Sunday, January 27, 2002
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Sunday, January 27, 2002 |
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Much to learn about Alzheimer's By MARY JANE HOLT I attended the funeral recently of a dear old man who died after suffering for more than a decade from Alzheimer's disease. I stood at the casket with a lady who told me her own father had just succumbed to the disease. I came home troubled. It is not possible to be exposed to this disease in any way and not be troubled. So I checked out the latest information from the National Institute of Health and today I share a summary with you. Alzheimer's disease is named after Dr. Alois Alzheimer, a German doctor. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. He found abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary tangles). Today, these plaques and tangles in the brain are considered hallmarks of AD. Scientists also have found other brain changes in people with AD. There is a loss of nerve cells in areas of the brain that are vital to memory and other mental abilities. There also are lower levels of chemicals in the brain that carry complex messages back and forth between nerve cells. AD may disrupt normal thinking and memory by blocking these messages between nerve cells. Every day scientists learn more, but right now the causes of AD are still unknown, and there is no cure. There probably is not one single cause, but several factors that affect each person differently. For instance, the number of people with the disease doubles every five years beyond age 65. Also, scientists believe familial AD, a rare form of AD that usually occurs between the ages of 30 and 60, can be inherited. Scientists are studying genetics and looking at education, diet, environment and viruses to learn what role they might play. AD begins slowly. At first, the only symptom may be mild forgetfulness. There may be trouble remembering recent events, activities, or the names of familiar people or things. Simple math problems may become hard to solve. People in the later stages of AD may forget how to do simple tasks, like brushing their teeth or combing their hair. They can no longer think clearly. They begin to have problems speaking, understanding, reading or writing. Later on, people with AD may become anxious or aggressive, or wander away from home. Eventually, patients need total care. An early, accurate diagnosis of AD helps patients and their families plan for the future. It gives them time to discuss care options while the patient can still take part in making decisions. Early diagnosis also offers the best chance to treat the symptoms of the disease. Today, the only definite way to diagnose AD is to find out whether there are plaques and tangles in brain tissue. To look at brain tissue, doctors must wait until they do an autopsy, which is an examination of the body done after a person dies. Therefore, doctors must make a diagnosis of "possible" or "probable" AD. At specialized centers, doctors can diagnose AD correctly up to 90 percent of the time, using several tools, including: A complete medical history includes information about the person's general health, past medical problems and any difficulties the person has carrying out daily activities. Medical tests, such as tests of blood, urine or spinal fluid, help the doctor find other possible diseases causing the symptoms. Neuropsychological tests measure memory, problem solving, attention, counting, and language. Brain scans allow the doctor to look at a picture of the brain to see if anything does not look normal. Information from the medical history and test results help the doctor rule out other possible causes of the person's symptoms. For example, thyroid problems, drug reactions, depression, brain tumors, and blood vessel disease in the brain can cause AD-like symptoms. Some of these other conditions can be treated successfully. For some people in the early and middle stages of AD, the drugs tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), or galantamine (Reminyl) may help prevent some symptoms from becoming worse for a limited time. Also, some medicines may help control behavioral symptoms of AD such as sleeplessness, agitation, wandering, anxiety, and depression. Developing new treatments for AD is an active area of research. Scientists are testing a number of drugs to see if they prevent AD, slow the disease, or help reduce behavioral symptoms. There is evidence that inflammation in the brain may contribute to AD damage. Scientists believe that anti-inflammatory drugs such as NSAIDs might help slow the progression of AD. Rofecoxib (Vioxx) and naproxen (Aleve) are two NSAIDs currently being studied. Research has shown that vitamin E slows the progress of some consequences of AD by about seven months. Recent research also suggests that ginkgo biloba, an extract made from the leaves of the ginkgo tree, may be of some help in treating AD symptoms. There is no evidence that ginkgo will cure or prevent AD. Scientists now are trying to find out whether ginkgo biloba can delay or prevent dementia in older people. Scientists now are trying to find out whether estrogen can prevent AD in women with a family history of the disease. To find out more about ongoing studies or clinical trials, contact the NIA's Alzheimer's Disease Education and Referral Center at 1-800-438-4380.
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