Wednesday, July 8, 2015

The Nature of Alzheimer's Disease

First described by Dr. Alois Alzheimer, a German psychiatrist, in 1906, Alzheimer's Disease is rapidly becoming the third most common cause of death in the United States (trailing only heart disease and cancer).  Primarily affecting individuals aged 65 and older, it is responsible for up to 80% of the cases of dementia; early-onset Alzheimer's Disease, representing 5% of those afflicted, is a familial, genetic-based form of the disease that presents in middle age.

The earliest sign of Alzheimer's disease is usually disordered short-term memory; indeed, imaging and pathologic studies reveal that the disease generally begins in the hippocampus, an area of the brain that stores and retrieves memory.  Over time, the disease spreads throughout the cerebral cortex, resulting in diminished cognitive function and leading to the inability to reason, think clearly and control emotions and behavior.  Medical research has revealed the presence of beta amyloid and tau protein buildup in the brains of patients with Alzheimer's Disease; these changes may precede clinical symptoms of the disease by a decade or more.  Whether the abnormal proteins are the cause of Alzheimer's disease or merely reflect underlying pathophysiology (e.g. vascular inflammation) has yet to be determined.  Current evidence suggests that the disease may be the product of genetic predisposition, aging and environmental factors; by age 80, 50% of persons have some degree of Alzheimer's disease.

There is no current cure for Alzheimer's Disease and treatment is limited to medications and supportive therapies that may slow the patient's mental decline; the course of the latter varies widely (2-20 years) but most often leads to death within 8 years.  As one who has cared for many individuals with Alzheimer's Disease over the years, I have witnessed the de-humanization wrought by this relentless malady and the emotional, physical and financial stress that it imposes on family members; until a cure for this devastating illness is found, I personally favor the right of patients to choose assisted suicide before the disease robs them of their humanity.