Sunday, October 25, 2009

The impact of Alzheimer’s

Alzheimer’s disease not only affects the patients but also the patient’s family. Almost one out of three households in the Figure 1.1 Alois Alzheimer (pictured here) is the German neurologist who is credited with discovering Alzheimer’s disease.

Defining Alzheimer’s Disease
United States is affected by AD. A little over half of the care provided to AD patients is at home; some estimates place the care at home closer to 75% (Figure 1.2). The combination of healthcare expenses and the loss of income of both the patient and the caregiver is approaching $100 billion nationwide. The Figure 1.2 Almost one out of three households in the United States is affected by Alzheimer’s disease. An estimated 75% of Alzheimer’s patients receive home care.

Over half of the nursing home residents in the United States have AD or some other form of dementia. The annual cost of caring for an AD patient ranges from $18,400 for mild symptoms to $36,132 for those with advanced symptoms. In addition, the average cost of nursing home care is almost $58,000 a year. Medicare and most health insurance plans do not cover the care of an AD patient since it is considered "custodial care".

Caregivers are a subset of the Alzheimer’s picture that is often overlooked. Stress and depression are reported frequently among caregivers: depression affects approximately 50% of caregivers, with stress occurring in at least 80%. Not surprisingly, the emotional, financial, and sometimes physical burden of witnessing a loved one decline mentally and physically is often overwhelming.

Defining Disease of Alzheimer

When Dr. Alzheimer’s patient died, he was able to study her brain at autopsy.
Alzheimer noted that the cerebral cortex, the outer layer of the brain responsible for numerous functions such as movement, perception, memory, and speaking, was thinner than normal and had severe atrophy. He also noted two other abnormalities. The first was “senile plaque” (now known as neuritic plaque) that had earlier been seen in the brains of the elderly. Second, there were neurofibrillary tangles within the cortex that had not been previously described. These hallmarks for which Alzheimer coined the term presenile dementia, are now known as Alzheimer’s disease (Figure 1.1). Neuritic plaques and neurofibrillary tangles will be discussed in more detail in Chapter 3. Interestingly, to this day, the only way to definitively know that a person has AD is at autopsy.

Who gets Disease of Alzheimer?
It is estimated that over 4 million Americans have Alzheimer’s disease. It is also estimated that by the year 2050, the number could increase to 14 million. One out of every ten persons 65 years of age and older develops AD, although some develop it in their 40s and 50s. Alzheimer’s affects approximately 20% of people between the ages of 75 and 84. The percentage of AD increases to almost 50% in Americans 85 years and older.

The clinical course of the disease is between 2 years and 20 years from the onset of symptoms until death, with an average of about 8 years. There are about 360,000 new cases of Alzheimer’s diagnosed every year and about 100,000 deaths each year from AD.1, 2 Alzheimer’s disease affects people from all walks of life.

The death of President Ronald Reagan from complications of AD has re-ignited an interest in finding a cure for the disease. Other famous people with Alzheimer’s include actors Charles Bronson, Rita Hayworth, Charlton Heston, Jack Lord, and James Doohan; sports stars Sugar Ray Robinson, Joe Adcock, Bill Quackenbush, and Tom Fears; E.B. White, the author of the children’s classic Charlotte’s Web, and Barry Goldwater, former senator of Arizona.

Alzheimerts Disease, History

A German neuropathologist and psychiatrist named Alois Alzheimer (see “Alois Alzheimer” box) studied a 51-year-old female patient with severe dementia. The woman started experiencing symptoms five years earlier, such as memory loss and trouble reading and writing. She rapidly declined to hallucinations and was unable to take care of herself.

Dr. Alois Alzheimer was born on June 14, 1864, in Bavaria.
He attended the universities of Aschaffenburg, Tubingen, Berlin, and Wurzburg, where he received a medical degree in 1887. The following year, Alzheimer joined the medical staff at the city mental asylum in Frankfurt, Germany. While he first began his career in psychiatry, Alzheimer quickly devoted himself to his great interest of neuropathology, the study of the causes, nature, and effects of brain diseases.

In 1903, he moved to the university psychiatric clinic in Munich. He recorded his findings on his first AD patient in 1907. For the next ten years, he studied patients with syphilis, Huntington’s disease, epilepsy, and a pseudosclerosis of the brain now known as Wilson’s disease. Alois Alzheimer died on December 19, 1915, at the age of 51, due to cardiac failure following endocarditis, inflammation of the membrane that lines the heart and forms part of the heart valves.