Untangling the Mystery
New approaches and treatments offer hope to those afflicted with Alzheimer's disease.
By Norman Brown

Alzheimer's is a disease that has profound effects not only on patients but also on family members who care for them. It afflicts nearly half of those 85 or older; in all, about 4 million Americans have the disease, but that number could reach 14 million by 2050 unless a cure or prevention is found, according to the Centers for Disease Control and Prevention.

Scientists still aren't sure what triggers Alzheimer's, but they know that the disease progresses when abnormal structures called plaques and tangles form in the brain, reducing nerve cell connections and causing short-term memory loss. Gradually, the plaques and tangles work into areas of the brain that control other cognitive and physical functions.

Alzheimer's is not immediately life-threatening, and patients may live 20 years or more. (The disease lasts an average of eight years and is considered terminal.) But over time, Alzheimer's causes more and more damage, resulting in confusion, behavioral changes, and impaired judgment. By the later stages, sufferers can no longer care for themselves.

Dispelling myths

In the past, memory loss was thought to be a normal part of aging. But with promising new research, experts now recognize severe memory loss as a symptom of serious illness, which they believe could be both preventable and treatable. They have identified several genes linked to Alzheimer's and hope to be able to modify them to prevent some cases of the disease — in particular, early-onset Alzheimer's that affects people in their 40s and 50s.

Several studies also have found that Alzheimer's is more common among individuals like boxers and football players who have sustained head injuries and especially concussions. Additional research is needed, however, to understand what happens to the brain in such injuries.

To compound matters, Alzheimer's can be confused with other conditions that also bring on memory loss and dementia, including strokes, depression, and substance abuse.

Controlling symptoms

"Alzheimer's disease is more than memory loss," says Dr. Eric Tangalos, gerontologist at the Mayo Clinic in Rochester, Minn. But anyone with several symptoms (see "10 Warning Signs of Alzheimer's," page 40) or with recurring lapses needs a thorough medical examination. Here are some common tests.

Neuroimaging of the brain can show shrinking of the extorhinal cortex and hippocampus regions (key memory centers of the brain).

Genetic testing can show early-onset Alzheimer's genes (presenilin) and a late-onset gene (APOE-4). About 65 percent of those with APOE-4 contract the disease.

Neural protein tests examine spinal fluid or urine for the protein known as NTP, which has been linked to Alzheimer's and other neurological disorders.

While there is no medical treatment to cure or stop the progression of the disease, four prescription drugs called cholinesterase inhibitors may temporarily improve or stabilize memory and thinking skills in some individuals. They are marketed as Reminyl, Exelon, Aricept, and Cognex. Statin drugs like Lipitor, used to lower cholesterol, also have been found to retard Alzheimer's symptoms, says Dr. Kristine Yaffe, geriatric psychiatrist at the San Francisco va Medical Center.

As with all drugs, there can be side effects, like nausea, vomiting, loss of appetite, and increased frequency of bowel movements. But most of these drugs are well-tolerated.

Other medications may be prescribed to help control behavioral symptoms such as sleeplessness, agitation, wandering, anxiety, and depression. Research continues on vitamin E, an antioxidant that may help keep blood vessels to the brain clear, forestalling damage to brain cells.

There's also evidence that an "oil change" of brain fluid using a shunt device may help Alzheimer's patients. Researchers at California's Stanford University School of Medicine theorize that the poor turnover of fluid may contribute to the buildup of plaques and tangled nerve fibers that are the hallmarks of the disease.

Researchers are studying the effects of estrogen-replacement therapy, and there is some indication that it may reduce a woman's risk of Alzheimer's, regardless of her family history. But there are possible risks associated with estrogen use; your doctor can provide more information. The disease also tends to be less common in people with severe arthritis who take large doses of nonsteroid anti-inflammatory drugs such as Aleve or Celebrex.

Boosting memory

People who regularly read books, do crossword puzzles, or otherwise exercise their brain are significantly less likely to develop Alzheimer's, according to one study of 800 elderly Catholic priests, nuns, and brothers. In the study, led by researchers at Rush-Presbyterian-St. Luke's Medical Center in Chicago, participants took a battery of annual tests over five years to evaluate their memory, language, and other brain functions.

"It appears that keeping your mind active can in fact slow the rate at which you lose mental ability," says researcher David Bennett. Those who took part in the mentally stimulating activities were 47 percent less likely to develop Alzheimer's than those who rarely engaged in the same activities.

"Every time you learn something new it builds connections to brain cells," says Margery Silver, Ph.D., associate director of the New England Centenarian Study. "That way, if you do have a few plaques or tangles associated with Alzheimer's and a few brain cells become damaged — you still have a reserve because of all the additional connections you have built up."

Noticing some lapses in your memory? Blame busy, complicated lives. Most people are trying to hold about 40 things in their head at one time, says researcher George Spilich, psychologist at Washington College in Chestertown, Md. Stress makes it hard to focus enough to register and store information.

Then there are sleep problems, which afflict about 40 million people. "One of the things the brain does while you're asleep is go over the events of the day, settle memories, and store them properly," explains Spilich. Inadequate shut-eye reduces the likelihood of retaining new data.

Holding on to and even improving memory is quite doable for some people, report experts on aging. Half the battle is living a healthy life, with regular exercise, a proper diet, and stress-management strategies such as yoga or meditation.

Coping with change

Finding out that a loved one has Alzheimer's can be frightening and overwhelming. Coping with the disease can bring significant changes to your day-to-day life as a caregiver. It may help to contact a support group where you can share your concerns and feelings (see "Caregiver Resources," page 41).

The following suggestions may help you cope with changes you see taking place in your loved one's life. (Remember, Alzheimer's is a degenerative disease; families will need to make continual changes as the disease progresses.)

Daily tasks. Someone with Alzheimer's may need help bathing, dressing, or preparing a meal. Plan the bath or shower for when he or she is most calm and agreeable. Don't rush things. Take a break if something is too difficult, or arrange for others to help you.

Communication. Minimize distractions and noise (television and radio) to help the patient focus on what you are saying. Call him or her by name, allow time for a response — and don't interrupt.

Driving. Understand that at some point it no longer will be safe for your loved one to drive. Make plans for family members, friends, and community services to provide transportation.

Memory changes. Post a schedule of things to do every day, such as meal times, regular exercise, medications, and bedtime. Keep a book containing important names or phone numbers handy at all times.

Living alone. Many individuals manage to live on their own during the early stages of Alzheimer's with assistance from others. Arrange for someone to help with housekeeping, meals, and other daily chores. Make arrangements for direct deposit of checks or help in paying bills. Leave a set of house keys with a neighbor you trust.