Alzheimer’s disease: The basics

Share

In 1906 Alois Alzheimer, a neurologist practicing in Munich Germany, reported on a 51 year old woman who became unexpectedly demented and died of her disease within three years. In this single case report, he noted that under light microscope there were two peculiar finding – plaques and neurofibrillary tangles.  For sixty years Alzheimer’s disease was felt to be a rare disorder, limited to people before the age of sixty.  For elderly dementia cases the diagnostic label was “senile dementia”, which was felt to be a vascular disorder.  Doctors often told families that their loved one had hardening of the arteries.

About 1970, questions began to arise about the relationship between the ‘rare’ Alzheimer’s disease and  the more common Senile Dementia.

Dr. Summers’ recall attending a lecture  in 1975 at Washington University School of Medicine (St. Louis) when Dr. Robert Butler from the National Institute of Aging showed the convincing evidence that Senile Dementia was the same as Alzheimer’s disease.  The two illnesses followed roughly the same course, and looked the same under the microscope.

Symptoms of Alzheimer’s include:

  1. Memory loss affecting job skills or other activities

  2. Difficulty performing familiar tasks (apraxia)

  3. Problems with language (aphasia)

  4. Disorientation regarding time or place

  5. Impaired judgment

  6. Problems with abstract thinking, math, and balancing checkbooks (acalculia)

  7. Misplacing objects

  8. Changes in mood or behavior

  9. Changes in personality

  10. Loss of initiative

  11. Memory recruitment (asking loved ones answers to simple questions such as what day is it today?).

  12. Altered taste and smell (dysguesia and dysosmia)

Alzheimer’s destructive patternAlzheimer’s disease is progressive, typically resulting in death within 8 -10 years of first symptoms.  As the illness progresses wandering or getting lost in familiar places occurs. Agitation with violent behavior or hours of disruptive verbalization (e.g. “Help! Help!”), can manifest in about 20-30% of cases.  Clinical (and treatable) depression can occur at any point in the course of the illness, but most frequently manifests in the two years before diagnosis is made.

As Alzheimer’s disease enters its final stages, the patient becomes fully disabled.  All activities of daily living must be done by others. This includes eating, toilet, and personal hygiene.  In the nursing home, the patients require assisted feeding.  Diapers are required at all times and care must be taken to prevent decubitus skin ulcers.  Dental care and hair care is done for the patient. Often patients forget how to walk at this time, and are confined to bed and wheel chairs. 

Osteoporosis from inactivity, lack of sun exposure, and decades of low sexual hormones leaves these patients subject to falls with hip fractures. Verbal skills are often reduced to sounds or near words.

Death occurs when the immune system breaks down.  There are now numerous studies showing at first heightened immune response and toward the end of the course of Alzheimer’s disease immune collapse.  The patients frequently die of pneumonia, flu, or bladder infections that spread into the blood stream.

Often Dr Summers has recommended to families that flu shots and antibiotics be withheld in the final year of life.  He states he has seen many instances where the family requests the infections be repeatedly treated. The patient’s debility continues to deteriorate leading to a bed ridden state, and the next infection recurs within a month or so. After the third or fourth cycle of infection, the end stage dementia patient is often growing a bacterium which is highly resistant to antibiotics. This makes this bedridden patient, an infectious disease threat to their neighbors in the nursing home.

In the past thirty years an enormous amount of research has occurred in an attempt to find a cure or more effective treatment for Alzheimer’s disease.   Most of this work has focused on interfering with the deposition of  Beta amyloid found by Alois Alzheimer on  microscopic examination of the brain of the first published case.  The assumption has been that Beta amyloid was the cause of the disease.  All clinical trials based on this theory to date have failed.

The approach of Dr Summers and the Alzheimer’s Corporation has been based on a different theory.

Share

Leave a Reply

Your email address will not be published. Required fields are marked *