By Chris Woolston
CONSUMER HEALTH INTERACTIVE

Note: This article has been localised for an Irish audience.

Alzheimer's disease is like a cat burglar. It slips into a person's life without making a sound, and soon treasured possessions start disappearing: memory, personality and independence. For many years, even the top medical detectives in the country were baffled by such robbery. Doctors knew that Alzheimer's filled a person's brain with tangled strings of protein and sticky clumps of plaque, but nobody had a clue where this clutter came from. Worse, nobody knew how to help the victims. In the bad old days-which weren't that long ago-people with Alzheimer's were often locked away in asylums and controlled with heavy sedatives. Alzheimer's is still a dreadful, devastating condition, but the outlook for patients and their families is brighter than before. Thanks to a new understanding of the emotions and needs of Alzheimer's patients, families can call on many tried-and-trusted techniques for keeping loved ones comfortable. With support, most patients can face the disease for many years before having to move to a nursing home; some are able to remain with their families to the end.

Recent medical breakthroughs offer even more cause for hope. Researchers are beginning to understand exactly how Alzheimer's kills brain cells, and every new insight brings them closer to finding a cure for the terrifying affliction. Their work has already brought a payoff: doctors can now prescribe drugs to slow down the disease, and large-scale studies are putting promising new treatments to the test. Scientists are looking at everything from antioxidants, oestrogen, anti-inflammatory drugs, cholesterol-lowering drugs, and nerve-growth factors as possible elements in protecting against the disease. Indeed, the need for a cure has never been greater. At least 25,000 Irish men and women suffer with Alzheimer's disease, affecting approximately 6 percent of the population over 65 years of age and 20 percent of those over 80. Although mainly a disease of old age, it can strike as early as 30 years of age.

Currently, it's impossible to say who will develop Alzheimer's and who will be spared. Some people inherit genes that make them vulnerable to the disease, particularly in cases of early-onset Alzheimer's. But in most cases, a single family member is diagnosed with the disease late in life.

The first step in coping with Alzheimer's disease is knowing what to expect. Every case is different, but the disease tends to follow a predictable downward spiral. In the first stage, which may last two to four years, Alzheimer's is subtle and easily overlooked. In the beginning, people may have trouble coming up with the names of acquaintances or of common objects such as bread or sugar. They may put keys or an iron in odd places, like the refrigerator, and be unable to remember how they got there. Friends and relatives may notice small changes in mood, perhaps a loss of interest in favourite activities or unusually high levels of anxiety.

Later, the disease will start interfering with everyday life. People may start losing things and making unusual mistakes at home or at work. Pretty soon, jobs left undone, unpaid bills, and missed appointments start to pile up. The patient may notice a problem, but he or she will probably deny anything is wrong.

In the middle stage of the disease-which may go on seven or more years-memory loss and confusion begin to take over. Patients may begin to have trouble recognising family members or remembering events of the day before. They may ask the same question over and over again, never quite registering the answer. They may wander the house in the middle of the night, perhaps calling for a parent who died decades ago. Simple jobs like cooking, washing clothes, and even bathing become impossible. Many patients eventually lose control over bladder and bowels during this stage.

In the last stage of Alzheimer's, patients lose all touch with reality. They may not recognise anybody at all, or even their own face in the mirror. They will need help for even the simplest tasks, such as combing their hair. Eventually, they will be unable to walk or talk. Very few patients live more than 13 years after the onset of the disease. Even in this stage, however, Alzheimer's patients still respond to kindness and love. A loss of cognition is not a loss of one's feelings or one's humanity.

At every stage, Alzheimer's poses enormous challenges to family members. Many excellent resources, including the Alzheimer Society of Ireland Carer's Guide, help caregivers understand the disease and support their loved ones.

As Alzheimer's progresses, a caring family general practitioner will be an invaluable ally. First, he or she should make certain that the diagnosis is Alzheimer's rather than some of the other conditions that cause dementia or dementia-like symptoms. In addition to providing advice and guidance, he or she can prescribe medications to slow down a patient's decline or ease his depression or anxiety.

For instance, the drug rivastigmine can delay the progress of symptoms in some Alzheimer's patients, boosting memory and helping people perform the daily tasks of living. Another drug, donepezil, can help some patients recapture some of their lost mental capacity. These drugs don't work for all people, are only available on prescription, and they require monitoring by a general practitioner. Unfortunately, even the modest improvements brought on by drugs don't last, and in most cases Alzheimer's eventually continues its relentless march.

In the future, patients and their families may be able to buy precious time with products already in their medicine cabinet. Recent studies have suggested that large amounts of vitamin E and regular doses of common non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen may help protect the brain and slow the course of Alzheimer's. Hormone replacement therapy in post-menopausal women may also delay the onset of the disease, as oestrogen is suspected to offer some protection against it. But the studies on NSAIDs and other possible treatments are not definitive, and the optimism with which these findings were announced has faded considerably. Moreover, these treatments carry risks-large doses of vitamin E thin the blood and can lead to serious bleeding; common NSAIDS can cause ulcers and other complications; -and they should be tried only under a doctor's supervision.

All of these therapies are important advances-and they may one day seem as crude as the overuse of medicinal leeches. New discoveries are constantly fuelling the hope that Alzheimer's will soon become as treatable as hypertension or diabetes. One big breakthrough came in April 2000, when researchers at Massachusetts General hospital announced that magnetic resonance imaging (MRI) could help detect Alzheimer's in its earliest stages. Previously, doctors had to wait for an autopsy to see any physical proof of the disease. And in June 2000, scientists announced that they had identified an enzyme suspected of playing a key role in the disease.

This enzyme appears to work as a sort of chemical scissors. It makes two specific cuts in a long, yarn-like protein in the brain, an action that leads to the formation of deposits thought to kill brain cells. Scientists have strong evidence that the heretofore unknown enzyme-which they called gamma secreatase-is really the enzyme presenilin 1, which has already been linked to a rare inherited form of early-onset Alzheimer's. And by knowing what the enzyme is, researchers say, they may have a better chance of inhibiting it. As researchers continue to unravel the different genes, proteins, and enzymes that drive Alzheimer's, talk of a cure no longer seems too far-fetched. One day, it may even be possible to prevent the disease with a simple shot. In 1999, researchers announced that an experimental vaccine prevented the build-up of Alzheimer's-type plaque in the brains of mice. Preliminary studies suggest the vaccine may be safe for humans, and by 2002, researchers hope to know whether it can ward off the disease in people.

Currently there is no cure or even a satisfactory treatment for Alzheimer's disease. However, with the input of modern medicines and modern care techniques, at least the disease is now better managed. It should no longer be such an appalling tragedy for a family as it was in the past.

The Alzheimer's Society of Ireland Tel: 01-2846616

-- Chris Woolston is a contributing editor of Consumer Health Interactive. He also writes for WebMD, Hippocrates, and Time Inc. Health.

This article has been revised by Vhihealthe for its audience and may contain, among other things, information or medical practices that are unique to Ireland. Neither Consumer Health Interactive nor the original author make any warranty as to the accuracy of the article as revised, and assume no responsibility for modified content.

First published March 21, 2001
Copyright © 2000 Consumer Health Interactive

• If you suspect a loved one has Alzheimer's, seek a diagnosis from a doctor. Many people may fear that memory loss is evidence of the disease, but it may be a sign of normal aging, a drug reaction or vitamin B12 deficiency, or another condition entirely. • Bring a list of questions to ask the doctor about Alzheimer's. Taking another family member or friend along will help you remember what he or she said. • If you're a caregiver, try to take good care of yourself as well. Read our story on recognizing symptoms of stress. • If you or your loved one has Alzheimer's, join a support group. Such groups offer a wealth of information and tips about services that you can tap.

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