What You Need To Know Now

By Dr. Isadore Rosenfeld

Young women are apt to worry about developing cancer of the breast (although more of them die from lung cancer), and heart attacks and stroke are the greatest concern of adult males. But Alzheimer’s disease (AD) is everyone’s greatest fear as we grow older. Alzheimer’s currently affects 4.5 million Americans; one in 10 of us has at least one family member suffering from it. That’s considerably more than in 1980—and the numbers are growing. Within the next 50 years, as many as 16 million men and women in the U.S. are expected to develop it. Alzheimer’s is named after the German doctor Alois Alzheimer, who in 1906 described a form of “cognitive impairment” that he considered to be a disorder of mid-life. He believed, as some still do, that the memory and behavioral changes—what we now call Alzheimer’s—in older people are part and parcel of the aging process.We now know that Alzheimer’s is a disease, regardless of the age at which it appears. Although it most often accompanies the aging process, growing older does not cause this disease. In fact, the vast majority of seniors do not have it. Those with “senile dementia” do not necessarily have AD. Their abnormal behavior may be due to any one of several neurological disorders to which older people are vulnerable.The brain of someone who died with AD contains two abnormal structures characteristic of the disease: plaques and tangles. Plaques are clumps of beta amyloid protein that accumulate around the brain’s nerve cells and eventually cause them to die. Tangles are twisted strands of another protein (called “tau”) that form within the cells. Many scientists believe that one or both of these proteins, more likely the beta amyloid, cause AD; they are now seeking ways to prevent them from occurring in the brain. An experimental “vaccine” has been developed that seems to be able to do so in animals. If it is found to work safely in humans, it could, conceivably, help control this terrible disease. The most recent speculation about the cause of Alzheimer’s implicates insulin. Researchers at Rhode Island Hospital and Brown University Medical School have found that insulin concentrations in the brain drop dramatically in early Alzheimer’s and continue to fall as the disease progresses. They opine that this may contribute to the cell death and tangles characteristic of AD. Another hallmark of Alzheimer’s—low levels of a substance called acetylcholine—also is directly linked to loss of insulin, all of which suggests that Alzheimer’s may be a form of diabetes. This opens up promising new possibilities in solving the enigma of Alzheimer’s disease.Is Alzheimer’s hereditary? There are two types of AD: familial and sporadic. The former affects less than 10% of patients, usually has its onset before age 65 and is accompanied by gene mutations on three chromosomes. In the more common sporadic (late-onset) form of AD, one gene may be involved. While there is no obvious inheritance pattern, if a parent or sibling has AD, you are at greater risk yourself. A downward spiral. Alzheimer’s typically begins with memory loss, especially of recent events. Patients can usually remember an event that occurred 50 years ago but may not recall what they ate for breakfast that morning. The disease progresses at an unpredictable rate. In addition to memory loss, there is often intellectual impairment, confusion and, in the late stages, inability to look after oneself. All this is frequently accompanied by personality changes and even violent behavior. Once the diagnosis of Alzheimer’s is made, average survival is about eight years but can be as long as 20.Late-stage AD is often devastating to family members. Many feel frustrated, worried and guilty—especially when a loved one must leave home to receive the kind of care that can best be given in a nursing home or other facility. The diagnosis: Rule out other possibilities. There is no single test that specifically confirms the presence of Alzheimer’s. But a proper history and available diagnostic procedures can identify it in 90% of cases. Do not accept this diagnosis, however, before making sure that the following conditions have been considered:
• Nutritional deficiencies (especially of the B vitamins). Patients diagnosed with Alzheimer’s are often miraculously “cured” when they eat a balanced diet.
• Medication. Tranquilizers, anti-anxiety drugs and other mood-altering agents can affect behavior.
• Multiple small strokes (usually due to poorly controlled high blood pressure). If unrecognized and untreated, they can damage the brain and cause behavioral changes.
• Depression for any reason—loneliness, bereavement, social adversities. It can lead to withdrawal and be mistaken for AD.
• Low thyroid function. This may cause the impaired cognition and lack of interest attributed to Alzheimer’s in older people. The behavior disappears when the missing thyroid hormone is replaced.
• Other diseases of the brain that can be accompanied by symptoms of AD. These include brain tumors, multiple sclerosis, Lou Gehrig’s disease and Parkinson’s.
• A blow to the head. It can cause blood to accumulate under the skull, press on the brain and result in behavioral changes.
• Lyme disease. An infection that strikes many different organs, it also can affect the brain.
So, before concluding that anyone has Alzheimer’s, make sure that all of these conditions have been ruled out. Until there’s a cure... There currently is no cure for Alzheimer’s, but there are several drugs that may improve or stabilize mild symptoms. Those approved by the FDA include Cognex, Aricept, Exelon, Razadyne and, in advanced cases, Namenda. Frankly, these are only stopgap measures until a cure is found. However, given the intensive current research in this area, I believe there is reason for optimism.

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