What is Alzheimer’s Disease?
Alzheimer’s Disease (AD) is a degenerative disease of the brain which affects up to 4 million Americans. The disease process which causes AD leads to the accumulation of a sticky protein substance in the brain called amyloid, which binds together to form lesions in the brain called "plaques". Fibrils also accumulate in certain nerve cells of the brain to form what are known as "tangles". These plaques and tangles are the hallmarks of the disease but can only be seen under a microscope. Therefore, we can only say with certainty that a person has had AD after their death and only if an autopsy is performed.
Doctors rely on certain characteristic symptoms to attempt to reach an accurate diagnosis and the diagnosis is correct about 85% of the time. The accuracy of the diagnosis may be increased to above 90% by the physician seeing the patient two or more times over a period of 6 to 12 months to monitor the nature and course of the symptoms. Many of the diseases which can be mistaken for AD can also unfortunately only be diagnosed at the time of autopsy.
How is a Diagnosis of Alzheimer’s Disease made?
To reach an accurate diagnosis of AD a thorough history and physical is essential. The gradual onset of progressive memory problems in an otherwise healthy adult is very typical for the presentation of AD. The earliest symptom of AD is usually short term memory problems, often accompanied by speech or language problems and difficulties with visual-spatial perception. To test for these problems, the clinician usually will use a short paper-and-pencil test to gauge the severity of the problems. The person with the memory problems is often unaware of their deficits so that access to a family member or friend who can provide information is necessary. Patients with only mild memory problems or persons with inconsistent deficits may see a psychologist for more detailed testing of their memory and other cognitive abilities at this point. The physician will often conduct a number of laboratory tests to screen for other medical causes of memory problems and may suggest that a brain scan be done. Using all of this information, a diagnosis is made.
What are the risk factors for developing Alzheimer’s disease?
The most potent risk factor for developing AD is simply growing old. Rates of AD increase steeply after the age of 60. Perhaps 1% of individuals at age 60 have significant memory problems and this percentage doubles every 5 years after that.
Having a close family member with Alzheimer’s also increases the risk of the disease at least up until the age of 75 or so. There are rare forms of the disease that are known to be genetic and usually occur much earlier in life, usually the 40s and 50s. In these families, if a parent is affected, then there is a 50% chance of inheriting the illness. The other inherited risk factor is for a gene that makes a protein called "apolipoprotein E" or simply "apo E". Certain forms of this gene are associated with an increased risk of the disease and an earlier age of onset. Testing for the presence of this gene is of research interest only at this time and is not recommended for routine use.
What treatments are available for Alzheimer’s disease?
The FDA has approved three drugs for the treatment of AD. These are Aricept™ (donepezil), Cognex™ (tacrine) and Exelon™ (rivastigmine). These drugs attempt to improve cognitive function in AD by enhancing levels of the chemical acetylcholine (ACh) in the brain.
ACh is the most important brain chemical for memory. It is made in the nerve cell, released into a gap outside the nerve cell where it sends a message to neighboring cells. In AD, these ACh-producing cells are damaged, contributing to the memory problems which are part of the disease. The net result of this damage is a reduction in the amount of ACh available.
None of these drugs appears to alter the fundamental disease process in AD other than they can slow the speed of decline for some persons for some period of time. They are certainly not curative.
What can the family do to help?
Perhaps the most important thing that the family member can do is to get the person to a physician and establish a diagnosis. The other priority for the family once an AD diagnosis is made is to learn more about AD and what can be expected. An excellent resource is the local Alzheimer’s Association (Omaha & Eastern Nebraska office helpline 402-572-3010, Lincoln/Greater Nebraska office helpline 1-800-487-2585) which is dedicated to helping families with the problems associated with the disease.
Is there hope for the future?
YES! The pace of research has exploded in the last 5 years and there are many promising leads being explored. Some of these treatments involve new drugs which interfere with the body’s production of amyloid or which attempt to reduce inflammation in the brain. There is even a vaccine being evaluated to reduce or eliminate amyloid in the brain.
Importantly, all of these new treatments rely on persons with AD and their families being willing to participate in clinical trials. If people don’t volunteer to test these new treatments, nothing new will be found. Most persons who have participated in research studies at our center have found the experience interesting and informative. We would like to see more people become involved in research studies so that the rate of progress in finding answers can continue to quicken.
Local Information
Alzheimer's Association
Omaha and Eastern Nebraska Southwestern Iowa
7101 Newport Avenue #305 3319 Nebraska Avenue
Omaha NE 68152 Council Bluffs IA 51501
402-572-3010 712-322-8840
800-309-2112 800-309-2112
Fax 402-572-3038 Fax 712-328-6899
www.omaha-cb-alz.org
alz@aksarben.net
