Alzheimer's disease is a slowly progressive, degenerative disorder of the brain that eventually results in abnormal brain function and death. The disease was first described in 1907 by a German physician, Dr. Alois Alzheimer.

Alzheimer's disease is a disorder marked by a gradual decline in brain function that gets worse with time. It used to be assumed that this change was a normal part of aging that we called "senility." Some persons develop this condition when they are as young as 40 years of age. However, the disease is most common in persons over the age of 65. It is estimated that approximately 10 percent of persons over 65 years of age may have Alzheimer's disease and that in persons over the age of 85, up to 50 percent may be affected.

Alzheimer's disease is not a normal part of the aging process. It is not "hardening of the arteries." It is not contagious, and it is not known how it can be prevented. While the physical changes in the brain are very similar among different people, the behavioral and psychological symptoms that result are complex and may differ from person to person. These symptoms lead to a form of "dementia" which is the loss of mental skills and abilities, including self-care capabilities. As Alzheimer's disease progresses, these losses will result in total dependency for even the simplest activities.


What are the symptoms of Alzheimer's disease?

The early symptoms of Alzheimer's disease in the general population often include:

Language problems. The person cannot find the right word or name for a familiar person, place or object. This is not the same as taking longer to recall a word. It is far more than the "occasional" slip of a name that everyone experiences.

Loss of recent memory. The person may forget that he or she just had breakfast or has left something cooking on the stove, or may check and recheck that the bed has been made. However, recall of events from the distant past is often unaffected.

Loss of a sense of time and place. The person may become more and more confused about what day it is, or forget the route to well-known places.

Decline in activities of daily living. The person may exhibit an unexplained loss of activities of daily living (ADL) skills. What once was an easy task for the person may now be difficult.

Personality changes. These may be so slight that, at first, they are difficult to notice. Some people become more quiet and withdrawn. In other cases, they may become more and more restless. Some persons may start to get angry over little things or have sudden changes of mood for no apparent reason.


What is the general course of Alzheimer's disease?

First (or onset stage):

The initial symptoms often appear very gradually. There may be some minimum memory loss, particularly of recent events. The individual may experience difficulty in finding the right words to use during casual conversations. Work performance may begin to deteriorate and changes in behavior may start to become obvious. These changes may last for a period of up to five years.


Second (or progressive stage):

The symptoms noted during the onset stage now become more obvious. There may be distinct problems with language abilities--this is typically the most obvious sign of movement to this stage. Persons affected may have difficulty naming objects or with maintaining a logical conversation. They may also have difficulty understanding directions or instructions. They often become easily disoriented with regard to what day it is (time), where they are (place), and who they are with (person). Confusion and the resulting frustration are often evident. Memory losses become even more pronounced. They may also begin to experience loss of self-care skills, including the ability to use the toilet (incontinence). Severe changes in personality may begin to become obvious, and their social behavior may be marked by suspiciousness (paranoia) and delusions. These changes may last for up to about twelve years.


Third (or terminal stage):

Persons affected now experience substantial dysfunction. Basic skills such as eating or drinking are forgotten. Because of eating problems, many persons may experience a substantial loss of body weight (up to 20- 30 percent). They may eventually lose their ability to maintain balance and walk. Their ability to recognize other persons and their environment is gone. Both long- and short-term memories are lost. At this stage, persons affected require complete 24-hour care and often become bedridden and inactive. Because of this, they are at increased risk for any infection, especially pneumonia, and consequently are far more likely to die. These changes, leading to death, may last for three or more years.


Can other conditions produce the same symptoms?

Yes. There are numerous other disorders or conditions that result in symptoms similar to those of Alzheimer's disease. Many of these conditions are treatable. It is therefore crucial to determine the cause of the symptoms and not assume they are always due to Alzheimer's disease.


If a diagnosis of Alzheimer's disease is assumed without adequate evaluation, the adult with a treatable condition may be deprived of remedies that could help return him or her to normal function. A variety of psychosocial and medical procedures must be used to rule out associated disorders as the cause of personality or behavior changes that otherwise could be mistakenly attributed to Alzheimer's disease.

It must not be assumed that someone has Alzheimer's disease because he or she exhibits some symptoms of the disease. Other common causes of these symptoms include: stroke, depression, medication reactions, thyroid disease, nutritional deficiencies, brain tumors, head trauma, subdural hematoma, and normal pressure hydrocephalus.

Although Alzheimer's disease is the most common cause of dementia, it is only one of many causes. There are also "related disorders" that cause various forms of dementia. These include multi-infarct dementia (a cortical dementia) and conditions like Huntington's disease, Parkinson's disease, and Creutzfeldt-Jakob disease (which are sub-cortical dementias).

There are also "associated disorders," such as thyroid abnormalities, arthritis, hearing loss, temperature sensitivity and sleep pattern changes, that may occur at the same time as Alzheimer's disease but which are not caused by Alzheimer's disease. These conditions may be reversible or treatable. They result in dementia-like symptoms but do not actually cause the permanent brain changes that result in dementia.

Lewis Harmen (c) copyright 1994

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