Description of the disease

“AD is named after Dr. Alois Alzheimer, a German doctor. In 1906, Dr. Alzheimer described
changes in the brain tissue of a woman who had died of an unusual mental illness. He found
abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called
neurofibrillary tangles).”
"General Information." National Institute on Aging. N.p., n.d. Web. 25 Nov. 2010.
<http://www.nia.nih.gov/Alzheimers/AlzheimersInformation/GeneralInfo/>.

“Recent research in India and Africa suggests that the risk of Alzheimer’s disease was
possibly higher for urban as compared to rural areas. This has raised several important issues for
research: What is the deciding factor? Is it increased life expectancy? Is it lifestyle? Is it diet?
[…]
It is generally believed that men and women are equally at risk of Alzheimer’s disease.
However, in developed countries, it is commonly observed that more women than men patients
are to be found in old age homes and special care facilities. This is a reflection of the higher
longevity of women as compared to men, and since this is a disease which strikes older people,
there are more women patients than men. There is no evidence that women are at an increased
risk of the disease than men, when the age factor is correlated in existing data. Also, women are
better able to care for male patients than men are able to care for female patients. Thus, a woman
with Alzheimer’s disease has a higher chance of being put into an institution because of her
husband’s inability to take care of her. However, a man with Alzheimer’s disease has a higher
chance of his wife taking care of him at home. Thus, a greater number of women patients are
found in institutions. […]
Some research studies have suggested that those with higher education are at a lower risk
for Alzheimer’s disease than those with less education. Although this has been repeatedly
demonstrated in several projects, the reason for this association is unknown. […]
From the available evidence, it would appear that the number of cases of Alzheimer’s
disease in Asia, and particularly in India and Africa, is lower than that reported from studies in
developed countries. This raises a major question - why?”
"ALZHEIMER'S DISEASE : Some facts and figures." WHO SEAR, Regional Health Situation, and World AIDS
Day, Health Report . N.p., n.d. Web. 25 Nov. 2010.
<http://www.searo.who.int/en/Section1174/Section1199/Section1567/Section1823_8066.htm>.

“As many as 5 million Americans suffer from Alzheimer’s disease. While younger people may
get Alzheimer’s disease, it is much less common. The disease usually begins after age 60, and
risk goes up with age. About 5 percent of men and women ages 65 to 74 have Alzheimer’s
disease, and nearly half of those age 85 and older may have the disease. It is important to note,
however, that Alzheimer’s disease is not a normal part of aging.”
"CDC::Aging - Healthy Brain Initiative: Alzheimer's Disease." Centers for Disease Control and Prevention. N.p.,
n.d. Web. 25 Nov. 2010. <http://www.cdc.gov/aging/aginginfo/alzheimers.htm>.
Causes of the disease
“Another characteristic of Alzheimer's disease is that brain cells produce reduced amounts of
chemicals, known as neurotransmitters, that are required for communication between nerves.
These chemicals include acetylcholine, serotonin, and norepinephrine.”
"Causes and Risk Factors of Alzheimer’s Disease ." WebMD - Better information. Better health.. N.p., n.d. Web. 25
Nov. 2010. <http://www.webmd.com/alzheimers/guide/causes-risk-factors>.

“In all brain regions, one might predict higher NFT counts to be associated with… lower
[neuropsychological] test scores and a longer disease duration. However, the correlations with
test scores were statistically significant in the expected direction only for NFTs in the nBM.”
NFT: neurofibrillary tangle
nBM: nucleus basalis of Meynert.
Samuel, William A., Victor W. Henderson, and Carol A. Miller. "Severity of Dementia in Alzheimer Disease and
Neurofibrillary Tangles in Multiple Brain Regions." Alzheimer Disease & Associated Disorders 5.1 (1991): 1-11.
Print.

“The brains of people with AD have an abundance of two abnormal structures—amyloid

plaques and neurofibrillary tangles—that are made of misfolded proteins (see "Protein
Misfolding" for more information). This is especially true in certain regions of the brain that are
important in memory.
The third main feature of AD is the loss of connections between cells. This leads to
diminished cell function and cell death.”
"The Hallmarks of AD." National Institute on Aging. N.p., n.d. Web. 25 Nov. 2010.
<http://www.nia.nih.gov/Alzheimers/Publications/Unraveling/Part2/hallmarks.htm>.
Symptoms of the disease
“Alzheimer’s disease is a progressive, degenerative brain disorder, clinically defined by a
gradual decline in both memory and impairment of at least one other area of higher intellectual
function. Such impairments may include aphasia, apraxia, agnosia, or disturbances in executive
functioning.”
Grossberg, George T., and Sanjeev M. Kamat. Alzheimer's: the latest assessment and treatment strategies. Sudbury,
Mass.: Jones and Bartlett Publishers, 2011. Print.

Mild
Memory loss
Confusion about the location of familiar places (getting lost begins to occur)
Taking longer than before to accomplish normal daily tasks
Trouble handling money and paying bills
Poor judgment leading to bad decisions
Loss of spontaneity and sense of initiative
Mood and personality changes, increased anxiety and/or aggression
Moderate
Increasing memory loss and confusion
Shortened attention span
Inappropriate outbursts of anger
Problems recognizing friends and family members
Difficulty with language and problems with reading, writing, and working with numbers
Difficulty organizing thoughts and thinking logically
Inability to learn new things or to cope with new or unexpected situations
Restlessness, agitation, anxiety, tearfulness, wandering—especially in the late afternoon or at night
Repetitive statements or movement, occasional muscle twitches
Hallucinations, delusions, suspiciousness or paranoia, irritability
Loss of impulse control (shown through undressing at inappropriate times or places or vulgar language)
An inability to carry out activities that involve multiple steps in sequence, such as dressing, making a pot of coffee,
or setting the table
Severe
Weight loss
Seizures
Skin infections
Difficulty swallowing
Groaning, moaning, or grunting
Increased sleeping
Lack of bladder and bowel control

"The Changing Brain in AD."National Institute on Aging. N.p., n.d. Web. 25 Nov. 2010.
<http://www.nia.nih.gov/Alzheimers/Publications/Unraveling/Part2/changing.htm>.
Early
Short-term memory loss is the most common early symptom of Alzheimer’s disease. Do you have trouble
remembering recent conversations or events?
Difficulty performing familiar tasks. Are you stumped by everyday activities, like brushing your teeth, washing
your hair, or making a telephone call?
Disorientation. Do you get lost in your own neighborhood? Do you find yourself putting household items in places
they don’t belong, like placing a book in the refrigerator?
Increasing problems with planning and managing. Have activities like balancing your checkbook, paying bills,
or preparing a shopping list become more difficult?
Trouble with language. Are you unable to recall words for everyday things? For example, does “car” become “that
thing I drive” or chair “that thing I sit on”?
Rapid, unpredictable mood swings. Do you suddenly shift from happy to sad or from calm to angry with no
apparent reason?
Lack of motivation. Have activities you have always loved lost their appeal? Do you see less of your friends &
family? Are you spending more time staring at the television?
Changes in sleep. Do you sleep more than usual? Do you sleep during the day rather than at night?
Middle
Difficulty completing everyday tasks, such as getting dressed, going to bathroom, or preparing meals
Hallucinations
Strong feelings of paranoia and anger
Wandering
Late
Inability to communicate with or recognize other people
Inability to walk
Difficulty swallowing
Inability to smile

"Alzheimer’s Disease Symptoms." WebMD - Better information. Better health.. N.p., n.d. Web. 25 Nov. 2010.
<http://www.webmd.com/alzheimers/guide/alzheimers-disease-symptoms>.
Tests and treatments
“Four medications, tested in clinical trials, have been approved by the FDA for use in treating
AD symptoms. Donepezil (Aricept®), rivastigmine (Exelon®), and galantamine (Razadyne®)
are prescribed to treat mild to moderate AD symptoms. Donepezil was recently approved to treat
severe AD as well. These drugs, known as cholinesterase inhibitors, act by stopping or slowing
the action of acetylcholinesterase, an enzyme that breaks down acetylcholine. They help to
maintain higher levels of acetylcholine in the brain. In some people, the drugs maintain abilities
to carry out activities of daily living. They also may maintain some thinking, memory, or
speaking skills, and can help with certain behavioral symptoms. However, they will not stop or
reverse the underlying progression of AD and appear to help people only for months to a few
years. The newest approved AD medication is memantine (Namenda®), which is prescribed to
treat moderate to severe AD symptoms. This drug appears to work by regulating levels of
glutamate, another neurotransmitter involved in memory function. Like the cholinesterase
inhibitors, memantine will not stop or reverse AD.”
"The Search for New Treatments." National Institute on Aging. N.p., n.d. Web. 25 Nov. 2010.
<http://www.nia.nih.gov/Alzheimers/Publications/Unraveling/Part3/search.htm>.

“Step 1: In evaluating a patient, the physician will need to check if there is a substantial
deterioration in the intellectual function of the aged person relative to his/her previous
status, who otherwise seems to be in good physical condition. In medical terms, it is necessary to
seek evidence of ‘dementia’.
Doctors will administer neuropsychological tests to check various components of
intellectual function. Examples of such tests are the Fuld Object Memory Test in which patients
are shown 10 objects and then asked to memorize this list of objects and repeat it to the
examiner. An average healthy adult should be easily able to recall 7-8 objects. However, patients
of Alzheimer’s disease can recall only one or two objects. Another neuropsychological test is the
Boston Naming Test in which subjects are shown various objects and asked to name them. Most
healthy people can easily name these objects, while patients with Alzheimer’s disease have
trouble naming even such simple objects as a comb or a pen. Similarly, there are
neuropsychological tests for speech, calculation, problem-solving and judgement. Based on the
results of these tests, loss of intellectual functions can be documented.
Step 2: The doctor needs to ensure that the loss of intellectual functioning is severe
enough to disable the person in activities of daily living. Patients of Alzheimer’s disease are
extremely disabled in function. When loss of intellectual function is so severe that it leads to
disabilities, conditions for Step 2 in the diagnosis of Alzheimer’s disease are met.
 Step 3: In the diagnosis of Alzheimer’s disease, it is important to exclude other causes of
loss of intellectual function. For this purpose, doctors will take a detailed history of the patient’s
illness from their relatives, then conduct a comprehensive medical, neurological and
neuropsychological examination. Blood tests and X-ray tests, such as CT scan and MRI scan,
will help to exclude conditions such as thyroid disease, brain tumour or stroke. In Alzheimer’s
disease, CT and MRI scans show a shrinking of the brain. This is medically referred to as
"cortical atrophy".”
"ALZHEIMER'S DISEASE : Diagnosis of Alzheimer's disease." WHO SEAR, Regional Health Situation, and
World AIDS Day, Health Report . N.p., n.d. Web. 25 Nov. 2010.
<http://www.searo.who.int/en/Section1174/Section1199/Section1567/Section1823_8061.htm>.

“The combination of drugs with different mechanisms of action may be more effective
than individual medications alone. Choline precursors have been combined with ChEIs without
observable benefit. Most practicing clinicians would not combine two ChEIs since their actions
are not additive. The combination of ChEIs with vitamin E or Ginkgo biloba does not appear to
worsen adverse effects; however, there is no efficacy evidence for this practice. Selegiline has
been combined with ChEIs in small pilot studies suggesting an additive effect, but this remains
to be replicated.
The most notably beneficial strategy of combined mechanisms is that of memantine
combined with the commonly used ChEI donepezil. In a large, placebo-controlled clinical trial,
memantine significantly improved cognitive, global, and functional outcomes in patients with
moderate to severe AD maintained on stable doses of donepezil compared with the ChEI
treatment alone. Since these findings will likely have a significant impact on clinical practice, it
will be helpful to know the effects of memantine in combination with other ChEIs in moderate to
severe AD, as well as in earlier stages of the disease.”
Tariot, Pierre N., and Howard J. Federoff. "Current Treatment for Alzheimer Disease and Future
Prospects." Alzheimer Disease & Associated Disorders 17.4 (2003): S105-S113. Print.
Works Cited
"ALZHEIMER'S DISEASE : Some facts and figures." WHO SEAR, Regional Health Situation, and World AIDS
Day, Health Report . N.p., n.d. Web. 25 Nov. 2010.
<http://www.searo.who.int/en/Section1174/Section1199/Section1567/Section1823_8066.htm>.

"Alzheimer’s Disease Symptoms." WebMD - Better information. Better health.. N.p., n.d. Web. 25 Nov. 2010.
<http://www.webmd.com/alzheimers/guide/alzheimers-disease-symptoms>.

"Causes and Risk Factors of Alzheimer’s Disease ." WebMD - Better information. Better health.. N.p., n.d. Web. 25
Nov. 2010. <http://www.webmd.com/alzheimers/guide/causes-risk-factors>.

"CDC::Aging - Healthy Brain Initiative: Alzheimer's Disease." Centers for Disease Control and Prevention. N.p.,
n.d. Web. 25 Nov. 2010. <http://www.cdc.gov/aging/aginginfo/alzheimers.htm>.

"General Information." National Institute on Aging. N.p., n.d. Web. 25 Nov. 2010.
<http://www.nia.nih.gov/Alzheimers/AlzheimersInformation/GeneralInfo/>.

Grossberg, George T., and Sanjeev M. Kamat. Alzheimer's: the latest assessment and treatment strategies. Sudbury,
Mass.: Jones and Bartlett Publishers, 2011. Print.

Samuel, William A., Victor W. Henderson, and Carol A. Miller. "Severity of Dementia in Alzheimer Disease and
Neurofibrillary Tangles in Multiple Brain Regions." Alzheimer Disease & Associated Disorders 5.1 (1991): 1-11.
Print.

Tariot, Pierre N., and Howard J. Federoff. "Current Treatment for Alzheimer Disease and Future
Prospects." Alzheimer Disease & Associated Disorders 17.4 (2003): S105-S113. Print.

"The Changing Brain in AD." National Institute on Aging. N.p., n.d. Web. 25 Nov. 2010.
<http://www.nia.nih.gov/Alzheimers/Publications/Unraveling/Part2/changing.htm>.

"The Hallmarks of AD." National Institute on Aging. N.p., n.d. Web. 25 Nov. 2010.
<http://www.nia.nih.gov/Alzheimers/Publications/Unraveling/Part2/hallmarks.htm>.

"The Search for New Treatments." National Institute on Aging. N.p., n.d. Web. 25 Nov. 2010.
<http://www.nia.nih.gov/Alzheimers/Publications/Unraveling/Part3/search.htm>.