Imagine being able to look inside the brain of a person with Alzheimer’s disease and see the changes that are interfering with that person’s thinking, memory, and other important brain functions. Scientists working in the field of neuropathology are doing just that. Neuropathology is the study of diseases of the brain, spinal cord, and nerves through analyzing tissues removed during autopsy or biopsy. This analysis is central to research on Alzheimer’s and other neurodegenerative diseases.

To understand more about the causes of Alzheimer’s and related dementias, NIA-funded researchers across the country are making connections between what happens while a person is alive and what can be seen in their brain after death. One such effort is the Religious Orders Study (ROS) and Rush Memory and Aging Project (MAP), referred to collectively as ROSMAP. For more than 25 years, ROSMAP has collected a combination of lifestyle and autopsy information that makes it a powerful resource for researchers around the world to study aging and dementia risk and progression.

ROSMAP researchers are discovering important clues about factors that may offer some protection from cognitive decline and dementia. According to ROSMAP autopsy data, nearly one third of older adults in the study who died have the amyloid plaques and tau tangles associated with Alzheimer’s but did not have any signs of cognitive decline. The ROSMAP study also found that eating the MIND diet — which focuses on plant-based foods and limits red meat, sweets, and saturated fats — helps to preserve cognition even in the presence of some Alzheimer’s pathology. Building on these results, researchers continue to study diet and other lifestyle factors that may help lower the risk or slow cognitive decline in Alzheimer’s and related dementias.

Good drivers are alert, think clearly, and make good decisions. When people with Alzheimer’s disease are not able to do these things, they should stop driving. But some people may not want to stop driving or even think there is a problem.

As the caregiver, you must talk with the person about the need to stop driving. Do this in a caring way. Understand how unhappy the person may be to admit that he or she has reached this new stage.

Safety First

People with moderate to severe Alzheimer’s disease should never get behind the wheel. People with very mild Alzheimer’s may be able to drive safely in certain conditions. But as memory and decision-making skills worsen, they need to stop because a driver with dementia may not be able to react quickly when faced with a surprise on the road. Someone could get hurt or killed. If the person’s reaction time or ability to focus slows, you must stop the person from driving.

Signs that the person should stop driving include:

• New dents and scratches on the car
• Taking a long time to do a simple errand and not being able to explain why, which may indicate the person got lost
• Two or more traffic tickets or increased car insurance premiums
• Comments from friends and neighbors about driving
• Speeding or sudden lane changes
• Confusing the brake and gas pedals
• Recommendations from a doctor to modify driving habits
• Other health issues that may affect driving ability, such as changes in vision, hearing, or mobility.
• Driving safety infographic icon
• Read and share this infographic if you are worried about a loved one’s safety on the road.
• Some people with memory problems decide on their own not to drive, while others may deny they have a problem.

State laws vary regarding when a person with Alzheimer’s should stop driving. In some States, doctors are required to report to the State’s Department of Motor Vehicles whether a person has been diagnosed with Alzheimer’s or dementia. In others, anyone can report a potentially unsafe driver to the State. Check with your State’s Department of Motor Vehicles for more information. You may need to notify the person’s car insurance company, too.

It is a good idea to have the person’s driving skills assessed regularly by a professional. The American Occupational Therapy Association maintains a national database of driving specialists, or you can ask your State’s Department of Motor Vehicles or the person’s doctor to recommend someone who can test the person’s driving skills. Note that there may be fees associated with these types of assessments.

Parkinson’s disease is a brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination.

Symptoms usually begin gradually and worsen over time. As the disease progresses, people may have difficulty walking and talking. They may also have mental and behavioral changes, sleep problems, depression, memory difficulties, and fatigue.

While virtually anyone could be at risk for developing Parkinson’s, some research studies suggest this disease affects more men than women. It’s unclear why, but studies are underway to understand factors that may increase a person’s risk. One clear risk is age: Although most people with Parkinson’s first develop the disease after age 60, about 5% to 10% experience onset before the age of 50. Early-onset forms of Parkinson’s are often, but not always, inherited, and some forms have been linked to specific gene mutations.

What causes Parkinson’s disease?

The most prominent signs and symptoms of Parkinson’s disease occur when nerve cells in the basal ganglia, an area of the brain that controls movement, become impaired and/or die. Normally, these nerve cells, or neurons, produce an important brain chemical known as dopamine. When the neurons die or become impaired, they produce less dopamine, which causes the movement problems associated with the disease. Scientists still do not know what causes the neurons to die.

People with Parkinson’s disease also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinson’s, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and sudden drop in blood pressure when a person stands up from a sitting or lying position.

Many brain cells of people with Parkinson’s disease contain Lewy bodies, unusual clumps of the protein alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to genetic mutations that impact Parkinson’s and Lewy body dementia.

Some cases of Parkinson’s disease appear to be hereditary, and a few cases can be traced to specific genetic mutations. While genetics is thought to play a role in Parkinson’s, in most cases the disease does not seem to run in families. Many researchers now believe that Parkinson’s results from a combination of genetic and environmental factors, such as exposure to toxins.

Symptoms of Parkinson’s disease
Parkinson’s has four main symptoms:

• Tremor in hands, arms, legs, jaw, or head
• Muscle stiffness, where muscle remains contracted for a long time
• Slowness of movement
• Impaired balance and coordination, sometimes leading to falls

Other symptoms may include:

• Depression and other emotional changes
• Difficulty swallowing, chewing, and speaking
• Urinary problems or constipation
• Skin problems

The symptoms of Parkinson’s and the rate of progression differ among individuals. Early symptoms of this disease are subtle and occur gradually. For example, people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinson’s. They may see that the person’s face lacks expression and animation, or that the person does not move an arm or leg normally.