Searching for Clues to Alzheimer's Disease
Hecht, Annabel, FDA Consumer
The occasion was a public hearing before the Maryland Governor's Task Force on Alzheimer's Disease and Related Disorders. A middle-aged woman rose to ask a question. When she prefaced her remarks with "As a future Alzheimer's patient ..." heads turned. Asked how she could predict such a diagnosis, she replied that she was already having some loss of memory. While watching television, she couldn't remember what had come before the commercial breaks.
The woman's concept of Alzheimer's disease is not surprising. Although this degenerative disease of the brain was first described nearly 80 years ago, it is still not fully understood, even by scientists, and there are many popularly held misconceptions about it, one of which is the belief that any memory loss is a sure sign that Alzheimer's will follow. It's gotten to the point where middle-aged people and even youngsters joke about their "Alzheimer's acting up" when they forget a name or that fact that's just on the tip of the tongue.
Forgetfulness is not reserved for the elderly. In fact, it can occur at any age. However, when memory loss becomes severe and other cognitive functions--reasoning, concentration and judgment--fail, it is a sign that the patient is suffering from some form of dementia, a classification that includes Alzheimer's disease.
Alzheimer's disease was named for Alois Alzheimer, a German physician credited with the first description of the disorder. In 1906, he told a medical group of a 51-year-old patient whose problems began with memory loss and disorientation, progressed to depression and hallucinations, and eventually resulted in severe dementia and death.
When he examined the dead patient's brain, Alzheimer found severe trophy (shrinkage) and an unusual clumping and distortion of fibers in the nerve cells of the cerebral cortex, or outer layer of the brain.
Becuase of the progression of symptoms occurred in a middle-aged patient, it was long thought that Alzheimer's was a disease that developed before age 65. Thus it was known as presenile dementia. Dementia that developed after 65, called senile dementia, was attributed to "hardening of the arteries" and was believed to be a normal of growing old.
As brain research continued, it was learned that the lesions Alzheimer found in his patient were also found in older patients with senile dementia. Blood vessel changes commonly related to age were found in only a small percentage of cases. The term "senile dementia of the Alzheimer's type" then came into use to refer to the late-onset form of the disease. Today, it is generally agreed that Alzheimer's is Alzheimer's, no matter at what age the illness starts.
The onset of Alzheimer's disease is graudal, usually starting with memory loss, particularly for recent events. What is striking is that the loss is complete, even including the circumstances surrounding the forgotten event. Eventually, the memory loss is so profound that the Alzheimer's victim can't remember the previous sentence in a conversation, can't identify once-familiar persons or objects and, in the end, can't remember the names of family members.
Other early behavioral changes include an inability to concentrate, anxiety, irritability, agitation, withdrawal and petulance. Later, the patient may have trouble with figures and understanding what is being read, and may become disoriented as to time and place.
Some Alzheimer's patients wander about and lose their way; others have temper tantrums and obsessional behavior, like washing and rewashing dishes. Depression and delusions are not uncommon. Often the victims accuse their spouses of being imposters or carry on conversations with imaginary people. Some forget how to dress themselves or become less neat in appearance.
Apathy, disorientation, and loss of bladder and bowel control mark the late stages of the disease. In extreme cases, Alzheimer's victims are totally incapable of caring for themselves. …