Alzheimer’s

How FINDcures Can Help

FINDcures specializes in providing help in areas that other foundations often miss or leave unaddressed.  When a family member is diagnosed with Alzheimer’s Disease, a cascade of questions and concerns materialize that can easily overwhelm a family.  Most often the patient is an elderly parent and a caregiver that can ensure their well-being will be needed.  Most of the time family members assume this role, at least initially, but as the disease progresses the need for professional caregivers are often required.

Beyond the issue of caregiving there are other adjustments that need to be considered.  Specific concerns, that most often arise in a progression of unanswered questions, can have an overwhelming impact on an individual’s and family’s sense of security and self-worth and need to be addressed. FINDcures has developed a service model (shown at right) called the “Perimeter of Hope” which is designed to provide solutions and answers to the myriad questions that arise when a neurological diagnosis occurs.

The most common questions that come up are these:

  1. Why is this happening?  What caused this?  How difficult is this going to be?  How will this impact me and my family?  How do I deal with all of the emotions I’m feeling?  (Mental Health & Well-Being Services)
  2. How much longer will I be able to provide for my family?  Or if the patient is a parent – How much longer will I be able to provide for my parent?  (Financial Planning & Retirement Services)
  3. How can I protect my assets so that they will be available as a resource for my family when I’m unable to do so or when I die?  Or if the patient is a parent – How can I protect my parent’s assets?  (Legal Assistance & Estate Planning Services)
  4. If our family needs to relocate to receive better care for our loved one or to reduce our expenses who can I turn to for help?  How can I reduce our housing expenses?  How can I ensure my loved one has a secure place in which to live?  (Housing, Relocation & Real Estate Services)
  5. Will I be able to help with my children’s/grandchildren’s education expenses in the future?  As the disease progresses how can I ensure their education expenses will be taken care of?  (Education Planning & Tuition Assistance)
  6. When will they find a cure?  What health steps can I take in the meantime?  (Medical Research & Information Services)

When an impacted individual or family is faced with making these decisions on their own and without help from qualified individuals familiar with the impact of neurological diseases, the task list can be overwhelming.  Why make things more difficult by going it alone when you can contact an experienced FINDcures representative and allow them to assist you?  Our services are free of charge.  The consultation costs you nothing and should you choose a service we offer, the cost, if any, is subsidized by the donations we receive.

Alzheimer’s – An Overview

Alzheimer’s Disease, also known as just Alzheimer’s, is an irreversible, chronic neurodegenerative disease that usually starts slowly and gets worse over time.  It is a form of dementia that affects memory, mental processing and behavior.  Alzheimer’s accounts for 60% to 70% of all dementia cases.[1], [2]

It was first described by, and later named after, German psychiatrist and pathologist Alois Alzheimer in 1906.[19] In developed countries, Alzheimer’s is one of the most financially costly diseases.[20], [21]

The cause of Alzheimer’s is poorly understood.[1]  The hallmark pathology of Alzheimer’s is the progressive accumulation of a protein fragment known as beta-amyloid, a plaque buildup on the outside neurons in the brain that appear as twisted strands of the protein (tangles) inside neurons.[3]  These changes eventually result in the death of neurons that impact the previous mentioned body functions.  A probable diagnosis is based on the history of the illness and cognitive testing with medical imaging and blood tests to rule out other possible causes.[4]

About 70% of the risk in getting Alzheimer’s is believed to be genetic with many genes usually involved.[3]  Other risk factors include a history of head injuries, depression, or hypertension.[1]  Mental and physical exercise, and avoiding obesity may decrease the risk of Alzheimer’s.[3]  There are no medications or supplements that decrease risk.[5]

This chart shows current thinking about the evolution from healthy aging to Alzheimer’s. Researchers view it as a series of events that occur in the brain over many years. This gradual process, which results from the combination of biological, genetic, environmental, and lifestyle factors, eventually sets some people on a course to Mild Cognitive Impairment (MCI) and possibly Alzheimer’s. Other people, whose genetic makeup may be the same or different and who experience a different combination of factors over a lifetime, continue on a course of healthy cognitive aging.

  Alzheimer’s by the Numbers

Incidence is the number of new cases per unit of persons during a specific timeframe (usually number of new cases per thousand persons in a year); while prevalence is the total number of cases of the disease in the population at any given time.

Incidence – According to the most recent Centers for Disease Control and Prevention (CDC) information more than 3 million new cases are diagnosed each year in the U.S.

Prevalence – In 2013, as many as 5.4 million Americans were living with Alzheimer’s disease.[6]

Rate of Growth in the U.S.

The disease has grown dramatically over the past several years with a new diagnosis made every 66 seconds.  By 2050, the number of those affected is projected to rise to 14 million, nearly a three-fold increase.[6]  For those beyond the age of 65 the number of people with the disease doubles every 5 years.

Alzheimer’s is the only disease among the top 10 causes of death in America that cannot be prevented, cured or even slowed.[36]

Age ranges of those affected[36]

  • Of the 5.4 million Americans with Alzheimer’s, an estimated 5.2 million people are age 65 and older, and approximately 200,000 individuals are under age 65 (younger-onset Alzheimer’s).
  • One in nine people age 65 and older has Alzheimer’s disease.
  • By mid-century, someone in the United States will develop the disease every 33 seconds.
  • Two thirds of those that contract Alzheimer’s are women.

Mortality Rate

Death rates for Alzheimer’s disease are increasing, unlike heart disease and cancer death rates that are on the decline.[10] Dementia, including Alzheimer’s disease, has been shown to be underreported in death certificates and therefore the proportion of older people who die from Alzheimer’s may be considerably higher.[11]

In 2013 there were 93,541 deaths attributed to Alzheimer’s, however this figure is most likely extremely lower than reality.  In 2010, according to death certificates the CDC reported 83,494 Americans died as a result of Alzheimer’s, making it the sixth leading cause of death in the U.S.  However, two groups of investigators at Rush University, Chicago, performed a detailed study in order to gain a clearer picture of the full burden of Alzheimer’s disease.  Both groups determined that Alzheimer’s-related mortality rates were several times higher than the official figure.  One group of researchers reported their findings in the March 2014 issue of Alzheimer’s and Dementia, and showed that an estimated 600,000 people age 65 and older with Alzheimer’s died in 2010.  They estimate that this number will rise to 900,000 is 2030 and to 1.6 million by 2050.  The other group of researchers published their findings online on March 5, 2014, in Neurology.  Their estimate of the number of Alzheimer’s deaths in 2010 was 503,400.  Both of these studies, if accurate, would have made the disease the third leading cause of death in 2010, behind heart disease and cancer.[6], [11]

Individuals with Alzheimer’s live an average of eight years after their symptoms become noticeable to others.[6]  Survival can range from 4 to 20 years, depending on age and health conditions.

Alzheimer’s is the fifth leading cause of death among adults aged 65 – 85 years.[8]

Impact on U.S. economy

In 2016, the costs are projected to be $236 billion.[36]  By 2050, these costs are projected to jump to more than $1 trillion (in 2016 dollars) annually.[36]

Impact on U.S. families[36]

Recent survey by Alzheimer’s Association found that many families have to cut back on basic necessities such as food and medical care for themselves and their families because of the high cost of caring for a loved one with Alzheimer’s.  The survey found that 28% are more likely than other adults to eat less or go hungry because they cannot afford to pay for food.

Symptoms

Alzheimer’s symptoms develop slowly in the beginning.  As the individual ages the symptoms increase exponentially.  The most common early symptom is difficulty in remembering recent events (short-term memory loss).[1]  The progression eventually becomes severe enough to impact daily tasks. Individuals with Alzheimer’s typically experience problems with language, disorientation (including easily getting lost), mood swings, loss of motivation, not managing self-care, and behavioral issues.[1], [2]  A sense of apathy and depression are common symptoms that manifest themselves in early onset of the disease.  As a person’s condition declines, they often withdraw from family and society.[1]  Gradually, bodily functions are lost, ultimately leading to death.[12]  Although the speed of progression can vary, the average life expectancy following diagnosis is three to nine years.[13], [14]   Mature symptoms of the disease include; impaired communication, disorientation, poor judgment, confusion, behavioral changes and eventually body functions such as difficulty in speaking, swallowing and walking.

Below is a list of the most common symptoms:

Cognitive

  • Alzheimer’s symptoms usually begin to appear after age 60 and the risk of getting them disease increases with age. Initial symptoms are often mistaken for normal aging.[1]  Examination of brain tissue is needed for a definite diagnosis.[3]
  • Mental decline, difficulty thinking and understanding
  • Confusion in the evening hours
  • Delusion
  • Disorientation
  • Forgetfulness
  • Making things up
  • Difficulty concentration
  • Inability to create new memories
  • Inability to do simple math
  • Inability to recognize common things

Behavioral

  • Aggression
  • Agitation
  • Difficulty with self-care
  • Irritability
  • Meaningless repetition of own words
  • Personality changes
  • Lack of restraint
  • Wandering and getting lost

Mood

  • Anger
  • Apathy
  • General discontent
  • Loneliness
  • Mood swings

Psychological

  • Depression
  • Hallucinations
  • Paranoia

Whole Body

  • Loss of appetite or restlessness

Current treatment methods

No treatments stop or reverse its progression, though some may temporarily improve symptoms.[2]  Affected people increasingly rely on others for assistance, often placing a burden on the caregiver; the pressures can include social, psychological, physical, and economic elements.[16]  Exercise programs are beneficial with respect to activities of daily living and can potentially improve outcomes.17  Treatment of behavioral problems or psychosis due to dementia with antipsychotics is common but not usually recommended due to there often being little benefit and an increased risk of early death.[18], [19]

Medications –

While there is no cure, prevention or treatment to stop Alzheimer’s progression, there are five prescription medications approved by the U.S. Food and Drug Administration (FDA) to treat its symptoms. Research shows these medications work 50 percent of the time for people who take these medications for up to two years.

  • Donepezil (Aricept)

This medication is used to treat all stages of Alzheimer’s. It can improve cognition and behavior of people with Alzheimer’s. Donepezil binds and inactivates reversibly cholinesterase’s, inhibiting hydrolysis of acetylcholine. The result is an increased acetylcholine concentration at cholinergic synapses.

The precise role that Donepezil plays in patients with Alzheimer’s is unsure, it has shown positive effects in the area of the cerebral cortex. The severity in the loss of cholinergic neurons in the central nervous system (CNS) correlate directly with the severity of cognitive impairment. Side effects of the medication include loss of appetite, gastrointestinal upset, diarrhea, difficulty sleeping, vomiting, or muscle cramping.

  • Galantamine (Razadyne)

This medication is used for mild to moderate symptoms. An alkaloid obtained synthetically from bulbs and flowers of the Galanthus caucasicus species. Galantamine has been used for several decades in Eastern Europe and Russion for treatment of myasthenia, myopathy, and sensory/motor dysfunction associated with disorders of the central nervous system.  Its use in the United States is FDA approved for Alzheimer’s treatment.

Galantamine increases concentration and action of acetylcholine in certain parts of the brain.

  • Rivastigmine (Exelon)

A medication used for mild to moderate symptoms of Alzheimer’s is a Para sympathomimetic or cholinergic agent used to treat mild to moderate dementia in Alzheimer’s and Parkinson’s Disease.  Administered orally and by transdermal patch. Rivastigmine has shown meaningful reduction in Alzheimer’s symptomatic effects.

This medication has helped patients remain independent and more like their true selves for longer periods of time. In particular, it shows marked improvement in patients showing a more aggressive progression such as those with younger onset ages, poor nutrition or those experiencing symptoms such as delusions or hallucinations

  • Memantine (Namenda)

A medication most often used for moderate to severe Alzheimer’s. Memantine acts on the glutamatergic system by blocking NMDA receptors. It was first synthesized by Eli Lilly and Company in 1968 as a potential agent to treat diabetes; the NMDA activity was discovered in the 1980s.

Memantine is used with individuals who are intolerant to ACHE acetylcholinesterase (a chemical or a drug that inhibits the acetylcholinesterase enzyme from breaking down acetylcholine, thereby increasing level and duration of action of the neurotransmitter acetylcholine).

  • Memantine & Donepezil (Namzaric)

A combination medication comprised of meantime hydrochloride extended-release, a NMDA receptor antagonist, and donepezil hydrochloride, an acetylcholinesterase inhibitor.

Namzaric improves mental function by decreasing abnormal activity in the brain and by increasing the amount of a certain naturally occurring substance in the brain.

Namzaric comes as a capsule to be taken by mouth, once daily. The capsules can be opened to allow the contents to be sprinkled on food for patients who have difficulty swallowing. Common side effects include headache, diarrhea and dizziness.

Specialties typically needed to treat Alzheimer’s Disease

  • Occupational therapist
  • Geriatrician
  • Neurologist
  • Psychiatrist

Life-style Impact and challenges

Currently, the vast majority of individuals living with Alzheimer’s disease are cared for at home by family members.

Caregiving can have positive aspects for the caregiver as well as the person being cared for. It may bring personal fulfillment to the caregiver, such as satisfaction from helping a family member or friend, and lead to the development of new skills and improved family relationships.

Although most people willingly provide care to their loved ones and friends, caring for a person with Alzheimer’s disease at home is a difficult task and can become overwhelming at times. Each day brings new challenges as the caregiver copes with changing levels of ability and new patterns of behavior. As the disease gets worse, people living with Alzheimer’s disease often need more intensive care.

Caregiving burden

The role of the main caregiver is often taken by the spouse or a close relative.[27]  Alzheimer’s disease is known for placing a great burden on caregivers which includes social, psychological, physical or economic aspects.[16], [28], [29]  Home care is usually preferred by people with Alzheimer’s and their families.[30]  This option also delays or eliminates the need for more professional and costly levels of care.[30], [31]  Nevertheless, two-thirds of nursing home residents have dementias.[35]

Dementia caregivers are subject to high rates of physical and mental disorders.[32]  Factors associated with greater psychosocial problems of the primary caregivers include having an affected person at home, the caregiver being a spouse, demanding behaviors of the cared person such as depression, behavioral disturbances, hallucinations, sleep problems or walking disruptions and social isolation.[33], [34]  Regarding economic problems, family caregivers often give up time from work to spend 47 hours per week on average with the person with Alzheimer’s, while the costs of caring for them are high.  Direct and indirect costs of caring for an Alzheimer’s patient average between $18,000 and $77,500 per year in the United States, depending on the study.[26], [27]

Lifestyle

People who engage in intellectual activities such as reading, playing board games, completing crossword puzzles, playing musical instruments, or regular social interaction show a reduced risk for Alzheimer’s disease.[23]  This is compatible with the cognitive reserve theory, which states that some life experiences result in more efficient neural functioning providing the individual a cognitive reserve that delays the onset of dementia manifestations.[23]  Education delays the onset of Alzheimer’s syndrome, but is not related to earlier death after diagnosis.[24]  Learning a second language even later in life seems to delay getting Alzheimer disease.[25]  Physical activity is also associated with a reduced risk of Alzheimer’s.[24]

Hope for a Cure:

Although research has not yet produced a cure for Alzheimer’s, there have been significant Advancements made by way of predicting and preventing onset of the disease. Howard Federoff CEO of U.C Irvine Health is a leading Alzheimer’s and Parkinson’s research scientist. Board-certified in internal medicine, endocrinology & metabolism, Federoff is nationally renowned for his clinical and research work in neurodegenerative disorders. Federoff believes a procedure referred to as Gene Therapy may hold the answers in identifying a person’s pre- disposition in acquiring Alzheimer’s, which can then open the pathway for preventative measures to circumvent early onset.

References

  1. Burns A, Iliffe S (5 February 2009).  “Alzheimer’s disease”.  The British Medical Journal.  338: b158. PMID 19196745.  (subscription required).
  2. “Dementia Fact sheet N°362”.  World Health Organization.  March 2015.  Archived from the original on 18 March 2015Retrieved 13 January 2016.
  3. Ballard C, Gauthier S, Corbett A, et al.  (19 March 2011).  “Alzheimer’s disease”.  377 (9770):1019–31.  PMID 21371747.
  4. “Dementia diagnosis and assessment” (PDF).  National Institute for Health and Care Excellence (NICE)Retrieved 30 November 2014.
  5. “More research needed on ways to prevent Alzheimer’s, panel finds” (PDF).  National Institute on Aging.  29 August 2006Retrieved 29 February 2008.
  6. Hebert LE, Weuve J, Scherr PA, Evans DL.  “Alzheimer disease in the United States (2010–2050) estimated using the 2010 census”.  Neurology.  2013; 80:1778-83.
  7. Xu J, Kochanek KD, Sherry L, Murphy BS, Tejada-Vera B.  Deaths: final data for 2007″.  National vital statistics reports; vol. 58, no. 19.  Hyattsville, MD: National Center for Health Statistics. 2010.
  8. Heron M.  Deaths: leading causes for 2010″.  National vital statistics reports; vol. 62, no 6. Hyattsville, MD: National Center for Health Statistics.  2013.
  9. Hurd MD, Martorell P, Delavande A, Mullen KJ, Langa KM.  “Monetary costs of dementia in the United States”.  NEJM.  2013;368(14):1326-34.
  10. Tejada-Vera B.  “Mortality from Alzheimer’s disease in the United States: data for 2000 and 2010”.  NCHS data brief, no 116.  Hyattsville, MD: National Center for Health Statistics.  2013.
  11. James BD. Leurgans SE, Hebert LE, et al.  “Contribution of Alzheimer disease to mortality in the United States”.  Neurology.  2014;82:1-6.
  12. “About Alzheimer’s Disease: Symptoms”.  National Institute on AgingRetrieved28 December2011.
  13. Querfurth HW, LaFerla FM (28 January 2010).  “Alzheimer’s disease”.  The New England Journal of Medicine.  362 (4):329–44.  PMID 20107219.
  14. Todd S, Barr S, Roberts M, Passmore AP (November 2013).  “Survival in dementia and predictors of mortality: a review”.  International Journal of Geriatric Psychiatry.  28(11): 1109–24.  PMID 23526458.
  15. “Alzheimer’s Disease: Unraveling the Mystery”. (PDF)  National Institute on Aging.  September 2008.  Retrieved 21 October 2016.
  16. “Systematic Review of Information and Support Interventions for Caregivers of People with Dementia”.  BMC Geriatrics.  2007;7:18.  PMID 17662119.
  17. Forbes D, Thiessen EJ, Blake CM, Forbes SC, Forbes S (4 December 2013).  “Exercise programs for people with dementia”.  The Cochrane Database of Systematic Reviews.  12: CD006489.  PMID 24302466.
  18. National Institute for Health and Clinical Excellence.  “Low-dose antipsychotics in people with dementia”.  National Institute for Health and Care Excellence (NICE). Retrieved 29 November 2014.
  19. “Information for Healthcare Professionals: Conventional Antipsychotics”.  US Food and Drug Administration.  16 June 2008Retrieved29 November 2014.
  20. “Evolution in the Conceptualization of Dementia and Alzheimer’s Disease: Greco-Roman Period to the 1960s”.  Neurobiology of Aging.  1998; 19(3):173–189. PMID 9661992.
  21. “Impact économique de la démence (English: The Economical Impact of Dementia)”.  Presse Médicale.  2005;34(1):35–41.  French.  PMID 15685097. Pharmacotherapy. 1998; 18 (2 Pt 2): 68–73; discussion 79–82.  PMID 9543467.
  22. Stern Y.  Cognitive reserve and Alzheimer disease”.  Alzheimer Disease and Associated Disorders.  July 2006; 20(2): 112-17. PMID 16917199.
  23. “Systematic Review of the Effect of Education on Survival in Alzheimer’s Disease”.  International Psychogeriatrics.  2009; 21(1): 25–32. PMID 19026089
  24. Neergaard, Lauran (19 February 2011).  “Speaking 2 Languages May Delay Getting Alzheimer’s”.  The Denver Post.  Associated Press
  25. “Informal Costs of Dementia Care: Estimates from the National Longitudinal Caregiver Study”.  The Journals of Gerontology.  Series B, Psychological Sciences and Social Sciences.  2001; 56(4): S219–28.  PMID 11445614.
  26. “The MetLife study of Alzheimer’s disease: The caregiving experience” (PDF).  MetLife Mature Market Institute.  August 2006. Archived (PDF) from the original on 8 January 2011Retrieved 5 February 2011.
  27. EUROCARE: a cross-national study of co-resident spouse carers for people with Alzheimer’s disease: I—Factors associated with carer burden.International Journal of Geriatric Psychiatry. 1999;14(8):651–661. PMID 10489656.
  28. EUROCARE: A Cross-National Study of Co-resident Spouse Carers for People with Alzheimer’s Disease: II—A Qualitative Analysis of the Experience of Caregiving.International Journal of Geriatric Psychiatry. 1999;14(8):662–7. PMID 10489657.
  29. Economic Considerations in the Management of Alzheimer’s Disease.Clinical Interventions in Aging. 2006;1(2):143–54. PMID 18044111.
  30. Early Community-based Service Utilization and Its Effects on Institutionalization in Dementia Caregiving.The Gerontologist. 2005;45(2):177–85. PMID 15799982.
  31. The Dementias.Lancet. 2002;360(9347):1759–66.  PMID 12480441.
  32. Psychosocial Effects on Carers of Living with Persons with Dementia.The Australian and New Zealand Journal of Psychiatry. 1990;24(3):351–61. PMID 2241719.
  33. Determinants of Carer Stress in Alzheimer’s Disease.International Journal of Geriatric Psychiatry. 1998;13(4):248–56.  PMID 9646153
  34. American Psychiatric Association practice guideline for the treatment of patients with Alzheimer’s disease and other dementias.The American Journal of Psychiatry. December 2007;164(12 Suppl):5–56. PMID 18340692
  35. 2016 Alzheimer’s Disease Facts and Figures”. Alzheimer’s Association. Retrieved October 21, 2016

Disclaimer

The information contained in the FINDcures website is provided for informational and educational purposes only, and should not be construed to be a diagnosis, treatment, regimen, or any other health-care advice or instruction.  The reader should seek his or her own medical or other professional advice, which the information contained in the FINDcures website is not intended to replace or supplement.  FINDcures disclaims any responsibility and liability of any kind in connection with the reader’s use of the information contained herein.