) 1 teaspoon tub margarine 1 ounce whole wheat roll 1 teaspoon tub margarine 1 cup water, coffee, or tea	1/4 cup dried apricots 1 cup flavored yogurt (chocolate)

Sample Menu 4
Breakfast	Lunch
Creamy oatmeal (cooked in milk) 1/2 cup uncooked oatmeal 1 cup fat-free milk 2 tablespoons raisins 2 teaspoons brown sugar 1 cup orange juice 2 teaspoons all-fruit preserves 1 cup fat-free chocolate milk	Taco salad 2 ounces tortilla chips 2 ounces cooked ground turkey (cooked in 2 teaspoons corn oil) 1/4 cup kidney beans 1/2 ounce low-fat cheddar cheese 1/2 cup chopped lettuce 1/2 cup avocado 1 teaspoon lime juice (on avocado) 2 tablespoons salsa 1 cup water, coffee, or tea
Dinner	Snack
Spinach lasagna roll-ups 1 cup lasagna noodles (2 ounces dry) 1/2 cup cooked spinach 1/2 cup ricotta cheese 1 ounce part-skim mozzarella cheese 1/2 cup tomato sauce 1 ounce whole wheat roll 1 teaspoon tub margarine 1 cup fat-free milk	2 tablespoons raisins 1 ounce unsalted almonds

Download sample menus (PDF, 117K)

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on Healthy Eating Plans

Choose My Plate
www.choosemyplate.gov

USDA Food and Nutrition Information Center
National Agricultural Library
1-301-504-5414
fnic@ars.usda.gov
www.nal.usda.gov/fnic

USDA Center for Nutrition Policy and Promotion
1-703-305-7600
www.cnpp.usda.gov

Healthy Eating

Food Safety

On this page:

Avoid Getting Sick From Your Food
Food Safety When Cooking
Food Safety When Eating Out

Avoid Getting Sick From Your Food

Some foods can be dangerous for an older person no matter what—so, if you are over 65, the U.S. Department of Agriculture recommends you avoid:

Raw or undercooked fish, shellfish, meat, and poultry
Refrigerated smoked fish (for example, lox)
Hot dogs, deli meats, and luncheon meats (unless these are reheated to 165 °F)
Raw or unpasteurized milk and milk products
Soft cheeses made from unpasteurized milk, including feta, brie, camembert, blue, and queso fresco
Raw or undercooked eggs or egg product, as found in cookie dough, eggnog, and some salad dressings
Raw sprouts
Unwashed fresh vegetables, including lettuce
Unpasteurized juice from fruits and vegetables

Changing Taste and Smell

Smart Storage

Try to use refrigerated leftovers within 3 or 4 days to reduce your risk of food poisoning. Throw away foods older than that or those that show moldy areas.

For recommended refrigerator and freezer storage times for common foods, download our Storing Cold Food tip sheet (PDF, 75K).

Food Safety When Cooking

When preparing foods, follow four basic steps—clean, separate, cook, and chill.

Clean

Keep your refrigerator clean, especially the vegetable and meat bins. When there is a spill, use hot soapy water to clean it up.

Separate

Cook

Bring sauces, marinades, soups, and gravy to a boil when reheating.

U.S. Department of Agriculture-Recommended Safe Minimum Internal Temperatures
Type of Food	Minimum Internal Temperature
All meats and seafood	145°F (with a 3-minute rest time)
All ground meats	160°F
Egg dishes	160°F
All poultry	165°F
Hot dogs and luncheon meats	165°F

No matter what temperature you set your oven at, the temperature inside your food needs to reach the level shown here to be safe.

Chill

Food Safety When Eating Out

It's nice to take a break from cooking or get together with others for a meal at a restaurant. But, do you think about food safety when you eat out? You should.

Pick a place that looks clean.
If your city or state requires restaurants to post a cleanliness rating near the front door, check it out.
Don't be afraid to ask the waiter or waitress how items on the menu are prepared. For example, could you have the tuna cooked well instead of seared? Or, if you find out the Caesar salad dressing is made with raw eggs, ask for another salad dressing.
Consider avoiding buffets. Sometimes food in buffets sits out for a while and might not be kept at the proper temperature—whether hot or cold.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on Food Safety

National Association of Nutrition and Aging Services Programs
1-202-682-6899
www.nanasp.org

USDA Food and Nutrition Information Center
National Agricultural Library
1-301-504-5414
fnic@ars.usda.gov
www.nal.usda.gov/fnic

Healthy Eating

Vitamins and Minerals

Vitamins

Vitamins and minerals are measured in a variety of ways. The most common are:

mg – milligram
mcg – microgram
IU – international unit

Minerals

Vitamin and Mineral Supplements for People Over Age 50
Vitamin D	If you are age 50–70, you need at least 600 IU, but not more than 4,000 IU. If you are age 70 and older, you need at least 800 IU, but not more than 4,000 IU. You can get vitamin D from fatty fish, fish-liver oils, fortified milk and milk products, and fortified cereals.
Vitamin B6	Men need 1.7 mg every day. Women need 1.5 mg every day. You can get vitamin B6 from fortified cereals, whole grains, organ meats like liver, and fortified soy-based meat substitutes.
Vitamin B12	You need 2.4 mcg every day. Some people over age 50 have trouble absorbing the vitamin B12 found naturally in foods, so make sure you get enough of the supplement form of this vitamin, such as from fortified foods. You can get vitamin B12 from fortified cereals, meat, fish, poultry, and milk.
Folate	You need 400 mcg each day. Folic acid is the form used to fortify grain products or added to dietary supplements. You can get folate from dark-green leafy vegetables like spinach, beans and peas, fruit like oranges and orange juice, and folic acid from fortified flour and fortified cereals.

Calcium

There are several types of calcium supplements. Calcium citrate and calcium carbonate tend to be the least expensive.

Calcium for People Over 50
Women age 51 and older	Men age 51 to 70	Men age 71 and older
1,200 mg each day	1,000 mg each day	1,200 mg each day
Women and men age 51 and older: Don’t take more than 2,000 mg of calcium in a day.

Sodium

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on Vitamins and Minerals

Office of Dietary Supplements
National Institutes of Health
1-301-435-2920
ods@nih.gov
www.ods.od.nih.gov

Healthy Eating

DASH Eating Plan

A number of major research studies have shown that following the Dietary Approaches to Stop Hypertension (DASH) Plan can lower blood pressure.

Quinoa salad with black beans and vegetables

DASH Plan Recommendations for Several Daily Calorie Count Examples
	1,600 calories	2,000 calories	2,600 calories
Grains	6 servings	6-8 servings	10-11 servings
Fruits	4 servings	4-5 servings	5-6 servings
Vegetables	3-4 servings	4-5 servings	5-6 servings
Fat-free or low-fat milk and milk products	2-3 servings	2-3 servings	3 servings
Lean meat, poultry, and fish	3-4 ounces or less	6 ounces or less	6 ounces or less
Nuts, seeds, and legumes	3-4 servings per week	4-5 servings per week	1 serving per day
Fats and oils	2 servings	2-3 servings	3 servings
Sweets and added sugars	3 servings or less per week	5 servings or less per week	less than 2 servings per day

DASH is organized by servings for most food groups. A DASH serving equals:

Grains—one ounce or equivalent

Fruits—half cup cut-up fruit or equivalent

Vegetables—half cup cooked vegetables or equivalent

Meats, poultry, and fish—one ounce cooked meats, poultry, or fish or one egg

Nuts, seeds, and legumes—foods like two tablespoons peanut butter, third cup or 1-1/2 ounces of nuts, half cup cooked beans, or one cup bean soup

Fats and oils—one teaspoon soft margarine or vegetable oil, one tablespoon mayonnaise, and one tablespoon regular salad dressing or two tablespoons low-fat dressing

Sugars—one tablespoon jam or jelly, half cup regular Jell-O, or one cup regular lemonade

Learn more about the food groups.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on the DASH Eating Plan

National Heart, Lung, and Blood Institute
1-301-592-8573
nhlbiinfo@nhlbi.nih.gov
www.nhlbi.nih.gov

Content reviewed: June 29, 2017

Healthy Eating

Getting Enough Fluids

It’s important for your body to have plenty of fluids each day. Water helps you digest your food, absorb nutrients, and then get rid of the unused waste.

Grandmother drinking water with her grandson

With age, some people may lose their sense of thirst. To further complicate matters, some medicines might make it even more important to have plenty of fluids.

Drinking enough fluids every day also is essential. Check with your doctor, however, if you’ve been told to limit how much you drink.

Try these tips for getting enough fluids:

Try to add liquids throughout the day.
Take sips from a glass of water, milk, or juice between bites during meals.
Have a cup of low-fat soup as an afternoon snack.
Drink a full glass of water if you need to take a pill.
Have a glass of water before you exercise or go outside to garden or walk, especially on a hot day.
Remember, water is a good way to add fluids to your daily routine without adding calories.
Drink fat-free or low-fat milk, or other drinks without added sugars.
If you drink alcoholic beverages, do so sensibly and in moderation. That means up to one drink per day for women and up to two drinks for men.
Don’t stop drinking liquids if you have a urinary control problem. Talk with your doctor about treatment.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on Fluids and Nutrition

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
1-800-860-8747 (toll-free)
1-866-569-1162 (TTY/toll-free)
healthinfo@niddk.nih.gov
www.niddk.nih.gov

National Heart, Lung, and Blood Institute
(Instituto Nacional del Corazón, los Pulmones y la Sangre)
1-301-592-8573
nhlbiinfo@nhlbi.nih.gov
www.nhlbi.nih.gov

National Association of Nutrition and Aging Services Programs
1-202-682-6899
www.nanasp.org

President’s Council on Fitness, Sports, and Nutrition
1-240-276-9567
fitness@hhs.gov
www.fitness.gov

Content reviewed: June 09, 2017

Most Searched Diseases & Conditions

Related Centers & Programs

CDC Home

Popular Health Links

Health.NY.Gov

Dementia, Memory Loss, & Healthy Aging

Forgetfulness and Brain Diseases

Do Memory Problems Always Mean Alzheimer's Disease?

Many people worry about becoming forgetful. They think forgetfulness is the first sign of Alzheimer's disease. But not all people with memory problems have Alzheimer's.

Other causes for memory problems can include aging, medical conditions, emotional problems, mild cognitive impairment, or another type of dementia.

Age-Related Changes in Memory

Differences Between Normal Aging and Alzheimer's Disease
Normal Aging	Alzheimer's Disease
Making a bad decision once in a while	Making poor judgments and decisions a lot of the time
Missing a monthly payment	Problems taking care of monthly bills
Forgetting which day it is and remembering it later	Losing track of the date or time of year
Sometimes forgetting which word to use	Trouble having a conversation
Losing things from time to time	Misplacing things often and being unable to find them

Memory Loss Related to Medical Conditions

Certain medical conditions can cause serious memory problems. These problems should go away once a person gets treatment. Medical conditions that may cause memory problems include:

Tumors, blood clots, or infections in the brain
Some thyroid, kidney, or liver disorders
Drinking too much alcohol
Head injury, such as a concussion from a fall or accident
Medication side effects
Not eating enough healthy foods, or too few vitamins and minerals in a person's body (like vitamin B12)

A doctor should treat serious medical conditions like these as soon as possible.

Memory Loss Related to Emotional Problems

Read about this topic in Spanish. Lea sobre este tema en español.

Cognitive Health

Memory and Thinking: What's Normal and What's Not?

Talk with your doctor to determine if memory and other thinking problems are normal or not, and what is causing them.

What's Normal and What's Not?

What's the difference between normal, age-related forgetfulness and a serious memory problem? Serious memory problems make it hard to do everyday things like driving and shopping. Signs may include:

Asking the same questions over and over again
Getting lost in familiar places
Not being able to follow instructions
Becoming confused about time, people, and places

Mild Cognitive Impairment

Signs of MCI include:

Losing things often
Forgetting to go to important events or appointments
Having more trouble coming up with desired words than other people of the same age

Dementia

Differences Between Normal Aging and Alzheimer's Disease
Normal Aging	Alzheimer's Disease
Making a bad decision once in a while	Making poor judgments and decisions a lot of the time
Missing a monthly payment	Problems taking care of monthly bills
Forgetting which day it is and remembering it later	Losing track of the date or time of year
Sometimes forgetting which word to use	Trouble having a conversation
Losing things from time to time	Misplacing things often and being unable to find them

When to Visit the Doctor

If you, a family member, or friend has problems remembering recent events or thinking clearly, talk with a doctor. He or she may suggest a thorough checkup to see what might be causing the symptoms

The annual Medicare wellness visit includes an assessment for cognitive impairment. This visit is covered by Medicare for patients who have had Medicare Part B insurance for at least 1 year.

Dementia and Memory Loss

What Is Dementia?

Older woman with glasses wearing a sari

Learn more about dementia from MedlinePlus.

Read about this topic in Spanish. Lea sobre esta tema en español.

For More Information About Dementia

Types of Dementia

Hispanic man with dementia sitting in a park

Alzheimer's disease
Frontotemporal disorders
Lewy body dementia

Other types of progressive brain disease include:

Vascular contributions to cognitive impairment and dementia
Mixed dementia, a combination of two or more types of dementia

In addition, certain medical conditions can cause serious memory problems that resemble dementia. These problems should go away once the conditions are treated. These conditions include:

Side effects of certain medicines
Emotional problems, such as stress, anxiety, or depression
Certain vitamin deficiencies
Drinking too much alcohol
Blood clots, tumors, or infections in the brain
Delirium
Head injury, such as a concussion from a fall or accident
Thyroid, kidney, or liver problems

Doctors have identified many other conditions that can cause dementia or dementia-like symptoms. These conditions include:

Argyrophilic grain disease, a common, late-onset degenerative disease
Creutzfeldt-Jakob disease, a rare brain disorder
Huntington's disease, an inherited, progressive brain disease
Chronic traumatic encephalopathy (CTE), caused by repeated traumatic brain injury
HIV-associated dementia (HAD)

Learn more about dementia from MedlinePlus.

Read about this topic in Spanish. Lea sobre esta tema en español.

For More Information About Types of Dementia

National Institute of Neurological Disorders and Stroke
1-800-352-9424 (toll-free)
braininfo@ninds.nih.gov
www.ninds.nih.gov

What Is Mixed Dementia?

For More Information About Mixed Dementia

Content reviewed: December 31, 2017

Biomarkers for Dementia Detection and Research

On this page:

What Are Biomarkers?

Types of Biomarkers and Tests

Brain Imaging

male medical technician with older woman about to get brain imaging test

Computerized Tomography

What is it?

CT scanner

What's the procedure like?

During a CT, a person lies in a scanner for 10 to 20 minutes. A donut-shaped device moves around the head to produce the image.

What does it show?

A head CT can show shrinkage of brain regions that may occur in dementia, as well as signs of a stroke or tumor.

When is it used?

Magnetic Resonance Imaging

What is it?

Doctor talking with patient before MRI

What's the procedure like?

Because MRI uses strong magnetic fields to obtain images, people with certain types of metal in their bodies, such as a pacemaker, surgical clips, or shrapnel, cannot undergo the procedure.

What does it show?

When is it used?

Positron Emission Tomography

What is it?

Examples of brain imaging scans from PET, CT, MRI

What's the procedure like?

The amount of radiation exposure during a PET scan is relatively low. People who are concerned about radiation exposure or who have had many x rays or imaging scans should talk with their doctor.

What does it show?

When is it used?

Cerebrospinal Fluid Biomarkers

Lumbar Puncture

What is it?

CSF is obtained by a lumbar puncture, also called a spinal tap, an outpatient procedure used to diagnose several types of neurological problems.

What's the procedure like?

What does it show?

When is it used?

In research, CSF biomarkers are valuable tools for early detection of a neurodegenerative disease. They are also used in clinical trials to assess the impact of experimental medications.

Other Types of Biomarkers

Blood Tests

Many other proteins, lipids, and other substances can be measured in the blood, but so far none has shown value in diagnosing Alzheimer's.

Currently, dementia researchers use blood biomarkers to study early detection, prevention, and the effects of potential treatments. They are not used in doctors' offices and other clinical settings.

Genetic Testing

Read more about Alzheimer's disease genetics.

Biomarkers in Development

Biomarkers in Dementia Diagnosis

Read more about diagnosing dementia.

Biomarkers in Dementia Research

In addition, biomarker measures may help researchers:

Better understand how risk factors and genetic variants are involved in Alzheimer's disease
Identify participants who meet particular requirements, such as having certain genes or amyloid levels, for clinical trials and studies
Track study participants' responses to a test drug or other intervention, such as physical exercise

Read about the new NIA-AA Research Framework focusing on biomarkers to help define and study Alzheimer's disease.

The Future of Biomarkers

Developing and validating a full range of biomarkers, particularly those that are less expensive and/or less invasive, to help test drugs that may prevent, treat, and improve diagnosis of Alzheimer's and related dementias
Advancing the use of novel PET imaging, CSF, and blood biomarkers to identify specific changes in the brain related to Alzheimer's and other neurodegenerative dementias
Using new MRI methods to measure brain structure, function, and connections
Developing and refining sensitive clinical and neuropsychological assessments to help detect and track early-stage disease
Using biomarkers in combination to build a model of Alzheimer's disease progression over decades, from its earliest, presymptomatic stage through dementia

How You Can Help

Learn more about participating in clinical research.

To find clinical trials and studies on Alzheimer's and related dementias, visit:

NIA Alzheimer's and Related Dementias Clinical Trials Finder
National Institute of Neurological Disorders and Stroke
Alzheimer's Disease Neuroimaging Initiative (ADNI)
National Institutes of Health

For More Information About Dementia Biomarkers

Content reviewed: April 01, 2018

Dementia Research and Clinical Trials

Common Questions About Participating in Alzheimer's and Related Dementias Research

How Can I Find Out About Alzheimer’s Trials and Studies?

Check the resources below:

Ask your doctor, who may know about local research studies that may be right for you.
Sign up for a registry or a matching service to be invited to participate in studies or trials when they are available in your area.
Contact Alzheimer’s research centers or memory or neurology clinics in your community. They may be conducting trials.
Visit the Alzheimer’s and related Dementias Education and Referral (ADEAR) Center clinical trials finder.
Look for announcements in newspapers and other media.
Search www.clinicaltrials.gov.

Why Would I Participate in a Clinical Trial?

There are many reasons why you might choose to join an Alzheimer’s or dementia clinical trial. You may want to:

Help others, including future family members, who may be at risk for Alzheimer’s disease or a related dementia
Receive regular monitoring by medical professionals
Learn about Alzheimer’s and your health
Test new treatments that might work better than those currently available
Get information about support groups and resources

What Else Should I Consider?

Consider both benefits and risks when deciding whether to volunteer for a clinical trial.

While there are benefits to participating in a clinical trial or study, there are some risks and other issues to consider as well.

What Happens When a Person Joins a Clinical Trial or Study?

What Is Informed Consent?

How Do Researchers Decide Who Will Participate?

Researchers carefully screen all volunteers to make sure they meet a study's criteria.

What Is Alzheimer's Disease?

Older woman with Alzheimer's looking out of a window

How Many Americans Have Alzheimer’s Disease?

What Does Alzheimer’s Disease Look Like?

How Long Can a Person Live with Alzheimer’s Disease?

The time from diagnosis to death varies—as little as 3 or 4 years if the person is older than 80 when diagnosed, to as long as 10 or more years if the person is younger.

Although treatment can help manage symptoms in some people, currently there is no cure for this devastating disease.

Learn more about Alzheimer's disease from MedlinePlus.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Alzheimer's Disease

How Is Alzheimer's Disease Diagnosed?

Doctor examining brain scans

To diagnose Alzheimer’s, doctors may:

Ask the person and 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
Carry out standard medical tests, such as blood and urine tests, to identify other possible causes of the problem
Perform brain scans, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET), to rule out other possible causes for symptoms

People with memory problems should return to the doctor every 6 to 12 months.

What Happens Next?

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

What Are the Benefits of Early Diagnosis?

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

In addition, an early diagnosis gives people greater opportunities to participate in clinical trials that are testing possible new treatments for Alzheimer’s disease or in other research studies.

Learn more about Alzheimer's disease from MedlinePlus.

Noticing Memory Problems? What to Do Next

Asking the same questions over and over again
Getting lost in places a person knows well
Not being able to follow directions
Becoming more confused about time, people, and places
Not taking care of oneself—eating poorly, not bathing, or being unsafe

Learn more about Alzheimer's disease from MedlinePlus.

Basics of Alzheimer’s Disease and Dementia

Frequently Asked Questions About Alzheimer's Disease

On this page:

What is the difference between Alzheimer's disease and dementia?
What are the early signs of Alzheimer's disease?
What are the stages of Alzheimer's disease?
What are the causes of Alzheimer's disease?
Is Alzheimer's disease hereditary?
Is there a cure for Alzheimer's disease?
Is there a way to prevent Alzheimer's disease?
Are there any sources of financial help for people with Alzheimer's or their caregivers?

What is the difference between Alzheimer's disease and dementia?

Learn more about Alzheimer's disease and dementia.

What are the early signs of Alzheimer's disease?

Learn more about the signs of Alzheimer's disease.

What are the stages of Alzheimer's disease?

Learn more about the stages of Alzheimer's disease.

What are the causes of Alzheimer's disease?

Learn more about the factors that influence Alzheimer's disease.

Is Alzheimer's disease hereditary?

Just because a family member has Alzheimer's disease does not mean that you will get it, too.

Learn more about assessing risk for Alzheimer's disease.

Is there a cure for Alzheimer's disease?

The U.S. Food and Drug Administration (FDA) has approved several drugs to treat the symptoms of Alzheimer's disease, and certain medicines and other approaches can help control behavioral symptoms.

Learn more about how Alzheimer's disease is treated.

Is there a way to prevent Alzheimer's disease?

Learn more about cognitive health and older adults.

Are there any sources of financial help for people with Alzheimer's or their caregivers?

Yes, there are several possible sources of help, depending on your situation. Read Paying for Care for information on government programs and other payment sources.

The following organizations also offer assistance with finding financial help:

Family Caregiver Alliance
1-800-445-8106 (toll-free)
www.caregiver.org/family-care-navigator

For More Information About Alzheimer's

Basics of Alzheimer’s Disease and Dementia Cognitive Health

Preventing Alzheimer’s Disease: What Do We Know?

Can Increasing Physical Activity Prevent Alzheimer's Disease?

older woman walking by lake with walking sticks

Until scientists know more, experts encourage exercise for its many other benefits. To learn more about exercise and physical activity for older adults, visit NIA's Go4Life campaign.

Can Controlling High Blood Pressure Prevent Alzheimer's Disease?

older man getting blood pressure checked by doctor

Can Cognitive Training Prevent Alzheimer's?

man in cap using computer with a group of people

Can Eating Certain Foods Prevent Alzheimer's Disease?

What Else Might Prevent Alzheimer's Disease?

Researchers are exploring these and other interventions that may help prevent, delay, or slow Alzheimer's dementia or age-related cognitive decline. Other research targets include:

New drugs to delay onset or slow disease progression
Diabetes treatment
Depression treatment
Blood pressure- and lipid-lowering treatments
Sleep interventions
Social engagement
Vitamins such as B12 plus folic acid supplements and D
Combined physical and mental exercises

What's the Bottom Line on Alzheimer's Prevention?

For More Information About Alzheimer's Prevention

Alzheimer's Association
1-800-272-3900 (toll-free)
1-866-403-3073 (TTY/toll-free)
info@alz.org
www.alz.org

Basics of Alzheimer’s Disease and Dementia Cognitive Health

Preventing Alzheimer’s Disease: What Do We Know?

Evaluating the Latest Prevention Research

Increased physical activity
Blood pressure control for people with high blood pressure (also called hypertension)
Cognitive training

The evidence for other interventions, such as medications and diet, was not as strong. However, scientists are continuing to explore these and other possible preventions.

Alzheimer’s Caregiving

Healthy Eating and Alzheimer's Disease

Eating healthy foods helps everyone stay well. It’s even more important for people with Alzheimer’s disease. Here are some tips for healthy eating.

bag of healthy groceries

Buying and Preparing Food

When the person with Alzheimer’s disease lives with you:

Buy healthy foods such as vegetables, fruits, and whole-grain products. Be sure to buy foods that the person likes and can eat.
Give the person choices about what to eat—for example, “Would you like green beans or salad?”
Buy food that is easy to prepare, such as premade salads and single food portions.

When a person with early-stage Alzheimer’s disease lives alone, you can buy foods that the person doesn’t need to cook. Call to remind him or her to eat.

Maintain Familiar Routines

Try these tips:

View mealtimes as opportunities for social interaction. A warm and happy tone of voice can set the mood.
Be patient and give the person enough time to finish the meal.
Respect personal, cultural, and religious food preferences, such as eating tortillas instead of bread or avoiding pork.
If the person has always eaten meals at specific times, continue to serve meals at those times.
Serve meals in a consistent, familiar place and way whenever possible.
Avoid new routines, such as serving breakfast to a person who has never routinely eaten breakfast.

Stay Safe

The person forgets to eat.
Food has burned because it was left on the stove.
The oven isn’t turned off.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Healthy Eating for a Person with Alzheimer's

Choose My Plate
www.choosemyplate.gov

Family Caregiver Alliance
1-800-445-8106 (toll-free)
info@caregiver.org
www.caregiver.org

Meals on Wheels America
1-888-998-6325 (toll-free)
info@mealsonwheelsamerica.org
www.mealsonwheelsamerica.org

Content reviewed: May 18, 2017

Featured Research

Alzheimer’s protein higher in women, may mean higher risk of symptoms

February 28, 2019

Alzheimer's Disease Neuroscience

group of women talking

This research was funded in part by NIA grants PO1AG036694, RO1AG053509, P50AG005134, K23AG049087, and K24AG035007.

Featured Research

Breakdowns in mitochondrial housekeeping provide another clue to Alzheimer’s culprit

March 13, 2019

Alzheimer's DiseaseNeuroscience

Puzzle piece illustration with mitochondria

References:

Fang EF, et al. Mitophagy inhibits Aβ and p-Tau pathologies and cognitive deficits in experimental models of Alzheimer’s disease. Nature Neuroscience. 2019;22(3):401-412.

Kingwell K. Turning up mitophagy in Alzheimer disease. Nature Reviews Drug Discovery. Published online March 4, 2019.

Featured Research

Breakdowns in mitochondrial housekeeping provide another clue to Alzheimer’s culprit

March 13, 2019

Alzheimer's DiseaseNeuroscience

Puzzle piece illustration with mitochondria

References:

Fang EF, et al. Mitophagy inhibits Aβ and p-Tau pathologies and cognitive deficits in experimental models of Alzheimer’s disease. Nature Neuroscience. 2019;22(3):401-412.

Kingwell K. Turning up mitophagy in Alzheimer disease. Nature Reviews Drug Discovery. Published online March 4, 2019.

Featured Research

Sleep loss encourages spread of toxic Alzheimer’s protein

February 12, 2019

Alzheimer's DiseaseClinical ResearchNeuroscience

From the NIH Director’s Blog by Dr. Francis Collins

The researchers went back and reanalyzed those same human samples for tau. Sure enough, the tau levels were elevated on average by about 50 percent.

References:

¹Holth JK, Fritschi SK, Wang C, et al. The sleep-wake cycle regulates brain interstitial fluid tau in mice and CSF tau in humans. Science. 2019 Jan 24. [Epub ahead of print]

Featured Research

Daytime sleepiness linked to elevated brain amyloid

October 11, 2018

Alzheimer's DiseaseCognitive HealthDementiasNeuroscience

Tired man at computer

This study was supported in part by NIA grants AG050507, AG050745, AG049872, AG050507-02S1 and NIA IRP funding.

Featured Research

Some Alzheimer's biomarkers differ by race, NIA-funded study finds

February 01, 2019

Alzheimer's DiseaseBiomarkersClinical Research

Nurse and female patient looking at a chart

This research was funded in part by NIA grants P50AG05681, P01AG03991, and P01AG026276.

References:

Morris JC, et al. Assessment of racial disparities in biomarkers for Alzheimer’s disease. JAMA Neurology. doi:10.1001/jamaneurol.2018.4249. Published online Jan. 7, 2019.

Barnes LB. Biomarkers for Alzheimer dementia in diverse racial and ethnic minorities—a public health priority. JAMA Neurology. doi:10.1001/jamaneurol.2018.3444. Published online Jan. 7, 2019.

Blood-brain barrier test may predict dementia

February 07, 2019

Alzheimer's DiseaseBiomarkersClinical ResearchDementiasNeuroscience

From NIH Research Matters

The researchers are planning to further validate these results by conducting a second trial with more participants.

This paper was funded in part by NIA grants R01AG023084, R01AG039452, P01AG052350, P50AG005142, RO1AG054434, R01AG055770, R21AG055034, P50AG05681, P01AG03991, and P01AG026276.

Can Increasing Physical Activity Prevent Alzheimer's Disease?

older woman walking by lake with walking sticks

Until scientists know more, experts encourage exercise for its many other benefits. To learn more about exercise and physical activity for older adults, visit NIA's Go4Life campaign.

Can Controlling High Blood Pressure Prevent Alzheimer's Disease?

older man getting blood pressure checked by doctor

Can Cognitive Training Prevent Alzheimer's?

man in cap using computer with a group of people

Can Eating Certain Foods Prevent Alzheimer's Disease?

What Else Might Prevent Alzheimer's Disease?

Researchers are exploring these and other interventions that may help prevent, delay, or slow Alzheimer's dementia or age-related cognitive decline. Other research targets include:

New drugs to delay onset or slow disease progression
Diabetes treatment
Depression treatment
Blood pressure- and lipid-lowering treatments
Sleep interventions
Social engagement
Vitamins such as B12 plus folic acid supplements and D
Combined physical and mental exercises

What's the Bottom Line on Alzheimer's Prevention?

For More Information About Alzheimer's Prevention

Alzheimer's Association
1-800-272-3900 (toll-free)

Talking with Older Patients About Cognitive Problems

Older woman taking an Alzheimer's questionnaire

Learn more: Assessing Cognitive Impairment in Older Patients

Cognitive Impairment

Conveying Findings

Following Up

Consider how your practice can coordinate and integrate care for the person and family across the many specialists and services that will be involved.

Learn more: Managing Older Patients with Cognitive Impairment

Working with Family Caregivers

Explain that much can be done to improve the patient's quality of life. Measures such as modifications in daily routine and medications may help control symptoms. If appropriate, bring in a palliative care consultant to help the patient with symptom management.
Let caregivers know there is time to adapt. Decline is rarely rapid. Provide information about the consumer resources and services available from local organizations, as well as support groups.
Help caregivers plan for the possibility that they eventually may need more help at home or may have to look into residential care.
Encourage caregivers to get regular respite especially when patients require constant attention. Ask if the caregiver, who is at considerable risk for stress-related disorders, is receiving adequate health care.

For More Information About Patients with Cognitive Problems

Content reviewed: May 17, 2017

Treatment of Alzheimer’s Disease

How Is Alzheimer's Disease Treated?

Older woman and her doctor having a serious conversation

Treatment for Mild to Moderate Alzheimer’s

Treatment for Moderate to Severe Alzheimer’s

The FDA has also approved Aricept®, the Exelon® patch, and Namzaric®, a combination of Namenda® and Aricept®, for the treatment of moderate to severe Alzheimer’s disease.

Drug Name	Drug Type and Use	How It Works	Common Side Effects
Aricept® (donepezil)	Cholinesterase inhibitor prescribed to treat symptoms of mild, moderate, and severe Alzheimer's	Prevents the breakdown of acetylcholine in the brain	Nausea, vomiting, diarrhea, muscle cramps, fatigue, weight loss
Exelon® (rivastigmine)	Cholinesterase inhibitor prescribed to treat symptoms of mild to moderate Alzheimer's (patch is also for severe Alzheimer's)	Prevents the breakdown of acetylcholine and butyrylcholine (a brain chemical similar to acetylcholine) in the brain	Nausea, vomiting, diarrhea, weight loss, indigestion, muscle weakness
Namenda® (memantine)	N-methyl D-aspartate (NMDA) antagonist prescribed to treat symptoms of moderate to severe Alzheimer's	Blocks the toxic effects associated with excess glutamate and regulates glutamate activation	Dizziness, headache, diarrhea, constipation, confusion
Namzaric® (memantine and donepezil)	NMDA antagonist and cholinesterase inhibitor prescribed to treat symptoms of moderate to severe Alzheimer’s	Blocks the toxic effects associated with excess glutamate and prevents the breakdown of acetylcholine in the brain	Headache, nausea, vomiting, diarrhea, dizziness, anorexia
Razadyne® (galantamine)	Cholinesterase inhibitor prescribed to treat symptoms of mild to moderate Alzheimer's	Prevents the breakdown of acetylcholine and stimulates nicotinic receptors to release more acetylcholine in the brain	Nausea, vomiting, diarrhea, decreased appetite, dizziness, headache

Drug Name	Manufacturer's Recommended Dosage	For More Information
Aricept® (donepezil)	Tablet: Initial dose of 5 mg once a day; may increase dose to 10 mg/day after 4-6 weeks if well tolerated, then to 23 mg/day after at least 3 months Orally disintegrating tablet: Same dosage as above (not available in 23 mg)	For current information about this drug's safety and use, visit www.aricept.com.
Exelon® (rivastigmine)	Capsule: Initial dose of 3 mg/day (1.5 mg twice a day); may increase dose to 6 mg/day (3 mg twice a day), 9 mg/day (4.5 mg twice a day), and 12 mg/day (6 mg twice a day) at minimum 2-week intervals if well tolerated Patch: Initial dose of 4.6 mg once a day; may increase dose to 9.5 mg once a day and 13.3 mg once a day at minimum 4-week intervals if well tolerated	For current information about this drug’s safety and use, visit the www.fda.gov/Drugs. Click on "Search Drugs@FDA," search for Exelon, and click on drug-name links to see label information.
Namenda® (memantine)	Tablet: Initial dose of 5 mg once a day; may increase dose to 10 mg/day (5 mg twice a day), 15 mg/day (5 mg and 10 mg as separate doses), and 20 mg/day (10 mg twice a day) at minimum 1-week intervals if well tolerated Oral solution: Same dosage as above Extended-release capsule*: Initial dose of 7 mg once a day; may increase dose to 14 mg/day, 21 mg/day, and 28 mg/day at minimum 1-week intervals if well tolerated	For current information about this drug's safety and use, visit www.namenda.com and www.namendaxr.com. Click on "Full Prescribing Information" to see the drug label.
Namzaric® (memantine and donepezil)	Extended-release capsule*: Initial dose of 28 mg memantine/10 mg donepezil once a day if stabilized on memantine and donepezil If stabilized on donepezil only, initial dose of 7 mg memantine/10 mg donepezil once a day; may increase dose to 28 mg memantine/10 mg donepezil in 7 mg increments at minimum 1-week intervals if well tolerated Only 14 mg memantine/10 mg donepezil and 28 mg memantine/10 mg donepezil available as generic	For current information about this drug’s safety and use, visit www.namzaric.com. Click on “Full Prescribing Information” to see the drug label.
Razadyne® (galantamine)	Tablet: Initial dose of 8 mg/day (4 mg twice a day); may increase dose to 16 mg/day (8 mg twice a day) and 24 mg/day (12 mg twice a day) at minimum 4-week intervals if well tolerated Extended-release capsule: Same dosage as above but taken once a day	For current information about this drug’s safety and use, visit www.janssenmd.com/razadyne. Click on "Full Prescribing Information" to see the drug label.

* Available as a generic drug.

Dosage and Side Effects

Managing Behavior

Examples of medicines used to help with depression, aggression, restlessness, and anxiety include:

Celexa® (citalopram)
Remeron® (mirtazapine)
Zoloft® (sertraline)
Wellbutrin® (bupropion)
Cymbalta® (duloxetine)
Tofranil® (imipramine)

Experts agree that medicines to treat these behavior problems should be used only after other strategies that don’t use medicine have been tried.

Medicines to Be Used with Caution

There are some medicines, such as sleep aids, anti-anxiety drugs, anticonvulsants, and antipsychotics, that a person with Alzheimer’s disease should take only:

After the doctor has explained all the risks and side effects of the medicine
After other, safer non-medication options have not helped treat the problem

You will need to watch closely for side effects from these medications.

Ambien® (zolpidem)
Lunesta® (eszopiclone)
Sonata® (zaleplon)

Ativan® (lorazepam)
Klonopin® (clonazepam)

Anticonvulsants are drugs sometimes used to treat severe aggression. Side effects may cause sleepiness, dizziness, mood swings, and confusion. Examples of these medicines include:

Depakote® (sodium valproate)
Tegretol® (carbamazepine)
Trileptal® (oxcarbazepine)

Risperdal® (risperidone)
Seroquel® (quetiapine)
Zyprexa® (olanzapine)

Looking for New Treatments

Learn more about Alzheimer's disease from MedlinePlus.

Read about this topic in Spanish. Lea sobre esta tema en español.

For More Information About Treating Alzheimer's

Eldercare Locator
1-800-677-1116 (toll-free)

Treatment

Treatment of Alzheimer’s Disease

Early-Onset Alzheimer's Disease: A Resource List

Older mon looking sad

The items on this list are organized by these categories:

General Resources
Living with Early-Onset Alzheimer’s
Legal and Financial Planning
Caregiving
Clinical Studies and Trials

General Resources

Alzheimer’s Disease Genetics Fact Sheet (2011)

Published by the NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center. Phone: 1-800-438-4380. Email: adear@nia.nih.gov.

Early-Onset Alzheimer’s Disease

Published by Johns Hopkins Medicine.

Early-Onset Alzheimer's: When Symptoms Begin Before Age 65 (2014)

Published by the Mayo Foundation for Medical Education and Research.

Early Onset Familial AD

Published by Alzforum.

Early-Onset Familial Alzheimer Disease (2012)

Available from the National Center for Biotechnology Information, National Library of Medicine.

What You Should Know About Early-Onset Alzheimer’s (2015)

Published by Health.com.

Younger/Early Onset Alzheimer's & Dementia

This web page briefly explains the disorder, providing information about diagnosis, causes, and sources of help.

Published by the Alzheimer’s Association. Phone: 1-800-272-3900. Email: info@alz.org.

Younger-Onset Dementia: An Overview (2013, 2 p.)

Published by Alzheimer’s Australia.

Living with Early-Onset Alzheimer’s

If You Have Younger-Onset Alzheimer’s Disease

Published by the Alzheimer’s Association. Phone: 1-800-272-3900. Email: info@alz.org.

Young Onset Dementia

Published by Alzheimer’s Society Canada. Phone: 1-800-616-8816. Email: info@alzheimer.ca.

HealthCare.gov

Available from the U.S. Department of Health and Human Services. Phone: 1-800-318-2596.

Legal and Financial Planning

Legal and Financial Planning for People with Alzheimer's

Published by the NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center. Phone: 1-800-438-4380. Email: adear@nia.nih.gov.

Social Security Compassionate Allowances Program

Published by the Social Security Administration. Phone: 1-800-772-1213. Email: compassionate.allowances@ssa.gov.

Caregiving

Alzheimer's Caregiving Information from the National Institute on Aging

Get Alzheimer’s care information and advice from NIA, including information on daily care, sundowning and other behaviors, and more.

Published by the NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center. Phone: 1-800-438-4380. Email: adear@nia.nih.gov.

Early Onset Dementia: Advice for Caregivers

Published by the National Initiative for the Care of the Elderly (Canada).

Clinical Studies and Trials

Participating in Alzheimer’s Disease Research

Learn what’s involved in volunteering for Alzheimer’s research. Read about benefits and risks, questions to ask, participant safety, and placebos.

Published by the NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center. Phone: 1-800-438-4380. Email: adear@nia.nih.gov.

Dominantly Inherited Alzheimer Network (DIAN)

To search for more clinical studies and trials, visit NIA's clinical trials finder.

Content reviewed: June 27, 2017

HEALTHY AGING

Healthy Aging

What Do We Know About Healthy Aging?

On this page:

Get Moving: Exercise and Physical Activity

For more information about how to get started and stick with an exercise and physical activity program, visit Go4Life, NIA’s exercise and physical activity campaign for adults 50+.

Pay Attention to Weight and Shape

Learn more about maintaining a healthy weight.

Healthy Food for Thought: Think About What You Eat

Learn more about healthy eating and smart food choices for healthy aging.

Participate in Activities You Enjoy

Granddaughter and grandfather gardening

Other studies have found that older adults who participate in what they see as meaningful activities, like volunteering in their community, reported feeling healthier and happier.

Learn more about participating in activities you enjoy.

For more information on healthy aging, search our A-Z Health Topics.

Content reviewed: June 25, 2018

Balance Problems and Disorders

Have you ever felt dizzy, lightheaded, or as if the room were spinning around you? These can be troublesome sensations. If the feeling happens often, it could be a sign of a balance problem.

Causes of Balance Problems

People are more likely to have problems with balance as they get older. But age is not the only reason these problems occur. In some cases, you can help reduce your risk for certain balance problems.

Symptoms of Balance Disorders

If you have a balance disorder, you may stagger when you try to walk, or teeter or fall when you try to stand up. You might experience other symptoms such as:

Older woman using a walker on a sidewalk

Dizziness or vertigo (a spinning sensation)
Falling or feeling as if you are going to fall
Lightheadedness, faintness, or a floating sensation
Blurred vision
Confusion or disorientation

Do I Have a Balance Problem? Questions to Ask Yourself

You can help identify a balance problem by asking yourself some key questions. If you answer "yes" to any of these questions, discuss the symptom with your doctor.

Do I feel unsteady?
Do I feel as if the room is spinning around me, even only for brief periods of time?
Do I feel as if I'm moving when I know I'm standing or sitting still?
Do I lose my balance and fall?
Do I feel as if I'm falling?
Do I feel lightheaded, or as if I might faint?
Does my vision become blurred?
Do I ever feel disoriented, losing my sense of time, place, or identity?

Coping with a Balance Disorder

Read about this topic in Spanish. Lea sobre este tema en español.

Prevent Falls and Fractures

If you or an older person you know has fallen, you're not alone. More than one in three people age 65 years or older falls each year. The risk of falling—and fall-related problems—rises with age.

Many Older Adults Fear Falling

Causes and Risk Factors for Falls

Older man using a walker to prevent falls

Some medications can increase a person's risk of falling because they cause side effects like dizziness or confusion. The more medications you take, the more likely you are to fall.

Take the Right Steps to Prevent Falls

Stay physically active. Plan an exercise program that is right for you. Regular exercise improves muscles and makes you stronger. It also helps keep your joints, tendons, and ligaments flexible. Mild weight-bearing activities, such as walking or climbing stairs, may slow bone loss from osteoporosis.
Have your eyes and hearing tested. Even small changes in sight and hearing may cause you to fall. When you get new eyeglasses or contact lenses, take time to get used to them. Always wear your glasses or contacts when you need them If you have a hearing aid, be sure it fits well and wear it.
Find out about the side effects of any medicine you take. If a drug makes you sleepy or dizzy, tell your doctor or pharmacist.
Get enough sleep. If you are sleepy, you are more likely to fall.
Limit the amount of alcohol you drink. Even a small amount of alcohol can affect your balance and reflexes. Studies show that the rate of hip fractures in older adults increases with alcohol use.
Stand up slowly. Getting up too quickly can cause your blood pressure to drop. That can make you feel wobbly. Get your blood pressure checked when lying and standing.
Use an assistive device if you need help feeling steady when you walk. Appropriate use of canes and walkers can prevent falls. If your doctor tells you to use a cane or walker, make sure it is the right size for you and the wheels roll smoothly. This is important when you're walking in areas you don't know well or where the walkways are uneven. A physical or occupational therapist can help you decide which devices might be helpful and teach you how to use them safely.
Be very careful when walking on wet or icy surfaces. They can be very slippery! Try to have sand or salt spread on icy areas by your front or back door.
Wear non-skid, rubber-soled, low-heeled shoes, or lace-up shoes with non-skid soles that fully support your feet. It is important that the soles are not too thin or too thick. Don't walk on stairs or floors in socks or in shoes and slippers with smooth soles.
Always tell your doctor if you have fallen since your last checkup, even if you aren't hurt when you fall. A fall can alert your doctor to a new medical problem or problems with your medications or eyesight that can be corrected. Your doctor may suggest physical therapy, a walking aid, or other steps to help prevent future falls.

What to Do If You Fall

Whether you are at home or somewhere else, a sudden fall can be startling and upsetting. If you do fall, stay as calm as possible.

Take several deep breaths to try to relax. Remain still on the floor or ground for a few moments. This will help you get over the shock of falling.

Decide if you are hurt before getting up. Getting up too quickly or in the wrong way could make an injury worse.

If you think you can get up safely without help, roll over onto your side. Rest again while your body and blood pressure adjust. Slowly get up on your hands and knees, and crawl to a sturdy chair.

If you are hurt or cannot get up on your own, ask someone for help or call 911. If you are alone, try to get into a comfortable position and wait for help to arrive.

Keep Your Bones Strong to Prevent Falls

Osteoporosis is a disease that makes bones weak and more likely to break. For people with osteoporosis, even a minor fall may be dangerous. Talk to your doctor about osteoporosis.

Learn how to fall-proof your home.

Read about this topic in Spanish. Lea sobre este tema en español.

Talking with Your Doctor

Fall-Proofing Your Home

Fall hazards in the home, including a scatter rug, dog, and empty slippers

In Stairways, Hallways, and Pathways

Have handrails on both sides of the stairs, and make sure they are tightly fastened. Hold the handrails when you use the stairs, going up or down. If you must carry something while you're on the stairs, hold it in one hand and use the handrail with the other. Don't let what you're carrying block your view of the steps.
Make sure there is good lighting with light switches at the top and bottom of stairs and on each end of a long hall. Remember to use the lights!
Keep areas where you walk tidy. Don't leave books, papers, clothes, and shoes on the floor or stairs.
Check that all carpets are fixed firmly to the floor so they won't slip. Put no-slip strips on tile and wooden floors. You can buy these strips at the hardware store.
Don't use throw rugs or small area rugs.

In Bathrooms and Powder Rooms

Mount grab bars near toilets and on both the inside and outside of your tub and shower.
Place non-skid mats, strips, or carpet on all surfaces that may get wet.
Remember to turn on night lights.

In Your Bedroom

Put night lights and light switches close to your bed.
Keep a flashlight by your bed in case the power is out and you need to get up.
Keep your telephone near your bed.

In Other Living Areas

Keep electric cords and telephone wires near walls and away from walking paths.
Secure all carpets and large area rugs firmly to the floor.
Arrange your furniture (especially low coffee tables) and other objects so they are not in your way when you walk.
Make sure your sofas and chairs are the right height for you to get in and out of them easily.
Don't walk on newly washed floors—they are slippery.
Keep items you use often within easy reach.
Don't stand on a chair or table to reach something that's too high—use a "reach stick" instead or ask for help. Reach sticks are special grabbing tools that you can buy at many hardware or medical-supply stores. If you use a step stool, make sure it is steady and has a handrail on top. Have someone stand next to you.
Don't let your cat or dog trip you. Know where your pet is whenever you're standing or walking.
Keep emergency numbers in large print near each telephone.

Your Own Medical Alarm

Home Improvements Prevent Falls

Read more about falls and falls prevention.

Read about this topic in Spanish. Lea sobre este tema en español.

Tips on Discussing Sensitive Topics with Your Doctor

On this page:

Illustration of a doctor and patient talking to each other

Alcohol

Falling and Fear of Falling

Feeling Unhappy with Your Doctor

Grief, Mourning, and Depression

There is no right or wrong way to grieve. Read how you can take care of yourself while you are mourning the death of a spouse.

Read more about depression in older adults.

HIV/AIDS

Incontinence

Learn more about bladder health.

Memory Problems

Problems with Family

Even strong and loving families can have problems, especially under the stress of illness. Although family problems can be painful to discuss, talking about them can help your doctor help you.

Learn more about how to recognize elder abuse.

Sexuality

Learn more about how growing older might affect your sex life.

For More Information to Help You Discuss Sensitive Subjects with Your Doctor

National Center on Elder Abuse
1-855-500-3537 (toll-free)
ncea-info@aoa.hhs.gov
https://ncea.acl.gov

National Institute on Alcohol Abuse and Alcoholism
National Institutes of Health
1-888-696-4222
niaaaweb-r@exchange.nih.gov
www.niaaa.nih.gov

Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE)
1-212-741-2247
info@sageusa.org
www.sageusa.org

Online Health Information: Is It Reliable?

On this page:

Many older adults share a common concern: “How can I trust the health information I find on the Internet?”

2 older men looking for health information online

Where Can I Find Reliable Health Information Online?

The National Institutes of Health website is a good place to start for reliable health information.

Questions to Ask Before Trusting a Website

1. Who sponsors/hosts the website? Is that information easy to find?

.gov identifies a U.S. government agency
.edu identifies an educational institution, like a school, college, or university
.org usually identifies nonprofit organizations (such as professional groups; scientific, medical, or research societies; advocacy groups)
.com identifies commercial websites (such as businesses, pharmaceutical companies, and sometimes hospitals)

2. Who wrote the information? Who reviewed it?

Is the health information written or reviewed by a healthcare professional? Dependable websites will tell you where their health information came from and how and when it was reviewed.

No information should replace seeing a doctor or other health professional who can give you advice that caters to your specific situation.

3. When was the information written?

4. What is the purpose of the site?

5. Is your privacy protected? Does the website clearly state a privacy policy?

6. How can I protect my health information?

These precautions can help better protect your information:

Use common sense when browsing the Internet. Do not open unexpected links. Hover your mouse over a link to confirm that clicking it will take you to a reputable website.
Use a strong password. Include a variation of numbers, letters, and symbols. Change it frequently.
Use two-factor authentication when you can. This requires the use of two different types of personal information to log into your mobile devices or accounts.
Do not enter sensitive information over public Wi-Fi that is not secure. This includes Wi-Fi that is not password protected.

Be careful what information you share over social media sites. This can include addresses, phone numbers, and email addresses. Learn how you can keep your information private.

7. Does the website offer quick and easy solutions to your health problems? Are miracle cures promised?

Health and Medical Apps

Social Media and Health Information

Check the source of the information, and make sure the author is credible. Fact-checking websites can also help you figure out if a story is reliable.

A Quick Checklist

You can use the following checklist to help make sure that the health information you are reading online can be trusted. You might want to keep this checklist by your computer.

Is the sponsor/owner of the website a Federal agency, medical school, or large professional or nonprofit organization, or is it related to one of these?
If not sponsored by a Federal agency, medical school, or large professional or nonprofit organization, is the website written by a healthcare professional or does it reference one of these trustworthy sources for its health information?
Why was the site created? Is the mission or goal of the website sponsor clear?
Can you see who works for the agency or organization and who authored the information? Is there a way to contact the sponsor of the website?
When was the information written or webpage last updated?
Is your privacy protected?
Does the website offer unbelievable solutions to your health problem(s)? Are quick, miracle cures promised?

Trust Yourself and Talk to Your Doctor

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Reliable Health Websites

Centers for Medicare & Medicaid Services
1-800-633-4227 (toll-free)
1-877-486-2048 (TTY/toll-free)
www.medicare.gov

Centers for Disease Control and Prevention (CDC)
1-800-232-4636 (toll-free)
1-888-232-6348 (TTY/toll-free)
cdcinfo@cdc.gov

U.S. Food and Drug Administration
1-888-463-6332 (toll-free)
druginfo@fda.hhs.gov
www.fda.gov

Content reviewed: October 31, 2018

Healthy Eating

Sample Menus: Healthy Eating for Older Adults

Learn more about healthy food choices for healthy aging:

Shopping for Food That's Good for You

Serving and Portion Sizes: How Much Should I Eat?

10 Tips for Eating Healthy on a Budget

Sample Menu 1
Breakfast	Lunch
Breakfast burrito 1 flour tortilla (8-inch diameter) 1 scrambled egg 1/3 cup black beans 2 tablespoons salsa 1/2 large grapefruit 1 cup water, coffee, or tea	Roast beef sandwich 1 small whole-grain hoagie bun 2 ounces lean roast beef 1 slice part-skim mozzarella cheese 2 slices tomato 1/4 cup mushrooms (cooked in 1 teaspoon corn/canola oil) 1 teaspoon mustard Baked potato wedges 1 cup potato wedges (cooked in 1 teaspoon canola oil) 1 tablespoon ketchup 1 cup fat-free milk
Dinner	Snack
Baked salmon on beet greens 4 ounce salmon filet 1 teaspoon olive oil 2 teaspoons lemon juice 1/3 cup cooked beet greens (cooked in 2 teaspoons canola oil) Quinoa with almonds 1/2 cup quinoa 1/2 cup silvered almonds 1 cup fat-free milk	1 cup cantaloupe balls

Sample Menu 2
Breakfast	Lunch
Whole wheat French toast 2 slices whole wheat bread 3 tablespoons fat-free milk 2/3 egg 2 teaspoons tub margarine 1 tablespoon pancake syrup 1/2 large grapefruit 1 cup fat-free milk	3-bean vegetarian chili on baked potato 1/4 cup each cooked kidney beans, navy beans, and black beans 1/2 cup tomato sauce 1/4 cup chopped onion 2 tablespoons chopped jalapeno peppers 1 teaspoon corn/canola oil (to cook onion and peppers) 1/4 cup cheese sauce 1 large baked potato 1/2 cup cantaloupe 1 cup water, coffee, or tea
Dinner	Snack
Hawaiian pizza 2 slices cheese pizza, thin crust 1 ounce lean ham 1/4 cup pineapple 1/4 cup mushrooms, cooked in 1 teaspoon safflower oil Green salad 1 cup mixed salad greens 4 teaspoons oil and vinegar dressing 1 cup fat-free milk	3 tablespoon hummus 5 whole wheat crackers

Sample Menu 3
Breakfast	Lunch
Cold cereal 1 cup shredded wheat 1/2 cup sliced banana 1/2 cup fat-free milk 1 slice whole wheat toast 2 teaspoons all-fruit preserves 1 cup fat-free chocolate milk	Tuna salad sandwich 2 slices rye bread 2 ounces tuna 1 tablespoon mayonnaise 1 tablespoon chopped celery 1/2 cup shredded lettuce 1 medium peach 1 cup fat-free milk
Dinner	Snack
Roasted chicken 3 ounces cooked chicken breast 1 large sweet potato, roasted 1/2 cup succotash (lima beans & corn) 1 teaspoon tub margarine 1 ounce whole wheat roll 1 teaspoon tub margarine 1 cup water, coffee, or tea	1/4 cup dried apricots 1 cup flavored yogurt (chocolate)

Sample Menu 4
Breakfast	Lunch
Creamy oatmeal (cooked in milk) 1/2 cup uncooked oatmeal 1 cup fat-free milk 2 tablespoons raisins 2 teaspoons brown sugar 1 cup orange juice 2 teaspoons all-fruit preserves 1 cup fat-free chocolate milk	Taco salad 2 ounces tortilla chips 2 ounces cooked ground turkey (cooked in 2 teaspoons corn oil) 1/4 cup kidney beans 1/2 ounce low-fat cheddar cheese 1/2 cup chopped lettuce 1/2 cup avocado 1 teaspoon lime juice (on avocado) 2 tablespoons salsa 1 cup water, coffee, or tea
Dinner	Snack
Spinach lasagna roll-ups 1 cup lasagna noodles (2 ounces dry) 1/2 cup cooked spinach 1/2 cup ricotta cheese 1 ounce part-skim mozzarella cheese 1/2 cup tomato sauce 1 ounce whole wheat roll 1 teaspoon tub margarine 1 cup fat-free milk	2 tablespoons raisins 1 ounce unsalted almonds

Download sample menus (PDF, 117K)

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on Healthy Eating Plans

Choose My Plate
www.choosemyplate.gov

USDA Food and Nutrition Information Center
National Agricultural Library
1-301-504-5414
fnic@ars.usda.gov
www.nal.usda.gov/fnic

USDA Center for Nutrition Policy and Promotion
1-703-305-7600
www.cnpp.usda.gov

Healthy Eating

Food Safety

On this page:

Avoid Getting Sick From Your Food
Food Safety When Cooking
Food Safety When Eating Out

Avoid Getting Sick From Your Food

Some foods can be dangerous for an older person no matter what—so, if you are over 65, the U.S. Department of Agriculture recommends you avoid:

Raw or undercooked fish, shellfish, meat, and poultry
Refrigerated smoked fish (for example, lox)
Hot dogs, deli meats, and luncheon meats (unless these are reheated to 165 °F)
Raw or unpasteurized milk and milk products
Soft cheeses made from unpasteurized milk, including feta, brie, camembert, blue, and queso fresco
Raw or undercooked eggs or egg product, as found in cookie dough, eggnog, and some salad dressings
Raw sprouts
Unwashed fresh vegetables, including lettuce
Unpasteurized juice from fruits and vegetables

Changing Taste and Smell

Smart Storage

Try to use refrigerated leftovers within 3 or 4 days to reduce your risk of food poisoning. Throw away foods older than that or those that show moldy areas.

For recommended refrigerator and freezer storage times for common foods, download our Storing Cold Food tip sheet (PDF, 75K).

Food Safety When Cooking

When preparing foods, follow four basic steps—clean, separate, cook, and chill.

Clean

Keep your refrigerator clean, especially the vegetable and meat bins. When there is a spill, use hot soapy water to clean it up.

Separate

Cook

Bring sauces, marinades, soups, and gravy to a boil when reheating.

U.S. Department of Agriculture-Recommended Safe Minimum Internal Temperatures
Type of Food	Minimum Internal Temperature
All meats and seafood	145°F (with a 3-minute rest time)
All ground meats	160°F
Egg dishes	160°F
All poultry	165°F
Hot dogs and luncheon meats	165°F

No matter what temperature you set your oven at, the temperature inside your food needs to reach the level shown here to be safe.

Chill

Food Safety When Eating Out

It's nice to take a break from cooking or get together with others for a meal at a restaurant. But, do you think about food safety when you eat out? You should.

Pick a place that looks clean.
If your city or state requires restaurants to post a cleanliness rating near the front door, check it out.
Don't be afraid to ask the waiter or waitress how items on the menu are prepared. For example, could you have the tuna cooked well instead of seared? Or, if you find out the Caesar salad dressing is made with raw eggs, ask for another salad dressing.
Consider avoiding buffets. Sometimes food in buffets sits out for a while and might not be kept at the proper temperature—whether hot or cold.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on Food Safety

National Association of Nutrition and Aging Services Programs
1-202-682-6899
www.nanasp.org

USDA Food and Nutrition Information Center
National Agricultural Library
1-301-504-5414
fnic@ars.usda.gov
www.nal.usda.gov/fnic

Healthy Eating

Vitamins and Minerals

Vitamins

Vitamins and minerals are measured in a variety of ways. The most common are:

mg – milligram
mcg – microgram
IU – international unit

Minerals

Vitamin and Mineral Supplements for People Over Age 50
Vitamin D	If you are age 50–70, you need at least 600 IU, but not more than 4,000 IU. If you are age 70 and older, you need at least 800 IU, but not more than 4,000 IU. You can get vitamin D from fatty fish, fish-liver oils, fortified milk and milk products, and fortified cereals.
Vitamin B6	Men need 1.7 mg every day. Women need 1.5 mg every day. You can get vitamin B6 from fortified cereals, whole grains, organ meats like liver, and fortified soy-based meat substitutes.
Vitamin B12	You need 2.4 mcg every day. Some people over age 50 have trouble absorbing the vitamin B12 found naturally in foods, so make sure you get enough of the supplement form of this vitamin, such as from fortified foods. You can get vitamin B12 from fortified cereals, meat, fish, poultry, and milk.
Folate	You need 400 mcg each day. Folic acid is the form used to fortify grain products or added to dietary supplements. You can get folate from dark-green leafy vegetables like spinach, beans and peas, fruit like oranges and orange juice, and folic acid from fortified flour and fortified cereals.

Calcium

There are several types of calcium supplements. Calcium citrate and calcium carbonate tend to be the least expensive.

Calcium for People Over 50
Women age 51 and older	Men age 51 to 70	Men age 71 and older
1,200 mg each day	1,000 mg each day	1,200 mg each day
Women and men age 51 and older: Don’t take more than 2,000 mg of calcium in a day.

Sodium

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on Vitamins and Minerals

Office of Dietary Supplements
National Institutes of Health
1-301-435-2920
ods@nih.gov
www.ods.od.nih.gov

Healthy Eating

DASH Eating Plan

A number of major research studies have shown that following the Dietary Approaches to Stop Hypertension (DASH) Plan can lower blood pressure.

Quinoa salad with black beans and vegetables

DASH Plan Recommendations for Several Daily Calorie Count Examples
	1,600 calories	2,000 calories	2,600 calories
Grains	6 servings	6-8 servings	10-11 servings
Fruits	4 servings	4-5 servings	5-6 servings
Vegetables	3-4 servings	4-5 servings	5-6 servings
Fat-free or low-fat milk and milk products	2-3 servings	2-3 servings	3 servings
Lean meat, poultry, and fish	3-4 ounces or less	6 ounces or less	6 ounces or less
Nuts, seeds, and legumes	3-4 servings per week	4-5 servings per week	1 serving per day
Fats and oils	2 servings	2-3 servings	3 servings
Sweets and added sugars	3 servings or less per week	5 servings or less per week	less than 2 servings per day

DASH is organized by servings for most food groups. A DASH serving equals:

Grains—one ounce or equivalent

Fruits—half cup cut-up fruit or equivalent

Vegetables—half cup cooked vegetables or equivalent

Meats, poultry, and fish—one ounce cooked meats, poultry, or fish or one egg

Nuts, seeds, and legumes—foods like two tablespoons peanut butter, third cup or 1-1/2 ounces of nuts, half cup cooked beans, or one cup bean soup

Fats and oils—one teaspoon soft margarine or vegetable oil, one tablespoon mayonnaise, and one tablespoon regular salad dressing or two tablespoons low-fat dressing

Sugars—one tablespoon jam or jelly, half cup regular Jell-O, or one cup regular lemonade

Learn more about the food groups.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on the DASH Eating Plan

National Heart, Lung, and Blood Institute
1-301-592-8573
nhlbiinfo@nhlbi.nih.gov
www.nhlbi.nih.gov

Content reviewed: June 29, 2017

Healthy Eating

Getting Enough Fluids

It’s important for your body to have plenty of fluids each day. Water helps you digest your food, absorb nutrients, and then get rid of the unused waste.

Grandmother drinking water with her grandson

With age, some people may lose their sense of thirst. To further complicate matters, some medicines might make it even more important to have plenty of fluids.

Drinking enough fluids every day also is essential. Check with your doctor, however, if you’ve been told to limit how much you drink.

Try these tips for getting enough fluids:

Try to add liquids throughout the day.
Take sips from a glass of water, milk, or juice between bites during meals.
Have a cup of low-fat soup as an afternoon snack.
Drink a full glass of water if you need to take a pill.
Have a glass of water before you exercise or go outside to garden or walk, especially on a hot day.
Remember, water is a good way to add fluids to your daily routine without adding calories.
Drink fat-free or low-fat milk, or other drinks without added sugars.
If you drink alcoholic beverages, do so sensibly and in moderation. That means up to one drink per day for women and up to two drinks for men.
Don’t stop drinking liquids if you have a urinary control problem. Talk with your doctor about treatment.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information on Fluids and Nutrition

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
1-800-860-8747 (toll-free)
1-866-569-1162 (TTY/toll-free)
healthinfo@niddk.nih.gov
www.niddk.nih.gov

National Heart, Lung, and Blood Institute
(Instituto Nacional del Corazón, los Pulmones y la Sangre)
1-301-592-8573
nhlbiinfo@nhlbi.nih.gov
www.nhlbi.nih.gov

National Association of Nutrition and Aging Services Programs
1-202-682-6899
www.nanasp.org

President’s Council on Fitness, Sports, and Nutrition
1-240-276-9567
fitness@hhs.gov
www.fitness.gov

Content reviewed: June 09, 2017

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