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Thief of Memory: Alzheimer's Examined In his years of practice, neurologist Allen Josephs, M.D., has found that the typical individual with Alzheimer's disease does not come to his office because he or she is concerned about having this dreaded condition. Instead, in the majority of cases, it is the spouse and/or an adult child that insists on the visit. The Diagnosis Often, the patient will sit silently in Dr. Josephs' office as the spouse describes a pattern of behavior change over the last two to three years. He used to read the paper, but now seems disinterested. He used to manage the finances, but now cannot balance a checkbook. He gets lost while driving and constantly repeats himself. His interest in beloved activities has waned and he watches television all day or sits around and sleeps. Dr. Josephs gives the individual a Mini-Mental Status Examination. In the Alzheimer's patient, questions that involve short-term memory will be met with confusion. Individuals may not know the date or be able to follow commands or repeat a series of items. In one part of the exam, Dr. Josephs tells the individual that he or she will be required to repeat three items in five minutes. Not only will an Alzheimer's patient not remember the items, he or she also may not recall that the physician said that this line of questioning would take place. The memory test is followed by a neurologic exam and neurological testing, with MRI or CAT scan, to rule out any potentially reversible conditions. If the patient is diagnosed with Alzheimer's, the condition can be expected to progress for about eight to ten years, depending on the age of onset and and other medical problems. As the condition worsens, the patient becomes bedridden and incontinent and often succumbs to pneumonia or other illness. "Alzheimer's is usually a slow, insidious disorder that chips away at the individual," says Dr. Josephs. "As a physician, it is a very painful diagnosis to deliver. Most families do not immediately ask me what the future holds because they do not want to know." Alzheimer's Defined Alzheimer's disease, the most common form of dementia, is a degenerative disease of the brain that usually occurs in the later years of life and causes profound changes in personality and mental functioning. Dr. Josephs says that while genetics may play a minor role in this condition, the primary risk factor for developing Alzheimer's aging itself. One in 10 persons over 65 and nearly of those over 85 have Alzheimer's disease. As the boomers age, it is estimated that 14 million Americans will have Alzheimer's by the middle of the next century. It is a fact that as we age, we lose memory. However, the difference between normal aging and Alzheimer's disease is the degree to which the memory loss interferes with daily activity, says Dr. Josephs. In Alzheimer's disease, unlike normal senescence of aging, the affected individual's brain actually undergoes pathological changes, particularly in the temporal and frontal lobes. Interestingly enough, while short-term memory is radically affected, long-term memory is often still intact. "It is thought that long-term memories, such as where you lived as a child, are stored chemically in the brain," he relates. "Short-term memory, on the other hand, be first stored electronically and later converted. This Tragically, while a patient might recall that he or she has a spouse or a child, diminished short-term memory does not allow the patient to recognize the faces of loved ones as they have aged over time. For a spouse of 40 years to suddenly not be recognized can be "Caregivers typically suffer much more than the patient," says Dr. Josephs. "While the patient may not recognize that he or she is declining, the caregiver knows what been lost. And, unlike an acute illness where you can nurse someone back to health, the patient is only going to get worse." Treating the Alzheimer's Patient While there is no known cure for Alzheimer's disease, there are four prescription medications approved as treatments by the Food and Drug Administration: tacrine (rarely prescribed due to serious side effects), donepezil, rivastigmine and galantamine, which was approved in 2001 and is sold as Reminyl®. The Alzheimer's Association reports that the degree of improvement in memory as a result of thesemedications is modest at best. These medications, known as cholinesterase inhibitors, are designed to enhance memory by influencing certain chemical activities in the brain. Acetylcholine is a chemical messenger that scientists believe is important for the function of brain cells involved in memory. In the Alzheimer's-afflicted brain, the cells that use acetylcholine are damaged or destroyed, resulting in lower levels of the chemical messenger. A cholinesterase inhibitor is designed to slow the breakdown of acetylcholine. Looking to other approaches, Dr. Josephs cites research published in The New England Journal of Medicine in 1997 demonstrating that large amounts of vitamin E may slow the progression of the disease. In this two-year study of 341 individuals with Alzheimer's, it was found that 2,000 IU per day of vitamin E extended the time patients were able to care for themselves, compared to those taking a placebo. Dr. Josephs also recommends adequate intake of the B vitamins and Vitamin C, not only for Alzheimer's patients but also for those who are concerned about the genetic risk of Alzheimer's. He sites studies that have shown that Alzheimer's patients tend to have low levels of B12. In other developments, Dr. Josephs describes work in the area of brain tissue transplant and vaccines to decrease amyloid proteins, a brain plaque. This research, he adds,is probably many years away from direct use. Caregiver Support
"In later stages, Alzheimer's patients may require 24-hour supervision, For a referral to a Saint Barnabas Medical Center neurologist, please call 1-888-SBMC-DOC. For information about any of the nine Saint Barnabas Health Care System Nursing and Rehabilitation Centers, please refer to the System's web site at www.barnabashealth.org or call 1-800-222-9147. For information about the Alzheimer's Dementia Special Care Unit, expected to open in late Fall 2001 at Llanfair House Nursing and Rehabilitation Center, Wayne, NJ, please call (973) 835-7443. [ top ] |
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"Generally, when I ask the potential Alzheimer's patient how things are going, the reply is that nothing seems different or that everything is fine," relates Dr. Josephs, Co-Chief of Neurology at Saint Barnabas Medical Center. "They lack awareness of the illness and are not overly upset by what most people would view as devastating life changes. Quite literally, they forget that they forget."
Most vital to the Alzheimer's patient is that his or her caregiver stay mentally and physicallyhealthy.
