Currently, there isn’t one particular diagnostic test that can detect 100% if a person has Alzheimer’s disease. With the new diagnostic tools and technology, doctors are able to make a diagnosis of Alzheimer’s disease with 90% accuracy. The diagnosis is made after carefully reviewing the medical history of the person and the results of several tests and examinations. The diagnoses process might include a meeting with his or her primary physician and other specialists, to talk about the symptoms and medical history and an evaluation of the mental status of the patient: the ability to remember, understand, and communicate particular things. There will also be a number of additional evaluations that test the memory and motor coordination of the patient. Generally a routine physical examination is performed along with additional tests that evaluate the activity of the individual’s nervous system functions. After completing the evaluations and examinations, a brain scan will be performed to look for other causes of the dementia, such as a stroke. Sometimes, blood and urine tests are done to gather more information about other problems that may be causing the dementia. (7)
After the testing is completed, the physician and other specialists will review the history of the person and the results of the tests and arrive at a diagnosis. The diagnosis will be either “probable Alzheimer’s” or “possible Alzheimer’s.” The diagnosis of “probable Alzheimer’s” means that the physician has ruled out any other disorders that could have been causing the dementia, and has therefore concluded that the symptoms the individual is experiencing are as a result of Alzheimer’s disease. A diagnosis of “possible Alzheimer’s” indicates that the physicians believe that the symptoms could be due to Alzheimer’s disease but that they think that another disorder may be affecting the severity of the symptoms as well. Even though huge progress has been made in diagnostic testing, the only foolproof way to diagnose Alzheimer’s disease, currently, is after completing a thorough autopsy upon the individual’s death. (8)
Currently, Alzheimer’s disease can only be confirmed after death. However, soon it may be able to be diagnosed with 100 % accuracy in its early stages. New research is being done on mice. Scientists were able to diagnose the disease in mice by using a chemical called PIB. This chemical was able to cross the blood-brain barrier and latch onto the amyloid plaques in the mice’ brains. Scientists could then detect the PIB and identify the plaques that are believed to cause Alzheimer’s (9). Recently, they have begun testing the procedure on humans. The ability to diagnose the disease during its early stages is important because it would allow for therapy to be started before much damage had occurred (2).
Studies have shown common patterns of the progression of symptoms that occur in individuals diagnosed to have Alzheimer’s disease. Based on these patterns, experts have come up with seven progressive stages. As the symptoms progress, they directly relate to the underlying nerve cell degeneration taking place in the cells of an individual with Alzheimer’s disease. The nerve cell damage begins with the cells that control the learning and memory and spread to cells that control other aspects of thinking and judgment. As the disease progresses, more cells degenerate and affect the cells that control movement and coordination. The stages are only manmade landmarks of a continuous process that varies from person to person, no person has experienced the exact same symptoms at the exact same times, they occur differently, at different times in different individuals. On average, a person diagnosed with Alzheimer’s will live 8 years after the diagnosis. The framework that provides the staging of Alzheimer’s disease is called the Global Deterioration Scale, and it is used throughout the world – corresponding with the concepts of mild, moderate, moderately sever, and severe Alzheimer’s disease. (7)
Stage 1: No noticeable memory problems appear to a physician.
Stage 2: Mild cognitive decline beginning. A person may have memory lapses or forget little things, but aren’t really noticeable.
Stage 3: One of the earliest stages that Alzheimer’s can be diagnosed. In this stage family members may notice some problems with the person’s memory or concentration. This can be clinically tested and reviewed for diagnosis of Alzheimer’s.
Stage 4: This is considered an early stage of Alzheimer’s disease. Usually clinical tests will show clear-cut results and should be able to diagnose easily. The person may forget current events and may not be able to manage finances or may forget personal history.
Stage 5: This is considered mid-stage Alzheimer’s disease. The person begins to forget how to do daily tasks and may need help. They may be confused with where they are or what day it is. But usually they don’t require help with eating or going to the bathroom in this stage.
Stage 6: This is considered a moderately severe mid-stage of Alzheimer’s disease. Memory problems increasingly get worse and the person may also experience major personality changes. Usually during this stage, most lose a sense of their surroundings, but still recognize familiar faces. They need help getting dressed properly, otherwise they may small errors like putting their shoes on the wrong feet. At this stage, some may need help going to the bathroom as well.
Stage 7: This is considered the late stage of Alzheimer’s disease. This is when the person will lose the ability to respond to their environment, ability to speak, and even lose control of their movements. They may lose their capacity to speak, but sometimes phrases may be uttered perfectly clearly. The person needs help eating and going to the bathroom. Then eventually the person will lose the ability to walk without assistance, and reflexes become abnormal and swallowing becomes impossible.
The symptoms continue to get worse until the brain cells die and the link between cells is lost. Currently, there are no drugs that alter the gradual loss of brain cells, but there are drugs that help to minimize or even stabilize symptoms (7). Some medications even help to delay the need for nursing home care for a time. The U.S. Food and Drug Administration has approved two types of drugs for treatment of cognitive symptoms due to Alzheimer’s disease. In 1993, the first type of drug approved for Alzheimer’s was a cholinesterase inhibitor (2). These drugs are designed to help prevent the breakdown of acetylcholine, a chemical in the brain that is important for memory and other thinking skills. The drug attempts to keep the levels of the chemical messenger, acytylcholine, high, even while the cells that produce the particular messenger are becoming weak and dying. Over half the people that take cholinesterase inhibitors experience a fair improvement in cognitive symptoms (8).
Another drug, Memantine, approved in October 2003, is used to treat moderate to severe Alzheimer’s disease (2). It was the first Alzheimer drug of this type to be approved in the United States. It attempts to regulate the activity of glutamate, a specialized messenger chemical in the brain that is involved in the processing, storage, and retrieval of information (7). Glutamate also plays a key role in learning and memory by alerting NMDA (N-methyl-D-asparate) receptors to control the amount of calcium that flow into a nerve cell, this helps regulate a balanced chemical environment required for storing information. However, too much glutamate may over stimulate the NMDA receptors and allow too much calcium into the nerve cells, this leads to the death of many brain cells. Memantine is believed to help protect cells against too much glutamate by blocking NMDA receptors (6).
Vitamin E supplements are prescribed for treatment of Alzheimer’s disease as well (7). Normal cell functions create a byproduct, an oxygen molecule that has the ability to potentially damage cell structures and other genetic material. Vitamin E helps brain cells defend themselves from this damage that may play a part in Alzheimer’s disease (2). Cells do have natural defenses against this type of oxidative stress damage, but with age, many natural defenses decline. Studies have shown that taking vitamin E supplements may benefit people with Alzheimer’s (9).
Some people also believe in herbal and other dietary supplements to help remedy symptoms of Alzheimer’s (11). Ginko biloba is a plant that contains some compounds that may have positive effects on brain cells (2). It is believed to have antioxidant and anti-inflammatory functions, as well as the ability to regulate neurotransmitter function. It has been used for centuries in Chinese medicine and has traveled to Europe, where it is currently being used to lessen cognitive symptoms associated with different types of neurological disorders (2). In a study published in the Journal of the American Medical Association, Pierre L. Le Bars, MD, PhD, of the New York Institute for Medical Research, observed that in some participants a fair improvement had occurred in their cognitive functions. Results of this study show that ginkgo may help some individuals with Alzheimer’s disease, but further research must be done to determine exactly how Ginkgo works in the body. The results from the study aren’t very reliable because only about 200 people participated in the study. Currently, a trial is taking place with over 3000 participants, to investigate whether Ginkgo may help prevent or delay the onset of Alzheimer’s disease (12).
There are many concerns about the alternative remedies available. The safety is not yet known. The maker of a dietary supplement is not required to give the FDA evidence that claims its safety and effectiveness. The FDA has no authority over the supplement’s production, it is the manufacturer’s responsibility to develop its own guidelines to ensure that its products are safe. Taking dietary supplements can also have serious side effects and reactions to other prescribed medications. (10)
Alzheimer’s disease continues to become an increasing concern throughout the world. Some of the best minds in science all over the world, have begun to try to unravel the mysteries of the disease. While most scientists agree that the problems of Alzheimer’s center around the loss of communication among the nerve cells in the brain, some pose the question and foster up new theories about what begins the process and based on that, how best to intervene (2).
The theory with the most followers remains the “amyloid hypothesis” (7). In Alzheimer’s disease, plaques develop in the areas of the brain that are related to memory. Most of the plaques are made of beta-amyloid proteins. Beta-amyloid is a piece of a protein created from a larger protein, the amyloid precursor protein, or APP. Normally the beta-amyloid proteins are soluble, but in Alzheimer’s disease, the beta-amyloid proteins form inside the cell and then are deposited outside the cell, causing a buildup of plaques. It is not yet clear whether amyloid plaques are the primary cause of Alzheimer’s disease. Numerous studies are taking place to learn more about the effects of amyloid proteins on brain cells. Studies have already led to identifying two potential therapeutic approaches based on amyloid plaque studies. One approach relies on various strategies for stimulating an immune system response that destroys beta-amyloid, but the first medication to reach clinical trials, failed. Even though the trial failed, it still has potential to provide insights into amyloid and its role in the progression of Alzheimer’s disease.
The second approach attempts to stop the enzymes from turning APP into smaller pieces that ultimately produce the beta-amyloid. A few pharmaceutical companies are developing secretases that stop the enzymes, the first drug of this kind that has reached clinical trials recently. (13)
Another Alzheimer theory blames the tau, a protein that usually helps to organize the cell’s internal skeleton, for the memory loss experienced during Alzheimer’s. Some scientists believe that an Alzheimer patient has deformed taus that lose the ability to support the cell, and eventually disrupt the neurofibrillary tangles. None of the therapies that have attempted to target tau have made it to clinical trials yet, however many experts are convinced that studying tau will reveal secrets about Alzheimer’s devastating effects on nerve cells, as well as provide insight into possible ideas for future intervention. (14)
Some have other ideas about the cause of Alzheimer’s. Epidemiological studies have shown that individuals taking anti-inflammatory drugs to treat conditions like arthritis, appear to have a lower rate of developing Alzheimer’s. A group of scientists have launched a number of clinical trials to investigate whether the use of anti-inflammatory drugs might indeed reduce the risk of developing Alzheimer’s. (7)
Another hypothesis that some experts have is that women taking estrogen may reduce the risk of developing Alzheimer’s. The Women’s Health Initiative Memory Study and other clinical trials have been testing to see whether estrogen may help delay or even prevent Alzheimer’s. (15)
In addition, scientists are gaining greater insight into the genetic factors contributing to Alzheimer's disease. Four genes have now been identified; three of these genes (located on chromosomes 1, 14, and 21) each contribute to early-onset Alzheimer's disease and one gene (located on chromosome 19) increases the risk of developing the disease later in life. Genetic risk factors alone, in most cases, are not enough to cause the disease, so other risk factors are involved and researchers are actively exploring them. (16)
A great deal has been learned since the early part of this century concerning the nature of the plaques and tangles and the parts of the brain that are affected as Alzheimer’s disease progresses. As the population continues to age, Alzheimer’s and other forms of dementias will become even more prevalent and impact an even greater number of families. Medical research must continue to make progress to determine the cause of Alzheimer’s as well as possible treatments to reduce the symptoms or even prevent the disease altogether.
The gradual loss of one’s memory, arguably the essence of a person, is one of the most distressing experiences for an individual and their family. We often take for granted one of the most important parts of our lives, the ability to remember. Memory is more than just an account of the past, it affects one’s ability to function, think and ultimately survive. An Alzheimer patient’s life gradually becomes reduced so that they need to rely on others to survive. This is a very difficult thing to endure and watch take place in a loved one. We must continue to do research in order to obtain the information needed to figure out the many mysteries of this disease. I know that my grandfather will die before any cures are created, but I do pray that they use the information obtained from my grandfather and his struggle with the disease, to help with further research so that others might not suffer the same struggles as he.
