Knowledge about Alzheimer's Disease in the Medical Community is Growing Rapidly, but Much is yet to be Learned. The Information Gained From Numerous Studies Has Been Helpful, and the Puzzle is Slowly Being Pieced Together.

Living with Alzheimer's

Let's start by understanding what Alzheimer's disease is not. Alzheimer's disease should be analyzed first in the context of the population as a whole. Both the young and old are prone to occasional forgetfulness. Perhaps after leaving the restaurant you suddenly realize your keys are still on the table, or your spouse scolds you for forgetting to take out the trash. Or you have trouble remembering the names of people you meet at a social gathering.

These memory lapses are a normal part of life and have become more prevalent in developed countries, in part, due to over-stimulation, increased work loads, and hectic social schedules.

So, in truth, many of us have problems with memory; lifelong problems that can be traced to cognitive conditioning (how we learn and process information) or to nutritional deficiencies, thyroid disorder, or due to the other factors such as the ones listed above. Alzheimer's Disease, which is the most common form of Dementia, does have symptoms that include memory loss in the early stages, but it involves physical changes in the brain; ones that are not testable except upon autopsy. There are a number of tests that help verify a diagnoses of Alzheimer's in the latter stages, but even then, they are not always accurate. The common ones include: neurological exams, Blood work, memory testing, various types of brain imaging scans, Neuropsycological exams and physical exams where the five senses, balance and reflexes are tested and muscle tone and strength is examined. It is imperative to diagnose Alzheimer's as early as possible, as proper treatment can delay the progression of the disease by as much as a few years.

There is talk of creating a test that would examine the two proteins (beta-amyloid and tau) in the brain that have been found to be associated with Alzheimer's. The beta-amyloid proteins would be tested for the presence of plaques and the Tau proteins would also be tested, which are now known to form neurofibrillary tangles in the brains of those with Alzheimer's disease. The test will involve taking cerebral spinal fluid thru a lumbar puncture. If successful, this test may help verify an early diagnosis of the disease.

In addition,there are a number of warning signs that doctors use to determine if a patient is likely to have Alzheimer's.They examine issues such as confusion, verbal skills, judgement,personality changes, problem solving, severe memory loss, the ability to do normal tasks, balance, mood, and short-term vs long-term memory.

With comprehensive testing, it is possible to accurately determine the presence of advanced Alzheimer's in about 90 % of patients, but as stated above, it can only be verified upon autopsy for the presence of beta-amyloid plaques and Tau tangles.

In the early stages of Alzheimer's, the diagnosis is made by comparing the warning signs listed above with a baseline of normal age related changes. The issue here is degree. For instance, we all may forget what day it is but would remember after thinking about it for awhile. A person with Alzheimer's, however, may be confused about what year it is, whether it is summer or winter, or might forget which century they live in. In the normal aging population, simple daily living tasks may become more difficult, but they are manageable. If Alzheimer's is present, however, simple tasks become overwhelming. A person with Alzheimer's may not be able to self administer medication because they can't remember if the medication had been taken, even if it was 15 minutes ago. They may forget to bathe or keep up other hygiene tasks, but an elderly person in the normal population would remember when they last had a bath, though may choose to take one less frequently. Commonly, someone with Alzheimer's will forget names and be unable to recall them. A normal grand parent might get one one their grand children's names wrong, but would remember it if prompted.

Although there are many good indicators of Alzheimer's disease, there is not a test at present that can verify it conclusively in the general population. Scientists have determined a genetic link, but this research affects only a small portion of those who develop Alzheimer's, and then only early onset forms of the disease, which are rare. Specifically, scientists know that three gene variants in protein: amyloid precursor protein (APP), presenilin-1 (PS-1) and presenilin-2 (PS-2) do cause Alzheimer's. However, these variants are always associated with early onset Alzheimer's affecting those 30-60. In this small group, Alzheimer's can be predicted by these variants and is known as "autosomal dominant Alzheimer's disease" (ADAD).

There have now been several gene variants found that are thought to be risk factors for Alzheimer's, but that's all they are for now until more is known. The first gene variant: Apolipoprotein E-e4 (APOE-e4), has been considered for some time to be a risk factor for late onset Alzheimer's. Other gene variants thought to play a role in Alzheimer's disease are: EPHA1, MS4A, CD2AP, CD33, CLU, CR1, and PICALM.

There is a saliva test that test for the presence of the APOE gene. the problem is there are several forms of this gene and the test does not distinguish between them. It is also true that many who don't carry the gene still develop Alzheimer's and many that do carry it never develop Alzheimer's.

There is growing evidence that external factors such as diet, blood pressure, head trauma, tobacco, and diabetes all may play a role as risk factors.

There is also growing evidence that exercise, higher education, advanced musical ability and cognitive stimulation thru ought one's life may be factors in preventing Alzheimer's.

Early diagnosis of the disease is critical to delay, as long as possible, it's more advanced stages. however, as mentioned, there still is no definitive test. Even the cerebral fluid test that can find abnormal levels of amyloid and tau proteinsis not yet standardized and researchers don't know exactly what is normal and what is not. For instance, up to 30% of those who have amyloid plaques in their brains never develop Alzheimer's.

The good news is that hundreds of clinical studies are being conducted world wide and we know much more about the disease than we did 25 years ago.