Alzheimer's disease From Wikipedia, the free encyclopedia Alzheimer's disease (AD), also known in medical literature as Alzheimer

disease, is the most common form of dementia. There is no cure for the disease, which worsens as it progresses, and eventually leads to death. It was first described by German psychiatrist and neuropathologist Alois Alzheimer in 1906 and was named after him.[1] Most often, AD is diagnosed in people over 65 years of age,[2] although the less-prevalentearly-onset Alzheimer's can occur much earlier. In 2006, there were 26.6 million sufferers worldwide. Alzheimer's is predicted to affect 1 in 85 people globally by 2050.[3] Although Alzheimer's disease develops differently for every individual, there are many common symptoms.[4] Early symptoms are often mistakenly thought to be 'age-related' concerns, or manifestations of stress.[5] In the early stages, the most common symptom is difficulty in remembering recent events. When AD is suspected, the diagnosis is usually confirmed with tests that evaluate behaviour and thinking abilities, often followed by a brain scan if available.[6] As the disease advances, symptoms can include confusion, irritability and aggression,mood swings, trouble with language, and long-term memory loss. As the sufferer declines they often withdraw from family and society.[5][7] Gradually, bodily functions are lost, ultimately leading to death.[8] Since the disease is different for each individual, predicting how it will affect the person is difficult. AD develops for an unknown and variable amount of time before becoming fully apparent, and it can progress undiagnosed for years. On average, the life expectancy following diagnosis is approximately seven years.[9] Fewer than three percent of individuals live more than fourteen years after diagnosis.[10] The cause and progression of Alzheimer's disease are not well understood. Research indicates that the disease is associated withplaques and tangles in the brain.[11] Current treatments only help with the symptoms of the disease. There are no available treatments that stop or reverse the progression of the disease. As of 2012, more than 1000 clinical trials have been or are being conducted to find ways to treat the disease, but it is unknown if any of the tested treatments will work.[12] Mental stimulation, exercise, and a balanced diet have been suggested as ways to delay cognitive symptoms (though not brain pathology) in healthy older individuals, but there is no conclusive evidence supporting an effect.[13] Because AD cannot be cured and is degenerative, the sufferer relies on others for assistance. The role of the main caregiver is often taken by the spouse or a close relative.[14] Alzheimer's disease is known for placing a great burden on caregivers; the pressures can be wideranging, involving social, psychological, physical, and economic elements of the caregiver's life.[15][16][17] In developed countries, AD is one of the most costly diseases to society.[18][19] Characteristics The disease course is divided into four stages, with progressive patterns of cognitive and functional impairments. Pre-dementia The first symptoms are often mistakenly attributed to ageing or stress.[5] Detailed neuropsychological testing can reveal mild cognitive difficulties up to eight years before a person fulfils the clinical criteria for diagnosis of AD.[20] These early symptoms can affect the most complex daily living activities.[21] The most noticeable deficit is memory loss, which shows up as difficulty in remembering recently learned facts and inability to acquire new information.[20][22] Subtle problems with the executive functions of attentiveness, planning, flexibility, and abstract thinking, or impairments in semantic memory (memory of meanings, and concept relationships) can also be symptomatic of the early stages of AD.[20] Apathy can be observed at this stage, and remains the most persistent neuropsychiatric symptom throughout the course of the disease.[23] The preclinical stage of the disease has also been termed mild cognitive impairment,[22] but whether this term corresponds to a different diagnostic stage or identifies the first step of AD is a matter of dispute.[24] Early In people with AD the increasing impairment of learning and memory eventually leads to a definitive diagnosis. In a small portion of them, difficulties with language, executive functions, perception (agnosia), or execution of movements (apraxia) are more prominent than memory problems.[25] AD does not affect all memory capacities equally. Older memories of the person's life (episodic memory), facts learned (semantic memory), and implicit memory (the memory of the body on how to do things, such as using a fork to eat) are affected to a lesser degree than new facts or memories.[26][27] Language problems are mainly characterised by a shrinking vocabulary and decreased word fluency, which lead to a general impoverishment of oral and written language.[25][28] In this stage, the person with Alzheimer's is usually capable of communicating basic ideas adequately.[25][28][29] While performing fine motor tasks such as writing, drawing or dressing, certain movement coordination and planning difficulties (apraxia) may be present but they are commonly unnoticed.[25] As the disease progresses, people with AD can often continue to perform many tasks independently, but may need assistance or supervision with the most cognitively demanding activities.[25] Moderate Progressive deterioration eventually hinders independence, with subjects being unable to perform most common activities of daily living.[25] Speech difficulties become evident due to an inability to recall vocabulary, which leads to frequent incorrect word substitutions (paraphasias). Reading and writing skills are also progressively lost.[25][29] Complex motor sequences become less coordinated as time passes and AD progresses, so the risk of falling increases.[25] During this phase, memory problems worsen, and the person may fail to recognise close relatives.[25] Long-term memory, which was previously intact, becomes impaired.[25] Behavioural and neuropsychiatric changes become more prevalent. Common manifestations are wandering, irritability and labile affect, leading to crying, outbursts of unpremeditated aggression, or resistance to caregiving.[25] Sundowning can also appear.[30]Approximately 30% of people with AD develop illusionary misidentifications and other delusional symptoms.[25] Subjects also lose insight of their disease process and limitations (anosognosia).[25] Urinary incontinence can develop.[25] These symptoms create stressfor relatives and caretakers, which can be reduced by moving the person from home care to other long-term care facilities.[25][31] Advanced During the final stage of AD, the person is completely dependent upon caregivers.[25] Language is reduced to simple phrases or even single words, eventually leading to complete loss of speech.[25][29] Despite the loss of verbal language abilities, people can often

understand and return emotional signals.[25] Although aggressiveness can still be present, extreme apathy and exhaustion are much more common results.[25] People with AD will ultimately not be able to perform even the simplest tasks without assistance.[25] Muscle mass and mobility deteriorate to the point where they are bedridden, and they lose the ability to feed themselves.[25] AD is a terminal illness, with the cause of death typically being an external factor, such as infection of pressure ulcers or pneumonia, not the disease itself.[25] http://www.italz.it/malatt-e.htm What is Alzheimers disease? Alzheimer's Disease (AD) is a degenerative disorder of the brain which causes progressive memory disturbance, impaired thinking and problem solving deficits, behavioural and personality changes. This progressive cognitive impairment (dementia) leads to inability to care for oneself, and patient becomes completely dependent on others. AD is the most common cause of the dementia syndrome, representing 60% of all cases. Risk of AD definitely increases with age: whereas roughly 5% of individuals over the age of 65 years are affected, as many as 20-40% of persons over the age of 85 may have the disease. AD has been described the first time by Alois Alzheimer, a german neurologist who identified tipical lesions, senile plaques and neurofibrillary tangles, in a brain of a 51 years old female affected by progressive dementia. What are the causes? The causes of AD are still unknown: probably a variety of mechanisms may differentially contribute to develope AD. At the present reserch has devoted to evaluating different hypotheses: exogenous and endogenous toxins; heritable predisposition, etc. It appears that AD may result from complex interaction between variable genetic predisposition and environmental factors. In certain rare families AD shows an autosomal dominant pattern of trasmission (1%). In the most cases, genetic predisposition may exist, as shown by some affected relatives. A potential risk factor is the apolipoprotein 4 in the isoform E4. How does Alzheimers manifest itself? Alzheimer's disease has a progressive course of action ; its duration is 10 years on average, but it is widely changeable from case to case. The onset is shifty and first symptoms are often simply believed as consequence of aging process. Most of times slight loss of memory (84% of cases) and speech problems (76%) represent the initial symptoms, but also changes in behaviour and personality disorder, decreasing interest for hobbies and apathy may occur .Afterwards clinical picture gets clear with severe memory problems, loss of one's bearing in space and time, attention and concentration capability. Sometimes even in the early phase there may be hallucinations and agitation. At the end patients become unable in day to day chores ; by this time, they must be cared for constantly so that the whole of the family is struck by such event : the financial, affective and psychological burden is immense ; in fact the disease involves not only the patients but the whole family. How to diagnose it ? It's absolutely important that the person who shows signs of serious cognitive deterioration is submitted to complete medical tests, so as to detect any other different disease. The early diagnosis allows to plan the future life both of the patient and his family, the most suited therapy and the care organization. What is important is a careful anamnesis and medical examination , blood and neuroimaging exams ; the neuropsychological evalutation may help to distinguish demented from depressed patients . Brain CT or MRI allow to exclude other causes of cognitive impairment. Even if the undoubted diagnosis is based only on the post-mortem brain examination, very careful clinical criteria lead to diagnostic accuracy of 90%. What can be done? For the time being, there are no effective therapies ; some recently discovered drugs (cholinesterases inibitors, such as donepezil and rivastigmine) slow down ,for short periods of time, the advancing of simptoms . According to English studies, 75-80% of people affected by Alzheimer's lives with their families. Since caring for a person affected by Alzheimer's means being put to the test on a physical, economic, affective and psychological level, it is necessary that the family is supported through an efficient social assistance program. Moreover, the family should not be left alone. It's for this very purpose that A.I.M.A, the Italian Alzheimer's Disease Association, was constituted in 1985, in order to offer a meeting point for families, doctors, social and health workers. The disease course can be divided into four stages: Early stage - decline of recent memory - mild temporal disorientation - difficulty in finding words properly - anxiety/ depression - lack of initiative - difficulty in tackling new situation Intermediate stage - spatial and temporal disorientation - severe loss of memory - language and comprehension disturbances - apraxia ( difficulties in dressing, handling tools etc) - delusions, hallucination and wandering - difficulty in recognizing objects and people - psychomotor slowing - Impairment in activities of daily living Advanced stage - severe cognitive impairment - complete loss of language abilities - neurologic abnormalities (seizures, myoclonus) - inability to care for oneself - incontinence Late stage - indifference, apathy

- complete loss of cognitive function - incontinence - walking and feeding disturbances - weight loss - complications (pneumonia, bedsores, phlebitis) Late stage - indifference, apathy - complete loss of cognitive function - incontinence - walking and feeding disturbances - weight loss - complications (pneumonia, bedsores, phlebitis) What is Alzheimer's disease? Alzheimer's disease is the most common cause of dementia, affecting around 496,000 people in the UK. The term 'dementia' describes a set of symptoms which can include loss of memory, mood changes, and problems with communication and reasoning. These symptoms occur when the brain is damaged by certain diseases and conditions, including Alzheimer's disease. This factsheet outlines the symptoms and risk factors for Alzheimer's disease, and describes what treatments are currently available. Alzheimer's disease, first described by the German neurologist Alois Alzheimer, is a physical disease affecting the brain. During the course of the disease, protein 'plaques' and 'tangles' develop in the structure of the brain, leading to the death of brain cells. People with Alzheimer's also have a shortage of some important chemicals in their brain. These chemicals are involved with the transmission of messages within the brain. Alzheimer's is a progressive disease, which means that gradually, over time, more parts of the brain are damaged. As this happens, the symptoms become more severe. Symptoms People in the early stages of Alzheimer's disease may experience lapses of memory and have problems finding the right words. As the disease progresses, they may: become confused and frequently forget the names of people, places, appointments and recent events experience mood swings, feel sad or angry, or scared and frustrated by their increasing memory loss become more withdrawn, due either to a loss of confidence or to communication problems have difficulty carrying out everyday activities - they may get muddled checking their change at the shops or become unsure how to work the TV remote. As the disease progresses, people with Alzheimer's will need more support from those who care for them. Eventually, they will need help with all their daily activities. While there are some common symptoms of Alzheimer's disease, it is important to remember that everyone is unique. No two people are likely to experience Alzheimer's disease in the same way. Mild cognitive impairment Recently, some doctors have begun to use the term mild cognitive impairment (MCI)when an individual has difficulty remembering things or thinking clearly but the symptoms are not severe enough to warrant a diagnosis of Alzheimer's disease. Recent research has shown that individuals with MCI have an increased risk of developing Alzheimer's disease. However, the conversion rate from MCI to Alzheimer's is low (about 10-20 per cent each year), and consequently a diagnosis of MCI does not always mean that the person will go on to develop Alzheimer's. What causes Alzheimer's disease? So far, no one single factor has been identified as a cause for Alzheimer's disease. It is likely that a combination of factors, including age, genetic inheritance, environmental factors, lifestyle and overall general health, are responsible. In some people, the disease may develop silently for many years before symptoms appear. Age Age is the greatest risk factor for dementia. Dementia affects one in 14 people over the age of 65 and one in six over the age of 80. However, dementia is not restricted to older people: in the UK, there are over 17,000 people under the age of 65 with dementia, although this figure is likely to be an underestimate. Genetic inheritance Many people fear that they may inherit Alzheimer's disease and scientists are currently investigating the genetic background to Alzheimer's. We do know that there are a few families where there is a very clear inheritance of the disease from one generation to the next. This is often in families where the disease appears relatively early in life. In the vast majority of cases, however, the influence of inherited genes for Alzheimer's disease in older people seems to be small. If a parent or other relative has Alzheimer's, your own chances of developing the disease are only a little higher than if there were no cases of Alzheimer's in the immediate family. For more information see our factsheet on Genetics and dementia (405). Environmental factors The environmental factors that may contribute to the onset of Alzheimer's disease have yet to be identified. A few years ago, there were concerns that exposure to aluminium might cause Alzheimer's disease. However, these fears have largely been discounted.

Other factors Because of the difference in their chromosomal make-up, people with Down's syndromewho live into their 50s and 60s are at particular risk of developing Alzheimer's disease. People who have had severe head or whiplash injuries also appear to be at increased risk of developing dementia. Boxers who receive continual blows to the head are at risk too. Research has also shown that people who smoke, and those who have high blood pressure, high cholesterol levels or diabetes, are at increased risk of developing Alzheimer's. You can help reduce your risk by not smoking, eating a healthy balanced diet and having regular checks for blood pressure and cholesterol from middle age. Maintaining a healthy weight and leading an active lifestyle combining physical, social and mental activity will also help. Getting a diagnosis If you are concerned about your own health, or the health of someone close to you, it is important to seek help from a GP. An early diagnosis will have a number of benefits including the opportunity to plan for the future and access treatment, advice and support. There is no straightforward test for Alzheimer's disease or for any other cause of dementia. A diagnosis is usually made by excluding other causes which present similar symptoms. The GP will need to rule out conditions such as infections, vitamin deficiency, thyroid problems, depression and the side-effects of medication. Specialists The GP may ask a specialist for help in carrying out a diagnosis. The specialist may be an old-age psychiatrist, a neurologist, a physician in geriatric medicine or a general psychiatrist. Who the person sees will depend on their age, how physically able they are and how well services are developed in the local area. Tests The person being tested will usually be given a blood test and a full physical examination to rule out or identify any other medical problems. The person's memory will be assessed, initially with questions about recent events and past memories. Their memory and thinking skills may also be assessed in detail by a psychologist. A brain scan may be carried out to give some clues about the changes taking place in the person's brain. There are a number of different types of scan, including computerised tomography (CT) and magnetic resonance imaging (MRI). Treatment There is currently no cure for Alzheimer's disease. However, drug treatments are available that can temporarily alleviate some symptoms or slow down their progression in some people. People with Alzheimer's have been shown to have a shortage of the chemical acetylcholine in their brains. The drugs Aricept, Exelon and Reminyl (trade names for the drugs donepezil hydrochloride, rivastigmine and galantamine) work by maintaining existing supplies of acetylcholine. As of March 2011, these drugs are recommended as an option for people in the mild-to-moderate stages of Alzheimer's disease. Please refer to the National Institute for Health and Clinical Excellence (NICE) website for guidance (see Useful organisations at the end of this factsheet). Side-effects are usually minor but may include diarrhoea, nausea, insomnia, fatigue and loss of appetite. A drug called Ebixa (trade name for the drug memantine) was launched in the UK in 2002. Ebixa works in a different way from the other three and is the only drug that is recommended for people in both the moderate and severe stages of Alzheimer's disease. Side-effects may include dizziness, headaches and tiredness, and - rarely - hallucinations or confusion. These drugs are not a cure, but they may stabilise some of the symptoms of Alzheimer's disease for a limited period, typically 6-12 months or longer. http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=100 What is dementia? Dementia is a syndrome characterized by: impairment in memory, impairment in another area of thinking such as the ability to organize thoughts and reason, the ability to use language, or the ability to see accurately the visual world (not because of eye disease), and these impairments are severe enough to cause a decline in the patient's usual level of functioning. Although some kinds of memory loss are normal parts of aging, the changes due to aging are not severe enough to interfere with the level of function. Many different diseases can cause dementia, but Alzheimer's disease is by far the most common cause for dementia in the United States and in most countries in the world. What is Alzheimer's disease? Alzheimer's disease (AD) is a slowly progressive disease of the brain that is characterized by impairment of memory and eventually by disturbances in reasoning, planning, language, and perception. Many scientists believe that Alzheimer's disease results from an increase in the production or accumulation of a specific protein (beta-amyloid protein) in the brain that leads to nerve cell death. The likelihood of having Alzheimer's disease increases substantially after the age of 70 and may affect around 50% of persons over the age of 85. Nonetheless, Alzheimer's disease is not a normal part of aging and is not something that inevitably happens in later life. For example, many people live to over 100 years of age and never develop Alzheimer's disease. Who develops Alzheimer's disease? The main risk factor for Alzheimer's disease is increased age. As a population ages, the frequency of Alzheimer's disease continues to increase. Ten percent of people over 65 years of age and 50% of those over 85 years of age have Alzheimer's disease. Unless new treatments are developed to decrease the likelihood of developing Alzheimer's disease, the number of individuals with Alzheimer's disease in the United States is expected to be 14 million by the year 2050. There are also genetic risk factors for Alzheimer's disease. Most patients develop Alzheimer's disease after age 70. However, 2%-5% of patients develop the disease in the fourth or fifth decade of life (40s or 50s). At least half of these early onset patients have inherited gene mutations associated with their Alzheimer's disease. Moreover, the children of a patient with early onset Alzheimer's disease who has one of these gene mutations has a 50% risk of developing Alzheimer's disease. There is also a genetic risk for late onset cases. A relatively common form of a gene located on chromosome 19 is associated with late onset Alzheimer's disease. In the majority of Alzheimer's disease cases, however, no specific genetic risks have yet been identified.

1. 2. 3.

Other risk factors for Alzheimer's disease include high blood pressure(hypertension), coronary artery disease, diabetes, and possibly elevated blood cholesterol. Individuals who have completed less than eight years of education also have an increased risk for Alzheimer's disease. These factors increase the risk of Alzheimer's disease, but by no means do they mean that Alzheimer's disease is inevitable in persons with these factors. All patients with Down syndrome will develop the brain changes of Alzheimer's disease by 40 years of age. This fact was also a clue to the "amyloid hypothesis of Alzheimer's disease" (see section later in this article) What are the symptoms of Alzheimer's disease? The onset of Alzheimer's disease is usually gradual, and it is slowly progressive. Memory problems that family members initially dismiss as "a normal part of aging" are in retrospect noted by the family to be the first stages of Alzheimer's disease. When memory and other problems with thinking start to consistently affect the usual level of functioning; families begin to suspect that something more than "normal aging" is going on. Problems of memory, particularly for recent events (short-term memory) are common early in the course of Alzheimer's disease. For example, the individual may, on repeated occasions, forget to turn off an iron or fail to recall which of the morning's medicines were taken. Mild personality changes, such as less spontaneity, apathy, and a tendency to withdraw from social interactions, may occur early in the illness. As the disease progresses, problems in abstract thinking and in other intellectual functions develop. The person 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 a diminishing ability to dress appropriately. Later in the course of the disorder, affected individuals may become confused or disoriented about what month or year it is, be unable to describe accurately where they live, or be unable to name a place being visited. Eventually, patients may wander, be unable to engage in conversation, erratic in mood, uncooperative, and lose bladder and bowel control. In late stages of the disease, persons may become totally incapable of caring for themselves. Death can then follow, perhaps from pneumonia or some other problem that occurs in severely deteriorated states of health. Those who develop the disorder later in life more often die from other illnesses (such as heart disease) rather than as a consequence of Alzheimer's disease. Ten warning signs of Alzheimer's disease The Alzheimer's Association has developed the following list of warning signs that include common symptoms of Alzheimer's disease. Individuals who exhibit several of these symptoms should see a physician for a complete evaluation. 1. Memory loss 2. Difficulty performing familiar tasks 3. Problems with language 4. Disorientation to time and place 5. Poor or decreased judgment 6. Problems with abstract thinking 7. Misplacing things 8. Changes in mood or behavior 9. Changes in personality 10. Loss of initiative It is normal for certain kinds of memory, such as the ability to remember lists of words, to decline with normal aging. In fact, normal individuals 50 years of age will recall only about 60% as many items on some kinds of memory tests as individuals 20 years of age. Furthermore, everyone forgets, and every 20 year old is well aware of multiple times he or she couldn't think of an answer on a test that he or she once knew. Almost no 20 year old worries when he/she forgets something, that he/she has the 'early stages of Alzheimer's disease,' whereas an individual 50 or 60 years of age with a few memory lapses may worry that they have the 'early stages of Alzheimer's disease.' Mild cognitive impairment The criteria for dementia are conservative meaning that a patient must have had considerable decline in the ability to think before a diagnosis of dementia is appropriate. The progression of Alzheimer's disease is so insidious and slow that patients go through a period of decline where their memory is clearly worse than its baseline, yet they still do not meet criteria for dementia. This transitional syndrome is called Mild Cognitive Impairment (MCI). Individuals affected with MCI have cognitive impairment that is demonstrated on formal neuropsychological testing but are still able to function well. Formal neuropsychological testing usually means that the patient is administered a battery of standardized tests of memory and thinking. Some of these tests are something like the IQ tests we may have taken in school. When these tests were developed they were administered to hundreds or thousands of people so that statistics are available to say how a person's score compares to a sample of healthy persons of the same age. If a person scores in the top 50%, it means that he or she did better than at least 50% of other normal people who took the test. Persons with lower scores - often in the bottom 7% - are considered to have MCI. There are several forms of MCI. Perhaps the most common is associated with impairment in memory but not in the ability to plan and reason. Persons with this type called "amnestic MCI" (amnestic comes from "amnesia" and means no memory) have a high risk of developing Alzheimer's disease over the next few years. Persons with preserved memory but impaired reasoning or impaired judgment (call non-amnestic MCI) have a lower risk of developing Alzheimer's disease. As treatments are developed that decrease the risk of developing Alzheimer's disease or slow its rate of progression (as of June 2007, no such medication has been approved by the FDA), recognition of amnestic MCI will be increasingly important. It is hoped that medications will be developed that will slow the rate of progression of MCI to Alzheimer's disease or completely prevent the development of Alzheimer's disease. What are causes of Alzheimer's disease? The cause(s) of Alzheimer's disease is (are) not known. The "amyloid cascade hypothesis" is the most widely discussed and researched hypothesis about the cause of Alzheimer's disease. The strongest data supporting the amyloid cascade hypothesis comes from the study of early-onset inherited (genetic) Alzheimer's disease. Mutations associated with Alzheimer's disease have been found in about half of

the patients with early-onset disease. In all of these patients, the mutation leads to excess production in the brain of a specific form of a small protein fragment called ABeta (A). Many scientists believe that in the majority of sporadic (for example, non-inherited) cases of Alzheimer's disease (these make up the vast majority of all cases of Alzheimer's disease) there is too little removal of this A protein rather than too much production. In any case, much of the research in finding ways to prevent or slow down Alzheimer's disease has focused on ways to decrease the amount of A in the brain. What are risk factors for Alzheimer's disease? The biggest risk factor for Alzheimer's disease is increased age. The likelihood of developing Alzheimer's disease doubles every 5.5 years from 65 to 85 years of age. Whereas only 1%-2% of individuals 70 years of age have Alzheimer's disease, in some studies around 40% of individuals 85 years of age have Alzheimer's disease. Nonetheless, at least half of people who live past the 95 years of age do not have Alzheimer's disease. Common forms of certain genes increase the risk of developing Alzheimer's disease, but do not invariably cause Alzheimer's disease. The best-studied "risk" gene is the one that encodes apolipoprotein E (apoE). The apoE gene has three different forms (alleles) -- apoE2, apoE3, and apoE4. The apoE4 form of the gene has been associated with increased risk of Alzheimer's disease in most (but not all) populations studied. The frequency of the apoE4 version of the gene in the general population varies, but is always less than 30% and frequently 8%-15%. Persons with one copy of the E4 gene usually have about a two to three fold increased risk of developing Alzheimer's disease. Persons with two copies of the E4 gene (usually around 1% of the population) have about a nine-fold increase in risk. Nonetheless, even persons with two copies of the E4 gene don't always get Alzheimer's disease. At least one copy of the E4 gene is found in 40% of patients with sporadic or late-onset Alzheimer's disease. This means that in majority of patients with Alzheimer's disease, no genetic risk factor has yet been found. Most experts do not recommend that adult children of patients with Alzheimer's disease should have genetic testing for the apoE4 gene since there is no treatment for Alzheimer's disease. When medical treatments that prevent or decrease the risk of developing Alzheimer's disease become available, genetic testing may be recommended for adult children of patients with Alzheimer's disease so that they may be treated. Many, but not all, studies have found that women have a higher risk for Alzheimer's disease than men. It is certainly true that women live longer than men, but age alone does not seem to explain the increased frequency in women. The apparent increased frequency of Alzheimer's disease in women has led to considerable research about the role of estrogen in Alzheimer's disease. Recent studies suggest that estrogen should not be prescribed to post-menopausal women for the purpose of decreasing the risk of Alzheimer's disease. Nonetheless, the role of estrogen in Alzheimer's disease remains an area of research focus. Some studies have found that Alzheimer's disease occurs more often among people who suffered significant traumatic head injuries earlier in life, particularly among those with the apoE 4 gene. In addition, many, but not all studies, have demonstrated that persons with limited formal education - usually less than eight years - are at increased risk for Alzheimer's disease. It is not known whether this reflects a decreased "cognitive reserve" or other factors associated with a lower educational level. How is the diagnosis of Alzheimer's disease made? As of June 2007, there is no specific "blood test" or imaging test that is used for the diagnosis of Alzheimer's disease. Alzheimer's disease is diagnosed when: 1) a person has sufficient cognitive decline to meet criteria for dementia; 2) the clinical course is consistent with that of Alzheimer's disease; 3) no other brain diseases or other processes are better explanations for the dementia. What treatment and management options are available for Alzheimer's disease? The management of Alzheimer's disease consists of medication based and non-medication based treatments. Two different classes of pharmaceuticals are approved by the FDA for treating Alzheimer's disease: cholinesterase inhibitors and partial glutamate antagonists. Neither class of drugs has been proven to slow the rate of progression of Alzheimer's disease. Nonetheless, many clinical trials suggest that these medications are superior to placebos (sugar pills) in relieving some symptoms. Cholinesterase inhibitors In patients with Alzheimer's disease there is a relative lack of a brain chemical neurotransmitter called acetylcholine. (Neurotransmitters are chemical messengers produced by nerves that the nerves use to communicate with each other in order to carry out their functions.) Substantial research has demonstrated that acetylcholine is important in the ability to form new memories. The cholinesterase inhibitors (ChEIs) block the breakdown of acetylcholine. As a result, more acetylcholine is available in the brain, and it may become easier to form new memories. Four ChEIs have been approved by the FDA, but only donepezil hydrochloride(Aricept), rivastigmine (Exelon), andgalantamine (Razadyne - previously called Reminyl) are used by most physicians because the fourth drug, tacrine (Cognex) has more undesirable side effects than the other three. Most experts in Alzheimer's disease do not believe there is an important difference in the effectiveness of these three drugs. Several studies suggest that the progression of symptoms of patients on these drugs seems to plateau for six to 12 months, but inevitably progression then begins again. Of the three widely used AchEs, rivastigmine and galantamine are only approved by the FDA for mild to moderate Alzheimer's disease, whereas donepezil is approved for mild, moderate, and severe Alzheimer's disease. It is not known whether rivastigmine and galantamine are also effective in severe Alzheimer's disease, although there does not appear to be any good reason why they shouldn't. The principal side effects of ChEIs involve the gastrointestinal system and includenausea, vomiting, cramping, and diarrhea. Usually these side effects can be controlled with change in size or timing of the dose or administering the medications with a small amount of food. Between 75% and 90% of patients will tolerate therapeutic doses of ChEIs.

http://www.medicinenet.com/alzheimers_disease_causes_stages_and_symptoms/page7.htm
WHAT IS ALZHEIMER'S DISEASE? Alzheimer's disease is a physical disease which attacks the brain resulting in impaired memory, thinking and behaviour. The disease is named for the German physician, Alois Alzheimer who, in 1907, first described it. As brain cells die, the substance of the brain shrinks. Abnormal material builds up as tangles in the centre of the brain cells and plaques outside the brain cells, disrupting messages within the brain, damaging connections between brain cells. This leads to the eventual death of the brain cells and prevents the recall of information.

Memory of recent events is the first to be affected, but as the disease progresses, longterm memory is also lost. The disease also affects many of the brain's other functions and consequently, many other aspects of behaviour are disturbed. There are two different types of Alzheimer's disease: Sporadic Alzheimer's disease The disease can affect adults at any age, but usually occurs after age 65 Sporadic Alzheimer's disease is by far the most common form of Alzheimer's disease It affects people who may or may not have a family history of the disease. Familial Alzheimer's disease The disease runs in a few families and is very rare If a parent has a mutated gene, each child has a 50% chance of inheriting it The presence of the gene means that the person will eventually develop Alzheimer's disease, usually in their 40's or 50's Familial Alzheimer's disease affects a very small number of people. WHAT ARE THE SYMPTOMS? In the early stages the symptoms of Alzheimer's disease can be very subtle. However, it often begins with lapses in memory and difficulty in finding the right words for everyday objects. Other symptoms may include: Persistent and frequent memory difficulties, especially of recent events Vagueness in everyday conversation Apparent loss of enthusiasm for previously enjoyed activities Taking longer to do routine tasks Forgetting well-known people or places Inability to process questions and instructions Deterioration of social skills Emotional unpredictability. Symptoms vary and the disease progresses at a different pace according to the individual and the areas of the brain affected. A person's abilities may fluctuate from day to day, or even within the one day, becoming worse in times of stress, fatigue or ill-health. However, there is always a deterioration over time. It is a progressive and currently irreversible disease. WHAT CAUSES ALZHEIMER'S DISEASE? Scientists are rapidly learning more about the chemical changes which damage brain cells in Alzheimer's disease but apart from the few individuals with Familial Alzheimer's disease, it is not known why one individual gets Alzheimer's disease late in life and another does not. A variety of suspected causes are being investigated including factors in the environment, biochemical disturbances and immune processes. The cause may vary from person to person and may be due to one factor or a number of factors. WHO GETS ALZHEIMER'S DISEASE? Alzheimer's disease can happen to anybody, but it is much more common after the age of 65. The incidence rate rises with age. For people 85 years and over, 1 in 4 have dementia. It can affect people in their 30's, 40's and 50's. HOW IS ALZHEIMER'S DISEASE DIAGNOSED? There is currently no single test to identify Alzheimer's disease. The diagnosis is made only after careful clinical consultation. The clinical diagnosis might include: A detailed medical history A thorough physical and neurological examination A test of intellectual function Psychiatric assessment A neuropsychological test Blood and urine tests. These tests will help to eliminate other conditions with similar symptoms such as nutritional deficiencies or depression. After eliminating other causes, a clinical diagnosis of Alzheimer's disease can be made with about 80% to 90% accuracy if the symptoms and signs are appropriate. The diagnosis can only be confirmed after death by examination of the brain tissue. It is important to have an early and accurate diagnosis to determine whether a treatable condition other than Alzheimer's disease, is causing the symptoms. If Alzheimer's disease is diagnosed medical treatment and other assistance can be discussed. HOW DOES ALZHEIMER'S DISEASE PROGRESS? The rate of progression of the disease varies from person to person. However, the disease does lead eventually to complete dependence and finally death, usually from another illness such as pneumonia. A person may live from three to twenty years with Alzheimer's disease, with the average being seven to ten years.