AlzheimerÂ’s affects approximately four million Americans, and is expected to triple by the year 2050 as our population continues to age, and develop more of the diseases associated with age.

There are several types of dementia of which AlzheimerÂ’s is the most common. Dementia occurs when healthy brain tissues degenerates and functional loss leaves brain circuitry with road blocks and dead ends. Memory and mental capacity are lost and the signs of AlzheimerÂ’s become more apparent. AlzheimerÂ’s begins with mild memory loss and confusion yet progresses to irreversible mental impairment, and eventually leads to the inability to remember even family, and destroys the individuals capacity to reason, learn, and imagine. Most individuals with AlzheimerÂ’s develop some degree of the following signs:

• Forgetfulness is something most have witnessed first hand. There is an elder relative or friend who asks the same question three and four times in series before the cycle is interrupted. This forgetfulness also impairs the persons ability to recall placement of objects or to place objects in odd places. Abstract thinking is affected. This is usually manifested by an inability to manage math skills or recall numbers.
• Disorientation occurs when an individual is unable to keep appointments, or keep track of dates, place or time. There is also the propensity to easily lose oneÂ’s bearings or feel lost even in familiar surroundings.
• Difficulty performing tasks is another commonly exhibited sign. The individual may lose the capacity to perform tasks requiring sequential steps such as cooking or balancing checkbooks.
• Personality changes are unfortunately those changes hardest to bear. The individuals may exhibit aggression, paranoia, and many other inappropriate behavioral changes.

Diagnosis may be delayed because many of the above symptoms occur gradually. Many individuals recognize early on difficulty with tasks and develop compensatory behavior to mask some of these signs. A personal experience with a patient in my practice is an elderly gentleman who eats breakfast everyday at the same restaurant and probably even has the same items on the menu. This individual has learned to compensate for some of the early orientation difficulties. The course of this disease varies from person to person, but the average survival from diagnosis is eight years. I mention this time frame with some trepidation since point of diagnosis seems to vary greatly, which would alter the survival time as well.

The causes of AlzheimerÂ’s unfortunately are poorly understood, despite the fact that damage to brain cells is well documented. Dr. Alzheimer in 1906, found that abnormal clumps and knots are present on examination. These are now called plaques and tangles respectively. Their roles are not clearly understood yet it is believed there is a relationship with production of abnormal amount of proteins that may be genetically linked in some cases. Inflammation at these sites may also be linked to disease progression.

Most risk factors as one may postulate are primarily fixed and this time non modifiable. There are a few environmental risks yet the verdict on some of these remain unclear. The role of estrogen therapy has made a pendulum swing. In the 1980Â’s and 1990Â’s estrogen was thought t be protective, newer studies may actually indicate the contrary, but the final verdict is yet to be announced. The other non modifiable risk factors include age, less than 5% between age 65 and 74, and nearly 50% of individuals after the age of 85 suffer from AlzheimerÂ’s. Women are more likely to develop the disease for unclear reasons. Level of education may have some bearing on the risk for disease. Some research theorizes that the more one uses the brain the greater number of synapses are created which may provide some reserves with age. The risk factor most seen, at least in San Antonio, is the presence of one or more risk factors for heart disease. Those same variables, such as high cholesterol, diabetes, high blood pressure.

Diagnosis is based on excluding other causes of memory loss:

• Medical history including family history are important in identifying risk for disease and other causes of memory loss.
• Routine lab test typically include thyroid panels, vitamin levels and syphilis screening. Mental status tests are also available to aid in quantifying the degree of dementia.
• Neuropsychological testing may be of benefit in special patient populations. Brain scans though donÂ’t diagnose AlzheimerÂ’s are important to rule out other causes of memory loss. Genetic testing can identify those who carry the predisposing gene, yet can not predict who will develop the disease.

Treatment has been aimed at slowing the progression of the disease. There is currently no cure. Preventive modalities have not proven to be conclusive, but preliminary data suggest that certain selective estrogen receptor modulators, cholesterol lowering drugs called statins, and non steroidal anti– inflammatory meds may have some promise. Mental fitness also is indeterminate on any real benefit. Support for patients and families is vital, and San Antonio has a chapter of the AlzheimerÂ’s Association locally with multifaceted support ranging from 24 hour help lines and support group information. A web search for AlzheimerÂ’s offers many other support alternatives.

“Think Healthy & Be Healthy.�