Treating Alzheimer's Disease Health Article

More than 5 million Americans have Alzheimer's disease (AD). For these individuals there is no cure yet—or even a sure-fire means for halting or preventing the disease. The good news, though, is that some therapy can alleviate symptoms.

What is Alzheimer's disease?

The National Institute on Aging (NIA) describes AD as an irreversible, progressive brain disease that slowly destroys memory and thinking skills, eventually even the ability to carry out the simplest tasks. Although the risk of developing AD increases with age, the disease is not a part of normal aging. It is caused by a disease that affects the brain.

The plaque formation associated with AD disrupts the communication, metabolism, and repair of the neurons (nerve cells in the brain). This disruption causes certain neurons in the brain to stop working, lose connections with other neurons, and finally, die. The destruction and death of neurons causes the memory failure, personality changes, problems in carrying out daily activities, and other features of the disease.

The brains of AD patients have an abundance of two abnormal structures, beta amyloid plaques and neurofibrillary tangles, especially in the region of the brain responsible for memory. Many older people develop some plaques and tangles, but the brains of AD patients have them to a much greater extent.

The causes of the AD process is unknown. The NIA says the time from diagnosis to death varies—from as little as three years if the person is older than 80 when diagnosed, to as long as 10 or more years if the person is younger. In most people with AD, symptoms first appear after age 60. Although the course of AD is not the same in every person with the disease, symptoms seem to develop over the same general stages.

What are the symptoms?

The brain changes that lead to AD probably start 10 to 20 years before any visible signs and symptoms appear. The diagnosis of AD is usually made when mild cognitive impairment becomes evident (called mild AD). Memory loss is usually the first sign. As the disease progresses, memory loss continues and changes in other cognitive abilities appear. According to the NIA, signs of mild AD can include:

• Memory loss

• Confusion about the location of familiar places (getting lost begins to occur)

• Taking longer to accomplish normal daily tasks

• Trouble handling money and paying bills

• Poor judgment leading to bad decisions

• Loss of spontaneity and sense of initiative

• Mood and personality changes, increased anxiety

In moderate AD, the damage has spread to the areas of the brain that control language, reasoning, sensory processing, and conscious thought. The NIA lists these as symptoms of this stage:

• Increasing memory loss and confusion

• Shortened attention span

• Problems recognizing friends and family members

• Difficulty with language; problems with reading, writing, working with numbers

• Difficulty organizing thoughts and thinking logically

• Inability to learn new things or to cope with new or unexpected situations

• Restlessness, agitation, anxiety, tearfulness, wandering, especially in the late afternoon or at night

• Repetitive statements or movement, occasional muscle twitches

• Hallucinations, delusions, suspiciousness or paranoia, irritability

• Loss of impulse control shown through sloppy table manners, undressing at inappropriate times or places, or vulgar language

• Perceptual-motor problems such as trouble getting out of a chair or setting the table

In the last stage, people with severe AD cannot recognize family and loved ones or communicate in any way. They may be in bed nearly all the time. Most people with AD die from other illnesses. A frequent cause is aspiration pneumonia, a type of pneumonia that happens when a person is not able to swallow properly and breathes food or liquids into the lungs.

Diagnosing Alzheimer's

The earlier that AD is diagnosed, the earlier that treatment can be started for relieving symptoms. An early diagnosis also allows the person with AD and family members time to plan, discuss options, and make decisions together.

The only method for positively determining AD is to examine the brain after death for amyloid plaques (abnormal clumps), tangled bundles of fibers, and other signs of the disease. These signs include a loss of nerve cells in parts of the brain used for memory and other mental abilities. AD patients also have lower levels of chemicals that carry messages between nerve cells.

Without a diagnostic tool available before death, any AD diagnosis today is called "possible or probable Alzheimer's." About 90 percent of cases that doctors have called "probable Alzheimer's" have turned out to be the disease.

To diagnose AD, a doctor may:

• Take a complete medical history—information about the person's general health, past medical problems, and any difficulties the person has carrying out daily activities.

• Order medical tests—such as tests of blood, urine, or spinal fluid—to help find other possible diseases causing the symptoms.

• Order neuropsychological tests—to measure memory, problem solving, attention, counting, and language.

• Order brain scans—to   look at a picture of the brain to see if anything does not look normal.

It's important to note that dementia can have other causes besides SD, and that symptoms of AD may be caused by other illnesses such as thyroid problems, drug reactions, depression, brain tumors, and blood vessel disease in the brain.

As things stand today, researchers are waging a battle against Alzheimer's on two main fronts:

• Biomedical treatment aimed at specific substances in the brain of patients to cure, stop, or vaccinate against the progression of the disease

• Treatment of symptoms through drugs or behavioral approaches

Biomedical treatment

The word that comes up often when talking of Alzheimer's disease is "plaque."

In the brain, it is a hard protein deposit that apparently slows or halts the thinking process by not allowing electrical transmissions between neurons. The material of plaque may also be neurotoxic.

The plaque gets in between the neurons and acts like a plastic that doesn't allow electrical signals through. The result is often confusion and memory loss.

Researchers have pinpointed an enzyme in the body called amyloid as the culprit in the making of plaques. The difficult part is to find out how to prevent amyloid plaque formation or how to dissolve the plaques before they can cause neurological damage. But there have been some breakthroughs.

One of the crippling characteristics of AD is the abnormal cell death of vulnerable neurons in regions of the brain that are essential to learning, memory, attention, and judgment. Some cell death is normal and keeps tissues healthy, but a high loss of these cells causes an irreversible loss of brain function.

In the last several years, researchers have discovered "cell terminator" enzymes, suggesting that therapies targeted against these enzymes may be helpful in the treatment of AD.

Medications to treat symptoms

For those already feeling the effects of AD, the primary need is for treatments to control their symptoms, including cognitive loss and problem behaviors such as verbal and physical aggression, agitation, wandering, depression, sleep disturbances, and delusions.

While scientists work to develop drugs that attack the fundamental Alzheimer's processes, treatments are needed to help people with AD.  

The FDA has approved five medications for AD. They are tacrine, donepezil hydrochloride, rivastigmine, galantamine, and memantine. They can help prevent some symptoms from becoming worse in some patients.

Other medications that may offer help for AD include:

• Vitamin E. This vitamin slows the progress of some AD damage by about seven months. Researchers are now studying whether vitamin E can prevent or delay AD in people with a condition called mild cognitive impairment.

• Ginkgo biloba. This extract from the leaves of the ginkgo tree may ease some symptoms of AD. Although there's no evidence that this herbal supplement can prevent Alzheimer's, researchers now want to find out if it can prevent or delay other forms of dementia. Earlier research did not demonstrate any improvement in memory of those taking ginkgo.

• Estrogen. Researchers are studying whether estrogen can help prevent AD. One study found that estrogen had no effect on slowing progression of AD that had been diagnosed, but the hormone may play another role in cognitive abilities.

Behavioral approaches

The Alzheimer's Association recommends non-drug treatment of behavioral symptoms as a first option. This is because these symptoms are best altered without medication. Some medications can induce further dementia symptoms.

Here are some of the group's recommendations:

• Get family education and counseling. You will cope better if you can learn what to expect from AD. Visit the Alzheimer's Association at http://www.alz.org to find your local chapter. The association offers educational materials, counseling, and support. Two other sources of information are the Alzheimer's Disease Education and Referral Center, http://www.alzheimers.org, a service of the National Institute on Aging; and the Alzheimer's Resource Room, http://www.aoa.gov/alz/, a service of the federal Administration on Aging.

• Modify the environment. Consider making plans to modify your home environment. Environmental factors such as lighting, color, and noise can greatly affect behavior. Dim lighting, for example, makes some individuals uneasy, while loud or erratic noise often causes confusion and frustration.

• Plan activities. Stay active for as long as you can and establish a routine. Daily routines such as bathing, dressing, cooking, cleaning, and laundry can be turned into productive activities. Other more creative leisure activities can include singing, playing a musical instrument, painting, walking, playing with a pet, or reading. Planned activities may relieve depression, agitation, and wandering, and help you enjoy the best quality of life. Care centers employ a number of similar activities to aid behavioral symptoms of Alzheimer's including singing and grooming routines.