What Is Alzheimer's
Disease?
"Alzheimer's disease" is the term
used to describe a dementing disorder marked
by certain brain changes, regardless of the
age of onset. Alzheimer's disease is not a normal
part of aging--it is not something that inevitably
happens in later life. Rather, it is one of
the dementing disorders, a group of brain diseases
that lead to the loss of mental and physical
functions. The disorder, whose cause is unknown,
affects a small but significant percentage of
older Americans. A very small minority of Alzheimer's
patients are under 50 years of age. Most are
over 65.
Alzheimer's disease is the exception, rather
than the rule, in old age. Only 5 to 6 percent
of older people are afflicted by Alzheimer's
disease or a related dementia--but this means
approximately 3 to 4 million Americans have
one of these debilitating disorders. Research
indicates that 1 percent of the population aged
65-74 has severe dementia, increasing to 7 percent
of those aged 75-84 and to 25 percent of those
85 or older. At least half the people in U.S.
nursing homes have Alzheimer's disease or a
related disorder; in 1985, the annual cost of
caring for individuals with Alzheimer's disease
and related dementias in institutional and community
settings was estimated between $24 billion and
$48 billion for direct costs alone and is probably
higher today. As our population ages and the
number of Alzheimer's patients increases, costs
of care will rise as well.
Although Alzheimer's disease is not curable
or reversible, there are ways to alleviate symptoms
and suffering and to assist families. Not every
person with this illness must necessarily move
to a nursing home. Many thousands of patients--especially
those in the early stages of the disease--are
cared for by their families in the community.
Indeed, one of the most important aspects of
medical management is family education and family
support services. When, or whether, to transfer
a patient to a nursing home is a decision to
be carefully considered by the family.
Who Gets Alzheimer's Disease?
The main risk factor for Alzheimer's disease
is increased age. The rates of the disease increase
markedly with advancing age, with 25 percent
of people over 85 suffering from Alzheimer's
or other severe dementia.
Some investigators, describing a family pattern
of Alzheimer's disease, suggest that in some
cases heredity may influence its development.
A genetic basis has been identified through
the discovery of several genetic markers on
chromosomes 21 and 14 for a small subgroup of
families in which the disease has frequently
occurred at relatively early ages (beginning
before age 50). Some evidence points to chromosome
19 as implicated in certain other families that
have frequently had the disease develop at later
ages.
At the same time, data indicate that the likelihood
that a close relative (sibling, child, or parent)
of an afflicted individual will develop Alzheimer's
disease is low. In most cases, such an individual's
risk is only slightly higher than that of someone
in the general population, where the lifetime
risk is below 1 percent. And, of course, many
disorders have a genetic potential that is never
expressed--that is, despite being at risk for
a certain illness, one might go through life
without ever developing any symptom of the disease.
What To Expect When Someone
Has Alzheimer's Disease
-- Mary Ellen's friends thought she was the
perfect mother, wife, friend, and hostess. Her
husband George, a prolific author, counted on
her to edit his works and manage his schedule.
He was the first to notice that she was no longer
able to remember her good friends' names, her
children's birthdays, or the details of her
busy life. During social occasions, she could
be seen sitting on the sidelines, answering
politely but vaguely if spoken to, but never
engaged in meaningful conversation. She was
no longer able to go shopping or pay the household
bills as she had done for the past 30 years.
George was bewildered and could not understand
what had happened to his close companion of
so many years.
The onset of Alzheimer's disease is usually
very slow and gradual, seldom occurring before
age 65. Over time, however, it follows a progressively
more serious course. Among the symptoms that
typically develop, none is unique to Alzheimer's
disease at its various stages. It is therefore
essential for suspicious changes to be thoroughly
evaluated before they become inappropriately
or negligently labeled Alzheimer's disease.
Problems of memory, particularly recent or
short-term memory, are common early in the course
of the disease. For example, the individual
may, on repeated occasions, forget to turn off
the iron or may not recall which of the morning's
medicines were taken. Mild personality changes,
such as less spontaneity or a sense of apathy
and a tendency to withdraw from social interactions,
may occur early in the illness. As the disease
progresses, problems in abstract thinking or
in intellectual functioning develop. The individual
may begin to have trouble with figures when
working on bills, with understanding what is
being read, or with organizing the day's work.
Further disturbances in behavior and appearance
may also be seen at this point, such as agitation,
irritability, quarrelsomeness, and diminishing
ability to dress appropriately.
Later in the course of the disorder, the affected
individuals may become confused or disoriented
about what month or year it is and be unable
to describe accurately where they live or to
name correctly a place being visited. Eventually
they may wander, be unable to engage in conversation,
seem inattentive and erratic in mood, appear
uncooperative, lose bladder and bowel control,
and, in extreme cases, become totally incapable
of caring for themselves if the final stage
is reached. Death then follows, perhaps from
pneumonia or some other problem that occurs
in severely deteriorated states of health. The
average course of the disease from the time
it is recognized to death is about 6 to 8 years,
but it may range from under 2 to over 20 years.
Those who develop the disorder later in life
may die from other illnesses (such as heart
disease) before Alzheimer's disease reaches
its final and most serious stage.
Though the changes just described represent
the general range of symptoms for Alzheimer's
disease, the specific problems, along with the
rate and severity of decline, can vary considerably
with different individuals. Indeed, most persons
with Alzheimer's disease can function at a reasonable
level and remain at home far into the course
of the disorder. Moreover, throughout much of
the course of the illness individuals maintain
the capacity for giving and receiving love,
for sharing warm interpersonal relationships,
and for participating in a variety of meaningful
activities with family and friends.
A person with Alzheimer's disease may no longer
be able to do math, but still be able to read
a magazine with pleasure for months or years
to come. Playing the piano might become too
stressful in the face of increasing mistakes,
but singing along with others may still be satisfying.
The chess board may have to be put away, but
one may still be able to play tennis. Thus,
despite the many exasperating moments in the
lives of Alzheimer patients and their families,
many opportunities remain for positive interactions.
Challenge, frustration, closeness, anger, warmth,
sadness, and satisfaction may all be experienced
by those who work to help the person with Alzheimer's
disease cope as well as possible with the disease.
The reaction of an individual to the illness--his
or her capacity to cope with it--also varies
and may depend on such factors as lifelong personality
patterns and the nature and severity of stress
in the immediate environment. Depression, severe
uneasiness, and paranoia or delusions may accompany
or result from the disease, but they can often
be alleviated by appropriate treatments. Although
there is no cure for Alzheimer's disease, treatments
are available to alleviate many of the symptoms
that cause suffering.
