Alzheimer's Disease

What is Alzheimer's disease?

Alzheimer's disease (AD) is a debilitating, life-altering disease that attacks the brain. Its primary symptom is progressive memory loss, but difficulties with vision, language skills, and emotional control are also common. The progressive deterioration continues for five to 20 years. At some point, a person with Alzheimer's disease will require 24-hour care and assistance with daily activities such as eating, grooming, and toileting. Because its impact on the affected person is so great, it profoundly affects family and caregivers.

About four million Americans have Alzheimer's disease. That number will likely increase to at least seven million by the early 21st century unless researches find a cure or a way to prevent the disease.

Age is clearly the major risk factor for Alzheimer's disease. While only five percent of those over 65 have the disease, nearly half the population over 85 have it. Genetics also appears to play an important role.

The course of Alzheimer's disease varies tremendously, but is always progressive. The disease claims more than 100,000 lives per year - the 4th leading cause of death for adults.


What are the symptoms?

Symptoms usually begin with memory loss, especially of recent events. For instance, the person will repeat stories in the same conversation. In the early stages, Alzheimer's patients cannot learn new information. The symptoms may include misplacing objects or becoming lost in familiar neighborhoods.

As the disease progresses, people with Alzheimer's disease become increasingly confused and disoriented. Some cannot find words in conversation, and cover by using automatic phrases and clichés. Another common symptom is personality and behavioral changes such as unusual agitation, depression, and paranoia. Judgment and common sense increasingly become impaired.

Eventually, patients forget how to perform simple tasks, like combing their hair or brushing their teeth. They often lose the ability to recognize faces and objects. Even well remembered information such as the names of children, is wiped off the memory's blackboard. Personality changes are more distinctive - ranging from progressive passivity to marked agitation. About half of patients have paranoid delusions, such as thinking that caregivers or family members are impostors or that their home is not their real home.

About 20-30 percent of Alzheimer's patients develop symptoms such as slow movement and trembling. Seizures occur in 10-20 percent of patients, often late in the disease.

Unfortunately, at least in the early stages, many people fail to recognize these symptoms as something wrong. They may mistakenly assume that such behavior is a normal part of the aging process; it isn't. Symptoms may develop gradually and go unnoticed for a long time. Some people don't act even when they know something is wrong.

It is important to see a physician when you recognize or suspect Alzheimer's symptoms. Only a physician can properly diagnose the person's condition, which could be a treatable form of dementia. Even if the diagnosis is Alzheimer's disease, new treatments are available for patients as is assistance for caregivers.

How is Alzheimer's Disease Diagnosed?

There is no simple test to diagnose Alzheimer's disease; a definite diagnosis can only be made by examining brain tissue, usually at autopsy. The patient's brain will be permeated with deposits of amyloid. Sick brain cells are filled with tangles of fibrillary material. While these changes occur in normal aging, a much greater density is found in Alzheimer's patients, which may cause brain cells to stop communicating with each other.

When Alzheimer's disease is suspected, it is important to have a thorough medical and neurological evaluation to identify treatable disorders with Alzheimer's-like symptoms. Illnesses like depression, hypothyroidism, vitamin B12 deficiency, hydrocephalus, cerebral vasculitis, neurosyphilis, AIDS, and stroke can cause dementia, as can alcohol and some medications.

The comprehensive evaluation necessary to rule out these causes and to make a probable diagnosis of Alzheimer's disease includes a complete health history, physical examination, neurological and mental status assessment and other tests including analysis of blood and urine, electrocardiogram and chest x-rays. Documenting symptoms and behavior over time, in a diary fashion, will help the physician understand the person's illness. The physician may order additional tests as needed including computerized tomography (CAT) scan, electroencephalography or a magnetic resonance image (MRI) scan.

What is the Cause?

The cause of Alzheimer's disease is currently unknown. It is not contagious. Genetic factors and aging appear to play an important role. Because a combination of factors are believed to be responsible for most forms of Alzheimer's, genetic testing usually is not recommended.

Alzheimer patients who have at least one other relative with the disease are categorized as "familial". "Familial" does not necessarily mean that it is genetic; family members may have been exposed to something in the environment that caused the disease. If a person has Alzheimer's disease and no other family members are known to have been affected, they are said to have "sporadic" Alzheimer's disease.

As stated earlier, most cases of Alzheimer's disease occur in those after age 65, but a small percentage of cases develop at an unusually young age - some people are diagnosed in their fifties, some in their forties, some even as young as their thirties. This form of the disease is called early-onset Alzheimer's disease, affecting from 1 to 10 percent of all cases.

A variation on chromosome 19, called APOE-e4, appears to be a risk factor for Alzheimer's. This gene variation is present in about 15 percent of the general population, but occurs in 50 percent of those with late-onset Alzheimer's patients than in people without the disease. Although people with this so-called e4 type appear to be more susceptible to the disease, they will not necessarily get it.


What are the treatments?

While currently there is no cure for Alzheimer's disease, there are some treatments that help manage the symptoms.

Tacrine and donepezil hydrochloride are currently FDA approved for the treatment of mild to moderate Alzheimer's disease. Neither drug slows the disease progress, but can ease symptoms in some patients by inhibiting the breakdown of a brain chemical called acetylcholine. Acetylcholine is in short supply in Alzheimer's patients. It is not yet clear which patients will benefit from these drugs.

There are also many approved medications for the behavioral symptoms, including drugs to control depression, agitation, anxiety, and delusions. Specific strategies for some of the physical and behavioral problems can improve a patient's quality of life. Vision and hearing problems, for instance, should be corrected.

Families and friends can help by recognizing that Alzheimer's disease impacts not only the patient, but also the primary caregiver. To take the best care of the Alzheimer's patient, the primary caregiver must take care of themselves. They should be encouraged to find out more about the disease, avoid isolation and seek support from family, friends, and professionals.

While there is no known way to prevent Alzheimer's disease, researchers believe there are several things that will help keep your brain healthy:

  • Avoid harmful substances - Excessive drinking and drug abuse are thought to damage brain cells.
  • Challenge yourself - Read widely; keep mentally active and learn new skills. This strengthens the brain connections and promotes new ones.
  • Trust yourself more - If you feel as you have control over your life, your brain chemistry actually improves.

Hope Through Research

Research, especially using animal models of the disease, provides tremendous hope for patients. The effects of estrogen hormones, anti-inflammatory agents, vitamin E, and other common medications are under intense study at this time.

Experimental treatments are currently being tested in multicenter clinical drug trials. One of the most promising is neurotransmitter research, or replacing the cells that produce neurotransmitters in the brain that have been destroyed by the disease. Neurotransmitters are chemicals that carry messages between brain cells. Participation in clinical trials can be highly rewarding because of the frequent contact with and support from health care providers. However, they usually require that a  portion of the patients receive placebo rather than active medication. A placebo - often a sugar pill - is an inactive substance that looks like the test drug. Most state Alzheimer's centers, federally funded Alzheimer's centers and many physicians specializing in Alzheimer's disease participate in these trials.

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