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Dementia is a brain disorder that seriously affects a person’s ability to
carry out daily activities. Alzheimer’s disease (AD) is the most common form of
dementia among older people. It involves the parts of the brain that control
thought, memory, and language. Every day scientists learn more, but right now
the causes of Alzheimer's Disease are still unknown, and there is no cure.
Scientists think that up to 4 million Americans suffer from Alzheimer's Disease. The disease
usually begins after age 60, and risk goes up with age. While younger people
also may get AD, it is much less common. About 3 percent of men and women ages
65 to 74 have Alzheimers Disease, and nearly half of those age 85 and older may have the
disease. It is important to note, however, that AD is not a normal part
of aging.
AD is named after Dr. Alois Alzheimer, a German doctor. In 1906, Dr.
Alzheimer noticed changes in the brain tissue of a woman who had died of an
unusual mental illness.
He found abnormal clumps (now called amyloid plaques) and tangled bundles of
fibers (now called neurofibrillary tangles). Today, these plaques and tangles in
the brain are considered hallmarks of AD.
Scientists also have found other brain changes in people with AD. There is a
loss of nerve cells in areas of the brain that are vital to memory and other
mental abilities. There also are lower levels of chemicals in the brain that
carry complex messages back and forth between nerve cells. AD may disrupt normal
thinking and memory by blocking these messages between nerve cells.
Scientists do not yet fully understand what causes Alzheimer's Disease. There probably is not
one single cause, but several factors that affect each person differently. Age
is the most important known risk factor for Alzheimer's Disease. The number of people with the
disease doubles every 5 years beyond age 65.
Family history is another risk factor. Scientists believe that genetics may
play a role in many AD cases. For example, familial Alzheimer's Disease, a rare form of AD that
usually occurs between the ages of 30 and 60, can be inherited. However, in the
more common form of AD, which occurs later in life, no obvious family pattern is
seen. One risk factor for this type of AD is a protein called apolipoprotein E
(apoE). Everyone has apoE, which helps carry cholesterol in the blood. The apoE
gene has three forms. One seems to protect a person from AD, and another seems
to make a person more likely to develop the disease. Other genes that increase
the risk of Alzheimer's Disease or that protect against AD probably remain to be discovered.
Scientists still need to learn a lot more about what causes Alzheimer's Disease. In addition
to genetics and apoE, they are studying education, diet, environment, and
viruses to learn what role they might play in the development of this
disease.
AD begins slowly. At first, the only symptom may be mild forgetfulness.
People with Alzheimers Disease may have trouble remembering recent events, activities, or the
names of familiar people or things. Simple math problems may become hard to
solve. Such difficulties may be a bother, but usually they are not serious
enough to cause alarm.
However, as the disease goes on, Alzheimers Disease symptoms are more easily noticed and become
serious enough to cause people with AD or their family members to seek medical
help. For example, people in the later stages of Alzheimer's Disease may forget how to do simple
tasks, like brushing their teeth or combing their hair. They can no longer think
clearly. They begin to have problems speaking, understanding, reading, or
writing. Later on, people with AD may become anxious or aggressive, or wander
away from home. Eventually, patients need total care.
An early, accurate diagnosis of AD helps patients and their families plan for
the future.
It gives them time to discuss care options while the patient can still take
part in making decisions. Early diagnosis also offers the best chance to
treat Alzheimers Disease symptoms.
Today, the only definite way to diagnose AD is to find out whether there are
plaques and tangles in brain tissue. To look at brain tissue, doctors must wait
until they do an autopsy, which is an examination of the body done after a
person dies. Therefore, doctors must make a diagnosis of "possible" or
"probable" AD.
At specialized centers, doctors can diagnose AD correctly up to 90 percent of
the time. Doctors use several tools to diagnose "probable" AD:
- A complete medical history includes information about the person's general
health, past medical problems, and any difficulties the person has carrying
out daily activities.
- Medical tests – such as tests of blood, urine, or spinal fluid –
help the doctor find other possible diseases causing the symptoms.
- Neuropsychological tests measure memory, problem solving,
attention, counting, and language.
- Brain scans allow the doctor to look at a picture of the brain to see if
anything does not look normal.
Information from the medical history and test results help the doctor rule
out other possible causes of the person's symptoms. For example, thyroid
problems, drug reactions, depression, brain tumors, and blood vessel disease in
the brain can cause Alzheimer's Disease-like symptoms. Some of these other conditions can be
treated successfully.
Recently, scientists have focused on a type of memory change called mild
cognitive impairment (MCI). MCI is different from both AD and normal age-related
memory change. People with MCI have ongoing memory problems but do not have
other losses like confusion, attention problems, and difficulty with language.
Scientists funded by the National Institute on Aging (NIA) are conducting the
Memory Impairment Study to learn whether early diagnosis and treatment of MCI
might prevent or slow further memory loss, including the development of AD.
AD is a slow disease, starting with mild memory problems and ending with
severe brain damage. The course the disease takes and how fast changes occur
vary from person to person. On average, AD patients live from 8 to 10 years
after they are diagnosed, though the disease can last for as many as 20
years.
No treatment can stop AD. However, for some people in the early and middle
stages of the disease, the drugs tacrine (Cognex), donepezil (Aricept),
rivastigmine (Exelon), or galantamine (Reminyl) may help prevent some symptoms
from becoming worse for a limited time. Also, some medicines may help control
behavioral symptoms of Alzheimers Disease such as sleeplessness, agitation, wandering, anxiety,
and depression. Treating these Alzheimers Disease symptoms often makes patients more comfortable
and makes their care easier for caregivers.
Developing new Alzheimer's Disease treatments is an active area of research. Scientists
are testing a number of drugs to see if they prevent AD, slow the disease, or
help reduce behavioral symptoms.
Scientists are testing two different types of nonsteroidal anti-inflammatory
drugs (NSAIDs) to find out if they slow the disease. There is evidence that
inflammation in the brain may contribute to AD damage. Scientists believe that
anti-inflammatory drugs such as NSAIDs might help slow the progression of AD.
Rofecoxib (Vioxx) and naproxen (Aleve) are two NSAIDs currently being
studied.
Research has shown that vitamin E slows the progress of some consequences of
AD by about 7 months. Scientists now are studying vitamin E to learn whether it
can prevent or delay AD in patients with MCI.
Recent research suggests that ginkgo biloba, an extract made from the leaves
of the ginkgo tree, may be of some help in treating Alzheimers Disease symptoms. There is no
evidence that ginkgo will cure or prevent Alzheimer's Disease. Scientists now are trying to find
out whether ginkgo biloba can delay or prevent dementia in older people.
Research also is under way to see if estrogen reduces the risk of AD or slows
the disease. One study showed that estrogen does not slow the progression of
already diagnosed disease, but more research is needed to find out if it may
play another role. For example, scientists now are trying to find out whether
estrogen can prevent Alzheimer's Disease in women with a family history of the
disease.
People with AD and those with MCI who want to help scientists test possible
treatments may be able to take part in clinical trials. Clinical trials are
studies to find out whether a new treatment is both safe and effective. Healthy
people also can help scientists learn more about the brain and AD. The NIA and
the Food and Drug Administration (FDA) are working together to maintain the AD
Clinical Trials Database, which lists Alzheimer's Disease clinical trials sponsored by the
Federal government and private companies. To find out more about these studies,
contact the NIA’s Alzheimers Disease Education and Referral (ADEAR) Center at
1-800-438-4380, or visit the ADEAR Center website at http://www.alzheimers.org/. You may want
to check regularly to see what new clinical trials have been added to the
database.
Many of these studies are being done at NIA-supported Alzheimer's Disease
Centers located throughout the United States. These centers carry out a wide
range of research, including studies of the causes, diagnosis, treatment, and
management of Alzheimer's Disease. To get a list of these centers, contact the ADEAR Center.
Most often, spouses or other family members provide the day-to-day care for
people with AD. As the disease gets worse, people often need more and more care.
This can be hard for caregivers and can affect their physical and mental health,
family life, job, and finances.
The Alzheimer's Association has chapters nationwide that provide educational
programs and support groups for caregivers and family members of people with AD.
For more information, contact the Alzheimer's Association listed at the end of
this fact sheet.
Scientists have come a long way in their understanding of AD. Findings from
years of research have begun to clarify differences between normal age-related
memory changes, MCI, and AD. Scientists also have made great progress in
defining the changes that take place in the AD brain, which allows them to
pinpoint possible targets for treatment. These advances are the foundation for
the National Institutes of Health (NIH) Alzheimer’s Disease Prevention
Initiative, which is designed to:
- understand why AD occurs and who is at greatest risk of developing it
- improve the accuracy of diagnosis and the ability to identify those at
risk
- discover, develop, and test new treatments
- discover treatments for behavioral problems in patients with AD
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
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More Information on Alzheimers Disease
Alzheimer's Association
Suite 1100
919 North Michigan
Avenue
Chicago, IL 60611-1676
800-272-3900
Web address: http://www.alz.org
Alzheimer's Disease Education and Referral (ADEAR) Center
PO Box
8250
Silver Spring, MD 20907-8250
800-438-4380
Web address: http://www.alzheimers.org
Eldercare Locator
800-677-1116
Web address: http://www.aoa.gov/elderpage/locator.html
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