Alzheimer's disease: Difference between revisions

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'''Alzheimer's disease''' causes incresing neurodegeneration of the brain, leading to accelerated memory loss.  The incorrect folding of [[protein folding|proteins]] leads to the formation of amyloid plaques.  Current research aims to determine if such plaques are the result of, or the cause of, Alzheimer's disease.


==Treatment==
'''Alzheimer's disease''' is also known as '''Alzheimer disease''', '''Alzheimer's''' and simply '''AD'''. It sometimes incorrectly called "Old timer's disease".
There is currently no cure for Alzheimer's disease.  Currently available medications offer relatively small symptomatic benefit for some patients but do not slow disease progression. The American Association for Geriatric Psychiatry published a consensus statement on Alzheimer's treatment in 2006.<ref name="pmid16816009">{{cite journal |author=Lyketsos CG, Colenda CC, Beck C, ''et al'' |title=Position statement of the American Association for Geriatric Psychiatry regarding principles of care for patients with dementia resulting from Alzheimer disease |journal=The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry |volume=14 |issue=7 |pages=561–72 |year=2006 |pmid=16816009 |doi=10.1097/01.JGP.0000221334.65330.55}}</ref>


===Atypical antipsychotics===
Alzheimer's the most common cause of [[dementia]], afflicting 24&nbsp;million people worldwide. Alzheimer's is a [[Terminal illness|terminal disease]] for which there is currently no known cure. It is most commonly found in people over 65&nbsp;years old, although a less-common form also occurs called [[early-onset Alzheimer's]] (or [[Familial Alzheimer's disease]]).<ref name="pmid16360788">
{{cite journal
|author=Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, Hall K, Hasegawa K, Hendrie H, Huang Y, Jorm A, Mathers C, Menezes PR, Rimmer E, Scazufca M
|title=Global prevalence of dementia: a Delphi consensus study
|journal=Lancet
|volume=366
|issue=9503
|pages=2112–2117
|year=2005
|pmid=16360788
|doi=10.1016/S0140-6736(05)67889-0
|url=
}}</ref>
 
Typically, the disease begins many years before it is diagnosed. In its early stages, [[short-term memory]] loss is the most common symptom, which is is often initially thought by the sufferer to be caused by other factors, such as aging or stress.<ref name="alzdiag">{{cite journal
|author=Waldemar G, Dubois B, Emre M, Georges J, McKeith IG, Rossor M, Scheltens P, Tariska P, Winblad B
|title=Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline
|journal=European Journal of Neurology
|volume=14
|issue=1
|pages=E1–26
|year=2007
|pmid=17222085
|doi=10.1111/j.1468-1331.2006.01605.x
}}</ref>
Later symptoms of the disease include confusion, anger, mood swings, language breakdown, [[long-term memory]] loss, and the general "withdrawal" of the sufferer as his or her senses decline.<ref name="alzdiag"/><ref name="pmid17823840">{{cite journal
|author=Tabert MH, Liu X, Doty RL, Serby M, Zamora D, Pelton GH, Marder K, Albers MW, Stern Y, Devanand DP
|title=A 10-item smell identification scale related to risk for Alzheimer's disease
|journal=Ann. Neurol.
|volume=58
|issue=1
|pages=155–60
|year=2005
|pmid=15984022
|doi=10.1002/ana.20533
}}</ref>
Gradually the sufferer will lose minor, and then major bodily functions, until [[death]] finally occurs.<ref name="nihstages">
{{cite web
| title=Understanding Stages and Symptoms of Alzheimer's Disease
| url=http://www.nia.nih.gov/Alzheimers/Publications/stages.htm
| publisher=National Institute on Aging
| date=2007-10-26
| accessdate=2008-02-21
}}</ref>
Survival after diagnosis has been estimated to be between 5 and 20&nbsp;years.<ref name="NINDS Prognosis">
{{cite web
|url=http://www.ninds.nih.gov/disorders/alzheimersdisease/alzheimersdisease.htm#What_is_the_prognosis
|title=Alzheimer's Disease Information Page
|publisher= National Institute of Neurological Disorders and Stroke (NINDS)
|date=2008-02-07
|accessdate=2008-02-12
}}</ref><ref name="healthlink">
{{cite web
| title=Alzheimer's Disease Treatment and Prognosis
| url=http://healthlink.mcw.edu/article/921383587.html
| publisher=Healthlink
| accessdate=2008-02-15
}}</ref>
 
===Symptoms===
 
Although the symptoms are common, they are typically experienced in unique ways.<ref name="alzheimers.org">
{{cite web
| title=What is Alzheimer’s disease?
| url=http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=100
| publisher=www.alzheimers.org.uk
| date=August 2007
| accessdate=2008-02-21
}}</ref> 
"Stages" are commonly referred to by professionals to describe the [[progressive disease|progressive]] nature of Alzheimer's (typically "early", "mid" and "late onset") but the symptoms can cross over these "boundaries" for many sufferers.
 
===Diagnosis===
 
The symptoms of Alzheimer's disease are generally reported to a doctor or physician when memory-loss (or symptoms surrounding memory loss) begin to pose a serious concern. When Alzheimer’s disease is suspected, diagnosis is typically confirmed by a behavioural assessment, and some form of [[cognitive test]]. Often this is followed by a [[brain scan]].<ref name="alzres">
{{cite web
| title=Alzheimer's Diagnosis of AD
| url=http://www.alzheimers-research.org.uk/info/diagnosis/
| publisher=Alzheimer's Reearch Trust
| accessdate=2008-02-29
}}</ref>
 
===Causes===
 
The actual cause, or causes of Alzheimer's disease is unknown, but it is known to be associated with "[[Senile plaques]]" and "[[neurofibrillary tangles]]" in the [[brain]].<ref name="pmid15184601"/> There are many ideas about possible causes and cures of the disease.
 
==== Research ====
 
Alzheimer's disease causes incresing neurodegeneration of the brain, leading to accelerated memory loss.  The incorrect folding of [[protein folding|proteins]] leads to the formation of amyloid plaques.  Current research aims to determine if such plaques are the result of, or the cause of, Alzheimer's disease.
 
===Treatment===
 
No treatment has been found to stop or reverse the disease, and it is not known whether current preferred treatments directly slow the spread of Alzheimer's in the brain, or simply manage the symptoms - and thus slow the progression of the disease that way. Many preventative measures have been suggested for Alzheimer's disease, but their values are uncertain: mental stimulation, [[exercise]] and a [[balanced diet]] are usually recommended, both as a possible prevention and as a sensible way of managing the disease.<ref name="prevention">
{{cite web
| title=The Search for AD Prevention Strategies
| url=http://www.nia.nih.gov/Alzheimers/Publications/ADPrevented/chap03.htm.htm
| publisher=National Institute on Aging
| accessdate=2008-02-29
| date =2006-08-29
}}</ref>
 
====Pharmaceutical====
 
Currently available medications offer relatively small symptomatic benefit for some patients but do not slow disease progression. The American Association for Geriatric Psychiatry published a consensus statement on Alzheimer's treatment in 2006.<ref name="pmid16816009">{{cite journal |author=Lyketsos CG, Colenda CC, Beck C, ''et al'' |title=Position statement of the American Association for Geriatric Psychiatry regarding principles of care for patients with dementia resulting from Alzheimer disease |journal=The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry |volume=14 |issue=7 |pages=561–72 |year=2006 |pmid=16816009 |doi=10.1097/01.JGP.0000221334.65330.55}}</ref>
 
=====Atypical antipsychotics=====
A [[systematic review]] found that the atypical antipsychotics [[risperidone]] and [[olanzapine]] showed the most benefit of all drugs; however they may increased the risk of [[stroke]].<ref name="pmid15687315">{{cite journal |author=Sink KM, Holden KF, Yaffe K |title=Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence |journal=JAMA |volume=293 |issue=5 |pages=596–608 |year=2005 |pmid=15687315 |doi=10.1001/jama.293.5.596}}</ref>
A [[systematic review]] found that the atypical antipsychotics [[risperidone]] and [[olanzapine]] showed the most benefit of all drugs; however they may increased the risk of [[stroke]].<ref name="pmid15687315">{{cite journal |author=Sink KM, Holden KF, Yaffe K |title=Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence |journal=JAMA |volume=293 |issue=5 |pages=596–608 |year=2005 |pmid=15687315 |doi=10.1001/jama.293.5.596}}</ref>


===Acetylcholinesterase inhibitors===
=====Acetylcholinesterase inhibitors=====
[[Randomized controlled trial]]s showed either small or absent benefit from [[acetylcholinesterase inhibitors]]<ref> {{cite journal | author = Kaduszkiewicz H, Zimmermann T, Beck-Bornholdt H, van den Bussche H | title = Cholinesterase inhibitors for patients with Alzheimer's disease: systematic review of randomised clinical trials. | journal = BMJ | volume = 331 | issue = 7512 | pages = 321-7 | year = 2005 | id = PMID 16081444}} </ref> such as [[donepezil]].<ref name="pmid17914039">{{cite journal |author=Howard RJ, Juszczak E, Ballard CG, ''et al'' |title=Donepezil for the treatment of agitation in Alzheimer's disease |journal=N. Engl. J. Med. |volume=357 |issue=14 |pages=1382–92 |year=2007 |pmid=17914039 |doi=10.1056/NEJMoa066583}}</ref><ref>{{cite journal | author = Courtney C, '''Farrell D''', Gray R, Hills R, Lynch L, Sellwood E, Edwards S, Hardyman W, Raftery J, Crome P, Lendon C, Shaw H, Bentham P | title = Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomised double-blind trial. | journal = Lancet | volume = 363 | issue = 9427 | pages = 2105-15 | year = 2004 | id = PMID 15220031}}</ref>
[[Randomized controlled trial]]s showed either small or absent benefit from [[acetylcholinesterase inhibitors]]<ref> {{cite journal | author = Kaduszkiewicz H, Zimmermann T, Beck-Bornholdt H, van den Bussche H | title = Cholinesterase inhibitors for patients with Alzheimer's disease: systematic review of randomised clinical trials. | journal = BMJ | volume = 331 | issue = 7512 | pages = 321-7 | year = 2005 | id = PMID 16081444}} </ref> such as [[donepezil]].<ref name="pmid17914039">{{cite journal |author=Howard RJ, Juszczak E, Ballard CG, ''et al'' |title=Donepezil for the treatment of agitation in Alzheimer's disease |journal=N. Engl. J. Med. |volume=357 |issue=14 |pages=1382–92 |year=2007 |pmid=17914039 |doi=10.1056/NEJMoa066583}}</ref><ref>{{cite journal | author = Courtney C, '''Farrell D''', Gray R, Hills R, Lynch L, Sellwood E, Edwards S, Hardyman W, Raftery J, Crome P, Lendon C, Shaw H, Bentham P | title = Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomised double-blind trial. | journal = Lancet | volume = 363 | issue = 9427 | pages = 2105-15 | year = 2004 | id = PMID 15220031}}</ref>


===N-methyl d-aspartate (NMDA) antagonists===
=====N-methyl d-aspartate (NMDA) antagonists=====
The [[N-methyl-d-aspartate receptor]] antagonist [[memantine]] has shown effectiveness.<ref name="Areosa">{{cite journal | author = Areosa Sastre A, McShane R, Sherriff F | title =  Memantine for dementia. | journal = Cochrane Database Syst Rev | pages = CD003154 | id = PMID 15495043}}</ref>
The [[N-methyl-d-aspartate receptor]] antagonist [[memantine]] has shown effectiveness.<ref name="Areosa">{{cite journal | author = Areosa Sastre A, McShane R, Sherriff F | title =  Memantine for dementia. | journal = Cochrane Database Syst Rev | pages = CD003154 | id = PMID 15495043}}</ref>
==== Care management ====
Due to the incurable and degenerative nature of the disease care-management of Alzheimer's is essential. The role of the main Carer is often taken by the spouse or a close relative.<ref name="glam">{{
cite journal
|url=http://www.cncforum.me.uk/S.O'Donovan%20PhD%20Thesis%20Exec%20Summary%202004.pdf
|author=O’Donovan ST
|title=Dementia caregiving burden and breakdown
|format=PDF
|publisher=Forum of Consultant Nurses, Midwives and Allied Health Professionals
|accessdate=2008-02-29
}}</ref>
Caregivers may themselves suffer from [[stress]], over-work, [[depression]], and from being physically assailed.<ref name="burden1">{{
cite journal
|author=Selwood A, Johnston K, Katona C, Lyketsos C, Livingston G
|title=Systematic review of the effect of psychological interventions on family caregivers of people with dementia
|journal=Journal of Affective Disorders
|volume=101
|issue=1-3
|pages=75–89
|year=2007
|pmid=17173977
|doi=10.1016/j.jad.2006.10.025
}}</ref>
=== Alzheimer's in society ===
Famous people who have, or have died of Alzheimer's disease, are the [[president of the United States of America|US president]] [[Ronald Reagan]], the [[Prime Minister of the United Kingdom| UK Prime minister]] [[Harold Wilson]], the writers [[Terry Pratchett]] and [[Iris Murdoch]], and the film stars [[Rita Hayworth]] and [[Charlton Heston]].


==References==
==References==
<references/>
<references/>

Revision as of 16:14, 26 March 2008

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https://en.citizendium.org/wiki/index.php?title=Alzheimer%27s_disease&printable=yes
This editable Main Article is under development and subject to a disclaimer.

Alzheimer's disease is also known as Alzheimer disease, Alzheimer's and simply AD. It sometimes incorrectly called "Old timer's disease".

Alzheimer's the most common cause of dementia, afflicting 24 million people worldwide. Alzheimer's is a terminal disease for which there is currently no known cure. It is most commonly found in people over 65 years old, although a less-common form also occurs called early-onset Alzheimer's (or Familial Alzheimer's disease).[1]

Typically, the disease begins many years before it is diagnosed. In its early stages, short-term memory loss is the most common symptom, which is is often initially thought by the sufferer to be caused by other factors, such as aging or stress.[2] Later symptoms of the disease include confusion, anger, mood swings, language breakdown, long-term memory loss, and the general "withdrawal" of the sufferer as his or her senses decline.[2][3] Gradually the sufferer will lose minor, and then major bodily functions, until death finally occurs.[4] Survival after diagnosis has been estimated to be between 5 and 20 years.[5][6]

Symptoms

Although the symptoms are common, they are typically experienced in unique ways.[7] "Stages" are commonly referred to by professionals to describe the progressive nature of Alzheimer's (typically "early", "mid" and "late onset") but the symptoms can cross over these "boundaries" for many sufferers.

Diagnosis

The symptoms of Alzheimer's disease are generally reported to a doctor or physician when memory-loss (or symptoms surrounding memory loss) begin to pose a serious concern. When Alzheimer’s disease is suspected, diagnosis is typically confirmed by a behavioural assessment, and some form of cognitive test. Often this is followed by a brain scan.[8]

Causes

The actual cause, or causes of Alzheimer's disease is unknown, but it is known to be associated with "Senile plaques" and "neurofibrillary tangles" in the brain.[9] There are many ideas about possible causes and cures of the disease.

Research

Alzheimer's disease causes incresing neurodegeneration of the brain, leading to accelerated memory loss. The incorrect folding of proteins leads to the formation of amyloid plaques. Current research aims to determine if such plaques are the result of, or the cause of, Alzheimer's disease.

Treatment

No treatment has been found to stop or reverse the disease, and it is not known whether current preferred treatments directly slow the spread of Alzheimer's in the brain, or simply manage the symptoms - and thus slow the progression of the disease that way. Many preventative measures have been suggested for Alzheimer's disease, but their values are uncertain: mental stimulation, exercise and a balanced diet are usually recommended, both as a possible prevention and as a sensible way of managing the disease.[10]

Pharmaceutical

Currently available medications offer relatively small symptomatic benefit for some patients but do not slow disease progression. The American Association for Geriatric Psychiatry published a consensus statement on Alzheimer's treatment in 2006.[11]

Atypical antipsychotics

A systematic review found that the atypical antipsychotics risperidone and olanzapine showed the most benefit of all drugs; however they may increased the risk of stroke.[12]

Acetylcholinesterase inhibitors

Randomized controlled trials showed either small or absent benefit from acetylcholinesterase inhibitors[13] such as donepezil.[14][15]

N-methyl d-aspartate (NMDA) antagonists

The N-methyl-d-aspartate receptor antagonist memantine has shown effectiveness.[16]

Care management

Due to the incurable and degenerative nature of the disease care-management of Alzheimer's is essential. The role of the main Carer is often taken by the spouse or a close relative.[17] Caregivers may themselves suffer from stress, over-work, depression, and from being physically assailed.[18]

Alzheimer's in society

Famous people who have, or have died of Alzheimer's disease, are the US president Ronald Reagan, the UK Prime minister Harold Wilson, the writers Terry Pratchett and Iris Murdoch, and the film stars Rita Hayworth and Charlton Heston.

References

  1. ↑ Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, Hall K, Hasegawa K, Hendrie H, Huang Y, Jorm A, Mathers C, Menezes PR, Rimmer E, Scazufca M (2005). "Global prevalence of dementia: a Delphi consensus study". Lancet 366 (9503): 2112–2117. DOI:10.1016/S0140-6736(05)67889-0. PMID 16360788. Research Blogging.
  2. ↑ 2.0 2.1 Waldemar G, Dubois B, Emre M, Georges J, McKeith IG, Rossor M, Scheltens P, Tariska P, Winblad B (2007). "Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline". European Journal of Neurology 14 (1): E1–26. DOI:10.1111/j.1468-1331.2006.01605.x. PMID 17222085. Research Blogging.
  3. ↑ Tabert MH, Liu X, Doty RL, Serby M, Zamora D, Pelton GH, Marder K, Albers MW, Stern Y, Devanand DP (2005). "A 10-item smell identification scale related to risk for Alzheimer's disease". Ann. Neurol. 58 (1): 155–60. DOI:10.1002/ana.20533. PMID 15984022. Research Blogging.
  4. ↑ Understanding Stages and Symptoms of Alzheimer's Disease. National Institute on Aging (2007-10-26). Retrieved on 2008-02-21.
  5. ↑ Alzheimer's Disease Information Page. National Institute of Neurological Disorders and Stroke (NINDS) (2008-02-07). Retrieved on 2008-02-12.
  6. ↑ What is Alzheimer’s disease?. www.alzheimers.org.uk (August 2007). Retrieved on 2008-02-21.
  7. ↑ Alzheimer's Diagnosis of AD. Alzheimer's Reearch Trust. Retrieved on 2008-02-29.
  8. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named pmid15184601
  9. ↑ The Search for AD Prevention Strategies. National Institute on Aging (2006-08-29). Retrieved on 2008-02-29.
  10. ↑ Lyketsos CG, Colenda CC, Beck C, et al (2006). "Position statement of the American Association for Geriatric Psychiatry regarding principles of care for patients with dementia resulting from Alzheimer disease". The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry 14 (7): 561–72. DOI:10.1097/01.JGP.0000221334.65330.55. PMID 16816009. Research Blogging.
  11. ↑ Sink KM, Holden KF, Yaffe K (2005). "Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence". JAMA 293 (5): 596–608. DOI:10.1001/jama.293.5.596. PMID 15687315. Research Blogging.
  12. ↑ Kaduszkiewicz H, Zimmermann T, Beck-Bornholdt H, van den Bussche H (2005). "Cholinesterase inhibitors for patients with Alzheimer's disease: systematic review of randomised clinical trials.". BMJ 331 (7512): 321-7. PMID 16081444.
  13. ↑ Howard RJ, Juszczak E, Ballard CG, et al (2007). "Donepezil for the treatment of agitation in Alzheimer's disease". N. Engl. J. Med. 357 (14): 1382–92. DOI:10.1056/NEJMoa066583. PMID 17914039. Research Blogging.
  14. ↑ Courtney C, Farrell D, Gray R, Hills R, Lynch L, Sellwood E, Edwards S, Hardyman W, Raftery J, Crome P, Lendon C, Shaw H, Bentham P (2004). "Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomised double-blind trial.". Lancet 363 (9427): 2105-15. PMID 15220031.
  15. ↑ Areosa Sastre A, McShane R, Sherriff F. "Memantine for dementia.". Cochrane Database Syst Rev: CD003154. PMID 15495043.
  16. ↑ O’Donovan ST. "Dementia caregiving burden and breakdown" (PDF). Retrieved on 2008-02-29.
  17. ↑ Selwood A, Johnston K, Katona C, Lyketsos C, Livingston G (2007). "Systematic review of the effect of psychological interventions on family caregivers of people with dementia". Journal of Affective Disorders 101 (1-3): 75–89. DOI:10.1016/j.jad.2006.10.025. PMID 17173977. Research Blogging.
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