Alzheimer's Disease/Dementia

Alzheimer's Disease is a progressive, degenerative disease of the brain in which brain cells die and are not replaced, resulting in impaired memory, thinking and behavior.

Dementia is a more general term that refers to a decline in intellectual functioning in such areas as memory, cognition (awareness) and judgment. Although there are many causes of dementia, the most common is Alzheimer's Disease, which accounts for about two-thirds of all dementia cases. Alzheimer's Disease was named after Dr. Alzheimer, who first described the condition in 1906.

Alzheimer's Disease is defined pathologically by amyloid plaques and neurofibrillary tangles in brain tissue that can be seen when the tissue is examined under a microscope. Acetylcholine (Ach), the most important brain chemical for memory and other intellectual functions, is found in reduced amounts in the brains of those afflicted with Alzheimer's.

At this time, age and heredity are the only known risk factors for Alzheimer's Disease. Approximately 3% of those ages 65-75, 20% of those ages 75-85 and nearly 50% of those over 85 will have Alzheimer's Disease. Since the fastest growing segment of our population is the over 85 age group (more than half of all those who have ever lived beyond 85 are alive today!), it is essential that this disease be understood and prevented, or a cure be found soon.

Alzheimer's is more common in certain families. Genetic mysteries associated with the incidence of this disease in families are gradually being solved. Scientists recently identified the chemical/enzyme that leads to amyloid deposits. These recent discoveries have opened new and hopeful strategies for treating this devastating condition.

Symptoms and Diagnosis

Memory decline is seen as a normal phenomenon as people age. Forgetting someone's name or telephone number is normal. If, however, a person frequently forgets familiar information or tasks, such as following a recipe, finding their way home, paying bills, turning off the stove or maintaining hygiene, a medical evaluation may be in order.

Evaluation by a knowledgeable physician should include:

• A complete health history, physical examination and blood studies to rule out hypothyroidism, diabetes, liver and kidney disease, etc.
• A CT or MRI scan of the brain to rule out conditions such as brain tumor, subdural hematoma and small strokes
• Objective neuropsychometric testing to compare the individual with others of similar age and educational background.

The diagnosis of Alzheimer's Disease can be confidently made if an elderly person experiences a gradual progression of dementia, with no other cause found for it, particularly if there is a strong family history of dementia.

Treatments

Current memory-enhancing medications work as cholinesterase inhibitors. Cholinesterase breaks down Acetylcholine (Ach), the most important brain chemical for memory and other intellectual functions. If cholinesterase can be inhibited, more Ach will be available to the brain for memory and other intellectual functions. The more convenient Aricept and, most recently, Exelon, have replaced Cognex, the first memory-enhancing medication available. These drugs are generally well-tolerated and are helpful in improving or delaying the decline in about 40% of patients, particularly those experiencing mild to moderate symptoms. These drugs have also been helpful in dealing with behavioral problems and maintaining activities of daily living, such as grooming and eating.

Behavioral medications, such as antidepressants, tranquilizers and sleeping pills, may be needed, particularly in the later stages of the disease.

Although non-specific medications, such as estrogen and anti-inflammatory medications, have recently received attention as preventive strategies, their use requires further study. Anti-oxidants, such as vitamin E, appear to be helpful, particularly in the form of fresh fruits and vegetables.

Measures that prevent amyloid deposits, such as vaccines, chemical antagonists to the enzyme leading to beta amyloid, or use of anti-inflammatories, may be available at some time in the future. Embryonic stem cells, which are capable of becoming brain cells or other cells in the body, have been discovered in adult persons and may provide "replacement parts" for our bodies. Genetic treatments could include changing the abnormal genetics in those families prone to Alzheimer's Disease, or using neuron growth factor gene transfer, which was recently shown to produce remarkable results in older monkeys.

In the meantime, it is critical for caregivers to have information to help them cope with caring for a person with Alzheimer's Disease. One of the best sources is the Alzheimer's Association, which has local chapters in many communities. Check out their website at www.alzheimers.org. They have pamphlets on many relevant topics, including behavioral problems (irritability, agitation, aggression, psychosis, etc.), incontinence (involuntary loss of urine), sleep problems, driving, legal matters and caregiver advice. Support groups are offered by our Clinic, as well as the Alzheimer's Association. These groups can provide valuable tips for preventing wandering, improving sleep at night, distracting from conflict and handling other common problems.

What is the prognosis for someone who has Alzheimer's?

Since Alzheimer's Disease is a progressive condition, the person may eventually become disoriented, have language problems, or become lost and confused. Normal inhibitions may disappear. Ultimately, the person will be totally dependent on others for eating, dressing and survival.

Three-fourths of persons diagnosed with Alzheimer's will require nursing home care within five years. Although the average time from diagnosis to death is nine years, this is highly variable. We are dealing with an aged population, many of whom have medical problems besides Alzheimer's. If a person has problems with sleep, wandering and incontinence and becomes a danger to him or herself or others, it will be nearly impossible for a caregiver to keep the person at home.

Alzheimer's is truly a devastating disease; however, there is a great deal of hope for prevention or cure in the foreseeable future.

Appointments

Ask your doctor about a referral to our Memory Center. To schedule an appointment, please call our offices at (763) 588-0661.

Where can I get more information about Alzheimer?s Disease?

NINDS Alzheimer's Disease Information