I remember, as a young man, when my intelligent and fiercely independent grandmother first began exhibiting symptoms. On top of the difficulties of the actual disease, she was aware of her decreasing ability to function and communicate....and it distressed her greatly.
I remember her crying with frustration simply trying to ask and answer simple questions...the look in her eyes...the panic, the fear, the frustration....and I remember the doctor telling us the only real hope was that, eventually, she'd be so far gone she wouldn't be aware of her incapacity: she wouldn't be afraid.
She would diminish, she would decline, she would lose every scrap of her dignity...and the best medicine had to offer was that she would lose her fear.
Now its forty years later and, truly, not much has changed. We think we know more about how the disease works...maybe a little about how to stall it or slow it coming on; but it's still irreversible.
And it's still profoundly, incredibly sad.
So if we're going to understand this, deal with it, let's start by trying to look at it clinically. To remove some of the pain and emotion and review what's known, what's suspected and what, if anything, can be done.
First off, Alzheimer's and dementia are not the same thing. Alzheimer's is a disease or a condition and dementia is a symptom. Much like the flu, influenza, is a virus and a fever is the symptom.
You can have a fever for a variety of reasons, not just the flu...and dementia can occur for a variety of reasons, not only Alzheimer's. Alzheimer's is believed, though, to be responsible for 50-80% of dementia cases in the first world.
At this time, it's believed that there are three distinct types of Alzheimers disease.
- Familial, which is very rare, less than 1% of the cases.
- Early On-set, where people are diagnosed before the age of 65, and this is also rare, less than 10% of known cases.
- Late On-set, the most common form, which accounts for more than 90% of all the cases and is believed to strike more than 50% of people over the age of 85.
Lastly, for this week, diagnosis.
At this time, Alzheimer's cannot be positively diagnosed in the living. An autopsy is required for positive diagnosis. I've read that a biopsy can work as well, but it would seem unlikely that coring a small section of a living person's brain simply to positively identify Alzheimer's, as opposed to other causes of dementia, is a common protocol.
Most commonly a diagnosis of Alzheimer's is made simply by a careful review of the symptoms. Because this can lead to misdiagnoses, the search for biomarkers or other positive methods of identification will be key, in upcoming years, to understanding, and eliminating this terrible, terrible disease.
In the next couple weeks, we'll expand...exactly what does Alzheimer's do to the brain, how can you slow down it's impact, etc.
Until then, be well, my friends!
And please spare a thought for the Alzheimer's caregivers: if you haven't done it, you simply can't imagine...