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
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
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.
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
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.
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.
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.