Alzheimer's disease causes brain changes that gradually get worse.

It's the most common cause of

dementia a group of brain disorders that cause progressive loss of intellectual and social skills,
severe enough to interfere with day-to-day life. In Alzheimer's disease, brain cells degenerate and die,
causing a steady decline in memory and mental function.
Current Alzheimer's disease medications and management strategies can temporarily improve
symptoms, maximize function and maintain independence. It's also important to seek social services
and tap into your support network to make life better. Research efforts aim to discover treatments that
prevent Alzheimer's or slow its progression.
The first symptoms of Alzheimer's disease you may notice are increasing forgetfulness and mild
confusion. Over time, the disease has a growing impact on your memory, your ability to speak and
write coherently, and your judgment and problem solving. If you have Alzheimer's, you may be the
first to notice that you're having unusual difficulty remembering things and organizing your thoughts.
Or you may not recognize that anything is wrong, even when changes are noticeable to your family
members, close friends or co-workers.
Brain changes associated with Alzheimer's disease lead to growing trouble with:
Memory
Everyone has occasional memory lapses. It's normal to lose track of where you put your keys or forget
the name of an acquaintance. But the memory loss associated with Alzheimer's disease persists and
gets worse. People with Alzheimer's may:

Repeat statements and questions over and over

Forget conversations, appointments or events, and not remember them later

Routinely misplace possessions, often putting them in illogical locations

Eventually forget the names of family members and everyday objects

Disorientation and misinterpreting spatial relationships
People with Alzheimer's disease may lose their sense of what day it is, the time of year, where they
are or even their current life circumstances. Alzheimer's may also disrupt your brain's ability to
interpret what you see, making it difficult to understand your surroundings. Eventually, these
problems may lead to getting lost in familiar places.
Speaking and writing
Those with Alzheimer's may have trouble finding the right words to identify objects, express thoughts
or take part in conversations. Over time, the ability to read and write also declines.
Thinking and reasoning
Alzheimer's disease causes difficulty concentrating and thinking, especially about abstract concepts
like numbers. Many people find it challenging to manage their finances, balance their checkbooks, and

keep track of bills and pay them on time. These difficulties may progress to inability to recognize and
deal with numbers.
Making judgments and decisions
Responding effectively to everyday problems, such as food burning on the stove or unexpected driving
situations, becomes increasingly challenging.
Planning and performing familiar tasks
Once-routine activities that require sequential steps, such as planning and cooking a meal or playing a
favorite game, become a struggle as the disease progresses. Eventually, people with advanced
Alzheimer's may forget how to perform basic tasks such as dressing and bathing.
Changes in personality and behavior
Brain changes that occur in Alzheimer's disease can affect the way you act and how you feel. People
with Alzheimer's may experience:

Depression

Anxiety

Social withdrawal

Mood swings

Distrust in others

Increased stubbornness

Irritability and aggressiveness

Changes in sleeping habits

Wandering

CAUSES
Scientists believe that for most people, Alzheimer's disease results from a combination of genetic,
lifestyle and environmental factors that affect the brain over time.
Less than 5 percent of the time, Alzheimer's is caused by specific genetic changes that guarantee a
person will develop the disease.
While the causes of Alzheimer's are not yet fully understood, its effect on the brain is clear.
Alzheimer's disease damages and kills brain cells. A brain affected by Alzheimer's disease has many
fewer cells and many fewer connections among surviving cells than does a healthy brain.

As more and more brain cells die, Alzheimer's leads to significant brain shrinkage. When doctors
examine Alzheimer's brain tissue under the microscope, they see two types of abnormalities that are
considered hallmarks of the disease:
Plaques. These clumps of a protein called beta-amyloid may damage and destroy brain cells

in several ways, including interfering with cell-to-cell communication. Although the ultimate cause of
brain-cell death in Alzheimer's isn't known, abnormal processing of beta-amyloid is a prime suspect.
Tangles. Brain cells depend on an internal support and transport system to carry nutrients

and other essential materials throughout their long extensions. This system requires the normal
structure and functioning of a protein called tau. In Alzheimer's, threads of tau protein twist into
abnormal tangles, leading to failure of the transport system. This failure is also strongly implicated
in the decline and death of brain cells.

RISK FACTOR
Age
Increasing age is the greatest known risk factor for Alzheimer's. Alzheimer's is not a part of normal
aging, but your risk increases greatly as you grow older. After you reach age 65, your risk of
developing the disease doubles about every five years. Nearly half of those over age 85 have
Alzheimer's.
People with rare genetic changes that guarantee they'll develop Alzheimer's often begin experiencing
symptoms in their 40s or 50s.
Family history and genetics
Your risk of developing Alzheimer's appears to be somewhat higher if a first-degree relative your
parent, sibling or child has the disease. Scientists have identified rare changes (mutations) in three
genes that guarantee a person who inherits them will develop Alzheimer's. But these mutations
account for less than 5 percent of Alzheimer's disease. Most genetic mechanisms of Alzheimer's
among families remain largely unexplained. The strongest risk gene researchers have found so far is
apolipoprotein e4 (APOE-e4). Other risk genes have been identified but not conclusively confirmed.
Sex
Women may be more likely than are men to develop Alzheimer's disease, in part because they live
longer.
Mild cognitive impairment
People with mild cognitive impairment (MCI) have memory problems or other symptoms of cognitive
decline that are worse than might be expected for their age, but not severe enough to be diagnosed
as dementia. Those with MCI have an increased risk but not a certainty of later developing
dementia.
Lifestyle and heart health
There's no lifestyle factor that's been conclusively shown to reduce your risk of Alzheimer's disease.

However, some evidence suggests that the same factors that put you at risk of heart disease may also
increase the chance that you'll develop Alzheimer's. Examples include:

Lack of exercise

Smoking

High blood pressure

High cholesterol

Poorly controlled diabetes

These risk factors are also linked to vascular dementia, a type of cognitive decline caused by damaged
blood vessels in the brain. Many people with cognitive decline have brain changes characteristic of
both Alzheimer's disease and vascular dementia. Some researchers think that each condition helps
fuel the damage caused by the other.
Working with your health care team on a plan to control these factors will help protect your heart
and may also help reduce your risk of dementia.
Lifelong learning and social engagement
Studies have found an association between lifelong involvement in mentally and socially stimulating
activities and reduced risk of Alzheimer's disease.
Factors that may reduce your risk of Alzheimer's include:

Higher levels of formal education

A stimulating job

Mentally challenging leisure activities, such as reading, playing games or playing a musical
instrument

Frequent social interactions

Scientists can't yet explain this link. One theory is that using your brain develops more cell-to-cell
connections, which protects your brain against the impact of Alzheimer-related changes. Another
theory is that it may be harder to measure cognitive decline in people who exercise their minds
frequently or who have more education. Still another explanation is that people with Alzheimer's
disease may be less inclined to seek out stimulating activities years before their disease can be
diagnosed.

COMPLICATION

Memory loss, impaired judgment and other cognitive changes caused by Alzheimer's can complicate
treatment for other health conditions. A person with Alzheimer's disease may not be able to:

Communicate that he or she is experiencing pain for example, from a dental problem

Report symptoms of another illness

Follow a prescribed treatment plan

Notice or describe medication side effects

As Alzheimer's disease progresses, brain changes begin to affect physical functions such as
swallowing, balance, and bowel and bladder control. These effects can increase vulnerability to
additional health problems such as:

Pneumonia and other infections. Difficulty swallowing may cause people with Alzheimer's
to inhale (aspirate) food or liquid into their airways and lungs, which can lead to pneumonia.
Inability to control emptying of the bladder (urinary incontinence) may require placement of a tube
to drain and collect urine (urinary catheter). Having a catheter increases your risk of urinary tract
infections, which can lead to more-serious, life-threatening infections.

Injuries from falls. People with Alzheimer's become increasingly vulnerable to falling. Falls
can lead to fractures. In addition, falls are a common cause of serious head injuries, such as
concussion or bleeding in the brain.

TEST?EXAM
There's no specific test today that confirms you have Alzheimer's disease. Your doctor will make a
judgment about whether Alzheimer's is the most likely cause of your symptoms based on the
information you provide and results of various tests that can help clarify the diagnosis.
Doctors can nearly always determine whether you have dementia, and they can accurately identify
whether your dementia is due to Alzheimer's disease about 90 percent of the time. Alzheimer's
disease can be diagnosed with complete accuracy only after death, when microscopic examination of
the brain reveals the characteristic plaques and tangles.
To help distinguish Alzheimer's disease from other causes of memory loss, doctors now typically rely
on the following types of tests.
Physical and neurological exam
Your doctor will perform a physical exam, and is likely to check your overall neurological health by
testing your:

Reflexes

Muscle tone and strength

Ability to get up from a chair and walk across the room

Sense of touch and sight

Coordination

Balance
Lab tests
Blood tests may help your doctor rule out other potential causes of memory loss and confusion, such
as thyroid disorders or vitamin deficiencies.
Mental status testing
Your doctor may conduct a brief mental status test to assess your memory and other thinking skills.
Short forms of mental status testing can be done in about 10 minutes. Commonly used tests include
the following tasks and questions:

Draw a clock face with the hands showing a time specified by the examiner.

Name today's date and your location.

Copy a design, such as two intersecting pentagons.

Follow a three-step command.

Remember a list of three words spoken to you by the examiner.

Follow a written instruction.

Write down a complete sentence.

Count backward from 100 by sevens.

Neuropsychological testing
Your doctor may recommend a more extensive assessment of your thinking and memory. Longer
forms of neuropsychological testing, which can take several hours to complete, may provide additional
details about your mental function compared with others' of a similar age and education level. This
type of testing may be especially helpful if your doctor thinks you may have a very early stage of
Alzheimer's disease or another dementia. These tests may also help identify patterns of change
associated with different types of dementia.
Brain imaging
Images of the brain are now used chiefly to pinpoint visible abnormalities related to conditions other
than Alzheimer's disease such as strokes, trauma or tumors that may cause cognitive change.

New imaging applications currently used primarily in major medical centers or in clinical trials
may enable doctors to detect specific brain changes caused by Alzheimer's.
Brain-imaging technologies include:
Computerized tomography (CT). For a CT scan, you'll lie on a narrow table that slides into

a small chamber. X-rays pass through your body from various angles, and a computer uses this
information to create cross-sectional images, or slices, of your brain. This test is painless and takes
about 20 minutes. It's currently used chiefly to rule out tumors, strokes and head injuries.
Magnetic resonance imaging (MRI). An MRI uses radio waves and a strong magnetic field

to produce detailed images of your brain. You lie on a narrow table that slides into a tube-shaped
MRI machine, which makes loud banging noises while it produces images. The entire procedure can
take an hour or more. MRIs are painless, but some people feel claustrophobic inside the machine
and are disturbed by the noise. MRIs are currently used primarily to rule out other conditions that
may account for cognitive symptoms. In the future, they may be used to measure the volume of
your brain tissue and whether shrinkage in brain regions implicated in Alzheimer's disease has
occurred.
Positron emission tomography (PET). During a PET scan, you'll be injected in a vein with a

low-level radioactive tracer. You'll lie on a table while an overhead scanner tracks the tracer's flow
through your brain. The tracer may be a special form of glucose (sugar) that shows overall activity
in various brain regions. This can show which parts of your brain aren't functioning well. New PET
techniques may be able to detect your brain level of plaques one hallmark abnormality linked to
Alzheimer's.
Future diagnostic tools
Researchers are working with doctors to develop new diagnostic tools to help clinch the diagnosis of
Alzheimer's. Another important goal is to detect the disease before it causes the symptoms targeted
by current diagnostic techniques at the stage when Alzheimer's may be most treatable as new
drugs are discovered. New tools under investigation include:

Additional approaches to brain imaging

Measuring levels of key proteins or protein patterns in blood or spinal fluid

More-sensitive mental status tests

TREATMENT
Drugs
Current Alzheimer's medications can help for a time with memory symptoms and other cognitive
changes. Two types of drugs are currently used to treat cognitive symptoms:

Cholinesterase inhibitors. These drugs work by boosting levels of a cell-to-cell

communication chemical depleted in the brain by Alzheimer's disease. Commonly prescribed

cholinesterase inhibitors include donepezil (Aricept), galantamine (Razadyne) and rivastigmine

(Exelon). The main side effects of these drugs include diarrhea, nausea and vomiting.
Memantine (Namenda). This drug works in another brain cell communication network. It's

sometimes used in combination with a cholinesterase inhibitor. Memantine's most common side
effect is dizziness.
Creating a safe and supportive environment
Adapting the living situation to the needs of a person with Alzheimer's is an important part of any
treatment plan. You can take these steps to support a person's sense of well-being and continued
ability to function:

Remove excess furniture, clutter and throw rugs.

Install sturdy handrails on stairways and in bathrooms.

Ensure that shoes and slippers are comfortable and provide good traction.

Reduce the number of mirrors. People with Alzheimer's may find images in mirrors confusing
or frightening.
Exercise
Regular exercise is an important part of everybody's wellness plan and those with Alzheimer's are
no exception. Activities like a daily 30-minute walk can help improve mood and maintain the health of
joints, muscles and your heart. Exercise can also promote restful sleep and prevent constipation. Make
sure that the person with Alzheimer's carries identification if she or he walks unaccompanied.
People with Alzheimer's who develop trouble walking may still be able to use a stationary bike or enjoy
chair exercises. You may be able to find exercise programs geared to older adults on TV or on DVDs.
Nutrition
People with Alzheimer's may forget to eat, lose interest in preparing meals or not eat a healthy
combination of foods. They may also forget to drink enough, leading to dehydration and constipation.
Offer:

High-calorie, healthy shakes and smoothies. You can supplement milkshakes with protein
powders (available at grocery stores, drugstores and discount retailers) or use your blender to
make smoothies featuring your favorite ingredients.

Water, juice and other healthy beverages. Try to ensure that a person with Alzheimer's
drinks at least several full glasses of liquids every day. Avoid beverages with caffeine, which can
increase restlessness, interfere with sleep and trigger frequent need to urinate.
Certain nutritional supplements are marketed as "medical foods" specifically to treat Alzheimer's
disease. The Food and Drug Administration (FDA) does not approve products marketed as medical

foods. Despite marketing claims, there's no definitive data showing that any of these supplements is
beneficial or safe.

HOME REMEDIES
Study results have been mixed about whether diet, exercise or other healthy lifestyle choices can
prevent or reverse cognitive decline. But these healthy choices promote good overall health and may
play a role in maintaining cognitive health, so there's no harm in including these strategies in your
general wellness plan:
Regular exercise has known benefits for heart health and may also help prevent cognitive

decline. There's also some evidence that exercise may help improve mood in those with
Alzheimer's.
A diet low in fat and rich in fruits and vegetables is another heart-healthy choice that

also may help protect cognitive health.

Omega-3 fatty acids are good for the heart. Most research showing a possible benefit for

cognitive health uses fish consumption as a yardstick for the amount of omega-3 fatty acids eaten.
Social engagement and intellectual stimulation may make life more satisfying and help

preserve mental function.

COPING
People with Alzheimer's disease experience a mixture of emotions confusion, frustration, anger,
fear, uncertainty, grief and depression.
You can help a person cope with the disease by being there to listen, reassuring the person that life
can still be enjoyed, providing support, and doing your best to help the person retain dignity and selfrespect.
A calm and stable home environment can help reduce behavior problems. New situations, noise, large
groups of people, being rushed or pressed to remember, or being asked to do complicated tasks can
cause anxiety. As a person with Alzheimer's becomes upset, the ability to think clearly declines even
more.
Caring for the caregiver
Caring for a person with Alzheimer's disease is physically and emotionally demanding. Feelings of
anger and guilt, frustration and discouragement, worry and grief, and social isolation are common. But
paying attention to your own needs and well-being is one of the most important things you can do for
yourself and for the person with Alzheimer's. If you're a caregiver for someone with Alzheimer's, you
can help yourself by:

Learning as much about the disease as you can

Asking questions of doctors, social workers and others involved in the care of your loved one

Calling on friends or other family members for help when you need it

Taking a break every day

Spending time with your friends

Taking care of your health by seeing your own doctors on schedule, eating healthy meals and
getting exercise

Joining a support group

Many people with Alzheimer's and their families benefit from counseling or local support services.
Contact your local Alzheimer's Association affiliate to connect with support groups, doctors, resources
and referrals, home care agencies, residential care facilities, a telephone help line, and educational
seminars.
Osteoporosis, which means "porous bones," causes bones to become weak and brittle so brittle that
a fall or even mild stresses like bending over or coughing can cause a fracture. In many cases, bones
weaken when you have low levels of calcium and other minerals in your bones.
A common result of osteoporosis is fractures most of them occur in the spine, hip or wrist. Although
it's often thought of as a women's disease, osteoporosis affects men too. And aside from people who
have osteoporosis, many others have low bone density, putting them at risk of developing
osteoporosis.
It's never too late or too early to do something about osteoporosis. You can take steps to keep
bones strong and healthy throughout life.
SYPMTOMS
In the early stages of bone loss, you usually have no pain or other symptoms. But once bones have
been weakened by osteoporosis, you may have osteoporosis signs and symptoms that include:

Back pain, which can be severe, as a result of a fractured or collapsed vertebra

Loss of height over time

A stooped posture

Fracture of the vertebra, wrist, hip or other bone

When to see a doctor

Because osteoporosis rarely causes signs or symptoms until it's advanced, the National Osteoporosis
Foundation recommends a bone density test if you are:

A woman older than age 65 or a man older than age 70, regardless of risk factors

A postmenopausal woman with at least one risk factor for osteoporosis

A man between age 50 and 70 who has at least one osteoporosis risk factor

Older than age 50 with a history of a broken bone

Take medications, such as prednisone, aromatase inhibitors or anti-seizure drugs, that are
associated with osteoporosis

A postmenopausal woman who has recently stopped taking hormone therapy

A woman who experienced early menopause

CAUSES
Scientists don't yet know exactly why osteoporosis occurs, but they do know that the normal bone
remodeling process is disrupted.
Your bone is continuously changing new bone is made and old bone is broken down (resorption)
a process called remodeling or bone turnover. When you're young, your body makes new bone faster
than it breaks down old bone and your bone mass increases. You reach your peak bone mass around
age 30. After that, bone remodeling continues, but you lose slightly more than you gain.
How likely you are to develop osteoporosis depends on how much bone mass you attained in your 20s
and early 30s (peak bone mass) and how rapidly you lose it later. The higher your peak bone mass,
the more bone you have "in the bank" and the less likely you are to develop osteoporosis as you age.
The strength of your bones depends on their size and density; bone density depends in part on the
amount of calcium, phosphorus and other minerals bones contain. When your bones contain fewer
minerals than normal, they're less strong and eventually lose their internal supporting structure.
Other factors, such as hormone levels, also affect bone density. In women, when estrogen levels drop
at menopause, bone loss increases dramatically. In men, low estrogen and testosterone levels can
cause a loss of bone mass.
Risk factors you can change

Low calcium intake. A lifelong lack of calcium plays a major role in the development of
osteoporosis. Low calcium intake contributes to diminished bone density, early bone loss and an
increased risk of fractures.

Tobacco use. The exact role tobacco plays in osteoporosis isn't clearly understood, but
researchers do know that tobacco use contributes to weak bones.

Eating disorders. Women and men with anorexia nervosa or bulimia are at higher risk of
lower bone density.

Sedentary lifestyle. People who spend a lot of time sitting have a higher risk of osteoporosis
than their more-active counterparts. Any weight-bearing exercise is beneficial for your bones, but
walking, running, jumping, dancing and weightlifting seem particularly helpful for creating healthy
bones.

Excessive alcohol consumption. Regular consumption of more than two alcoholic drinks a
day increases your risk of osteoporosis, possibly because alcohol can interfere with the body's
ability to absorb calcium.

Corticosteroid medications. Long-term use of corticosteroid medications, such as

prednisone, cortisone, prednisolone and dexamethasone, is damaging to bone. These medications
are common treatments for chronic conditions, such as asthma, rheumatoid arthritis and lupus, and
you may not be able to stop taking them to lessen your risk of osteoporosis. If you need to take a
steroid medication for long periods, your doctor should monitor your bone density and recommend
other drugs to help prevent bone loss.

Other medications. Long-term use of aromatase inhibitors to treat breast cancer, the
antidepressant medications called selective serotonin reuptake inhibitors (SSRIs), the cancer
treatment drug methotrexate, some anti-seizure medications, the acid-blocking drugs called proton
pump inhibitors and aluminum-containing antacids are all associated with an increased risk of
osteoporosis.
Risk factors you can't change

Being a woman. Fractures from osteoporosis are almost twice as common in women as they
are in men.

Getting older. The older you get, the greater your risk of osteoporosis.

Race. You're at greatest risk of osteoporosis if you're white or of Asian descent.

Family history. Having a parent or sibling with osteoporosis puts you at greater risk,
especially if you also have a family history of fractures.

Frame size. Men and women who are exceptionally thin (with a body mass index of 19 or
less) or have small body frames tend to have a higher risk because they may have less bone mass
to draw from as they age.

Thyroid hormone. Too much thyroid hormone also can cause bone loss. This can occur either

because your thyroid is overactive (hyperthyroidism) or because you take excess amounts of
thyroid hormone medication to treat an underactive thyroid (hypothyroidism).
Medical conditions and procedures that affect bone health. Stomach surgery

(gastrectomy) and weight-loss surgery can affect your body's ability to absorb calcium. So can
conditions such as Crohn's disease, celiac disease, hyperparathyroidism and Cushing's disease a
rare disorder in which your adrenal glands produce excessive corticosteroid hormones.
COMPLICATION
Fractures are the most frequent and serious complication of osteoporosis. They often occur in your
spine or hip bones that directly support your weight. Hip fractures often result from a fall. Although
most people do relatively well with modern surgical treatment, hip fractures can result in disability and
even death from postoperative complications, especially in older adults. Wrist fractures from falls also
are common.
In some cases, spinal fractures can occur even if you haven't fallen or injured yourself. The bones in
your back (vertebrae) can simply become so weakened that they begin to compress or collapse.
Compression fractures can cause severe pain and require a long recovery. If you have many such
fractures, you can lose height as your posture becomes stooped.
TEST
Dual energy X-ray absorptiometry
The best screening test is dual energy X-ray absorptiometry (DXA). This procedure is quick, simple
and gives accurate results. It measures the density of bones in your spine, hip and wrist the areas
most likely to be affected by osteoporosis and it's used to accurately follow changes in these bones
over time.
Other tests that can accurately measure bone density include:

Ultrasound

Quantitative computerized tomography (CT) scanning

Single-photon absorptiometry
Medications
A number of medications are available to help slow bone loss and maintain bone mass, including:

Bisphosphonates. Much like estrogen, this group of drugs can inhibit bone breakdown,
preserve bone mass, and even increase bone density in your spine and hip, reducing the risk of
fractures. Examples of these medications include alendronate (Fosamax), ibandronate (Boniva),
risedronate (Actonel) and zoledronic acid (Reclast).

Bisphosphonates may be especially beneficial for men, young adults and people with steroid-induced
osteoporosis. They're also used to prevent osteoporosis in people who require long-term steroid
treatment for a disease such as asthma or arthritis.
Side effects, which can be severe, include nausea, abdominal pain, difficulty swallowing and the risk of
an inflamed esophagus or esophageal ulcers. Bisphosphonates that can be taken once a week or once
a month may cause fewer stomach problems. If you can't tolerate oral bisphosphonates, your doctor
may recommend periodic intravenous infusions of bisphosphonate preparations.
There have also been reports of serious side effects with bisphosphonates, such as osteonecrosis of
the jaw, a rare type of thigh fracture, irregular heartbeats and visual disturbances. Discuss the
potentials risks and benefits of these medications with your doctor, and let your dentist know if you're
taking any medications prior to any dental surgery.

Raloxifene (Evista). This medication belongs to a class of drugs called selective estrogen
receptor modulators (SERMs). Raloxifene mimics estrogen's beneficial effects on bone density in
postmenopausal women, without some of the risks associated with estrogen, such as increased risk
of uterine cancer and, possibly, breast cancer. Hot flashes are a common side effect of raloxifene,
and you shouldn't use this drug if you have a history of blood clots. This drug isn't currently
recommended for use in men, though a small study found that it may also be helpful for preserving
bone density in men.

Calcitonin. A hormone produced by your thyroid gland, calcitonin reduces bone resorption
and may slow bone loss. It may also prevent spine fractures, and may even provide some pain relief
from compression fractures. It's usually administered as a nasal spray and may cause nasal
irritation in some people who use it, but it's also available as an injection. Because calcitonin isn't as
potent as bisphosphonates, it's normally reserved for people who can't take other drugs.

Teriparatide (Forteo). This powerful drug, an analog of parathyroid hormone, treats

osteoporosis in postmenopausal women and men who are at high risk of fractures. It works by
stimulating new bone growth, while other medications prevent further bone loss. Teriparatide is
given once a day by injection under the skin on the thigh or abdomen. Long-term effects are still
being studied, so therapy is recommended for two years or less.
Hormone therapy
Estrogen, especially when started soon after menopause, can help maintain bone density. However,
the use of hormone therapy can increase your risk of blood clots, endometrial cancer, breast cancer
and possibly heart disease. Because of concerns about its safety and because other treatments are
available, hormone therapy is generally not a first-choice treatment anymore.
Physical therapy
In addition to medications or hormones, physical therapy programs may help you build bone strength
and improve your posture, balance and muscle strength, making falls less likely.
These suggestions may help relieve symptoms and maintain your independence if you have
osteoporosis:

Maintain good posture. Good posture which involves keeping your head held high, chin
in, shoulders back, upper back flat and lower spine arched helps you avoid stress on your spine.
When you sit or drive, place a rolled towel in the small of your back. Don't lean over while reading
or doing handwork. When lifting, bend at your knees, not your waist, and lift with your legs,
keeping your upper back straight.

Prevent falls. Wear low-heeled shoes with nonslip soles and check your house for electrical
cords, area rugs and slippery surfaces that might cause you to trip or fall. Keep rooms brightly lit,
install grab bars just inside and outside your shower door, and make sure you can get in and out of
your bed easily.

Manage pain. Discuss pain management strategies with your doctor. Don't ignore chronic
pain. Left untreated, it can limit your mobility and cause even more pain.
PREVENTION
Three factors essential for keeping your bones healthy throughout your life are:

Adequate amounts of calcium

Adequate amounts of vitamin D

Regular exercise
Calcium
The amount of calcium you need to stay healthy changes over your lifetime. The Institute of Medicine
(IOM) recommends the following amounts of daily calcium from food and supplements:

Up to 1 year old 210 to 270 milligrams (mg)

Age 1 to 3 years 500 mg

Age 4 to 8 years 800 mg

Age 9 to 18 years 1,300 mg

Age 19 to 50 years 1,000 mg

Age 51 and older 1,200 mg

Dairy products are one, but by no means the only, source of calcium. Almonds, broccoli, spinach,
cooked kale, canned salmon with the bones, sardines and soy products, such as tofu, also are rich in
calcium.
If you find it difficult to get enough calcium from your diet, consider taking calcium supplements. The
IOM recommends taking no more than 2,500 mg of calcium daily.

Vitamin D
Getting enough vitamin D is just as important to your bone health as getting adequate amounts of
calcium. Scientists don't yet know the optimal daily dose of vitamin D, but it's safe for anyone older
than 1 year to take up to 2,000 international units (IU) a day.
Experts generally recommend that adults get between 400 and 1,000 IUs daily.
Although many people get adequate amounts of vitamin D from sunlight, this may not be a good
source if you live in high latitudes, if you're housebound, or if you regularly use sunscreen or you
avoid the sun entirely because of the risk of skin cancer. Although vitamin D is present in oily fish,
such as tuna and sardines, and in egg yolks, you probably don't eat these on a daily basis. Vitamin D
supplements or calcium supplements with added vitamin D are a good alternative.
Exercise
Exercise can help you build strong bones and slow bone loss. Exercise will benefit your bones no
matter when you start, but you'll gain the most benefits if you start exercising regularly when you're
young and continue to exercise throughout your life. Combine strength training exercises with weightbearing exercises. Strength training helps strengthen muscles and bones in your arms and upper
spine, and weight-bearing exercises such as walking, jogging, running, stair climbing, skipping
rope, skiing and impact-producing sports mainly affect the bones in your legs, hips and lower spine.
Swimming, cycling and exercising on machines such as elliptical trainers can provide a good
cardiovascular workout, but because such exercises are low impact, they're not as helpful for
improving bone health as weight-bearing exercises are.
Other tips for prevention
These measures also may help you prevent bone loss:
Don't smoke. Smoking increases bone loss, perhaps by decreasing the amount of estrogen a

woman's body makes and by reducing the absorption of calcium in your intestine.
Avoid excessive alcohol. Consuming more than two alcoholic drinks a day may decrease

bone formation and reduce your body's ability to absorb calcium.

A cataract is a clouding of the normally clear lens of your eye. For people who have cataracts,
seeing through cloudy lenses is a bit like looking through a frosty or fogged-up window.
Clouded vision caused by cataracts can make it more difficult to read, drive a car especially
at night or see the expression on a friend's face.

Most cataracts develop slowly and don't disturb your eyesight early on. But with time,
cataracts will eventually interfere with your vision.

At first, stronger lighting and eyeglasses can help you deal with cataracts. But if impaired
vision interferes with your usual activities, you might need cataract surgery. Fortunately,
cataract surgery is generally a safe, effective procedure.

Signs and symptoms of cataracts include:

Clouded, blurred or dim vision

Increasing difficulty with vision at night

Sensitivity to light and glare

Seeing "halos" around lights

Frequent changes in eyeglass or contact lens prescription

Fading or yellowing of colors

Double vision in a single eye

At first, the cloudiness in your vision caused by a cataract may affect only a small part of the eye's
lens and you may be unaware of any vision loss. As the cataract grows larger, it clouds more of your
lens and distorts the light passing through the lens. This may lead to signs and symptoms you're more
likely to notice.
When to see a doctor
Make an appointment for an eye exam if you notice any changes in your vision. If you develop sudden
vision changes, such as double vision or blurriness, see your doctor right away.

CAUSES
Most cataracts develop when aging or injury changes the tissue that makes up your eye's lens. Some
cataracts are caused by inherited genetic disorders that cause other health problems and increase
your risk of cataracts.
How a cataract forms
The lens, where cataracts form, is positioned behind the colored part of your eye (iris). The lens
focuses light that passes into your eye, producing clear, sharp images on the retina the lightsensitive membrane on the back inside wall of your eyeball that functions like the film of a camera. A
cataract scatters the light as it passes through the lens, preventing a sharply defined image from
reaching your retina. As a result, your vision becomes blurred.
As you age, the lenses in your eyes become less flexible, less transparent and thicker. Aging-related
changes to the lens cause tissues to break down and to clump together, clouding small areas of the
lens. As the cataract continues to develop, the clouding becomes denser and involves a greater part of
the lens.
A cataract can develop in one or both of your eyes.

Types of cataracts
Cataract types include:

Cataracts that affect the center of the lens (nuclear cataracts). A nuclear cataract may
at first cause you to become more nearsighted or even experience a temporary improvement in
your reading vision. But with time, the lens gradually turns more densely yellow and further clouds
your vision. Nuclear cataracts sometimes cause you to see double or multiple images. As the
cataract progresses, the lens may even turn brown. Advanced yellowing or browning of the lens can
lead to difficulty distinguishing between shades of color.

Cataracts that affect the edges of the lens (cortical cataracts). A cortical cataract
begins as whitish, wedge-shaped opacities or streaks on the outer edge of the lens cortex. As it
slowly progresses, the streaks extend to the center and interfere with light passing through the
center of the lens. Problems with glare are common for people with this type of cataract.

Cataracts that affect the back of the lens (posterior subcapsular cataracts). A
posterior subcapsular cataract starts as a small, opaque area that usually forms near the back of
the lens, right in the path of light on its way to the retina. A subcapsular cataract often interferes
with your reading vision, reduces your vision in bright light and causes glare or halos around lights
at night.

Cataracts you're born with (congenital cataracts). Some people are born with cataracts
or develop them during childhood. Such cataracts may be the result of the mother having
contracted an infection during pregnancy. They may also be due to certain inherited syndromes,
such as Alport's syndrome, Fabry's disease and galactosemia. Congenital cataracts, as they're
called, don't always affect vision, but if they do they're usually removed soon after detection.

RISK FACTOR
Factors that increase your risk of cataracts include:

Increasing age

Diabetes

Drinking excessive amounts of alcohol

Excessive exposure to sunlight

Exposure to ionizing radiation, such as that used in X-rays and cancer radiation therapy

Family history of cataracts

High blood pressure

Obesity

Previous eye injury or inflammation

Previous eye surgery

Prolonged use of corticosteroid medications

Smoking

DX
To determine whether you have a cataract, your doctor will perform an eye exam that may include:

Asking you to read an eye chart (visual acuity test). A visual acuity test uses an eye
chart to measure how well you can read a series of letters. Your eyes are tested one at a time, while
the other eye is covered. Using a chart or a viewing device with progressively smaller letters, your
eye doctor determines if you have 20/20 vision or if your vision shows signs of impairment.

Using a light and magnification to examine your eye (slit-lamp examination). A slit
lamp allows your eye doctor to see the structures at the front of your eye under magnification. The
microscope is called a slit lamp because it uses an intense line of light a slit to illuminate your
cornea, iris, lens, and the space between your iris and cornea. The slit allows your doctor to view
these structures in small sections, which makes it easier to detect any tiny abnormalities.

Dilating your eyes (retinal examination). To prepare for a retinal examination, your eye
doctor puts dilating drops in your eyes to open your pupils wide. This makes it easier to examine
the back of your eyes (retina). Using a slit lamp or a special device called an ophthalmoscope, your
eye doctor can examine your lens for signs of a cataract.

TREATMENT
When to consider cataract surgery
Talk with your eye doctor about whether surgery is right for you. Most eye doctors suggest considering
cataract surgery when your cataracts begin to affect your quality of life or interfere with your ability to
perform normal daily activities, such as reading or driving at night.
It's up to you and your doctor to decide when cataract surgery is right for you. For most people, there
is no rush to remove cataracts because they usually don't harm the eye. Delaying the procedure won't
make it more likely that you won't recover your vision if you eventually decide to have cataract
surgery. Take time to consider the benefits and risks of cataract surgery with your doctor.
If you choose not to undergo cataract surgery for now, your eye doctor may recommend periodic
follow-up exams to see if your cataracts are progressing. How often you'll see your eye doctor
depends on your situation.

What happens during cataract surgery

Cataract surgery involves removing the clouded lens and replacing it with a plastic lens implant. The
replacement lens sits in the same place as your natural lens and becomes part of your eye.
For some people, other eye problems prohibit the use of a replacement lens. In these situations, once
the cataract is removed, vision can be corrected with eyeglasses or contact lenses.
Surgery is usually done on one eye at a time, with a few weeks between surgeries. It's generally done
on an outpatient basis, which means you won't need to stay in a hospital after the surgery. During
cataract surgery your eye doctor uses local anesthesia to numb the area around your eye, but you
stay awake during the procedure. Cataract surgery is generally safe, but carries a risk of infection and
bleeding. Cataract surgery increases the risk of retinal detachment.
To deal with symptoms of cataracts until you decide to have surgery, try to:

Make sure your eyeglasses or contact lenses are the most accurate prescription possible

Use a magnifying glass to read

Improve the lighting in your home with more or brighter lamps

When you go outside during the day, wear sunglasses or a broad-brimmed hat to reduce glare

Limit your night driving

Self-care measures may help for a while, but as the cataract progresses, your vision may deteriorate
further. When vision loss starts to interfere with your everyday activities, consider cataract surgery.

PREVENTION
It's not clear what causes cataracts, but doctors think you may be able to reduce your risk of cataracts
if you:

Have regular eye exams. Eye exams can help detect cataracts and other eye problems at
their earliest stages. Ask your doctor how often you should have an eye exam.

Quit smoking. Ask your doctor for help to stop smoking. Medications, counseling and other
strategies are available to help you.

Wear sunglasses. Ultraviolet light from the sun may contribute to the development of
cataracts. Wear sunglasses that block ultraviolet B (UVB) rays when you're outdoors.

Take care of other health problems. Follow your treatment plan if you have diabetes or
other medical conditions that can increase your risk of cataracts.

Maintain a healthy weight. If your current weight is a healthy one, work to maintain it by

exercising most days of the week. If you're overweight or obese, work to lose weight slowly by
reducing your calorie intake and increasing the amount of exercise you get each day.
Choose a healthy diet that includes plenty of fruits and vegetables. Adding a variety of

colorful fruits and vegetables to your diet ensures that you're getting a lot of vitamins and nutrients.
Fruits and vegetables are full of antioxidants, which in theory could prevent damage to your eye's
lens. Studies haven't proven that antioxidants in pill form can prevent cataracts. But fruits and
vegetables have many proven health benefits and are a safe way to increase the amount of
vitamins in your diet.

Arthritis is inflammation of one or more of your joints. The main symptoms of arthritis are
joint pain and stiffness, which typically worsen with age. The two most common types of
arthritis are osteoarthritis and rheumatoid arthritis.

Osteoarthritis is usually caused by normal wear and tear, while rheumatoid arthritis is an
autoimmune disorder. Other types of arthritis can be caused by uric acid crystals, infections or
even an underlying disease such as psoriasis or lupus.

Treatments vary, depending on the type of arthritis. The main goals of arthritis treatments are
to reduce symptoms and improve quality of life.

The most common signs and symptoms of arthritis involve the joints. Depending on the type of
arthritis you have, your signs and symptoms may include:

Pain

Stiffness

Swelling

Redness

Decreased range of motion

CAUSES
The pain associated with arthritis is caused by joint damage. Joints are made up of the following
parts:

Cartilage. A hard, but slick, coating on the ends of bones, cartilage allows bones of the joint
to slide smoothly over each other.

Joint capsule. This tough membrane encloses all the joint parts.

Synovium. This thin membrane lines the joint capsule and secretes synovial fluid, which

lubricates the joint and nourishes the cartilage.

How arthritis damages joints
The two main types of arthritis damage joints in different ways.
Osteoarthritis. In osteoarthritis, wear-and-tear damage to cartilage can result in bone

grinding directly on bone, which causes pain and restricts movement. This wear and tear can occur
over many years, or it can be hastened by a joint injury or infection.
Rheumatoid arthritis. In rheumatoid arthritis, the body's immune system attacks joints and

inflames the synovium, causing swelling, redness and pain. The disease can eventually destroy
cartilage and bone within the joint.

RISK FCTOR
Risk factors for arthritis include:
Family history. Some types of arthritis run in families, so you may be more likely to develop

arthritis if your parents or siblings have the disorder. Your genes can make you more susceptible to
environmental factors that may trigger arthritis.
Age. The risk of many types of arthritis including osteoarthritis, rheumatoid arthritis and

gout increases with age.

Sex. Women are more likely than are men to develop rheumatoid arthritis, while most of the

people who have gout are men.

Previous joint injury. People who have injured a joint, perhaps while playing a sport, are

more likely to eventually develop arthritis in that joint.

Obesity. Carrying excess pounds puts stress on joints, particularly your knees, hips and

spine. Obese people have a higher risk of developing arthritis.

COMPLICATION
Severe arthritis, particularly if it affects your hands or arms, can make it difficult for you to take care
of daily tasks. Arthritis of weight-bearing joints can keep you from walking comfortably or sitting up
straight. In some cases, joints may become twisted and deformed.

DX
Laboratory tests
The analysis of different types of body fluids can help pinpoint the type of arthritis you may have.
Fluids commonly analyzed include:

Blood

Urine

Joint fluid
To obtain a sample of your joint fluid, your doctor will cleanse and numb the area before inserting a
needle in your joint space to withdraw some fluid.
Imaging
These types of tests can detect problems within your joint that may be causing your symptoms.
Examples include:
X-rays. Using low levels of radiation to visualize bone, X-rays can show cartilage loss, bone

damage and bone spurs. X-rays may not reveal early arthritic damage, but they are often used to
track progression of the disease.
Computerized tomography (CT). CT scanners take X-rays from many different angles and

combine the information to create cross-sectional views of internal structures. CTs can visualize
both bone and the surrounding soft tissues.
Magnetic resonance imaging (MRI). Combining radio waves with a strong magnetic field,

MRI can produce more-detailed cross-sectional images of soft tissues such as cartilage, tendons and
ligaments.
Ultrasound. Using sound waves to create images of both hard and soft tissues within the

body, ultrasound can help determine needle placement if your doctor wants to withdraw fluid from
your joint or inject medicine.
Arthroscopy
In some cases, your doctor may look for damage in your joint by inserting a small, flexible tube
called an arthroscope through an incision near your joint. The arthroscope transmits images from
inside the joint to a video screen.

TRTMENT
Arthritis treatment focuses on relieving symptoms and improving joint function. You may need to try
several different treatments, or combinations of treatments, before you determine what works best for
you.
Medications
The medications used to treat arthritis vary, depending on the type of arthritis. Commonly used
arthritis medications include:

Analgesics. These types of medications help reduce pain, but have no effect on inflammation.
Examples include acetaminophen (Tylenol, others), tramadol (Ultram, Ryzolt) and narcotics
containing oxycodone (Percocet, Oxycontin, others) or hydrocodone (Vicodin, Lortab, others).

Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce both pain and

inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and naproxen
(Aleve). Some types of NSAIDs are available only by prescription. Oral NSAIDs can cause stomach
irritation, and some may increase your risk of heart attack or stroke. Some NSAIDs are also
available as creams or gels, which can be rubbed on joints.
Counterirritants. Some varieties of creams and ointments contain menthol or capsaicin, the

ingredient that makes hot peppers spicy. Rubbing these preparations on the skin over your aching
joint may interfere with the transmission of pain signals from the joint itself.
Disease-modifying antirheumatic drugs (DMARDs). Often used to treat rheumatoid

arthritis, DMARDs slow or stop your immune system from attacking your joints. Examples include
methotrexate (Trexall) and hydroxychloroquine (Plaquenil).
Biologics. Typically used in conjunction with DMARDs, biologic response modifiers are

genetically engineered drugs that target various protein molecules that are involved in the immune
response. Examples include etanercept (Enbrel) and infliximab (Remicade).
Corticosteroids. This class of drug, which includes prednisone and cortisone, reduces

inflammation and suppresses the immune system. Corticosteroids can be taken orally or be injected
directly into the painful joint.
Therapy
Physical therapy can be helpful for some types of arthritis. Exercises can improve range of motion and
strengthen the muscles surrounding joints. In some cases, splints or braces may be warranted.
Surgery
If conservative measures don't help, your doctor may suggest surgery, such as:
Joint replacement. This procedure removes your damaged joint and replaces it with an

artificial one. Joints most commonly replaced are hips and knees.
Joint fusion. This procedure is more often used for smaller joints, such as those in the wrist,

ankle and fingers. It removes the ends of the two bones in the joint and then locks those ends
together until they heal into one rigid unit.

Weight loss. If you're obese, losing weight will reduce the stress on your weight-bearing
joints. This may increase your mobility and limit future joint injury.

Exercise. Regular exercise can help keep your joints flexible. Swimming or water aerobics is
often a good choice because the buoyancy of the water reduces stress on weight-bearing
joints.

Heat and cold. Heating pads or ice packs may help relieve arthritis pain.

Assistive devices. Using canes, walkers, raised toilet seats and other assistive devices can
help protect your joints and improve your ability to perform daily tasks.

Many people use alternative remedies for arthritis, but there is little reliable evidence to support the
use of many of these products. Some alternative remedies appear to reduce the symptoms of some
types of arthritis but not others. The most promising alternative remedies for arthritis include:
Acupuncture. This therapy uses fine needles inserted at specific points on the skin to reduce

many types of pain, including that caused by some types of arthritis.

Glucosamine. Although study results have been mixed, it now appears that glucosamine

works no better than placebo. However, glucosamine and the placebo both relieved arthritis pain
better than taking nothing, particularly in people who have moderate to severe pain.
Transcutaneous electrical nerve stimulation (TENS). Using a small device that produces

mild electrical pulses, TENS therapy stimulates nerves near the aching joint and may interfere with
the transmission of pain signals to the brain.
Yoga or tai chi. The slow, stretching movements associated with yoga and tai chi may help

improve joint flexibility and range of motion in people with some types of arthritis.

Glaucoma is not just one eye disease, but a group of eye conditions resulting in optic nerve
damage, which causes loss of vision. Abnormally high pressure inside your eye (intraocular
pressure) usually, but not always, causes this damage.

Glaucoma is the second leading cause of blindness. Sometimes called the silent thief of sight,
glaucoma can damage your vision so gradually you may not notice any loss of vision until the
disease is at an advanced stage. The most common type of glaucoma, primary open-angle
glaucoma, has no noticeable signs or symptoms except gradual vision loss.

Early diagnosis and treatment can minimize or prevent optic nerve damage and limit
glaucoma-related vision loss. It's important to get your eyes examined regularly, and make
sure your eye doctor measures your intraocular pressure.