- Alzheimer's Disease (AD) is the most
common cause of dementia in older people. Dementia is a
medical condition that disrupts the way the brain works.
AD affects the part of the brain called the cerebral cortex
(language and reasoning) which controls thought, memory,
and language and is caused by a loss of nerve cells in areas
of the brain central to memory. Researchers have found that
individuals with Alzheimer's have disruptions in their nerve
cells - cells stop functioning and loose connections with
other nerve cells.
- Abnormal structures have neuritic plaques
(dense deposits of protein) and neurofibrillary tangles.
AD occurs gradually and results in memory loss, behavior
changes and a decline in reasoning abilities. Eventually
many areas of the brain are involved.
- It is estimated that four million Americans
currently suffer from AD or a related form of dementia.
Nearly 10 percent of all people over age 65 and up to half
of those over age 85 are thought to have AD or another form
- Approximately 19 million Americans have
a family member with Alzheimer's. Approximately 360,000
new cases occur each year. However, these numbers are increasing
as the population of elderly increases. It is estimated
that 14 million Americans will have AD by the middle of
- A person with AD lives an average of
eight years after initial diagnosis and may live as many
as 20 years after the onset of symptoms. The length of time
people live with AD has profound emotional and financial
impact on their families and caregivers.
- People with AD tend to live with their
families until the most advanced stages of the disease.
However, many families find that at some point in time,
they need to place elderly relatives with advanced Alzheimer's
in a nursing home. Today, it is estimated that half of all
nursing home patients suffer from AD. The average per patient
cost for nursing home care averages $42,000/year, but can
exceed $70,000 per year.
- The greatest risk factor for AD is age,
followed by family history of the disease. With few exceptions,
researchers believe AD is not caused by a single factor
or gene, but by a combination of factors acting together.
AD is a chronic disease. There is no cure for the it, but
there are effective treatments to manage the symptoms and
slow the progression. Many families often discount the symptoms
of dementia as a normal process of aging, but dementia is
not a natural part of aging. Most older Americans never
experience significant memory loss or any form of dementia.
- Alzheimer's Disease usually begins after
age 65, although AD has been diagnosed in individuals under
- Most people suffering from dementia have
AD. Vascular dementia (multi-infarct dementia) is caused
by a series of strokes, but is much less common. Dementia
can also be caused by an adverse reaction to a medication
or by alcohol use.
- Research is currently being conducted
on possible genetic origins of AD. Research indicates that
genetic factors may be involved in more than half of the
cases of AD. Other possible "causes" include environmental
factors and a virus. It is generally accepted that several
factors acting independently and individually in each person
may cause the onset of AD. There also appears to be a correlation
between levels of education and the incidence of AD.
- The first signs of Alzheimer's often
include loss of memory (especially recent events), language
difficulties, and difficulty performing routine activities
such as driving, and shopping. Mood changes also may be
indicative of AD. It is critical that people who demonstrate
these symptoms are seen by a physician to a) assess whether
the symptoms are caused by a physical ailment or b) the
early signs of dementia. Reversible physical conditions
that can cause dementia include: high fever, vitamin deficiency,
bad reactions to medicine, thyroid problems, minor head
- If the diagnosis is Alzheimer's or a
related dementia, treatment is available to control the
symptoms, delay the onset of the severity of the progression
of the disease, improve the quality of life and lengthen
the time the individual can stay in their family home.
- As the disease progresses, behavioral problems are common.
Alzheimer's patients can become easily agitated and have
difficulty with both long and short-term memory, have problems
with judgment and begin to have difficulty with such basic
daily activities as dressing, eating, grooming and using
the bathroom. Some of the most common problematic behaviors
include: agitation, aggression, combativeness, delusions,
hallucinations, insomnia, and wandering. Behavioral symptoms
may be the result of a treatable problem such as pain, infection,
discomfort, and can be treated through both non-pharmacological
and pharmacological treatments.
Costs of Disease
- Alzheimer Disease costs the U.S. at least
$100 billion per year. Medicare and private health insurance
cover a portion of the health care related expenses, but
not the costs associated with care giving or the type of
long term care needed by most patients at the most severe
part of the Disease. In addition, it is also estimated that
AD costs U.S. businesses at least $33 billion per year -
either through lost productivity by caregivers or related
health and long term care costs.
- The average lifetime costs per AD patient
- The Federal government spent approximately
$466 million for Alzheimer's research in 2000 - the Federal
research appropriation is scheduled to increase to $500
million in 2001.
Treatment and New Research
- The specialty of geriatric psychiatry is
especially trained to treat patients with AD as well as
counsel and advise the caregivers of patients with AD. Specialized
knowledge and clinical skills are required to address the
unique problems of older adults with mental disorders. The
geriatric psychiatrist can do the following: perform comprehensive
clinical assessments; provide comprehensive treatment and
management; and provide consultative services and education
regarding mental health problems for older adults. Geriatric
psychiatrists also can help family members cope with the
psychological toll of care giving.
- If a person demonstrates any probably symptoms
of dementia, a person should visit their physician and ensure
that the following tests are completed: a complete medical
history, a physical exam, a neurological exam including
tests of memory, problem solving, language, and counting,
a mental status exam and an assessment of the functional
capabilities. Physicians may also take brain scans. The
only absolute means of diagnosing AD is recognizing symptoms
- then confirming it after death through an autopsy. Taking
brain tissue from a living person can be painful and risky,
so physicians have developed other means to determine if
a patient has AD - with 85 to 90 percent accuracy. They
carefully review a patient's symptoms, record a thorough
medical history and conduct a complete medical examination.
- The primary goals of treatment for individuals
with AD is to improve the quality of life of the patient
and caregiver as well as maximize functional performance
by enhancing cognition, mood, and behavior. Treatments include
pharmacological and non-pharmacological approaches.
- Ensuring that someone with AD feels mentally
and physically secure is an important and meaningful part
of care giving. People with AD need help minimizing confusion
and maintain a sense of stability and comfort in their lives.
Establishing a daily routine in familiar surroundings is
one way to help. It is also important to provide nutrious
meals on a regular schedule for optimal health. Keeping
patients in touch with family and friends and reminding
them of past memories, current events, and important dates
are good mental exercises.
- Several drugs have been developed to alleviate
some of the cognitive as well as the behavioral symptoms
of AD. Pharmacological treatments for the cognitive symptoms
includes: drugs such as tacrine (cognex), donepezil (Aricept)
and rivastigmine (Exelon). These agents may also have beneficial
effects on behavioral symptoms in some patients and prolonged
therapy may delay nursing home placement. Clinical trials
of other agents to improve cognitive function are ongoing.
- Treatment of behavioral and mood changes
is also critical as these symptoms can be dangerous to both
the patient and the caregiver. Co-morbid conditions associated
with AD are common and treatable. They include AD with delirium,
AD with depression, and AD with delusions. In addition,
many patients developed agitated or aggressive behaviors.
All of these conditions can lead to functional disability.
- Agitation is a general term that refers
to a range of behavioral disturbances, including aggression,
combativeness, shouting, hyperactivity and disinhibition.
As many as 50 percent of all dementia patients exhibit agitation,
particularly in the middle and later stages of the Disease.
Antipsychotic drugs can produce a modest improvement in
some behavioral symptoms in dementia such as risperidone,
olanzapine, quetiapine, oxazepam, lorazepam, flupheazine,
haloperiodl, thloridzaine, and clozapinel.
- People with AD should visit their physician
on a regular basis. The physician can chart the progression
of the Disease and make alternations in treatment as needed.
The physician can also offer support as well as specific
therapies to the patients and their families.
The Role of the Care Giver