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slowly destroys memory and thinking skills and, eventually, the ability to
carry out the simplest tasks of daily living. In most people with AD,
symptoms first appear after age 60.
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• Alzheimer's and the brain
Just like the rest of our bodies, our brains change as we
age. Most of us notice some slowed thinking and occasional
problems remembering certain things. However, serious
memory loss, confusion and other major changes in the way
our minds work are not a normal part of aging. They may be
a sign that brain cells are failing.
The brain has 100 billion nerve cells (neurons). Each nerve
cell communicates with many others to form networks.
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History
At a scientific meeting in November 1906, German physician
Alois Alzheimer presented the case of “Frau Auguste D.,” a
51-year-old woman brought to see him in 1901 by her
family. Auguste had developed problems with memory,
unfounded suspicions that her husband was unfaithful, and
difficulty speaking and understanding what was said to her.
Her symptoms rapidly grew worse, and within a few years
she was bedridden. She died in Spring 1906, of
overwhelming infections from bedsores and pneumonia.
Total healthcare costs are more than three times higher for
people with Alzheimer’s and other dementias than for other
people age 65 and older, according to the Alzheimer’s
Association’s 2009 Alzheimer’s Disease Facts and Figures,
released today.
New report
2009 Alzheimer's
Disease
Facts and Figures
* Payments by source do not exactly equal total payments due to the effect of population weighting.
Source: Alzheimer’s Association 2009 Alzheimer’s Disease Facts and Figures
The new Facts and Figures report highlights the BRFSS survey
findings from the states of Washington and North Carolina. The
BRFSS survey allows residents to say for themselves what their
challenges are. For example in Washington, 48 percent of the
caregivers for individuals with memory loss or cognitive
impairment revealed that stress was the greatest difficulty they
faced. Beginning this year, an approved set of family caregiving
questions is available for all states to add to their BRFSS survey,
and another set of questions on cognitive impairment is being
developed for 2010.
According to the FDA, as of May 2006, the agency had not been
presented with any scientific evidence that would lead to change
its conclusions on the safety of aspartame for most people. The
agency says its conclusions are based on more than 100
laboratory and clinical studies. Read the May 2006 FDA statement
about aspartame.
Misplacing things.
Loss of initiative.
Help for you and your loved ones – Care and support services
are available, making it easier for you and your family to live the
best life possible with Alzheimer’s or dementia.
Learn how the Alzheimer's Association helps families.
Risk Factors
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• Introduction
• Risk factors
Introduction
While scientists know Alzheimer’s disease involves progressive
brain cell failure, they have not yet identified any single reason
why cells fail. However, they have identified certain risk factors
that increase the likelihood of developing Alzheimer’s.
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Risk factors
Age
The greatest known risk factor for Alzheimer’s is increasing age.
Most individuals with the disease are 65 or older. The likelihood of
developing Alzheimer’s doubles about every five years after age
65. After age 85, the risk reaches nearly 50 percent.
Family history
Another risk factor is family history. Research has shown that
those who have a parent, brother or sister, or child with
Alzheimer’s are more likely to develop Alzheimer’s. The risk
increases if more than one family member has the illness. When
diseases tend to run in families, either heredity (genetics) or
environmental factors or both may play a role.
Genetics (heredity)
Scientists know genes are involved in Alzheimer’s. There are two
categories of genes that can play a role in determining whether a
person develops a disease. Alzheimer genes have been found in
both categories:
Genetic tests are available for both APOE-e4 and the rare genes
that directly cause Alzheimer’s. However, health professionals do
not currently recommend routine genetic testing for Alzheimer’s
disease. Testing for APOE-e4 is sometimes included as a part of
research studies.
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• Brain imaging
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Neurological exam
The neurological examination is an important part of the physical.
Its goal is to assess the function of the brain and nervous system
to identify symptoms of brain disorders other than Alzheimer’s.
• Reflexes
• Coordination and balance
• Muscle tone and strength
• Eye movement
• Speech
• Sensation
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Brain imaging
New imaging technologies have revolutionized our understanding
of the structure and function of the living brain.
Today, Medicare will cover a PET scan for Alzheimer’s only to help
distinguish the disease from frontotemporal dementia, a rare
related disorder that may cause dramatic loss of function in the
front and side regions of the brain.
Find out if the doctor will manage care going forward and, if not,
who will be the primary doctor. The diagnosing doctor can then
schedule the next appointment or provide a referral.
Planning ahead
Planning for the future plays an important part in making life
better for those living with Alzheimer’s. Advance planning enables
individuals with Alzheimer’s to make their wishes about medical
care and living arrangements known. Knowing what to expect can
help foster ease of mind for all concerned.
You can plan for the right care by using the Alzheimer’s
Association CareFinder™. This Web guide helps individuals and
families make informed decisions when selecting a care provider
for home-based or residential care.
After you enter information about your situation, the guide gives
you a confidential, customized report with care recommendations
and questions to ask providers. The CareFinder guide will also
help you learn how to recognize good care, plan for care,
communicate with care providers and find local support.
Treatments
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In this section:
• Standard Treatments
• Vitamin E
• Treatments for Sleep Changes
• Alternative Treatments
Standard Treatments
• Introduction
• Treatments for cognitive symptoms
• Treatments for behavioral symptoms
• Talking with the doctor
• More information
Introduction
Health professionals often divide the symptoms of Alzheimer's
disease into "cognitive" and "behavioral and psychiatric"
categories.
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These drugs:
Memantine:
Treatments-at-a-glance
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Non-drug approaches
Steps to developing successful non-drug treatments include:
Potential solutions
• citalopram (Celexa)
• fluoxetine (Prozac)
• paroxeine (Paxil)
• sertraline (Zoloft)
• trazodone (Desyrel)
• lorazepam (Ativan)
• oxazepam (Serax)
• aripiprazole (Abilify)
• clozapine (Clozaril)
• haloperidol (Haldol)
• olanzapine (Zyprexa)
• quetiapine (Seroquel)
• risperidone (Risperdal)
• ziprasidone (Geodon)
• carbamazepine (Tegretol)
• divalproex (Depakote)
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Ask the doctor the following questions when you discuss any
treatments. They will not address all treatment needs, but the
answers to these questions will help you understand the options
and make informed decisions.
• Introduction
• Treatments
Introduction
Many people with Alzheimer’s experience changes in their sleep
patterns. Scientists do not completely understand why this
happens. As with changes in memory and behavior, sleep
changes somehow result from the impact of Alzheimer’s on the
brain.
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• Depression
• Restless legs syndrome, a disorder in which unpleasant
“crawling” or “tingling” sensations in the legs cause an
overwhelming urge to move them
• Sleep apnea, an abnormal breathing pattern in which people
briefly stop breathing many times a night, resulting in poor
sleep quality
• Maintain regular times for meals and for going to bed and
getting up
• Seek morning sunlight exposure
• Encourage regular daily exercise, but no later than four
hours before bedtime
• Avoid alcohol, caffeine and nicotine
• Treat any pain
• If the person is taking a cholinesterase inhibitor (tacrine,
donepezil, rivastigmine or galantamine), avoid giving the
medicine before bed
• Make sure the bedroom temperature is comfortable
• Provide nightlights and security objects
• If the person awakens, discourage staying in bed while
awake; use the bed only for sleep
• Discourage watching television during periods of
wakefulness
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• Introduction
• Concerns
• Coenzyme Q10
• Coral calcium
• Ginkgo biloba
• Huperzine A
• Omega-3 fatty acids
• Phosphatidylserine
• More information
Introduction
A growing number of herbal remedies, vitamins and other dietary
supplements are promoted as memory enhancers or treatments
for Alzheimer’s disease and related diseases.
Claims about the safety and effectiveness of these products,
however, are based largely on testimonials, tradition and a rather
small body of scientific research. The rigorous scientific research
required by the U.S. Food and Drug Administration (FDA) for the
approval of a prescription drug is not required by law for the
marketing of dietary supplements.
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Coenzyme Q10
Coenzyme Q10, or ubiquinone, is an antioxidant that occurs
naturally in the body and is needed for normal cell reactions. This
compound has not been studied for its effectiveness in treating
Alzheimer’s.
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Coral calcium
“Coral” calcium supplements have been heavily marketed as a
cure for Alzheimer’s disease, cancer and other serious illnesses.
Coral calcium is a form of calcium carbonate claimed to be
derived from the shells of formerly living organisms that once
made up coral reefs.
In June 2003, the Federal Trade Commission (FTC) and the Food
and Drug Administration (FDA) filed a formal complaint against
the promoters and distributors of coral calcium. The agencies
state that they are aware of no competent and reliable scientific
evidence supporting the exaggerated health claims and that such
unsupported claims are unlawful.
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Ginkgo biloba
Ginkgo biloba is a plant extract containing several compounds
that may have positive effects on cells within the brain and the
body. Ginkgo biloba is thought to have both antioxidant and anti-
inflammatory properties, to protect cell membranes and to
regulate neurotransmitter function. Ginkgo has been used for
centuries in traditional Chinese medicine and currently is being
used in Europe to alleviate cognitive symptoms associated with a
number of neurological conditions.
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Huperzine A
Huperzine A (pronounced HOOP-ur-zeen) is a moss extract that
has been used in traditional Chinese medicine for centuries. It
has properties similar to those of cholinesterase inhibitors, one
class of FDA-approved Alzheimer medications. As a result, it is
promoted as a treatment for Alzheimer's disease.
Evidence from small studies shows that the effectiveness of
huperzine A may be comparable to that of the approved drugs. In
Spring 2004, the National Institute on Aging (NIA) launched the
first large U.S. clinical trial of huperzine A as a treatment for mild
to moderate Alzheimer’s disease.
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See also the 2004 FDA press release announcing extension of the
qualified health claim for omega-3s and coronary heart disease
from supplements to foods.
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Phosphatidylserine
Phosphatidylserine (pronounced FOS-fuh-TIE-dil-sair-een) is a
kind of lipid, or fat, that is the primary component the
membranes that surround nerve cells. In Alzheimer’s disease and
similar disorders, nerve cells degenerate for reasons that are not
yet understood. The theory behind treatment with
phosphatidylserine is its use may shore up the cell membrane
and possibly protect cells from degenerating.
• In most people, th
language area is chiefly o
the left.
Link
Brain Basics Alzheimer's Disease and the Brain Act
Brain Tour 1234567 8 9 10 11 12 13 14 15 16 17
Cre
6. Cell signaling
Signals that form memories and
thoughts move through an
individual nerve cell as a tiny
electrical charge.
. Signal coding
100 billion nerve cells… 100
trillion synapses… dozens of
neurotransmitters… This
“strength in numbers” provides
your brain’s raw material. Over
time, our experiences create
patterns in signal type and
strength. These patterns of
activity explain how, at the
cellular level, our brains code our
thoughts, memories, skills and
sense of who we are.
• Reading words
• Hearing words
• Saying words
• A brain with
advanced Alzheimer’s
• Shrinkage is especially
severe in the hippocampus, an
area of the cortex that plays a
key role in formation of new
memories.
• Ventricles (fluid-filled
spaces within the brain) grow
larger.
• Plaques, abnormal
clusters of protein fragments,
build up between nerve cells.
Beta-amyloid is chemically
"sticky" and gradually builds up
into plaques.
In healthy areas:
• Earliest Alzheimer's –
changes may begin 20 years
or more before diagnosis.
• Mild to moderate
Alzheimer stages – generally
last from 2 - 10 years.
• Severe Alzheimer’s –
may last from 1 - 5 years.
• Speaking and
understanding speech
In advanced Alzheimer’s
disease, most of the cortex is
seriously damaged. The brain
shrinks dramatically due to
widespread cell death.
Individuals lose their ability to
communicate, to recognize
family and loved ones and to
care for themselves.
Clinical Studies
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• Introduction
• Consider participating
• How clinical trials work
• How to find a study
• More information
Introduction
Over the last 15 years, scientists have made enormous strides in
understanding how Alzheimer’s disease affects the brain. Many of
these recent insights point toward promising new strategies for
treatment, prevention and diagnosis.
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There are two main strategies to reduce the likelihood that hopes
and beliefs will affect the outcome of clinical studies:
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Informed consent
Participating in research is a big step. Informed consent is the
process of learning key facts about a study before deciding
whether to volunteer. The FDA requires potential participants to
be given complete information about the study in writing. Study
staff also meet personally with each potential participant to
explain risks and possible benefits and answer any questions.
People who decide to join the study must sign the informed
consent form.
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• Introduction
• Promoting research and supporting
individuals with Alzheimer's
• Focus on prevention
• Research advances span the spectrum
• Caring for the caregiver
• Association expands research funding
• More information
Introduction
The year 2007 entered the history books as a period of
tremendous advances in Alzheimer research. These advances
occurred on all fronts, encompassing areas as diverse as genetic
risk factors for Alzheimer's, imaging studies to identify
Alzheimer's in the living brain and blood tests that may one day
be used to diagnose Alzheimer's.
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Road Map
The Road Map highlights the importance of maintaining and
improving cognitive health to the overall health of the nation.
CDC Director Julie L. Gerberding, M.D., M.P.H., told the
gathering, "By embracing cognitive health as a priority issue,
legislators and the public health community would be mobilized to
study, identify and implement effective interventions that
preserve it. Our challenge is to offer a coordinated and unified
national effort. The Road Map meets that challenge by laying out
a shared vision that builds on the foundation of the work done to
date and shapes the work of the future."
Treatment horizon
In the meantime, updates on research under way were much
anticipated highlights of the conference. Many of the updates
focused on anti-amyloid therapies. These are therapies that either
reduce the production of the protein beta-amyloid that forms the
hallmark plaques of Alzheimer's or that increase the clearance of
beta-amyloid from the brain.
A Phase III study was also planned for LY450139, made by Lilly.
Results of Phase II studies showed that the gamma-secretase
inhibitor decreased beta-amyloid levels in both blood and spinal
fluid.
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SORL1
In the January 14, 2007, online Nature Genetics, researchers
described results of a study implicating the gene SORL1 in late-
onset Alzheimer's disease. The gene, also known as SORLA
(sortilin-related, low-density lipoprotein receptor class A repeat-
containing protein), is one of several involved in a cellular sorting
process that sends amyloid precursor protein (APP) down one of
two paths: a path in which it is recycled or a path that moves it
to cell structures called endosomes where the enzymes beta- and
gamma-secretase cut it apart, freeing the beta-amyloid peptide
component of APP to leave the brain cell, combine with additional
beta-amyloid and potentially form the amyloid plaques of
Alzheimer's.
PET-PIB
An established technology for identifying Alzheimer's in the living
brain will be an invaluable tool for early diagnosis of the disease
and monitoring the effects of drugs designed to stop or slow its
progression. Study results published in the March 2007 issue of
Archives of Neurology demonstrated that significant strides are
being made toward that goal. The article describes the first
postmortem study of an individual with dementia who, before
death, had undergone positron emission tomography (PET) after
injection of Pittsburgh compound B (PIB), a radioactive dye.
Because Alzheimer's can now only be definitively diagnosed on
autopsy, a postmortem comparison of amyloid distribution was
necessary to confirm the accuracy of PET-PIB. The study showed
that the distribution of amyloid at autopsy matched the overall
distribution on PET-PIB. If the accuracy of PET-PIB is replicated in
additional, large studies, it could enable a definitive diagnosis of
Alzheimer's in the living brain.
Protein patterns
The impact of an even simpler test for Alzheimer's, such as a
blood test, would be enormous. Researchers reported taking a
step in that direction in an article appearing October 15, 2007, in
the online Nature Medicine. They studied 120 proteins involved in
cell-to-cell communication, looking for patterns that differed
between people with and without Alzheimer's. They found that as
few as 18 proteins were needed to identify an Alzheimer's-specific
pattern. Among the 92 study volunteers, the protein pattern
identified with 90 percent accuracy those who had clinically
diagnosed Alzheimer's. In 47 volunteers with mild cognitive
impairment, the pattern accurately identified 91 percent of
volunteers who would go on to develop Alzheimer's during the
follow-up period.
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