The disease – named after a German psychiatrist, Alois Alzheimer – is a disorder of the brain and nervous system that affects approximately half of all nursing home patients; one in ten people age 65 and over; and half of people over age 85.  It is now the 4^th leading cause of death in American adults, and the number of patients has been doubling every five years.  Worldwide, more than fifteen million people are affected.  The cost in terms of human suffering and dollars is difficult to estimate, but it is huge.

Since many of the signs of the disease coincide with symptoms of normal aging, afflicted persons do not always seek help when they should, and the diagnosis is often missed.  The main symptoms are:  Progressive loss of memory and judgment, loss of orientation to surroundings, and increasing inability to express oneself.  The well-known scenario of an elderly person showing up in a neighborhood not her or his own, confused and lost, unable to give an address or name family members, is typical of advanced AD.  There are less well known symptoms:  Bone fragility, difficulty in swallowing, restlessness, mood swings (especially increasing irritability) and paranoid ideas—may be part of the picture of middle-stage and late AD.  The fact that these features can be found in so many other conditions complicates diagnosis further.

For example, depression in the elderly is often accompanied by some of the above features; and schizophrenia can mimic some of the symptoms as well.        

Risk factors, besides age, include having a close family member diagnosed with AD;  having a family history of Down’s syndrome; and high blood pressure and high cholesterol.  Women are at slightly more at risk than men.  As far as age is concerned, the most common age at which symptoms begin to appear is 65; but cases of much younger patients are on record.  There is a correlation with population groups.  Although the U.S., Canada, and Britain have the highest incidence of the disease, people of some other origins show surprisingly low incidence:  The elderly in India, for example, have less than one tenth the incidence of the U.S.[1] However, all races and countries are affected, so it is to some extent a “universal disease.”  That does not mean that a cure will not be found some day – some think it will be found quite soon.

What causes AD?  There is general agreement that a protein in the brain which normally facilitates mental function, can “fold” the wrong way (proteins are long molecules that can bend and twist into different shapes and thus change their activities).  When this happens, the misshaped proteins can clump together and form tangles or plaques.  These are usually called “beta amyloid plaques”, named after $-amyloid, a protein fragment that is usually broken down and disposed of in the normal brain.  In AD, however, these pieces of amyloid accumulate faster than they are broken down.  The clumps, tangles, or plaques have a severe disrupting effect on transmission of signals and information.  They do this not only by their own presence, but also by getting tangled up in the long branches of nerve cells.  When this happens, the nerve cells die.  This occurs in the cortex of the brain, but also in the mid-brain and spinal cord.  Eventually motor neurons – the cells responsible for the body’s movement and coordination – are also affected.  This is the prevailing explanation of what happens in AD.  Whether or not amyloid is the actual cause of the disease, the plaques seem to be strongly associated with symptoms, and beta-amyloid is the “number one suspect”.  

Although “breakthroughs” in the treatment of the disease have been announced many times with subsequent disappointments, a recent discovery is certainly going to advance research:  Called PIB (Pittsburgh Imaging Agent), this new substance can be given to patients who are suspected of having the disorder.  Then PET scans of the brain will actually reveal clusters of beta amyloid, which show up as reddish patches.  This is the first time it has been possible to see how amyloid is distributed in the living brain.  The possibilities are great:  Different drugs and chemical agents can now be tested for their effectiveness in treating the disease by direct observation of the “number one suspect.”

Treatment should involve both individual and family counseling.  Since caring for someone with AD is usually extremely challenging, caregivers may require a great deal of support.  In fact, support groups for AD caregivers are common and fill an important need.  There are a few medicines that seem to slow the effects of AD; your physician will know about these.  Some research suggests that vitamins C and E, like other anti-oxidants, may be helpful, but their value is not as well established as we would like.

If you or someone you know may be at risk for developing AD, you may want to contact one of the many helpful branches of the Alzheimer’s Association for more information.  In the Cleveland area, the telephone number is (216) 721-8457.  Of course, it is always a good idea to check with your physician or psychiatrist if you have some of the above symptoms, especially if you are having difficulty carrying out ordinary routines and chores.

There are so many web sites devoted to Alzheimer’s that the main difficulty is finding those that best suit your needs.  Some are about very sophisticated research, and hard for most people to follow.  Others are more practically oriented and very useful for nearly anyone interested in the disease.  A good site to start with is: http://www.ninds.nih.gov/health_and_medical/disorders/alzheimersdisease_doc.htm

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