Alzheimer's Disease
Alzheimer's Main Page|Etiology|Diagnosis|Treatment|Prevention|Research
Introduction
Alzheimer's disease is a degenerative brain disorder that causes cognitive impairment and eventually leads to death. Symptoms of Alzheimer's include memory loss, behavior changes, personality changes, confusion, and a loss of the ability to carry out activities of daily living. According to the Center for Disease Control, Alzheimer's disease has dramatically increased in prevalence in the last 25 years, and is currently one of the seven leading causes of death in the United States. It is unclear whether more people have Alzheimer's than in the past, or if the effects are more noticeable as our population lives longer and older adults are more likely to suffer from the symptoms of Alzheimer's. Regardless, Alzheimer's is impacting our aging population and will likely continue to increase as Baby Boomer's age. According to the Alzheimer's Association, annual costs to Medicare and Medicaid will increase 65% in the next five years to treat Alzheimer's patients.
History of Alzheimer's Disease
In 1901, a 51-year-old woman, Auguste D, was admitted to the state asylum in Frankfurt. She was suffering from cognitive and language deficits, auditory hallucinations, delusions, paranoia and aggressive behaviour, and was studied by Alois Alzheimer (1864–1915), a doctor at the hospital.
Alzheimer moved to the Munich medical school in 1903 to work with Emil Kraepelin – one of the foremost German psychiatrists of that era – and when Auguste D died in April 1906, her brain was sent to him for examination. In November of that year, Alzheimer presented Auguste's case at a psychiatry meeting, and he published his talk in 1907.
In 1910, Kraepelin coined the term 'Alzheimer's disease' – a term still used to refer to the most common cause of senile dementia.
Course (from the Surgeon General)
Patients with Alzheimer’s disease experience a gradual decline in functioning throughout the course of their illness. Typically, a loss of 4 points per year on the Mini Mental Status Exam is detected, but there is a great deal of heterogeneity in the rate of decline (Olichney et al., 1998). Memory dysfunction is not only the most prominent deficit in dementia but also is the most likely presenting symptom. Deficits in language and executive functioning, while common in the disorder, tend to manifest later in its course (Locascio et al., 1995). Depression is prevalent in the early stages of dementia and appears to recede with functional decline (Locascio et al., 1995). Although this may reflect decreasing awareness of depression by the patient, it also could reflect inadequate detection of depression by health professionals. Behavioral symptoms, such as agitation, seem to be more prevalent in the later stages of Alzheimer’s disease (Patterson & Bolger, 1994); however, psychosis has been observed in patients with varying levels of severity (Borson & Raskind, 1997). The duration of illness, from onset of symptoms to death, averages 8 to 10 years (DSM-IV).
Prevalence and Incidence (from the Surgeon General)
Alzheimer’s disease is a prominent disorder of old age: 8 to 15 percent of people over age 65 have Alzheimer’s disease (Ritchie & Kildea, 1995). The prevalence of dementia (most of which is accounted for by Alzheimer’s disease) nearly doubles with every 5 years of age after age 60 (Jorm et al., 1987). Although more women than men have Alzheimer’s disease (that is, the prevalence of the disease appears to be higher among women), this may reflect women’s longer life spans, because studies do not show marked gender differences in incidence rates (Lebowitz et al., 1998). Incidence studies also reveal age-related increases in Alzheimer’s disease (Breteler et al., 1992; Paykel et al., 1994; Hebert et al., 1995; Johansson & Zarit, 1995; Aevarsson & Skoog, 1996). One percent of those age 60 to 64 are affected with dementia; 2 percent of those age 65 to 69; 4 percent of those age 70 to 74; 8 percent of those 75 to 79; 16 percent of those age 80 to 84; and 30 to 45 percent of those age 85 and older (Jorm et al., 1987; Evans et al., 1989).
The “graying of America” is likely to result in an increase in the number of individuals with Alzheimer’s disease, yet shifts in the composition of the affected population also are anticipated. Increased education is correlated with a lower frequency of Alzheimer’s disease (Hill et al., 1993; Katzman, 1993; Stern et al., 1994), and future cohorts are expected to have attained greater levels of education. For example, the portion of those currently 75 years of age and older—those most vulnerable to Alzheimer’s disease—with at least a high school education is 58.7 percent. Of those currently age 60 to 64 who will enter the period of maximum vulnerability by the year 2010, 75.5 percent have at least a high school education. A higher educational level among the at-risk cohort may delay the onset of Alzheimer’s disease and thereby decrease the overall frequency of Alzheimer’s disease (by decreasing the number of individuals who live long enough to enter the period of maximum vulnerability). However, this trend may be counterbalanced or overtaken by greater longevity and longer survival of affected individuals. Specifically, improvements in general health and health care may lengthen the survival of dementia patients, increasing the number of severely affected patients and raising their level of medical comorbidity. Similarly, through dissemination of information to patients and clinicians, better detection, especially of early-stage patients, is expected. Increased use of putative protective agents, such as vitamin E, also may increase the number of patients in the middle phases of the illness (Cummings & Jeste, 1999).
Symptoms of Alzheimer's disease
According to the Alzheimer's Association, the following symptoms may indicate the possibility of Alzheimer's disease:
1. Memory loss that affects day-to-day function. It's normal to occasionally forget appointments, colleagues' names or a friend's phone number and remember them later. A person with Alzheimer's disease may forget things more often and not remember them later, especially things that have happened more recently.
2. Difficulty performing familiar tasks. Busy people can be so distracted from time to time that they may leave the carrots on the stove and only remember to serve them at the end of a meal. A person with Alzheimer's disease may have trouble with tasks that have been familiar to them all their lives, such as preparing a meal.
3. Problems with language. Everyone has trouble finding the right word sometimes, but a person with Alzheimer's disease may forget simple words or substitute words, making her sentences difficult to understand.
4. Disorientation of time and place. It's normal to forget the day of the week or your destination -- for a moment. But a person with Alzheimer's disease can become lost on their own street, not knowing how they got there or how to get home.
5. Poor or decreased judgment. People may sometimes put off going to a doctor if they have an infection, but eventually seek medical attention. A person with Alzheimer's disease may have decreased judgment, for example not recognizing a medical problem that needs attention or wearing heavy clothing on a hot day.
6. Problems with abstract thinking.
From time to time, people may have difficulty with tasks that require abstract thinking, such as balancing a checkbook. Someone with Alzheimer's disease may have significant difficulties with such tasks, for example not recognizing what the numbers in the checkbook mean.
7. Misplacing things. Anyone can temporarily misplace a wallet or keys. A person with Alzheimer's disease may put things in inappropriate places: an iron in the freezer or a wristwatch in the sugar bowl.
8. Changes in mood and behavior. Everyone becomes sad or moody from time to time. Someone with Alzheimer's disease can exhibit varied mood swings -- from calm to tears to anger -- for no apparent reason.
9. Changes in personality. People's personalities can change somewhat with age. But a person with Alzheimer's disease can become confused, suspicious or withdrawn. Changes may also include apathy, fearfulness or acting out of character.
10. Loss of initiative. It's normal to tire of housework, business activities or social obligations, but most people regain their initiative. A person with Alzheimer's disease may become very passive, and require cues and prompting to become involved.
Risk Factors for Alzheimer's disease
Most people with Alzheimer's disease are 65 years old or older. Risk of Alzheimer's greatly increases after age 85. Additionally, family history of the disease increases one's chance of developing Alzheimer's. Some other risk factors include head injuries and poor heart function.
Alzheimer's Main Page|Etiology|Diagnosis|Treatment|Prevention|Research