alzheimer's disease

Alzheimer’s Disease is the most common form of dementia. It affects almost five millions Americans and their families.

Alzheimer’s Disease is the most common form of dementia. It affects almost five millions Americans and their families.    Alzheimer’s Disease (AD,) a gradually progressive illness diminishes a person’s memory and over time affects all mental functions.  The largest risk factor for the development of AD is age, but AD is NOT a normal part of aging.  About eight percent of people over age 65 have AD and over one third of people over 85 have AD.  As the baby boom generation ages, the number of affected people will grow significantly.  The economic impact due to lost productivity and medical and custodial care runs in the billions annually.  

Mild forgetfulness may be a normal age-related experience.  Alzheimer’s symptoms include short-term memory impairment, speech or word finding difficulties, motor skill problems and diminished abilities to recognize familiar surroundings or people.   These symptoms represent a significant decline from an individual’s normal state.  They are not attributable to underlying medical or psychiatric illness.  AD is a chronic, progressive illness; all of the symptoms worsen over time.  Behavioral or personality changes often occur.  One’s underlying personality may be exaggerated or changed.  

A person with early AD may be relatively self-sufficient.  However, as the illness progresses, additional help will be required.  The abilities to drive safely, manage finances, prepare meals, and maintain one’s home and care for one’s personal hygiene are gradually lost.  If family or friends are not able to provide enough assistance, then either hired help in the home, or a move to a care facility may become necessary.  In addition to nursing homes, which provide the highest level of care, assisted living facilities and group homes are options.

No cure exists for AD, but promising research continues for the prevention and treatment of AD.  Two types of prescription medications are available.  The first category, Acetylcholinesterase Inhibitors, is indicated for the treatment of mild to severe AD.  They do not halt the symptoms of dementia, but can slow progression of memory loss and reduce the behavioral changes that often occur. Independent functioning skills may also be helped by these medications.  The three medications in this category include:  Aricept (Donepezil), Exelon (Rivastigmine) and Razadyne (Galantamine).  Only one of these medications is used at a time, and is most effective when started as early as possible.  Namenda (Memantine) is approved by the FDA for the treatment of moderate to severe AD.  This appears to be most effective when combined with a medication from the first category.

One difficult to treat symptom of AD is insomnia.  Insomnia my affect ability to fall asleep timely, cause middle of the night awakenings, or result is waking up to early.  Typical insomnia medications may worsen memory functions.  A better night sleep usually results in a better following day.

Unfortunately, studies show that primary care doctors often fail to diagnose dementia.  One large study showed that only about one third of people with advanced dementia were diagnosed as having dementia.  Early recognition, diagnosis and treatment are essential to preserve one’s cognitive and functional abilities.  If insomnia is present, that should be appropriately treated.

If you are concerned that you or a loved one may have Alzheimer’s Disease, consult your primary care doctor or a specialist.  If you are experiencing troublesome memory loss, do not accept an opinion that this is normal for your age.  A thorough physical examination and appropriate blood work may be indicated, as well as a comprehensive memory examination.  Geriatric specialists may be consulted.   Much information is available about AD on the Internet; one excellent resource is the Alzheimer’s Association.      

Cary J. Kohlenberg, M.D, has prepared this article.  He is a psychiatrist, board certified by the American Board of Psychiatry and Neurology, in both general and geriatric psychiatry. He is also co-medical director of IPC Research and Principal Investigator for a number of studies of investigational new medications for the treatment of Alzheimer’s disease.  He is currently enrolling patients in FDA approved studies of new investigational Alzheimer’s medications and a sleep medication for people with AD and insomnia.  These medications may hold promise for the treatment of AD.  Dr. Kohlenberg and the IPC Research staff can be reached at 262-513-0700.