~Alzheimer's Disease

~Alzheimer's Disease
Reprinted with permission of Life Extension®.



Alzheimer's disease was first described in 1907 by Alois Alzheimer, a German psychiatrist. He noted the pathologic hallmarks of the disease, including neurofibrillary tangles and senile plaques. The symptoms of Alzheimer's disease usually begin in the seventh to ninth decades of life, although early-onset familial forms of the illness are well-described.

The most characteristic symptom of Alzheimer's disease is a profound impairment of recent memory. Individuals begin to misplace everyday items, such as the car keys or eyeglasses, and become disoriented and get lost in familiar surroundings, such as when driving on well-known streets. As the disease progresses they may experience mood swings with anxiety, depression, or aggressive behavior. They often become uninterested in usual activities. In the terminal phase, there is apathy and an inability to communicate.

Neuropsychiatric symptoms that commonly accompany Alzheimer's disease include (Cummings 2001):

  • Agitation, 60-70% of patients
  • Apathy, 60-70%
  • Depression, 50%
  • Anxiety, 50%
  • Irritability, 50%
  • Delusional disorders and psychosis, 40-50%
  • Disinhibition, 30%
  • Hallucinations, 10%


Incidence

Alzheimer's disease is the leading cause of dementia in the elderly and is the fourth leading cause of death in developed nations (after heart disease, cancer, and stroke). Up to 70% of dementia cases are due to Alzheimer's disease, with blood vessel disease (stroke and atherosclerosis) being the second most common cause.

As age advances, the risk of developing Alzheimer's disease rises sharply. The frequency of Alzheimer's among 60-year-olds is about 1%. This incidence doubles approximately every 5 years, becoming 2% at age 65, 4% at 70, 8% at 75, 16% at 80, and 32% at 85. It is estimated that as many as two-thirds of those in their nineties suffer from some form of dementia. For those who aspire to live a very long life, dementia is a threat second only to death. Some believe that dementia is a natural way to end life.

There are over 100,000 deaths per year related to Alzheimer's disease. Four million people and their families suffer from this disease. Annual costs to the United States from Alzheimer's disease are over $60 billion. If a treatment was developed that only delayed the onset of the disease by five years, costs to society would decrease by about half and save $30-$40 billion each year in this country alone (Martin 1999).

Course

Alzheimer's disease leads to death within an average of 8 years after diagnosis, the last 3 years of which are typically spent in an institution. Besides memory loss, Alzheimer's patients show dramatic personality changes, disorientation, declining physical coordination, and an inability to care for themselves. In the final stages, victims are bedridden, lose urinary and bowel control, and are completely dependent on the care of others. Death is usually due to pneumonia or urinary tract infection.

Risk Factors

There are a wide range of risk factors associated with the development of dementia. Many consider Alzheimer's disease to be caused by several different factors. Three different risk factor hypotheses are summarized below.

Diagnosis

  • Very likely: advanced age, family history of Alzheimer's or Parkinson's disease, apolipoprotein E-e4 (ApoE-e4) gene expression, head trauma, reduced blood flow, stroke, estrogen imbalance, poor word fluency
  • Likely: toxic damage, alcohol abuse, nutrient deficiencies to the brain, neurotransmitter deficits, metabolic defects, underactivity, lower educational level
  • Possible: aluminum exposure, depression, latent viruses, sugar consumption, olfactory deficit, coronary artery disease


Alzheimer's disease is the most common cause of dementia. However, it is a diagnosis of exclusion. The diagnosis is only 85-90% accurate and the diagnosis is only absolutely confirmed by brain biopsy after death. Brain biopsy is usually unacceptable prior to death, and other causes of dementia must be considered and eliminated before the diagnosis of Alzheimer's is made.

Alzheimer's-like symptoms can be manifested by a variety of different diseases including:

  • Neurological damage that occurs after a stroke or with multiple infarctions
  • Space-occupying lesions in the brain, such as brain cancer and subdural hematoma
  • Other neurological disorders, such as Parkinson's disease (a deficiency of dopamine), Huntington's disease, and multiple sclerosis
  • Infectious diseases such as meningitis, late-stage syphilis, and AIDS
  • Endocrine disorders, such as hypothyroidism and hypoglycemia
  • Cardiovascular disorders, such as congestive heart failure and vascular disease
  • Liver or kidney dysfunction


Nutritional deficiencies of vitamin E, magnesium, and B vitamins (B12, folic acid, niacin, and thiamin) can also produce symptoms which might be mistaken for dementia.

Assessment

Currently, the most respected standard for assessing the status of Alzheimer's patients is the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog). Memory, orientation, language, and functionality are measured on a 70-point scale that increases (on average) by 7 to 10 points per year as the patient's cognition worsens. A decrease of 4 points corresponds to a clinically significant reversal of symptoms of nearly half a year.

The Mini-Mental Status Exam (MMSE) is frequently used for a quick clinical assessment in following patients with Alzheimer's disease. The MMSE checks for orientation and simple thinking ability.

Lab Tests

Standard lab tests for Alzheimer's disease include:

  • Complete Blood Count (CBC)
  • Thyroid panel: T3, T4, TSH
  • Liver function tests
  • STD testing: VRDL for syphilis, HIV if young
  • EKG to assess heart function
  • EEG to differentiate focal vs. diffuse brain dysfunction
  • Vitamin B12 and folate levels


A CT or MRI of the head is usually ordered to determine if the symptoms are caused by multi-infarct dementia or a subdural hematoma.

Several alternative lab tests may be helpful in evaluating patients with Alzheimer's disease to guide treatments. These include:

  • A comprehensive hormone panel, including estrogen (E1, E2, and E3), progesterone, testosterone, and melatonin
  • Adrenal function test, including cortisol and DHEA
  • Oxidative stress levels
  • Essential Fatty Acid Panel
  • Homocysteine, B6, B12, and folate levels
  • Markers of inflammation, including C-Reactive Protein (CRP)
  • Hair mineral analysis to assess heavy metal toxicity
  • A comprehensive vitamin panel (including vitamins A, C, E, K, and beta-carotene)


Continued . . .


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