Definition
Alzheimer’s disease (pronounced Alts’-hi-merz) is a progressive, degenerative disease that attacks the brain and results in impaired memory, thinking and behavior. Alzheimer’s disease is the most common form of dementia. Dementia is a loss of intellectual function (thinking, remembering and reasoning) so severe that it interferes with an individual’s daily functioning and eventually results in death. Men and women are affected almost equally. The disease was first described by Dr. Alois Alzheimer in 1906. Since then, researchers have developed a deeper understanding of the changes in the brain (plaques and tangles) and behavioral changes that characterize the disease. Identified risk factors are age and family history. Most people diagnosed with Alzheimer’s are older than age 65; however, Alzheimer’s disease can occur in people in their 30s, 40s and 50s.

Symptoms
Symptoms of Alzheimer’s can include gradual memory loss, decline in the ability to perform routine tasks, disorientation, difficulty in learning, loss of language skills, impairment of judgment and planning and personality changes. The rate of progression varies from person to person. The time from the onset of symptoms until death ranges from 3 to 20 years; the average is 8 years. Eventually persons with Alzheimer’s disease become totally incapable of caring for themselves.

Diagnosis
Early and careful evaluation is important because many conditions, including some that are treatable or reversible, can cause dementia. Potentially reversible conditions include depression, adverse drug reactions, metabolic changes and nutritional deficiencies.

There is no single clinical test to identify Alzheimer’s. A comprehensive evaluation to establish a diagnosis will include a complete health history, physical examination, neurological and mental status assessments and other tests, including analysis of blood and urine, electrocardiogram (EKG) and chest x-rays. Documenting symptoms and behavior over time, in a diary fashion, will help physicians understand the person’s illness. The physician may order additional tests as needed, including: computerized tomography (CT scan), electroencephalograph (EEG), formal psychiatric assessment and/or neuropsychological testing. While this evaluation may provide a diagnosis of possible or probable Alzheimer’s disease, confirmation of Alzheimer’s disease requires examination of brain tissue at autopsy.

Treatment
Although no cure for Alzheimer’s disease is currently available, good planning and medical and social management can ease the burdens on the patient and family. Health care directives and decisions can be made while the patient has the mental capacity to do so. Physical exercise and social activity are important, as is proper nutrition. A calm and well-structured environment may help the afflicted person to continue functioning. Intervention strategies and, if necessary, appropriate medication can lessen symptoms such as agitation and anxiety, and improve sleep and participation in activities. There are currently two FDA-approved drug treatments for Alzheimer’s disease — tacrine (Cognex®) and donepezil (Aricept®). A third drug, rivastigimine (Exelon®), is expected to be available in 2000.

Cause and research
The causes of Alzheimer’s disease are not known and are currently receiving intensive scientific investigation. Suspected causes include diseased genes or a genetic predisposition, abnormal protein build-up in the brain and environmental toxins. Scientists are applying the newest knowledge and research techniques in molecular genetics, pathology, immunology, toxicology, neurology, psychiatry, pharmacology, biochemistry and epidemiology to find the cause, treatments and cure for Alzheimer’s disease.

Economic impact
At some point, persons with Alzheimer’s disease will require 24-hour care, including assistance with daily activities such as eating, grooming and toileting. The financing of care for Alzheimer’s disease — including costs of diagnosis, treatment, nursing home care and formal or paid care — is estimated to be more than $100 billion each year. It’s estimated that Alzheimer’s disease costs American businesses more than $33 billion a year due to the absenteeism of caregivers — employees who take care of people with the disease — and the cost of care.

The Alzheimer’s Association is the largest national voluntary health organization dedicated to research for the causes, treatments, prevention and cure of Alzheimer’s disease and to providing education and support services to people with the disease, their families and caregivers. A nationwide 24-hour information and referral line links families who need assistance with nearby local chapters. For information or help, call (800) 272-3900 or contact your local chapter.

For more information, please contact the Alzheimer’s Association at (800) 272-3900 or www.alz.org.

Source
Alzheimer’s Disease and Related Disorders Association, Inc., 2000.