Alzheimer's Disease

Dementia is a general term for a number of syndromes characterized by a decline in intellectual functioning that interferes with normal daily activities and social relationships. There are many causes - both reversible and irreversible - of dementia. Alzheimer's Disease (AD) is the most common cause of irreversible dementia in the older person, affecting an estimated 4,000,000 persons in the United States. AD was first described by a Bavarian psychiatrist and neuropathologist named Alois Alzheimer in 1907.

Alzheimer's Disease is defined by the National Institute on Aging as progressive, irreversible declines in memory, performance of routine tasks, time and space orientation, language and communication skills, abstract thinking, and the ability to learn and carry out mathematical calculations. Other symptoms include personality changes and impaired judgement.

The hallmark changes of AD are dense deposits (neuritic plaques) of a protein fragment called beta amyloid outside the nerve cells (neurons) in the brain, and twisted strands (neurofibrillary tangles) of a protein called tau inside the cells. There is a loss of these neurons' connections (synapses) with other neurons in areas of the brain that are vital to memory and other mental abilities. In addition to the loss of neurons, there are also lower levels of chemicals (neurotransmitters) in the brain that carry complex messages back and forth between millions of nerve cells.

The diagnosis of Alzheimer's disease is called a "diagnosis of exclusion". This means that when all other possible causes of the symptoms have been excluded, the diagnosis of AD can be made with a high level of probability. The definitive diagnosis of AD can only be obtained by performing an autopsy of the brain after death. However, a suggestive history and the successful exclusion of other possible causes usually allow a reasonable level of comfort with the diagnosis.

Goals of Treatment

There are several major goals of treatment in the care of the patient with Alzheimer's disease. These goals include:

• Establishing the diagnosis as soon as possible to allow time for education, counseling, and planning.
• Minimizing risks and complications and maximizing independence, function and quality of life as the disease progresses.
• Assessment and monitoring of treatments aimed at slowing progression of the disease, and managing depression, unsafe behaviors and troublesome symptoms such as hallucinations.
• Providing ongoing support for the caregivers as they manage the 24-hour a day pressures and demands of caring for a person with AD.
• Planning for and addressing issues surrounding end-of-life care.

A team approach utilizing the expertise of the primary health care provider, a nurse, and a social worker together with the patient, significant others, and caregivers is usually the most effective approach. Other disciplines may, at times, be very important members of this team, including physical or occupational therapy, speech therapy, psychiatry, case management, support groups, clergy and hospice.

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• What are the results of the latest clinical trials?
• Where are the support groups and additional resources in my area?
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