Are there treatments available for Alzheimer’s disease? [ 04/29/13 ]
Yes, while there is no cure for Alzheimer's disease as yet, there are medications that can help control its symptoms and to help manage conditions such as agitation, depression, or psychosis (hallucinations or delusions), which may occur as the disease progresses:
Cholinesterase inhibitors: People with Alzheimer's disease have low levels of a key nerve messenger, called acetylcholine, believed to be important for memory and thinking. Four drugs called cholinesterase inhibitors make more of that messenger available by slowing its breakdown, enabling greater cell-to-cell communication and slowing the progress of cognitive impairment in some patients with early- to middle-stage Alzheimer's disease. The four cholinesterase inhibitors are:
- Razadyne® (galantamine)
- Exelon® (rivastigmine)
- Aricept® (donepezil)
- Cognex® (tacrine)
All four have been approved by the Food and Drug Administration (FDA) for early- to middle-state Alzheimer's disease; Aricept® is also approved for severe-stage symptoms. Cognex® was the first approved cholinesterase inhibitor but is rarely prescribed today due to safety concerns.
Namenda® (memantine) The first FDA-approved drug for moderate to severe Alzheimer's disease, Namenda is thought to protect brain cells by regulating a nerve communication chemical, called glutamate, that is released in great quantities by Alzheimer's-damaged cells. Glutamate is normally involved with learning and memory, but when released in excess by damaged cells, it attaches to “docking sites” called NMDA receptors that in turn accelerate cell damage.
Treatment for mental illnesses People with the later stages of Alzheimer's disease often experience depression, agitation, paranoia, delusions, and/or hallucinations, which can in turn cause screaming, repetitive questions, hoarding, pacing, hyperactivity, and aggressive behavior.
These symptoms can arise from non-medical triggers as well as medical causes. The former could take the form of a change in the person's environment (a new place to live, a new caretaker, a change in routine) or from frustration at the inability to communicate. If the trigger can be identified, the environment can be modified to change the behavior.
If non-medical intervention doesn't work, or the patient becomes a danger to himself or others, a physician should be asked to evaluate the need for medical treatment.
Sources for financial assistance for Alzheimer's disease prescription drugs can be found at www.brightfocus.org/alzheimers/resources/alzheimers-disease.html. Always consult a physician before taking any medications.
Is Alzheimer's disease infectious? [ 04/29/13 ]
The national media made a tragic mistake in labeling Alzheimer's disease as “infectious.” The issue emerged from a highly regarded series of technical reports that described how a protein related to Alzheimer's disease might move from one cell to a neighboring cell. The word “infect” was used to describe an event that may be happening in a single person's brain. The scientific papers do not suggest that the disease might be able to move from one person to another through normal interactions.
Catherine Clelland, Ph.D. of Columbia University, worked on one of the studies quoted in the media and has received prior funding from BrightFocus. She explained:
Our study highlighted that different regions of the brain become altered by Alzheimer's disease over time, through spreading of abnormal tau protein from cells in regions where abnormal tau is initially present, to other, directly connected cells within the brain. It is important to note that there is no evidence from this work, or those of others in the field, that Alzheimer's disease is infectious, or that people who come into contact with Alzheimer's patients are at risk.
It is true that, in animal studies, it has been shown that removing portions of an Alzheimer's brain, and surgically implanting it inside a healthy brain, can sicken the previously healthy cells. That is obviously a highly unlikely occurrence in humans. As suggested by Dr. Clelland and others, there is no evidence suggesting that animals or humans living and interacting with one another normally can contract the disease from each other.
Unfortunately, the media picked up the word “infection” and used it erroneously in their reporting. That term functions as a way of scientifically describing how a protein might move between cells within one person's body. But the usage of that word has had tremendously negative consequences. It has unnecessarily frightened and isolated many people living with the disease…a disease that is not infectious and not contagious.
In contrast, the engagement, exercise, and mental stimulation that might be found in social environments are believed by some scientists to play a positive role in helping lessen the burden of Alzheimer's disease. Patients and families suffering with Alzheimer's disease have been hidden from society for far too long. Quite the contrary, we need people talking about Alzheimer's and interacting with others to help end this terrible disease.
Definitions: “Infectious” is something that can cause disease; “contagious” is passable between people.
Is Alzheimer's disease hereditary? [ 04/29/13 ]
Familial Alzheimer's disease (FAD) or early-onset Alzheimer's is an inherited, rare form of the disease, affecting less than 10 percent of Alzheimer's disease patients. FAD develops before age 65, in people as young as 35. It is caused by one of three gene mutations on chromosomes 1, 14 and 21. If even one of these mutated genes is inherited from a parent, the person will almost always develop FAD. All offspring in the same generation have a 50/50 chance of developing FAD if one parent has it.
The majority of Alzheimer's disease cases are late-onset, usually developing after age 65. Late-onset Alzheimer's disease has no known cause and shows no obvious inheritance pattern. However, in some families, clusters of cases are seen. Although a specific gene has not been identified as the cause of late-onset Alzheimer's disease, genetic factors do appear to play a role in the development of this form of the disease. A gene called Apolipoprotein E (ApoE) appears to be a risk factor for the late-onset form of AD. There are three forms of this gene: ApoE2, ApoE3 and ApoE4. Roughly one in four Americans has ApoE4 and one in twenty has ApoE2. While inheritance of ApoE4 increases the risk of developing AD, ApoE2 substantially protects against the disease.
Scientists believe that several other genes may influence the development of Alzheimer's disease. Two of these genes, UBQLN1 and SORL1, are located on chromosomes 9 and 11. Researchers have also identified three genes on chromosome 10, one of which produces an insulin degrading enzyme that may contribute to the disease. A gene, called TOMM40, appears to significantly increase one's susceptibility to developing Alzheimer's when other risk factors are present, such as having the ApoE-4 gene. Several recently discovered genes that influence Alzheimer's disease risk are CLU (also called APOJ) on chromosome 8, which produces a protein called clusterin, PICALM on chromosome 11 and CR1 on chromosome 1.
Genetic risk factors alone are not enough to cause the late-onset form of Alzheimer's disease, so researchers are actively exploring education, diet and environment to learn what role they might play in the development of this disease.
What are the stages of Alzheimer's disease? [ 04/29/13 ]
The following stages represent the general course the disease follows, but moving from one stage to another may not be perceptable due to the fact that the symptoms are on a gradual continuum of severity.
Physical conditions connected to Alzheimer’s disease exist in a person’s body long before symptoms are evident. These conditions are normally defined through the use of “biomarker” tests, like those searching for beta-amyloid and tau proteins in blood and cerebrospinal fluid, and specialized PET and MRI scans. Currently, this stage is only defined in research settings and clinical trials and is unlikely to be given as an official clinical diagnosis by a health professional.
Mild Cognitive Impairment (MCI) Due To Alzheimer’s Disease/Prodromal Stage:
Recently, scientists have identified a condition between normal age-related memory loss and dementia called mild cognitive impairment (MCI). Individuals with MCI have persistent memory problems (for example, difficulty remembering names and following conversations and marked forgetfulness) but are able to perform routine activities without more than usual assistance. MCI often leads to Alzheimer’s, but while all those who progress to some form of dementia go through a period of MCI, not all patients exhibiting MCI will develop Alzheimer’s disease. An official clinical diagnosis of MCI can be given by a health professional.
Dementia Due To Alzheimer’s Disease (Mild, Moderate, Severe Stages):
Mild (Stage 1)
Early in the illness, people with Alzheimer’s tend to lose energy and spontaneity, though often no one notices anything unusual. They exhibit minor memory loss and mood swings and are slow to learn and react. After a while they start to shy away from anything new and prefer the familiar. In this stage, Alzheimer’s patients can still perform basic tasks independently but may need assistance with more complicated activities. Speech and understanding become slower, and patients often lose their train of thought in midsentence. They may also get lost while traveling or forget to pay bills. As they become aware of this loss of control, they may become depressed, fearful, irritable, and restless.
Moderate (Stage 2)
Eventually, people with the illness begin to be disabled by it. Though the distant past may be recalled, recent events become difficult to remember. Advancing Alzheimer’s affects the ability to comprehend location, the day, and the time. Caregivers must give clear instructions and repeat them often. As Alzheimer’s patients’ minds continue to slip away, they may invent words and not recognize formerly familiar faces.
Severe (Stage 3)
During the final stage, patients become more and more unresponsive. Memory becomes so poor that no one is recognizable. Patients lose bowel and bladder control and eventually need constant care. They lose the ability to chew and swallow and become bedridden and vulnerable to pneumonia, infection, and other illnesses. Respiratory problems worsen, particularly when the patient becomes bedridden. This terminal stage eventually leads to coma and death.
Who should I go to if I suspect I may have Alzheimer's disease? [ 04/29/13 ]
First, visit your regular family physician. The physician will probably do a variety of tests to determine the probability of Alzheimer's. Specialists such as neurologists, gerontologists and geriatric psychiatrists may also be involved in the evaluation process.
What kind of information should I bring to my first visit to the doctor? [ 04/29/13 ]
If you visit a new doctor, bring your medical records; for any doctor, bring a list of over the counter and prescription medicines you are currently taking. If you don't know the names of the drugs, bring the pill bottles with you. A medication or a combination of medications can sometimes cause symptoms that resemble Alzheimer's disease. Also make a list of current medical problems. It's a good idea to show the doctor a list of symptoms, behaviors and any problems carrying out routine activities (for example, paying bills) in yourself or your loved one that concern you.
How is Alzheimer’s disease diagnosed? [ 04/29/13 ]
While an autopsy can confirm the presence of the disease, skilled physicians can correctly diagnose Alzheimer's disease about 90 percent of the time based on mental and behavioral symptoms, a physical examination, and neuropsychological and laboratory tests. Scientists have recently developed a number of new biomarker and brain scanning techniques that may help to improve diagnosis.
Mentally, having trouble following instructions, losing one's orientation, displaying poor judgment, and having difficulty managing money, shopping, or driving are all possible symptoms of Alzheimer's disease.
The physical exam will usually include a general physical, blood tests, and urinalysis. The doctor can use such test results to eliminate other forms of dementia—for instance, certain vitamins and hormones can provoke symptoms of dementia if they are present in too little a quantity. Brain scans can rule out non-Alzheimer's disease dementia and can reveal structural changes present in Alzheimer's disease.
The physician will determine whether neuropsychological testing is called for to examine memory, attention, math calculations, language and other intellectual functions.
The place to start is with one's own physician, who may then suggest specialists to do further testing.
How long does Alzheimer's disease last on average? [ 04/29/13 ]
On average, patients with Alzheimer's disease live for 8 to 10 years after diagnosis. However, this terminal disease can last for as long as 20 years.