Alzheimer's Disease (AD) affects 4 million people in this country alone, and is associated with memory loss, confusion, special orientation problems, mood swings, delusions, and language difficulties, among other symptoms. Alzheimer's is most common in older patients, and lasts on average 10 years (largely related to the effect Alzheimer's has on limiting survival). Before the age of 65 1 in 1000 people will develop Alzheimer's. After 65, it affects 1 in 50, and after age 80 the risk is 1 on 5. Nursing home care is necessary at some point, often at the 6-year mark. Risk factors for AD are family history, age, and Down's syndrome.
The condition is caused by the development of plaques in the brain that are filled with something called amyloid. These plaques are concentrated in parts of the brain involved in learning and memory, including the hippocampus, frontal lobe, cingulate, temporal and parietal cortex. On a chemical level, there is damage to the acetylcholine system, which plays a role in memory, i.e., a loss of receptors for this chemical in the hippocampus and other areas.
While AD is present in 60% of patients with dementia, it must be differentiated from Mild Cognitive Impairment (MCI), which may or may not progress to Alzheimer's. Alzheimer's must also be differentiated from fronto-temporal dementia, vascular dementia (from small strokes, seen in 15% of patients), and depression, which are not necessarily associated long-term with the development of Alzheimer's. Unlike Alzheimer's, dementia if often caused by deficiencies of the vitamins B12 and folate, which can happen in the elderly and can be treated with vitamin supplementation. However diagnosing Alzheimer's in the early stages of the illness is often difficult.
One of the factors weighing most heavily on families dealing with a loved one who suffers from Alzheimer's is its cost: $16,000 per year for the care of affected patients, including the costs of nursing homes, doctors, and medications . Once a patient with Alzheimer's loses the ability to care for him or her self, the disorder quickly progresses to a total loss of function and eventual death. Alzheimer's takes a particularly heavy toll on families of affected patients; studies show that 80% of caregivers are under heavy stress, and 50% suffer from depression. Given these grim statistics, it is no wonder that families, patients, and their doctors are desperate for treatments for this disorder.
In spite of the fact that there is no cure for Alzheimer's and if the diagnosis is accurate, there is no hope for symptoms to reverse, patients and their families spend billions of dollars on medications each year in an attempt to do what they can to combat the inevitable onslaught of decline. At best the meds available can push memory up a few points on the scale, and perhaps buy a year of time, but not change the rate of decline or its inevitable conclusion because for some, one more year with a loved one can be worth it, however. And I can understand that completely. One year might make all the difference when it comes to a relationship with a parent or spouse. However, I also want you to understand what study results really show for Alzheimer's drugs, so that you understand the limits of what these drugs can really accomplish and for how long.
All of the studies consistently show about a 5-point change on the Alzheimer's Disease Assessment Scale-Cognitive Subsection (ADAS-Cog), a measure of Alzheimer's related cognitive impairment, which translates into about a 7% increase in cognition. Let's take a look at what this really means. Here's an example: if I asked you to buy 10 items at the grocery store, you would remember seven with the drug, and six without it. The increase is just a tweak of the chemical system, and doesn't do anything to stop the underlying disease. To paraphrase a colleague's observation, I don't think it is worth $250 per month to name 11 animals in a minute versus 10 animals."
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