Alzheimer's Disease (AD)

Excerpted from
Power to the Patient : The Treatments to Insist on When You're Sick
By Isadore Rosenfeld, M.D.

Alzheimer's disease (AD) has replaced cancer, stroke, heart attacks, and AIDS as the most feared affliction of mankind. It's insidious, devastating, and incurable, engulfing not only the patient but his or her loved ones as well. Families must witness for years the inexorable, tragic deterioration of a vital, active human being. What begins with subtle memory loss ends in total dementia. To make matters worse, spending time with an AD patient whom you love may leave you identifying with him or her and fearing for your own sanity. Harmless memory lapses such as forgetting where you left your keys or where you parked your car may trigger panic and raise the question "Is this the beginning for me too?"

What Is Alzheimer's?

Although the incidence of Alzheimer's is rising, it's by no means a new disease. Ancient Greeks and Romans described it thousands of years ago. Alzheimer's is named after a German doctor, Alois Alzheimer, who in 1908 discovered twisted strands of fiber in the brains of some persons with "mental illness." These "neurofibrillary tangles" remain the only objective proof of Alzheimer's-and they're found only at autopsy.

Not until seventy-five years later did scientists discover that the characteristic Alzheimer plaques contain beta amyloid, a string of forty or more amino acids whose parent protein is called amyloid precursor protein (APP). This observation may be very important because researchers are now testing a vaccine that prevents this protein from forming. If it works, it may cure or prevent Alzheimer's. The tangles also contain another protein called tau, which too is being studied.

AD starts in an area of the brain called the entorhinal cortex, moves to the hippocampus (important for memory formation), then moves deep inside the brain, and finally to the centers of higher function in the cerebral cortex that are concerned with thought, language, and reason.

In addition to these anatomic changes, the Alzheimer brain loses 90 percent of its acetylcholine, a neurotransmitter used predominantly by neurons (nerve cells in the brain) in the areas most important for memory. Drug therapy of this disease, such as it is, is based on replenishing this missing acetylcholine.

The best guesstimate is that there are 4 million cases of Alzheimer's in this country alone, and the numbers are increasing as our population ages. There are two main types; one accounts for 95 percent of cases and is "sporadic"-that is, it occurs randomly and for no apparent reason; the other 5 percent are genetically determined and develop in families in whom as many as half the members are afflicted.

Alzheimer's is not an immediate threat to life. Some patients survive for twenty years or more. However, many die a few years after the diagnosis is made, usually from pneumonia or some other disease. AD costs Americans $100 billion a year, whether caring for its victims at home or in nursing facilities.

AD is not an inevitable consequence of aging. Yes, you are more likely to develop it as you grow older, but there is no such thing as "natural" senility. When you "lose" your mind at any age, it's because some disease or disorder has affected it. Alzheimer's is one of several such conditions, and the most common.

The memory loss and other behavioral abnormalities of AD can usually be accurately assessed by neurological and psychiatric tests. Some are as simple as asking, "What's the date, the day of the week, the year, and who's the president of the United States?" However, since there is presently no objective test to diagnose Alzheimer's with certainty during life, everyone suspected of having it should undergo a careful neurological and medical evaluation to rule out the various other disorders that can produce similar symptoms. Do not accept a diagnosis of Alzheimer's until you've had such an evaluation. Insist on it.

Although several Alzheimer genes have been identified, many people without the genes have the disease, while others who possess them never develop it.

Several drugs and herbs can improve some of the symptoms of Alzheimer's, but there is no cure for it, and no way to stop it's inevitable progress.

What Is Dementia and How Can You Recognize It?

"Dementia" refers to deterioration of mental function due to any cause. You forget someone's name at a cocktail party but remember it later. Is that dementia? Or you suddenly draw a blank on a telephone number you've dialed every day for months. Or you decide to phone a friend, dial the number, and then can't remember whom you're calling. Should you worry? Not if it only happens now and then. But if these lapses occur frequently, they may be early signs of serious trouble. The following should prompt a visit to your doctor:

• Forgetfulness is affecting your job performance. Customers or colleagues ask for your input on important matters, and you promise to get back to them but forget to do so. Even worse, you don't even recall the conversation in the first place.

• You're preparing dinner and forget that you've left the rice on the stove. That's bad enough, but if you then leave the house to go to a movie, you'd better tell your doctor about it.

• Dan Quayle and George W. Bush have trouble using the right word, like saying "hostile" instead of "hostage." That's not too serious, but when your sentences as a whole are gibberish, you're in trouble.

• You don't know the day, the month, or the year.

• While driving your car you suddenly forget where you were going.

• You've lived in the same part of town for years, have gone for the same daily ten-minute walk for as long as you can remember, but now don't know where you are, how you got there, why you went in the first place, and can't find your way home.

• Your color coordination may not qualify you to be a design consultant-neither does mine-but wearing one black shoe and one white one is cause for concern. As is putting on two shirts.

• Most people dislike the task of balancing their checkbooks, but if you stare blankly at the numbers and don't know what they mean, you need help.

• Everyone forgets occasionally where he or she has put something-a book, keys, wallet, glasses, or any one of the countless personal items we carry with us. But when you find one of your shoes in the refrigerator or your pocket comb in the sugar bowl, you've got problems.

• It's normal to feel angry, depressed, or frustrated once in a while, but sudden dramatic mood swings from one moment to the next for no apparent reason may suggest dementia.

• Our tastes change as we grow older. What gave us pleasure and made us smile years ago may bore us today. That's normal. But demented individuals often undergo a fundamental change in their personality: They become aggressive, paranoid with a persecution complex, confused, or withdrawn for no apparent reason.

• Everyone needs a vacation from time to time to regain the energy necessary to get on with the job. A demented individual loses interest that cannot be rekindled and needs constant prompting to get on with life.

• When the above behavior patterns become habitual, they may progress to inability to speak intelligibly and communicate effectively; loss of appetite; no control of the bowels and bladder, and finally the need for a round-the-clock caregiver.

Most of us, even doctors who should know better, almost reflexively attribute these signs and symptoms to Alzheimer's, but several other disease processes can also cause them. The distinction should be made as quickly as possible because dementia caused by something other than Alzheimer's can often be cured or arrested if diagnosed and treated promptly. Here are a few of the conditions, some common, others rare, that must be ruled out before you accept the Alzheimer diagnosis.