Introduction and Overview to Alzheimer’s

What is Alzheimer’s Disease?

When you hear the phrase “Alzheimer’s disease,” what comes to mind? Some people may think of a person over 65 years old who has been having trouble with their memory for a few years. Others may think of a condition where more research needs to be done since there are only few available therapies. But Alzheimer’s disease, which is commonly referred to as “AD”, actually may occur in a variety of age groups and also has a variety of potential therapies that can reduce risk and help to improve memory. How many years do you think AD starts in the brain before symptoms occur? Many people are unaware that it could actually be as many as 20, or even 30 years from the time the disease manifests in the brain to the onset of the first signs and symptoms!

We now know that there are many “stages” of Alzheimer’s. The disease progresses very slowly over a period of years or even decades. There is often a huge gap between the first recognized symptoms and an initial diagnosis of Alzheimer’s disease. The period when the disease process is present, but there are no actual symptoms is referred to as Stage I. Take for example a real life scenario of an individual named Maria who started experiencing symptoms of mild memory loss at age 70. Her primary caregiver was her eldest daughter Nicole, who told her primary care doctor (Dr. Smith) that her mom began asking repetitive questions and losing items she was never able to find. She also began having difficulty remembering phone numbers and appointments. Maria had lost her spouse 3 years prior to the time when her memory problems first started. Maria was still generally able to care for herself, but would occasionally forget how to complete the steps of simple tasks she had performed all her life such as doing her knitting. Another initial symptom Nicole reported to Dr. Smith was her lack of interest in gardening or participating in local church events-which in the past, she would never miss. As we continue on in Lesson 1a, lets keep Marias story fresh in our minds, as it may help to better understand some of the learning points that we will be covering.

AD symptoms may vary quite a bit from one individual to another, but one of the first symptoms may be changes in mood. Most commonly, forgetfulness is an initial symptom, but the forgetfulness must be severe enough to interfere with work or the enjoyment of hobbies in order to be considered in the diagnosis of AD. This differs from the common memory loss attributed to aging, where an individual forgets a word that is on the tip of their tongue for a short period of time, but later recalls it. In AD, details are not able to be recalled in a sequence of steps such as how to balance the checkbook. Confusion, getting lost in places that should be familiar, misplacing items and difficulty with speaking and writing are other common symptoms of Alzheimer’s disease. As time goes on, the symptoms of AD continue to get worse, although there are now a variety of therapies that may improve symptoms, or even perhaps slow down the decline.

Alzheimer’s is known as the most common form of a condition called “dementia.”. But what exactly does this term dementia mean? Dementia is a general term for the loss of memory and thinking skills which are serious enough to interfere with activities of daily living, such as dressing in the morning, or cooking meals. Many times a person with dementia can’t recall the steps to cook a favorite meal or may get confused when driving and forget the usual route he/she commonly takes to get home.

Impact of AD on society

But just how big is this problem of AD today? AD is the most common type of dementia, you may be surprised to find out that up to about 70% of all dementia is a result of AD, affecting millions of individuals in the U.S and their family members and caretakers.

In 2011, the first group of baby boomers turned 65. This prompted the United States Congress to sign The National Alzheimer’s Project Act (NAPA), in an effort to create a national strategy to help overcome the epidemic of Alzheimer’s disease in the U.S. While this law did not provide any funding for research, patient care or caregiver support, it was enacted to help carve out a plan to assist with Alzheimer’s patient care and support caregivers. In 2012, President Obama announced that $156 million dollars would be given for research funds and caregiver support. Alzheimer’s disease is suspected to have such a future impact on the health and wellness of this country that the disease was even mentioned in the 2013 State of the Union address, and was a frequent topic covered on TV and newspaper stories throughout 2014.

When it comes to AD, public health priorities include:
• early diagnosis and treatment
• risk reduction
• public education
• research (to find new therapies and potential causes of AD) by a variety of members of the healthcare team.

Why is it early diagnosis of AD so important? When we are able to diagnose Alzheimer’s earlier the result may be more effective treatment and prevention strategies.

In the United States, someone is diagnosed with AD every 68 seconds. According to the Alzheimer’s Association’s 2014 statistics, nearly 5.4 million people in the US have Alzheimer’s today-most are over 65 years of age. According to the Alzheimer’s Association, approximately 200,000 of those with Alzheimer’s disease have “younger onset Alzheimer’s” meaning they were diagnosed before they turned 65. Alzheimer's disease is the 6th leading cause of death in the United States. It is considered the only disease among the top 10 in the U.S. that has no cure.

As the baby boomers age, the percentage of individuals at risk for Alzheimer’s will continue to increase. To demonstrate just how those numbers will translate; by the year 2025 it is estimated that 7.1 million people over 65 will be diagnosed with Alzheimer’s disease, and by 2050 that number will jump to an astounding 13 million.

Stages of Alzheimer’s Disease

When it comes to stages of Alzheimer’s disease, there can be a lot of confusion. If you research the term “stages of Alzheimer’s disease” you will find quite a bit of conflicting information. It seems that no one in the past really agreed on how to classify each stage of the disease even from one medical professional to another.

The most recent definition was written in 2011 by the National Institute on Aging & Alzheimer’s Association, and describes a spectrum of disease starting many, many years before the very first symptom of memory trouble ever occurs. In fact, only recently has medical science realized that symptoms may not appear for up to 20 or 30 years after the disease starts in the brain. This new model breaks down Alzheimer’s disease into 3 different “stages” (called Stages 1, 2 and 3). There is also a “Stage 0” which means that a person is “Alzheimer’s free”, since the disease has not started yet nor is it known for sure whether or not it will ever occur. More information about these three stages will be covered in Lesson 1b, but here is a quick summary. Stage 0 means a person does not have AD and there are no symptoms of memory loss. Stage 1 means that AD has started in the brain but no memory loss has occurred yet. Stage 2 means that there are mild changes in memory and perhaps other thinking skills (called “Mild Cognitive Impairment”), but the person can still go about their usual daily activities. Stage 3 is what most of us in the past have referred to as AD, meaning memory and thinking skills do impact a person’s daily function. Stage 3 can be categorized as either mild, moderate or severe. We will go into much more detail about all of these in Lesson 1b, but lets recall the story about Maria that we discussed earlier. Now, lets take a moment to consider a question - based on these stages, what Stage would Maria be considered? Stage 0, 1, 2 or 3?

Upon examination by her physician Dr. Smith, who took into account the families report of all of the recent changes she was experiencing, Maria was diagnosed with stage 2 AD. This was based on the fact that she had mild symptoms (also called Mild Cognitive Impairment or MCI), but was still able to perform activities of daily living-(ADLs). Her daughter mentioned to Dr. Smith that based upon what she read and research on the internet, a diagnosis of AD was what she was most concerned about. The physician stated that while there is no current cure for AD, that there are a variety of potential therapies available now, as well as many that hold promise for the future. Nicole asked about what her chances were of getting AD, (this topic will be covered in more detail in Lesson 2), and Dr. Smith mentioned currently there was no 100% way to know for sure, but that there are a variety of brain-healthy lifestyle choices that may help to reduce risks or possibly delay the onset of the disease These topics will be covered in more detail in Introductory Lessons 9, 13, 14, 15 and several Advanced Lessons as well.

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