What Alzheimer's Disease Is
An elderly woman finds she can't seem to follow a cheesecake recipe she's been using for years. While driving her car, this woman sometimes forgets where she is going and has trouble finding her way home. More and more often, she is confused. This woman has Alzheimer's disease. She could be your grandmother, your mother, your sister, your friend -- or she could be you.
The most common cause of dementia, Alzheimer's disease affects 4.5 million Americans, more of them women than men. And as former President Reagan's death from complications of Alzheimer's reminds us, this fatal disease profoundly affects not only the person suffering from it, but his or her caregivers, family members, and friends.
First discovered in 1906 by German physician Alois Alzheimer, Alzheimer's is a complex disease that is not yet fully understood. It starts in one part of the brain and gradually spreads to other regions, leaving behind abnormal clumps (plaques) and twisted fibers of protein. As it progresses, it causes confused thought patterns. Over time, Alzheimer's disease slowly robs a person of her language and reasoning skills, her memory, and ultimately her personality.
The odds of the getting Alzheimer's increase as a person gets older; as many as 10 percent of people over age 65, and close to 50 percent of people over 85 have the disease. A rare form of AD develops as early as age 40. But Alzheimer's is not an inevitable part of aging. The dementia associated with Alzheimer's is not the mild forgetfulness that many older people joke about.
Early symptoms of Alzheimer's include forgetfulness, language problems, difficulty concentrating, and general confusion. While some people may experience one or more of these symptoms as they age, in people with Alzheimer's, the symptoms are severe enough to interfere with their family relationships, social activities, and work.
"The memory loss associated with Alzheimer's is more functional in nature. Instead of forgetting where she put her keys, a woman with Alzheimer's will forget what those keys are used for," says Neil S. Buckholtz, PhD, chief of the Dementias of Aging branch of the Neuroscience and Neuropsychology Program at the National Institute on Aging, Bethesda, Maryland.
According to the Alzheimer's Association, the following symptoms may be warning signs of Alzheimer's:
1. Memory loss. We all forget names or telephone numbers now and then, but people with Alzheimer's have forgetfulness that is chronic and disruptive.
2. Difficulty performing everyday tasks. A person with Alzheimer's may suddenly forget how to take a shower or work an oven.
3. Language problems. A person with Alzheimer's will forget frequently used words.
4. Disorientation. It's normal to forget which day of the week it is now and then, but a person with Alzheimer's will forget where she is driving, or she will become lost on her own street.
5. Decreased or poor judgment. On a hot day, a person with Alzheimer's may dress in many layers, or she may donate much more money to her place of worship than she can afford.
6. Trouble with abstract thinking. While balancing a checkbook, someone with Alzheimer's may have absolutely no idea what the numbers represent or what she should do with them.
7. Losing things. A person with Alzheimer's doesn't just misplace things; she puts them in strange places, like a wallet in the freezer or an address book in the medicine cabinet.
8. Mood or behavior changes. Someone with Alzheimer's may experience rapid mood swings -- from laughter to anger -- suddenly and for no apparent reason.
9. Personality changes. Personality may change in a person with Alzheimer's, causing a normally calm woman to suddenly become suspicious and paranoid.
10. Loss of initiative. A person with Alzheimer's may lose complete motivation to do anything and spend hours in front of the television or sleeping.
Risk Factors for Alzheimer's Disease
The biggest risk factor for Alzheimer's is increasing age. Another risk factor is family history -- having a parent or sibling with the disease increases your odds for developing it. And researchers have identified three genes that cause the rare, early-onset form of the disease.
There's also some evidence that cardiovascular symptoms may increase a person's chances of developing Alzheimer's. "In the past few years, we've realized that some of the same risk factors for stroke, high blood pressure, and high cholesterol, for example, also put people at risk for Alzheimer's," says Vladimir Hachinski, MD, FRCPC, MSc, DSc, professor of neurology, University of Western Ontario, Canada. "This realization is exciting because it means if we treat these cardiovascular risk factors, we may someday be able to prevent or delay Alzheimer's in some people."
Unfortunately, there are currently no known proven methods to prevent Alzheimer's.
New findings from a memory sub-study of the landmark, federally funded Women's Health Initiative (WHI), show that hormone therapy, a combination of the hormones estrogen and progestin, do not offer any protection from dementia. Prior to the announcement of the findings, it was hypothesized that estrogen may provide some protective benefits against Alzheimer's in women.
The WHI is a 15-year study (comprising many sub-studies) designed to test the effects of postmenopausal hormone therapy, diet modification, and calcium and vitamin D supplements on heart disease, fractures, and breast and colorectal cancer -- some of the most common causes of death in postmenopausal women.
It found that older postmenopausal women (age 65 and older -- those women who participated in the study) who initiated hormone therapy (a hormone therapy product known as Prempro) had twice the rate of developing dementia, including Alzheimer's disease, compared with women who do not take the medication. Absolute risk (how often these health effects actually occurred) was 23 cases per 10,000 women years.
The study also found that hormone therapy did not protect against the development of mild cognitive impairment (MCI), a form of cognitive decline less severe than dementia. Of note, MCI is considered a precursor to dementia and the fact that it was not increased in this study while dementia was has yet to be explained.
Early diagnosis of Alzheimer's remains the best strategy for attempting to slow the disease's progression. Therefore, it's important to report any unusual symptoms in yourself or a loved one to a healthcare professional as soon as possible.
And there is some evidence that good general health, supported by a healthy diet and exercise, may play a part in prevention as well. "A number of studies have shown that both physical and mental exercises preserve the health of the body and mind. It doesn't guarantee a person will prevent the disease, but these exercises will help the brain function," Dr. Hachinski says.
If you suspect you or a loved one is suffering from symptoms of Alzheimer's, the first steps are to see a healthcare professional for an evaluation. A series of specific neuropsychological tests measuring physical and cognitive functioning will be performed.
"The clinical evaluation will look at a person's global functioning, and specific neurological tests will determine memory and other changes," Dr. Buckholtz says. Medical specialists use these and other assessments to diagnose "probable Alzheimer's disease." A definitive diagnosis is possible only after an autopsy of the brain, which will show the hallmark plaques and tangles that indicate Alzheimer's, Dr. Buckholtz adds.
Treating Alzheimer's Disease
Medications are used to slow the progression of Alzheimer's and to manage some Alzheimer's-related symptoms. There are five drugs presently approved by the U.S. Food and Drug Administration (FDA) for the treatment of Alzheimer's.
For treatment of mild to moderate Alzheimer's, the most commonly prescribed drugs are acetylcholinesterase inhibitors, which work to slow down the breakdown of acetylcholine, a brain chemical whose levels decline in people with the disease. There are three drugs in this category.
For people with moderate to severe Alzheimer's, healthcare professionals are now prescribing a new drug called memantine that blocks excess amounts of glutamate, a brain chemical that leads to brain destruction in people with the disease.
And to improve some of the intense behavioral symptoms that can accompany Alzheimer's, such as delusions, paranoia, anxiety, agitation, and depression, healthcare professionals may recommend antipsychotic medications, antidepressants, or anti-anxiety medications.
Success with medication varies from person to person in both length of response and duration. "A drug may work for one person for six months and for another for two years, but generally these drugs don't seem to be effective for more than two to three years at the most," Dr. Buckholtz says.
In the Future
Memory studies currently underway and funded by the National Institutes of Neurological Disorders and Stroke include research measuring the effects of nonsteroidal anti-inflammatory drugs, statins (the medications used to lower high cholesterol), vitamins B and E, and ginkgo biloba, and to establish whether they may prevent the progression of Alzheimer's.
In the area of diagnosis, researchers are exploring how magnetic resonance imaging and positron emission tomography scans, both of which provide images of the brain, can be used to diagnose Alzheimer's in earlier stages.
For more information
For additional information on Alzheimer's disease, contact one or more of the following organizations:
Alzheimer's Disease Education and Referral (ADEAR) Center PO Box 8250 Silver Spring, MD 20907-8250 800-438-4380
The Alzheimer's Association 225 N. Michigan Ave. Fl. 17 Chicago, IL 60601-7633 800-272-3900 (information, support and referral available 24 hours a day)
The National Institute of Neurological Disorders and Stroke (NINDS) NINDS Alzheimer's Disease Information Page
The National Women's Health Resource Center 157 Broad Street, Suite 315 Red Bank, NJ 07701 877-986-9472
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