It may be easy to brush off misplacing your dog’s leash before a walk or forgetting the rules of a card game. But when moments of forgetfulness regularly make it hard to do daily tasks, it may be a sign of more serious memory loss triggered by Alzheimer’s disease.
What is Alzheimer’s disease?
Alzheimer’s disease is the most common type of dementia, which is a condition that chips away at your memory, behavior, and ability to think. Over time, the brain shrinks from a buildup of plaque and tangles of proteins from dead nerve cells,1 making it difficult to function in day-to-day life. According to the Centers for Disease Control and Prevention, 6.7 million Americans had Alzheimer’s disease in 2023 and that number could rise to 14 million people by 2060.2
What are the signs of Alzheimer’s disease?
From having difficulty following and participating in conversations to increased irritability, there are a number of early symptoms of Alzheimer’s and other dementias the Alzheimer’s Association found that can help you spot changes in you or a loved one’s behavior, including:3
- Memory loss that disrupts daily life. One of the first symptoms of Alzheimer’s, such as easily forgetting new information, needing to constantly set reminders, or repeating questions during a conversation.
- Difficulty completing familiar tasks. Forgetting how to record a favorite TV show, or no longer remembering the way to drive to church or the grocery store.
- Trouble understanding visual images and spatial relationships. Finding it harder to read or losing your balance easily because of changes to your vision. You can no longer judge how far or close things really are from you.
- Misplacing things and losing the ability to retrace steps. Forgetting to put belongings in their usual places, making them harder to find later.
- Withdrawal from work or social activities. Skipping outings and gatherings because being unable to hold conversations makes it harder to socialize.
What is my risk for getting Alzheimer’s?
While the jury’s still out on what causes Alzheimer’s disease, experts say it’s important to be aware of any combination of these risk factors:
- Age. Age is a leading risk factor for Alzheimer’s disease. The risk of having Alzheimer’s only increases after age 65, with one in 13 people age 65 to 84 developing the disease.4
- Lifestyle. Certain habits can have a negative impact on the health of your body and brain. Being physically active, quitting smoking, and reducing alcohol use are just a few healthy habits that promote better brain health.4 The National Institute on Aging also recommends getting adequate sleep, eating healthy, and keeping your mind sharp through reading, hobbies, and socializing.
- Family history. If someone’s parent or sibling has Alzheimer’s disease, that person may be at higher risk of developing it in the future. This risk could come from a combination of a family’s lifestyle and genetics.5
- Genetics. Two types of genes determine risk for Alzheimer’s disease: Risk genes and deterministic genes. Risk genes, such as the APOE gene, increase your chance of developing Alzheimer’s. Deterministic genes are genes that, in very rare cases, strongly indicate you will develop Alzheimer’s.6 While genetic tests are available, the Alzheimer’s Association recommends discussing testing with a genetics counselor.
- Race or ethnicity. Higher rates of cardiovascular diseases among Latinos and Blacks may lead to an increased chance of Alzheimer’s disease and other forms of dementia.7 Older Latinos are one-and-a-half times as likely than older whites to develop these diseases, while older Blacks are twice as likely to develop them than older whites.7
How is Alzheimer’s disease diagnosed?
Health care providers will use a combination of the following tests, screenings, and questions to figure out if someone has Alzheimer’s disease:8
What health care providers use to diagnose Alzheimer's
- A review of medical history. Do you have a family history of Alzheimer’s? How has your behavior or thinking changed over time? A doctor may ask these starter questions to assess someone’s risk.
- Physical exam. As a doctor checks your blood pressure, listens to your heart and other routine parts of a checkup, expect questions about your exercise, eating habits, and a timeline for when your symptoms began.
- Neurological exam. Tests of eye movement, reflexes, and speech can determine whether someone has Alzheimer’s or other brain conditions such as Parkinson’s disease.
- Cognitive, functional, and behavioral tests. Can you follow simple instructions? Can you memorize a list? A doctor who specializes in brain function may test you on these memory and cognitive tasks.
- Depression screenings. A doctor may ask about feelings of depression, including any shifts in your mood, negative thoughts, or loss of interest in activities you used to enjoy.
- Brain imaging. Brain scans such as magnetic resonance imaging, known as an MRI, can identify any brain shrinkage or blood vessel damage.
- Cerebrospinal fluid tests. Cerebrospinal fluid is inside the tissue surrounding your spinal cord and the brain. It can help a doctor find evidence of the plaque that builds up in Alzheimer’s disease. A doctor will need to insert a needle into your spine, known as a spinal tap, to collect a sample.
More research is needed to develop widely available FDA-approved blood tests to determine the signs of Alzheimer’s disease.
Getting an official diagnosis may seem scary, but early detection can give you and your family time to develop a plan of action around your future health and long-term
Can Alzheimer’s be treated?
The U.S. Food and Drug Administration has approved multiple medications to either slow Alzheimer’s progression or manage the disease symptoms, such as loss of judgment and memory.
The most commonly prescribed drugs taken by mouth are:
- Cholinesterase inhibitors: Drugs such as donepezil (brand name Aricept ®) preserve the brain chemical acetylcholine, which connects the nerves that help your judgment, thinking, and memory.9
- Glutamate regulators: Glutamate is an acid that can destroy brain nerve cells.10 Drugs such as memantine (brand name Namenda) control glutamate levels and help you with reasoning, memory, and language skills.
The most commonly prescribed drugs taken intravenously:
- Recently, the FDA approved two treatments to break up the proteins that form plaque in the brain: Aduhelm (generic name aducanumab) and Leqembi (generic name lecanemab). Both are given intravenously—or through IV—and they are only for people in the early stages of Alzheimer’s. As of July 2023, a similar drug, donanemab, showed promise in clinical trials and awaits possible FDA approval in early 2024.11
Each Alzheimer’s disease medicine can have different side effects, such as nausea or loss of appetite.9 Your doctor may also recommend medications that address other Alzheimer’s symptoms such as agitation, insomnia, and depression. Health care providers will recommend a treatment plan based on the stage of the disease and symptoms.
Will Medicare cover Alzheimer’s treatments?
The level of Medicare coverage depends on the Alzheimer’s drug.
Medicare Part D prescription plans are required to cover a minimum of two Alzheimer’s drugs for two types: cholinesterase inhibitors and glutamate regulators.12
Medicare covers the use of both Aduhelm and Leqembi on three conditions:13
- You are a Medicare enrollee
- You have evidence of brain plaques and a doctor’s diagnosis of mild cognitive impairment or mild Alzheimer’s disease dementia
- Your doctor is part of an approved registry that includes a clinical team and follow-up care
While there is still concern about whether these drugs are affordable, a new law offers some relief. Starting in 2025 out-of-pocket costs for prescription drugs will be no more than $2,000 for Medicare enrollees.14 There will also be an option to spread out payments over the year, rather than paying for expensive drugs all at once.14
How do I care for someone with Alzheimer’s?
Care for Alzheimer’s disease is a labor of love but can take an emotional and physical toll on caregivers. If you help someone with Alzheimer’s who can no longer live safely on their own, they may benefit from memory care.
Memory care is a specialized form of long-term residential care for people with Alzheimer’s disease where the staff is trained in caring for people with dementia. Memory care facilities are secure environments where people can socialize, exercise, and get help with medication. The National Council on Aging’s Adviser offers a resource on memory care that has tips on how to find the best facility.
Alternatives to long-term memory care facilities include:15
- Skilled nursing facilities (nursing homes)
- Adult “day out” or day services programs
There are also resources to find in-home care for people with Alzheimer's for help with daily tasks such as bathing and giving medicine. NCOA’s BenefitsCheckUp and the U.S. Administration for Community Living’s Eldercare Locator are free resources to help you find a variety of services for people with dementia.
How do I pay for memory care?
Memory care can be expensive over the long run. As of February 2023, the average U.S. cost of memory care was $6,160 per month.16 But there are many payment options available to create a plan for your family that makes it as affordable as possible. Government assistance includes:15
Medicare
Medicare Part A coverage can help pay for someone to stay up to 100 days in a skilled nursing facility after a hospital stay, home health care for Alzheimer’s patients who cannot leave their homes, and hospice care for people with six months or less to live.
Medicare Part A will not cover room and board at these facilities:
- Assisted living facilities: These are residential communities where people have the privacy of their own room, but access to shared living spaces for socializing and help with bathing and dressing.17
- Independent living communities: These can be condominium or apartment buildings, retirement communities with a mix of apartments and single-family homes, or housing for older adults with low incomes. Services offered may include meals, social activities, and transportation.18
Medicare Part A also does not cover the costs of daily tasks like helping someone bathe, eat, or put their clothes on, which many people with dementia need help with. However, Medicare may cover the costs of medical care, such as physical therapy, at assisted living facilities17 and independent living communities.18
Medicare Part B will help pay for cognitive tests to diagnose dementia, help for caregivers who need Alzheimer’s disease action plans, and prescription drugs. Prescriptions will still be subject to a 20% copay.
There are also private insurance options through Medicare Advantage (Medicare Part C) that offer coverage Medicare Parts A and B provide, and additional insurance coverage through Medigap to cover out-of-pocket costs.
Medicaid
If you are enrolled in Medicaid or become eligible, Medicaid may cover 100% of the cost of a nursing home stay. It typically will not cover the costs of room and board at an assisted living facility or independent living community. However, some state Medicaid programs do offer waivers to help you pay for room and board at assisted living facilities.17
Medicaid’s Home and Community-Based Services program may also cover the costs of services at Medicaid-approved memory care facilities, such as assisted living.19 This program provides services to help with medication management, transportation, bathing, and dressing.
Contact your state Medicaid agency to see what your options are as coverage varies from state to state.
Veterans benefits
Eligible veterans and their families may be able to access long-term care facilities, adult day services, and support for caregivers through the VA Health System.20
For veterans, their spouses, and unmarried dependent children who get a VA pension, there are two kinds of monthly payments to afford memory care help: Aid and Attendance benefits and Housebound benefits.21 You can only receive one of these benefits.
You are eligible for Housebound benefits if a permanent disability requires you to spend most of your time indoors. For Aid and Attendance benefits, you must meet at least one of the following guidelines:21
- You need help with activities of daily living like dressing and bathing
- You are mostly in bed because of an illness
- You are staying in a nursing home due to a disability
- You have trouble seeing even with glasses or contact lenses
Contact your local VA office about how to apply for these benefits.
Other payment options for memory care
Other options include long-term care insurance that helps reimburse memory care expenses, a reverse mortgage to turn your home equity into money to pay for memory care, and private assets such as Social Security income, savings, or investments.15
"Signing up for long-term care insurance is not a realistic option for older adults and especially people with dementia because costs are prohibitive or they may be denied coverage,” said Kathleen Cameron, Senior Director of NCOA’s Center for Healthy Aging. “But if someone already has a long-term policy, then this can be used toward the cost of memory care.”
Read NCOA’s guide on Medicare’s coverage of memory care to learn about the benefits and risks of all these options.
Sources
1. Alzheimer's Association. Inside the Brain. Found on the internet at https://www.alz.org/alzheimers-dementia/what-is-alzheimers/brain_tour_part_2
2. Centers for Disease Control and Prevention. About Alzheimer’s Disease. Found on the Internet at https://www.cdc.gov/aging/alzheimers-disease-dementia/about-alzheimers.html
3. Alzheimer’s Association. 10 Early Signs and Symptoms of Alzheimer's and Dementia. Found on the Internet at https://www.alz.org/alzheimers-dementia/10_signs
4. National Institute on Aging. Thinking About Your Risk for Alzheimer’s Disease? Five Questions To Consider. Found on the Internet at https://www.nia.nih.gov/health/alzheimers-causes-and-risk-factors/thinking-about-your-risk-alzheimers-disease-five
5. Alzheimer’s Association. Causes and Risk Factors for Alzheimer's Disease. Found on the Internet at https://www.alz.org/alzheimers-dementia/what-is-alzheimers/causes-and-risk-factors
6. Alzheimer’s Association. Is Alzheimer's Genetic? Found on the Internet at https://www.alz.org/alzheimers-dementia/what-is-alzheimers/causes-and-risk-factors/genetics
7. Alzheimer’s Association. Causes and Risk Factors for Alzheimer's Disease. Found on the Internet at https://www.alz.org/alzheimers-dementia/what-is-alzheimers/causes-and-risk-factors
8. Alzheimer’s Association. Medical Tests for Diagnosing Alzheimer’s. Found on the Internet at https://www.alz.org/alzheimers-dementia/diagnosis/medical_tests
9. Alzheimer’s Association. Medications for Memory, Cognition and Dementia-Related Behaviors. Found on the Internet at https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory
10. Alzheimer's disease: Does memantine help? National Library of Medicine. Found on the Internet at https://www.ncbi.nlm.nih.gov/books/NBK279356/
11. Alzheimer’s Association. Donanemab for Treatment of Early Alzheimer's Disease — News Pending FDA Review. Found on the Internet at https://www.alz.org/alzheimers-dementia/treatments/donanemab
12. National Council on Aging. What Does Medicare Cover for Alzheimer’s Disease?Found on the Internet at https://www.ncoa.org/article/what-does-medicare-cover-for-alzheimers-disease
13. Centers for Medicare & Medicaid Services. Statement: Broader Medicare Coverage of Leqembi Available Following FDA Traditional Approval. Found on the Internet at https://www.cms.gov/newsroom/press-releases/statement-broader-medicare-coverage-leqembi-available-following-fda-traditional-approval
14. Medicare.gov. Saving money with the prescription drug law. Found on the Internet at https://www.medicare.gov/about-us/prescription-drug-law
15. National Council on Aging. Does Medicare Cover Memory Care? A Comprehensive Guide. Found on the Internet at https://www.ncoa.org/article/does-medicare-cover-memory-care-a-comprehensive-guide
16. Dementia Care Central. Alzheimer’s / Dementia Care Costs: Home Care, Adult Day Care, Assisted Living & Nursing Homes. February 9, 2023. Found on the internet at https://www.dementiacarecentral.com/assisted-living-home-care-costs/#assisted-living
17. National Council on Aging. What Is Assisted Living? Found on the Internet at https://www.ncoa.org/adviser/local-care/assisted-living/
18. National Council on Aging. What is Independent Living? Found on the Internet at https://www.ncoa.org/adviser/local-care/independent-living/
19. National Council on Aging. Does Medicaid Cover Memory Care? Found on the Internet at https://www.ncoa.org/article/does-medicaid-cover-memory-care
20. U.S. Department of Veterans Affairs. Geriatrics and Extended Care. Found on the. Internet at https://www.va.gov/GERIATRICS/pages/
21. U.S. Department of Veterans Affairs. VA Aid and Attendance benefits and Housebound allowance. Found on the Internet at https://www.va.gov/pension/aid-attendance-housebound
